The body is more than the sum of it’s parts. This holds as a granite truth
more than ever , as knowledge about the origins , nature and purpose of human
beings expand, discovered and re –discovered. Human beings can also be
considered as a concrete example of an open system. An open system reacts
and adjusts itself to the environment.
Betty Neuman (Neuman & Fawcett ,2002) , a community health nurse and
clinical psychologist, developed a model based on the individuals relationship to
stress , the reaction to it, and reconstitution factors that are dynamic in nature.
Reconstitution is the state of adaption to stressors.
Neuman used Selye’s definition of stress, which is the nonspecific
response to the body to any demand made on it. Stress increases the demand
for re-adjustment. This demand is nonspecific demand for activity. Stressors are
the tension-producing stimuli that result in stress; this maybe positive or negative
Neuman (1995; Neuman & Fawcett, 2002) adhered to the metaparadigm
concepts and has developed numerous additional concepts for her model.
Person. A “client / client system, as a composite of variables (physiological,
psychological sociocultural developmental, and spiritual), each of which is
a subpart of all parts …forms the whole of the client… a basic structure of
protective concentric rings, for retention attainment or maintenance of system
stability and integrity”.
Five person variable or subsystems:
•Physiological- Refer of the physicochemical structure and function of
•Psychological- Refers to mental processes and emotions.
•Socio-cultural- Refers to relationships; and social/cultural
expectations and activities.
•Spiritual- Refers to the influence of spiritual beliefs.
•Developmental- Refers to those processes related to development
over the lifespan.
ENVIRONMENT. Composed of both internal and external forces surrounding the
client, influencing and being influenced by the client at any point in time, and an
HEALTH. Defined as a “continuum; wellness and illness are at opposites
ends…”. Variances from wellness or varying degrees of system instability are
caused by stressors invasion of normal line of defense.
NURSING. The major concern is to maintain client system stability through
accurately assessing environmental and other stressors and assisting in client
adjustments to maintain optimal wellness.
Neuman categorizes stressors as intrapersonal stressors those that
occur within an individual; interpersonal stressor those that occur between
individuals and extrapersonal stressor those that occur outside the person. The
individuals reaction to stressors depends on the strength of the line of defense.
When the line of defense fail, the resulting reaction depends on the strength of
the line of resistance. As part of the reaction, a person’s system can adapt to a
stressor, an effect known as reconstitution. Nursing interventions focus on
retaining or maintaining system stability. The interventions are carried out on
three preventive levels.
Neuman adapts the concept of levels of prevention from Caplan’s
conceptual model and relates these prevention levels to nursing. Primary
prevention is used to protect the organism before it encounters a harmful
stressor reducing the possibility of encountering the stressor or strengthening
the organism to decrease it’s reaction to stressor. Secondary prevention
attempts to reduce the effect or possible effects of stressors through early
diagnosis and effective treatment of symptoms. Tertiary prevention attempts to