A System Model Study Using an EvidenceBased Theory
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Based on a wholistic approach to patient care.
Views the client as an open system.
includes :
patient
family
community
society
Proposes that “nurses enter into the client’s
world to promote stability and balance “.
Neuman & Fawcett, 2002
 The Neuman model is illustrated by multiple
circles which demonstrate the patients line of
defense.
◦ Lines of Resistance: LOR
◦ Flexible Lines of Defense: FLD
◦ Normal Line of Defense: NLD
 These structures of Neumans system model
will be referred to throughout the case study
which will be presented.
A clients stability and balance can be affected by
stress. “Stressors disrupt client systems,
sometimes causing physical illness or emotional
and social crises” (Ume-Nwagbo,DeWan, and
Lowry, 2006).
 The Neuman Model assesses the client with
different variables of stressors.
 Five variables of stressors are:
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Physiological
Psychological
Sociocultural
Developmental
Spiritual
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The client is a 60 year old man
He is scheduled for a CABG in 1 week
History of mild COPD, d/t 20 year history of
smoking
Overall a good candidate for surgery, based
on the cardiothoracic surgeons
Primary stressor is Physiological due to
mechanical ventilation
It is the responsibility of the nurse to assist the
client in identifying potential stressors in a
health related issue.
Once the stressor is identified, “the nurse will
assess the stressor reaction in all five
variables, as well as the perception of the
client.
Once identified, the nurse and client will
negotiate goals and formulate strategies to
meet the goals.”(Neuman & Fawcett, 2002).
The protective abilities of the NLD were evaluated:
 blood count with differential, chemistry profile, liver
enzymes
 chest x-ray,
 urinalysis,
 clotting studies
 medication assessment
The FLD in relation to the physiological assessment:
 intact intrapleural space
 skin integrity
 perfusion capabilities
 contractility of the heart
 glomerular function
 peripheral perfusion
The Line of Resistance:
 protects the basic structure energy resources
 provide internal protection factors when
stressors have penetrated the NLD
In this study, the LOR is evaluated by:
 preoperative lab values
 skin integrity,
 cardiac function
 pulmonary function
 sympathetic and parasympathetic systems
Once the physiological variables are assessed,
the psychological variables are determined:
1. Psychological health of the patient; ego
strength.
2. Patient’s values, and ability to react to
stressors
3. Patient’s past experience with surgical
procedures
4. Coping mechanisms
5. Perception of wellness
The developmental variable
 age-related developmental skills
 ability to function as a dependent person
 perceive appropriate pain management
The sociocultural variables
 financial resources
 cultural/ethnic
 personal financial obligations.
The spiritual assessment
 spiritual practices
 spiritual values
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The main stressor in this case is the surgical
procedure and the postoperative mechanical
ventilation.
CABG is a major physiological stressor
If uncomplicated the stressor will benefit the
patient by preventing further disease
Nursing diagnosis was met by the patients
ability to overcome the stress of CABG
Primary
 Diet
 Medication
 Secondary
Secondary
 Immediate post-op care
 System stability
Tertiary (1 week to 6 months post-op)
 Rehabilitative period
 Wellness assessment
The evaluation will determine if goals were
met.
 In this particular case the patients goals were
met.
 Periodic evaluation will be done to evaluate
for stressors that can affect his health.
 Assess for healthy lifestyle
The Neuman system model provides a
theoretical framework for assessing,
planning, evaluating and providing evidencebased outcomes.
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Credibility:
1. Comprehensive
2. Flexible
3. Client focused
4. Wholistic
5. Individualized
Because the system is theory based, it ensures
integrity of care.
Limitations:
“Neuman focuses on client stressors rather than
medical diagnoses, which may have the
potential to leave nursing expertise
behind”(Ume-Nwagbo, 2006).
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Neuman, B., & Fawcett, J. (2002). The Neuman
systems model (4th ed.). Upper Saddle River, NJ:
Prentice Hall.
Ume-Nwagbo, P. N., DeWan, S. A., & Lowry, Lois W.
(2006). Using the Neuman Systems Model for Best
Practices. Nursing Science Quarterly , 19 (1), 3135.
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