NEUMAN SYSTEMS

MODE
L
A. CASE PRESENTATION
B. THEORY APPLICATION &
CORRELATION
C. BRACKETT SYSTEMS
MODEL

presentation
Baby TOF is a 2-year-old girl,
born on the 30th of October
2003. She was admitted in a
tertiary hospital in the City of
San Fernando on February
23, 2006 with an admitting
diagnosis of Tetralogy of
Fallot,
She was T/C then
Endocarditis.
discharged on March 03,
2006, with a referral to a Cardiac Center in
Manila. Baby TOF is the youngest of 5
children and according to Mrs. TOF, no one
in the family suffered from the same
condition that Baby TOF had.
case
At 4 months of life,
Baby TOF was
noted of having
tachypnea, which
progressed into
difficulty in
breathing
accompanied with
cyanosis for a few
minutes, whenever
she case
cried.
No medicine
or any
procedure was
done but they
were asked to
go to the
tertiary
hospital in
Pampanga.
case
Intravenous fluid (IVF)
and oxygen (O2)
therapy were started
and blood was
extracted. Chest Xray
(CXR) was done after 2
days of confinement.
The family was also
asked to secure money
for an Echocardiogram
where a diagnosis of
Tetralogy of Fallot
(TOF) could be made.
case
During the course of
hospitalization, Baby
TOF still manifested
tachypnea, occasional
difficulty of breathing
and cyanosis,
noticeable especially
when she’s restless.
The mother could not
recall the explanation
of the doctors but
knows that Baby TOF
was suffering from a
heart problem.
case
Her manifestations of
tachypnea, difficulty of
breathing and cyanosis
were still occurring but
being managed with
cuddling and soothing
measures, or sometimes
the symptoms subside
spontaneously. The
follow up check up in
Manila did not
materialize nor any
other visits to the
case
doctor due to financial
According to Mrs. TOF,
Baby TOF, had
occasional episodes of
difficulty of breathing
and increasing
cyanosis as she was
growing but was never
brought to the hospital
again. Like the rest of
the family, she only
had common cough
and colds that would
usually last for a day
or two. case
The mother further
stated that she did
not see Baby TOF
joining so much on
plays that involved
running and/or
jumping since she
easily gets tired.
Since the family
knows that Baby TOF
has a heart problem,
they usually stop hercase
Two weeks prior to
admission, Baby TOF
had a fever, by touch,
with increased
difficulty of
breathing. She was
initially sponge
bathed that did not
offer relief. She was
kept inside and was
not allowed to play
with the other case
Until, 1 week prior
to admission,
Baby TOF
manifested
increased
respiratory effort,
cyanosis with on
and off fever and
was noted to be
having poor
appetite and
case
lethargy.
6 hours prior to admission,
Baby TOF was crying a lot,
not comforted by cuddling
or any other soothing
measures with progression
of symptoms into severe
difficulty of breathing,
described by the mother
as 1 breath followed by
shoulder lag, with
cyanosis and eventually,
sudden loss of
consciousness for several
minutes, which prompted
admission to the tertiary
hospital. She was
caseon February 23,
admitted
2006 at 5:30 p.m.
A. CASE PRESENTATION
B. THEORY APPLICATION &
CORRELATION
C. BRACKETT SYSTEMS
MODEL

presentation
 NEUMAN SYSTEMS
MODEL
PHYSIOLOGICAL Baby TOF had an ongoing IVF with
VARIABLE supplemental O2. It was evident that
because she had cardiac structural defects,
it was hard for the heart to redistribute
oxygenated blood systemically. And due to
a VSD, tachypnea is evident and cyanosis is
seen whenever there is Overexertion or
exhaustion.
PSYCHOLOGICAL The nurse observed that the child
VARIABLE sometimes withdraws herself from other
children. Her mother instructed her to do
so, and in turn, she may feel that she is
unlike other “normal” children. Moreover,
according to Erickson’s Psychosocial Theory,
Baby TOF is under the stage of autonomy vs
shame and doubt, however, she has not fully
met this category since she experiences
difficulty of breathing and cyanosis when
she engages in active play.
theory application & correlation
 NEUMAN SYSTEMS
MODEL
SOCIO-CULTURAL Since it was diagnosed that Baby TOF had
VARIABLE cardiac structural defects, it was evident
that the parents had no choice but to just
wait and save for her operation. Distraught
and worry were seen in the eyes of the
parents and the mother told the researcher
that it would be hard to come up with that
sum of money, considering they barely had
enough for every single day but the father
affirmed that he will work twice as hard to
DEVELOPMENTAL help
Babyhis
TOFchild.
is a 2-year-old girl who was born
VARIABLE with cardiac structural defects, thus, is
limited to several activities that do not
require excessive energy consumption.

theory application & correlation

 NEUMAN SYSTEMS
MODEL

SPIRITUAL VARIABLE The mother of Baby TOF

placed a scapular around the
neck of the child, telling her
that prayers would help her
get better. And because of
this, the child always prays
that she may play with her
friends and do whatever
“normal” kids do.

theory application & correlation

 The nurse who practices
holistic nursing principles
is able to identify
potential and real causes
of problems, and help the
client to move along a
continuum toward
optimal wellness. The
researcher adopted the
Neuman Systems Model
to explain what nursing
is and to prepare nurses
to meet current and
evolving health care
needs of our community.
theory application & correlation
Person/Client
The first key-nursing
concept we need to
understand to provide
holistic care is the
concept of person or
client/client system.
Neuman and Fawcett
(2002) view the person as
a client or client system.
This client can be an
individual, a family, a
group, a community or a
social issue. Baby TOF is
an example of the client
theory application
as an individual. & correlation
 NEUMAN SYSTEMS
MODEL
VARIABLES NEUMAN & RESERACHER
Physiological FAWCETT
Bodily structure and Biological structure, biological function,
Variable internal function physical appearance, physical exam,
past & present medical history,
diagnostic tests, lab studies
Psychological Mental processes Mental status, intelligence, perceptions,
Variable and internal self awareness, level of anxiety,
environmental feelings, defense mechanisms, self
esteem
effects, internally
and externally
Socio-cultural Combined effects of Family of origin, culture, ethnicity,
Variable social and cultural education, family of choice, lifestyle,
conditions and occupation
influences
Development Age-related Gender identity, chronological age,
al Variable developmental developmental age, developmental
processes and stages, developmental tasks,
maturational crisis, level of maturity,
activities moral development
Spiritual Spiritual beliefs and Personal meaning, values, love, hope,
Variable influences power, beliefs, connections, religion,
sense of purpose

theory application & correlation

 NEUMAN SYSTEMS
MODEL

theory application & correlation

 NEUMAN SYSTEMS
MODEL

theory application & correlation

 NEUMAN SYSTEMS
MODEL

theory application & correlation

 NEUMAN SYSTEMS
MODEL

theory application & correlation

Person (Client/Client System)
and Environment—How Do
These Concepts Apply to
Baby TOF?
Baby TOF’s nurse reviewed
her nursing history and her
current situation. Based on
this data the nurse identified
several problems for Baby
TOF. She currently is
experiencing difficulty of
breathing, anxiety,
ineffective individual coping,
altered role performance and
spiritual distress. johann pestalozzi
 NEUMAN SYSTEMS
MODEL
Client Variables
Structur
Physio Psych Socio Dev Spi
e
FLD Difficulty of Anxiety due Client could not Unable to Guidance
breathing to lack of play such as experience from her
during playtime or running or play and mother;
activities limited jumping like less time “prayers can
activities what normal with help her”
compared to kids do playmates
normal
children
NLD Normal rate Believes that Complete family A client with Suffering is
of she should who does TOF, trying viewed as
respiration enjoy going everything they to something
if without outside, can to help the understand that a child
cardiac playing with client that she is should not
structural her friends unlike other experience
deformities children
LOR Cyanosis Cries A two-year-old Unable to Because of
whenever she girl suffering express her condition,
is not allowed from TOF and herself due she could not
to play by her may think that to her function as a
mother she could die condition normal child
from exhaustion
theory application & correlation
 NEUMAN SYSTEMS
Application of Environment (Stressors) toMODEL
Baby TOF
Client Variable
Structure
(Causes of Physio Psych Socio Dev Spi
the
Problem)
Intraperson Cardiac Ineffective Due to She could Wonders
al Stressors Structural coping her not feel why
(within the Defects since she defect, what it is though
client) (Pulmonary is not she could to be a she prays
Stenosis, mature not play, “real” kid at night,
Ventricular enough, jump, or due to her she still
Septal she could run like condition has her
Defect, not fully what problem
Overriding comprehe other kids every
of the nd why do day
Aorta, her
Right mother
Ventricular wants her
Hypertroph to refrain
y) from
theory application & correlation
playing
 NEUMAN SYSTEMS
MODEL
Interperson Afraid that Parents do Her Her Client
al Stressors every time not have playmates parents sometim
(between she goes to the means may tease limits her es
the client the to have her her from refrains
and other hospital, operated because playing from
people) she will get or even that is playing
hurt referred to what her with
a Cardiac mother siblings;
Center. wants she just
plays
with her
Extraperson Activities Questions If she had Client None
doll
al Stressors such as why she enough could not observe
(not people running or could not toys, she fully d at that
related) jumping live a would be express time
are normal life happy her
detrimenta like other even childhood
l to her kids; without
health compares her
herself to playmates
them
theory application & correlation
Health is a manifestation of
living energy available to
preserve and enhance system
integrity. The Neuman
Systems Model wellness-
illness continuum implies
that energy flow is
continuous between the
client system and the
environment. Client
movement is toward wellness
when more energy is being
generated than used. When
more energy is required than
is being generated,
movement is toward illness
theory application
and possible death (Neuman
& correlation
Neuman describes nursing as
“a unique profession
concerned with all variables
affecting clients in their
environment. Nursing is
preventive intervention”
(Neuman & Fawcett).

theory application & correlation

 NEUMAN SYSTEMS
Neuman and Fawcett’s Definitions for MODEL
Primary, Secondary and
Tertiary
Prevention as Interventions; and an Example of These Interventions for Baby
TOF. Examples are Limited to “tet” or Hypercyanotic Spells

Prevention Neuman & Fawcett’s Example of Interventions for

as Definitions
Interventi
on
Primary Intervention before a reaction to
stressors occurs to reduce the
possibility of an encounter with a
stressor and strengthen the
flexible line of defense. Includes
health promotion.
Secondary Intervention after a stressor
reaction occurs and treatments to
reduce their harmful effects.
Tertiary Intervention following treatment
of a stressor— readaptation,
reeducation & maintenance of
stability.
theory application & correlation
Baby TOF
Instruct mother not to agitate the
client by letting her get tired due to
running, jumping, etc. or even
scolding her or shouting at her, even
scaring her that could make her cry.
During an episode or a tet spell,
position the client in a squatting
position or flex her knees towards
her abdomen. If she sees the client
squatting after walking or running,
just let her be.
Instruct parents to bring the child to
a hospital immediately if cyanosis
persists. And refer the child to a
Cardiac Center whenever they have
the means to do so.
 Nursing and the Nursing
Process
It is believed that the nursing
process is the process of
assisting an individual’s
movement toward wellness.
Nurses are concerned with
“keeping the client system
stable through accuracy in
assessing the effects and
possible effects of
environmental stressors and in
assisting client adjustments
required for an optimal
wellness level” (Neuman &
theory application
Fawcett). & correlation
A. CASE PRESENTATION
B. THEORY APPLICATION &
CORRELATION
C. BRACKETT SYSTEMS
MODEL

presentation
•1.  The Core
The researcher adopted
the following nine core
needs to further
describe the client’s
basic structure. These
core needs are Anxiety;
Circulation/Aeration;
Elimination; Fluids and
Electrolytes; Mobility;
Nutrition/Metabolism;
Safety; Sexuality; and
Sensation/Perception.
brackett systems
2.  The Client
The client, unlike the
NSM, focuses solely on
one individual.
However, like
Neuman’s model, the
researcher opted to
adopt the five variables
that make up every
person, namely:
physiological,
psychological, socio-
cultural,
brackett systems
developmental, and
•3.  Prime Factors
These prime factors, which
are age, intensity, control,
and health, are factors,
which differentiate one
person from another, giving
emphasis on each other’s
uniqueness. In the NSM,
Neuman may have said that
her model may be used
with a group of people for a
client system, assuming
there is synchrony among
the members. However,
the researcher affirms
individualism – the good
and ill brackett
effects thatsystems
one
person brings or gives to
•4.  Coping Mechanism
Barrier
This barrier is just like the
flexible line of defense,
which acts as an accordion-
like structure, which adapts
to whatever situation.
However, unlike the FLD,
this structure’s main
function is internally
situated. This has a direct
effect on the created
environment made by the
client and may extend even
further than the normal line
brackett
of defense systems
and FLD.
•5.  Health-Illness
Continuum
This is the horizontal bar
intersecting the core.
Evidently, it has the
individual at the center,
showing that health and
illness are a continuum –
two different states that
any person may
experience due to s
stressor. And with it
being situated at the
center, this proves that
brackett systems
there is a dichotomy
•6.  Environmental Pillar
The environmental pillar
emphasizes the fact that the
environment has indeed a direct
influence on the individual. It is
the perpendicular bar
intersecting both the core and
the health-illness continuum.
This was adopted from Dunn’s
Model of Wellness, with the
favorable environment being at
the superior region and the
unfavorable, at the inferior
region. However, unlike Dunn’s
model, the researcher opted to
divide this pillar into 5 sub-
portions – the environmental
event factors related to stress
appraisal: unpredictability,
uncertainty, timing of event,
brackett systems
duration of event, and the
•7.  Lines of Resistance
•Like the NSM, this
acts as the third line of
defense for an
individual that if
penetrated by any
stressor, may have
detrimental effects to
the client. This may
also serve as the
client’s tertiary
prevention when the
normal line of defense brackett systems
is broken.
•8.  Normal Line of Defense
•This represents the
individual’s system
stability. It is considered to
be the usual level of
stability for the system or
the normal wellness state
and is used as the baseline
for determining deviation
from wellness for the client
system. The normal line of
defense has changed
overtime as a result of
coping with a variety of
stressors. The stability
represented by the normal
line of defense is actually a
brackett systems
•9.  Flexible Line of
Defense
The FLB, just like what
was stated by Neuman in
her model, acts as the
system’s primary
defense. Just like the
Coping Mechanism
Barrier, it is accordion-
like and adjusts to the
NLD basing on the
client’s ability to cope
with stress. It acts as a
buffer that prevents
stressors from invading
the normal line of
brackett systems
defense, which could
 10. Refocusing
Refocusing, similar to the
NSM’s reconstitution, is a
state wherein the individual,
or the client, refocuses his
energies to eliminate the
stressor and try to achieve
homeostasis. However,
unlike Neuman’s
reconstitution, this is
depicted in a wave-like form.
The researcher believes that
when a person tries to re-
channel his remaining energy
to achieve stability, it is
never attained directly. The
waveform represents the
gradual change that the
brackett systems
individual experiences in the
 11. Degrees of
Prevention
In nursing, it is said that
prevention is a primary
intervention done by a
nurse to any client. And
because of this,
prevention is subdivided
into three stages:
primary, secondary, and
tertiary prevention. This
is similar to what is
stated in Neuman’s
model.brackett systems
  12. Reaction
This is
depicted as the
result of internal
and external
stressors.

brackett systems
1 13. Nursing
Since this model is
applied to patients,
it is imperative
that we also
include the nursing
process. And
everything that
happens to the
client system,
nursing is entwined
brackett systems
to it.
 14. Stressors
The stressors are basically
the internal and external
stimuli that affect the
individual. And stressors, in
this model, have been
subdivided into 2 –
intrapersonal stressors,
which happen within, and
extrapersonal stressors,
occurring outside. Unlike in
the NSM, Neuman included
the interpersonal stressors
as 1 category, however, due
to several criticisms and
unclear justifications, the
researcher opted to include
interpersonal stressors as a
brackett systems
sub-category of
 15. Collaborative
Arch
The collaborative
arch symbolizes other
members of the health
care team. These
arches show that
assessment and
interventions are not
sole responsibilities of a
nurse but a
collaborative response
of several health care
professionals to abrackett systems
presented by ej brackett, rn