The person is a layered multidimensional being. Each layer consists of
five person variables or subsystems:
The layers, usually represented by concentric circle, consist of the
central core, lines of resistance, lines of normal defense, and lines
of flexible defense. The basic core structure is comprised of survival
mechanisms including: organ function, temperature control, genetic structure,
response patterns, ego, and what Neuman terms knowns and commonalities.
Lines of resistance and two lines of defense protect this core. The person
may in fact be an individual, a family, a group, or a community in Neuman's
model. The person, with a core of basic structures, is seen as being in
constant, dynamic interaction with the environment. Around the basic core
structures are lines of defense and resistance (shown diagrammatically
as concentric circles, with the lines of resistance nearer to the core.
The person is seen as being in a state of constant change and-as an open
system-in reciprocal interaction with the environment (i.e. affecting,
and being affected by it).
The environment is seen to be the totality of the internal and external
forces which surround a person and with which they interact at any given
time. These forces include the intrapersonal, interpersonal and extrapersonal
stressors which can affect the person's normal line of defense and so
can affect the stability of the system.
- The internal environment exists within the client
- The external environment exists outside the client
- Neuman also identified a created environment which
is an environment that is created and developed unconsicously by the
client and is symbolic of system wholeness.
Neuman sees health as being equated with wellness. She defines health/wellness
as "the condition in which all parts and subparts (variables) are in harmony
with the whole of the client (Neuman, 1995)". As the person is in a constant
interaction with the environment, the state of wellness (and by implication
any other state) is in dynamic equilibrium, rather than in any kind of
steady state. Neuman proposes a wellness-illness continuum, with the person's
position on that continuum being influenced by their interaction with
the variables and the stressors they encounter. The client system moves
toward illness and death when more energy is needed than is available.
The client system moves toward wellness when more energy is available
than is needed.
Neuman sees nursing as a unique profession that is concerned with all
of the variables which influence the response a person might have to a
stressor. The person is seen as a whole, and it is the task of nursing
to address the whole person. Neuman defines nursing as actions which assist
individuals, families and groups to maintain a maximum level of wellness,
and the primary aim is stability of the patient/client system, through
nursing interventions to reduce stressors. Neuman states that, because
the nurse's perception will influence the care given, then not only must
the patient/client's perceptions be assessed, but so must those of the
caregiver (nurse). The role of the nurse is seen in terms of degrees of
reaction to stressors, and the use of primary, secondary and tertiary
Neuman envisions a 3-stage nursing process:
- Nursing Diagnosis - based of necessity in a thorough assessment,
and with consideration given to five variables in three stressor areas.
- Nursing Goals - these must be negotiated with the patient,
and take account of patient's and nurse's perceptions of variance
- Nursing Outcomes - considered in relation to five variables,
and achieved through primary, secondary and tertiary interventions.