maintain optimal client health or wellness.
Neuman (1995) believes the nurse creates a linkage
among the client, the environment, health, and
nursing in the process of keeping the system stable.
PREVENTION AS INTERVENTION
Primary prevention as intervention involves the
nurse’s actions that promote client wellness by
stressor prevention and reduction of risk factors.
These interventions can begin at any point a
stressor is suspected or identified, before a reaction
has occurred. They protect the normal line of de-
fense and strengthen the flexible lines of defense.
Health promotion is a significant intervention. The
goal of these interventions is to “retain” optimal
stability or wellness. The nurse should consider
primary prevention along with secondary and ter-
tiary preventions as interventions. Once a reaction
occurs from a stressor, the nurse can use secondary
prevention as intervention to protect the basic
structure by strengthening the internal lines of re-
sistance. The goal of these interventions is to
“attain” optimal client-system stability, or wellness,
and energy conservation. The nurse should use as
much of the client’s existing internal and external
resources as possible to stabilize the system by
strengthening the internal lines of resistance and
reducing the degree of reaction to the stressors.
Neuman suggested the nurse should collaborate
with the client to establish relevant goals. The goals
are derived only after synthesizing comprehensive
client data and relevant theory in order to deter-
mine an appropriate nursing diagnostic statement.
With the nursing diagnostic statement and goals in
mind, appropriate interventions can be planned
and implemented (Neuman, 1995).
Reconstitution represents the return and main-
tenance of system stability following nursing inter-
vention for stressor reaction. The state of wellness
may be higher, the same, or lower than the state of
wellness before the system was stabilized. Death
occurs when secondary prevention as intervention
fails to protect the basic structure and thus fails to
reconstitute the client (Neuman, 1995).
Tertiary prevention as intervention can begin at
any point in the client’s reconstitution. These ac-
tions are designed to “maintain” an optimal well-
ness level by supporting existing strengths and
conserving client system energy. Tertiary preven-
tion tends to lead back to primary prevention in a
circular fashion. Neuman pointed out that one or
all three of these prevention modalities give direc-
tion to or may be used for nursing action with
possible synergistic benefits (Neuman, 1995).Nursing Tools for Model Implementation
Neuman has designed the Neuman nursing process
format and the format for prevention as interven-
tion to facilitate implementation of the Neuman
model. These formats are presented in the third
edition of Neuman’s book (1995, pp. 18–20). The
format demonstrates a process that guides infor-
mation processing and goal-directed activities.
Neuman used the nursing process within three
categories: nursing diagnosis, nursing goals, and
nursing outcomes. Comprehensive data are col-
lected prior to formulating a nursing diagnosis.
This process is facilitated using guides such as the
assessment and intervention tool mentioned in
Neuman’s book (1995). Nursing goals are deter-
mined mutually with the caregiver–client-client
system, along with mutally agreed upon prevention
as intervention strategies. Nursing outcomes are
determined by the accomplishment of the inter-
ventions and evaluation of goals following inter-
vention. The Neuman nursing process format was
validated in 1982 by doctoral students. The for-
mat’s validity and social utility have been proven in
a wide variety of nursing education and practice
areas. Using the Neuman Systems Model, the nurse
acquires significant and comprehensive client data
to determine the impact or possible impact of envi-
ronmental stressors upon the client system.
Selected information is prioritized and related to
relevant social science and nursing theories.
Neuman suggested that the Neuman nursing
process format has a unique component—that the
client and caregiver perceptions are determined for
relevant goal-setting. The nurse and the client mu-
tually determine the client-intervention goals.
Neuman pointed out that mutually agreed-upon
goals and interventions are consistent with current
mandates within the health-care system for client
rights in health-care issues.
Neuman designed the format for prevention as
intervention to convey appropriate nursing actions
with each typology of prevention. Primary, second-
ary, and tertiary prevention nursing actions are listed
in a table format in Neuman’s book (1995, p. 20)CHAPTER 18 Betty Neuman:The Neuman Systems Model and Global Applications 289