284 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration
Stressors
Identified
Classified as knowns
or possibilities, i.e.,
Loss
Pain
Sensory deprivation
Cultural change
Inter
Intra
Extra
Personal
factors
Stressors
More than one stressor
could occur
simultaneously*
Same stressors could vary
as to impact or reaction
Normal defense line varies
with age and development
Basic structure
Basic factors common to
all organisms, i.e,
Normal temperature
range
Genetic structure
Response pattern
Organ strength or
weakness
Ego structure
Knowns or commonalities
Stressor Stressor
Reaction
BASIC
STRUCTURE
ENERGY
RESOURCES
Reconstitution
Could begin at any degree
or level of reaction
Range of possibility may
extend beyond normal line
of defense
Primary prevention
Reduce possibility of
encounter with stressors
Strengthen flexible line
of defense
Inter
Intra
Extra
Personal
factors
Inter
Intra
Extra
Personal
factors
Secondary prevention
Early case-finding and
Treatment of symptoms
Tertiary prevention
Readaptation
Reeducation to prevent
future occurrences
Maintenance of stability
Reaction
Individual intervening
variables, i.e.
Basic structure
idiosyncrasies
Natural and learned
resistance
Time of encounter
with stressor
*Physiological, psychological,
sociocultural, developmental, and
spiritual variables are considered
simultaneously in each client
concentric circle
NOTE:
Interventions
Can occur before or after resistance
lines are penetrated in both reaction
and reconstitution phases
Interventions are based on:
Degree of reaction
Resources
Goals
Anticipated outcome
Flexibl
eLineofDefe
nse
Norm
alLineofDefen
se
Lines
ofResista
nce
Degree of
Reaction
Reconstitu
tion
FIGURE 18–1 The Neuman Systems Model. Original diagram copyright 1970 by Betty Neuman. A holistic view of a dynamic open
client-client system interacting with environmental stressors, along with client and caregiver collaborative participation in promoting an
optimum state of wellness. From Neuman, 1995, p. 17, with permission.