A System Model Study Using an Evidence- Based Theory

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: ◦ Physiological ◦ Psychological ◦ Sociocultural ◦ Developmental ◦ Spiritual

 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

 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 evidence- based outcomes.

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).

 Neuman, B., & Fawcett, J. (2002). The Neuman systems model (4 th 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), 