Definition/Introduction

The clinical work of nurses can result in personal joy and job satisfaction and can also lead to exhaustion and burnout. Resilience has been pointed out as an essential trait for those working in the nursing field because of the stressors involved. The Neuman Systems Model concentrates on stress factors that can harm the health and well-being of a person.

One of the unique facets of the nursing profession is that the nurses provide support for patients through the most intimate times of vulnerability and pain, such as surgical procedures and traumas, tragedies and infirmities, and personal and physical losses.[1]  In all of this, nurses provide physical, emotional, and psychological support for their patients. Such duties place emotional and physical stress and strain on nurses that can affect their personal health, psychological well-being, and interpersonal relationships.[2] 

Issues of Concern

The Neuman system model diagram breaks down into the four concepts of the meta-paradigm of nursing (environment, person, nursing, health). It can also help nurses understand and relate more easily to the broader concepts of nursing skills to practical day-to-day nursing experience. Within the model of Neuman systems, the individual is viewed as a client or client system composed of innate features embedded within a specific structure. A person, a family, a community, or a social problem is considered to be "a composite of variables (physiological, psychological, sociocultural, developmental and spiritual) composed of a [central] core or essential survival factor structure and surrounding concentric defensive rings. The client system develops a series of defenses that are used as protection to interact with the environment called "defense lines." The normal line of defense can be interpreted as the client's usual level of wellness.

Beyond this line of defense is the flexible line of defense, which prevents client system stressor invasions, keeps the system free from stressor reactions or symptoms. The lines of resistance are within the normal line of defense.  When an environmental stressor breaks through the normal protection line and causes an adverse reaction, the resistance lines are triggered to protect the basic structure that is at the center or core of the client system. To penetrate the lines of resistance leaves the fundamental structure at risk and poses a potentially lethal threat to the client system. The effect of the stressor can be affected by the number of stressors the client system faces at a particular time, the intensity of the stressors, and the stability or well-being state of the system.[3][4] 

Various factors were identified as crucial to resilience development. Protective factors are intrinsic characteristics that serve to protect the person against adverse events and can be either physiological (homeostatic processes that help the body react to stresses) or psychological (more conceptual processes involving relationships, intuition, self-reliance, problem-solving and aid-seeking skills).[5] Strategies to cope with and gain expertise in stress management techniques have also been demonstrated to improve and enhance resilience in nurses.[6] 

The standard line of defense works as a protector for client wellness and is the product of how the client has adapted to surrounding stressors. The flexible line of defense is described as a dynamic "protective buffer" for the normal state of the client, which prevents stressors from invading the normal line of defense. Examples include social support, tenacity, spiritual well-being, age, and specific physiological measures.[7] When the flexible line of defense extends away from the normal line of defense, greater protection is provided; as it comes closer, there is less protection. 

There are times when the normal defense line for a client is penetrated by an environmental stressor, leading to an adverse reaction, and symptoms of disease appearance. When this happens, resistance lines are triggered, which attempt to stabilize the client and help the return to wellness, a process called "reconstitution." If reconstitution is not met, and the environmental stressor pierces the resistance lines, the customer's core becomes at risk of penetration, which poses a highly dangerous threat to the client. The core serves as the fundamental structure of all species. The invasion of the core by a stressful situation could result in severe health impacts like death, severe depression, spiritual consequences abandonment, or delays in development.[3] 

Clinical Significance

The Neuman Systems Model can guide to strengthen the management of stressors in the workplace for the nurses.[8] The willingness of a nurse to bounce back, respond to stress and adversity, and survive after becoming especially active in stressful circumstances are considered to be optimistic, multidimensional resilience adaptations affected by individual variables such as age, life experience, education, and spirituality.[9] 

The use of the model of Neuman systems provides the framework for understanding the idea of adversity by delineating the relationship between parts and whole, the effects of circumstances, and the client's contact with his or her environment. Within the framework of the model, relevant principles and hypotheses that help clarify the reaction of the client system to the environment and endorse nursing strategies unique to the reconstitution process can serve to potentially improve the client system in all domains, thereby achieving a higher degree of well-being and health. 

When nurses begin to understand the relationship between the individual and the environment, they can make better clinical decisions, offer assistance that is specific to the client and their family, and have a better chance of success in helping the client return to a wellness state, which is the ultimate goal.[7]

Nursing, Allied Health, and Interprofessional Team Interventions

An interprofessional team that provides a holistic and integrated approach to patient care can help achieve the best possible outcomes. Neuman developed the model from the idea that unique nursing techniques may enhance client healing with an emphasis on stress management or elimination. From this perspective, the objective of nursing is to reduce stressors (or the potential for stressors) by using primary, secondary, or tertiary prevention interventions aimed at maintaining, achieving or sustaining an optimal level of wellbeing for the client. The nurse needs to understand the impact not only of the stressor but also on the response of the system.

Once an adverse event has breached the normal defense line within the client system and the resistance lines have come into play to protect the integrity of the system, the system is faced with the task of returning to a stable state. The term reconstitution in the Neuman model of systems refers to the recovery of the system from stressors (adversity) and the return to a state of equilibrium or well being.[7] 

Nursing interventions help to target particular phases of the stress response, including primary, secondary, and tertiary response interventions to prevent it. Primary strategies aim to preserve the integrity of the client 's system by extending the flexible line of defense, including health promotion programs and risk factors recognition. Secondary interventions aim to help the client achieve system stability by identifying and implementing actions that reinforce the defense lines, which in turn promotes reconstitution and reduces the stress response.

Tertiary interventions work towards preventing recurrence by helping the customer maintain the current wellness level, offering protection from additional stressors, proper nutrition and rest, and holistic addressing of other aspects of physiology, psychology, spirituality, socio-culture, and development. The primary prevention objective is to identify the risk factors and prevent the occurrence of stressors. The secondary intervention involves acknowledging problems and interventions that address issues before the stressors become the target for the lines of resistance. Tertiary resilience-building interventions include decreasing or eliminating the stress response and promoting equilibrium maintenance, which restructures the defense lines of the nurse. 

Collaboration shared decision making, and communication is key elements for a good outcome. The interprofessional care provided to the patient must use an integrated care pathway combined with an evidence-based approach to planning and evaluation of all joint activities.[5]