Primary prevention is appropriate before symptoms occur. The focus is to build up the flexible line of defense which serves as a buffer around a person's normal line of defense, or usual method of coping (Leddy & Pepper, 1993). Suppose, in primary prevention, the nurse works to strengthen the person's flexible line of defense by teaching weight reduction to decrease the client's chances of developing diabetes. If the person is successful in losing weight, the normal line of defense may never have to deal with the diagnosis of diabetes.
Secondary prevention occurs when symptoms are evident. The goal is to build up the internal lines of resistance which come into play once the normal lines of defense have been penetrated by a stressor. These lines of resistance attempt to maintain balance by drawing on additional resources that are not usually required (Neuman, 1995). An example of this would be parents that have a disabled child. Initially they may feel they can never accept this situation. However, they are able to draw on resources they were unaware of and eventually find themselves coping well.
Tertiary prevention focuses on the return of system client balance, or client wellness. This is achieved by building on the client's strengths. Tertiary prevention leads to primary prevention (Leddy & Pepper, 1993). To demonstrate this, the newly diagnosed diabetic is referred to the
These three levels of prevention are directed at reduction of stressors and promotion of the client's lines of resistance (Leddy & Pepper, 1993).
Neuman employs a three step nursing process (Neuman, 1995). In the initial assessment, the nurse looks at the client's basic makeup and the known, unknown and universal stressors. When examining the client's basic makeup, predispositions are considered. They are important because they affect how the client will deal will stressors. The nurse also looks at Neuman's five variables: physiological, psychological, sociocultural, developmental and spiritual. The nurse uses these variables to examine the person's predispositions and stressors. The client's perception of these stressors is discussed and the nurse provides input. Stressors are identified as intrapersonal, interpersonal or extrapersonal. The next step addresses the nursing diagnosis which describes the context of the whole client as a system (Neuman).
Goals are then determined in collaboration with the client. Interventions are determined relative to the goals, and are carried out at three levels: primary, secondary and tertiary prevention.
The next step involves nursing outcomes which refers to evaluation of the effectiveness of interventions. This includes assessing changes in intrapersonal, interpersonal and extrapersonal factors. Any changes in the nature of the stressors is examined, as change in these areas determines the success of the nursing interventions (Neuman, 1995). If change has not occurred, more data collection is required and the nursing process is repeated. -Brenda, April 2002
Leddy, S. & Pepper, J. M. (1993). Conccptual Bases of Professional Nursing (3rd ed.). Philadelphia: J. B. Lippincatt Company.
Neuman, B. (1995). The Neuman Systems Model (3rd ed.). Stamford: Appleton & Lange.