In Neuman's model, the nursing diagnosis describes the whole client situation (Neuman, 1995). The nursing diagnosis could be described as 'multiple stressors in too short a time frame penetrated Janice's normal line of defense, causing an energy drain and a variance from wellness. Subsequently, system integrity was not maintained and Janice developed symptoms of anxiety, depression and insomnia'. This lengthy explanation allows one to understand the concept of how the nursing diagnosis is made.
In Neuman's model, goals are set in collaboration with the client. Janice stated her goals were to learn ways to handle her anxiety without medication and to learn ways to minimize her chances of becoming depressed again. These are reasonable goals in an outpatient group therapy program. These goals are relevant because they were determined by the client and were deemed by the nurse to be manageable goals in this practice setting.
Neuman's interventions are carried out at three levels: primary, secondary and tertiary prevention. By the time symptoms are evident, as with Janice, secondary prevention is appropriate. Reaction to stressors is assessed and symptoms are treated. By the time people are referred to an outpatient group therapy program, the crisis has generally subsided. New crises can and do occur, especially as the client becomes more aware of his/her created environment. This crisis intervention is secondary prevention. As Janice enters an outpatient program, it would be reasonable to expect some secondary prevention has occurred. (cont'd in part 2).
-Brenda, April 2002
Neuman, B. (1995). The Neuman Systems Model (3rd ed.). Stamford: Appleton & Lange.