Conceptual FrameworkThe Neuman Systems Model provides a frameworkfor the significance of the exploration of interventionalstrategies to decrease stress and anxiety among undergraduatenursing students in the clinical learning environment.Fawcett (2000) said, “Neuman’s work focuseson the wellness of the client system in relation to environmentalstressors and reactions to stressors” (p. 195).Stress and stress reactions are central to this model, andthe overall goal is to promote optimal wellness and systemstability by preventing stress or by intervening to providesupport (August-Brady, 2000). This model views nursingas primarily concerned with implementing appropriateactions in stress-related situations or in reactions of clientsto stress (Fawcett, 2000). Implementing strategiesto decrease high levels of stress and anxiety is a meansof providing student support in the clinical learning environment;however, strategies can also be implemented byclinical nursing faculty as a method of prevention.In the Neuman Systems Model, the concepts of theclient-client system, interacting variables, central core,flexible line of defense, normal line of defense, and line ofresistance represent the concept person. Neuman referredto the client system as an individual, family, or group andviewed each with two components—stress and reaction tostress. The client system is composed of interacting variablesfunctioning in a state of wellness or illness. Thesevariables encompass five dimensions: physiologic, psychological,sociocultural, spiritual, and developmental (Fawcett,2000). The central core refers to basic survival factorscommon to an individual, such as normal temperaturerange, genetic structure, response patterns, and strengthsand weaknesses of body organs (Fawcett, 2000). The flexibleline of defense is a mechanism that prevents stressin the client system, keeping the system free from stressreactions. The flexible line of defense protects the normalline of defense, which is the client-client system’s normalor usual wellness state as a result of adjustment to environmentalstressors. The line of resistance is a mechanismthat attempts to stabilize the client-client system and assistsin the return to usual wellness following an environmentalstressor reaction (Fawcett, 2000).The individual perspective of the Neuman SystemsModel applies to undergraduate nursing students experiencingstress and anxiety in the clinical learning environment.The clinical stress students experience invades thenormal line of defense, and when students cannot managestress, the normal line of defense is broken and anxietyresults. During this time, interventional strategies areneeded to decrease anxiety, which will increase resistanceto stressors and strengthen students’ flexible line of defense.According to Fawcett (2000), Neuman’s concept of environmentencompasses all stress factors within the environmentaffecting the client-client system. Stress factorscan be intrapersonal, interpersonal, and extrapersonal.According to Neuman, as cited in Fawcett (2000), stressorsare “tension producing stimuli or forces within theinternal or external environmental boundaries of the client/clientsystem” (p. 203). Intrapersonal stressors occurwithin the client-client system, interpersonal stressorsoccur from the external environment, and extrapersonalstressors occur outside the boundaries of the client-clientsystem and the external environment. The clinical learningenvironment is the setting in which students experienceintrapersonal stressor anxiety. This intrapersonalstressor can produce the interpersonal stressor of performancedifficulties, which can lead to the stress of an unsuccessfulclinical rotation. Clinical evaluation, negativeinteractions with nursing staff, and fear of failure are alsosome examples of the interpersonal stressors undergraduatenursing students experience in the clinical learningenvironment
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