Betty Neuman Systems

Model
SITHARA.S
Sr. LECTURER, MIMS CON
BETTY NEUMAN
• She was born in 1924 near Lowell, Ohio.
• Her initial nursing education was
completed with double honors at Peoples
Hospital School of Nursing, Akron,
Ohio in 1947.
• She completed her baccalaureate degree
with honors in nursing in 1957.
• In 1966, she received her master’s
degree in Mental Health, Public Health
Consultation, from UCLA.
• She received a doctoral degree in
clinical psychology from Pacific
Western University in 1985.
• She was a pioneer of nursing involvement in mental health.

• In California, she worked as hospital staff and head nurse,

school nurse and industrial nurse.

• She was also involved in clinical teaching in the areas of

medical-surgical, communicable disease, and critical care.

• In 1970, she designed a conceptual model for nursing and
first published in 1972 as a 'Model for teaching total
person approach to patient problems' in Nursing
Research.

• She then defined and refined various aspects of the model in

preparation for her book, The Neuman Systems Model:
Application to Nursing Education and Practice.

• Further development and revisions of the model are

illustrated in the second (1989) and third (1995) editions.
• Betty Neuman’s system model provides a comprehensive, flexible, holistic
and system-based perspective for nursing.

• It focuses attention on the response of the client system to actual or

potential environmental stressors.

• And the use of primary, secondary and tertiary nursing prevention

intervention for retention, attainment, and maintenance of optimal client
system wellness.
MAJOR CONCEPTS OF
NEUMAN SYSTEMS MODEL
PERSON

• Human being is a total person as a client system and

has 5 interacting variables

– Physiological - Refers of the physicochemical

structure and function of the body.
– Psychological - Refers to mental processes and
emotions.
PERSON
– Socio-cultural - Refers to relationships and
social/cultural expectations and activities.
– Spiritual - Refers to the influence of spiritual
beliefs.
– Developmental - Refers to those processes
related to development over the lifespan.
ENVIRONMENT
• “The totality of the internal and external forces
which surround a person and with which they
interact at any given time."

• The internal environment exists within the client

system.
ENVIRONMENT
• The external environment exists outside the
client system.

• The created environment is the client’s

unconscious mobilization of all system
variables toward system stability, and
integrity. E.g. use of denial
Stressors
• Tension-producing stimuli occurring within the
boundaries of the client system.

• They may be:

Intrapersonal- emotions
Interpersonal- role expectation
Extrapersonal- job pressure
HEALTH
“The condition in which all parts and subparts (variables)
are in harmony with the whole of the client (Neuman,
1995)”.

• The client system moves toward illness and death

when more energy is needed than is available. The
client system moved toward wellness when more
energy is available than is needed
NURSING
• Neuman defines nursing as “action which assist
individuals, families and groups to maintain a
maximum level of wellness, and the primary aim is
stability of the patient/client system, through nursing
interventions to reduce stressors.’’

• The role of the nurse is seen in terms of degree of

reaction to stressors, and the use of primary,
secondary and tertiary interventions.
Stability
• A state of balance or harmony as the client adequately
cope with the stressors to  retain, attain, or maintain
an optimal level of health thus preserving system
integrity.
Negentropy
• A process of energy
utilization that
assists system
progression toward
stability or wellness.
Entropy
• A process of energy
depletion and
disorganization that
moves the system toward
illness or possible death.
Neuman’s Systems Model
Basic Structure
• “The core structure consists of basic survival factors or
energy resources of the client (normal temperature, genetic
structure, response pattern, organ strength/weakness etc)”

Basic
Structure
Energy
Resources
Flexible Line of Defense

Lines of Resistance

Basic
Structure
Energy
Resources

Normal Line of Defense

Flexible Line of Defense
• The model’s outer broken ring.
• It is dynamic and can be rapidly altered over a
short time.
• It is perceived as a protective buffer for
preventing stressors from breaking through
usual wellness state.
• E.g. Sleep or Rest
Normal Line of Defense
• Is the model’s outer solid circle.
• It represents a stability state for the individual
or system.
• It includes system variables and behaviors
such as the individual’s usual coping patterns,
lifestyle, and developmental stage.
Lines of Resistance
• Are the series of broken rings surrounding the
basic core structure.
• These rings represent resource factors that help
the client defend against stressors.
• E.g. Body’s immune response system
Optimal system stability

• Optimal wellness is the greater possible degree

of system stability or highest possible health
condition at a given point in time (Neuman
2002)
Variance from wellness

• The difference from the normal or usual

wellness condition (Neuman 2002)
Illness
• Illness is an excessive expenditure of energy.
When more energy is used by the system in its
disorganization than is built and stored, the
outcome may be death. (Neuman 2002)
Prevention as Intervention
• Are purposeful actions to help the client retain,
attain, and/or maintain system stability.

• Three levels of intervention: (1) primary, (2)

secondary, and (3) tertiary.
Prevention as Intervention
• Are purposeful actions to help the client retain,
attain, and/or maintain system stability.

• Three levels of intervention: (1) primary, (2)

secondary, and (3) tertiary.
Primary Level

• Occurs before the system reacts to a stressor.

• Strengthens the person (primary the flexible LOD) to
enable him to better deal with stressors
• Includes health promotion and maintenance of
wellness.
Secondary Level

• Occurs after the system reacts to a stressor and is

provided in terms of existing system.

• Focuses on preventing damage to the central core by

strengthening the internal lines of resistance and/or
removing the stressor.
Tertiary level
• Occurs after the system has been treated through
secondary prevention strategies.

• Offers support to the client and attempts to add

energy to the system or reduce energy needed in
order to facilitate reconstitution.
Reconstitution
• Is the state of adaptation to stressors in the internal
and external environment.

• The return and maintenance of system stability,

following treatment for stressor reaction, which may
result in a higher or lower level of wellness.
Sample Situation:
• Mr. X is a 42 year-old business executive. His colleagues describe
him as hardworking, perfectionist and workaholic. His day starts by
leaving the house very early and begins work by delegating various
tasks with firm expectations and deadlines that somewhat impossible
to meet. He usually responds with pressure and intimidating remarks
for works not perfectly done. He smokes and drinks alcohol whenever
he is stressed. Recently, the company experienced continuous
dropped in their sells and his bosses started to put blame to him.
• Mr. X began exhibiting weird mannerisms and behaviors that appear
strange to his family and people around him. He misses meals very
often and sleeps very late at night while doing work. He has no time
anymore for his family and focuses to hard on meeting deadlines and
his preconceived objectives. Because of these weird changes in him,
the company decided to temporarily relieve him from his position as
executive manager. A week later, he started to have periods of mania
and depression. His family becomes worried and called up the hospital
to seek assistance after he locked himself in the room, refusing to eat,
and most of the time quiet and staring blankly on the wall. Later, he
developed pneumonia.
• Using Neuman’s System Model in the situation, the identified
possible stressors that contributed to Mr. X’s condition were
as follows: work, personality, and attitude. Mr. X is not
anymore able to handle the stressors and that had caused the
“breakdown” of his lines of defense. Without seeking help
from his family and friends, he was not able to maintain his
flexible line of defense and brought instability to his system. 
Usefulness of the Theory
Practice
• Facilitates goal-directed, unified, wholistic approaches to
client care, yet it is also appropriate for multidisciplinary
use to prevent fragmentation of client care.

• The model was selected and utilized in a variety of nursing

practice settings with individuals, families, groups, and
communities.

• It has been applied and adapted to various specialties

include family therapy, public health, rehabilitation, and
hospital nursing.
• It is also used effectively in advanced nursing
practice such as psychiatric home visits, critical care,
collaborative practice by nurse practitioners and
physicians, and practice of nurse anesthesia.

• The model is being studied and applied in other

disciplines, such as physical therapy.
Education
• The model has been accepted in academic circles and is
used widely as a curriculum guide oriented toward wellness.

• It has been selected for baccalaureate programs on the basis

of its theoretical and comprehensive perspectives for a
wholistic curriculum and its potential for use with the
individual, family, small groups, and community.

• It has been used effectively in postbasic nursing education

and beyond.
Research
• The model is one of the most frequently used models for
nursing research.
• Systems Model has provided the conceptual framework for
recently published research across the life span, on nurses
and lay persons as caregivers, and on nursing education
and administration.
• Neuman’s model can easily generate nursing research.
ANALYSIS OF THE THEORY
Clarity
• It presents abstract concepts but familiar to nurses.

• The model’s concept of client, environment, health,

and nursing are congruent with traditional nursing
values.
Simplicity
• They are organized in a complex, yet logical manner
and variables tend to overlap to some degree.
• The model can be used to describe, explain or predict
nursing phenomena.
• The model is complex in nature; therefore it cannot
be described as a simple framework, yet nurses using
the model describe it as easy to understand and use
across cultures in a wide variety of practice settings.
Generality
• The broad scope of this model allows it to be
considered general enough to be useful to nurses and
other healthcare professionals in working with
individuals, families, groups, or communities in all
healthcare settings.
Empirical precision
• The model has provided clear, comprehensive guidelines for
nursing education and practice in a variety of settings; this is its
primary contribution to nursing knowledge.

• The concept within the guidelines is clearly explicated and many

applications of the theory have been published, little research
explicitly derived from this model has been published to date. 

• Continued testing and refinement will increase the model’s

empirical precision as the research process, analysis, and
synthesis of findings from multiple studies are completed.
NEUMAN'S MODEL AND
CHRACTERISTICS
• Interrelated concepts
• Logically consistent.
• Logical sequence
• Fairly simple and straightforward in approach.
• Easily identifiable definitions
• Provided guidelines for nursing education and
practice
• Applicable in the practice
REFERENCES
• Current Nursing: A Portal for Nursing Professionals (2008).
http://www.currentnursing .com
• George, Julia B. (2002). Nursing Theories: The Base for Professional Nursing
Practice. 5th Edition. Prentice Hall: New Jersey, USA.
• Heyman, Patrick and Sandra Wolfe (April 2000). Neuman Systems Model. Retrieved
December 4, 2009, from http://www.patheyman.com/essays/neuman/index.htm
• Parker, Marilyn E. (2005). Nursing Theories and Nursing Practice. 2nd Edition. F.A.
Davis: Philadelphia.
• Tomey, Ann M. and Martha Alligood (2004). Nursing Theorists and their Work. 5th
Edition. Elsevier Publishers: Singapore.