Betty Neuman: Neuman Systems

Model

NURSING THEORIES GUIDE

Presented by:
Maria Suzette T. Carampatan
Betty Neuman (1924 – present)
- nursing theorist who developed the Neuman Systems Model
- gave many years perfecting a systems model that views at patients holistically
- inquired theories from several theorists and philosophers
- applied her knowledge in clinical and teaching expertise to come up with the Neuman
Systems Model
- Neuman Systems Model has been accepted, adopted, and applied as a core for nursing
curriculum in many areas around the world.
Biography of Betty Neuman
Early life
Betty Neuman was born in 1924 near Lowell, Ohio.
She grew up on a farm which later encouraged her to help people who are in
need.
Her father was a farmer who became sick and died at the age of 36.
Her mother was a self-educated midwife, that led the young Neuman to be
always influenced by the commitment that took her away from home from time
to time.
 Her love for nursing started when she took the responsibility of taking care of
her father which later created her compassion in her chosen career path.
Biography of Betty Neuman
Education
As a young girl, she attended the same one-room schoolhouse that her parents
had attended and was excited when she went to a high school that had a library.
She was always engaged and fascinated with the study of human behavior.
During World War II, she had her first job as an aircraft instrument technician.
In 1947, she received her RN Diploma from Peoples Hospital School of Nursing,
Akron, Ohio.
Biography of Betty Neuman
Nursing Career
Worked in a variety of capacities as a hospital nurse and head
nurse at Los Angeles County General Hospital, school nurse,
industrial nurse, and clinical instructor at the University of
Southern California Medical Center, Los Angeles.
In 1957, she received a baccalaureate degree in public health
and psychology with honors.
She also managed to work as a fashion model and learned to
fly a plane.
She also earned a master’s degree in mental health, public
health consultation in 1966 from the University of California,
Los Angeles (UCLA).
Biography of Betty Neuman
Nursing Career
Neuman developed the first community mental health
program for graduate students in the LA area from 1967 to
1973.
In 1985, Betty Neuman concluded a doctoral degree in
clinical psychology at Pacific Western University.
She was a pioneer of nursing involvement in mental
health.
She and Donna Aquilina were the first two nurses to
develop the nurse counselor role within community crisis
centers in Los Angeles.
Biography of Betty Neuman
Nursing Career
Neuman persisted to start a private practice as a
marriage and family therapist, specializing in Christian
counseling.
She is a Fellow of the American Association of Marriage
and Family Therapy and of the American Academy of
Nursing.
Until 2009, she was the director of the Neuman Systems
Model Trustees Group, Inc. that she established in 1988,
and still attends as a consultant.
The Trustees Group was created to preserve and maintain
the message of her nursing theory for the health care
community.
Works of Betty Neuman
Works of Betty Neuman

In 1970, Betty Neuman designed a nursing conceptual model to expand

students’ understanding of client variables beyond the medical model.
Her teaching programs at UCLA paved the way for developing her nursing
model.
During those times, she did not write a book but made her concepts known to
Joan Riehl-Sisca and Sr. Callista Roy and incorporated them in their 1971
book, Conceptual Models for Nursing Practice.
Works of Betty Neuman

In 1972, Neuman published a draft of

her model.
She developed and improved the
concepts and published her book, The
Neuman System Model: Application to
Nursing Education and Practice, in 1982.
As a speaker and author, she spent
countless hours teaching and explaining
the many concepts and aspects of the
model to students and professors.
Works of Betty Neuman

Neuman has also been involved in

numerous publications, paper
presentations, consultations, lectures,
and conferences on application and use
of the model.
She worked as a consultant nationally
and internationally concerning the
implementation of the model for
nursing education programs and for
clinical practice facilities.
Awards and Honors of Betty Neuman

Betty Neuman has done many things

including a nurse, educator, health
counselor, therapist, author, speaker, and
researcher.
Throughout the years, she earned many
awards and honors including several
honorary doctorates and was an honorary
member of the American Academy of
Nursing.
The profound effect of her work on
the nursing profession is well known
throughout the world.
Awards and Honors of Betty Neuman

Honorary Doctorate of Letters,

Neumann College, Aston, PA (1992)
Honorary Member of the Fellowship
of the American Academy of Nursing
(1993)
Honorary Doctorate of Science, Grand
Valley State University, Michigan (1998)
Awards and Honors of Betty Neuman

She was honored by President Richard

Jusseaume and Provost Dr. Laurence Bove with
the Walsh University Distinguished Service
Medal which is awarded to those who have
contributed outstanding professional or
voluntary service to others within the national,
regional or local community.
In an annual Nursing Research Day sponsored
by Walsh’s Phi Eta Chapter of Sigma Theta Tau,
Byers School of Nursing Dean Dr. Linda Linc
granted Neuman with the first annual Neuman
Award, named in her honor, for outstanding
service in the nursing profession.
Betty Neuman’s Nursing Theory

Three words frequently used in relation to stress are inevitable, painful and
intensifying.
• It is generally subjective, and can be interpreted as the circumstances one regards as
conceivably threatening and out of their control.
A nursing theory developed by Betty Neuman is based on the person’s relationship to
stress, the response to it, and reconstitution factors that are progressive in nature.
The Neuman Systems Model presents a broad, holistic and system-based method to
nursing that maintains a factor of flexibility.
• It focuses on the response of the patient system to actual or potential environmental
stressors and the maintenance of the client system’s stability through primary, secondary,
and tertiary nursing prevention intervention to reduce stressors.
What is the Neuman Systems Model?

Betty Neuman describes the Neuman

Systems Model as
• “a unique, open-system-based perspective
that provides a unifying focus for
approaching a wide range of concerns.
• A system acts as a boundary for a single
client, a group, or even a number of
groups; it can also be defined as a social
issue.
• A client system in interaction with the
environment delineates the domain of
nursing concerns.”
What is the Neuman Systems Model?

The Neuman Systems Model views the client as an open system that responds to stressors in
the environment.
The client variables are physiological, psychological, sociocultural, developmental, and spiritual.
The client system consists of a basic or core structure that is protected by lines of resistance.
The usual level of health is identified as the normal line of defense that is protected by a flexible
line of defense.
Stressors are intra-, inter-, and extrapersonal in nature and arise from the internal, external,
and created environments.
• When stressors break through the flexible line of defense, the system is invaded and the lines
of resistance are activated and the system is described as moving into illness on a wellness-
illness continuum.
• If adequate energy is available, the system will be reconstituted with the normal line of
defense restored at, below, or above its previous level.
What is the Neuman Systems Model?

Nursing interventions occur through three

prevention modalities. 
• Primary prevention occurs before the
stressor invades the system; 
• Secondary prevention occurs after the
system has reacted to an invading
stressor; 
• Tertiary prevention occurs after
secondary prevention as reconstitution is
being established.
Assumptions
The following are the assumptions or “accepted truths” made by Neuman’s Systems Model:

Each client system is unique, a composite of factors and characteristics within a given
range of responses.
Many known, unknown, and universal stressors exist. Each differs in its potential for
disturbing a client’s usual stability level or normal line of defense. The particular
interrelationships of client variables at any point in time can affect the degree to which
a client is protected by the flexible line of defense against possible reaction to stressors.
Each client/client system has evolved a normal range of responses to the environment
that is referred to as a normal line of defense. The normal line of defense can be used as
a standard from which to measure health deviation.
When the flexible line of defense is no longer capable of protecting the client/client
system against an environmental stressor, the stressor breaks through the normal line
of defense.
Assumptions
The following are the assumptions or “accepted truths” made by Neuman’s Systems Model:

The client, whether in a state of wellness or illness, is a dynamic composite of the

interrelationships of the variables. Wellness is on a continuum of available energy to
support the system in an optimal state of system stability.
Implicit within each client system are internal resistance factors known as lines of
resistance, which function to stabilize and realign the client to the usual wellness
state.
Primary prevention relates to general knowledge that is applied in client assessment
and intervention, in identification and reduction or mitigation of possible or actual
risk factors associated with environmental stressors to prevent possible reaction.
Assumptions
The following are the assumptions or “accepted truths” made by Neuman’s Systems Model:

Secondary prevention relates to symptomatology following a reaction to stressors,

appropriate ranking of intervention priorities, and treatment to reduce their
noxious effects.
Tertiary prevention relates to the adjustive processes taking place as
reconstitution begins and maintenance factors move the client back in a circular
manner toward primary prevention.
The client as a system is in dynamic, constant energy exchange with the
environment. (Neuman, 1995)
Major Concepts of Neuman Systems Model
In this section, we will define the nursing metaparadigm and the major concepts in Betty Neuman’s Neuman Systems Model.

Human being
• Human being is viewed as an open system that interacts with both internal and external
environment forces or stressors. The human is in constant change, moving toward a dynamic
state of system stability or toward illness of varying degrees.
Environment
• The environment is a vital arena that is germane to the system and its function. The
environment may be viewed as all factors that affect and are affected by the system.
• In Neuman Systems Model identifies three relevant environments: (1) internal, (2) external,
and (3) created.
 The internal environment exists within the client system. All forces and interactive influences that are
solely within boundaries of the client system make up this environment.
 The external environment exists outside the client system.
 The created environment is unconsciously developed and is used by the client to support protective
coping.
Major Concepts of Neuman Systems Model
In this section, we will define the nursing metaparadigm and the major concepts in Betty Neuman’s Neuman Systems Model.

Health
• In Neuman’s nursing theory, Health is defined as the condition or degree of system stability
and is viewed as a continuum from wellness to illness.
• When system needs are met, optimal wellness exists.
• When needs are not satisfied, illness exists. When the energy needed to support life is not
available, death occurs.
Nursing
• The primary concern of nursing is to define the appropriate action in situations that are
stress-related or in relation to possible reactions of the client or client system to stressors.
• Nursing interventions are aimed at helping the system adapt or adjust and to retain, restore,
or maintain some degree of stability between and among the client system variables and
environmental stressors with a focus on conserving energy.
Major Concepts of Neuman Systems Model
In this section, we will define the nursing metaparadigm and the major concepts in Betty Neuman’s Neuman Systems Model.

Open System
• A system in which there is a continuous flow of input and process, output and
feedback.
• It is a system of organized complexity, where all elements are in interaction.
Basic Stricture and Energy Resources
• The basic structure, or central core, is made up of those basic survival factors
common to the species.
• These factors include the system variables, genetic features, and strengths and
weaknesses of the system parts.
Major Concepts of Neuman Systems Model
In this section, we will define the nursing metaparadigm and the major concepts in Betty Neuman’s Neuman Systems Model.

Client Variables
Neuman views the individual client holistically and considers the variables simultaneously and
comprehensively.
• The physiological variable refers to the structure and functions of the body.
• The psychological variable refers to mental processes and relationships.
• The sociocultural variable refers to system functions that relate to social and
culturalexpectations and activities.
• The developmental variable refers to those processes related to development over the
lifespan.
• The spiritual variable refers to the influence of spiritual beliefs.
Major Concepts of Neuman Systems Model
In this section, we will define the nursing metaparadigm and the major concepts in Betty Neuman’s Neuman Systems Model.

Flexible line of defense

• A protective accordion-like mechanism that surrounds and protects the normal line of
defense from invasion by stressors.
Normal line of defense
◦ An adaptational level of health developed over time and considered normal for a particular
individual client or system; it becomes a standard for wellness-deviance determination.
Lines of resistance
• Protection factors activated when stressors have penetrated the normal line of defense,
causing a reaction synptomatology.
Subconcepts of Neuman Systems Model
Stressors
• A stressor is any phenomenon that might penetrate both the flexible and normal lines of
defense, resulting in either a positive or negative outcome.
 Intrapersonal stressors are those that occur within the client system boundary and
correlate with the internal environment.
 Interpersonal stressors occur outside the client system boundary, are proximal to the
system, and have an impact on the system.
 Extrapersonal stressors also occur outside the client system boundaries but are at a greater
distance from the system that are interpersonal stressors. An example is social policy.
Stability
• A state of balance or harmony requiring energy exchanges as the client adequately copes
with stressors to retain, attain, or maintain an optimal level of health thus preserving system
integrity.
Subconcepts of Neuman Systems Model
Degree of Reaction
• The amount of system instability resulting from stressor invasion of the normal line of
defense.
Entropy
• A process of energy depletion and disorganization moving the system toward illness or
possible death.
Negentropy
• A process of energy conservation that increases organization and complexity, moving the
system toward stability or a higher degree of wellness.
Input/Output
• The matter, energy, and information exchanged between the client and environment that is
entering or leaving the system at any point in time.
Subconcepts of Neuman Systems Model
Reconstitution
• The return and maintenance of system stability, following treatment of stressor reaction, which may
result in a higher or lower level of wellness.
Prevention as Intervention
• Intervention modes for nursing action and determinants for entry of both client and nurse into the
health care system.
• Primary prevention occurs before the system reacts to a stressor; it includes health promotion and maintenance of wellness.
Primary prevention focuses on strengthening the flexible line of defense through preventing stress and reducing risk factors.
This intervention occurs when the risk or hazard is identified but before a reaction occurs.
• Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing symptoms. Secondary
prevention focuses on strengthening the internal lines of resistance and, thus, protects the basic structure through
appropriate treatment of symptoms. The intent is to regain optimal system stability and to conserve energy in doing so.
• Tertiary prevention occurs after the system has been treated through secondary prevention strategies. Its purpose is to
maintain wellness or protect the client system reconstitution through supporting existing strengths and continuing to
preserve energy. Tertiary prevention may begin at any point after system stability has begun to be re-established
(reconstitution has begun). 
Strengths and Weaknesses
Betty Neuman reports her nursing model was
designed for nursing but can be used by other
health disciplines, which both has pros and
cons.
As a strength, if multiple health disciplines use
the Neuman’s System Model, a consistent
approach to client care would be facilitated.
As a con, if the model is useful to a variety of
disciplines, it is not specific to nursing and thus
may not differentiate the practice of nursing
from that of other disciplines.
Strengths and Weaknesses
Strengths
• The major strength of the Neuman Systems Model is its flexibility for use in all areas of
nursing – administration, education, and practice.
• Neuman has presented a view of the client that is equally applicable to an individual, a
family, a group, a community, or any other aggregate.
• The Neuman Systems Model, particularly presented in the model diagram, is logically
consistent.
• The emphasis on primary prevention, including health promotion, is specific to this model.
• Once understood, the Neuman Systems Model is relatively simple, and has readily
acceptable definitions of its components.
Weaknesses
• The major weakness of the model is the need for further clarification of terms used.
• Interpersonal and extrapersonal stressors need to be more clearly differentiated.
Analysis
The delineation of Neuman’s three defense lines were not clearly explained.
• In reality, the individual resists stressors with internal and external reflexes which were made
complicated with the formulation of different levels of resistance in the open systems model of
Neuman.
Neuman made mention of energy sources in her model as part of the basic structure.
• It can be more of help when Neuman has enumerated all sources of energy that she is pertaining to.
• With such, new nursing interventions as to the provision of needed energy of the client can be
conceptualized.
The holistic and comprehensive view of the client system is associated with an open system.
• Health and illness are presented on a continuum with movement toward health described as
negentropic and toward illness as entropic.
• Her use of the concept of entropy is inconsistent with the characteristics of entropy which is closed,
rather than an open system.
Thank you!