Systems Model : Betty Neuman ( 1924- 2012 ) (UCLA).

After her graduation, she was

hired as a department chair in the UCLA
School of Nursing graduate program.
 Betty Neuman was born in 1924 and
 In 1985, Betty Neuman concluded a
grew up on a farm in Ohio. Her rural
doctoral degree in clinical psychology at
background helps her develop a
Pacific Western University. She was a
compassion for people in need, which
pioneer of nursing involvement in
has been evident throughout her
mental health.
career.
 Neuman persisted to start a private
 She completed her initial nursing
practice as a marriage and family
education with double honors at
therapist, specializing in Christian
Peoples Hospital School of Nursing
counseling.
(now General Hospital), Akron, Ohio in
1947.  She is a Fellow of the American
Association of Marriage and Family
 As a young nurse, Neuman moved to
Therapy and of the American Academy
California and worked in a variety of
of Nursing. Until 2009, she was the
roles that included hospital nurse,
director of the Neuman Systems Model
school nurse, industrial nurse and
Trustees Group, Inc. that she
clinical instructor at the University of
established in 1988
Southern California Medical Center.
What is the Neuman Systems Model?
 She earned a baccalaureate degree in
public health and psychology with  The aim of the Neuman model "...is to
honors (1957) and a master’s degree in set forth a structure that depicts the
mental health, public health parts and subparts and their
consultation (1966) from the University interrelationships for the whole of the
of California, Los Angeles (UCLA). client as a complete system" (Neuman,
2002 p.11).
 She completed a doctoral degree in
clinical psychology at Pacific Western  The Neuman's systems model has two
University in 1985. major components--- stress and
reactions to stress.
 Betty Neuman moved to California and
worked in a variety of capacities as a  The client in the Neuman's model is
hospital nurse  and head nurse at Los viewed as an open system in which
Angeles County General repeated cycles of input, process,
Hospital, school nurse , industrial nurse, output, and feedback, constitute a
and clinical instructor at the University dynamic organizational pattern.
of Southern California Medical Center,
 The client may be an individual, a
Los Angeles.
group, a family, a community, or an
 She also earned a master’s degree aggregate.
in mental health, public health
consultation in 1966 from the
University of California, Los Angeles
Major concepts identified in the model are:  Variations in both the client system and
the environment can affect the
a. Wholistic approach
direction of the reaction.
 Clients are viewed as wholes whose
 internal environment exists within the
parts are in dynamic interaction.
client system. All forces and interactive
 The model considers all variables influences that are solely within the
simultaneously affecting the client boundaries of the client system make
system: physiological, psychological up this environment.
sociocultural, developmental, and
 external environment exists outside
spiritual.
the client system. Those forces and
 Neuman included the spiritual variable interactive influences that are outside
in the second edition (1989). the system boundaries are identified as
external.
 She changed the spelling of the term
holistic to wholistic in the second  created environment. The created
edition enhance understanding of the environment is developed
term as referring to the whole person unconsciously by the client and is
(B.Neuman, person communication, symbolic of system wholeness.
June 20, 1988).

d. Client system
b. Open system
 "a composite of five variables
 a system is open when "there is a (physiological, psychological,
continuous flow of input and process, sociocultural, developmental, and
output, and feedback." spiritual) in interaction with the
environment (Neuman 2011c, p.327).
 "Stress and reaction to stress are basic
components" of an open system (Neum  "The physiological variable refers to
2011c, p.328; see also Neuman, 1982, body structure and function.
1989, 1995, 2002b).
 The psychological variable refers to
mental process in interaction with the
environment.
c. Environment
 The sociocultural variable refers to the
 Neuman (1995) defines environment as effects and influences of social and
all the internal and external factors or cultural conditions.
influences that surround the client or
client system.  The developmental variable refers to
age-related processes and activities.
 The influence of the client on the
environment and the environment on  The spiritual variable refers to spiritual
the client may be positive or negative at beliefs and influences"
any time.
e. Normal Line of Defense h. Stressors

 The normal line of defense is the  tension-producing stimuli "that have

model's outer solid circle. the potential o disrupt system stability
leading to an outcome that may be
 It represents the "adaptational level of
positive or negative."
health developed over the course of
time and serves as the standard by  They may arise from the following:
which to measure wellness deviation
 Intrapersonal stressors occurring within
determination" (Neuman, 2011c, p.
the individual system boundary.
328); see also Neumans 1982 1989
1995) • example: autoimmune response
 when invaded or penetrated, client  interpersonal stressors – occur outside
system reacts. the client system boundary
 reaction will be apparent in symptoms - are proximal to the system, have an
of instability or illness impact to the system.

- example : role expectations

f. Flexible Line of Defense  extrapersonal stressors - occur outside
the individual
 represented in the model diagram as
the outer boundary and initial - example: financial circumstances
response, or protection, of the system
to stressors.

 serves as a cushion and is described as i. Degreee of reaction

accordionlike as it expands away from - represents the system instability that occurs
or contracts closer to the normal line of when the stressors invade the normal line of
defense (Neuman, 1995). defense.
 It protects the normal line of defense
and acts as a buffer for the client
system's usual stable state. j. Prevention as intervention

 The flexible line of defense is dynamic - interventions are purposeful actions to help
rather than stable and can be altered client retain, attain or maintain system
over a relatively short period by factors stability.
such as inadequate nutrition or sleep. - occur before or after protective lines of
 Either single or multiple stressors may defense and resistance are penetrated.
invade the flexible line of defense.

g. Health

 it is a continuum of wellness to illness

that is dynamic in nature.
  Primary prevention  may begin at any point after system
stability has begun to be reestablished
 occurs before the system reacts to a
stressor  Tends to lead back to primary
prevention.
 it includes health promotion and
maintenance of wellness.

 focuses on strengthening the flexible k. Reconstruction

line of defense through preventing
 occurs after treatment for stressor
stress and reducing risk factors.
reactions. "It represents return of the
This intervention occurs when the risk or hazard system to stability" which may be at a
is identified but before a reaction occur. higher or lower level of wellness than
before stressor invasion (Neuman,
201Ic., p.328).
 Secondary prevention

 occurs after the system reacts to a

NURSING METAPARADIGM
stressor and is provided in terms of
existing symptoms. Human Beings ( Person/Client)

 focuses on strengthening the internal  "Neuman presents the concept of

lines of resistance . human beings as an open client system
in reciprocal interaction with the
 intent is to regain optimal system
environment.
stability and to conserve energy in
doing so.  The client may be an individual, family,
group, community, or social issue.”
 If secondary prevention is unsuccessful
and reconstitution does not occur, the  The person is a layered
basic structure will be unable to multidimensional being.
support the system and its
Each layer consists of the person variables
interventions, and death will occur
or subsystem:

o Physical/physiological
 Tertiary prevention
o Psychological
 occurs after the system has been
treated through secondary prevention o Socio-cultural
strategies. o Developmental
 Its purpose : o Spiritual
 to maintain wellness or protect the
client system reconstitution thru
supporting existing strength and
continuing to conserve energy
Health relation to possible reactions of the
client or client system to stressors.
 Neuman sees health as being equated
with wellness.  Nursing interventions are aimed at
helping the system adapt or adjust and
 She defines health/wellness as "the
to retain, restore, or maintain some
condition in which all parts and
degree of stability between and among
subparts (variables) are in harmony
the client system variables and
with the whole of the client (Neuman
environmental stressors with a focus on
1995)".
conserving energy.
 As the person is in a constant
interaction with the environment the
state of wellness (and by implication
any other state) is in dynamic
equilibrium, rather than in any kind of
steady state.

 Environment

 Neuman defines "environment as all

the internal and external factors that
surround and influence the client
system."

 Stressors (intrapersonal, interpersonal,

and extrapersonal) are significant to the
concept of environment and are
described as environmental forces that
interact with and potentially alter
system stability (Neuman, 2011b, p.19).

 Neuman (1995) identifies three relevant

environments:

o internal

o external

o created

 Nursing

 the primary concern of nursing is to

define the appropriate action in situa-
tions that are stress-related or in