Betty Neuman: The Neuman Systems Model

Introduction
Since the 1960s, Betty Neuman has been recognized
as a pioneer in the field of nursing, particularly in the
area of community mental health.
She developed her model while lecturing in
community mental health at UCLA and first published
it in 1972 under the title “A Model for Teaching the
Total Person Approach to Patient Problems” (Neuman
& Fawcett, 2011).
Since that time, she has been a prolific writer, and
her model has been used extensively in colleges of
nursing, beginning with Neumann College’s Bsc
nursing program in Aston, Pennsylvania.
Numerous other nursing programs have organized
their curricula around her model both in the US and
internationally (Neuman & Fawcett, 2011).
The major elements in this review of the Neuman
Systems Model are taken from the fifth edition of
her book (Neuman & Fawcett, 2011), with
references to earlier writings to show development
of the model over time.
The model was deductively derived and emanated
from requests of graduate students who wanted
assistance with a broad interpretation of nursing.
 Neuman’s model uses a systems approach that is
focused on the human needs of protection or relief
from stress (Neuman & Fawcett, 2011)
Neuman believed that the causes of stress can be
identified and remedied through nursing interventions.
She emphasized the need of humans for dynamic
balance that the nurse can provide through
identification of problems, mutually agreeing on goals,
and using the concept of prevention as intervention.
Neuman’s model is one of only a few considered
prescriptive in nature.
The model is universal, abstract, and applicable for
individuals from many cultures (Neuman & Fawcett,
2011).
 Background of the Theorist

Betty Neuman was born in 1924 on a farm near Lowell,

Ohio.
In 1947 she earned her nursing diploma from People’s
Hospital School of Nursing, Akron, Ohio, and moved to
California shortly thereafter.
She earned a bachelor’s degree in nursing from UCLA and
also studied psychology and public health.
In 1966, she earned a master’s degree in mental health and
public health consultation, also from UCLA.
And then earned her doctorate in clinical psychology in
1985 from Pacific Western University.
She worked as a hospital staff nurse, a head
nurse, and an industrial nurse and consultant
before becoming a nursing instructor.
She has taught medical-surgical nursing,
critical care, and communicable disease
nursing at the University of Southern
California Medical Center in Los Angeles and
at other colleges in Ohio and West Virginia
(Lawson, 2014;Neuman & Fawcett, 2011).
 Philosophical Underpinnings of the Theory

Neuman used concepts and theories from a number of

disciplines in the development of her theory.
In her works, she referred to Chardin and Cornu on
wholeness in systems.
Von Bertalanffy and Lazlo on general systems theory.
 Selye on stress theory, and Lazarus on stress and
coping (Neuman & Fawcett, 2011).
Major Assumptions, Concepts, and
Relationships
Concepts
Neuman (Neuman & Fawcett, 2011) adhered to the
metaparadigm concepts and has developed numerous
additional concepts for her model.
In her work, she defined human beings as “client
system a composite of five interacting variable areas
physiological, psychological, sociocultural,
developmental, and spiritual.”(Neuman & Fawcett,
2011, p. 16).
The ring structure is a “basic structure of protective
concentric rings, for retention attainment or
maintenance of system stability and integrity”
(Neuman & Fawcett, 2011, p. 16).
Environment to Neuman is a structure of concentric
rings representing the three environments, internal,
external, and created environments, all of which
influence the client’s adaptation to stressors.
Health is defined as “a continuum; wellness and
illness are at opposite ends.
Health for the client is equated with optimal system
stability that is the best possible wellness state at any
given time”(p. 23).
Variances from wellness or varying degrees of system
instability are caused by stressor invasion of the
normal line of defense” (p. 24).
Finally, in the nursing component, the major concern
is to maintain client system stability through accurately
assessing environmental and other stressors.
And assisting in client adjustments to maintain
optimal wellness.
Concept Definition
Basic structure Basic survival factors common to human beings; they are located in
the central core and represent basic client system energy resources.
Boundary lines The flexible line of defense is the outer boundary of the client
system.
Degree of The amount of system instability resulting from stressor invasion of
reaction the normal line of defense.
Feedback The process within which matter, energy, and information provides
feedback for corrective action to change, enhance, or stabilize the
system.
Flexible line of A protective, accordion-like mechanism that surrounds and protects
defense the normal line of defense from invasion by stressors
Input/output The matter, energy, and information exchanged between client and
environment that is entering or leaving the system at any point in
time.
Lines of Protection factors activated when stressors have penetrated the
resistance normal line of defense, causing a reaction symptomatology.
Negentropy A process of energy conservation that increases organization and
complexity, moving the system toward stability or a higher degree of
wellness.
Normal line of An adaptation level of health developed over time and considered
defense normal for a particular individual client or system; it becomes a
standard for wellness–deviance determination.
Open system A system in which there is a continuous flow of input and process,
Wellness/illness Wellness is the condition in which all system parts and subparts
are in harmony with the whole system of the client.
Illness indicates disharmony among the parts and subparts of the
client system.

Prevention as Intervention modes for nursing action and determinants for entry
intervention of both client and nurse into the health care system.

Reconstitution The return and maintenance of system stability, following

treatment of stressor reaction, which may result in a higher or
lower level of wellness.
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.

Stressors Environmental factors, intra-, inter-, and extrapersonal in nature,

that have potential for disrupting system stability. A stressor is any
phenomenon that might penetrate both the flexible and normal
lines of defense, resulting in either a positive or negative outcome.
 Relationships
Neuman defined five interacting variables: physiologic,
psychological, sociocultural, developmental, and
spiritual.
These five variables function in time to attain, maintain,
or retain system stability.
The model is based on the client’s reaction to stress as it
maintains boundaries to protect client stability. (Neuman
&Fawcett, 2011)
Neuman delineated a three-step nursing process model.
1.Nursing diagnosis (the first step) assumes that the
nurse collects an adequate database from which to
analyze variances from wellness to make the diagnoses
(Neuman & Fawcett, 2011).
2.Nursing goals which are determined by negotiation
with the client are set in the second step.
Appropriate prevention as intervention strategies are
decided in that step.
3.The third step, nursing outcomes, is the step in which
confirmation of prescriptive change or reformulation of
nursing goals is evaluated.

The nurse links the client, environment, health, and

nursing.
The nurse links the client, environment, health, and
nursing.
The findings feed back into the system as applicable.
 Assumptions
1.Each individual client or group as an open system is
unique, a composite of factors and characteristics within
a given range of responses contained within a basic
structure.
2. The client as a system is in dynamic, constant energy
exchange with the environment.
3, 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 interrelationships of client variables can affect the
degree to which a client is protected by the flexible
line of defense against possible reaction to stressors.
4. 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.
5. 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.
6. 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.
7. 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.
8. Primary prevention relates to general knowledge that
is applied in client assessment and intervention, in
identification, and in reduction or mitigation of possible
or actual risk factors associated with environmental
stressors to prevent possible reaction.
9. Secondary prevention relates to symptomatology
following a reaction to stressors, appropriate ranking of
intervention priorities, and treatment to reduce their
noxious effects.
10. Tertiary prevention relates to the adjective processes
taking place as reconstitution begins and maintenance
factors move the client back in a circular manner
toward primary prevention.
 Usefulness
Neuman’s model has been used extensively in nursing
education and nursing practice.
In her latest work, she provides a number of specific
examples of the systems processes (Neuman & Fawcett,
2011).
The Neuman Systems Model is in place in numerous
states of the US and internationally in countries as
diverse as Taiwan and the Netherlands.
It reportedly has been initiated to guide nursing
practice for the management of patient care in the areas
of medicine and surgery, mental health, women’s
health, pediatric nursing community as client, and
gerontology.
Graduate students, in particular, find Neuman’s model
realistic to define their practice
Because of its utility and popularity as a model, it has
been monitored by a group called the Neuman Systems
Model Trustees Group, Inc.
This group meets periodically to discuss research and
practice related to the model and to promote exchange
of information and ideas.
Neuman’s model is in use as a guide in a plethora of
nursing schools at all levels; a partial listing is included
in Neuman and Fawcett (2011).
 Testability
Although the Neuman’s model is not testable in its
entirety, it gives rise to directional hypotheses that are
testable in research.
As a result, it has been used as a conceptual
framework extensively in nursing research, and aspects
of the model have been empirically tested.
Intermediate theories using the Neuman Systems
Model have been developed and are being tested.
Examples of Nursing Research Studies Using Neuman
Systems Model.
Adamson, E. (2014). Caring behavior of nurses in Malaysia
is influenced by spiritual and emotional intelligence,
psychological ownership and burnout. Evidence-Based
Nursing, 17(4), 121. doi:10.1136/eb-2013-101704.
Adler, M., & Pietsch, T. (2016). Relationship among
smoking, chronic pain, mental health and opioid use in older
adults. Catalyst, Neuman Journal of Student Research and
Academic Scholarship, 2(1), 97–113.
Bachman, A. O., Danuser, B., & Morin, D. (2015).
Developing a theoretical framework using a nursing
perspective to investigate perceived health in the “sandwich
generation” group. Nursing Science Quarterly, 28(4), 308–
318.
.
 Parsimony
Neuman’s model is complex, and many parts of the
model function in multiple ways.
The description of the model’s parts can be confusing;
therefore, the model is not considered to be
parsimonious (Neuman and Fawcett 2011)
However, have developed intermediate diagrams to
clarify the interactions among parts of the model and
to facilitate its use.
The definitions are well developed in the latest edition
of the model, and the assumptions (propositions),
although multileveled, are well organized.
 Value in Extending Nursing Science
The Neuman Systems Model has extended nursing
science as a needs and causality-focused framework.
It appeals to nurses who consider the client to be a
holistic individual who reacts to stressors because it
predicts the outcomes of interventions to strengthen
the lines of defense against stress, which may
destabilize the system.
Neuman’s model is useful not only in the acute critical
care area because of the focus on attaining, regaining,
and maintaining system stability but also in
community health situations because of its focus on
prevention as intervention(Neuman & Fawcett, 2011).
 Summary

Betty Neuman gave nurses the systems model with

its lines of defense against stress.
She believed that the causes of stress can be
identified and remedied through nursing
interventions.
She developed the concept of prevention as
intervention.
Neuman’s model is one of only a few considered
prescriptive in nature.
?
THANK YOU!
 References
• Adhikari, R. D. (2010). Nursing theories and modules (2
nd ed). Makalu Publication House: Dillibazar, Kathmandu.
• George, J. B. (2011). Nursing theories: the base for
professional nursing practice (6 th ed). Pearson, India
• Rai, L. (2011). Nursing Concepts Theories and Principles
(2nd edition ed.). Udayapur: Nabin Kumar Rai.
• Raj, D. E. (2011). Nursing Theories A practical View. New
Delhi: Jaypee Brothers Medical Publisher (Pvt.) Ltd.