The Neuman Systems Model

The Neuman Systems Model is a unique, open systems-based

perspective that provides a unifying focus for approaching a
wide range of international health concerns (Betty Neuman,
2008, taken from www.neumansystemsmodel.org).
Neumans model is a conceptual framework used for thinking
about client and nurse interactions. The Neuman Systems Model
(NSM) utilizes a holistic perspective which allows a broad use of
creativity by nurses in its use, and we believe it is very flexible
and has the staying power for its use well into the future.
The NSM focuses on the client (individual, family, group, or
community) as a system and on their responses to stressors.
The model views humans as layered, multidimensional wholes
that are in constant dynamic interaction with the environment.
Humans in the NSM are described as having concentric rings
that include lines of resistance or defense (Skalaski,
DiGerolamo, & Gigliotti, 2006, p. 70).
The model suggests the use of three levels (primary, secondary,
and tertiary) of nursing prevention for the maintenance of
optimal client system wellness (taken from currentnursing.com).
Assist the client in promoting health by strengthening their lines
of defense and resistance.
For the nurse, it is important to understand not only the impact
of the stressor but also the systems response (Gehrling &
Memmott, 2008, p. 135).

When nurses understand the connection between the client and
their environment, they have a better chance in helping the
client maintain their state of health and increase their wellness.
Born in 1924, in Lowell,
Ohio
Ph.D. in clinical
psychology, UCLA
Pioneer in community
mental health movement
Published NSM in 1972
Influenced by de Chardin,
Cornu, VonBertalanfy,
Lazlo, Selye, and Laraus
(currentnursing.com [history and background of
theorist])
Original title
Neuman developed the
systems model for use by
her graduate students
the promotion of holistic
health through education
and curriculum consultation
for programming within
national and international
universities and health care
facilities using the Neuman
System Model developed
in 1970.

(Betty Neuman, 2008, taken from
www.neumansystemsmodel.org)
Leader of Neuman
Systems Group
-Model Consultant
-Educator
-Author
-Lecturer
-Private practice health
consultant

(neumansystemsmodel.org [trustees, current positions])
Nursing theory has been defined as
the set of concepts, definitions, and
propositions that project a systematic view of
phenomena by designating specific inter-
relationships among concepts for the purpose
of describing, explaining, and predicting
phenomena (Adams, 1991. p. 1487).
Global
Concepts
Human
Being
Environment
Health
Nursing
Their relationship together is linked as essential
concepts of the model. It takes all four global
concepts to make the content of the nursing
model.
Nursing is defined as being
concerned with the whole
person and all the variables
affecting an individuals
response to stressors. The
opinion nurses assume defines
what care is given.
Clients outside stressors are to be considered when treating the whole client. The person can
be an individual, family, group, community, or social issue. It is seen being in a state of constant
change with interaction with the environment.
The environment is considered all the factors (internal and
external) that surround the client. Neuman identifies three
relevant environments: internal, external, and created (Freese
& Lawson, 2005. p.316). The internal is intrapersonal, within
the client system. The external is all factors outside the client.
The created environment is established and developed
unconsciously by the client and is symbolic of system wholeness.
Concept according to Neuman
Health is wellness and is defined as the
condition of optimal stability of the client/client
system (Tourville, Ingalls, 2003. p.26). The
client moves toward illness and death when
more energy is needed that is available, and
moves toward wellness when more energy is
available than is needed. (Betty Neuman, 2008,
taken from www.neumansystemsmodel.org).
Focused on nursing, but includes
all scopes:
Nursing practice
Education
Research
Influenced by variety of sources:
deChardin-A priest that believed
human beings are continually
evolving towards a state of
perfection.
Gestalt theory-Proposed that the
dynamic interaction of the individual
and the situation determines
experience and behavior.
General Adaption Syndrome-
Individuals reaction to stress by:
alarm, resistance, and exhaustion.
General Systems Theory- world is
made up of systems that are
interconnected and influenced by
others (taken from patheyman.com)

Four global concepts:
Nursing
Human Being
Environment
Health is wellness
Can be adapted to all different scopes
of nursing, based on three steps:
Assessment
Intervention
Evaluation

(Freese & Lawson, 2005, p.
322)
Many people have stressors in their lives that
inhibit healing. The client shall be an active
participant in setting goals and selecting
interventions. When a patient is admitted to
the hospital with uncontrolled hypertension, the
nurse needs to look at the whole picture. Does
the patient have stressors that are contributing
to this, such as money difficulties, family issues,
or lack of education regarding his/her
condition? If a patient is admitted with
contractions at week 30, is there underlying
stress causing this such as marital issues or job
stress?
Having been influenced by many great philosophers, The Neuman Systems Model was
born. The model is an effective framework for the practice of nursing wherein the person is
an open system with interrelated parts, maintaining balance and harmony between the
environment by adjusting to stress and defending against tension-producing stimuli. The
nursing profession is primarily concerned with the effects of stress on health. They focus on
the patients stress and interventions for reductions to regain stability in the system. While
recognizing lines of resistance, as a facilitator in coping with stress, adaption occurs
creating a protective barrier for change thus regaining stability in the open system by
inclusion of the four metaparadigms of nursing. The model goes beyond the scope of
nursing to include multidisciplinary collaboration for prevention including primary,
secondary, and tertiary to attain balance and harmony in the environment.
Neuman Systems Model is: broad, provides guidelines for nurses to practice quality of
care for the patient by attaining wellness through prevention and interventions of stress,
adaptable by many health care settings, applicable to the future of nursing practice, and
research that will improve new knowledge for the enhancement of nursing practice.
Betty Neumans, holistic was changed to wholistic in reference to the whole person much
as the nursing profession should challenge themselves to the Shakespearean quote, To be
or not to be: that is the question.
(Alligood & Tomey, 2010, pp. 309-323)
Betty Neuman System Model
Name-Emma J.
Age- 37 years
Sex- Female
Marital Status-Divorced, receiving some child support
Job-Fulltime employment
Spiritual
Children-2 (ages 10 &12)
Next of Kin-Mother
Sustained Injuries from car accident-fractured right leg, bilateral wrists, and
lacerations to face
Hospitalized on 6/30/10, surgical placement of pins and plates in leg, bilateral
arms casted, and sutured lacerations
Discharged 7/10/10 with medications: Vicodin 5/500 mg q 6 hours PRN and
Ibuprofen 800 mg q 6 hours PRN
Homecare implemented 7/13/2010
Acute pain
Unable to ambulate, wheelchair bound
Extending healthcare- physical therapy after casts removed
Unable to perform ADLs-acquires assistance
Depression-Emma reports, feeling of powerlessness due to the
accident and the inability to care for herself.
Guilt-Emma reports, I feel guilty for relying on my family and
friends for care.
Concerns related to financial burdens include: insurance coverage of
all expenses and unable to work to support family
Visits from friends, co-workers, minister, and fellowship members who
assist in housework and cooking.
Caregiver role strain-between Emma, mother, and ex-husband helping
with children
As the nurse, what do you assess as Emmas stressors?
A. Financial difficulties
B. Emotional state
C. Inability to fulfill prior roles
D. Supportive family
E. Strength in faith
F. A,B and C
G. All of the above
Rationale: The Neuman Systems Model looks at the impact of
stressors on health and addresses stress and the reduction of stress (in
the form of stressors). Stressors are capable of having either a
positive or negative effect on the client system. A stressor is any
environmental force which can potentially affect the stability of the
system: they may be:
! Intrapersonal - occur within person, e.g. emotions and feelings
! Interpersonal - occur between individuals, e.g. role expectations
! Extra personal - occur outside the individual, e.g. job or finance
pressures
The person has a certain degree of reaction to any given stressor at
any given time. The nature of the reaction depends in part on the
strength of the lines of resistance and defense. By means of primary,
secondary and tertiary interventions, the person (or the nurse)
attempts to restore or maintain the stability of the system.

Caregiver role strain related to inability to fulfill prior role, never
been in a situation where she was unable to care for her family and
mother and ex-husbands assistance makes Emma feel that she is
failing
Acute pain-controlled by medications, Emma reports administration
of Ibuprofen three times daily, occasional Vicodin
Ambulating short distances in home by using the left foot to propel the
wheelchair
Transfers with assistance
Improved mood since hospitalization, beginning to have hope
Emma reports, majority of my stressors are related to the financial
aspects of my illness and nurse notes Emma able to recognize
positive stressors.
What interventions, would you, as the nurse put in place?

A. Adaptive equipment
B. List of resources
C. Exercises
D. Counseling
E. Nursing home placement
F. A,B,C and D
G. All of the above
Rationale: Current needs are being met by: adaptive
equipment, list of resources, exercises, and counseling as
interventions. Nursing home placement is presumptuous as an
intervention.
Healthcare Nurse
List of outside resources for
assistance
Adaptive equipment to foster
independence with ADLs
Exercises to perform while
wheelchair bound-will
maintain muscle strength and
increase positive mood
Family, Church, Work, and
School
Consultation with minister has
reduced depression symptoms
Church volunteers sitting with
Emma to relieve mother
Children attended youth groups
for recreation and expression
of their feelings
School-raised money and food
donations for the family
Short term disability benefits
from employer received
Presented By:
Audra Parmer
Kara Elkins
Amy Brown
M. Susan Nason Melissa Burleson
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Maryland Heights: Mosby Elsevier.
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10.1177/0894318408316405
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