Betty Neuman (System Model)

• Was born in 1942 and grew up on a farm in Ohio. Her rural background
helper her develop a compassion for people in need.
• She completed her initial nursing education with double honors at peoples
hospital school of nursing (now general Hospital), Akron, Ohio in 1947.
• She moved to California and worked in a variety of roles that included
hospital nurse, school nurse, industrial nurse, clinical instructor at the
University of southern California medical center.

Theoretical Sources

• The Neuman Systems model is based in general system theory and

reflects the nature of living organism as open system, Neuman synthesis
knowledge from several disciplines and incorporates her own
philosophical beliefs and clinical nursing expertise, particularly in mental
health nursing.

Major concept and definitions

• The major concept and identified in the model are wholistic approach,
open system (including function, input and output, feedback, entropy and
stability), environment, created environment, wellness and illness client
system (including 5 client variables, basic structure, linens of resistance,
normal line of defense), stressors, degree of reaction, prevention as
intervention and recon-stitution.
Wholistic approach

• The Neuman system model is a dynamic, open, system approach to

clients care originally developed a unifying focus for nursing problem
definitions and for best understanding the client in interaction with the
environment.
• The model considers all variables simultaneously affecting the client
system:

1. Physiological variables

• Refers to the body structure and function.

2. Psychological variables

• Refers to mental process in interaction with the environment.

3. Socio Cultural variables

• Refers to the effects and influences of social and cultural

conditions.

4. Development variables

• Refers to age related processes and activities.

5. Spiritual variable

• Refers to spiritual beliefs and influences.

Open System

• System is open when its elements are continuously exchanging

information and energy within its complex organization stress and reaction
to stress are basic components of an open system.

Function or process

• The client as a system exchanges energy, information and matter with the
environment as it uses available energy resources to more toward stability
and wholeness.
Input and output

• For the clients as a system, input and output are the matter, energy and
information that are exchanged between the client and the environment.

Feedback

• System output in the form of matter, energy and information serves as

feedback for future input for corrective action to change, enhance or
stabilize the system.

Negentropy

• Neuman defines Negentropy as “a process of energy conservation

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”.

Stability

• “A desires state of balance in which the system copes with stressors to

maintain an optimal level of health and integrity”.

Environment

• “Internal and external forces surrounding and affecting the client at any
time comprise the environment”.

Created environment

• The created environment is developed unconsciously by the client to

express system wholeness symbolically. Its purpose is to provide a safe
arena for client system functioning and insulate the client from stressors.

Basic client structure

• The client as a system is composed of a central core surrounded by

concentric rings. The inner circle of the diagram represents the basic
survival factor or energy resources of the client this core structure.
 CORE

Line of
Resistance

Normal lines
of defense

Flexible Line
of Defense

Lines of resistances

• The series of broken rings surrounding the basic core structure are called
the lines of Resistance.
• These rings represent client defend against a stressor.
• Lines of resistance are effective, the client system can reconstitute; if they
ineffective, death may ensure.

Normal line of defend

• The 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 pattern, lifestyle and developmental stage of defense reflects an
enhanced wellness sate; contraction, a diminished state of wellness.

Flexible line of defense

• The model’s outer broken ring is called the flexible line of defense. It is
dynamic and can be altered rapidly over a short time.
• The 5 variable can be affect the degree to which individual are able to use
their flexible line of defense against possible reaction to a stressor or
stressors, such as a loss of sleep.

Wellness

• Wellness exists as a stable condition when the parts of the client system
interact in harmony with the whole system. System needs are met.
Illness

• Illness occurs when needs not satisfied, resulting in a state of instability

and energy depletion.

Stressors

• Stressors are tension producing stimuli that have the potential to disrupt
system stability. They maybe:
1. Intrapersonal forces occurring within the individual, such as
conditioned response.
2. Interpersonal forces occurring between one or more individuals,
such as role expectations.
3. Extra personal forces occurring outside the individual, such as
financial circumstances.

Degree of reaction

• Is the amount of energy required for the client to adjust to the stressor.

Prevention as intervention

• Interventions are based on possible or actual degree of reaction,

resources, goals and the anticipated outcome.
• Nueman identifies the following 3 levels of intervention:
1. Primary prevention – Is carried out when a stressor is suspected
or identified. A reaction has not yet occurred, but the degree of risk
is known.
2. Secondary prevention – involves interventions or treatment
initiated after symptoms from stress have occurred.
3. Tertiary prevention – occurs after the active treatment or
secondary prevention stage. It focuses on readjustment toward
optimal client system stability.
– The primary goal is to strengthen resistance
to stressors to help prevent recurrence of reaction or
regression.

Reconstitution
• Occurs after the active treatment of stressor reaction. It represents return
of the system to stability, which may be at a higher or lower level of
wellness than prior to stressor invasion.
FOUR MAJOR CONCEPTS

1. NURSING

• Neuman sees nursing as a unique profession that is concerned with all of

the variables which influence the response a person might have to a
stressor.
• The person is seen as a whole, and it is the task of nursing to address the
whole person.
• 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.’’
• Neuman states that, because the nurse’s perception will influence the care
given, then not only must the patient/client’s perception be assessed, but
so must those of the caregiver (nurse).
• The role of the nurse is seen in terms of degree of reaction to stressors,
and the use of primary, secondary and tertiary interventions.

2. PERSON as CLIENT or CLIENT SYSTEM

• The focus of the Neuman model is based on the philosophy that each
human being is a total person as a client system and the person is a
layered multidimensional being.
• CLIENT SYSTEM is viewed as being in constant change or motion and is
seen as an open system in reciprocal interaction with the environment.
• Each layer consists of five person variable or subsystems:

Physiological - Refer of the physicochemical structure and

function of the body.

Psychological - Refers to mental processes and emotions.

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.
3. HEALTH

• Neuman sees health as being equated with wellness. She defines

health/wellness as “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.

4. ENVIRONMENT

• The environment is seen to be the totality of the internal and external

forces which surround a person and with which they interact at any given
time.
• These forces include the intrapersonal, interpersonal and extra-personal
stressors which can affect the person’s normal line of defense and so can
affect the stability of the system.

Internal environment – Is intra personal, with all interaction

contained exists within the system clients.

External environment – Interpersonal or extra personal, with

interactions occurring outside the client system.

Created environment - which is an environment that is created

and developed unconsciously by the client and is symbolic of system
wholeness.

ACCEPTANCE BY THE NURSING COMMUNITY

• Neuman’s model has been described as a grand nursing theory.

• Grand theories can provide a comprehensive perspective for nursing
practice, education, and research and Neuman’s model does.

Nursing Process Format

3 Steps:

1. NURSING DIAGNOSIS

• It depends on acquisition of appropriate database; the diagnosis identifies,

assesses, classifies, and evaluates the dynamic interaction of the five
variables.
 • Variances from wellness (needs and problems) are determined by
correlations and constraints through synthesis of theory and data base.
• Broad hypothetical interventions are determined maintain flexible line of
defense.

2. NURSING GOALS

• These must be negotiated with the patient, and take account of patient’s
and nurse’s perceptions of variance from wellness.

3. NURSING OUTCOMES

• Nursing intervention using one or more preventive modes.

• Confirmation of prescriptive change or reformulation of nursing goals.
• Short term goal outcomes influence determination of intermediate and
long – term goals.
• A client outcome validates nursing process.

Basic Structure Energy Resources

• This is otherwise known as the central core, which is made up of the basic
survival factors common to all organisms.
• These include the following:
1. Normal temperature range – body temperature regulation ability.
2. Genetic structure – Hair color and bodily features.
3. Response pattern – functioning of body systems homeostatic ally.
4. Organ strength or weakness
5. Ego structure
6. Known’s or commonalities – value system.

• The person's system is an open system - dynamic and constantly

changing and evolving.

• Stability, or homeostasis, occurs when the amount of energy that is

available exceeds that being used by the system.

• A homeostatic body system is constantly in a dynamic process of input,

output, feedback, and compensation, which leads to a state of balance.