Betty Neuman

Neuman’s Systems Model

 
Betty Neuman - born in 1924, in Lowel, Ohio.
BS in nursing in 1957; MS in Mental Health Public health
consultation, from UCLA in 1966; Ph.D. in clinical psychology
Theory was publlished in:
“A Model for Teaching Total Person Approach to Patient
Problems” in Nursing Research - 1972.
"Conceptual Models for Nursing Practice", first edition in 1974,
and second edition in 1980.
Neuman’s 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 several groups; it can also be defined as a social issue. A client system in interaction with the environment
delineates the domain of nursing concerns.”
 
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 health level is identified as the normal
defense line protected by a flexible line of defense. Stressors are intra-, inter-, and extra personal 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. 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 defense
line restored at, below, or above its previous level.
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.
 
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 impact the system.
 
Extrapersonal stressors also occur outside the client system boundaries but are at a greater distance from the system
than are interpersonal stressors. An example is a 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 health level, thus preserving system integrity.
 
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
 
An energy conservation process 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 entering or leaving the system at any point in time.
 
Reconstitution
 
Following treatment of stressor reaction, the return and maintenance of system stability may result in a higher or lower wellness level.
Prevention as Intervention
 
Intervention modes for nursing action and determinants for both client and nurse entry into the health care system.
 
Primary prevention occurs before the system reacts to a stressor; it includes health promotion and wellness
maintenance. 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.
Strategies that might be used include immunization, health education, exercise, and lifestyle changes.
 
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 conserve energy in
doing so. If secondary prevention is unsuccessful and reconstitution does not occur, the basic structure will be unable to
support the system and its interventions, and death will occur.
 
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 by supporting existing strengths and preserving energy.
Tertiary prevention may begin at any point after system stability has begun reestablished (reconstitution has begun).
Tertiary prevention tends to lead back to primary prevention. (Neuman, 1995)
 
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, comprises those basic survival factors common to the species. These factors include
the system variables, genetic features, and strengths and weaknesses of the system parts.
 
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 cultural expectations 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.
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 is considered normal for a particular individual client or
system; it becomes a standard for wellness-deviance determination.
 
Lines of resistance
 
Protection factors are activated when stressors have penetrated the normal line of defense, causing reaction
symptomatology.
Major Concepts of Neuman Systems Model
 
 
Human being
 
The human being is an open system that interacts with internal and external environment forces or stressors. The human
is constantly changing, moving toward a dynamic state of system stability or 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 the
client system’s boundaries 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.
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
 
Nursing’s primary concern is to define the appropriate action in situations that are stress-related or concerning possible
reactions of the client or client system to stressors. Nursing interventions aim to help the system adapt or adjust and
retain, restore, or maintain some degree of stability between the client system variables and environmental stressors,
focusing on conserving energy.
 
Systems Model Nursing Process Format (3 components)
 
Nursing Diagnosis: nursing process for the stressors, get client perception/awareness
Nursing Goals: propose, prioritize interventions and goals
Nursing Outcomes: implements the 3 levels of interventions