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Betty Neuman' s theory of nursi ng

Betty Neumans system model provides a comprehensive flexible holistic and
system based perspective for nursing.
It focuses on the response of the client system to actual or potential environmental
stressors and the use of primary, secondary and tertiary nursing prevention
intervention for retention, attainment, and of optimal client system wellness.
Betty Neuman was born in 19!, in "owel, #hio.
B$ in nursing in 19%&
'$ in 'ental (ealth )ublic health consultation, from *+", in 19--.
)h... in clinical psychology
, pioneer in the community mental health movement in the late 19-/s.
.eveloped the model while wor0ing as a lecturer in community health nursing at
*niversity of +alifornia, "os ,ngeles.
1he models was initially developed in response to graduate nursing students
expression of a need for course content that would expose them to breadth of
nursing problems prior to focusing on specific nursing problem areas.
1he model was published in 19& as 2, 'odel for 1eaching 1otal )erson
,pproach to )atient )roblems3 in Nursing 4esearch.
It was refined and subse5uently published in the first edition of +onceptual
'odels for Nursing )ractice, 19&!, and in the second edition in 196/.
Neumans model was influenced by a variety of sources.
1he philosophy writers de+hardin and cornu 7on wholeness in system8.
9on Bertalanfy, and "a:lo on general system theory.
$elye on stress theory.
"ararus on stress and coping.
;ach client system is uni5ue, a composite of factors and characteristics within a
given range of responses contained within a basic structure.
'any 0nown, un0nown, and universal stressors exist. ;ach differ in its potential
for disturbing a clients usual stability level or normal "#.
1he particular inter<relationships of client variables at any point in time can
affect the degree to which a client is protected by the flexible "#. against
possible reaction to stressors.
;ach client= client system has evolved a normal range of responses to the
environment that is referred to as a normal "#.. 1he normal "#. can be used
as a standard from which to measure health deviation.
>hen the flexible "#. is no longer capable of protecting the client= client
system against an environmental stressor, the stressor brea0s through the normal
1he client whether in a state of wellness or illness, is a dynamic composite of the
inter<relationships of the variables. >ellness is on a continuum of available
energy to support the system in an optimal state of system stability.
Implicit within each client system are internal resistance factors 0nown as "#4,
which function to stabili:e the client to the usual wellness state.
)rimary prevention relates to ?.@. that is applied in client assessment and
intervention, in identification and reduction of possible or actual ris0 factors.
$econdary prevention relates to symptomatology following a reaction to
stressor, appropriate ran0ing of intervention priorities and treatment to reduce
their noxious effects.
1ertiary prevention relates to adAustive processes ta0ing place as reconstitution
begins and maintenance factors move the bac0 in circular manner toward
primary prevention.
1he client as a system is in dynamic, constant energy exchange with the
Content -
the variables of the person in interaction with the internal and external
environment comprise the whole client system
Basic structure/Central core
1he basic structure, or central core, is made up of the basic survival factors that
are common to the species 7Neuman,//8.
1hese factors includeB< < Normal temp. range, ?enetic structure.< 4esponse
pattern. #rgan strength or wea0ness, ;go structure
$tability, or homeostasis, occurs when the amount of energy that is available
exceeds that being used by the system.
, homeostatic body system is constantly in a dynamic process of input, output,
feedbac0, and compensation, which leads to a state of balance.
Degree to reaction
1he amount of system instability resulting from stressor invasion of the normal
, process of energy depletion and disorgani:ation moving the system toward
illness or possible death.
Flexible LOD
, protective, accordion li0e mechanism that surrounds and protects the normal
"#. from invasion by stressors.
Normal LOD
It represents what the client has become over time, or the usual state of wellness.
It is considered dynamic because it can expand or contract over time.
Line of Resistance-LOR
)rotection factors activated when stressors have penetrated the normal "#.,
causing a reaction symptomatology. ;.g. mobili:ation of >B+ and activation of
immune system mechanism
Input- output
1he matter, energy, and information exchanged between client and environment
that is entering or leaving the system at any point in time.
, process of energy conservation that increase organi:ation and complexity,moving
the system toward stability or a higher degree of wellness.
Open system
, system in which there is continuous flow of input and process, output and
feedbac0. It is a system of organi:ed complexity where all elements are in
re!ention as inter!ention
Interventions modes for nursing action and determinants for entry of both client
and nurse in to health care system.
1he return and maintenance of system stability, following treatment for stressor
reaction, which may result in a higher or lower level of wellness.
, state of balance of harmony re5uiring energy exchanges as the client
ade5uately copes with stressors to retain, attain, or maintain an optimal level of
health thus preserving system integrity.
;nvironmental factors, intra 7emotion, feeling8, inter 7role expectation8, and extra
personal 7Aob or finance pressure8 in nature, that have potential for disrupting
system stability.
, stressor is any phenomenon that might penetrate both the C and N "#.,
resulting in either a positive or negative outcome.
>ellness is the condition in which all system parts and subparts are in harmony
with the whole system of the client.
o Illness is a state of insufficiency with disrupting needs unsatisfied
7Neuman, //8.
o Illness is an excessive expenditure of energyD when more energy is used
by the system in its state of disorgani:ation than is built and storedE the
outcome may be death 7Neuman, //8.
1he primary nursing intervention. )revention focuses on 0eeping stressors and
the stress response from having a detrimental effect on the body.
rimary pre!ention
)rimary prevention occurs before the system reacts to a stressor. #n the one
hand, it strengthens the person 7primary the flexible "#.8 to enable him to
better deal with stressors. )rimary prevention includes health promotion and
maintenance of wellness.

"econ$ary pre!ention
$econdary prevention occurs after the system reacts to a stressor and is provided in terms
of existing system.
$econdary prevention focuses on preventing damage to the central core by
strengthening the internal lines of resistance and=or removing the stressor.
%ertiary pre!ention
1ertiary prevention occurs after the system has been treated through secondary
prevention strategies.
1ertiary prevention offers support to the client and attempts to add energy to the
system or reduce energy needed in order to facilitate reconstitution.
(uman being is a total person as a client system and the person is a layered
multidimensional being.
;ach layer consists of five person variable or subsystemsB
o &ysiological< 4efer of the physicochemical structure and function of the
o syc&ological- 4efers to mental processes and emotions.
o "ocio-cultural< 4efers to relationshipsE and social=cultural expectations
and activities.
o "piritual- 4efers to the influence of spiritual beliefs.
o De!elopmental- 4efers to those processes related to development over the
1he 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.
1hese forces include the intrapersonal, interpersonal and extra<personal stressors
which can affect the persons normal line of defense and so can affect the stability
of the system.
o 1he internal environment exists within the client system.
o 1he external environment exists outside the client system.
o Neuman also identified a created environment which is an environment
that is created and developed unconsciously by the client and is symbolic of
system wholeness.
Neuman sees health as being e5uated with wellness. $he defines health=wellness
as 2the condition in which all parts and subparts 7variables8 are in harmony with
the whole of the client 7Neuman, 199%83.
1he client system moves toward illness and death when more energy is needed
than is available. 1he client system moved toward wellness when more energy is
available than is needed.
Neuman sees nursing as a uni5ue profession that is concerned with all of the
variables which influence the response a person might have to a stressor.
1he person is seen as a whole, and it is the tas0 of nursing to address the whole
Neuman defines nursing as 2action 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 nurses perception will influence the care given,
then not only must the patient=clients perception be assessed, but so must those
of the caregiver 7nurse8.
1he role of the nurse is seen in terms of degree of reaction to stressors, and the
use of primary, secondary and tertiary interventions.
It depends on ac5uisition of appropriate databaseE the diagnosis identifies,
assesses, classifies, and evaluates the dynamic interaction of the five variables.
9ariances from wellness 7needs and problems8 are determined by correlations
and constraints through synthesis of theory and data base.
N+R"IN, ,O*L"
1hese must be negotiated with the patient, and ta0e account of patients and
nurses perceptions of variance from wellness.
N+R"IN, O+%CO(E"
Nursing intervention using one or more preventive modes.
+onfirmation of prescriptive change or reformulation of nursing goals.
$hort term goal outcomes influence determination of intermediate and long F
term goals.
, client outcome validates nursing process.
Neumans nursing process format designates the following categories of data about
the client system as the maAor areas of assessment.
)otential and actual stressors.
+ondition and strength of basic structure factors and energy sources.
+haracteristics of flexible and normal line of defenses, lines of resistance, degree
of reaction and potential for reconstitution.
Interaction between client and environment.
)erceptual difference between care giver and the client.
1he data collected are then interpreted to condition and formulate the Nursing
(ealth see0ing behaviors.
,ctivity intolerance.
Ineffective coping.
Ineffective thermoregulation.
In Neumans systems model the goal is to 0eep the client system stable.
)lanning is focused on strengthening the lines of defense and resistance.
1he goal of stabili:ing the client system is achieved through three modes of
)rimary prevention B actions ta0en to retain stability
$econdary prevention B actions ta0en to attain stability
1ertiary prevention B actions ta0en to maintain stability
1he nursing process is evaluated to determine whether e5uilibrium is restored
and a steady state maintained.
*CCE%*NCE B- %)E N+R"IN, CO((+NI%-
Neumans model has been described as a grand nursing theory by wal0er and
?rand theories can provide a comprehensive perspective for nursing practice,
education, and research and Neumans model does.
1he Neuman systems model has been applied and adapted to various specialties
include family therapy, public health, rehabilitation, and hospital nursing.
1he sub specialties include pulmonary, renal, critical care, and hospital medical
units. #ne of the models strengths is that it can be used in a variety of settings
*sing this conceptual model permits comparison of a nurses interpretation of a
problem with that of the patient, so the patient and nurse do not wor0 on two
separate problems.
1he role of the nurse in the model is to wor0 with the patient to move him as far
as possible along a continuum toward wellness.
Because this model re5uires individual interaction with the total health care
system, it is indicative of the futuristic direction the nursing profession is ta0ing.
1he patient is being relabeled as a consumer with individual needs and wants.
1he model has also been widely accepted in academic circles.
+urriculum guide for a conceptual framewor0 at Indiana *niversity,
Northwestern $tate *niversity in $hreveport, "ouisiana.
, study was published by 4iehl and 4oy to test the usefulness of the Neuman
model in nursing practice.
,cceptance by the nursing community for research applying this model is in the
beginning stages and positive.
NeumanGs model connects the interrelated concepts in such a way as to create a
different way of loo0ing at a particular phenomenon.
Neumans model in general presents itself as logically consistent.
1here is a logical se5uence in the process of nursing wherein emphasis on the
importance of accurate data assessment is basic to the se5uential steps of the
nursing process.
Neumans model is fairly simple and straightforward in approach.
1he terms used are easily identifiable and for the most part have definitions that
are broadly accepted.
Neumans model, due to its high level and breadth of abstraction, lends itself to
theory development.
1. 1imber B@, 2Cundamental s0ills and concepts in )atient +are3, &th edition,
">>, NH.
. ?eorge B. Iulia , 2Nursing 1heories< 1he base for professional Nursing
)ractice3, Jrd ed. Norwal0, ,ppleton and "ange.
J. >ills '.;velyn, 'c;wen 'elanie 7//8, 21heoretical Basis for Nursing3,
)hiladelphia, "ippincott >illiamsK >il0ins.
!. .elaune $+, "adner )@, 2Cundamental of nursing, standard and practice3,
nd edition, 1homson, NH, //.