parts) as well as physiological sociocultural,
BETTY NEUMAN
System Model in Nursing Practice
“Health is a condition in which all parts and subparts are in
harmony”
Background of the Theorist:
 Born on September 11, 1924 in a farm near Lowell,
Ohio
 Died on October 6, 2012 at the age of 90
 1947: Received RN Diploma from Peoples Hospital
Nursing, Akron, Ohio
 Moved to California and gained experience as a
hospital staff and head nurse; school nurse and
industrial nurse; and as a clinical instructor in
medical-surgical, critical care and communicable
disease nursing.
 1972: Her model was first published in Nursing
Research as a “Model for teaching total person
approach to patient problems
 The model was developed by Dr. Neuman to teach
an introductory nursing course to nursing students.
 The model is based on philosophical views, Gestalt
Theory, Hans Selye’s Stress Theory and General
System Theory
General Information:
 Systems Model “Neuman’s model focuses on the
person as a complete system, the subparts of which
are interrelated physiological, psychological,
sociocultural, spiritual and developmental factors”.
 Neuman’s model deals with stress and stress
reduction and is primarily concerned with the effects
of stress on health
Metaparadigm:
 PERSON
- Is viewed by Neuman as a whole
multidimensional, dynamic system
- Can be individual, family, or group of
community
- She sees a person as an open system that works
together with the environment.
 Open System- characterized by presence of
an exchange of information and reaction
with other factors surrounding a person
- Is composed of basic core (genetic features and
the strengths and weaknesses of the system
development and spiritual variables.
 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)
- Views health as continuum of wellness to illness
that is dynamic in nature and constantly subject
to change
- “Optimal Wellness or stability indicates the total
system needs are being met”
- The client is in a dynamic state of either
wellness or illness in varying degrees at any
given point of time.
 ENVIRONMENT
- Defined as being all the internal and external
factors that surrounds or interacts with the
person and client
* Internal Environment exists within the client
system
* External Environment exists outside the client
system
- Includes stress or described as environment
forces that interacts with and potentially after
system stability
 NURSING
- Neuman believes nursing is concerned with
whole person (holistic approach), an approach
that considers all factors affecting a client’s
health status.
- Views nursing as a unique profession that is
concerned with all of the variables affecting an
individuals response to stress
- The primary aim is stability of the patients/client
system, through nursing interventions to reduce
stressors.
System Model in Nursing Practice
a. Client Variable
- Can be one or combination of the following
*physiological, sociocultural, psychological,
spiritual and developmental
- These variables function to achieve stability in
relation to the environmental stressors
experienced by the client
b. Lines of Resistance
- Represent the internal factor of a person that
help defend against a stressor
 - It acts to facilitate coping to overcome the
stressors that are present within the individual
c. Normal Line of Defense
- Represents a stability state for the individual or
system.
- it is maintained overtime and serves as a
standard to assess deviations from the clients
usual wellness.
- It includes system variables and behaviors such
as the individuals usual coping patterns, lifestyle
and developmental stage
d. Flexible Line of Defense
- Acts as a protective barrier to prevent stressors
from breaking through the normal stage of
defense.
- can be affected by variables such as loss pf
sleep, that reduce a clients ability to use a
flexible line of defense against stressors
Flexible line of defense
Normal
line of
Defense
CORE
Line of resistance
e. Stressors
- are forces that produce tension, alteration, or a
potential problem causing instability with in the
clients system. They can be:
 Intrapersonal Stressors- are those stimuli
that occurs within the individual (e.g.:
emotions & feelings etc.)
 Interpersonal Stressors- are those stimuli
that occur between individuals
 Extrapersonal Stressors- are those stimuli
that occur outside the person
f. Reaction
- Are the outcomes or produced results of certain
stressors and actions of the lives of resistance of
a client
- can be positive or negative depending on the
degree of reaction the client produces to adjust
and adapt with the situation.
- Neuman specified these reactions
 Negentropy- is set towards stability
and wellness
 Entropy- is set towards disorganization
of the system producing illness.
g. Degree of Reaction
- Is the amount of energy required for the client
to adjust to the stressor
h. Prevention
- Interventions are purposeful actions to help the
client retain, attain, and or maintain system
stability.
- Used to attain balance within the continuum of
health
- These are actions that generate good results or
are armed towards hindering negative
outcomes.
3 Levels of Prevention
 PRIMARY PREVENTION 
- -refers to intervention before a reaction occurs 
- - is carried out when a stressor is suspected or      
identified 
- it also aims to strengthen the capacity of a person to
maintain an optimum level of functioning while
being interactive with the environment l, like health
promotion and disease prevention 
 SECONDARY PREVENTION 
- refers to intervention after a reaction occurs 
- focuses on helping alleviate the actual existing
effects of an action that altered that balance of
health of a person 
- it aims to reduce environmental influences that
lead to the decline of the level of functioning of
a person and strengthening or restoring a
person’s resistance after the illness exposure 
- eg: early detection of disease and prompt
treatment 
 TERTIARY PREVENTION
- refers to intervention that occurs after the
system has been treated through secondary 
- focuses on actual treatments or adjustments to
facilitate the strengthening of a person after
being exposed to a certain or illness 
- it aims to prevent the reoccurrence of the illness
in the manner of rehabilitation, as in the case of
disability avoidance and physical therapy 
i. RECONSTITUTION 
- is the adjustment state from the degree of
reaction 
- it is the state of going back to the actual state of
health before the illness occurred.
 - More recently, health is the process of being
SISTER CALLISTA ROY and becoming an integrated and while person 
“Adaptation Model” - Is it a reflection of adaptation that is the
interaction if the person and the environment 
Background of the theorist: - Adaptation is defined as the process and
outcome whereby thinking and feeling, as
 born on October 14,1939 in Los Angeles, California  individuals and groups, use conscious awareness
 BSN in 1963, Mount St. Mary College, Los Angeles  and choice to create human and environmental
 MA in Pediatric Nursing 1966/ Doctorate in integration. 
Sociology in 1977 University of California, LA 
 With honorary doctorate from 4 other institutions   NURSING 
 She is a nurse and a professor  - Is the science and practice that expands
 She is a fellow in the American Academy of Nursing, adaptive abilities and enhances person and
an honorary nursing society that elects nursing environment transformation. 
leaders annually  - Roy’s goal of nursing is the promotion of
 Has numerous publications, including books and adaptation in each of the 4 modes thus
journal articles on nursing theory and other contributing to health, quality of life and dying
professional topics  with dignity 
- Introduction to Nursing: An Adaptation Model  - Nursing is about the increase, enhancement,
- Essentials of the Roy Adaptation Model  modification and alteration of the stimulus to
- Theory Construction in Nursing: An Adaptation achieve adaptation. 
Model 
- Roy Adaptation Model: The Definitive The Roy Adaptation Model 
Statement      The Key Concept
          the person is adapting in a stable interaction with
Metaparadigm:  the environment, either internal or external 
 The environment serves as the source of a range of
 PERSON  stimuli that will either threaten or promote the
- is the recipient of nursing care, main focus of persons unique wholeness 
nursing   The persons major task is to maintain integrity in
- A biopsychosocial being in constant interaction face of these stimuli. 
with a changing environment   INTEGRITY 
- the person is an open adaptive system who uses - the degree of wholeness achieved by adapting
coping skills to deal with stressors  to changes in needs. 
- it includes people as individuals or in a group SYSTEM
- an adaptive system has cognator and regulator  - is a set of parts connected to function as a
subsystems to maintain the 4 adaptive modes whole for some purpose and that does so by
physiologic- physical, self-concept group virtue of the interdependence of its part 
identity, role function and interdependence   Roy considers the recipient of care to be an open
adaptive system 
 ENVIRONMENT  React and interact with other system in the
- conditions l, circumstances and influences that environment 
surround and affect the development and  Have boundaries that are flexible and open to
behavior of the person  permit interaction with other systems 
- consist of internal and external environments,  Employ a feedback cycle of input, throughput,
which provide input in the form of stimuli  output 
- stressors are stimuli that ate significant in
human adaptation: stages of development,  Input
family and culture  - defined as stimuli which can come from the
environment or from within a person. 
 HEALTH   
- was originally described by Roy as a health- Types of Stimuli (Helson, 1964) 
illness continuum; health and illness were  FOCAL - the internal or external stimulus most
considered an inevitable dimension of the immediately confronting the person, it attracts the
persons life  most connection 
  CONTEXTUAL - all other stimuli present in the  Stabilizer Subsystem - analogous to regulator
situation that strengthens/contribute the effect of concerned with stability. 
the focal stimuli  Innovator Subsystem - analogous to cognator
 RESIDUAL - these stimuli that can affect the focal concerned with creativity, change and growth 
stimulus but the effect is unclear  
The three types of stimuli act together and influenced the ADAPTATION LEVEL 
adaptation level which is defined as the ability to respond 1. Integrated- adaptation level at which the structures
positively in a situation  and functions of a life  process are working as a
whole to meet human needs. 
 Throughput         (e.g. stable processes of ventilation, the complex
- makes use of a persons processes and effectors  process of breathing that exchanges air between
- Processes refers to the control mechanism that a lungs and atmosphere.) 
person uses as an adaptive system 
- effectors refers to the physiological function, self- 2. Compensatory - adaptation model at which the
concept and role function involves in adaptation  cognator and regulator have been activated by a
challenge to the integrated life process
 Output      (e.g. grieving, role transition) 
- is the outcome of the system, when the system is a
person, the output refers to the persons behavior.  3. Compromise - adaptation level resulting from
- Categories of Output inadequate integrated and compensatory life
 Adaptive Responses - those that promote process, adaptation problem. 
integrity in terms of the goals of the human       (e.g. Hypoxia, Ventilatory Impairment,
system Unresolved     lose, Abusive Relationships) 
 Ineffective Response - those that do not
contribute to integrity in terms of the goals of
the human system 

COPING MECHANISM AND CONTROL PROCESS 

 COPING MECHANISM
- are the processes that a person uses for self-
control
- are innate or acquired ways of interacting with
the changing environment 
 Innate Coping Mechanism are genetically
determined or common to the species and are
genetically viewed as automatic process 
 Acquired Coping Mechanism are developed
through strategies such as learning

 Regulatory Subsystem 
- major coping process involving the neural,
chemical, and endocrine system (e.g. increase in
vital signs - sympathetic response to stress

 Cognator Subsystem 
- is a major coping process involving four
cognitive-emotive channels: perceptual and
information processing, learning, judgement
and emotion (e.g. effects of prolonged
hospitalization for a 4-year old child) 

 CONTROL PROCESS 
- stabilizer subsystem and innovator subsystem