THEORETICAL FOUNDATIONS IN NURSING

BETTY NEUMAN’S SYSTEMS MODEL

(Week No. 8)

INTRODUCTION

The Neuman Systems Model provides a comprehensive, flexible, holistic, and systems-based
perspective for nursing. This conceptual model of nursing focuses attention on the response
of the client system to actual or potential environmental stressors, and the use of primary,
secondary, and tertiary nursing prevention interventions for retention, attainment, and
maintenance of optimal client system wellness.”

—Betty Neuman (1996)

Neuman’s model is based on the general systems theory and reflects the nature of living
organisms as open systems (Bertalanfly, 1968, cited in Alligood, 2018) in interaction with
each other and the environemtn. It uses a systems approach that is focused on the human
needs of protection or relief from stress (Neuman & Fawcett, 2009). Neuman believed that the
causes of stress can be identified and remedied through nursing interventions. She
emphasized the need of humans for dynamic balance that the nurse can provide through
identification of problems, mutually agreeing on goals, and using the concept of prevention
as intervention. Neuman’s model is one of only a few considered prescriptive in nature. The
model is universal, abstract, and applicable for individuals from many cultures (Neuman,
1995; Neuman & Fawcett, 2009).

LEARNING OUTCOME

After finishing this module the student will be able to:

1. Enumerate propositions/assumptions of Neuman’s Systems Model
2. Explain Neuman’s systems model
3. Discuss the theoretical assertions
4. Inculcate caring as essential part of nursing practice.

OUTLINE
1. Credentials and Background of the Theorist
2. Influences / Philosophical Underpinnings
3. The Neuman System’s Model and its Propositions
4. Major Assumptions
5. Theoretical Assertions
a. Nursing
b. Health
c. Environment
d. Person
6. References

Far Eastern University 1

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING

CONTENT

Credentials and Background of the Theorist

Betty Neuman developed the Neuman Systems Model in 1970 to “provide unity, or a focal point, for
student learning”at the School of Nursing, University of California, in Los Angeles (Neuman, 1995, p. 674
cited in Parker, 2001). The need to have a comprehensive framework for nursing was addressed by the
Neuman Systems Model which was developed strictly as a teaching aid for practitioners as well as
educators. At present, the model is highly recognized and used globally as a conceptual model for nursing.

Dr. Neuman was one of the first nurses licensed as a marriage, family, and child counselor in the state of
California in 1970. She is an author, lecturer, and independent nursing curriculum consultant. She has
published numerous books and journal articles on the application of the model to education, practice,
research, and administration.

Dr. Neuman received two honorary doctorates—one in science in 1998 from Grand Valley State
University in Allendale, Michigan, and the other in letters in 1992 from Neuman College in Aston,
Pennsylvania. In 1993, Dr. Neuman became an honorary member of the Fellowship of the American
Academy of Nursing.

Philosophical Underpinnings / Influences

Philosophical Underpinnings of the Theory Neuman used concepts and theories from a number of
disciplines in the development of her theory. In her works, she referred to Chardin and Cornu on
wholeness in systems, von Bertalanfy and Lazlo on general systems theory, Selye on stress theory,
and Lazarus on stress and coping (Neuman, 1995; Neuman & Fawcett, 2009).
1. Pierre Tielhard deChardin : a philosopher-priest that believed human beings are continually
evolving towards a state of perfection – an Omega Point
2. Gestalt Theory : A theory of German origin which proposes that the dynamic interaction of the
individual and the situation determines experience and behavior.
3. General Adaptation Syndrome mainly talks about an individual’s reaction to stress on the 3
levels a) alarm b) resistance c) exhaustion
4. General Systems Theory postulates that the world is made up of systems that are
interconnected and are influenced by each other.

The Neuman Systems Model

As its name suggests, the Neuman Systems Model is classified as a systems model or a systems
category of knowledge. Betty Neuman describes the Neuman Systems Models as a unique, open-
systems-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 a number of groups. It
can also be defined as a social issue. The Neuman Systems Model illustrates a client-client system
and presents nursing as a field primarily concerned with defining appropriate nursing actions in
stressor-related situations or in possible reactions of the client-client system. The client and
environment may be positively or negatively affected by each other. There is a tendency within

Far Eastern University 2

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING
any system to maintain a steady state or balance among the various disruptive forces operating
within or upon it. Neuman has identified these forces as stressors, and suggests that possible
reactions and actual reactions with identifiable signs or symptoms may be mitigated through
appropriate early interventions (Neuman, 1995).

PROPOSITIONS

Neuman has identified 10 propositions inherent within her model. The following propositions
describe, define, and connect concepts essential to understanding the conceptual model.

1. Although each individual client or group as a client system is unique, each system is a composite
of common known factors or innate characteristics within a normal, given range of response
contained within a basic structure.

2. Many known, unknown, and universal environmental stressors exist. Each differs in its potential
for disturbing a client’s usual stability level or normal line of defense. The particular
interrelationships of client variables—physiological, psychological, sociocultural, developmental,
and spiritual—at any point in time can affect the degree to which a client is protected by the
flexible line of defense against possible reaction to a single stressor or a combination of stressors.

3. Each individual client-client system has evolved a normal range of response to the environment
that is referred to as a normal line of defense, or usual wellness/stability state. It represents
change over time through coping with diverse stress encounters. The normal line of defense can be
used as a standard from which to measure health deviation.

4. When the cushioning, accordionlike effect of the flexible line of defense is no longer capable
of protecting the client-client system against an environmental stressor, the stressor breaks through
the normal line of defense. The interrelationships of variables—physiological, psychological,
sociocultural, developmental, and spiritual—determine the nature and degree of system reaction
or possible reaction to the stressor.

5. The client, whether in a state of wellness or illness, is a dynamic composite of the

interrelationships of variables—physiological, psychological, sociocultural, developmental, and
spiritual. Wellness is on a continuum of available energy to support the system in an optimal state
of system stability.

6. Implicit within each client system are internal resistance factors know as lines of resistance,
which function to stabilize and return the client to the usual wellness state (normal line of defense)
or possibly to a higher level of stability following an environmental stressor reaction.

7. Primary prevention relates to general knowledge that is applied in client assessment and
intervention in identification and reduction or mitigation of possible or actual risk factors
associated with environmental stressors to prevent possible reaction. The goal of health promotion
is included in primary prevention.

8. Secondary prevention relates to symptomatology following a reaction to stressors, appropriate

ranking of intervention priorities, and treatment to reduce their noxious effects.

Far Eastern University 3

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING
9. Tertiary prevention relates to the adaptive processes taking place as reconstitution begins and
maintenance factors move the client back in a circular manner toward primary prevention.

10. The client as a system is in a dynamic, constant energy exchange with the environment.
(Neuman, 1995)

MAJOR ASSUMPTIONS

NURSING

1. Neuman (1982) believes that nursing is concerned with the whole person.
2. Nursing is a unique profession in that it is concerned with all the variables affecting an
individual’s response to stress.
3. The nurse’s perception influences the care being given hence the perceptual field of the
caregiver and the client must be assessed.

PERSON

1. A person is an open client system in reciprocal interaction with the environment.

2. The client may be an individual, family, group, community or social issue.
3. The client system is a dynamic composite of interrelationships among physiological,
psychological, sociocultural, developmental and spiritual factors.

HEALTH

Nueman considers her work as a wellness model:

a) Views health as a continuum of wellness to illness that is dynamic in nature and is

constantly changing.
b) Optimal wellness or stability indicates that total system needs are being met.
c) A reduced state of wellness is the result of unmet systemic needs.

ENVIRONMENT

1. All the internal and external factors that surround and influence the client system.

2. Stressors (intrapersonal, interpersonal and extrapersonal) are significant to the concept of

environment and are described as environmental forces that interact with and potentially
alter system stability.

3. Neuman identifies 3 relevant environments;

a. Internal – is interpersonal, with all interactions contained within the client

b. External – is interpersonal or extrapersonal, with all factors arising from outside
the client.
c. Created – is unconsciously developed and is used by the client to support
protective coping. Primarily interpersonal. Dynamic in nature and mobilizes all

Far Eastern University 4

Manila, Philippines
 THEORETICAL FOUNDATIONS IN NURSING
system variables to create an insulating effect that helps the client cope with the
threat of environmental stressors by changing the self or the situation. Created
environment perpetually influences and is influenced by changes in the client’s
perceived state of wellness.

THEORETICAL ASSERTIONS

Theoretical assertions are the relationships among the essential concepts of model (Torres, 1986
cited in Alligood, 2018).

1. The Neuman model depicts the nurse as an active participant with the client and as
concerned with all the variables affecting an individual’s response to stressors.
2. The client is in a reciprocal relationship with the environment in that he interacts with this
environment by adjusting himself to do it or adjusting it to himself.
3. Neuman links the 4 essential concepts of person, environment, health and nursing in her
statements regarding primary, secondary and tertiary prevention.
4. Numerous theoretical assertions have been proposed, tested and published throughout the
works of Neuman and Fawcett (2011)

REFERENCES

Alligood, M. R., & Marriner-Tomey, A. (2010). Nursing theorists and their work (5th ed.).
Maryland Heights, Mo.: Mosby/Elsevier.
Alligood, M. R., (2018). Nursing theorists and their work (9th ed). Singapore,: Elsevier
(Singapore) Pte. Ltd..

Far Eastern University 5

Manila, Philippines