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NEUMAN’S SYSTEMS MODEL

BETTY NEUMAN LIFE
Early Life
 Betty Neuman was born in 1924 near Lowell, Ohio.
 She grew up on a farm which later encouraged her to help
people who are in need.
 Her father was a farmer who became sick and died at the age
of 36. Her mother was a self-educated midwife that led the
young Neuman to be always influenced by the commitment
that took her away from home from time to time.
 Her love for nursing started when she took care of her father,
which later created her compassion in her chosen career path.

Education
 She was always engaged and fascinated with the study of
human behaviour.
 During World War II, she had her first job as an aircraft
instrument technician. Source-www.neumansystemsmodel.org/
 In 1947, she received her RN Diploma from Peoples Hospital photo-gallery-1
School of Nursing, Akron, Ohio.

Nursing Career
 Betty Neuman moved to California and worked in various capacities as a hospital nurse and
head nurse at Los Angeles County General Hospital, school nurse, industrial nurse, and
clinical instructor at the University of Southern California Medical Center, Los Angeles.
 In 1957, she received a baccalaureate degree in public health and psychology with honours.
Amidst her hectic life as a nurse, she also managed to work as a fashion model and learned to
fly a plane.
 She also earned a master’s degree in mental health, public health consultation in 1966 from
the University of California, Los Angeles (UCLA).
 Neuman developed the first community mental health program for graduate students in the
LA area from 1967 to 1973.
 In 1985, Betty Neuman concluded a doctoral degree in clinical psychology at Pacific Western
University.
 She and Donna Aquilina were the first two nurses to develop the nurse counsellor role within
community crisis centres in Los Angeles.

Awards and Honours 

 Honorary Doctorate of Letters, Neumann
College, Aston, PA (1992)
 Honorary Member of the Fellowship of the
American Academy of Nursing (1993)
 Honorary Doctorate of Science, Grand Valley
State University, Michigan (1998)

Source- www.neumansystemsmodel.org/photo-gallery-1

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NEUMAN’S SYSTEMS MODEL

INTRODUCTION
A holistic strategy, Neuman's Systems Model promotes an interdisciplinary focus on health
promotion, wellness maintenance, prevention, and treatment of stresses that are thought to be
determinants of poor health.
According to Neuman, optimal wellbeing is the highest level of system stability that is feasible at
any given time. In order to help graduate nursing students, base their practise on a synthesis of
information from their education, life experience, nurse training, and clinical experience, Neuman's
Systems Model was created as a teaching tool.
This paradigm urged practitioners to see the patient as a complete and integrated entity at a time
when healthcare was becoming more fragmented and specialised.

THEORETICAL SOURCES
 The Neuman Systems Model, which is based on general system theory, depicts living things as
open systems that interact with one another and their surroundings (Neuman, 1982).
 In this framework, Neuman integrates knowledge from several academic fields as well as her
personal philosophical views and clinical nursing experience, particularly in the field of mental
health nursing.
 The Gestalt theory (Perls, 1973), which is where the model gets its inspiration from, defines
homeostasis as the process by which an organism maintains its equilibrium and, by extension, its
health, under a variety of circumstances. According to Neuman, adjustment is the method
through which the organism satisfies its requirements.
 Illness may arise when the stabilising mechanism fails partially or when the organism is left in
an unbalanced state for an extended period of time. Death may occur if the body is unable to
compensate through disease (Neuman & Young, 1972).
 The model is also influenced by Marxist and de Chardinnian intellectual ideas (Neuman, 1982).
According to Marxist theory, in dynamically organised systems, larger wholes can influence a
part's characteristics. With this perspective, Neuman (1982) supports the fullness of life
philosophy of de Chardin that the patterns of the whole influence awareness of the part.
 Selye's concept of stress-is the body's general response to any pressure. The need for adjustment
is increased by stress. This demand is general; it calls for problem adaptability regardless of the
problem's nature. Therefore, the nonspecific need for action is the fundamental component of
stress (Selye, 1974). The tension-inducing triggers that cause stress are known as stressors. They
could be favourable or unfavourable.
 In conceptual model from 1964, Caplan introduced the idea of degrees of prevention, which
Neuman adapts and connects to nursing. The organism is protected through primary prevention
before it comes into contact with a damaging stressor. Primary prevention entails lowering the
likelihood that the stressor will be encountered or bolstering the client's natural line of defence to
lessen the stressor's reaction. After the client has come into contact with a negative stressor,
secondary and tertiary preventions are applied. Through early diagnosis and efficient treatment
of sickness symptoms, secondary prevention—which Neuman refers to as strengthening the
internal lines of resistance—attempts are made to lessen the effect or potential effect of stresses.
After treatment, tertiary prevention aims to lessen the effects of lingering stressors and restore
the client's wellness (Capers, 1996; Neuman, 2002b).

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MAJOR CONCEPTS & DEFINITIONS

Betty Neuman (2011b) describes the Neuman systems model by stating the following:

‘‘The Neuman Systems Model is 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. A client system in interaction with the environment delineates the
domain of nursing concerns’’

1. Wholistic Approach
The Neuman Systems Model is a dynamic, open systems approach to client care that was initially
created to give nursing concerns a unified emphasis and to comprehend clients in relation to their
surroundings. The client as a system could be a single individual, a family, a group of people, a
community, or a social issue (Neuman, 2011c). Customers are seen as wholes whose pieces interact
dynamically. The model takes into account all aspects of the client system at once, including
physiology, psychology, sociocultural, development, and spirituality. In the second edition, Neuman
included the spiritual variable (1989). In the second edition, she spelled the word holistic as
wholistic to make it clearer that it refers to the full person (B. Neuman, personal communication,
June 20, 1988).

2. Open System
A system is open when there is a continuous flow of input and processes, output, and feedback.
Stress and reaction to stress are basic components of an open system (Neuman, 2011c, see also
Neuman, 1982, 1989, 1995, 2002b)

Function or Process
The client as a system exchanges energy, information, and matter with the environment as well
as other parts and subparts of the system as it uses available energy resources to move toward
stability and wholeness. (Neuman, 2011c, see also Neuman, 1982, 1989, 1995, 2002b).
Input and Output
For the client as a system, input and output are the matter, energy, and information that are
exchanged between the client and the environment (Neuman, 2011c).
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 (Neuman, 2011c).
Negentropy
The process of energy conservation that assists system in the progression toward stability or
wellness is negentropy (Neuman, 2011c, see also Neuman, 1982, 1989, 1995, 2002b)
Stability
Stability is a dynamic and desirable state of balance in which energy exchanges can take place
without disruption of the character of the system, which points toward optimal health and
integrity (Neuman, 2011c, see also Neuman, 1982, 1989, 1995, 2002b).

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3.Environment
As defined by Neuman, “. . . internal and external forces surrounding the client, influencing and
being influenced by the client, at any point in time” (Neuman, 2011c, see also Neuman, 1982,
1989, 1995, 2002b)

Created Environment
The created environment is developed unconsciously by the client to express system wholeness
symbolically. Its purpose is to provide protection for client system functioning and to insulate the
client from stressors (Neuman, 2011c, see also Neuman, 1982, 1989, 1995, 2002a).

4.Client System
The client system is a composite of five variables (physiological, psychological, sociocultural,
developmental, and spiritual) in interaction with the environment. The physiological variable
refers to body structure and function. The psychological variable refers to mental processes in
interaction with the environment. The sociocultural variable refers to the effects and influences of
social and cultural conditions. The developmental variable refers to age-related processes and
activities. The spiritual variable refers to spiritual beliefs and influences (Neuman, 2011c, see also
Neuman, 1982, 1989, 1995, 2002a).

Basic 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 factors or energy resources of the client. This
core structure “. . . consists of basic survival factors common to human beings,” such as innate or
genetic features (Neuman, 2011c, see also Neuman, 1982, 1989, 1995, 2002a).

Lines of Resistance
A series of broken rings surrounding the basic core structure are called the lines of resistance.
These rings represent resource factors that help the client defend against a stressor. Lines of
resistance serve as protection factors that are activated by stressors penetrating the normal line of
Defense (Neuman, 2011c,).

Normal Line of Defense

The normal line of Defense is the model’s outer solid circle. It represents the adaptational level
of health developed over the course of time and serves as the standard by which to measure
wellness deviation. (Neuman, 2011c, p. 328; see also Neuman, 1982, 1989, 1995). Expansion of
the normal line of Defense reflects an enhanced wellness state, and contraction indicates a
diminished wellness state (Neuman, 2001, p. 322)

Flexible Line of Defense

The model’s outer broken ring is called the flexible line of defense (see Figure 16–1). It is
perceived as serving as a protective buffer for preventing stressors from breaking through the
usual wellness state as represented by the normal line of defense. Situational factors can affect
the degree of protection afforded by the flexible line of defense, both positively and negatively
(Neuman, 2011c, p. 327; see also Neuman, 1982, 1989, 1995, 2002a).
Neuman describes the flexible line of defense as the client system’s first protective mechanism.
“When the flexible line of defense expands, it provides greater short-term protection against
stressor invasion; when it contracts, it provides less protection” (Neuman, 2011, p. 322).
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5.Health
Health is a continuum of wellness to illness that is dynamic in nature. Optimal wellness exists
when the total system needs are being completely met (Neuman, 2011c, p. 328).

Wellness
Wellness exists when all system subparts interact in harmony with the whole system and all
system needs are being met (Neuman, 2011c, p. 329; see also Neuman, 1982, 1989, 1995, 2002b).

Illness
Illness exists at the opposite end of the continuum from wellness and represents a state of
instability and energy depletion (Neuman, 2011c, p. 329; see also Neuman, 1982, 1989, 1995,
2002b).

Stressors
Stressors are tension-producing stimuli that have the potential to disrupt system stability, leading
to an outcome that may be positive or negative. They may arise from the following:
 Intrapersonal forces occurring within the individual, such as conditioned responses
 Interpersonal forces occurring between one or more individuals, such as role expectations
 Extra personal forces occurring outside the individual, such as financial circumstances
(Neuman, 2002b, p. 324; see also Neuman, 1982, 1989, 1995).

6.Degree of Reaction
The degree of reaction represents system instability that occurs when stressors invade the normal
line of defense (Neuman, 2011c, p. 327; see also Neuman, 1982, 1989, 1995, 2002a).

7.Prevention As Intervention
Interventions are purposeful actions to help the client retain, attain, or maintain system stability.
They can occur before or after protective lines of defense and resistance are penetrated. Neuman
supports beginning intervention when a stressor is suspected or identified. Interventions are based
on possible or actual degree of reaction, resources, goals, and anticipated outcomes. Neuman
identifies three levels of intervention: (1) primary, (2) secondary, and (3) tertiary (Neuman, 2011, p.
328; see also Neuman, 1982, 1989, 1995).

Primary Prevention
Primary prevention is used when a stressor is suspected or identified. A reaction has not yet
occurred, but the degree of risk is known. The purpose is to reduce the possibility of encounter
with the stressor or to decrease the possibility of a reaction (Neuman, 1982, p. 15; 2011c, p. 328)

Secondary Prevention
Secondary prevention involves interventions or treatment initiated after symptoms from stress
have occurred. The client’s internal and external resources are used to strengthen internal lines of
resistance, reduce the reaction, and increase resistance factors (Neuman, 1982, p. 15; see also
Neuman, 2011c, p. 328).

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Tertiary Prevention
Tertiary prevention occurs after the active treatment or secondary prevention stage. It focuses on
readjustment toward optimal client system stability. The goal is to maintain optimal wellness by
preventing recurrence of reaction or regression. Tertiary prevention leads back in a circular
fashion toward primary prevention (Neuman, 2011c, p. 328; see also Neuman, 1982).

Reconstitution
Reconstitution occurs after treatment for stressor reactions. It represents return of the system to
stability, which may be at a higher or lower level of wellness than before stressor invasion
(Neuman, 2011c, p. 328)

Source- Betty Neuman — Neuman Systems Model

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MAJOR ASSUMPTIONS

Nursing
Neuman (1982) believes that nursing is concerned with the whole person. She views nursing as a
“unique profession in that it is concerned with all other variables affecting an individual’s
response to stress” (p. 14). The nurse’s perception influences the care given; therefore,
Neuman (1995) states that the perceptual field of the caregiver and the client must be assessed.

Person
Neuman presents the concept of person as an open client system in reciprocal interaction with the
environment. The client may be an individual, family, group, community, or social issue. The
client system is a dynamic composite of interrelationships among physiological, psychological,
sociocultural, developmental, and spiritual factors (Neuman, 2011b, p. 15)

Health
Neuman considers her work a wellness model. She views health as a continuum of wellness to
illness that is dynamic in nature and is constantly changing. Neuman states that “Optimal wellness
or stability indicates that total system needs are being met. A reduced state of wellness is the result
of unmet systemic needs” (2011c, p. 328).

Environment
Neuman defines environment as all the internal and external factors that surround and influence
the client system. Stressors (intrapersonal, interpersonal, and extra personal) are significant to the
concept of environment and are described as environmental forces that interact with and
potentially alter system stability (2011c, p. 327).
Neuman (1995) identifies three relevant environments: (1) internal, (2) external, and (3)
created. The internal environment is intrapersonal, with all interaction contained within the client.
The external environment is interpersonal or extra personal, with all factors arising from outside
the client. The created environment is unconsciously developed and is used by the client to
support protective coping. It is primarily intrapersonal. The created environment is dynamic in
nature and mobilizes all 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. Examples are the
use of denial (psychological variable) and life cycle continuation of survival patterns
(developmental variable). The created environment perpetually influences and is influenced by
changes in the client’s perceived state of wellness (Neuman, 1995, 2011

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THEORETICAL ASSERTIONS

Theoretical assertions are the relationships among the essential concepts of a model (Torres,
1986). 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”
(Neuman, 1982, p. 14). The client is in a reciprocal relationship with the environment in that “he
interacts with this environment by adjusting himself to it or adjusting it to himself”
(Neuman, 1982, p. 14).
Neuman links the four essential concepts of person, environment, health, and nursing in her
statements regarding primary, secondary, and tertiary prevention. Neuman’s earlier publications
stated basic assumptions that linked essential concepts of the model. These statements have been
recognized as propositions and serve to define, describe, and link the concepts of the model.
Numerous theoretical assertions have been proposed, tested, and published, as noted throughout
Neuman and Fawcett (2011)

RESEARCH
Application of the Betty Neuman systems model in the nursing care
of patients/clients with multiple sclerosis

Abstract
Objective: This study aimed to assess the application of the Betty Neuman systems model to the
care of patient/clients with multiple sclerosis.

Methods: This clinical study resulted from the application of the nursing process to a patient/client
admitted with multiple sclerosis in the neurological ward of a hospital in an urban area of Iran.

Results: A patient/client was evaluated according to the Neuman model. Intrapersonal stressors
(physiological, psychological, socio-cultural, and spiritual), interpersonal stressors (being away
from family and children) and extra-personal stressors (aggression and psychological pressure
from the spouse) were found. Based on the examination, 12 nursing diagnoses based on the
taxonomy of the North American Nursing Diagnosis Association International, and nursing care
based on three levels of prevention that are important in the view of Neuman, are presented. The
results were used in the classification of nursing interventions and the classification and nursing
outcomes respectively.

Conclusions: The results suggest the desirability of care and patient/client satisfaction in the
evaluation of nursing care based on the Neuman model. The model can be used as a framework to
help nurses care for patients/clients. Thus, the application of this model and other models is
recommended in the nursing care of patients/clients.

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BIBLIOGRAPHY

1. Ahmadi Z, Sadeghi T. Application of the Betty Neuman systems model in the

nursing care of patients/clients with multiple sclerosis. Mult Scler J Exp Transl
Clin. 2017 Aug 18;3(3):2055217317726798. doi: 10.1177/2055217317726798.
PMID: 28839950; PMCID: PMC5565031.
2. Business Bliss Consultants FZE. Nursing Theory Application: The Betty
Neuman Systems Model. November 2018 Retrieved from
https://nursinganswers.net/essays/nursing-theory-application-the-betty-
neuman-systems-model.php?vref=1
3. Alligood Martha Raile.Nursing theorists and their work. 2014. 8th ed. St.
Louis, Missouri: Elsevier.
4. https://www.researchgate.net/publication/
327915559_Betty_Neuman_Systems_Model_Analysis_according_to_Meleis
5. https://www.neumansystemsmodel.org/photo-gallery-1

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