Biography of Betty Neuman

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. She had
one older brother and a brother who was younger which makes her the middle child among her
siblings. Her love for nursing started when she took the responsibility of taking care of her
father which later created her compassion in her chosen career path.
Education
As a young girl, she attended the same one-room schoolhouse that her parents had
attended and was excited when she went to a high school that had a library. She was always
engaged and fascinated with the study of human behavior. During World War II, she had her
first job as an aircraft instrument technician. In 1947, she received her RN Diploma from
Peoples Hospital School of Nursing, Akron, Ohio.
Nursing Career of Betty Neuman
Betty Neuman moved to California and worked in a variety of 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
honors. Amidst her hectic life as a nurse, she also managed to work as a fashion model and
learned to fly a plane. She got married, supported her husband’s medical practice, and had their
daughter in 1959.
She also earned a master’s degree in mental health, public health consultation in 1966
from the University of California, Los Angeles (UCLA). After her graduation, she was hired as a
department chair in the UCLA School of Nursing graduate program. 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 was a pioneer of nursing involvement in mental health. She and Donna
Aquilina were the first two nurses to develop the nurse counselor role within community crisis
centers in Los Angeles.
Neuman persisted to start a private practice as a marriage and family therapist,
specializing in Christian counseling. She is a Fellow of the American Association of Marriage
and Family Therapy and of the American Academy of Nursing. Until 2009, she was the director
of the Neuman Systems Model Trustees Group, Inc. that she established in 1988, and still
attends as a consultant. The Trustees Group was created to preserve and maintain the message of
her nursing theory for the health care community.
Works of Betty Neuman
In 1970, Betty Neuman designed a nursing conceptual model to expand students’
understanding of client variables beyond the medical model. Her teaching programs at UCLA
paved the way for developing her nursing model. During those times, she did not write a book
but made her concepts known to Joan Riehl-Sisca and Sr. Callista Roy and incorporated them in
their 1971 book, Conceptual Models for Nursing Practice.
In 1972, Neuman published a draft of her model. She developed and improved the
concepts and published her book, The Neuman System Model: Application to Nursing
Education and Practice, in 1982. Further revisions were made in later editions. As a speaker and
author, she spent countless hours teaching and explaining the many concepts and aspects of the
model to students and professors.
Neuman has also been involved in numerous publications, paper presentations,
consultations, lectures, and conferences on application and use of the model. She worked as a
consultant nationally and internationally concerning the implementation of the model for
nursing education programs and for clinical practice facilities.
Awards and Honors of Betty Neuman
Betty Neuman has done many things including a nurse, educator, health counselor,
therapist, author, speaker, and researcher. Throughout the years, she earned many awards and
honors including several honorary doctorates and was an honorary member of the American
Academy of Nursing. The profound effect of her work on the nursing profession is well known
throughout the world.
 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)
She was honored by President Richard Jusseaume and Provost Dr. Laurence Bove with
the Walsh University Distinguished Service Medal, which is awarded to those who have
contributed outstanding professional or voluntary service to others within the national, regional
or local community.
In an annual Nursing Research Day sponsored by Walsh’s Phi Eta Chapter of Sigma
Theta Tau, Byers School of Nursing Dean Dr. Linda Linc granted Neuman with the first annual
Neuman Award, named in her honor, for outstanding service in the nursing profession.

Betty Neuman’s Nursing Theory

Three words frequently used in relation to stress are inevitable, painful and intensifying.
It is generally subjective, and can be interpreted as the circumstances one regards as conceivably
threatening and out of their control. A nursing theory developed by Betty Neuman is based on
the person’s relationship to stress, the response to it, and reconstitution factors that are
progressive in nature. The Neuman Systems Model presents a broad, holistic and system-
based method to nursing that maintains a factor of flexibility. It focuses on the response of
the patient system to actual or potential environmental stressors and the maintenance of the client
system’s stability through primary, secondary, and tertiary nursing prevention intervention to
reduce stressors.
What is the Neuman 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 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.”
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 level of health is identified as the normal line of
defense that is protected by a flexible line of defense. Stressors are intra-, inter-, and
extrapersonal 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 and 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 line
of defense 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.
Assumptions
The following are the assumptions or “accepted truths” made by Neuman’s Systems
Model:
 Each client system is unique, a composite of factors and characteristics within a given
range of responses.
 Many known, unknown, and universal 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 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
stressors.
 Each client/client system has evolved a normal range of responses to the environment
that is referred to as a normal line of defense. The normal line of defense can be used
as a standard from which to measure health deviation.
 When 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 client, whether in a state of wellness or illness, is a dynamic composite of the
interrelationships of the variables. Wellness 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 known as lines of
resistance, which function to stabilize and realign the client to the usual wellness state.
 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.
  Secondary prevention relates to symptomatology following a reaction to stressors,
appropriate ranking of intervention priorities, and treatment to reduce their noxious
effects.
 Tertiary prevention relates to the adjustive processes taking place as reconstitution
begins and maintenance factors move the client back in a circular manner toward
primary prevention.
 The client as a system is in dynamic, constant energy exchange with the environment.
(Neuman, 1995)
Major Concepts of Neuman Systems Model
In this section, we will define the nursing metaparadigm and the major concepts in Betty
Neuman’s Neuman Systems Model.
Human being
Human being is viewed as an open system that interacts with both internal and external
environment forces or stressors. The human is in constant change, moving toward a dynamic
state of system stability or toward 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 boundaries of the client system 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
The primary concern of nursing is to define the appropriate action in situations that are
stress-related or in relation to possible reactions of the client or client system to stressors.
Nursing interventions are aimed at helping the system adapt or adjust and to retain, restore, or
maintain some degree of stability between and among the client system variables and
environmental stressors with a focus on conserving energy.
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, is made up of 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
culturalexpectations 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 considered normal for a
particular individual client or system; it becomes a standard for wellness-deviance determination.
Lines of resistance
Protection factors activated when stressors have penetrated the normal line of defense,
causing a reaction synptomatology.
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 have an impact on the system.
 Extrapersonal stressors also occur outside the client system boundaries but are at a
greater distance from the system that are interpersonal stressors. An example is 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 level of health 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
A process of energy conservation 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 that
is entering or leaving the system at any point in time.
Reconstitution
The return and maintenance of system stability, following treatment of stressor reaction,
which may result in a higher or lower level of wellness.
Prevention as Intervention
Intervention modes for nursing action and determinants for entry of both client and nurse
into the health care system.
 Primary prevention occurs before the system reacts to a stressor; it includes health
promotion and maintenance of wellness. 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 to
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 through supporting existing strengths and continuing to preserve
energy. Tertiary prevention may begin at any point after system stability has begun to
be reestablished (reconstitution has begun). Tertiary prevention tends to lead back to
primary prevention. (Neuman, 1995)
Strengths and Weaknesses
Betty Neuman reports her nursing model was designed for nursing but can be used by
other health disciplines, which both has pros and cons. As a strength, if multiple health
disciplines use the Neuman’s System Model, a consistent approach to client care would be
facilitated. As a con, if the model is useful to a variety of disciplines, it is not specific to nursing
and thus may not differentiate the practice of nursing from that of other disciplines.
Strengths
 The major strength of the Neuman Systems Model is its flexibility for use in all areas
of nursing – administration, education, and practice.
 Neuman has presented a view of the client that is equally applicable to an individual, a
family, a group, a community, or any other aggregate.
 The Neuman Systems Model, particularly presented in the model diagram, is logically
consistent.
 The emphasis on primary prevention, including health promotion, is specific to this
model.
 Once understood, the Neuman Systems Model is relatively simple, and has readily
acceptable definitions of its components.
Weaknesses
 The major weakness of the model is the need for further clarification of terms used.
 Interpersonal and extrapersonal stressors need to be more clearly differentiated.
Analysis
The delineation of Neuman’s three defense lines were not clearly explained. In reality,
the individual resists stressors with internal and external reflexes which were made complicated
with the formulation of different levels of resistance in the open systems model of Neuman.
Neuman made mention of energy sources in her model as part of the basic structure. It can be
more of help when Neuman has enumerated all sources of energy that she is pertaining to. With
such, new nursing interventions as to the provision of needed energy of the client can be
conceptualized.
The holistic and comprehensive view of the client system is associated with an open system.
Health and illness are presented on a continuum with movement toward health described as
negentropic and toward illness as entropic. Her use of the concept of entropy is inconsistent with
the characteristics of entropy which is closed, rather than an open system.