NEUMAN’S

SYSTEM MODEL THEORY

PRESENTED BY: GEORGE A. BARELA & EDLYN VEÑEGAS
INTRODUCTION
OVERVIEW OF THE THEORY

Betty Neuman’s system model provides a comprehensive

flexible holistic and system based perspective for
nursing.
It 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 intervention for retention, attainment, and
maintenance of optimal client system wellness.
 BIOGRAPHY
Betty Neuman was born in 1924, in Lowel,Ohio.
She completed BS in nursing in 1957 and MS in Mental Health Public health consultation, from UCLA in 1966.
She holds a Ph.D. in clinical psychol
She was a pioneer in the community mental health movement in the late 1960s.
Betty Neuman began developing her health system model while a lecturer in community health nursing at
University of California, Los Angeles.
The 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.
The model was published in 1972 as “A Model for Teaching Total Person Approach to Patient Problems” in
Nursing Research.4
It was refined and subsequently published in the first edition of Conceptual Models for Nursing Practice,
1974, and in the second edition in 1980.
 ACCORDING TO BETTY
NEUMAN
“NURSING IS A UNIQUE
PROFESSION THAT IS
CONCERNED WITH ALL THE
VARIABLES AFFECTING AN
INDIVIDUAL RESPONSE TO
STRESS’’
THE SYSTEMS MODEL THEORY
 THE SYSTEMS MODEL THEORY
NEUMAN DESCRIBES HUMANS AS HAVING SEVERAL LINE OF DEFENSE OF
ALL THAT WHICH PROTECT THE CORE (CENTRA SRUCTURE THAT MAKES US
HUMAN) OUR STRENGHTS AND WEAKNESSES. MADE UP OF BASIC SURVIVA
THAT INCLUDES THE ABILITY TO REGULATE TEMPERATURE, COGNITIVE
ABILITY, VALUES AND PHYSICAL STRENGTH, VALUES , HAIR AND EYE COLOR

LINES OF RESISTANCE - THIS LINES REPRESENTS THE INTERNAL FACTORS

THAT AIDS THE PERSON DEFEND AGAINST THE STRESSOR.

NORMAL LINE OF DEFENSE - IS THE PERSON STATE OF EQUILIBRIUM OR THE

STATE OF ADAPTATION DEVELOPED AND MAINTAINED OVER TIME WHICH IS
CONSIDERED NORMAL FOR THE PERSON.
 FOUR MAJOR CONCEPTS

PERSON ENVIRONMENT

HEALTH NURSING
 PERSON
THE FOCUS OF THE NEUMAN MODEL IS BASED ON THE PHILOSOPHY THAT EACH HUMAN BEING IS A
TOTAL PERSON AS A CLIENT SYSTEM AND THE PERSON IS A LAYERED MULTIDIMENSIONAL BEING.

EACH LAYER CONSISTS OF FIVE PERSON VARIABLE OR SUBSYSTEMS:

PHYSIOLOGICAL- REFER OF THE PHYSICOCHEMICAL STRUCTURE

AND FUNCTION OF THE BODY.
PSYCHOLOGICAL- REFERS TO MENTAL PROCESSES AND
EMOTIONS.
SOCIO-CULTURAL- REFERS TO RELATIONSHIPS; AND
SOCIAL/CULTURAL EXPECTATIONS AND ACTIVITIES.
SPIRITUAL- REFERS TO THE INFLUENCE OF SPIRITUAL BELIEFS.
DEVELOPMENTAL- REFERS TO THOSE PROCESSES RELATED TO
DEVELOPMENT OVER THE LIFESPAN.
 ENVIRONMENT
THE 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.
THESE FORCES INCLUDE THE INTRAPERSONAL, INTERPERSONAL AND
EXTRA-PERSONAL STRESSORS WHICH CAN AFFECT THE PERSON’S
NORMAL LINE OF DEFENSE AND SO CAN AFFECT THE STABILITY OF THE
SYSTEM.

THE INTERNAL ENVIRONMENT EXISTS WITHIN THE CLIENT SYSTEM.

THE EXTERNAL ENVIRONMENT EXISTS OUTSIDE THE CLIENT SYSTEM.
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.
 STRESSORS
OCCUR WITHIN THE
INDIVIDUAL
E.G, INFECTIONS,THOUGHTS
FEELINGS

INTRAPERSONAL INTERPERSONAL

OCCUR OUTSIDE THE

INDIVIDUAL OCCUR BETWEEN ONE OR
E.G, JOB MORE INDIVIDUALS
RESPONSIBILITIES, E.G, ROLE EXPECTATIONS
FINANCE CONCERN

EXTRAPERSONAL
 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)”.
· THE CLIENT SYSTEM MOVES TOWARD ILLNESS AND DEATH WHEN MORE ENERGY IS NEEDED THAN IS
AVAILABLE. THE CLIENT SYSTEM MOVED TOWARD WELLNESS WHEN MORE ENERGY IS AVAILABLE THAN IS
NEEDED
 NURSING
NEUMAN SEES NURSING AS A UNIQUE PROFESSION THAT IS CONCERNED
WITH ALL OF THE VARIABLES WHICH INFLUENCE THE RESPONSE A PERSON
MIGHT HAVE TO A STRESSOR.
THE PERSON IS SEEN AS A WHOLE, AND IT IS THE TASK OF NURSING TO
ADDRESS THE WHOLE PERSON.
NEUMAN DEFINES NURSING AS “ACTION 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 NURSE’S PERCEPTION WILL INFLUENCE
THE CARE GIVEN, THEN NOT ONLY MUST THE PATIENT/CLIENT’S PERCEPTION
BE ASSESSED, BUT SO MUST THOSE OF THE CAREGIVER (NURSE).
THE ROLE OF THE NURSE IS SEEN IN TERMS OF DEGREE OF REACTION TO
STRESSORS, AND THE USE OF PRIMARY, SECONDARY AND TERTIARY
INTERVENTIONS
 NORMAL LINE OF DEFENSE
IT IS COMPOSED OF FIVE VARIABLES

PHYSIOLOGICAL- REFER OF THE PHYSICOCHEMICAL

STRUCTURE AND FUNCTION OF THE BODY.
PSYCHOLOGICAL- REFERS TO MENTAL PROCESSES AND
EMOTIONS.
SOCIO-CULTURAL- REFERS TO RELATIONSHIPS; AND
SOCIAL/CULTURAL EXPECTATIONS AND ACTIVITIES.
SPIRITUAL- REFERS TO THE INFLUENCE OF SPIRITUAL
BELIEFS.
DEVELOPMENTAL- REFERS TO THOSE PROCESSES
RELATED TO DEVELOPMENT OVER THE LIFESPAN.
 FLEXIBLE LINE OF DEFENSE

FLEXIBLE LINE OF DEFENSE- IS FLEXIBLE , DYNAMIC AND

CAN BE READILY AND RAPIDLY CHANGE OVER SHORT
PERIOD OF TIME

IT IS A PROTECTIVE LAYER FOR PREVENTING STRESSORS

FROM BREAKING THROUGH THE USUAL WELLNESS STATE
 RECONSTITUTION

IT OCCURS FOLLOWING THE

TREATMENT OF STRESSO
REACTION MARKS THE CLIENT
SYSTEM ABILITY
 LEVELS OF PREVENTION
PRIMARY FOCUSES ON PROTECTING THE NORMAL LINE OF DEFENSE AND STRENGTHENING
THE FLEXIBLE LINE OF DEFENSE
THIS IS CARRIED OUT WHEN A STRESSOR IS SUSPECTED OR IDENTIFIED. THE
PREVENTION DEGREE OF RISK IS ALREADY KNOWN BUT THE REACTION OF THE CLIENT MAY
NOT YET VISIBLE.

SECONDARY FOCUS ON STRENGHTEINING INTERNAL LINE OF RESISTANCE REDUCING THE

REACTION OF THE STRESSOR AND INCREASING RESISTANCE FACTORS IN ORDER

PREVENTION
TO PREVENT DAMAGE TO THE CENTRAL CORE
THIS IS CARRIED OUT WHEN SYMPTOMS FROM STRESS HAVE ALREADY OCCURED.
IT INVOLVES ACTIVITIES THAT “TREAT” THE SYMPTOMS

FOCUSES ON ADAPTATION AND STABILITY, AND PROTECTS RECONSTITUTION OR

TERTIARY RETURN TO WELLNESS TREATMENT
THIS IS CARRIED OUT WHEN A STRESSOR IS SUSPECTED OR IDENTIFIED. THE
PREVENTION DEGREE OF RISK IS ALREADY KNOWN BUT THE REACTION OF THE CLIENT MAY
NOT YET VISIBLE.
 STAGES OF NURSING PROCESS
(BY NEUMAN)

NURSING DIAGNOSIS NURSING GOALS

NURSING OUTCOMES
NURSING DIAGNOSIS
IT DEPENDS ON ACQUISITION OF APPROPRIATE
DATABASE; THE DIAGNOSIS IDENTIFIES, ASSESSES,
CLASSIFIES, AND EVALUATES THE DYNAMIC
INTERACTION OF THE FIVE VARIABLES.

VARIANCES FROM WELLNESS (NEEDS AND

PROBLEMS) ARE DETERMINED BY CORRELATIONS
AND CONSTRAINTS THROUGH SYNTHESIS OF THEORY
AND DATA BASE.

BROAD HYPOTHETICAL INTERVENTIONS ARE

DETERMINED, I.E. MAINTAIN FLEXIBLE LINE OF
DEFENSE.
 NURSING GOALS
THESE MUST BE NEGOTIATED WITH THE PATIENT, AND TAKE
ACCOUNT OF PATIENT’S AND NURSE’S PERCEPTIONS OF
VARIANCE FROM WELLNESS.

EXPECTED OUTCOMES, SPECIFIC DESIRABLE BEHAIORAL

RESPONSES TO DEAL WITH THE ACTUAL OR POTENTIAL
VARIANCES FROM WELLNESS WHICH IS DECIDED JOINTLY BY
THE CLIENT AND THE CAREGIVER.

PLANNED INTERVENTIONS, SPECIFIC ACTIONS OF THE

CLIENT, THE CAREGIVER OR OTHERS TO EFFECT THE
EXPECTED OUTCOMES
NURSING OUTCOMES

NURSING INTERVENTION USING ONE OR MORE PREVENTIVE

MODES.
CONFIRMATION OF PRESCRIPTIVE CHANGE OR
REFORMULATION OF NURSING GOALS.
SHORT TERM GOAL OUTCOMES INFLUENCE DETERMINATION OF
INTERMEDIATE AND LONG – TERM GOALS.
 NEUMAN’S SYSTEM MODEL FORMAT
NEUMAN’S NURSING PROCESS FORMAT DESIGNATES THE
FOLLOWING CATEGORIES OF DATA ABOUT THE CLIENT SYSTEM
AS THE MAJOR AREAS OF ASSESSMENT.

ASSESSMENT NURSING DIAGNOSIS GOAL

EVALUATION IMPLEMENTING PLANNING

 ASSESSMENT
POTENTIAL AND ACTUAL STRESSORS.
CONDITION AND STRENGTH OF BASIC STRUCTURE FACTORS AND ENERGY
SOURCES.
CHARACTERISTICS OF FLEXIBLE AND NORMAL LINE OF DEFENSES, LINES OF
RESISTANCE, DEGREE OF REACTION AND POTENTIAL FOR RECONSTITUTION.
INTERACTION BETWEEN CLIENT AND ENVIRONMENT.
LIFE PROCESS AND COPING FACTORS (PAST, PRESENT AND FUTURE) ACTUAL
AND POTENTIAL STRESSORS (INTERNAL AND EXTERNAL) FOR OPTIMAL
WELLNESS EXTERNAL.
PERCEPTUAL DIFFERENCE BETWEEN CARE GIVER AND THE CLIENT.
 NURSING DIAGNOSIS

THE DATA COLLECTED ARE THEN INTERPRETED TO CONDITION AND FORMULATE

THE NURSING DIAGNOSIS
HEALTH SEEKING BEHAVIORS
ACTIVITY INTOLERANCE
INEFFECTIVE COPING
INEFFECTIVE THERMOREGULATION.
 GOALS
· IN NEUMAN’S SYSTEMS MODEL THE GOAL IS TO KEEP THE CLIENT SYSTEM
STABLE.

PLANNING
· LANNING IS FOCUSED ON STRENGTHENING THE LINES OF DEFENSE AND
RESISTANCE.
 IMPLEMENTATION

THE GOAL OF STABILIZING THE CLIENT SYSTEM IS ACHIEVED THROUGH THREE

MODES OF PREVENTION

· PRIMARY PREVENTION : ACTIONS TAKEN TO RETAIN STABILITY

· SECONDARY PREVENTION : ACTIONS TAKEN TO ATTAIN STABILITY
· TERTIARY PREVENTION : ACTIONS TAKEN TO MAINTAIN STABILITY
 IMPLEMENTATION
THE DATA COLLECTED ARE THEN INTERPRETED TO CONDITION AND
FORMULATE THE NURSING DIAGNOSIS
HEALTH SEEKING BEHAVIORS
ACTIVITY INTOLERANCE
INEFFECTIVE COPING
INEFFECTIVE THERMOREGULATION.

EVALUATION
· THE NURSING PROCESS IS EVALUATED TO DETERMINE WHETHER
EQUILIBRIUM IS RESTORED AND A STEADY STATE MAINTAINED.
 EVALUATION

THE DATA COLLECTED ARE THEN INTERPRETED TO CONDITION AND FORMULATE

THE NURSING DIAGNOSIS
HEALTH SEEKING BEHAVIORS
ACTIVITY INTOLERANCE
INEFFECTIVE COPING
INEFFECTIVE THERMOREGULATION.
 ACCEPTANCE BY THE NURSING COMMNUNITY
· NEUMAN’S MODEL HAS BEEN DESCRIBED AS A GRAND NURSING
THEORY BY WALKER AND AVANT.

· GRAND THEORIES CAN PROVIDE A COMPREHENSIVE PERSPECTIVE

FOR NURSING PRACTICE, EDUCATION, AND RESEARCH AND NEUMAN’S
MODEL DOES.
 NURSING PRACTICE
THE NEUMAN SYSTEMS MODEL HAS BEEN APPLIED AND ADAPTED TO VARIOUS SPECIALTIES INCLUDE
FAMILY THERAPY, PUBLIC HEALTH, REHABILITATION, AND HOSPITAL NURSING.
THE SUB SPECIALTIES INCLUDE PULMONARY, RENAL, CRITICAL CARE, AND HOSPITAL MEDICAL UNITS.
ONE OF THE MODEL’S STRENGTHS IS THAT IT CAN BE USED IN A VARIETY OF SETTINGS
USING THIS CONCEPTUAL MODEL PERMITS COMPARISON OF A NURSE’S INTERPRETATION OF A PROBLEM
WITH THAT OF THE PATIENT, SO THE PATIENT AND NURSE DO NOT WORK ON TWO SEPARATE PROBLEMS.
THE ROLE OF THE NURSE IN THE MODEL IS TO WORK WITH THE PATIENT TO MOVE HIM AS FAR AS POSSIBLE
ALONG A CONTINUUM TOWARD WELLNESS.
BECAUSE THIS MODEL REQUIRES INDIVIDUAL INTERACTION WITH THE TOTAL HEALTH CARE SYSTEM, IT IS
INDICATIVE OF THE FUTURISTIC DIRECTION THE NURSING PROFESSION IS TAKING.
THE PATIENT IS BEING RELABELED AS A CONSUMER WITH INDIVIDUAL NEEDS AND WANTS.
 NURSING PRACTICE
· THE MODEL HAS ALSO BEEN WIDELY ACCEPTED IN ACADEMIC CIRCLES.
· IT HAS OFTEN BEEN SELECTED AS A CURRICULUM GUIDE FOR A CONCEPTUAL FRAMEWORK ORIENTED
MORE TOWARD WELLNESS THAN TOWARD A MEDICAL MODEL AND HAS BEEN USED AT VARIOUS LEVELS OF
NURSING EDUCATION.
· IN THE ASSOCIATE DEGREE PROGRAM AT INDIANA UNIVERSITY.
· ONE OF THE OBJECTIVES FOR NURSING GRADUATE IS TO DEMONSTRATE ABILITY TO USE THE NEUMAN
HEALTH CARE SYSTEM IN NURSING PRACTICE. THIS HELPS PREPARE THE STUDENTS FOR DEVELOPING A
FRAME OF REFERENCE CENTERED ON HOLISTIC CARE.
· AT NORTHWESTERN STATE UNIVERSITY IN SHREVEPORT, LOUISIANA, THE FACULTY DETERMINED THAT A
SYSTEMS MODEL APPROACH WAS PREFERRED FOR THEIR MASTER’S PROGRAM BECAUSE OF THE
UNIVERSALITY FRAMEWORK.
· ACCEPTANCE BY THE NURSING COMMUNITY FOR EDUCATION THEREFORE IS EVIDENT.
 EDUCATION
· THE MODEL HAS ALSO BEEN WIDELY ACCEPTED IN ACADEMIC CIRCLES. · IT HAS OFTEN BEEN SELECTED
AS A CURRICULUM GUIDE FOR A CONCEPTUAL FRAMEWORK ORIENTED MORE TOWARD WELLNESS THAN
TOWARD A MEDICAL MODEL AND HAS BEEN USED AT VARIOUS LEVELS OF NURSING EDUCATION. · IN THE
ASSOCIATE DEGREE PROGRAM AT INDIANA UNIVERSITY. · ONE OF THE OBJECTIVES FOR NURSING
GRADUATE IS TO DEMONSTRATE ABILITY TO USE THE NEUMAN HEALTH CARE SYSTEM IN NURSING
PRACTICE. THIS HELPS PREPARE THE STUDENTS FOR DEVELOPING A FRAME OF REFERENCE CENTERED ON
HOLISTIC CARE. · AT NORTHWESTERN STATE UNIVERSITY IN SHREVEPORT, LOUISIANA, THE FACULTY
DETERMINED THAT A SYSTEMS MODEL APPROACH WAS PREFERRED FOR THEIR MASTER’S PROGRAM
BECAUSE OF THE UNIVERSALITY FRAMEWORK. · ACCEPTANCE BY THE NURSING COMMUNITY FOR
EDUCATION THEREFORE IS EVIDENT.
 RESEARCH
RESULTS INDICATED THAT THE MODEL CAN HELP CATEGORIZE DATA FOR ASSESSING AND
PLANNING CARE AND FOR GUIDING DECISION MAKING.
NEUMAN’S MODEL CAN EASILY GENERATE NURSING RESEARCH.
IT DOES THIS BY PROVIDING A FRAMEWORK TO DEVELOP GOALS FOR DESIRED OUTCOMES.
ACCEPTANCE BY THE NURSING COMMUNITY FOR RESEARCH APPLYING THIS MODEL IS IN THE
BEGINNING STAGES AND POSITIVE.