Betty Neuman:

The Neuman Systems Model

(Theory Analysis: Walker and Avant)

Presented By :
Seham Alhajoori
Azizah Majrashi
Learning Objectives

After completing this lecture the student

: should be able to

Identify and explain theory evaluation of -1

Betty Neuman according to Walker and
. Avant
A- Theory Description
B-Theory Evaluation (CRTIQUE)
 Origin of the theory
Neuman’s primary field of practice was mental Health
She originally developed a model to focus on teaching
community mental health
Neuman then developed: A Model for Teaching Total Person
Approach to Patient Problems.
Which developed into the Neuman Systems Model.
Biography of Betty Neuman

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
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
.She got married, supported her husband’s medical practice, and had their daughter in 1959
Background of the theorist
1- 1947 she earned her nursing diploma from people’s hospital school of nursing
2- she earned abachelor’s degree in nursing from UClA and also studied psychology and public
health
3- 1966 she earned a master’s degree in mental health and public health consultation also from
UCLA
Then earned her doctorate in clinical psychology in 1985 from pacific western university
 Level of the theory ( scope)
The neuman systems model is grand nursing theory based on human needs.
it is both a model and a grand nursing theory.

As a model, it is provides a conceptual framework for nursing practice ,

research and education .

As grand theory , it proposes ways of viewing nursing phenomena and

nursing actions that are assumed to be true but may form propositions for
testing.
 Meaning of the theory
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

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

Newman adhered to the nursing concepts and has developed numerous

additional concepts for her model, here are some of the major concepts and
.sub concepts of her model
 Metaparadigm Concept

Human
being Environme
Health nt Nursing
individu(
)al
 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.
The external environment exists outside the client system.
The created environment is an environment that is created and
developed unconsciously by the client and is symbolic of system
wholeness.
Health
Health is equated with wellness.

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
 MAJOR CONCEPTS

• Protected by lines of resistance

Basic Usual level of health Flexible
structure line of defense

Normal line • Usual state of wellness

of defense
Flexible line • First line of defense
of defense
Lines of
Resistance Last line of defense
 Major concepts

Negentropy Degree to reaction Entropy

A process of energy
conservation that The amount of system a process of energy
increase organization indistability resulting depletion and
and complexity, moving from stressor invasion of disorganization moving
the system toward the normal line of the system toward illness
stability or a higher defense or possible death.
degree of wellness.
 MAJOR CONCEPTS

• The return and maintenance of system

stability, following treatment for stressor
Reconstriction reaction, which may result in a higher or
lower level of wellness
• The matter, energy, and information
exchanged between the client and
Input/Output environment that is entering or leaving
the system at any point in time.
• A state of balance of harmony requiring
energy exchanges as the client
adequately copes with stressors to
Stability retain, attain, or maintain an optimal
level of health thus preserving sys tem
integrity.
 MAJOR CONCEPTS
A stressor is any phenomenon that might
penetrate both the flexible and normal lines of
defense, resulting either a positive or negative
outcome
Extrapersonal
Intrapersonal Interpersonal occur outside the client system
boundaries but are at a greater
occur within the occur outside the client
distance from the system that are
client system system boundary, are
interpersonal stressors. An example
boundary proximal to the system
is social policy.
MAJOR CONCEPTS

• is the condition in which all

Wellness system parts and subparts
are in harmony with the
whole system of the client.

• is a state indicates
Illness disharmony among the parts
and subparts of the client
system
 MAJOR CONCEPTS

.Intervention modes for nursing action and determinants for entry of both client and nurse into the health care system

.occurs before the system reacts to a stressor

it includes health promotion and maintenance of
wellness
occurs after the system reacts to a stressor and is
provided in terms of existing system.

occurs after the system has been treated through

secondary prevention strategies.
: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 cultural
expectations 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.
Relationships
Neuman defined five interacting variables: physiologic, psychological,
sociocultural, developmental, and spiritual.
These five variables function in time to attain, maintain, or retain system
stability.
The model is based on the client's reaction to stress as it maintains
boundaries to protects client's stability (Neuman and Fawcett, 2009).
Structure
The Neuman Systems Model shows a comprehensive conceptual structure
related to stressors, reactions given against stressors and protective
interventions.
In the model, the system approach is taken as basis and it is explained how
the system remains in balance against the stressors.
 Assumptions

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 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)
 Logical adequacy of the theory
:he ◦

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
Theory Evaluation
Clarity

Complexity

Testability

Generality

Importance
Clarity

 Neuman presents abstract concepts that are familiar to

nurses.
 The model’s essential concepts of client , environment, health,
and nursing are congruent with traditional understanding of
the nursing metaparadigm.
 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.
 : usefulness Application in Practice
Interdisciplinary practice
Social workers
Physical therapy
Acute care psychiatric patients
Public health facilities
Hospital settings
Individuals, families, groups, communities
Various countries other than the USA
Complexity
The model concepts are organized in a complex yet systematically logical manner.
Multiple interrelationships exist among concepts, and variables overlap to some
degree.
 loss of theoretical meaning would occur if the concepts were separated
completely

The model is complex; therefore, it cannot be described as being simple, yet

nurses using the model describe it as easy to understand and it is used across
cultures and in a wide variety of practice settings
Testability

the Neuman model is not testable in its entirety, it gives rise to

directional hypotheses that are testable in research. As a result, it has
been used as a conceptual framework extensively in nursing research,
and aspects of the model have been empirically tested. Intermediate
theories using the Neuman Systems Model have been developed and
are being tested.
Generality
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.
 Importance
Neuman’s conceptual model includes guidelines for the professional nurse
for assessment of the client system, utilization of the nursing process, and
implement action of preventive interventions, which are all important to
delivery of care

The focus on primary prevention and inter disciplinary care is futuristic and
serves to improve quality of care.

the model is its potential to generate nursing theory, for example, the
theories of optimal client stability and prevention as intervention(Fawcett,
1995a)
Summary and Conclusion

The Neuman Systems Model proved to be a multi-use reference for many

nurse related fields and has a rich and dense content for the nursing
community who wants to develop and upgrade nurse related aspects.
Although it is strong in concept but it has some shady and dark areas where
the author hasn’t really explained the definitions and meanings of some of the
theoretical and practical ways in her theory which makes difficult in a way for
a learner to acquire.
Also her theory is not practical in general but it is used extensively in nursing
researches.
 References
Neuman, B. M. (1990). The Neuman Systems Model: A theory for practice. In M. E. Parker (Ed.),
Nursing theories in practice (pp. 241–261).
New York: National League for Nursing Press. Neuman, B. (1995).
The Neuman Systems Model (3rd ed.). Stamford, CT: Appleton & Lange. Neuman, B., & Fawcett,
J. (2002).
The Neuman Systems Model (4th ed.). Upper Saddle River, NJ: Prentice-Hall. Neuman, B., &
Fawcett, J. (2009).
The Neuman Systems Model (5th ed.). Upper Saddle River, NJ: Pearson Education, Inc.
Theoretical Basis for Nursing (4th ed.). Philadelphia, PA: McEwen, M., & Wills, E. Lippincott
Williams & Wilkins. (2014).
?Any Questions