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Betty Neumanns system model provides a comprehensive flexible holistic and system based
attainment, and maintenance of optimal client system wellness. HISTORY AND BACKGROUND OF THE THEORIST
Betty Neumann was born in 1924, in Lowel, Ohio. She completed BS in nursing in 1957 and MS in Mental Health Public health consultation, from
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
Practice, 1974, and in the second edition in 1980. DEVELOPMENT OF THE MODEL
Neumanns model was influenced by a variety of sources. The philosophy writers deChardin and cornu (on wholeness in system). Von Bertalanfy, and Lazlo on general system theory. Selye on stress theory. Lararus on stress and coping.
BASIC ASSUMPTIONS
Each client system is unique, a composite of factors and characteristics within a given range of
to as a normal LOD. The normal LOD can be used as a standard from which to measure health deviation.
When the flexible LOD is no longer capable of protecting the client/ client system against an
The client whether in a state of wellness or illness, is a dynamic composite of the inter-relationships 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 LOR, which function to
Secondary prevention relates to symptomatology following a reaction to stressor, appropriate ranking of intervention priorities and treatment to reduce their noxious effects. Tertiary prevention relates to adjustive processes taking place as reconstitution begins and maintenance factors move the back in circular manner toward primary prevention.
The client as a system is in dynamic, constant energy exchange with the environment.
CONCEPTS
Content: - the variables of the person in interaction with the internal and external environment
species (Neumann,2002).
These factors include:- - Normal temp. range, Genetic structure.- Response pattern. Organ strength or
by the system.
A homeostatic body system is constantly in a dynamic process of input, output, feedback, and
LOD.
Entropy: - a process of energy depletion and disorganization moving the system toward illness or
possible death.
Flexible LOD: - a protective, accordion like mechanism that surrounds and protects the normal LOD
Prevention as intervention: - Interventions modes for nursing action and determinants for entry of
with stressors to retain, attain, or maintain an optimal level of health thus preserving system integrity.
Stressors: - environmental factors, intra (emotion, feeling), inter (role expectation), and extra personal
(job or finance pressure) in nature, that have potential for disrupting system stability.
A stressor is any phenomenon that might penetrate both the F and N LOD, resulting either a positive or
negative outcome.
Wellness/Illness: - Wellness is the condition in which all system parts and subparts are in harmony
Illness is a state of insufficiency with disrupting needs unsatisfied (Neuman, 2002). Illness is an excessive expenditure of energy when more energy is used by the system in its state of disorganization than is built and stored; the outcome may be death (Neuman, 2002).
PREVENTION
According to Neumanns model, prevention is the primary nursing intervention. Prevention focuses on
keeping stressors and the stress response from having a detrimental effect on the body. PRIMARY PREVENTION
Primary prevention occurs before the system reacts to a stressor. On the one hand, it strengthens the
person (primary the flexible LOD) to enable him to better deal with stressors
On the other hand manipulates the environment to reduce or weaken stressors. Primary prevention includes health promotion and maintenance of wellness.
SECONDARY PREVENTION
Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing
system.
Secondary prevention focuses on preventing damage to the central core by strengthening the internal
o Spiritual- Refers to the influence of spiritual beliefs. o 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
persons normal line of defense and so can affect the stability of the system.
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The internal environment exists within the client system. The external environment exists outside the client system. Neumann also identified a created environment which is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness.
HEALTH
Neumann 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 (Neumann, 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
Neumann sees nursing as a unique profession that is concerned with all of the variables which
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 nurses perception will influence the care given, then not only must
the patient/clients 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 STAGES OF NURSING PROCESS (BY NEUMAN) NURSING DIAGNOSIS
It depends on acquisition of appropriate database; the diagnosis identifies, assesses, classifies, and
NURSING GOALS
These must be negotiated with the patient, and take account of patients and nurses perceptions of
Short term goal outcomes influence determination of intermediate and long term goals. A client outcome validates nursing process.
NEUMANNS SYSTEM MODEL FORMAT Neumanns nursing process format designates the following categories of data about the client system as the major areas of assessment. 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
NURSING DIAGNOSIS
The data collected are then interpreted to condition and formulate the Nursing diagnosis. Health seeking behaviors. Activity intolerance. Ineffective coping. Ineffective thermoregulation.
GOAL
In Neumanns systems model the goal is to keep the client system stable.
PLANNING
Planning 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
EVALUATION
The nursing process is evaluated to determine whether equilibrium is restored and a steady state
The Neumann systems model has been applied and adapted to various specialties include family
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
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 Neumann 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 masters program because of the universality framework.
Acceptance by the nursing community for education therefore is evident.
RESEARCH
A study was published by Riehl and Roy to test the usefulness of the Neumann model in nursing
practice.
There were two major objectives of the study. o To test the model/assessment tool for its usefulness as a unifying method of collecting and
nursing community for research applying this model is in the beginning stages and positive. NEUMANNS AND THE CHARACTERISTICS OF A THEORY
Theories connects the interrelated concepts in such a way as to create a different way of looking
at a particular phenomenon.
o The Neumann model represents a focus on nursing interest in the total person approach to the
o The interrelationships between the concepts of person, health, nursing and society/environment are
repeatedly mentioned throughout the Neumann model and are considered to be basically adequate according to the criteria.
Theories must be logical in nature o
o There is a logical sequence in the process of nursing wherein emphasis on the importance of accurate
accepted.
o The multiple use of the model in varied nursing situations (practice, curriculum, and administration)
development.
o One are for future consideration as a beginning testable theory might be the concept of prevention
The model has provided clear, comprehensive guidelines for nursing education and practice in a variety of settings; this is its primary contribution to nursing knowledge. The concept within the guidelines is clearly explicated and many applications of the theory have been published, little research explicitly derived from this model has been published to date. Theories can be utilized by the practitioner to guide and improve their practice. One of the most significant attributes of the Neumann model is the assessment/intervention instrument together with comprehensive guidelines for its use with the nursing process. These guidelines have provided a practical resource for many nursing practitioners and have been used extensively in a variety of setting in nursing practice, education and administration. Theories must be consistent with other validated theories, laws and principles but will leave open unanswered questions that need to be investigated. In general, there is no direct conflict with other theories. There is, however, a lack of specificity in systems concepts such as boundaries which are indirectly addressed throughout the model.
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Research Articles
Using the Neuman Systems Model for Best Practices--Sharon A. DeWan, Pearl N. UmeNwagbo, Nursing Science Quarterly, Vol. 19, No. 1, 31-35 (2006). The purpose of this study was to present two case studies based upon Neuman systems model; one case is directed toward family care, and the other demonstrates care with an individual. Theory-based exemplars serve as teaching tools for students and practicing nurses. These case studies illustrate how nurses' actions, directed by Neuman's wholistic principles, integrate evidence-based practice and generate high quality care Melton L, Secrest J, Chien A, Andersen B. A community needs assessment for a SANE program using Neuman's model J Am Acad Nurse Pract. 2001 Apr;13(4):178-86. The purpose of the study was to present guidelines for a community needs assessment for a Sexual Assault Nurse Examiner (SANE) program using Neuman's Systems Model. Sexual assault is a problem faced by almost every community. A thorough community assessment is an important first step in establishing programs that adequately meet a community's needs. Guidelines for conducting such an assessment related to implementation of a SANE program are rare, and guidelines using a nursing model were not found in the literature Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, N George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3 rd ed. Norwalk, Appleton and Lange. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3 rd ed. Philadelphia, Lippincott. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed. Philadelphia, Lippincott. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts Process & Practice 3rd ed. London Mosby Year Book. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15 Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225 Delaune SC,. Ladner PK, Fundamental of nursing, standard and practice, 2nd edition, Thomson, NY, 2002
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