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Betty Neuman was born in rural Ohio in 1924. She

graduated from a nursing diploma program at Peoples
Hospital in !ron in 194"# re$ei%ed her B.S. in publi$
health in 19&" and earned an '.S. as a publi$ health(
mental health nurse $onsultant in 19)). fter graduating#
Neuman be$ame fa$ulty $hair of the '.S. program she
graduated from at *ni%ersity of +alifornia# ,os ngeles.
She began de%eloping her theory in as a tea$hing aid for
an introdu$tory $ourse in said program and $ontinued to
de%elop it after multiple e%aluations.
Neuman systems theory see!s to identify positi%e and
negati%e stressors and determine how they $an disrupt the
system. -he theory uses %ariables that pertain to
spiritual# de%elopmental# and psy$hologi$al aspe$ts of
the body system# among other %ariables# to define how
stressors affe$t the body system.
Neuman.s theory sees the person as an open system in
$on/un$tion with the en%ironment. -he en%ironment is used
to e0plain how e0ternal fa$tors $an bring about stress.
Health is $onsidered a line of defense against stress and
may be impa$ted by stress. Nursing is used to inter%ene
between stressors and the body system through the nursing
-he Neuman systems model $ombats system stressors by
adapting the nursing pro$ess into 1 steps2 diagnosis#
goal setting# and out$ome planning. -he system also uses
pre%ention of a stressor as an inter%ention.
Early Life and Nursing Education
Betty Neuman was born in 1924 on a farm in rural Ohio. She was the
second of three children and the only girl in her family. Her mother worked
as a rural midwife while raising Neuman and her siblings. Her father
passed away of chronic renal disease when she was eleven years old.
Neuman attributes her desire to join the nursing feld to her father's high
esteem of his nurses and her mother's work. When she graduated high
school, however, Neuman could not aford a nursing education. She worked
three jobs to raise money for school and help care for her mother and
younger brother. She also joined the Cadet Nurse Corps Program, which
accelerated her acceptance into nursing school. She graduated from Peoples
Hospital's (now Akron General Medical Center) diploma program in 1947.
In 1957, she received a Bachelors in Public Health Nursing from the
University of California in Los Angeles. She earned a masters degree in
Public Health/Mental Health Services Consultation from the University of
California, Los Angeles in 1966.
Six months after receiving her masters degree, she became a faculty chair of
her graduate program. She created the Neuman Systems Model in response
to a request of graduate students in the University of California, Los
Angeles nursing program. These students wanted, "an introductory course
that would provide an overview of the physiological, psychological,
sociocultural, and developmental aspects of human beings." (Neuman,
2002a, p.325-396) The model was developed as a way to integrate all of these
aspects into a holistic, teachable format.
The following is an interview in which Neuman discusses the development of
her theory.
Besides working as the faculty chair of University of California, Los
Angeles' graduate program and developing her model, Neuman has also
worked as a mental health consultant. She was also one of the frst nurses
licensed as a marriage and family counselor in the state of California, is a
clinical fellow of the American Association of Marriage and Family
Therapists, maintains her own private counseling practice. She also
attained the honor of becoming a fellow in the American Academy of
Nursing in 1993. Neuman has received two honorary doctorates, as well: one
from Grand Valley State University in Allendale Michigan, and one from
Neumann College in Aston, Pennsylvania. She is also a licensed real estate
agent and has a private pilot's license. (George, 2010, p. 338-339)
Nursing Theory, Concepts, and Propositions
The Neuman Systems Model is based on stress and the reaction/ potential reaction to
stress, with a philosophical basis in wholeness, wellness, client perception and
motivation, energy, and environmental interaction (George, !"", p# $%"&# 'n the
Neuman Systems Model (NSM&, it is considered ideal to achieve a stable system#
(nce stability is achieved, a revitali)ation occurs (George, !"", p# $%"&# Neuman
identi*ies stressors as *orces that see+ to disrupt the system,s stability# Neuman views
stressors as either a positive or negative e**ect on the system (George, !""&#

Basic Structure
The central *ocus o* the Neuman Systems Model is basic survival *actors# Neuman
de*ines basic survival *actors as system variables, genetic *eatures, and strengths and
wea+nesses o* the system# System variables re*er to the physiological, psychological,
sociocultural, developmental, and spiritual variables o* a species#
Other Components of the Neuman Systems Model
-lient .ariables
Neuman views that individual client wholistically and considers *ive variables
simultaneously and comprehensively (George, !"", p# $%&# /hysiological variables
include the structure and internal/e0ternal *unctions o* the body# /sychological
variables are the mental processes and relationships# Sociocultural variables are the
*unctions that relate to social/cultural e0pectations, activities, and in*luences#
1evelopmental variables are processes related to human development# Spiritual
variables are those that in*luence spiritual belie*s (George, !""&#
2ines o* 3esistance
The lines o* resistance protect the basic structure and become activated when the
normal line o* de*ense is invaded by environmental stressors (George, !"", p#$%$&#
The lines o* resistance are the last boundary to protect the basic structure (3eyes,
3icana, 3ico, 3imas, 4 3osales, !!5&# '* the lines o* resistance are e**ective, the
system will rebuild but i* the lines o* resistance prove to be ine**ective, death may
occur (George, !""&#
Normal/6le0ible 2ines o* 1e*ense
The normal lines o* de*ense indicate the system,s stability over time whereas the
*le0ible lines o* de*ense represent the initial response to system stressors# 7ny
stressor may invade the normal line o* de*ense when the *le0ible line o* de*ense o**ers
inade8uate protection (George, !"", p#$%$&# The normal lines o* de*ense represent
the client,s typical wellness level# The *le0ible lines o* de*ense (reaction to stressors&
is dependent upon the amount o* sleep, nutritional status, 9and: the 8uality and
8uantity o* stress e0perienced (3eyes et al#, !!5&#

The environment in the Neuman Systems Model includes any internal/e0ternal *actors
that impact the client# The environment has the potential to be positive or negative and
can a**ect the client,s reaction to stress# George (!""& gives an e0ample o*
individuals that are sleep deprived and e0perience a higher susceptibility to the
common cold# The sleep deprivation would be an internal *actor and the common cold
would be an e0ternal *actor#
Stressors, in the Neuman Systems Model, are stimuli that produce tensions and 9may
cause: system instability (George, !"", p#$%%&# 'n this model, stressors are neutral<
the client,s perception o* the stressors determines whether they are positive or
negative# Stressors can be intrapersonal (within the system boundary&, interpersonal
(outside the system boundary&, or e0trapersonal (outside the system boundary at a
greater distance&# 7n e0ample o* an intrapersonal stressor is the client,s autoimmune
response# 'nterpersonal may include role e0pectations o* the client# ;0trapersonal
could include social policy that a**ects the client#
Neuman identi*ies health as complete system stability or harmony among the *ive
variables (George, !"", p# $%>&# 7s the client moves towards illness and death,
entrophy, or a need *or more energy, occurs# 7s the client moves towards wellness,
negentrophy, or e0cess energy, occurs# 3eaction can be positive or negative and is
impacted by entrophy and negentrophy (George, !""&#
There are three *orms o* prevention?as?intervention@ primary, secondary, and tertiary#
/rimary prevention occurs prior to the system,s reaction to a stressor (health
promotion and wellness maintenance&# Secondary prevention occurs a*ter the system
reacts to a stressor (provided based upon e0isting symptoms&# Tertiary prevention
begins a*ter the system is treated (maintain wellness a*ter treatment through secondary
prevention& (George, !""&#
3econstitution is initiated a*ter the treatment *or stressors begins# 't can be viewed as
the return to and maintenance o* system stability (George, !"", p#$%A&#
3econstitution may improve, return to, or decrease the previous level o* wellness
(George, !""&#
The Neuman Systems Model addresses nursing as a means to help the client system
attain, maintain, or retain system stability (George, !"", p#$%A&# This can be done by
adBusting the prevention?as?intervention methods (primary, secondary, and tertiary& to
*it the needs o* the client# The nurse is the lin+ between client system, environment,
health, and nursing (George, !"", p# $%A&#
Application of Meta-
Paradigms to
Neuman's Theory
A meta-paradigm is a set of concepts that describe the reasoning behind a certain
discipline. The four main links in a meta-paradigm include the person, environment,
health, and nursing (Potter & Perry, 2!2, pg. "#.
The person is $hoever is receiving the nursing care. The person can be a single
individual, or even a $hole community. Environment relates to any condition affecting
the person. The person is directly related to the environment that they are $ithin. The
health of a person is al$ays changing. The nurse must make sure to provide patient-
centered, high %uality care (Potter & Perry, 2!2, pg. "-"!#. According to the American
&urses Association, nursing is the '...diagnosis and treatment of human responses to
actual or potential health problems...' (American &urses Association, 2!#.
(sing )etty &euman*s theory, the four ma+or concepts in the nursing meta-paradigm are
applied belo$.
&euman sees the person as an open system that $orks $ith the environment. The
human being is constantly changing, either in positive or negative $ays. The client*s
system mechanisms can be vie$ed using the diagram belo$. The line of resistance
protects the core and consists of $hat $ould be the immune response and basic
physiological mechanisms. The ne,t part, the normal line of defense, represents ho$
the person has changed over time. This includes $hat they have learned, their attitudes
developed, and their abilities (-night, !.., pg. "".#. /astly, there is the fle,ible line of
defense. The fle,ible line of defense depends on present day contributions such as
sleep, nutrition, and social activity (0oss & )ourbonnais, !.12, pg. 2-2!#. A person
is sub+ect so stress both in internally and e,ternally, and people react to this stress in
either learned or natural $ays. A person*s perception of a stressor- $hether it*s
important or not, the intensity, and the timing all impact ho$ a person $ill react to a
certain type of stress (-night, !.., "".#. 3ach person also has different variables. The
variables are physiological, sociocultural, psychological, developmental, and spiritual
(0eed, !..4, pg. !-!!#.
The environment is an important factor to the system5 it includes internal, e,ternal, and
created environments. The internal environment of a person includes such things as
smoking, infection, or disease (0oss & )ourbonnais, !.12, pg. 2!#. The e,ternal
environment brings about stress related interpersonally, or $ith other people. This can
be seen in role changes, such as $hen a child no$ has to care for an older parent. A
person can also find resources such as gaining education, family support, or community
help $ithin their environment to help relieve some of the stressors (-night, !.., pg.
"".#. The last type of environment is the created environment, $hich is unconsciously
created by the person. 6n a created environment, a person unconsciously does certain
acts to reduce stress. An e,ample $ould be rearranging furniture in an old, familiar $ay
$hen moving to a ne$ home (0eed, !..4, pg. !2#.
Health is looked at as a continuum from optimal health to illness (7eorge, 2!!, p.
4"1#. 8ptimal health occurs $hen all system needs are tended to, $hile illness $ill
occur $hen needs are not tended to. 6n regards to the person, $ellness is defined as
the fle,ible line of defense preventing anything from harming the normal line of defense.
6llness occurs $henever the normal line of defense is hindered and needs are not met
(-night, !.., pg. "".#.
Nursing defines the action in certain situations that are stress induced or related to
reactions of the client. This is $here nursing interventions come into play- to help
restore stability and reduce stress. 9hen using the nursing process of assessment,
diagnosis, planning, intervention, and evaluation5 the nurse must communicate
thoroughly $ith the patient throughout the entire process. &euman stated that the
nursing interventions can be implemented $henever a stressor is occuring, or $henever
it is a potential risk for occuring (-night, !.., pg. "2#. The interventions that can take
place include primary, secondary, and tertiary prevention.

Theory's Implication to Nursing Practice, Education, and
The Nursing Process
The nursing process is implemented in the Neuman systems model in an altered
format. The Neuman systems model follows the nursing process, initially, by utilizing
the assessment phase. The nurse can assist the patient in regaining optimal wellness
by assessing the actual and potential efects of stressor invasion and helping the client
to implement necessary changes (George, 2011). The nurse supports system stability
by utilizing primary, secondary, and tertiary and by linking the client system to the
environment, health, and nursing (George, 2011).
The Neuman systems model used in clinical practice consists of a three-step
process: nursing diagnosis, nursing goals, and nursing outcomes. The frst step is
nursing diagnosis. This involves utilizing databases to identify alterations in wellness
and development compared to correlations and constraints (George, 2011). It is
organized according to client system, level of response, client subsystem responding to
the stressor (i.e. psychological, physiological, etc.), the source of the stressor, and the
type of stressor (George, 2011). Data is collected, prioritized, and compared to theories
that are able to explain the clients condition (George, 2011). Any factor out of the norm
is included as a risk factor, whether it is an intra-, inter-, or extrapersonal factor.
The next step of the process is nursing goals. This consists of caregiver-client
oriented strategies agreed upon to attain, maintain, or retain system stability (George,
2011). Goals need to be negotiated upon and accepted by the patient to be efective.
There are two parts to the goal process: expected outcomes and planned interventions
(Knight, 1990). The goal of the nurse should be to maximize the clients energy
conservation while also using the clients energy to improve their condition (George,
2011). The goals are based on the needs of the client and the resources available.
The fnal step of the Neuman systems model in practice is nursing outcomes,
which begins with interventions. The interventions portion of the outcomes stage
consists of the prevention-as-intervention stages mentioned previously (George, 2011).
Each prevention-as-intervention (whether primary, secondary, or tertiary) are followed-
up by an evaluation (George, 2011).
Below are pictures illustrating the nursing process. The photo on left is a picture
of the traditional nursing process. The photo on the right is the Neuman systems model
of the nursing process. Both utilize the same factors, however, the Neuman systems
model consolidates outcome identifcation and planning into goals and implementation
and evaluation into outcomes.
Primary prevention consists of: preventing the invasion of a stressor, providing
information to promote the strengths of the client, support positive actions, eliminate
possible stressors, promote wellness, incorporating theories and epidemiological input,
education, and utilizing stress as a positive intervention strategy (George, 2011).
Secondary prevention includes: protection from stressors after invasion, optimizing
resources (internal and external) to maximize energy conservation, controlling the
reaction to stressors, further education of clients toward health and wellness goals,
encouraging positive wellness, and providing primary prevention as needed (George,
2011). Tertiary prevention occurs after undergoing treatment from secondary
prevention. Tertiary prevention consists of: attaining and maintaining optimal wellness
and stability post-treatment, reeducating and adapting to changes, supporting the client
towards implemented goals, implementing health service resources, and following-up
with primary prevention as needed (George, 2011).
In Research and Education
The fexibility of the Neuman systems model makes it ideal for utilization in
research and education. This is due to the fact that the model works with open-system
characteristics, it incorporates time as a variable, and it incorporates major client
variables which are unique to specifc situations, regardless of complexity and
unpredictability (Knight, 1990). A major client variable that the model focuses on in
research is perception. This allows the researcher to focus on the client's feelings,
attitudes, and beliefs that could afect the nature of the disease process (Knight, 1990).
In education, the Neuman systems model's versatility, once again, plays a major
role. It can be used for many levels of education such as continuing education
programs, baccalaureate, or masters (Bourbonnais & Ross, 1985). The model can be
used in various types of settings such as public health, hospitals, and daycares and also
for the invdividual, family, or community client (Bourbonnais & Ross, 1985). As
mentioned above, the model can be used to maintain health, promote health, or restore
health (Bourbonnais & Ross, 1985). The extent of the type of care the Neuman systems
model can be used for varies from managing pain, rehabilitation, acute or chronic care
and more (Bourbonnais & Ross, 1985).
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