BETTY NEUMAN  The sociocultural variable - refers to system functions that
relate to social and cultural expectations and activities.
SYSTEMS MODEL
MAJOR CONCEPTS AND DEFINITIONS
1. Wholistic Approach - Clients are viewed as wholes whose
parts are in dynamic interaction.
2. 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.
 Function or Process - The client as a system exchanges
energy, information, and matter with the environment as
well as other parts and subparts of the system as it uses
available energy resources to move toward stability and
wholeness.
 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.
 Feedback - The output in the form of matter, energy, and
information serves as feedback for future input for
corrective action to change, enhance, or stabilize the
system
 Negentropy - A process of energy conservation that
increases organization and complexity, moving the system
toward stability or a higher degree of wellness.
 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.
3. Environment - "the totality of the internal and external forces
(intrapersonal, interpersonal and extra-personal stressors) which
surround a person and with which they interact at any given
time."
 internal environment - exists within the client system.
 external environment - exists outside the client system.
 created environment - is an environment that is created
and developed unconsciously by the client. Its purpose is to
provide protection for client system functioning and to
insulate the client from stressors.
4. Client System - Neuman views the individual client holistically
and considers the variables simultaneously and comprehensively.
 physiological variable - refers to the structure and functions
of the body.
 psychological variable - refers to mental processes and
relationships.
 developmental variable - refers to those processes related
to development over the lifespan.
 spiritual variable - refers to the influence of spiritual beliefs.
5. Lines of resistance - Protection factors activated when
stressors have penetrated the normal line of defense.
6. Basic structure/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.
7. 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.
8. Flexible line of defense - A protective accordion-like
mechanism that surrounds and protects the normal line of
defense from invasion by stressors.
9. Health - is a continuum of wellness to illness that is dynamic in
nature.
 Wellness - is the condition in which all system parts and
subparts are in harmony with the whole system of the
client.
 Illness - is a state of insufficiency with disrupting needs
unsatisfied
10. Stressors - 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
individual, such as conditioned responses
 Interpersonal forces - occurring between one or more
individuals, such as role expectations
 Extra personal forces - occurring outside the individual,
such as financial circumstances.
11. Degree to reaction - the amount of system instability
resulting from stressor invasion of the normal LOD.
12. 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. It 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. It 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.
Reconstitution - The return and maintenance of system stability,
following treatment for stressor reaction, which may result in a
higher or lower level of wellness.
FOUR METAPARADIGMS
NURSING – Neuman believes that nursing is concerned with the
whole person. She views nursing as a “unique profession in that
it is concerned with all of the variables affecting an individual’s
response to stress”
PERSON - Neuman presents the concept of person as an open
client system in reciprocal interaction with the environment. The
client may be an individual, family, group, community, or social
issue.
HEALTH – Neuman views health as a continuum of wellness to
illness that is dynamic in nature and is constantly changing.
ENVIRONMENT - Neuman defines environment as all the internal
and external factors that surround and influence the client
system.
APPLICATIONS
PRACTICE - facilitates goal-directed, unified, wholistic approaches
to client care, yet the model is also appropriate for
multidisciplinary use to prevent fragmentation of client care.
 - The Neuman Nursing Process Format consists of three
steps: (1.) nursing diagnosis, (2) nursing goals, and (3)
nursing outcomes.
 Diagnosis -involves obtaining a broad, comprehensive data
base from which variances from wellness can be
determined.
 Goals - are established by negotiation between client and
caregiver for desired prescriptive changes to correct
variances from wellness.
 Outcomes – are established in relation to the goal for one
or more of the three prevention-as-intervention modes.
EDUCATION - The model’s wholistic perspective provides an
effective framework for nursing education at all levels.
RESEARCH - used frequently by nurse researchers as a
conceptual framework, as it lends itself to both quantitative