Theoretical Foundation in Nursing client system, these include: physiological, psychological,
sociological, developmental, and spiritual.
Chapter 11
Betty Neuman’s Systems Model
History and Background
1. Betty Neuman was born on September 11, 9124 near Lowell,
Ohio.
2. She received her Diploma in Nursing from People’s Hospital
School of Nursing, Akron, Ohio in 1947.
3. She received her BSN in 1957 and her Master of Science in
Mental Health in 1966, both from the UCLA.
4. Recognized as pioneer in the field of nursing involvement in
community mental health.
5. Her model was published in 1972 as a “Model for Teaching
Total Person Approach to Patient Problems” in nursing
research.
6. She received an Honorary Doctorate in Clinical Psychology
from Pacific Western University in 1985 and her second
honorary doctorate from Grand Valley State University,
Allendale, Michigan.
7. Her first book, The Neuman Systems Model, was published
in 1982. It includes nursing process format care plans, and
was a total approach to client care. Newer editions were
published in 1989, 1995, 2002, and 2010.
8. She died on January 10, 2014 at the age of 89.
Theoretical Sources
9. The primary foundations of Neuman’s model are Selye’s
stress theory, Von Bertalanffy’s general systems theory,
Caplan’s levels of prevention, Lewis’ field theory, and de
Chardin’s philosophy of life. These perspectives support the
idea that a holistic viewpoint of humans is crucial.
10. Neuman’s systems model reflects the nature of living
organisms as open systems in interactions with each other
and with the environment.
11. The model draws from Gestalt theory which describes
homeostasis as the process by which an organism maintains
its equilibrium and consequently health, under varying
conditions. Neuman describes adjustment as the process by
which the organism satisfies its needs – it is dynamic and
continuous.
12. Marxist philosophy suggests that the properties of
parts are determined partly by the larger wholes within
dynamically organized systems. With this view, Neuman
confirms that the patterns of the whole influence awareness
of the part, which is drawn from de Chardin’s philosophy of
the wholeness of life.
13. Neuman used Selye’s definition of stress, which is the
nonspecific response of the body to any demand made on it.
14. Neuman adapts the concept of levels of prevention
from Caplan’s Conceptual Model and relates these
prevention levels to nursing.
15. Neuman’s model is a system model. In a system
model, the main focus is on the interaction of the parts or
subsystems within the system.
Major Concepts and Definitions
 The Neuman’s model has two major components --- stress
and reactions to stress.
 The client is viewed as an open system in which repeated
cycles of input, process, output, and feedback, constitute a
dynamic organizational pattern. The client may be an
individual, group, family, community, or aggregate.
Major concepts identified in the model are:
 Wholistic Approach. Clients are viewed as wholes whose
parts are in dynamic interaction with itself and the
environment. All variables simultaneously affecting the
 Open System. A system is open when “there is a continuous
flow of input and process, output, and feedback.” Stress and
reaction to stress are basic components of an open system.
 Function of Process. The client is 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 and Output. Are matter, energy, and information that
are exchanged between the client and the environment.
 Feedback. System 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 at a higher degree of wellness.
 Stability. A dynamic and “desirable state of balance in which
energy exchanges can take place without disruption of the
character of the system,” which points toward optimal
health.
 Environment. Neuman defined environment as consists of
both internal and external forces surrounding the client,
influenced by the client, at any point in time.
 Created Environment. Developed unconsciously by the
client to express system wholeness symbolically. Its purpose
is to provide perceptual protection for client system
functioning and to maintain system stability.
 Client System. A composite of five variables – physiologic,
psychological, sociocultural, developmental, and spiritual in
interaction with the environment.
 Basic Structure. The client as system is composed of a
central core surrounded by concentric rings. The inner circle
of the diagram represents the basic survival factors or
energy resources of the client. This core structure “consists
of basic survival factors common to human beings”, such as
innate or genetic features.
 Lines of Resistance. A series of broken rings surrounding the
basic core structure are called the lines of resistance. These
rings represent resource factors that help the client defend
against a stressor. Lines of resistance serve as protection
factors that are activated by stressors penetrating the
normal line of defense.
 Normal Line of Defense. The outer solid circle. It represents
the adaptational level of health developed over the course
of time and serves as the standard by which to measure
wellness deviation determination. Expansion of this line
reflects an enhanced wellness state and contraction
indicates a diminished wellness state.
 Flexible Line of Defense. It is the outer broken ring of the
model. It is perceived as serving as a protective buffer for
preventing stressors from breaking through the usual
wellness state as represented by the normal line of defense.
Situational factors can affect the degree of protection
afforded by the flexible line of defense, both positively and
negatively. It is the client’s system’s first protective
mechanism. “When the flexible line of defense expands, it
provides greater short – term protection against stressor
invasion
 Health. A continuum of wellness to illness that is dynamic in
nature. Optimal wellness exists when the total system needs
are being completely met.
 Wellness. It exists when all system subparts interact in 7. Each patient has implicit internal resistance factors known
harmony with the whole system and all system needs are as line of resistance, which function to stabilize and realign
being met. patient to the usual state of wellness.
 Illness. Illness exists at the opposite end of the continuum 8. Primary prevention is applied in patient assessment and
from wellness and represents a state of instability and intervention, in identification and reduction of possible
energy depletion. actual risk factors.
 Stressors. Stressors are tension – producing stimuli “that 9. Secondary prevention relates to symptomatology following
have the potential to disrupt system stability, leading to an a reaction to stressors, appropriate ranking of intervention
outcome that may be positive or negative.” They may arise priorities, and treatment to reduce their noxious effects.
from the following: 10. Tertiary prevention relates to adjustive processes
o Intrapersonal forces occurring within the individual, “such taking place as reconstitution begins, and maintenance
as conditioned responses” factors move them back in a cycle toward primary
o Interpersonal forces occurring “between one or more prevention.
individuals, such as role expectations” 11. The patient is in a dynamic, constant energy exchange
o “Extrapersonal forces occurring outside the individual, with the environment.
such as financial circumstances”
 Degree of Reactions. The degree of reaction represents the
system instability that occurs when stressors invade the
normal line of defense.
 Prevention as Intervention (Preventive Intervention).
Purposeful actions to help the client retain, attain, or
maintain system stability and carried out when a stressor is
either suspected or identified.
 Primary Prevention. It is used when a stressor is suspected
or identified. A reaction has not yet occurred, but the degree
of risk is known. The purpose is to reduce the possibility of
encounter with the stressor or to decrease the possibility of
a reaction.
 Secondary Prevention. It involves interventions or
treatment initiated after symptoms from stress have
occurred. The client’s internal and external resources are
used to strengthen internal lines of resistance, reduce the
reaction, and increase resistance factors.
 Tertiary Prevention. Tertiary prevention occurs after the
active treatment or secondary prevention stage. It focuses
on readjustment toward optimal client system stability. The
goal is to maintain optimal wellness by preventing
recurrence of reaction or regression. Tertiary prevention
leads back in a circular fashion toward primary prevention.
 Reconstruction. Reconstruction occurs after treatment for
stressor reactions. It represents return of the system to
stability which may be at a higher or lower level of wellness
than before stressor invasion.
Basic Assumptions of the Model
1. Each patient system is a unique composite of factors and
characteristics within a range of responses contained in a
basic structure.
2. Many known, unknown, and universal stressors exist. Each
differs in their potential for upsetting a client’s usual
stability level.
3. Each patient has evolved a normal range of responses to
the environment referred to as the normal line of defense.
It can be used as a standard by which to measure health
deviation.
4. The particular inter – relationships of patient variables can,
at any point in time, affect the degree to which a client is
protected by the flexible line of defense against possible
reaction to stressors.
5. When flexible line of defense is incapable of protecting the
patient against an environmental stressor, that stressor
breaks through the line of defense.
6. The client is a dynamic composite of the inter–relationships
of the variables, whether in a state of illness or wellness.
Wellness is on a continuum of available energy to support
the system in a state of stability.