Neuman Systems Model Presentation

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The Neuman Systems Model of Nursing :

The Neuman Systems Model of Nursing By Juana Williams 1

Betty Neuman:

2 Betty Neuman

Betty Neuman :

Born in Ohio & lives in Watertown, Ohio Nursing Experience -Community Health nurse -Staff nurses -Office nurse -Mental Health Nurse -Private duty nurse Professor (UCLA) Consultant Family Therapist 3 Betty Neuman


B.S. and M.S. in Public Health Two Honorary Degrees: Honorary Doctorate of Science, Grand Valley State University, Michigan (1998) Honorary Doctorate of Letters, Neumann College, Aston, PA (1992) 4 Education:

Origins of the Neuman Systems Model :

Original Title: “A Model for teaching Total Person Approach to Patient Problems” (Neuman and Young, 1972 ) Based on Neuman’s personal philosophy, “of helping each other live ”(Neuman, 2002). Influences by various models and theories (nursing and other scientific fields) 5 Origins of the Neuman Systems Model

Neuman Systems Model: Structure (Neuman, 2002).:

Provides a comprehensive system based framework for nursing and other health care disciplines that are concerned with stressors, reactions to stressors, and the prevention interventions that address potential and actual reactions to stressors. Provides a systematic approach to viewing the Domain of Nursing: Humans, Environment, Health and Nursing Model was developed to explain the client–client system as an individual person for the discipline of nursing. 6 Neuman Systems Model: Structure (Neuman, 2002).


Client-Client System (Person) Basic structure energy source (Central Core) Flexible lines of defense Normal line of defense Lines of resistance Five interactive variables Environment Health Nursing 7 Metaparadigm :

Slide 8:

8 Neuman Systems Model Original copyright 1970 by Betty Neuman

Client-Client System::

Structure: see diagram Client/client system is conceptualized as: Individual , Family, Group/ aggregate, Community . Viewed holistically Client system is represented by a series of concentric rings or circles surrounding a basic structure (central core). The concentric rings (the lines of defense and resistance ) serve as a protective mechanism for the basic structure. 9 Client-Client System:

Central Core (Neuman, 2002):

Central Core: made up of basic survival structures common to all human beings. Characteristics are innate in nature to the client system. • Normal temp range • genetic structure • response pattern • strength/ weakness of system parts • cognitive ability 10 Central Core (Neuman, 2002)

Flexible Line of Defense :

Outer boundary of the model (broken circle surrounding the normal line od defense) Initial response zone- first line defense, protects the client system Protects the normal line of defense or wellness state Prevents stressor invasion of the client system Acts as a protective buffer for the client system Dynamic , altered quickly to react to stressors 11 Flexible Line of Defense

Normal Line of Defense (Neuman, 2002):

Protected by the flexible line of defense Depicted as a solid circle surrounding the internal lines of resistance Represents the client’s stability over time Defines client’s normal or usual wellness state Baseline for determining the clients/systems deviation from health over time This normal defense line is the standard for determining any variance from wellness Change over time, reflective of coping, can be adversely impacted when stressor invades this line (symptoms and illness result) 12 Normal Line of Defense (Neuman, 2002)

Lines of Resistance (Neuman, 2002):

Represented by a series of concentric broken circles surrounding the basic structure Protect and support the client’s basic structure Activates when the normal line of defense fails due to environmental stressors Contain certain known and unknown internal and external resource factors that support the client’s basic structure Protective mechanism that attempts to stabilize the client system (Example: immune system response to infection) Effectiveness of the lines of resistance allows for the reconstitution of the client system by fostering a return to usual wellness (getting better) Ineffectiveness of the lines will deplete energy and lead to death. 13 Lines of Resistance (Neuman, 2002)

Five interactive variables (Neuman, 2002):

Physiological Variable – the structure and internal and external functions of the body Psychological Variable- to mental process and relationships Sociocultural Variable- to system functions that relate to social & cultural expectations, activities, and influences Developmental Variable- to those processes related to development over the life span Spiritual Variable – to the influence of spiritual beliefs, most recently added variable (1989), exists on a continuum, viewed as innate because the client may or may not want to develop this variable, may impact optimal wellness (if developed). 14 Five interactive variables (Neuman, 2002 )

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Occur and are considered simultaneously in each concentric circle that make up the client system. Vary is degrees of development within each client system Have a wide range of interactive styles and potentials within each client system Are broadly and generally defined (open to interpretation) The first four are well known to Nursing The last one (spirituality), is more open to interpretation Permeate the central core, the lines of defense and resistance, and the flexible line of defense. 15

Environment (Neuman, 2002): :

Broadly defines as internal and external influences surrounding and influencing the client system. Client also influence the environmental factors Three types of environments defined in the NSM : 1. Internal environment 2. External environment 3. Created environment 16 Environment (Neuman, 2002):

Three types of environments (Neuman, 2002)::

Internal environment – forces that exist within the client, intra-personal External environment- forces that exists outside of the client, inter-personal & extra-personal 17 Three types of environments ( Neuman, 2002 ) :

Three types of environments (Neuman, 2002)::

Created environment- forces that exist within and external to the client, intra-personal, inter-personal & extra-personal in nature. open system created unconsciously by the client symbolic expression of the systems wholeness expressed consciously, unconsciously or both simultaneously dynamic and purposeful in nature Provides perceptive coping shield Ex: denial (coping mechanism) 18 Three types of environments (Neuman, 2002):

Stressors (Neuman, 2002) :

Are tension producing stimuli with the potential for causing system instability. Stressors can occur within the internal or external environment of the client system. One of more stressors can be imposed on the client system at any given time. May have an negative or positive outcome effect on client system Stressor impact is dependent on client perception and cognition of the stressor during the encounter (beneficial vs noxious) 19 Stressors (Neuman, 2002)

Stressor classifications (Neuman, 2002)::

Intra-personal stressors- internal environment forces that occur within the boundaries of the client system Inter-personal stressors- external environment forces that occur outside the boundaries of the client system at the proximal range Extra-personal stressors- are external environmental interaction forces that occur outside the boundaries of the client system at the distal range 20 Stressor classifications (Neuman, 2002):

Health (Neuman, 2002)::

Neuman Systems Model wellness-illness continuum (Neuman, 2002) 21 Health (Neuman, 2002 ) :

Health (Neuman, 2002)::

Health , according to Neuman is the manifestation of living energy available to preserve and enhance system integrity. Viewed as a continuum Wellness and Illness are on opposite ends of the continuum Health for a client is equated with optimal system stability during a given period of time (known as optimal wellness) Health rises and falls throughout the life span Changes in the health spectrum are indicative of responses , which can be satisfactory or unsatisfactory , to environmental stress factors. 22 Health (Neuman, 2002 ) :

Nursing (Neuman, 2002) ::

Major concern is to keep the client system stable by: accurately assessing the effects & possible effects of environmental stressors assisting client adjustments required for optimal wellness Nursing actions are initiated to retain, attain, and maintain optimal client health using three preventions as interventions. In implementing these nursing actions, a linkage is created between the client, the environment , health, and nursing. 23 Nursing (Neuman, 2002) :

Prevention as Intervention Typology (Neuman, 2002)::

3 Types: Primary Prevention by intervention Secondary Prevention by intervention Tertiary Prevention by intervention 24 Prevention as Intervention Typology (Neuman, 2002 ) :

Neuman’s Nursing Process (Neuman, 2002)::

Nursing Diagnosis Nursing Goals Nursing Outcomes 25 Neuman’s Nursing Process (Neuman, 2002 ) :

Neuman Systems Model Evaluation (Neuman, 2002) ::

Origins: Neuman drew from her own clinical experience, knowledge gained through literature review and experience. The Neumann Systems Model best fits the totality paradigm. 26 Neuman Systems Model Evaluation (Neuman, 2002) :

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Prepositions: Betty Neuman identified 10 propositions, which are inherent within her model, to describe, define and link the concepts in the NSM (Fawcett, 1995a). Parsimonious: The Neuman Systems Model is presented in a clear and concise manner. Neuman developed a pictorial model which is helpful when explaining the relationships between the concepts in the NSM. 27

Applications and Empirical Adequacy::

Applications: Nursing education Nursing research Administration Direct patient care Empirical Adequacy: Used extensively globally NSM has been validated for its usability Greater need for meta-analysis in research 28 Applications and Empirical Adequacy:

Website: Betty Neuman’s Systems Model:

http:// 29 Website : Betty Neuman’s Systems Model

Recommended Article::

Neuman, B. (1999). Leadership-scholarship integration : Using the Neuman systems model for the 21st century professional nursing practice. Nursing Science Quarterly , 13(1), 60-63. 30 Recommended Article:


August-Brady, M. (2000). Prevention as intervention. Journal of Advanced Nursing , 31 , 1304-1308 . Fawcett, J. (1989). Analysis and evaluation of the Neuman systems model. In B. Neuman , The Neuman systems model (2nd ed., pp. 65–92). Norwalk, CT: Appleton & Lange . George, J. (2010). Nursing theories : The base for professional nursing practice. Upper Saddle River, NJ: Prentice Hall. Gigliotti , E. (1997). Use of Neuman's lines of defense and resistance in nursing research : Conceptual and empirical considerations. Nursing Science Quarterly , 10, 136–143 . Louis , M., & Koertvelyessy , A. (1989). The Neuman model in research. In B. Neuman, The Neuman systems model (2nd ed., pp. 93–114). Norwalk, CT: Appleton & Lange . 31 References:

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Louis, M., Neuman, B., & Fawcett, J. (2002). Guidelines for Neuman systems model-based nursing research. In B. Neuman & J. Fawcett (Eds.), The Neuman systems model (4th ed., pp. 113-119). Upper Saddle River, NJ: Prentice Hall . Lowry, L.W., Walker, P.H., & Mirenda , R. (1995). Through the looking glass: Back to the future. In Neuman Systems Model (3rd ed., pp 63-76). Norwalk, CT: Appleton & Lange . Neuman, B. (1996, Summer). The Neuman systems model in research and practice. Nursing Science Quarterly , 3, 129-135 . Neuman, B. (1999). Leadership-scholarship integration: Using the Neuman systems model for the 21st century professional nursing practice. Nursing Science Quarterly , 13(1), 60-63. 32


How would any one of Fawcett’s criticisms of the NSM affect its suitability for use in your practice? Describe how you would apply the NSM to guide your nursing practice. How would any one aspect of the NSM affect your likelihood of success in applying it? 33 Questions:

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