Betty Neuman Systems Model

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Nursing theorist Betty Neuman and her Systems model.


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Presentation Transcript

Betty Neuman Systems Model : 

Betty Neuman Systems Model Reported by: Lea Jane D. Buensalido, RN


BETTY NEUMAN She was born in 1924 on a farm near Lowell, Ohio. Her initial nursing education was completed with double honors at Peoples Hospital School of Nursing, Akron, Ohio in 1947. In California, she worked as hospital staff and head nurse, school nurse and industrial nurse. She was also involved in clinical teaching in the areas of medical-surgical, communicable disease, and critical care.

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She completed her baccalaureate degree with honors in nursing in 1957. In 1966, she received her master’s degree in Mental Health, Public Health Consultation, from UCLA. She received a doctoral degree in clinical psychology from Pacific Western University in 1985. She was a pioneer of nursing involvement in mental health.

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The model was initially developed in response to graduate nursing students expression of a need for course content that would expose them to breadth of nursing problems prior to focusing on specific nursing problem areas. In 1970, she designed a conceptual model for nursing and first published in 1972 as a 'Model for teaching total person approach to patient problems' in Nursing Research. She then defined and refined various aspects of the model in preparation for her book, The Neuman Systems Model: Application to Nursing Education and Practice. Further development and revisions of the model are illustrated in the second (1989) and third (1995) editions.

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Betty Neuman’s system model provides a comprehensive, flexible, holistic and system-based perspective for nursing. It focuses attention on the response of the client system to actual or potential environmental stressors. And the use of primary, secondary and tertiary nursing prevention intervention for retention, attainment, and maintenance of optimal client system wellness.



1. General System Theory : 

1. General System Theory Reflects the nature of living organism as an open system. States that all elements in a complex organization are in interaction. Two key assumptions are that energy is needed to maintain a high organizational state and that a dysfunction in one system will affect other systems.

2. Gestalt Theory : 

2. Gestalt Theory It describes homeostasis as the process by which an organism maintains its equilibrium, and consequently its health, under varying conditions.

3. Marxist & Pierre Tielhard deChardin’s Philosophy : 

3. Marxist & Pierre Tielhard deChardin’s Philosophy Suggests that the properties of parts are determined partly by the larger wholes within dynamically organized system. Wholeness of life

4. Hans Selye’s Definition of Stress : 

4. Hans Selye’s Definition of Stress The nonspecific response of the body to any demand made on it. Stressors are the tension-producing stimuli that results in stress; they may be positive or negative.

5. Caplan’s Conceptual Model (Levels of Prevention) : 

5. Caplan’s Conceptual Model (Levels of Prevention) Primary Level Secondary Level Tertiary Level

Primary Level : 

Primary Level It focuses on individuals not currently experiencing health problems. Includes activities oriented to assisting clients in maintaining and improving health, meeting basic needs, preventing future illnesses, health education programs in areas as diverse as dental hygiene, nutrition, or sexual reproduction, and providing immunization against common childhood illness.

Secondary Level : 

Secondary Level It focuses on individuals who are experiencing health problems or illnesses, who have unmet needs, and who are at risk for developing complications or worsening conditions. Most nursing care delivered in hospitals and other institutions are under this level. Educating clients in the hospitals and providing emotional support to help clients adapt to illness and continue to comply to therapy may fall under this level.

Tertiary level : 

Tertiary level It focuses on individuals with short-term or long-term disabilities, many unmet needs, or reduced functioning resulting illness. The goal of care is to help clients adapt as fully as possible to limitations caused by illness, meet basic needs, or to overcome problems related to limited functioning. It involves preventing further disability or reduced functioning.



Wholistic Client Approach : 

Wholistic Client Approach The client as a system may be defined as a person, family, group or community.

Wholistic Concept : 

Wholistic Concept Clients are viewed as wholes whose parts are in dynamic interaction. The model considers all variables simultaneously affecting the client system: physiological, psychological, socio-cultural, developmental, and spiritual.

Open System : 

Open System Elements are exchanging information energy within its complex organization. Stress and reaction to stress are basic components of an open system.

Basic Structure : 

Basic Structure “The core structure consists of basic survival factors common to the species, such as innate or genetic features. The inner circle of the diagram represents the basic survival factors or energy resources of the client.”

Environment : 

Environment Comprises of internal and external forces affecting and being affected by the client at any time.

Created environment : 

Created environment Is the client’s unconscious mobilization of all system variables toward system integration, stability, and integrity. E.g. use of denial

Stressors : 

Stressors Are tension-producing stimuli occurring within the boundaries of the client system. They may be: Intrapersonal- emotions Interpersonal- role expectation Extrapersonal- job pressure

Input & Output : 

Input & Output Matter, energy, and information that are exchanged between the client system & the environment.

Feedback : 

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.

Stability : 

Stability Coping or adaptation to stressors; it is able to maintain an adequate level of health. A homeostatic body system is constantly in a dynamic process of input, output, feedback, and compensation, which leads to a state of balance.

Negentropy : 

Negentropy A process of energy utilization that assists system progression toward stability or wellness.

Entropy : 

Entropy A process of energy depletion and disorganization that moves the system toward illness or possible death.

Normal Line of Defense : 

Normal Line of Defense Is the model’s outer solid circle. It represents a stability state for the individual or system. It includes system variables and behaviors such as the individual’s usual coping patterns, lifestyle, and developmental stage.

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Basic Structure Energy Resources Normal Line of Defense

Flexible Line of Defense : 

Flexible Line of Defense The model’s outer broken ring. It is dynamic and can be rapidly altered over a short time. It is perceived as a protective buffer for preventing stressors from breaking through usual wellness state. E.g. Sleep or Rest

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Basic Structure Energy Resources Flexible Line of Defense

Lines of Resistance : 

Lines of Resistance Are the series of broken rings surrounding the basic core structure. These rings represent resource factors that help the client defend against stressors. E.g. Body’s immune response system

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Basic Structure Energy Resources Lines of Resistance Normal Line of Defense Flexible Line of Defense

Degree of Reaction : 

Degree of Reaction Is the amount of energy required for the client to adjust to the stressor(s).

Prevention as Intervention : 

Prevention as Intervention Are purposeful actions to help the client retain, attain, and/or maintain system stability. Three levels of intervention: (1) primary, (2) secondary, and (3) tertiary.

Reconstitution : 

Reconstitution Is the state of adaptation to stressors in the internal and external environment. The return and maintenance of system stability, following treatment for stressor reaction, which may result in a higher or lower level of wellness.

Wellness : 

Wellness Existence of harmony in client system. System needs are met.

Illness : 

Illness Disharmony among the parts of the system, which is the result of unmet needs in varying degrees.

The Metaparadigm : 

The Metaparadigm Person Presents the concept as a client/client system that may be an individual, family, group or community. The client system is a dynamic composite of interrelationships among physiological, psychological, socio-cultural, developmental, and spiritual factors.

The Metaparadigm : 

The Metaparadigm Health The condition in which all parts and subparts (variables) are in harmony with the whole of the client  A continuum of wellness to illness that is dynamic in nature and constantly subject to change. Equated with stability of normal line of defense

The Metaparadigm : 

The Metaparadigm Environment all the internal and external factors that surround, or interact with person. Stressors are described as environmental forces that interact with and potentially alter system stability. Three relevant environments: (1) internal, (2) external, and (3) created

The Metaparadigm : 

The Metaparadigm Nursing “A unique profession in that it is concerned with all of the variables affecting an individual’s response to stress.” Actions which assist individuals, families and groups to maintain a maximum level of wellness, and the primary aim is stability of the patient/client system, through nursing interventions to reduce stressors.


BASIC ASSUMPTIONS Each client system is unique, a composite of factors and characteristics within a given range of responses contained within a basic structure. Many known, unknown, and universal stressors exist. Each differs in its potential for disturbing a client’s usual stability level or normal LOD. The particular inter-relationships of client variables at any point in time can affect the degree to which a client is protected by the flexible LOD against possible reaction to stressors. Each client/ client system has evolved a normal range of responses to the environment that is referred 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 environmental stressor, the stressor breaks through the normal LOD.

Slide 50: 

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 stabilize and realign the client to the usual wellness state. Primary prevention relates to general knowledge that is applied in client assessment and intervention, in identification and reduction of possible or actual risk factors.  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.

Sample Situation: : 

Sample Situation: Mr. X is a 42 year-old business executive. His colleagues describe him as hardworking, perfectionist and workaholic. His day starts by leaving the house very early from Laguna to Makati and begins work by delegating various tasks with firm expectations and deadlines that somewhat impossible to meet. He usually responds with pressure and intimidating remarks for works not perfectly done. He smokes and drinks alcohol whenever he is stressed. Recently, the company experienced continuous dropped in their sells and his bosses started to put blame to him.

Slide 53: 

continuation… Mr. X began exhibiting weird mannerisms and behaviors that appear strange to his family and people around him. He misses meals very often and sleeps very late at night while doing work. He has no time anymore for his family and focuses to hard on meeting deadlines and his preconceived objectives. Because of these weird changes in him, the company decided to temporarily relieve him from his position as executive manager. A week later, he started to have periods of mania and depression. His family becomes worried and called up the hospital to seek assistance after he locked himself in the room, refusing to eat, and most of the time quiet and staring blankly on the wall. Later, he developed pneumonia.

Slide 54: 

Using Neuman’s System Model in the situation, the identified possible stressors that contributed to Mr. X’s condition were as follows: work, personality, and attitude. Mr. X is not anymore able to handle the stressors and that had caused the “breakdown” of his lines of defense. Without seeking help from his family and friends, he was not able to maintain his flexible line of defense and brought instability to his system.

Usefulness of the Theory : 

Usefulness of the Theory

Practice : 

Practice Facilitates goal-directed, unified, wholistic approaches to client care, yet it is also appropriate for multidisciplinary use to prevent fragmentation of client care. The model was selected and utilized in a variety of nursing practice settings with individuals, families, groups, and communities. It has been applied and adapted to various specialties include family therapy, public health, rehabilitation, and hospital nursing.

Slide 58: 

It is also used effectively in advanced nursing practice such as psychiatric home visits, critical care, collaborative practice by nurse practitioners and physicians, and practice of nurse anesthesia. The model is being studied and applied in other disciplines, such as physical therapy.

Education : 

Education The model has been accepted in academic circles and is used widely as a curriculum guide oriented toward wellness. It has been selected for baccalaureate programs on the basis of its theoretical and comprehensive perspectives for a wholistic curriculum and its potential for use with the individual, family, small groups, and community. It has been used effectively in postbasic nursing education and beyond.

Research : 

Research The model is one of the most frequently used models for nursing research. Systems Model has provided the conceptual framework for recently published research across the life span, on nurses and lay persons as caregivers, and on nursing education and administration. A study was published by Riehl and Roy to test the usefulness of the Neuman model in nursing practice. There were two major objectives of the study: To test the model/assessment’ tool for its usefulness as a unifying method of collecting and analyzing data for identifying client problems. To test the assessment tool for its usefulness in the identification of congruence between the client’s perception of stressors and the care giver’s perception of client stressors. Results indicated that the model can help categorize data for assessing and planning care and for guiding decision making. Neuman’s model can easily generate nursing research.



Clarity : 

Clarity It presents abstract concepts but familiar to nurses. The model’s concept of client, environment, health, and nursing are congruent with traditional nursing values.

Simplicity : 

Simplicity They are organized in a complex, yet logical manner and variables tend to overlap to some degree. The model can be used to describe, explain or predict nursing phenomena. The model is complex in nature; therefore it cannot be described as a simple framework, yet nurses using the model describe it as easy to understand and use across cultures in a wide variety of practice settings.

Generality : 

Generality The broad scope of this model allows it to be considered general enough to be useful to nurses and other healthcare professionals in working with individuals, families, groups, or communities in all healthcare settings.

Empirical precision : 

Empirical precision 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.  Continued testing and refinement will increase the model’s empirical precision as the research process, analysis, and synthesis of findings from multiple studies are completed.


REFERENCES Current Nursing: A Portal for Nursing Professionals (2008). http://www.currentnursing .com George, Julia B. (2002). Nursing Theories: The Base for Professional Nursing Practice. 5th Edition. Prentice Hall: New Jersey, USA. Heyman, Patrick and Sandra Wolfe (April 2000). Neuman Systems Model. Retrieved December 4, 2009, from Parker, Marilyn E. (2005). Nursing Theories and Nursing Practice. 2nd Edition. F.A. Davis: Philadelphia. Tomey, Ann M. and Martha Alligood (2004). Nursing Theorists and their Work. 5th Edition. Elsevier Publishers: Singapore.

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