BETTY NEUMAN’S SYSTEM MODEL

INTRODUCTIONBetty Neuman’s system model provides a

comprehensive flexible holistic and systembased perspective for nursing.

It focuses attention on the response of theclient system to actual or potentialenvironment stressors.

And the use of primary, secondary andtertiary nursing prevention intervention.

HISTORY AND BACKGROUND OF

THE THEORISTBorn in 1924


THE THEORIST CONTD….• Initial nursing education with

double honors at PeoplesHospital School of Nursing,Akron Ohio, in 1947.

• B. Sc. in Nursing in 1957

• M. Sc. in mental health,public health consultation,from UCLA in 1966.

• PhD in clinical Psychology.


THE THEORIST CONTD….• She was a pioneer in the community mental

health movement in the late 1960.

• She began developing her health systemmodel while a Lecturer in Community HealthNursing at University of California, LosAngeles.

• Published in the first edition of ConceptualModels for Nursing Practice, 1974, and in thesecond edition in 1980.

THE NEUMAN SYSTEM MODEL

(NSM) • TWO MAJOR COMPONENTS:

Stress

Reaction to stress

ASSUMPTIONS:

1. Each client system is unique.

2.Many known, unknown anduniversal stressors exist, withdifferent potential for disturbing aclient’s usual stability level ornormal line of defence.

ASSUMPTIONS CONTD….

3.The particular inter-relationships of client variables at

any point in time can affect the degree to which client is

protected by the flexible line of defence against

possible reaction to stressors.

4. Each client/client system has evolved a normal range of

responses to the environment that is referred to as a

normal line of defence. The normal line of defence can

be used as a standard from which to measure health

deviation.


5.When the flexible line of defence is no longer

capable of protecting the client/ client system

against an environmental stressor, the stressor

breaks through the normal line of defence.

6.The client whether in a state of wellness or

illness, is a dynamic composite of the inter-

relationships of the variables.


7.Implicit within each client system are internal

resistance factors known as line of resistance,

which function to stabilise and realign the client

to the usual wellness state.

8.Primary prevention relates to G.K. that is applied

in client assessment and intervention, in

identification and reduction of possible or actual

risk factors.


9.Secondary prevention relates to symptomatology

following a reaction to stressor, appropriate ranking

of intervention priorities and treatment to reduce

their noxious effects.

10.Tertiary prevention relates to adjustive processes

taking place as reconstitution begins and

maintenance factors move the back in circular

manner toward primary prevention.


11. The client as a system

is in dynamic, constant

energy exchange with

the environment

CONCEPTS IN NEUMAN’S

SYSTEM MODEL• The major concepts

are:

1.HOLISTIC

CLIENT

APPROACH: Here

the clients are

viewed as whole

whose parts are in

dynamic interaction.


SYSTEM MODEL CONTD….2.BASIC STRUCTURE/ CENTRAL CORE:

Common client survival factors in unique

individual characteristics representing basic

system energy resources.

• The basic structure or central core is made up of

basic survival factors that are common to the

species.

2.BASIC STRUCTURE/ CENTRAL

CORE contd....• These factors include: normal temperature

range, genetic structure-response pattern,

organ strength or weakness, ego structure.

• Stability or homeostasis occurs when the

amount of energy that is available exceeds that

being used by the system.

• A homeostatic body system is constantly in a

dynamic process of input, output, feedback and

compensation which leads to a state of

balance.


SYSTEM MODEL CONTD….3.CONTENT: The variables of the person in

interaction with the internal and external

environment comprise the whole client system.

4.OPEN SYSTEM: A system in which there is

continuous flow of input, output and feedback. It is

a system of organised complexity where all

elements are in interaction. E.g. stress and

reaction to stress.


SYSTEM MODEL CONTD….5. PROCESS OR FUNCTION: The exchange of

matter, energy and information with the

environment and the interaction of the parts and

supports of the system of man. A living system

tends to move toward wholeness.

6. INPUT AND OUTPUT: The matter, energy and

information exchanged between man and

environment, which is entering or leaving the

system at any point in time.


SYSTEM MODEL CONTD….7.FEEDBACK: The process within

which the matter, energy and

information as a system output

provides feedback for corrective

action to change, enhance or stabilise

the system.

8. ENTROPY: A process of energy

depletion and disorganisation moving

the system toward illness or possible

death.


SYSTEM MODEL CONTD….9.NEGENTROPY: A process of

energy conservation that increase

organisation and complexity,

moving the system toward stability

or a higher degree of wellness.

10.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.


SYSTEM MODEL CONTD….11.FLEXIBLE LINE OF

DEFENCE: A protective,

accordion like mechanism that

surrounds and protects the normal

line of defence from invasion by

stressors.

12. NORMAL LINE OF DEFENCE:

It represents what the client has

become over time, or the usual

state of wellness. It is considered

dynamic because it can expand or

contract over time.


SYSTEM MODEL CONTD….

13.Line of resistance: The series of

concentric circles that surrounds the

basic structure.


SYSTEM MODEL CONTD….14. DEGREE OF REACTION: The

degree of reaction is the amount of

system instability resulting from

stressor invasion of the normal line

of defence.

15. RECONSTITUTION: The return

and maintenance of system

stability, following treatment for

stressor reaction, which may result

in a higher or lower level of

wellness.


SYSTEM MODEL CONTD….16.STRESSORS: These are the

environmental factors, intra

(emotion, feeling), inter (role

expectation), and extra personal

(job or finance pressure) in

nature, that have potential for

disrupting system stability.

• A stressor is any phenomenon

that might penetrate both the

flexible and normal line of

defence resulting either a

positive or negative outcome.


SYSTEM MODEL CONTD….17. WELLNESS/ILLNESS:-

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.


SYSTEM MODEL CONTD….18. PREVENTION:

• According to Neumann’s

model, prevention is the

primary nursing

intervention. Prevention

focuses on keeping

stressors and the stress

response from having a

detrimental effect on the

body.


SYSTEM MODEL CONTD….

LEVELS OF

PREVENTION

Primary prevention

Secondary

prevention

Tertiary prevention

PARADIGM OF NEUMAN’S MODEL

FOUR MAJOR CONCEPTS ARE:

MAJOR CONCEPTS

PERSON

ENVIRONMENT

HEALTH

NURSING

FOUR MAJOR CONCEPTS

CONTD….1.PERSON:

The focus of the

Neumann model is

based on the philosophy

that each human being

is a total person as a

client system and the

person is a layered

multidimensional being.

FOUR MAJOR CONCEPTS

CONTD….• Each layer consists of five person variable or

subsystems: DEVELOPMENTAL

SPIRITUAL

SOCIO-CULTURAL

PSYCHOLOGICAL

PHYSIOLOGICAL

FOUR MAJOR CONCEPTS

CONTD….2. ENVIRONMENT:

The environment is seen

to be the totality of the

internal and external

forces which surround a

person and with which

they interact at any given

time.

FOUR MAJOR CONCEPTS

CONTD….

INTERNAL

EXTERNAL

CREATED

ENVIRONMENT

FOUR MAJOR CONCEPTS

CONTD….

3. HEALTH:

• Neuman sees health as

being equated with

wellness. She defines

health/wellness as “the

condition in which all parts

and subparts (variables) are

in harmony with the whole

of the client (Neumann,

1995)”.

FOUR MAJOR CONCEPTS

CONTD….4. NURSING:

• Neuman sees nursing as a

unique profession that is

concerned with all of the

variables which influence

the response a person

might have to a stressor.

• The person is seen as a

whole, and it is the task of

nursing to address the

whole person.

FOUR MAJOR CONCEPTS

CONTD….• Neuman defines nursing as “action 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.’’

• The role of the nurse is seen in terms of degree

of reaction to stressors, and the use of primary,

secondary and tertiary interventions.

THE NEUMAN SYSTEM MODEL AND THE

NURSING PROCESS:

• Neuman (1982-1995) presents a three step nursing

process format.

NURSING DIAGNOSIS

NURSING GOALS

NURSING OUTCOMES

NEUMANN’S SYSTEM MODEL

FORMAT

1. ASSESSMENT:

• Potential and actual stressors.

• Condition and strength of basic structure factors and

energy sources.

• Characteristics of flexible and normal line of defences,

lines of resistance, degree of reaction and potential for

reconstitution.

1. ASSESSMENT contd...

• Interaction between client and

environment.

• Life process and coping factors (past,

present and future) actual and potential

stressors (internal and external) for

optimal wellness.

• Perceptual difference between care giver

and the client.

NEUMANN’S SYSTEM MODEL FORMAT

CONTD….

2. NURSING DIAGNOSIS:

• The data collected are then interpreted to

condition and formulate the Nursing

diagnosis.

• Health seeking behaviours.

• Activity intolerance.

• Ineffective coping.

• Ineffective thermoregulation.


CONTD….

3. GOAL:

In Neumann’s systems

model the goal is to

keep the client system

stable.


CONTD….

4. PLANNING:

Planning is focused on

strengthening the lines

of defence and

resistance.

NEUMANN’S SYSTEM MODEL

FORMAT CONTD….

5. IMPLEMENTATION:

• The goal of stabilizing the client system is achieved

through three modes of prevention

Primary prevention : actions taken to retainstability

Secondary prevention : actions taken to attain

stability

Tertiary prevention : actions taken to maintainstability


CONTD….

6. EVALUATION:

The nursing process is

evaluated to determine

whether equilibrium is

restored and a steady

state maintained.

GLOBAL APPLICATIONS OF THE MODEL

1. CLINICAL PRACTICE:

The Neumann systems

model has been applied and

adapted to various

specialties include family

therapy, public health,

rehabilitation, and hospital

nursing.

One of the model’s

strengths is that it can be

used in a variety of settings.

GLOBAL APPLICATIONS OF THE MODEL

CONTD….

Using this conceptual model permits comparison

of a nurse’s interpretation of a problem with that

of the patient, so the patient and nurse do not

work on two separate problems.

The role of the nurse in the model is to work with

the patient to move him as far as possible along

a continuum toward wellness.

GLOBAL APPLICATIONS OF THE

MODEL CONTD….

Because this model requires individual

interaction with the total health care

system, it is indicative of the futuristic

direction the nursing profession is taking.

The patient is being relabelled as a

consumer with individual needs and wants.


MODEL CONTD….2. EDUCATION:

It has often been

selected as a curriculum

guide for a conceptual

framework oriented more

toward wellness than

toward a medical model

and has been used at

various levels of nursing

education.


MODEL CONTD….

One of the objectives for nursing graduate is to

demonstrate ability to use the Neumann health care

system in nursing practice. This helps prepare the

students for developing a frame of reference centred on

holistic care.

At north-western State University in Shreveport,

Louisiana, the faculty determined that a systems model

approach was preferred for their master’s program

because of the universality framework.


MODEL CONTD….RESEARCH

• A study done by

Riehl and Roy to test

the usefulness of the

Neumann model in

nursing practice was

published in

conceptual models

for nursing practice

3rd edn in 1989.


MODEL CONTD….

Results indicated that the model can help categorize

data for assessing and planning care and for guiding

decision making.

Neumann’s model can easily generate nursing research.

It does this by providing a framework to develop goals

for desired outcomes. Acceptance by the nursing

community for research applying this model is in the

beginning stages and positive.

REFERENCES1.Reed S Karen, “Betty Neuman (The neuman

system model), Notes on nursing Theories”,

SAGE publishers, Pp: 1-29.

2.Parker Marilyn, “Nursing theories and nursing

practice”, FA Davis publishers, Pp: 330-340.

3.Basvanthappa BT, “Nursing Theories”2nd edn,

Jaypee publishers, Pp: 225-241.

•

REFERENCES CONTD….4. Mary Walton, “The nursing journal of India”, October

2009, vol C No. 10, Pp: 230-232.

5. Gunusen Partlak Neslihan, Ustun Besti, Gigliotti Eileen,

“Nursing Science Quarterly theory, research and practice”,

vol 22, number 3 July 2009, Pp: 200-204.

6. Flanagan Jane, “Nursing Science Quarterly theory,

research and practice”, vol 22, No. 2, April 2009, Pp: 160-

161.

•

REFERENCES CONTD….

7.http://currentnursing.com/nursing_theory/N

euman.htm.

8.http://currentnursing.com/nursing_theory/app

lication_Betty_Neuman’s_Model.htm.

http://currentnursing.com/nursing_theory/Neuman.htm

http://currentnursing.com/nursing_theory/application_Betty_Neuman's_Model.htm

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