Betty Neuman

SYSTEMS MODEL

BETTY NEUMAN'S SYSTEM MODEL

INTRODUCTIONTheorist - Betty Neuman - born in 1924, in

Lowel, Ohio.BS in nursing in 1957; MS in Mental Health

Public health consultation, from UCLA in 1966; Ph.D. in clinical psychology

Betty Neuman’s system model provides a comprehensive flexible holistic and system based perspective for nursing.

DEVELOPMENT OF THE MODELNeuman’s model was influenced by:The philosophy of deChardin.Von Bertalanfy, and Lazlo on general system

theory.Selye on stress theory.Lararus on stress and coping.

BASIC ASSUMPTIONSEach 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 differ in it’s potential for disturbing a client’s usual stability level or normal LOD (Line of Defence).

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

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 G.K. 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.

The client as a system is in dynamic, constant energy exchange with the environment.

MAJOR CONCEPTS (Neuman,2002)Wholistic client

approachOpen systemBasic structureEnvironmentCreated environmentStressorsLine of defence and

resistance

Degree of reactionPreventionContentInput and outputFeedbackNegentropathyEntropyStabilityWellness and illness.

Wholistic client approach

The client as a system may be defined as a person, family, group, community.

Client is viewed as a whole whose parts are in dynamic interaction.

In the ideal situation, these variables functions are in harmony with stability, in relation to internal and external environmental stressors.

Open systemExchange energy.A system in which there is continuous flow of

input and process, output and feedback. It is a system of organized complexity where

all elements are in interaction.

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."The internal environment exists within the

client system.The external environment exists outside the

client system.The created environment is an environment

that is created and developed unconsciously by the client and is symbolic of system wholeness.

Contentthe variables of the person in interaction

with the internal and external environment comprise the whole client systemThe 5 variables are:PhysiologicalPsychologicalSocio-culturalDevelopmentalspiritual

Basic structure/Central coreThe common client survival factors in unique

individual characteristics representing basic system energy resources.

The basis structure, or central core, is made up of the basic survival factors which include:

system variablesgenetic structurestrength or weakness of system parts.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.

Process/ functionThe 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 tend to move towards wholeness.

Input- outputThe matter, energy, and information

exchanged between client and environment that is entering or leaving the system at any point in time.

FeedbackThe process within which the matter, energy,

and information as a system output provides feedback for corrective action to change, enhance or to stabilize the system.

NegentropyA process of energy conservation that increase

organization and complexity, moving the system toward stability or a higher degree of wellness.

Entropya process of energy depletion and

disorganization moving the system toward illness or possible death.

StabilityThe client adequately copes with stressors, it is

able to maintain an adequate level of health and preserving system integrity.

Stressorsenvironmental factors that may alter system

stability.intrapersonal (emotion, feeling),interpersonal(role expectation), extra personal (job or finance pressure) A stressor is any phenomenon that might

penetrate both the F and N LOD, resulting either a positive or negative outcome.

Wellness/IllnessWellness 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 (Neuman, 2002).

Normal LODIt is the outer solid circle.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. 

Flexible LODa protective, mechanism that surrounds and

protects the normal LOD from invasion by stressors.Outer boundary, and initial response, or protection

of the system to stressors.

Degree to reactionthe amount of system instability resulting

from stressor invasion of the normal LOD.

Line of Resistance-LORThe series of concentric circles that

surrounds the basic structure.Help the client to defend againist the

stressor.Protection factors activated when stressors

have penetrated the normal LOD, causing a reaction symptomatology.

E.g. mobilization of WBC and activation of immune system mechanism

Prevention as interventionInterventions modes for nursing action and

determinants for entry of both client and nurse in to health care system.

ReconstitutionThe return and maintenance of system

stability, following treatment for stressor reaction, which may result in a higher or lower level of wellness.

Preventionthe primary nursing intervention.focuses on keeping stressors and the stress response from having

a detrimental effect on the body.Primary Prevention

occurs before the system reacts to a stressor.strengthens the person (primary the flexible LOD) to enable him to

better deal with stressors includes health promotion and maintenance of wellness.

Secondary Preventionoccurs after the system reacts to a stressor and is provided in terms

of existing symptoms. focuses on preventing damage to the central core by strengthening

the internal lines of resistance and/or removing the stressor.Tertiary Prevention

occurs after the system has been treated through secondary prevention strategies.

offers support to the client and attempts to add energy to the system or reduce energy needed in order to facilitate reconstitution

FOUR NURSING PARADIGMS PERSON Human being is a total person as a client system and the person is a layered

multidimensional being. Each layer consists of five person variable or subsystems:

Physiological - Refers of the physicochemical structure and function of the body. Psychological - Refers to mental processes and emotions. Socio-cultural - Refers to relationships and social/cultural expectations and activities. Spiritual - Refers to the influence of spiritual beliefs. Developmental - Refers to those processes related to development over the lifespan.

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."

The internal environment exists within the client system. The external environment exists outside the client system. The created environment is an environment that is created and developed

unconsciously by the client and is symbolic of system wholeness.

HEALTH Health is equated with wellness. “the condition in which all parts and subparts (variables) are in harmony with

the whole of the client (Neuman, 1995)”. The client system moves toward illness and death when more energy is needed

than is available. The client system moved toward wellness when more energy is available than is needed

NURSING a unique profession that is concerned with all of the variables which influence

the response a person might have to a stressor. person is seen as a whole, and it is the task of nursing to address the whole

person. 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.

CORE Lines of Resistance

Normal Line of Defense

Flexible Line of Defense

CORE Normal Line of Defense Normal Line of Defense Normal Line of Defense

NEUMAN'S MODEL & CHRACTERISTICSinterrelated conceptslogically consistent.logical sequencefairly simple and straightforward in approach.easily identifiable definitionsprovided guidelines for nursing education and

practiceapplicable in the practice

Research Articles“Using the Neuman Systems Model for Best

Practices’’--Sharon A. DeWan, Pearl N. Ume-Nwagbo, Nursing Science Quarterly, Vol. 19, No. 1, 31-35 (2006).

Melton L, Secrest J, Chien A, Andersen B.    “A community needs assessment for a SANE program using Neuman's model”  J Am Acad Nurse Pract. 2001 Apr;13(4):178-86.

CONCLUSIONBetty Neuman’s system model provides a

comprehensive flexible holistic and system based perspective for nursing.

Neuman's model focuses 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.

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