Betty Neuman's System Model
INTRODUCTION
Theorist - 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
Theory was publlished in:
o A Model for Teaching Total Person Approach to Patient Problems in
Nursing Research - 1972.
o "Conceptual Models for Nursing Practice", first edition in 1974, and
second edition in 1980.
Betty Neumans system model provides a comprehensive flexible holistic and
system based perspective for nursing.
DEVELOPMENT OF THE MODEL
Neumans model was influenced by:
The philosophy writers deChardin and Cornu (on wholeness in system).
Von Bertalanfy, and Lazlo on general system theory.
Selye on stress theory.
Lararus on stress and coping.
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 differ in its
potential for disturbing a clients 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)
Content
the variables of the person in interaction with the internal and external
environment comprise the whole client system
Basic structure/Central core
The 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: normal temp. 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.
Degree to reaction
the amount of system instability resulting from stressor invasion of the normal
LOD.
Entropy
a process of energy depletion and disorganization moving the system toward
illness or possible death.
Flexible LOD
a protective, accordion like mechanism that surrounds and protects the normal
LOD from invasion by stressors.
Normal LOD
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.
Line of Resistance-LOR
The series of concentric circles that surrounds the basic structure.
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
Input- output
The matter, energy, and information exchanged between client and
environment that is entering or leaving the system at any point in time.
Negentropy
A process of energy conservation that increase organization and complexity,
moving the system toward stability or a higher degree of wellness.
Open system
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.
Prevention as intervention
Interventions modes for nursing action and determinants for entry of both
client and nurse in to health care system.
Reconstitution
The return and maintenance of system stability, following treatment for
stressor reaction, which may result in a higher or lower level of wellness.
Stability
A state of balance of 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.
Stressors
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 F and N LOD,
resulting either a positive or negative outcome.
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 (Neuman,
2002).
Prevention
the primary nursing intervention.
focuses on keeping stressors and the stress response from having a detrimental
effect on the body.
Primary Prevention
o occurs before the system reacts to a stressor.
o strengthens the person (primary the flexible LOD) to enable him to
better deal with stressors
o includes health promotion and maintenance of wellness.
Secondary Prevention
o occurs after the system reacts to a stressor and is provided in terms of
existing system.
o focuses on preventing damage to the central core by strengthening the
internal lines of resistance and/or removing the stressor.
Tertiary Prevention
o occurs after the system has been treated through secondary prevention
strategies.
o 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:
o Physiological - Refers of the physicochemical structure and function
of the body.
o Psychological - Refers to mental processes and emotions.
o Socio-cultural - Refers to relationships and social/cultural
expectations and activities.
o Spiritual - Refers to the influence of spiritual beliefs.
o 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.
NEUMAN'S MODEL & CHRACTERISTICS
interrelated concepts
logically consistent.
logical sequence
fairly simple and straightforward in approach.
easily identifiable definitions
provided guidelines for nursing education and practice
applicable in the practice
Research Articles
1. 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).
2. 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.
CONCLUSION
Betty Neumans 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.
REFERENCES
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LWW, NY.
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3rd ed. Philadelphia, Lippincott.
5. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care 4th ed.
Philadelphia, Lippincott.
6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing Concepts
Process & Practice 3rd ed. London Mosby Year Book.
7. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing
theories to prepare nurse therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-
15
8. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006
Jul;19(3):225
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