Betty Neuman

Biography

 Born on 1924 and grew up on a farm in Ohio

 Her rural background help her develop a compassion for people in need
 Completed her initial nursing education with double honors at Peoples Hospital
School of Nursing (now General Hospital)
 Worked in a variety of roles that included hospital nurse, school nurse, industrial
nurse and clinical instructor at the University of Southern California Medical
Center
 Earned a baccalaureate degree in public health and psychology with honors
(1957)
 Earned master’s degree in mental health, public health consultation (1966) from
the University of California, Los Angeles (UCLA)
 Completed a doctoral degree in clinical psychology at Pacific Western University
(1985)

Pioneer of nursing involvement in mental health

Works/Activities/Career

 The Neuman Systems Model: Application to Nursing Education and Practice was
published in 1982
 Fellow of the American Association of Marriage and Family Therapy and of the
American Academy of Nursing
 Taught nurse continuing education at UCLA and in community agencies for 14
years and was in private practice as a licensed clinical marriage and family
therapist, with an emphasis on pastoral counseling
 Lives in Seattle and maintains a leadership role in the Neuman Systems Model
Trustees Group

The Neuman Systems Model is based on general system theory and reflects the nature
of living organisms as open systems in interaction with each other and with the
environment.

All life is characterized by this ongoing interplay of balance and imbalance within the
organism.

When the organism remains in a state of disharmony for too long, illness may develop.

Systems Model
The Neuman Systems Model is a unique, open-systems-based perspective that provides
a unifying focus for approaching a wide range of concerns. A system acts as a boundary
for a single client, a group; it can also be defined as a social issue. A client system in
interaction with the environment delineates the domain of nursing concerns.

Major Concepts:

 Wholistic Approach
o Client as a system may be defined as a person, family, group, community,
or social issue.
o Clients are viewed as a wholes whose parts are in dynamic interaction.
o Variables simultaneously affecting the client system: physiological,
psychological, sociocultural, developmental, and spiritual.
 Open System
o A system is open when “there is a continuous flow of input and process,
output and feedback.”
o Stress and reaction to stress are basic components
 Function/Process
o The client as a system exchanges energy, information, and matter with
the environment as well as other parts and subparts of the system”
o “To move toward stability and wholeness”
 Input and Output
o The matter, energy, and information that are exchanged between the
client and the environment
 Feedback
o 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.
 Negentropy
o A process of energy conservation that increases organization and
complexity, moving the system toward stability at a higher degree of
wellness.
 Stability
o Desirable state of balance to which energy exchanges can take place
without disruption of the character of the system.
 Environment
o The environment consists of both internal and external forces surrounding
the client, influencing and being influenced by the client, at any point in
time.
 Created Environment
o Developed unconsciously by the client to express system wholeness
symbolically.
o It’s purpose is to provide perceptual protection for client system
functioning and to maintain system stability.
 Client System
o A composite of five variables (physiological, psychological, sociocultural,
developmental, and spiritual) in interaction with the environment.
o Physiological variable: body structure and function
o Psychological variable: mental processes
o Sociocultural variable: effects and influences of social and cultural
conditions
o Developmental variable: are-related processes and activities
o Spiritual variable: spiritual beliefs and influences
 Basic Structure
o The client as a system is composed of a central core structure surrounded
by concentric rings.
o Inner Circle: represents the basic survival factors or energy resources of
the client.
o This core structure consists of basic survival factors common to human
beings.
 Lines of Resistance
o Series of broken lines surrounding the basic core structure.
o Protection factors activated when stressors have penetrated the normal
line of defense.
 Normal Line of Defense
o Outer solid circle
o An adaptational level of health developed over time and considered
normal for a particular individual client or system; it becomes a standard
for wellness-deviance determination.
 Flexible Line of Defense
o Outer broken ring
o It is perceived as serving as a protective buffer for preventing stressors
from breaking through the usual wellness state.
o The client’s first protective mechanism.
 Health
 o The condition or degree of system stability and is viewed as a continuum
from wellness to illness. When system needs are met, optimal wellness
exists.
 Wellness
o Wellness exists when all system subparts interact in harmony with the
whole system and all system needs are being met.
 Illness
o Illness exists at the opposite end of the continuum from wellness and
represents a state of instability and energy depletion.
 Stressors
o Tension-producing stimuli “that have the potential to disrupt system
stability, leading to an outcome that may be negative or positive.
o Intrapersonal stressors: occurring within the individual
o Interpersonal stressors: occurring between one or more individuals, such
as role expectations
o Extrapersonal stressors: occurring outside the individual such as financial
circumstances
 Degree of Reaction
o Represents the system instability that occurs when stressors invade the
normal life of defense
 Prevention as Intervention
o Purposeful actions to help the client retain, attain, or maintain system
stability.
o Based on possible or actual degree of reaction, resources, goals, and
anticipated outcomes.
 Primary Prevention
o Stressor is suspected or identified
o Reduce the possibility of encounter with the stressor or to decrease the
possibility of a reaction.
 Secondary Prevention
o Occurs after the system reacts to a stressor and is provided in terms of
existing symptoms.
o The client’s internal and external resources are used to strengthen internal
lines of resistance, reduce the reaction, and increase resistance factors
 Tertiary Prevention
o Occurs after the system has been treated through secondary prevention
strategies.
 o Its purpose is to maintain wellness or protect the client system
reconstitution through supporting existing strengths and continuing to
preserve energy.
o Tertiary prevention may begin at any point after system stability has
begun to be reestablished. Tertiary prevention tends to lead back to
primary prevention.
 Reconstitution
o The return and maintenance of system stability, following treatment of
stressor reaction, which may result in a higher or lower level of wellness.

Metaparadigm

Nursing:
- Concerned with the whole person.
- “Unique profession in that it is concerned with all of the variables affecting an
individual’s response to stress”
- The nurses perception influences the care given; therefore Neuman states that
the perceptual field of the caregiver and the client must be assessed.
Human Beings:
- An open client system in reciprocal interaction with the environment.
- An individual, family, group, community, or social issue.
- The client system is a dynamic composite of interrelationships among
physiological, psychological, sociocultural, developmental, and spiritual factors.

Health:
- A wellness model.
- A continuum of wellness to illness that is dynamic in nature and is constantly
changing.
- Neuman states that “Optimal wellness or stability indicates that total system
needs are being met. A reduced state of wellness is the result of unmet
systematic needs.”

Environment:
- All the internal and external factors that surround and influence the client
system.
- Stressors (intrapersonal, interpersonal, and extrapersonal) are significant to the
concept of environment and are described as environmental forces that interact
with and potentially alter system stability.
- Neuman identifies three relevant environments:
 Internal – it is intrapersonal, with all interaction contained within the client.
 External – is interpersonal or extrapersonal, with all factors arising from
outside the client.
 Created – is dynamic in nature and mobilizes all system variables to create an
insulating effect that helps the client cope with the threat of environmental
stressors by changing the self or the situation. Moreover, the created
environment perpetually influences and is influenced by changes in the
client’s perceived state of wellness.