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 Neuman’s system model provides a comprehensive flexible
holistic and system based perspective for nursing.
DEVELOPMENT OF THE MODEL
Neuman’s 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
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.
M A J O R C O N C E P T S (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 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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4th ed. Philadelphia, Lippincott.
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