CREDENTIALS & BACKGROUND OF THE THEORIST

Betty Neumen was born in1924 near Lowell, Ohio.

1947- Earned Diploma in Nursing with double honors in people hospital school of
Nursing(Now general hospital ) in Akron, Ohio.
1957- Baccalaureate degree in nursing, public health & Psychology
1966- Master degree in Mental health, public healt consultative from the
University of California at Los Angels (UCLA).
1985- Doctoral degree in Clinical psychology from Pacific Western University,
San Fernands, CA.
Neumen was a poineer of nursing involvement in mental health. She refined mental
health Programme for post master level nurses at UCLA
Her nursing background includes work in public health school, industry, & Hospital
setting.
Practiced as a staff, head nurse, School nurse, Industrial nurse, Nurse counselor,
& as professor at UCLA.
Consultant to educational & practice Institute.
Practiced as a licensed clinical marriage & family therapist.
Consultant Internationally for nursing Schools.
She was also involved in clinical teaching in the areas of medical surgical, communicable
disease & critical care because she had always been interested in human behavior . Then
helped to establish & manage her husbands obstetrical & gynecological practice .
She developed her first explicit teaching & practice model for mental health consultation
in the late 1960s.
1971-This teaching & Practice model is cited in her first book publication
1970-Neuman then designed a conceptual model for nursing. The model emphasis
breath rather than depth in understanding the variables in nursing.
1972- She published in Nursing Research as a Model for teaching total person
approach to patient problems.
1974-80- She refined various aspects of model.
1989- published The Neuman Systems Model ; Application to Nursing Education
and practice.
Betty Neuman developed her model while she attempted to help nursing students
organize their thinking and look as clients holistically.
The Neumans Health care systems model specifies that the purpose of nursing is
to facilitate optimal client system stability by reducing the impact of environmental
stimuli or stressors.
The Neuman system model application to nursing education & practice . The
Neuman systems model, Neuman has been involved in a wide variety of professional
international activities, including numerous publications, paper presentations,
consultations, lectures & conference.

THEORETICAL SOURCES
The Neuman system model is based on General System theory. This theory
reflects the nature of living organism as open systems.
All elements in a complex organization are in interactions.
The Neuman system model has some similarity to gestalt theory.
The Gestalt approach considers the individual as a function of the organism
environmental field & view behavior as reflection of relatedness within that field.
Neuman describes adjustment as the process by which the organism satisfies its needs.
Because many needs exist and each may disturb client balance (or) stability the
adjustment process is dynamic and continuous
All life is characterized by his ongoing interplay of balance & imbalance with the
organisms.
Neuman describes the person as having a core that is protected by buffering systems. The
four key concepts describe interaction of the person with the environmental stressors that
determine health status.
The model is also derived from the philosophical views of Pierreteihard Dechardin &
Bernard Marxist Philosophy suggests that the properties of parts are determined partly
by the larger wholes within dynamically organized systems.
Dechardins Philosophy states wholeness of life.
to seek (or) maintain a balance among the various factors both within and ou Neuman
confirmed that the patterns of the whole influence awareness of the part.
She used Hans selyes definition of stress, which is the nonspecific response of the
body to any demand made on it. Stress increases the demand for readjustment. This
demand is non specific; it requires adaptation to a problem.
The ideal is to achieve optimal system stability. Han selye (1980)says that when a system
achieves stability a revitalization occurs. As an open system, the client system has a
propensity tside the system, that seek to disrupt it .
Using a systems perspective, the client may be an individual, a group, a family, a
community , can any aggregate.
In their development toward growth and survival open systems continuously
become more differentiated collaborate (or) complex. As they become more complex,
the internal conditions of regulating become more complex. The system may adjust to
the environment ( or) adjust the environment to itself.
Neuman adapts Caplans conceptual model for the concept of level of prevention.
- Primary prevention protect the organisms before it encounter a harmful
stressors.

 -Secondary prevention reduce the efeects or possible effect of stressors through

early diagnosis & treatment.
-Tertiary prevention- Reduces the residual stressors effect after treatment.
The Neuman system model is synthesis of knowledge from several science disciplines
and also incorporates Neumans philosophic beliefs and earlier clinical nursing
experience, particularly in mental health nursing.
The Neuman systems model of consists 2 major components are stress and the
reaction to stress . The client in the Neuman systems models is viewed as an open system
in which repeated cycles of
The Neuman system model diagram present the major aspects of the model,
Physiological
Psychological
Socio cultural
Developmental and Spiritual variables
Basic structure & Energy resources

 Originally looked empirical support.

1995- Research Survey identified nearly 100 studies for which the model
provided the organizing framework.
1996-2000- Over 50 additional studies published in dissertations, theses & journal
articles.
MAJOR CONCEPTS & DEFINITIONS:
The major concepts identified in the model are,
Wholistic Client approach
Open system
Basic structure
Environment

Created environment
Stressor
Lines of defense
Resistance
Degree of reaction
Prevention as intervention
Reconstitution
WHOLISTIC CLIENT APPROACH
:
The Neuman system model is a dynamic, open, system approach to client care originally
developed to provide a unifying focus for nursing problem definition and for best
understanding the client in interaction with the environment.
The client as a system may be defined as person, family, group, community (or)
issue.
WHOLISTIC CONCEPT
Clients are viewed as wholeness whose parts are in
dynamic interaction.
The model considers all variables simultaneously affecting the
client system
1.
Physiological
2.
Psychological
3.
Socio - Cultural
4.
Developmental
5.
Spiritual.
These variables have a basic core structure unique to individual but common to all human
beings
OPEN SYSTEM:
A system is open when its elements are exchanging information energy within its
complex organization;
Stress and reaction to stress are basic components of an open system.
ENVIRONMENT:
Internal and external forces affecting and being affected by the client at any time
comprise the environment.
CREATED ENVIRONMENT:
The created environment is the clients unconscious mobilization of all system
variables toward system integration, stability, and integrity.
CONTENT :
The five variables ( Physiological, psychological, socio- cultural, developmental and
spiritual ) of man in interaction with the environment comprise the whole system of the
client.
BASIC STRUCTURE:
The basic structure consists of all variables as survival factors common to man,such
as innate or genetic factors, which is unique to the individual.
The inner circle of the diagram represents the basic survival factors or energy

PROCESS (OR) FUNCTION:

The exchange of matter, energy and information with an environment and the
interaction of the parts and sub parts of the system of man.
A living system tends to move toward wholeness, stability, wellness, and negentropy
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
FEED BACK :
The process within which the matter, energy, and information, as system out put,
provides feedback for corrective action to change, enhance (or) stabilize the system
NEGENTROPY:
A process of energy utilization that assist system progression toward stability (or)
well ness.
ENTROPY:
A process of energy depletion and disorganization that moves the system toward illness
( or) possible death.
STABILITY: The client (or) a system successfully copes with stressors. It is able
to maintain an adequate level of health.Functional harmony ( or) balance preserves the
integrity of the system
STESSORS:
Stressors are environmental forces that may alter system stability.
Neuman views stressors as :
Intrapersonal forces occurring within the individual Ex:Conditioned responses( Anger,
Fear)
Interpersonal forces occurring between one (or) more individuals
Ex : Role expectations (Child rearing practices)
Intrapersonal forces occurring outside the individual
Ex : Financial circumstances
Stressors are stimuli which might penetrate both clients flexible and normal lines of
defense; both potential outcome of an interaction with a stressor may be beneficial
(positive) or noxious (negative).
Wellness exists when the parts of the client system interact in harmony.
System needs are met.
ILLNESS:
The Disharmony among the a parts of the system is considered illness in varying
degrees reflecting unmet needs.

NORMAL LINE OF DEFENSE:

The normal line of defense is the models outer solid circle
It represent s a stability state or equilibrium state for the individual, system or the
condition following adjustment made to stressors and maintained over time that is
considered uniquely normal.
This is a result or composite of several variables and behaviors such as the
individuals usual level of wellness includes coping patterns, lifestyle, and developmental
stage;
NORMAL LINE OF DEFENCE
It is basically the way in which an individual copes with stressors while
functioning within cultural pattern of birth and to which he attempts to conform.
FLEXIBLE LINES OF DEFENCE
It is dynamic and can be rapidly altered over a short time.
It is perceived as a protective buffer for preventing stressors from breaking
through the solid line of defense.
The relationship of the variables can affect the degree to which individuals are
able to use their flexible line of defense against possible reaction to a stressor or
stressors, such as loss of sleep.

 It is important to strengthen this flexible line of defense to prevent a possible

reaction.
LINES OF RESISTANCE:
The series of broken rings surrounding the basic core structure are called the lines of
resistance.
These rings represent resource factors or internal factors that help the client defend
against a stressor.
Ex: The bodys immune response system
DEGREE OF REACTION
the degree of reaction is the amount of system instability resulting from stressor
invasion of the normal line of defense.
DEGREE OF REACTION
It is determined by the timing, type, and strength of the stressors, as well as by the
persons basic core structure experiences, available energy resources & the
perception of the stressors.
PREVENTION AS INTERVENTION:
Interventions are purposeful actions to help the client retain, attain and/or maintain
system stability. They can occur before/after protective lines of defense and resistance
are penetrated in both reaction and reconstitution phases. Neuman supports beginning
intervention when a stressor is either suspected or identified. Interventions are based on
possible or actual degree of reaction, resources, goals, and the anticipated outcome.
Neuman identifies three levels of intervention. Primary, Secondary, and tertiary.
PRIMARY PREVENTION:
Primary prevention is carried out when a stressor is suspected ( or) identified
Neuman states The actor ( or) intervention would perhaps attempt to reduce
the possibility of the individuals encounter with the stressor ( or) in some way attempt
to strengthen the individuals encounter with the stressor ( or ) attempt to strengthen the
individuals flexible line of defense to decrease the possibility of a reaction.
Eg. Preparing special diet for mother who breast feeds her infant.
SECONDARY PREVENTION:
Secondary prevention involves interventions (or) treatment initiated after
symptoms from stress have occurred.
Both the clients internal and external resources would be used toward system
stabilization to strengthen internal lines of resistance, reduce the reaction and
increase resistance factors client.Eg. Counseling a grieving client.

TENTIARY PREVENTION:
Tertiary prevention occurs after the active treatment ( or ) secondary prevention stage
It focuses on readjustment toward optimal client system stability
A primary goal is to help prevent recurrence of reaction ( or) regression
This process leads back in a circular fashion toward primary prevention
Ex: Avoidance of stressor known to be hazards to the client hazardous to the client
RECONSTITUION:
Reconstitution is the state of adaptation to stressors in the internal and external
environment.
It can begin at any degree (or) level reaction and may progress beyond ( or) stabilize
somewhat below the clients previous normal line of defense.
Included in reconstitution are,
Interpersonal
Intrapersonal
Extra personal
Environmental factors interrelated with client system physiological psychological, socio
-cultural, developmental, and spiritual variables
Nursing intervention

Neuman relates these prevention levels to nursing in the following manner

1. Primary prevention involves counteraction harmful environmental stressors
before occurrence of illness.

2. Secondary prevention attempts- to reduce the effect ( or ) possible effect of

stressors through early diagnostic & effective treatment of illness symptoms.
3. Tertiary prevention attempts to reduce the residual stressor effects after
treatment.
MAJOR ASSUMPTIONS
MAJOR ASSUMPTIONS REGARD THE FOUR BASICS AS:
NURSING
PERSON
HEALTH
ENVIRONMENT
ARE AS FOLLOWS:
NURSING :

Neuman believes nursing is concerned with the whole person. She views nursing as a
unique profession in that it is concerned with all of the variables affecting an
individuals response to stress. She has developed an assessment and intervention
tool to help with this task.

PERSON:
The Neuman systems model presents the concept of person as a client system that
may be an individual, family , group, community ( or) social issue.
The client system is dynamic composite of interrelationship among physiological,
psychological , socio- culture, developmental & spiritual factors.
The client system is viewed as being in constant change (or) motion and is seen as an
open system in reciprocal interaction with the environment.
HEALTH :
Neuman considers her work as a wellness model. She views health as a
continuum of well ness to illness that is dynamic in nature and constantly subject
to change. Harmony or balance of all the parts and subparts the client systems
Optimal wellness (or) stability indicates that total system needs are being met .
A reduced state of wellness is the result of unmet system needs.
The client is in a dynamic state of either wellness (or) illness, in varying degrees
at any given point in time.
ENVIRONEMENT:

 Environment and man are identified as the basic phenomena of the Neuman system
model, with the relationship between environment and man being reciprocal.
Environment is defined as being all the internal and external factors that surround ( or)
interact with man client
Significant to the concept of environment are stressor ( Intra, Inter, Extra personal )
which are identified as environment forces that interact with and potentially alter system
stability.
Neuman has identified relevant environments
Internal Environment
External Environment
Created Environment
Internal Environment - That is Intrapersonal with all interaction contained within the
client
External Environment- is Interpersonal ( or) intrapersonal with all interactions
occurring outside the client.
Created Environment : - is primary intrapersonal but also encompasses the external
environment that is subconsciously developed by the client as a Symbolic expression
of system wholeness
THEORETICAL ASSERTIONS
Theoretical assertions are the relations among the essential concepts of a model.
NURSE: An active participant with the client and as concerned with all the
variables affecting an individuals response to stressors.
CLIENT: He interacts with the environment by adjusting himself to it or
adjusting it to himself.
PROPOSITIONS
Although each individual client or group as a client system is unique, each system
is a composite of common known factors or innate characteristics within a
normal, given range of response contained within a basic structures.
Many known, unknown and universal environmental stressors exist. Each differs
in its potential for disturbing a clients usual stability level, or normal line of
defense.
The normal line of defense can be used as a standard from which to measure
health deviation.
The interrelationships of variables determines the nature and degree of system
reaction or possible reaction to the stressors

The client whether in a state of wellness or illness, is a dynamic composite of

interrelationships of 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 lines of
resistance.
The goal of health promotion is included in primary prevention
Secondary prevention relates to symptomatology following a reaction to stressors.
Tertiary prevention relates to the adjustive processes taking place as
reconstitution, maintenance factor, back to primary prevention.
Client system is in dynamic, constant energy exchange with the environment.
ACCEPTANCE BY THE NURSING COMMUNITY
The Neuman model has attained acceptance throughout the world & Provides an
ideal framework.
The model has been adopted equally well to all levels of nursing education & to a
wide variety of practice areas.

PRACTICE
Nurse facilitate goal directed, unified, wholistic approaches to client care.
Multidisciplinary approaches to prevent fragmentation of client care.
Classification of stressors that can be understood & used by all members of the
health care team.
Successfully used in many settings- Hospital, Nursing homes, Rehabilitation
centre, Hospices, &Child birth centre.
NEUMAN SYSTEM MODEL AND NURSING PROCESS
Neuman (1982,1995) presents three step nursing process.
Nursing diagnoses: Data base, identification of variances, hypothetical interventions
Nursing goals: care giver client negotiation of interventions to retain, attain or
maintain system stability
Nursing Outcomes: implementation and evaluation process.
EDUCATION
Its Wholistic perspective provides an effective framework for education of
nursing students.
Used for curriculum development.
This model is used as a comprehensive framework to organize data collection.
Levels of prevention as intervention are used to level content throughout courses
across the curriculum.
The model has demonstrated its effectiveness in supporting the conceptual
transition among levels of nursing education.
The model enabled students to study selected client populations as high risk and
to plan health prevention activities.
The models emphasis on wholism, system, prevention and wellness prompted
CAPTE to adopt it.

 This model is used to provide the conceptual frame work for multiple levels of
nursing and health related curricula around the world.
Acceptance by the nursing community is clearly evident.
RESEARCH
Neuman reports that her model is one of the three most frequently used models
for nursing research.
1987 42 studies.
1989-1993 more than 100 studies as organizing frame work.
The model has been used extensively to guide research to enhance the nursing
care of clients with specific physiological stressors.
The biennial Neuman system model symposia provide a forum for presentation of
research using this model.
This model has proved itself empirically, additional research is indicated to
validate the lines of defense and of resistance.
Research is indicated regarding spiritual variable, high risk population, provide
nursing care across cultural barriers, development and evaluation of primary
prevention
FURTHER DEVELOPMENT
The model diagram has remained unchanged because of continuous positive feed
back.
It allows for much creativity with the structure.
Two areas are identified for further clarification and development are concept of
health, relationship between client and environment.
Two components needed further development: spiritual variable and created
environment.
Future validity of the model depends on development and testing of middle-range
theory from it.
CRITIQUE
Neuman developed a comprehensive nursing conceptual model that
operationalizes system concepts for nursing relevant to the breadth of nursing
phenomena.
The models wholistic perspective allows for a wide range of nursing creativity in
its use.
Its comprehensive and flexible nature will allow for future structuring of all
nursing activities as it has proven to do in the past.
CLARITY
The models concepts of client, environment, health, and nursing congruent with
traditional values.Concept are used consistently throught the model.

SIMPLICITY
Multiple interactions and interrelationships organized in a complex yet logical manner,
tend to overlap to some degree.
Using the prevention concept within the framework, one can predict the origin of
stressors.
Nurses are using the model describe it as easy to understand and to use across cultures
and in a wide variety of settings.
GENERALITY
This model has been used in a wide variety of nursing situations; it is readily
adaptable and comprehensive enough to be useful in all health care settings,
including administration and research.
The social goals and utility of the model for example, Wholistic care,
prevention, and system concepts are congruent with present social values.
EMPRICAL PRECISION
Continued testing and refinement will increase the models empirical precision as
the research process, analysis, and synthesis of findings from multiple studies are
completed.
DERIVABLE CONSEQUENCES
The focus on primary prevention and inter disciplinary care facilities improved quality
of care and is futuristic. It is potential to generate nursing theories like theories of optimal
client stability .The model is broad and systemically based.