Betty Neuman's Systems Model
Elizabeth Berkemeier, Jaime Ziemba &
Lindsey Randstadler
Unique focus of Neuman systems model
according to Betty Neuman, (2001)
"The Neuman system model reflects nursing's interest in well and ill
people as holistic systems and in environmental influences on
health. Clients' and nurses' perceptions of stressors and resources are
emphasized, and clients act in partnership with nurses to set goals and
identify relevant prevention interventions. The individual, family or
other group, community or social issues, all are client systems which
are viewed as composites of interacting physiological, psychological,
sociocultural, developmental and spiritual variables" (p. 322).
What shaped Betty Neuman
Born in 1924 on a farm in rural Ohio - this background helped her
develop compassion for those in need.
• 1947- RN from diploma
program in OH
• 1957-BSN, UCLA mental
health & public health
• 1966-MSN, UCLA
• 1967-1973, UCLA faculty.
• Developed first community
mental health program for
graduate students at UCLA.
• 1985- PhD Western Pacific
History of the Neuman's Systems Model
• Developed in 1970 as a teaching
tool to integrate four variables of
• 1974 - published and classified as a
systems model called "The Betty
Neuman Health-Care Systems
Model: A Total Approach to Patient
• Published first book detailing NSM in 1982. Notable change:
"patient" now referred to as "client"
• The Neuman Systems Model, 2nd ed.,1989. Spiritual variable
added to diagram as fifth variable.
• 3rd, 4th & 5th editions of The Neuman Systems Model published
in 1995, 2002 & 2010
Who and what influenced the NSM?
• The writings of philospher de Chardin on the wholeness
of life.
• Marxist Cornu's views on the oneness of man and
• Gestalts theories on the interaction between man and the
• Von Bertalannfy's, Emery's and Lazarus' views on
• Selye's concept of stress and Caplan's levels of
Fawcett, J. (2001). The nurse theorists: 21st-century updates-Betty Neuman.
Nursing Science Quarterly, 14(3), 211-214.
More on the origins of NSM
(Neuman, 1995)
"The development of the wholistic systemic perspective of the
Neuman systems model was motivated by my own basic philosphy of
helping each other live, many diverse observations and clinical
experiences in teaching and encouraging positive aspects of human
variables in a wide variety of community settings, and theoretical
perspectives and stress related to the interactive, interrelated,
interdependent, and wholistic nature of systems theory. The
significance of perception and behavioral consequences [also] cannot
be overestimated" (p. 675-676)
Neuman, B. (1995). The Neuman systems model (3rd ed.). Norwalk, CT:
Appleton and Lange.
Key Concepts of the Neuman Systems
Each client system is made up of 5 variables
Physiological variables
o bodily structure & function
Psychological variables
o mental processes & relationships
Sociocultural variables
o social & cultural funtions
Developmental variables
o developmental processes of life
Spiritual variables
o continuum of spirituality - from complete
unawareness to full spiritual understanding.
Client system as a core
Lines of
Flexible line of defense:
-The outermost ring of
defense, prevents invasion
of stressors.
Normal line of defense:
- Represents the client
systems normal or usual
line of
wellness state.
Normal line
of defense
Lines of resistance:
- Involuntarily activated
when a stressor invades
normal line of defense.
Environment and Stressors
Internal environment-all forces or influences internal to or
contained within the boundaries of the defined client system, the
source of intrapersonal stressors.
External environment-all forces or
influences external to or outside the client
system, the source of interpersonal and
extrapersonal stressors.
Created environment-subconsciously
developed by the client as a symbolic
expression of system wholeness. Acts as
a safety mechanism to block the reality
of the environment and health experience.
Supercedes the internal and external
Variance from wellness & illness according to
Betty Neuman
Variance from wellness
• Varying degrees of system
• The difference from the
usual or normal wellness
• Illness is a state of
insufficiency with disrupting
needs unsatisfied
• Illness is an excessive
expenditure of energy…
when more energy is used by
the system in its state of
disorganization than is built
and stored, the outcome may
be death
Nursing implications of the NSM
Neuman's Systems Model Nursing Process Format
1. Nursing diagnosis: determined on the basis of
assessment of the variables and lines of defense and
resistance that make up the specific client system.
2. Nursing goals: determined with the client for desired
prescriptive changes to correct variances from wellness.
3. Nursing outcomes: Nursing interventions are
implemented using one or more of the prevention as
intervention methods.
How it's done: Prevention as Intervention
Primary prevention as intervention- nursing actions
preventing stressor invasion; providing resources to retain or strengthen existing
client/client system strengths; supporting positive coping and functioning;
motivating the client system toward wellness; educating the client system
• Secondary prevention as intervention-nursing actions
protecting the client system's basic structure; mobilizing and optimizing the client
system's internal and external resources to attain stability and energy
conservation; facilitating purposeful manipulation of stressors and reactions to
stressors; motivating, educating, and involving the client system in mutual
establishment of health care goals; facilitating appropriate treatment and
intervention measures
Tertiary prevention as intervention-nursing actions
attaining and maintaining the highest possible level of client system wellness and
stability during reconstitution; educating, reeducating, and/or reorienting the client
system as needed; supporting the client system toward appropriate goals;
coordinating and integrating health services resources; providing primary and/or
secondary preventive intervention as required. The nurse evaluates the outcome
goals by: confirming attainment of outcome goals with the client system and
reformulating goals as necessary with the client system
Fig. 1
"A total person approach to viewing patient problems"
(Neuman and Young, 1972)
Global Concepts
Human being- The client. Viewed as a whole, dynamic. Individuals
interact with their environment, and everything in the environment
relates to the individual.
Environment- Both external and internal. Environment is dynamic,
and this influences the client.
Health- The result of clients interaction with their environment.
Maintained by lines of defenses within the client.
Nursing- Focuses on all aspects of life and problem solving for
clients using one of three levels of prevention while viewing the client
as an integrated being. (Bott, Duke, Marett & Memmott, 2000)
What's the point? Was she just another
Neuman System Model grew out of a movement in the 1970's and
1980's that began to recognize the patients as whole systems. With the
growing complexity of medicine, health care became more
fragmented (Bott, et al).
This is where Betty comes in. Her views were shaped by the
emerging health care practices at the time, which included taking a
broader look at patients and their needs. Also around this time the
hospice movement took place.
Neuman System Model has been criticized for being to complicated,
broad and abstract. With increasing complexity of our health and
managing major illnesses, this model is becoming more relevant in
the 21st century (Bott, et al).
So what do we do with it?
Neuman System Theory has a way of mashing all the global concepts
together. You really have to look at the individual situation to define
the concepts for that specific situation. They will change every time;
they are dynamic.
This model can be used for any situation at any given time. It is broad
and abstract, but relevant and applicable.
This system seems to be particularly useful for hospice and case
management nursing. It is well suited to not only serve an individual
client, but also families, groups and communities because of its
Nursing and Beyond
Betty Neuman's theory was designed for nursing, but now other parts
of the interdisciplinary health care team are beginning to use her
Members of the interdisciplinary health care team may include:
 physicians
 physical therapy
 occupational therapy
 respiratory therapy
 speech therapy
 psychologists
 lab, x-ray
What/Who Influenced Betty Neuman?
The influences of this model are deeply rooted in both philosophy and
psychology as they pertain to client health and well being
The influences of Betty Neuman were:
 Pierre Tielhard deChardin
 Gestalt Theory
 General Adaptation Syndrome
 General Systems Theory
Are the Global Concepts Represented?
The overall contributions of the model to the discipline of nursing are
summarized by Neuman:
 "The Neuman's System Model fits well with the wholistic
concept of optimizing a dynamic yet stable
interrelationship of spirit, mind, and body of the client in
a constantly changing environment and society" (Neuman
& Young, 1972).
Narrow View?
Betty Neuman designed her model around the idea that it is universal
and can be adapted to many situations involving a client and the
client's stress and their reaction to it.
This model can be used in the OB and OR situation. The client, as
well as their families, have much stress in both situations. The nurse
will be able to implement the three levels of prevention:
1. Protects the normal line and strengthens the flexible line of defense
2. Strengthens the internal lines of resistance
3. Readapt, stabilizes, and protects the client's return to wellness after
Practice Situation #1
Below are slides in which the Neuman model was used by a nurse to
care for a client. The information was taken from
About a week ago I had in my care the wife of the captain of the ill-fated Princess of the Stars. In this case, I was able to identify the
following stressors:
1. Psychological-Emotional:
Anxiety which stemmed from the uncertainty about the fate of her husband.
A sense of guilt because relatives of the passengers are blaming her husband for the tragedy.
Ambivalence in the sense that she would be happy if her husband survived and at the same time worried too
if he did survive he would be subjected to court litigation.
2. Financial Stress: Her husband is the breadwinner of the family and in a brood of 5 children, only one
employed; the rest are still in school.
3. Physical Stress manifested as:
a. Insomnia
b. Elevated blood pressure unresponsive to maintenance medications
c. Persistent chest pains
(continued on next slide)
Practice Situation #1
Nursing interventions are carried out on three preventive levels:
• Primary Prevention would not be applicable because the accident causing the stressors has
already occurred and the patient has already developed the reactions/symptoms of stress.
• Secondary Prevention is applicable in this case. Because of the persistent elevated blood pressure
( above 200/110) accompanied by severe chest pains, the patient was admitted to the hospital for
both diagnostic and therapeutic management. Nursing intervention centered initially on the round
the clock monitoring of the blood pressure and giving of the ordered anti- hypertensive drugs. Since
the EKG showed ischemia, the patient was closely watched for worsening of the pain because of the
possibility of a myocardial infarction. Immediate referral of the patient to the resident physician is
to be made if chest pain persisted despite giving isosorbide dinitrate for proper evaluation. Aside
from giving anxiolytics to decrease the anxiety of the patient, I have to warn visiting relatives to
refrain from talking about the tragedy. Sedatives were given before bedtime to prevent insomnia.
• Tertiary Prevention: Upon discharge, I gave the patient and the immediate family members the
following advice:
1. If possible to stay in a relative’s house for a few weeks because they were being hounded by media
who were camped outside their home.
2. Regular monitoring of the patient’s blood pressure by a daughter who is a student-nurse who
should also monitor her intake of medications as prescribed by the physician.
3. Avoid watching TV shows that mention about the tragedy.
4. Avoid answering the phone.
5. She should have a close relative with her aside from the children who will manage their affairs in
the meantime.
Practice Situation #2
In the Community...
In one of the rotations of my students in the community, we encountered this very interesting newly
married young couple (both are 18 years old). They have been married only for 3 months, but the
supposed to be happy pair is already facing a lot of stressors.
One condition that brings extrapersonal stress is the unemployment of the husband. Their financial
source is not enough to meet their needs. The woman somzd enough for her son. This relationship poses
as an interpersonal stress to her.
The wife is also pregnant at that time, and her poor nutritional (underweight) and emotional status
(sadness and anger at her mother-in-law) create intrapersonal stresses.
We know, based on Neuman’s Systems Model, that the reaction to stressors would depend on the
strength of the lines of defense. The woman, due to financial constraints, is suffering from poor
nutritional status. She usually lacks enough sleep due to the nature of her work. This creates a breach to
her flexible line of defense. The normal line of defense also becomes unreliable because of her uncaring
attitude toward her pregnancy and sexual behaviors that predispose her to a lot of possible illnesses.
Her coping abilities are also affected because she is sometimes preoccupied with her relationship
problems with her mother-in-law.
Practice Situation #2
These conditions put not only our client but also her unborn child on the verge of developing various
illnesses. Hence, our interventions focused on restoring system stability, by helping the client’s system
adapt to the stressors.
Starting with primary prevention, we tried to educate their family on the importance of having good
nutrition. We suggested some nutritious but cheap food choices. We also tried to advice her on possible
alternative jobs that would not jeopardize her health and that of her unborn baby.
For the secondary prevention, we advised that she seek pre-natal check-up, and make use of the
available services of the nearby health center.
After about 1 month of constant visits to these clients, we really observed noticeable improvements in
their health conditions. The woman began to show weight gains consistent with her age of gestation. The
couple has also learned to plant and eat nutritious food such as fruits and vegetables. The husband
started to work as a production operator in a nearby factory, allowing his wife to take a break from her
old job.
Before our duty in the community ended, we were able to initiate tertiary prevention by supporting and
commending the positive behavioral changes exhibited by the couple. We also dwelt on strengthening the
positive attributes of the family, such as their unwavering faith in God, and their strong devotion to each
other. We learned from this experience that no problem is unsolvable with the use of consistent and wellcontemplated nursing care.
Case Study
Sally, a nurse for community mental health is caring for 3 clients
today. First, she meets Sam. Sam has been admitted to a psychiatric
unit with a diagnosis of psychosis and schizophrenia. Sally provides
Sam with appropriate interventions to help stabilize his condition,
monitors his compliance with medication and conducts therapy
1. Sally is using what level of prevention according to the Neuman
Systems Model?
2. Give a few examples of nursing actions using Tertiary preventions
as interventions.
Bott, R., Duke, L., Marett, K., Memmot, R. (2002). Use of the
Neuman Systems Model for interdisciplinary teams. Online
Journal of Rural Nursing and Health Care. 1(2) 35-43.
Fawcett, J. Appendix N1: Conceptual models and theories
of nursing. (n.d.). In Tabers Cyclopedic Medical Dictionary
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Kozier, B. et. Al (2004). Fundamentals ofNursing:Concepts,Process,
and Practice (4th ed.) New Jersey: Pearson
Marriner-Tomey, A. (1994). Nursing Theorists and Their Work (2nd
edition). St. Louis: Mosby
Neuman, B., & Fawcett, J. (Eds.). (2011). The Neuman systems
model (5th ed.). Upper Saddle River, NJ: Pearson.
Neuman, B., & Young, R.J. (1972). A model for teaching total
person approach to patient problems. Nursing Research 21,
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Betty Neuman`s Systems Model