Dr. Betty Neuman spent many years developing and perfecting her nursing theory, the
Neuman Systems Model. She initially developed the theory while she was teaching graduate
nursing students at the University of California, Los Angeles (UCLA). Her goal was to
create an understanding of nursing that would separate it from the medical model. First
introduced in 1972, she spent years defining and perfecting the theory. Her first book,
The Neuman Systems Model, was published in 1982, and she revised the theory in each of
four later editions.
Dr. Neuman's theory presents the patient from a holistic perspective. She studied the
works of a number of theorists and philosophers and incorporated some of their thoughts
into her theory, forming an integrated system that applies to nursing practice.
There are many layers in the Neuman Systems Model. Her basic assumptions recognize
that each person and situation is different, and stress could affect each in multiple
ways. She included Caplan's concepts of preventing and lowering stress.
- The Gestalt theory describes how people maintain equilibrium in their lives by
homeostasis. If reactions to different situations are in balance, the body stays healthy,
but if a person allows reactions to create an imbalance, illness will occur.
- The Marx philosophy considers the characteristics of parts of the body to be components of the larger whole.
- The deChardin philosophy describes the wholeness of life.
- Selye's theory states that stress can be either positive or negative.
- Caplan's concept describes the prevention of harm by lowering the effects of stress.
- Each person is unique with different characteristics.
- Many stressors exist that differ in their potential for disturbing a person's normal equilibrium.
- Variable interrelationships can affect a person's reaction to stress at any time.
- Each person has a normal line of defense to stressors in the environment. This line of defense can be used to measure the variation from health.
- The line of defense is broken when it cannot protect the person from the environment.
- Whether a person is healthy or ill, variable interrelationships form active components of the whole. The available energy supports the stability of the system.
- The internal line of defense serves to stabilize and restore the person to wellness.
- Primary prevention of stress is identified and addressed in the assessment of the person.
- Secondary prevention of stress reduces its effects by intervention and treatment.
- Tertiary prevention is the reduction of effects on the body after treatment has occurred.
- A person has a constant and active relationship with the environment.
- The unique characteristics of the person interacting with the internal and external environment comprise the patient system.
- Basic system energy and resources influence patient survival.
- The central core includes basic survival factors that include vital signs, organ strength, response pattern and ego strength.
- Equilibrium is achieved when the amount of available energy is more than the energy being used by the system.
- The active process of input, output, compensation and feedback influences the stability of the body system.
- Instability of the system is influenced by the amount of stressors on the line of defense.
- Depletion of energy and disorders of the system move a patient to illness and possible death.
- A flexible mechanism protects the normal line of defense from the invasion of stress.
- The normal line of defense represents the patients customary state of health and can increase or decrease over time.
- Protective factors are activated when stressors invade the normal line of defense. Examples of these are increased white blood cell counts and immune system activation.
- There is information and energy input and output between the patient and environment at all times.
- The system moves toward equilibrium and health through a process of energy conservation.
- An open system is present when all of the elements are interacting with an ongoing flow of input and output, process and feedback.
- Prevention of stress is used as an intervention by both patient and nurse.
- Reconstitution is the return and upkeep of system equilibrium following treatment. It may result in a higher or lower level of health.
- Stability is the balance of energy exchanges as the patient effectively copes with stressors to preserve system wholeness.
- Stressors are factors in the environment that have the potential for disturbing the stability of the system.
- A stressor is anything that can penetrate either the flexible or the normal line of defense and cause a positive or negative consequence.
- Wellness means that the whole system of the patient is in agreement including all parts and subparts.
- The state of illness means that needs of the system are unsatisfied.
- The most important nursing intervention is prevention of stress.
- The focus of the nursing process is to keep stressors from having a harmful effect on the body.
- The patient system is layered and has many dimensions.
- Each layer has five subsystems: physiological, psychological, sociocultural, developmental and spiritual.
- The environment is the total of the internal and external forces surrounding a person at any given time. These forces are intrapersonal, interpersonal and extrapersonal.
- The internal environment is within the patient.
- The external environment is outside the patient.
- The created environment is unconsciously formed by the patient and is a symbol of system wholeness.
- Health is synonymous with wellness and is the state in which all parts and subparts agree.
- When more energy is needed than is available, the system moves toward illness.
- When more energy is available than needed, the system moves toward health.
- Nursing is concerned with everything that influences responses to stressors.
- Nursing addresses the whole person.
- Nursing helps patients, families and groups maintain maximum health, and their primary purpose is intervention that reduces stressors and promotes equilibrium.
- The nurse uses primary, secondary and tertiary preventive interventions to influence the reaction to stressors.
Dr. Neuman's Systems Model is multilayered. The three levels of prevention are very
important. The primary prevention focuses on foreknowing the result of a situation
and preventing its effects. This is very valuable in health education and disease
prevention. Examples of secondary prevention are early disease detection and prompt
treatment of disease. Tertiary prevention gives attention to interventions and treatments
and tries to prevent the recurrence of the disease.
In practice, the theory is a holistic approach to patient care. It is comprehensive,
easy to use and general enough to be used in any health care setting. It provides
guidelines for professional nurses and works with the nursing process of assessment,
nursing diagnosis, care planning, implementation and evaluation.
- The nurse actively interacts with patients and addresses everything that affects their reactions to stressors.
- Patients adapt to the environment by adjusting to it or by adjusting it to themselves.
- The four nursing paradigms of person, environment, health and nursing are linked to primary, secondary and tertiary preventions of stress.
Publications related to Betty Neuman's Systems Model
- The Neuman Systems Model (5th Edition)
- Nursing Theories and Nursing Practice
- Conceptual Models for Nursing Practice
- Neuman, B. and Young, R. J. A Model for Teaching Total Person Approach to Patient Problems, Nursing Research, 1972
- Neuman, B. The Neuman Systems Model: Its Importance for Nursing, Senior Nurse, 1985
- Neuman, B. Health as a Continuum Based on the Neuman Systems Model, Nursing Science Quarterly, 1990
- Neuman, B. The Neuman Systems Model in Research and Practice, Nursing Science Quarterly, 1996