Betty Neuman
Betty Neuman
Betty Neuman
Education
As a young girl, she attended the same one-room schoolhouse that her parents
had attended and were excited to go to a high school library. She was always
engaged and fascinated with the study of human behavior. During World War II,
she had her first job as an aircraft instrument technician. In 1947, she received her
RN Diploma from Peoples Hospital School of Nursing, Akron, Ohio.
She also earned a master’s degree in mental health, public health consultation in
1966 from the University of California, Los Angeles (UCLA). After her graduation,
she was hired as a department chair in the UCLA School of Nursing graduate
program. Neuman developed the first community mental health program for
graduate students in the LA area from 1967 to 1973.
Image via neumansystemsmodel.org
In 1985, Betty Neuman concluded a doctoral degree in clinical psychology at
Pacific Western University. She was a pioneer of nursing involvement in mental
health. She and Donna Aquilina were the first two nurses to develop the nurse
counselor role within community crisis centers in Los Angeles.
In 1972, Neuman published a draft of her model. She developed and improved
the concepts and published her book, The Neuman System Model: Application to
Nursing Education and Practice, in 1982. She made further revisions in later
editions. As a speaker and author, she spent countless hours teaching and
explaining the model’s many concepts and aspects to students and professors.
Neuman with her colleagues | neumansystemsmodel.org
Neuman has also been involved in numerous publications, paper presentations,
consultations, lectures, and conferences on applying and using the model. She
worked as a consultant nationally and internationally concerning implementing
the nursing education programs and clinical practice facilities model.
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The Neuman Systems Model views the client as an open system that responds to
stressors in the environment. The client variables are physiological, psychological,
sociocultural, developmental, and spiritual. The client system consists of a basic
or core structure that is protected by lines of resistance. The usual health level is
identified as the normal defense line protected by a flexible line of defense.
Stressors are intra-, inter-, and extra personal in nature and arise from the
internal, external, and created environments. When stressors break through the
flexible line of defense, the system is invaded, and the lines of resistance are
activated. The system is described as moving into illness on a wellness-illness
continuum. If adequate energy is available, the system will be reconstituted with
the normal defense line restored at, below, or above its previous level.
Assumptions
The following are the assumptions or “accepted truths” made by Neuman’s
Systems Model:
Each client system is unique, a composite of factors and characteristics
within a given range of responses.
Many known, unknown, and universal stressors exist. Each differs in its
potential for disturbing a client’s usual stability level or normal line of
defense. The particular interrelationships of client variables at any point in
time can affect the degree to which a client is protected by the flexible line
of defense against possible reaction to stressors.
Each client/client system has evolved a normal range of responses to the
environment referred to as a normal line of defense. The normal line of
defense can be used as a standard from which to measure health deviation.
When the flexible line of defense is no longer capable of protecting the
client/client system against an environmental stressor, the stressor breaks
through the normal line of defense.
Whether in a state of wellness or illness, the client is a dynamic composite
of the variables’ interrelationships. Wellness is on a continuum of available
energy to support the system in an optimal system stability state.
Implicit within each client system is internal resistance factors known as
lines of resistance, which function to stabilize and realign the client to the
usual wellness state.
Primary prevention relates to general knowledge applied in client
assessment and intervention in identifying and reducing or mitigating
possible or actual risk factors associated with environmental stressors to
prevent a possible reaction.
Secondary prevention relates to symptomatology following a reaction to
stressors, an appropriate ranking of intervention priorities, and treatment
to reduce their noxious effects.
Tertiary prevention relates to the adjustive processes as reconstitution
begins and maintenance factors move the client back in a circular manner
toward primary prevention.
The client as a system is in dynamic, constant energy exchange with the
environment. (Neuman, 1995)
Environment
The environment is a vital arena that is germane to the system and its function.
The environment may be viewed as all factors that affect and are affected by the
system. In Neuman Systems Model identifies three relevant environments: (1)
internal, (2) external, and (3) created.
The internal environment exists within the client system. All forces and
interactive influences that are solely within the client system’s boundaries
make up this environment.
The external environment exists outside the client system.
The created environment is unconsciously developed and is used by the
client to support protective coping.
Health
In Neuman’s nursing theory, Health is defined as 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. When needs are not satisfied,
illness exists. When the energy needed to support life is not available, death
occurs.
Nursing
Nursing’s primary concern is to define the appropriate action in situations that
are stress-related or concerning possible reactions of the client or client system
to stressors. Nursing interventions aim to help the system adapt or adjust and
retain, restore, or maintain some degree of stability between the client system
variables and environmental stressors, focusing on conserving energy.
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Open System
A system in which there is a continuous flow of input and process, output and
feedback. It is a system of organized complexity, where all elements are in
interaction.
Client Variables
Neuman views the individual client holistically and considers the variables
simultaneously and comprehensively.
Degree of Reaction
The amount of system instability resulting from stressor invasion of the normal
line of defense.
Entropy
A process of energy depletion and disorganization moving the system toward
illness or possible death.
Negentropy
An energy conservation process that increases organization and complexity,
moving the system toward stability or a higher degree of wellness.
Input/Output
The matter, energy, and information exchanged between the client and
environment entering or leaving the system at any point in time.
Reconstitution
Following treatment of stressor reaction, the return and maintenance of system
stability may result in a higher or lower wellness level.
Prevention as Intervention
Intervention modes for nursing action and determinants for both client and nurse
entry into the health care system.
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Strengths
The Neuman Systems Model’s major strength is its flexibility for use in all
areas of nursing – administration, education, and practice.
Neuman has presented a view of the client equally applicable to an
individual, a family, a group, a community, or any other aggregate.
The Neuman Systems Model, particularly presented in the model diagram,
is logically consistent.
The emphasis on primary prevention, including health promotion, is
specific to this model.
Once understood, the Neuman Systems Model is relatively simple and has
readily acceptable definitions of its components.
Weaknesses
The major weakness of the model is the need for further clarification of the
terms used.
Interpersonal and extrapersonal stressors need to be more clearly
differentiated.
Analysis
The delineation of Neuman’s three defense lines was not clearly explained. In
reality, the individual resists stressors with internal and external reflexes, which
were made complicated by the formulation of different resistance levels in
Neuman’s open systems model.
Neuman made mention of energy sources in her model as part of the basic
structure. It can be more of help when Neuman has enumerated all the energy
sources that she is about. With such, new nursing interventions regarding the
provision of the client’s needed energy can be conceptualized.