BETTY NEUMAN

SYSTEMS THEORY IN NURSING PRACTICE

“Health is a condition in which all parts and subparts are in harmony with the
whole of the client.”

Background of the theorist

 Born in 1924 on a farm near Lowell, Ohio.

 1947 - Received RN Diploma from Peoples Hospital School of Nursing,
Akron, Ohio
 Moved to California and gained experience as a hospital, staff, and head
nurse; school nurse and industrial nurse; and as a clinical instructor in
medical-surgical, critical care and communicable disease nursing
 1972   Her model was first published in Nursing Research as a “Model for
teaching total person approach to patient problems”
 The model is based on philosphical views, Gestalt theory, Han’s Selye’s
stress theory & General System’s theory

General Information
 Systems Model “Neuman’s model focuses on the person as a complete
system, the subparts of which are interrelated physiological,
psychological, sociocultural, spiritual, and developmental factors.”
 Neuman’s model deals with stress & stress reduction & is primarily
concerned with the effects of stress on health

METAPARADIGM
Person
 Is viewed by Neuman as a whole multidimensional, dynamic system
 Can be an individual, family or group or community
 She sees a person as an open system that works together with other
parts of its body as it interact with the environment
* open system – characterized by presence of an exchange of
information & reaction with other factors surrounding a person
 Is composed of basic core (genetic features, and the strengths and
weaknesses of the system parts) as well as physiological, sociocultural,
developmental & spiritual variables
Health
 Neuman sees health as being equated with wellness.
 She defines health/wellness as "the condition in which all parts and
subparts (variables) are in harmony with the whole of the client (Neuman,
1995)".
 Views health as a continuum of wellness to illness that is dynamic in
nature & constantly subject to change
 “optimal wellness or stability indicates that total system needs are being
met”
 The client is in a dynamic state of either wellness or illness in varying
degrees at any given point of time.

Environment
 Defined as being all the internal & external factors that surround or
interact with person & client
*internal environment exists within the client system.
*external environment exists outside the client system.
 Includes stressor, described as environmental forces that interact with &
potentially alter system stability

Nursing
 Neuman believes nursing is concerned with whole person (holistic
approach), an approach that considers all factors affecting a client’s
health status.
 Views nursing as a unique profession that is concerned with all of the
variables affecting an individual’s response to stress.
 the primary aim is stability of the patient/client system, through nursing
interventions to reduce stressors.

Systems Model in Nursing Practice

A. ) Client Variables
 The client variables can be one or combination of the following:
* physiological , sociocultural, psychological, spiritual & developmental
 These variables function to achieve stability in relation to the
environmental stressors experienced by the client
B.) Lines of Resistance
 Represent the internal factors of a person that help defend against a
stressor ( e.g. body’s immune response system)
 It acts to facilitate coping to overcome the stressors that are present with
in the individual.
C.) Normal Line of Defense
 Represents a stability state for the individual or system
 It is maintained overtime & serves as a standard to assess deviations
from the client’s usual wellness
 It includes system variables & behaviors such as the individual’s usual
coping patterns, lifestyles, & developmental stage
D.) Flexible Line of Defense
 Acts as a protective barrier to prevent stressors from breaking through the
normal line of defense
 Is dynamic and can change rapidly over a short time
 Can be affected by variables such as loss of sleep, that reduce a client’s
ability to use a flexible line of defense against stressors.
E.) Stressors
 Are forces that produce tensions, alterations or a potential problems
causing instability with in the client’s system
 They may be:
1. Intrapersonal stressors – are those stimuli that occur within the
individual (e.g. emotions and feelings)
2. Interpersonal stressors – are those stimuli that occur between
individuals (e.g. pressures related to role expectation)
3. Extrapersonal stressors – are those stimuli that occur outside the
person (e.g. job or financial pressures)
F.) Reaction
 Are the outcomes or produced results of certain stressors & actions of the
lines of resistance of a client
 Can be positive or negative depending on the degree of reaction the client
produces to adjust & adapt with the situation
 Neuman specified these reactions as:
* negentropy – is set towards stability or wellness
* egentropy – is set towards disorganization of the system producing
illness
G.) Degree of Reaction
- Is the amount of energy required for the client to adjust to the stressors
H.) Prevention
 interventions are purposeful actions to help the client retain, attain & or
maintain system stability
 Used to attain balance within the continuum of health
 These are the actions that generate good results or aimed towards
hindering negative outcomes

3 Levels of Prevention
1. Primary Prevention
▪ Refers to intervention before a reaction occurs
▪ Is carried out when a stressor is suspected or identified
▪ It also aims to strengthen the capacity of a person to maintain an optimum
level of functioning while being interactive with the environment, like
health promotion & disease prevention
2. Secondary Prevention
▪ Refers to intervention after a reaction occurs
▪ Focuses on helping alleviate the actual existing effects of an action that
altered that balance of health of a person
▪ It aims to reduce environmental influences that lead to the decline of the
level of functioning of a person & strengthening or restoring a person’s
resistance after the illness exposure
▪ Examples: early detection of disease & prompt treatment
3. Tertiary Prevention
▪ Refers to intervention that occurs after the system has been treated
through secondary
▪ Focuses on actual treatments or adjustments to facilitate the
strengthening of a person after being exposed to a certain or illness
▪ It aims to prevent the reoccurrence of the illness in the manner of
rehabilitation, as in the case of disability avoidance & physical therapy
I.) Reconstitution
→ Is the adjustment state from the degree of reaction
→ It is a state of going back to the actual state of health before the
illness occurred.