BETTY NEUMAN

“Health is a condition in which all parts and subparts are in

harmony with the whole of the client“

System Model in Nursing Practice

❖ The Neuman systems model is based on stress and the client’s reaction to the stressor. In thismodel the
client is the individual, group, family, or community.
❖ The system is composed of five concepts that interact with one another: physio- logical,
psychological, sociocultural, developmental, and spiritual.
❖ These concepts interact with both internal and external environmental factors and all levels of
prevention (primary, secondary, and tertiary) to achieve optimal wellness. Neumanconsiders any
internal and external factors as stressors that affect the patient’s stability andany or all of the five
system concepts.
❖ The role of nursing is to stabilize the patient or situation. When you apply the Neumansystems
model, you assess the stressor and the patient’s response to the stressor, identify nursing diagnoses,
plan patient-centered care, implement interventions, evaluate the patient’s response, and
determine if the stressor is resolved.
❖ Her theory incorporated the concept of a whole person and an open system approach.
❖ The concept is aimed towards the development of a person in a state of wellness havingthe
capacity to function optimally.
The main role of the nurse in her theory is to help a person to adapt with environmentalstimuli causing
illnesses back to a state of wellness.

Terms Related to Neuman’s System Theory

Client Variables
i. The clients’ variables can be one or combination of the following:
- Physiological
- Sociocultural
- Developmental
- Spiritual.
ii. These variables function to achieve stability in relation to the environmentalstressors
experienced by the client.
Lines of Resistance
i. . Lines of Resistance act when the Normal Line of Defense is invaded by toomuch stressor,
producing alterations in the client’s health.
Normal Line of Defense
i. To achieve the stability of the system, the Normal Line of Defense must act incoordination with the
normal wellness state. It must reflect the actual range of responses that is normally acted by
clients in response to any stressors. It isthe baseline in determining the level of client within the
continuum of health.
Flexible Line of Disease
i. It serves as a boundary for the Normal Line of Defense to adjust to situationsthat threaten the
imbalance withinthe client’s stability.
Stressors
i. These are forces that produce tensions, alterations or potential problemscausing instability
within the client’s system.
Reaction
i. These are the outcomes or produced results of certain stressors and actionsof the lines
resistance of a client.
ii. It can be positive or negative depending on the degree of reaction the clientproduces to adjust
 and adapt with the situation.
iii. Neuman specified these reaction negentropy or entropy.
a. Negentropy is set towards stability or wellness while
b. Entropy is set towards disorganization of the system producing illness.

THE NEUMAN SYSTEMS MODEL The goal of the model was to provide a wholistic
overview of the physiological, psychological,
sociocultural, and developmental aspects of human
beings.

Neuman Systems Model’s two major components are

stress and the reaction to stress. The client in
Neuman Systems Model is viewed as an open system in
which repeated cycles of input, process, output and
feedback constitute a dynamic organizational
pattern. Using the systems perspective, the client
may be an individual, a group, a family, a
community, or any aggregate. As they become
more complex, the internal conditions of
regulation become more complex. Exchanges with
the environment are reciprocal; both the client and
the environment may be affected either positively
or negatively by the other. The system may adjust
to the environment or adjust theenvironment to
itself.

MAJOR CONCEPTS:
I. PERSON VARIABLES
Each layer, or concentric circle, of the Neuman model is made up of the five person variables.Ideally,
each of the person variables should be considered simultaneously and comprehensively.
1. Physiological - refers of the physicochemical structure and function of the body
2. Psychological - refers to mental processes and emotions
3. Sociocultural - refers to relationships; and social/cultural expectations and activities
4. Spiritual - refers to the influence of spiritual beliefs
5. Developmental - refers to those processes related to development over the lifespan
II. CENTRAL CORE
The basic structure, or central core, is made up of the basic survival factors that are common to the
species (Neuman, 1995, in George, 1996). These factors include: system variables, genetic features, and
the strengths and weaknesses of the system parts. Examples of these may include: hair color, body
temperature regulation ability, functioning of body systems homeostatically, cognitive ability,
physical strength, and value systems. The person's system is an open system andtherefore is dynamic and
constantly changing and evolving. Stability, or homeostasis, occurswhen the amount of energy that
is available exceeds that being used by the system. A homeostatic body system is constantly in a
dynamic process of input, output, feedback, and compensation, which leads to a state of balance.

III. FLEXIBLE LINES OF DEFENSE

The flexible line of defense is the outer barrier or cushion to the normal line of defense, the line of
resistance, and the core structure. If the flexible line of defense fails to provide adequate
protection to the normal line of defense, the lines of resistance become activated. The flexible lineof
defense acts as a cushion and is described as accordion-like as it expands away from or contracts
closer to the normal line of defense. The flexible line of defense is dynamic and can be changed/altered
in a relatively short period of time.

V. NORMAL LINE OF DEFENSE

The normal line of defense represents system stability over time. It is considered to be the usual level of
stability in the system. The normal line of defense can change over time in response to coping or
responding to the environment. An example is skin, which is stable and fairly constant, but can thicken
into a callus over time.

V. LINES OF RESISTANCE
The lines of resistance protect the basic structure and become activated when environmental
stressors invade the normal line of defense. Example: activation of the immune response after
invasion of microorganisms. If the lines of resistance are effective, the system can reconstitute andif the
lines of resistance are not effective, the resulting energy loss can result in death.

VI. RECONSTITUTION
Reconstitution is the increase in energy that occurs in relation to the degree of reaction to the
stressor. Reconstitution begins at any point following initiation of treatment for invasion of stressors.
Reconstitution may expand the normal line of defense beyond its previous level, stabilize thesystem
at a lower level, or return it to the level that existed before the illness.

VII.STRESSORS
The Neuman Systems Model looks at the impact of stressors on health and addresses stress and the
reduction of stress (in the form of stressors). Stressors are capable of having either a positive or negative
effect on the client system. A stressor is any environmental force which can potentially affect the
stability of the system: they may be:
• Intrapersonal - occur within person, e.g. emotions and feelings
• Interpersonal - occur between individuals, e.g. role expectations
• Extra personal - occur outside the individual, e.g. job or finance pressures
The person has a certain degree of reaction to any given stressor at any given time. The nature ofthe
reaction depends in part on the strength of the lines of resistance and defense. By means of primary,
secondary and tertiary interventions, the person (or the nurse) attempts to restore ormaintain the
stability of the system.
VIII. PREVENTION
As defined by Neuman's model, prevention is the primary nursing intervention. Prevention focuses on
keeping stressors and the stress response from having a detrimental effect on the body.
• Primary -Primary prevention occurs before the system reacts to a stressor. On the one hand, it
strengthens the person (primarily the flexible line of defense) to enable him to better dealwith
stressors, and on the other hand manipulates the environment to reduce or weakenstressors.
Primary prevention includes health promotion and maintenance of wellness.
• Secondary-Secondary prevention occurs after the system reacts to a stressor and is provided
in terms of existing systems. Secondary prevention focuses on preventing damageto the central
core by strengthening the internal lines of resistance and/or removing thestressor.
• Tertiary -Tertiary prevention occurs after the system has been treated through secondary
prevention strategies. Tertiary prevention offers support to the client and attempts to add
energy to the system or reduce energy needed in order to facilitate reconstitution.

NURSING METAPARADIGM
Person
o The person is a layered multidimensional being. Each layer consists of five personvariables or
subsystems:
i. Physical/Physiological
ii. Psychologicayuyuuuuuu
iii. Socio-cultural
iv. Developmental
v. Spiritual
o Neuman sees a person as an open system that works together with other parts of itsbody as it
interacts with the environment
o an open system that interacts with both internal and external environmental forces or stressors.
Open system is characterized by the presence of an exchange of information and reaction with
other factors surrounding a person.
o The human being is in constant change, moving toward a dynamic state of systemstability or
toward illness or varying degrees.
Health
o “Health is a condition in which all parts and subparts (variables) are in harmony with thewhole of
the client.”
o considers health as dynamic in nature in which the person’s health is at the level ofhealth
continuum—wellness or illness.
o equated with wellness
o Wellness exists when all the part or system of person works harmoniously.
o the condition or degree of system stability and is viewed as a continuum from wellness to illness
o Neuman proposes a wellness-illness continuum, with the person's position on that continuum
being influenced by their interaction with the variables and the stressors they encounter. The
client system moves toward illness and death when more energy isneeded than is available. The
client system moves toward wellness when more energiesavailable than is needed.
Environment
o the totality of the internal and external forces which surround a person and with which they
interact at any given time. These forces include the intrapersonal, interpersonal and extra
personal stressors which can affect the person's normal line of defense and so can affect the
stability of the system.
- INTERNAL ENVIRONMENT – exists within the system; all forces and interactive influences
that are solely within the boundaries of the clientsystem
- EXTERNAL ENVIRONMENT – exists outside the client system.
- CREATED ENVIRONMENT – developed unconsciously by the client and is symbolic of system
wholeness; it represents the open system exchange ofenergy with both the internal and external
environments.
Nursing
o a unique profession that is concerned with all of the variables which influence the response a
person might have to a stressor
o Neuman believes that nursing requires a holistic approach that considers all factorsaffecting
a client's health—physical, physiological, psychological, mental, social, cultural, developmental
and spiritual well-being.
o actions which assist individuals, families and groups to maintain a maximum level ofwellness,
and the primary aim is stability of the patient/client system, through nursing interventions to
reduce stressors
o The primary concern of NURSING is to define the appropriate action in situations thatare stress
related or in relation to possible reactions of the client or client systems tostressors.