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Betty Neuman
Betty Neuman
"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.
Education
• 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
University-clinical
psychology.
History of the Neuman's Systems Model
• Developed in 1970 as a teaching
tool to integrate four variables of
man.
• 1974 - published and classified as a
systems model called "The Betty
Neuman Health-Care Systems
Model: A Total Approach to Patient
Problems"
Neuman, B. (1995). The Neuman systems model (3rd ed.). Norwalk, CT:
Appleton and Lange.
Key Concepts of the Neuman Systems
Model
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
Flexible line of defense:
-The outermost ring of
defense, prevents invasion
Lines ofof stressors.
resistance
Normal line of defense:
core
- Represents the client
Flexiblesystems normal or usual
line of wellness state.
defense
Lines of resistance:
- Involuntarily activated
when a stressor invades
Normal line
normal line of defense.
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.
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
environments.
Variance from wellness & illness according to
Betty Neuman
http://www.neumansystemsmodel.org/NSMdocs/nsm_powerpoint_overview.
htm
Variance from wellness Illness
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.
Betty Neuman's theory was designed for nursing, but now other parts
of the interdisciplinary health care team are beginning to use her
model
The influences of this model are deeply rooted in both philosophy and
psychology as they pertain to client health and well being
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.
Below are slides in which the Neuman model was used by a nurse to
care for a client. The information was taken from
nursingtheories.blogspot.com/2008/07/betty-neumans.html
• 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
that 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
is 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 well-
contemplated nursing care.
Case Study
Fig.1: http://nursing.jbpub.com/sitzman/art/Betty%20Neuman%27s
%20Systems%20Model.jpg
Links
http://nursing-theory.org/nursing-theorists/Betty-
Neuman.php
www.rno.org/journal/index.php/online-
journal/article/viewFile/76/73
nursingtheories.blogspot.com/2008/07/betty-neumans.html
http://www.neumansystemsmodel.org/
http://currentnursing.com/nursing_theory/application_Betty
_Neuman's model.html