Betty Neuman 

(1924 – present) is a nursing theorist who developed

the Neuman Systems Model. She gave many years perfecting a systems model
that views patients holistically. She inquired about theories from several theorists
and philosophers and applied her knowledge in clinical and teaching expertise to
develop the Neuman Systems Model that has been accepted, adopted, and
applied as a core for nursing curriculum in many areas worldwide.

 Biography of Betty Neuman

o Early Life
o Education
o Nursing Career of Betty Neuman
o Works of Betty Neuman
o Awards and Honors of Betty Neuman
 Betty Neuman’s Nursing Theory
o What is the Neuman Systems Model?
o Assumptions
o Major Concepts of Neuman Systems Model
 Human being
 Environment
 Health
 Nursing
 Open System
 Basic Stricture and Energy Resources
 Client Variables
 Flexible line of defense
 Normal line of defense
 Lines of resistance
o Subconcepts of Neuman Systems Model
 Stressors
 Stability
 Degree of Reaction
 Entropy
 Negentropy
 Input/Output
 Reconstitution
 Prevention as Intervention
o Strengths and Weaknesses
  Strengths
 Weaknesses
o Analysis
 See Also
 References
 External Links

Biography of Betty Neuman

Early Life
Betty Neuman was born in 1924 near Lowell, Ohio. She grew up on a farm which
later encouraged her to help people who are in need. Her father was a farmer
who became sick and died at the age of 36. Her mother was a self-educated
midwife that led the young Neuman to be always influenced by the commitment
that took her away from home from time to time. She had one older brother and
a younger brother, which makes her the middle child among her siblings. Her
love for nursing started when she took care of her father, which later created her
compassion in her chosen career path.

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.

Nursing Career of Betty Neuman

 Betty Neuman
Betty Neuman moved to California and worked in various capacities as a
hospital nurse and head nurse at Los Angeles County General Hospital, school
nurse, industrial nurse, and clinical instructor at the University of Southern
California Medical Center, Los Angeles.

In 1957, she received a baccalaureate degree in public health and psychology

with honors. Amidst her hectic life as a nurse, she also managed to work as a
fashion model and learned to fly a plane. She got married, supported her
husband’s medical practice, and had their daughter in 1959.

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.

Neuman persisted in starting a private practice as a marriage and family

therapist, specializing in Christian counseling. She is a Fellow of the American
Association of Marriage and Family Therapy and the American Academy of
Nursing. Until 2009, she was the Neuman Systems Model Trustees Group, Inc.
that she established in 1988 and still attends as a consultant. The Trustees Group
was created to preserve and maintain the message of her nursing theory for the
health care community.

Works of Betty Neuman

Neuman with Sister Callista Roy | neumansystemsmodel.org
In 1970, Betty Neuman designed a nursing conceptual model to expand students’
understanding of client variables beyond the medical model. Her teaching
programs at UCLA paved the way for developing her nursing model. During
those times, she did not write a book but made her concepts known to Joan
Riehl-Sisca and Sr. Callista Roy and incorporated them in their 1971
book, Conceptual Models for Nursing Practice.

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.

Awards and Honors of Betty Neuman

 Neuman honored by Walsh University’s Byers School of
Nursing | www.walsh.edu
Betty Neuman has done many things, including a nurse, educator, health
counselor, therapist, author, speaker, and researcher. Throughout the years, she
earned many awards and honors, including several honorary doctorates, and was
an honorary member of the American Academy of Nursing. The profound effect
of her work on the nursing profession is well known throughout the world.

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 Honorary Doctorate of Letters, Neumann College, Aston, PA (1992)

 Honorary Member of the Fellowship of the American Academy of Nursing
(1993)
 Honorary Doctorate of Science, Grand Valley State University, Michigan
(1998)
She was honored by President Richard Jusseaume and Provost Dr. Laurence Bove
with the Walsh University Distinguished Service Medal, which is awarded to those
who have contributed outstanding professional or voluntary service to others
within the national, regional or local community.
Neuman honored with Distinguished Service Medal | www.walsh.edu
In an annual Nursing Research Day sponsored by Walsh’s Phi Eta Chapter of
Sigma Theta Tau, Byers School of Nursing Dean Dr. Linda Linc granted Neuman
with the first annual Neuman Award, named in her honor, for outstanding service
in the nursing profession.

Betty Neuman’s Nursing Theory

Three words frequently used concerning stress are inevitable, painful, and
intensifying. It is generally subjective and can be interpreted as the circumstances
of conceivably threatening and out of their control. A nursing theory developed
by Betty Neuman is based on the person’s relationship to stress, response, and
reconstitution factors that are progressive in nature. The Neuman Systems Model
presents a broad, holistic, and system-based method to nursing that maintains a
factor of flexibility. It focuses on the patient system’s response to actual or
potential environmental stressors and maintains the client system’s stability
through primary, secondary, and tertiary nursing prevention interventions to
reduce stressors.

What is the Neuman Systems Model?

Betty Neuman describes the Neuman Systems Model as “a unique, open-
system-based perspective that provides a unifying focus for approaching a wide
range of concerns. A system acts as a boundary for a single client, a group, or
even several groups; it can also be defined as a social issue. A client system in
interaction with the environment delineates the domain of nursing concerns.”

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.

Nursing interventions occur through three prevention modalities. Primary

prevention occurs before the stressor invades the system; secondary
prevention occurs after the system has reacted to an invading stressor; tertiary
prevention occurs after secondary prevention as reconstitution is being
established.

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)

Major Concepts of Neuman Systems Model

This section will define the nursing metaparadigm and the major concepts in
Betty Neuman’s Neuman Systems Model.
Human being
The human being is an open system that interacts with internal and external
environment forces or stressors. The human is constantly changing, moving
toward a dynamic state of system stability or illness of varying degrees.

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.

Basic Stricture and Energy Resources

The basic structure, or central core, comprises those basic survival factors
common to the species. These factors include the system variables, genetic
features, and strengths and weaknesses of the system parts.

Client Variables
Neuman views the individual client holistically and considers the variables
simultaneously and comprehensively.

 The physiological variable refers to the structure and functions of the

body.
 The psychological variable refers to mental processes and relationships.
 The sociocultural variable refers to system functions that relate to social
and cultural expectations and activities.
 The developmental variable refers to those processes related to
development over the lifespan.
 The spiritual variable refers to the influence of spiritual beliefs.
Flexible line of defense
A protective accordion-like mechanism that surrounds and protects the normal
line of defense from invasion by stressors.

Normal line of defense

An adaptational level of health developed over time and is considered normal for
a particular individual client or system; it becomes a standard for wellness-
deviance determination.
Lines of resistance
Protection factors are activated when stressors have penetrated the normal line
of defense, causing reaction symptomatology.

Subconcepts of Neuman Systems Model

Stressors
A stressor is any phenomenon that might penetrate both the flexible and normal
lines of defense, resulting in either a positive or negative outcome.

 Intrapersonal stressors are those that occur within the client system

boundary and correlate with the internal environment.
 Interpersonal stressors occur outside the client system boundary, are
proximal to the system, and impact the system.
 Extrapersonal stressors also occur outside the client system boundaries
but are at a greater distance from the system than are interpersonal
stressors. An example is a social policy.
Stability
A state of balance or harmony requiring energy exchanges as the client
adequately copes with stressors to retain, attain, or maintain an optimal health
level, thus preserving system integrity.

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.

 Primary prevention occurs before the system reacts to a stressor; it

includes health promotion and wellness maintenance. Primary prevention
focuses on strengthening the flexible line of defense through preventing
stress and reducing risk factors. This intervention occurs when the risk or
hazard is identified but before a reaction occurs. Strategies that might be
used include immunization, health education, exercise, and lifestyle
changes.
 Secondary prevention occurs after the system reacts to a stressor and is
provided in terms of existing symptoms. Secondary prevention focuses on
strengthening the internal lines of resistance and, thus, protects the basic
structure through appropriate treatment of symptoms. The intent is to
regain optimal system stability and conserve energy in doing so. If
secondary prevention is unsuccessful and reconstitution does not occur,
the basic structure will be unable to support the system and its
interventions, and death will occur.
  Tertiary prevention occurs after the system has been treated through
secondary prevention strategies. Its purpose is to maintain wellness or
protect the client system reconstitution by supporting existing strengths
and preserving energy. Tertiary prevention may begin at any point after
system stability has begun reestablished (reconstitution has begun).
Tertiary prevention tends to lead back to primary prevention. (Neuman,
1995)

Strengths and Weaknesses

Betty Neuman reports her nursing model was designed for nursing but can be
used by other health disciplines, which have pros and cons. As a strength, if
multiple health disciplines use Neuman’s System Model, a consistent approach to
client care would be facilitated. As a con, if the model is useful to various
disciplines, it is not specific to nursing. It thus may not differentiate the practice
of nursing from that of other disciplines.

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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.