BETTY NEUMAN

The System Model

 HISTORY
• Born in 1924 on a farm in rural Ohio
• Received RN Diploma from Peoples Hospital School of Nursing, Akron,
Ohio in 1947
• Received BS in nursing from UCLA in 1957
• Received Masters degree in Mental Health, Public Health Consultation
from UCLA in 1966
• Her model was first published as a 'Model for teaching total person
approach to patient problems' in Nursing Research in 1972
• 1974 - published and classified as a systems model called "The Betty
Neuman Health-Care Systems Model Total Approach to Patient
Problems"
• Published first book detailing NSM in 1982.  Notable change:
"patient" now referred to as "client" The Neuman Systems Model, 2nd
ed.,1989. Spiritual variable added to diagram as fifth variable.   
Neuman envisions of 3-stage nursing process

• Nursing Diagnosis - based on necessity of a thorough

assessment and with consideration given to five variables
in three stressor areas.

• Nursing Goals - these must be discussed with the patient

and take account of patient's and nurse's perceptions of
variance from wellnes.

• Nursing Outcomes - considered in relation to the five

variables and achieved through primary, secondary and
tertiary interventions.
 
Each client system is made up of 5 variables
 1.Physiological variables
-bodily structure & function
 2.Psychological variables
-mental processes & relationships
 3.Sociocultural variables
-social & cultural funtions
 4.Developmental variables
-developmental processes of life
 5.Spiritual variables
-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 of
                                                             of stressors.
resistanc
                                                        
core e
                                                             Normal line of defense:
                                                           - Represents the client
Flexible systems normal or usual
                                                              
line of
                                                               wellness state.
defense
 
Lines of resistance:
Normal - Involuntarily activated
line of when a stressor invades
defense normal line 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.
 
External environment-all forces or
influences external to or outside the client
system, the source of interpersonal and
extrapersonal 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 
 
Variance from Illness
wellness  
 Illness is a state of
 
insufficiency with
  disrupting needs
  Varying degrees of unsatisfied
system instability.  
   Illness is an excessive
  The difference from expenditure of energy…
the usual or normal when more energy is
wellness condition. used by the system in its
state of disorganization
 
than is built and stored,
  the outcome may be
  death
Neuman System
 The Neuman Systems Model is used at all levels of nursing
education from diploma through doctorate. The model is used in
many clinical areas in institutional and community nursing
practice at national and international sites.
 a nursing theory based on the individual's relationship to stress,
the reaction to it, and reconstitution factors that are dynamic in
nature
 Neumans model can be used today as a framework for nursing
practice when applied to
•the client
•the health
•the environment
 The Client
 Consists of the individual, the family, friends, as well as the
community.
 The theory states, nurses should not only view the individual
holistically, but should also take the family, friends, and the
community into consideration.
 The Health

 Neuman views health as a state of equilibrium between a

clients internal and external environment.
 Health, according to Neuman, is equated with optimum
system stability, that is, the best possible wellness state at
any given time.Nurses apply this theory by individualizing
the optimum state of wellness for each client.
The Environment

 Neumans concept of environment is that of an internal

and external environment with varying degrees of
harmony and balance between the two.
 By recognizing the two environments, the nurse
educates and implements treatments that are
individualized for each patient not only for her
psychological, spiritual, and physiological nature, but
also for her family and social relationships.
IMOGENE KING
The Goal Attainment Theory
 born on January 30, 1923, in West Point, Iowa

 In 1945, she received a diploma in Nursing from St. John’s

Hospital School of Nursing

 In 1948, she received Bachelors of science in Nursing

Education form Louis University

 In 1957, she received a Master of Science in Nursing from

St. Louis University

 She received her EdD in 1961 at Teacher’s College,

Columbia University

 And in 1960’s she introduced the Theory of Goal Attainment

Systems framework
• Personal system concepts includes: coping,
spirituality, perception, self, body image, growth
and development.
• Interpersonal system concepts includes: interaction,
communication, transaction, role, stress and
coping.
• Social system concepts includes: organization,
authority, power, status, and decision making.
 King’s Experience
• Practiced as an office nurse, staff nurse, school nurse,
nurse educator, and nurse administrator
• Administrator at Ohio State University
• Educator at St. John’s Hospital School of Nursing, Loyola
University, and the University of South Florida
• Adult Medical-Surgical Nursing Practitioner
• Assistant chief of the Research Grants Branch, Division
of Nursing, Department of Health, Education and Welfare
• Professor emeritus at the University of South Florida
 Theory of Goal Attainment

• Describes the importance of the participation of all individuals

in decision making as well as choices, alternatives, and
outcomes of nursing care.
• It pertains to the importance of interaction, perception,
communication, transaction, self, role, stress, growth and
development, time, and personal space.
• Reflects King’s belief that the practice of nursing is
differentiated from other healthcare professions by what
nurses do with and what they do for individuals
• The nurse and patient/client communicates information in
order to set goals mutually and then acts to attain those goals.
Seven Hypothesis in goal attainment
1. Perceptual congruence in nurse-patient interactions increases
mutual goal settings
2. Communication increases mutual goal setting between nurses
and patients which leads to satisfaction
3. Satisfaction in nurses as well as patients increases goal
attainment
4. Goal attainment decreases stress and anxiety in nursing
situations
5. Goal attainment increases patient learning and coping in
nursing situations
6. Role conflict experienced by nurses, patients, or both
decreases transactions in nurse-patient interactions
7. Congruence in role expectations and role performance
King’s Theory Applied in current
practice
• In current practice the use of this theory relies on
participation of both the nurse and the patient for
effectiveness
• It can be used in most any practice
• Reviewing the patient’s plan of care and providing the
patient with information as well as education each day
• Providing the patient with options for their plan of care
• Keeping the patient “in the loop” during their process of
care
• Making decisions with the patient rather than for the
patient
• Bedside report is a good start to this theory.
Hildegard E.
Peplau
Theory of Interpersonal Relations
 Born on September 1, 1909 in Reading, Pennsylvania

 She has been described as the mother of psychiatric nursing.

 She is a psychiatric nursing expert, educator, author, nursing

leader, and theorist.

 Diploma program in Pottstown, Pennsylvania in 1931.

 BA in interpersonal psychology - Bennington College in 1943.

 MA in psychiatric nursing from Colombia University New York

in 1947.

 EdD in curriculum development in 1953.

 Developed the Interpersonal Relations (Psychodynamic
Nursing), in 1952.

Interpersonal Relations in Nursing describes the

importance of the nurse-patient relationship as a
“significant, therapeutic interpersonal process” and
is recognized as the first nursing theory textbook
since Nightingale’s work in the 1850s.
Major Concepts:
 The theory explains the purpose of nursing is to help
others identify their felt difficulties.

 Nurses should apply principles of human relations to the

problems that arise at all levels of experience.

 Peplau's theory explains the phases of interpersonal

process, roles in nursing situations and methods for
studying nursing as an interpersonal process.

 Nursing is therapeutic in that it is a healing art, assisting

an individual who is sick or in need of health care.
 Nursing is an interpersonal process because it involves
interaction between two or more individuals with a
common goal.

 The attainment of goal is achieved through the use of a

series of steps following a series of pattern.

 The nurse and patient work together so both become

mature and knowledgeable in the process.
View of the 4 basic metaparadigms:
 PERSON – a developing organisms that tries to reduce anxiety
caused by needs.

 HEALTH – Peplau defines health as a word symbol that implies

forward movement of personality and other ongoing human
processes.

 ENVIRONMENT – Peplau implicity defines the environment in terms

of existing forces outside the organism and in the context of culture.

 NURSING – Peplau describes nursing as a significant, therapeutic

interpersonal process. It functions cooperatively with other human
process that make health possible for individuals in communities.
Peplau describes four phases of nurse-patient
relationship:
 ORIENTATION

 IDENTIFICATION

 EXPLOITATION

 RESOLUTION
ORIENTATION
During the orientation phase, the individual has a felt
need and seeks professional assistance.
IDENTIFICATION
The patient identifies with those who can help him or her.
The nurse permits exploration of feelings to aid the patient
in undergoing illness as an experience.
EXPLOITATION
During the exploitation phase, the patient attempt to derive
full value from what he or she is offered through the
relationship. The nurse projects new goals to be achieved
through personal effort from the nurse to the patient.
RESOLUTION
The patient gradually puts aside old goals and adopts new
goals. This is a process in which the patient frees himself or
herself from identification with the nurse.
Peplau described six nursing roles:

STRANGER

RESOURCE PERSON

TEACHER

LEADER

SURROGATE

COUNSELOR
STRANGER ROLE
Peplau states that because the nurse and patient are
strangers to each other, the nurse should treat the patient
with ordinary courtesy.

RESOURCE PERSON ROLE

The nurse provide specific answers to questions,
especially regarding health information, and interprets to the
patient the treatment or medical plan of care.
TEACHING ROLE
This is a combination of all roles and always proceeds
from the what the patient knows and develops around his
interest in wanting and ability to use information.

LEADERSHIP ROLE
This involves the democratic process. The nurse helps the
patient meet the tasks at hand through a relationship of
cooperation and active participation.
SURROGATE ROLE
The nurse’s behaviours and attitudes create feeling tones
in the patient that reactivate feelings in a previous
relationship.

COUNSELING ROLE
Counseling functions in the nurse-patient relationship by
the way nurses responds to patient’s demands.
Four psychobiological experiences:
 NEEDS

 FRUSTRATIONS

 CONFLICTS

 ANXIETY