Betty Neuman 2

Objectives
 Explore credentials, theoretical sources,
and historical perspective of Betty
Neuman

 Review concepts/definitions and concept
map

 Critique theory

 Examine the Neuman Systems Model’s
acceptance by the nursing community

 Demonstrate NSM’s use through case

Background Credentials
 Born: 1924
 Ohio
 1947: RN from Peoples Hospital School of
Nursing Akron, OH.
 Received double honors
 Moved to California
 Variety of Nursing Roles
 Hospital nurse, School Nurse, Industrial Nurse and
clinical instructor at University of Southern California

(Aligood & Toomey, 2010

Background Credentials
 1957- Bachelors degree in public health &
psychology - honors
 1966- Masters degree in mental health &
public health consultation - UCLA
 1985- Doctoral Degree in clinical psychology -
Pacific Western University.
 1998- Honorary doctorate - Grand Valley State
University, Allendale, MI.


Theory Development

 Neuman System Model (NSM)
developed in 1970 and published in
1972
 Firstpublished as “Model for teaching
total person approach to patient
problems” in Nursing Research.


Theoretical Sources

 General System Theory
Reflects the nature of living
organisms as open systems in
interaction with each other and
with environment


Theoretical Sources

 Gestalt Theory
Describes homeostasis as the
process by which an organism
maintains equilibrium, and
consequently its health, under
varying conditions.


Theoretical Sources

 Marx
 Philosophy“suggests properties of parts
are determined partly by the larger
wholes within a dynamically organized
systems.”
 de Chardin
 Philosophy of the wholeness of life


Theoretical Sources

 Selye’s  Caplan
definition of  Adapted levels
stress: of prevention
 Any tension  Primary
producing stimuli
 Secondary
that causes a
response  Tertiary

 Canbe positive or
negative.

Historical Perspective
 Time of great historical development in
nursing
 1970’s- Nursing Research concluded a
lack in conceptual connection and
theoretical frameworks.
 Leading to two major findings:
1. Standardization of nursing curricula
2. Doctoral education for nurses should be in
nursing.

Conceptual Model

“A conceptual model provides a
distinct frame of reference for its
adherents…that tells them how to
observe and interpret the
phenomena of interest to the
discipline.”


Betty Neuman, Cedar Crest College, October 22, 2008

Major Concepts and Definitions

 WHOLISTIC APPROACH
 Client viewed as “whole”
 Person, family, group, community, or social
issue

5 person variable
 Physiological
 Psychological
 Sociocultural
 Developmental
 Spiritual


 OPEN SYSTEM
 Function or Process
 Client
as a system exchanges energy, information and
matter with the environment as it uses available
energy resources to move toward stability and
wholeness
 Input or Output
 Matter,
energy, and information that are exchanged
between the client and the environment
 Feedback
 System output in the form of matter, energy, and
information for corrective action to change, enhance or
stabilize the system

 Negentropy
 Defined by Neuman as a process of energy conservation
utilization that assists system profession toward stability or
wellness
 Stability
 Dynamic and desired state of balance
 Copes with stressors to maintain an optimal level of health
and integrity



 ENVIRONMENT
 Created Environment
 CLIENT SYSTEM
 Basic Client Structure
 Composed of a central core surrounded by concentric
rings

 Lines of Resistance


 Normal Lines of Defense
 Model’s outer solid circle
 Represents stability for the individual or system
 Maintained over time and serves to assess deviations
from client’s usual wellness
 Flexible Lines of Defense
 Model’s outer broken ring
 Can be altered over time; Protective buffer for preventing
stressors from breaking through usual wellness state
 According to Neuman, “When the flexible line of defense
expands, it provides greater short-term protection against
stressor invasion; when it contracts, it provides less
protection.” (Alligood and Tomey, 2010)


 HEALTH
 Wellness

 Illness

 STRESSORS
 Tension producting stimuli that have the potential
to disrupt system stability
 DEGREE OF REACTION
 Represents system instability that occurs when
stressors invade normal line of defense


 PREVENTION AS INTERVENTION
 Purposeful actions to help client maintain system
stability
 Levels of Prevention: Primary, Secondary,
Tertiary
 Primary: Used when stressor is suspected or
identified; Degree of risk in known
 Secondary: Involves interventions or treatment
initiated after symptoms occurred
 Tertiary: Occurs after active treatment; maintenance

 RECONSTITUTION
 Occurs after treatment for stressor reaction

Empirical Evidence

 Neuman took the lead to hypothesize
her theory along with other theories to
create the model
 Evaluated the use of model by using
graduate nursing students at UCLA


NURSING

 Nursing concerns
whole person
 Perception influences
care


PERSON
 Open system, reciprocal to environment
 Client system always changing
 Physiological, psychological, sociocultural,
developmental and spiritual all interrelated


HEALTH

 Stability of system
important
 Wellness model
 Stability is associated with
total system needs being
met


ENVIRONMENT

 Seen as internal and external influences
 Stressors can threaten stability
 Three environments
 Internal=allinteraction in client
 External=all factors outside client

 Created=unconscious, coping


THEORETICAL ASSERTIONS

 Nurse and client interact
 Nurse concerned with variables that
affect response to stressors
 Copes by flexing environment
 Either changes himself to
stressors or adjusts stressors to
himself


SIMPLICITY

 Complex yet logical
 Some concepts overlap
 Usable in variety of
practice settings


GENERALITY
 Comprehensive and adaptable
 Broad scope, useful in applying theory to all
healthcare settings
 Wholistic approach, client participation
works well in today’s
views of prevention and
interdisciplinary care


EMPIRICAL PRECISION

 Extensive use in nursing research
 Continues to be tested and refined


DERIVABLE CONSEQUENSES

 Guideline for
assessment
 Use of nursing process
 Implement prevention
 Client involvement in
goals
 Expansion of scientific
knowledge for nurses

Practice
 Approach
 Goal-Directed

 Unified

 Wholistic

 Multidisciplinary
 Prevent fragmentation of care
 Flexible


Practice
 Multidisciplinary
 Stressors

 Client system

 Guidelines
 Nursing

 Allied services


Practice

• Neuman Nursing Process Format
– Nursing diagnosis
• Data base  variance from wellness
– Nursing goals
• Negotiation btw client and caregiver  desired changes
– Nursing outcomes
• Prevention-as-intervention
• Evaluation

• when used by other disciplines, nursing is
changed accordingly


Practice
• Hospitals
• Nursing homes
• Rehab centers
• Community-based services
• Multiple countries
– Holland, Malaysia
• Individuals & communities
• Acute care & clinic


Education

 Curriculum guide
 Clinical
learning
 Health promotion

 Widely accepted in education


Research
 Used as framework in nearly 100 studies
between 1989 – 1993 (per 3rd edition)
 Qualitative and Quantitative
 Multiple cultures
 Pragmatic
 Extension to middle range theory


Case Simulation

Barry Stinson

60-year-old male presents to surgical staging
area for bilateral knee replacement surgery.

Case Simulation

 http://www.youtube.com/watch?v=WEY9pxxcx
SQ

References
 Alligood, M.R. & Tomey, A.M. (2010). Nursing
Theorists and Their Work 7th Edition. Maryland
Heights, Missouri: Mosby Inc.
 Photo and diagram courtesy of Neuman Systems
Model Inc. www.neumansystemsmodel.org Last
updated 2011

Betty Neuman 2

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