The Nursing Theory of Betty Neuman

Stress is frequently described using three words: inevitable, painful, and intensifying. It is generally subjective and can be interpreted as situations that are potentially dangerous and beyond their control. Betty Neuman’s nursing theory is based on the individual’s relationship to progressive stress, response, and reconstitution factors. The Neuman Systems Model of Nursing provides a comprehensive, holistic, and system-based approach to nursing that retains a degree of flexibility. It is concerned with the patient system’s response to actual or potential environmental stressors and with ensuring the client system’s stability through primary, secondary, and tertiary nursing prevention interventions aimed at mitigating stressors.

What is the Neuman Model of Systems?

Betty Neuman defines the Neuman Systems Model as “a unique, open-systems-based perspective that serves as a unifying lens through which a diverse range of concerns can be approached.” A system serves as a barrier between an individual client, a group, or even multiple groups; it can also be defined as a social issue. The interaction of a client system with its environment denotes the domain of nursing concerns.”

According to the Neuman Systems Model, the client is an open system that responds to environmental stressors. Physiological, psychological, sociocultural, developmental, and spiritual variables affect the client. The client system is composed of a fundamental or core structure that is protected by resistance lines. The normal health level is defined as the normal defense line, which is protected by a flexible defense line.

Stressors can be intrapersonal, interpersonal, or extrapersonal in nature, and they originate in the internal, external, or created environments. When stressors penetrate the system’s adaptable line of defense, the system is invaded, and the system’s lines of defense are activated. On a wellness-illness continuum, the system is described as progressing toward illness. If sufficient energy is available, the system will be reconstructed with the normal defense line restored to its previous level, below, or above.

Three types of nursing interventions are used to prevent disease. Primary prevention occurs prior to the stressor invading the system; secondary prevention occurs after the system has reacted to the invading stressor; and tertiary prevention occurs following secondary prevention as the system is reconstituted.

Assumptions of Nursing Theory of Betty Neuman

Neuman’s Systems Model makes the following assumptions or “accepted truths”:

Each client system is unique, comprised of a variety of variables and characteristics that fall within a predefined range of responses.

Numerous known and unknown stressors exist. Each has a different potential for interfering with a client’s normal level of stability or line of defense. At any point in time, the specific interrelationships of client variables can affect the degree to which a client is protected by the flexible line of defense against possible stressor reactions.

Each client/client system has evolved a standard set of environmental responses, referred to as a standard line of defense. The normal line of defense can be used to establish a baseline against which health deviations can be measured.

When the flexible line of defense fails to protect the client/client system from an environmental stressor, the stressor penetrates the normal line of defense.

Whether healthy or ill, the client is a dynamic composite of the variables’ interactions. Wellness exists on a continuum of available energy that assists the system in maintaining an optimal state of stability.

Internal resistance factors referred to as lines of resistance exist implicitly within each client system. They serve to stabilize and realign the client to their normal state of wellness.

Primary prevention refers to the application of general knowledge in client assessment and intervention with the goal of identifying and reducing or mitigating potential or actual risk factors associated with environmental stressors in order to avert a reaction.

Secondary prevention is concerned with the symptomatology associated with a response to stressors, the prioritization of interventions, and treatment to mitigate their deleterious effects.

Tertiary prevention is concerned with the adjustive processes that occur as reconstitution begins and maintenance factors reintroduce the client to primary prevention in a circular fashion.

The client as a system is constantly exchanging energy with the environment. (1995, Neuman)

Neuman Systems Model’s Fundamental Concepts

This section will define the nursing paradigm and the key concepts contained in Betty Neuman’s Neuman Systems Model.

Being human

The human being is an open system that interacts with forces or stressors from both the internal and external environment. The human being is constantly changing, edging closer to a dynamic state of system stability or varying degrees of illness.

Environment

The environment is a critical domain that is critical to the system’s operation and function. The environment can be defined as all factors affecting and being influenced by the system. Neuman Systems Model distinguishes three pertinent environments: internal, external, and created.

The client system’s internal environment exists. This environment is comprised of all forces and interactive influences that exist solely within the client system’s boundaries.

Outside of the client system is the external environment.

The created environment is developed subconsciously and is utilized by the client to aid in protective coping.

Health

Health is defined in Neuman’s nursing theory as the state or degree of system stability and is viewed as a continuum ranging from wellness to illness. When the system’s requirements are met, optimal wellness occurs. When basic needs are not met, illness occurs. When the energy required to sustain life is depleted, death occurs.

Nursing

Nursing’s primary objective is to define the appropriate course of action in situations involving stress or potential client or client system reactions to stressors. Nursing interventions are designed to assist the system in adapting or adjusting and reestablishing, restoring, or maintaining some degree of stability between client system variables and environmental stressors, with an emphasis on energy conservation.

Embedded System

A system in which input and processing, output and feedback are all continuous. It is a system of organized complexity in which all elements are in communication with one another.