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Betty Neuman and Her Systems Model


Betty Neuman is one of the prominent American nursing theorists. Neuman’s System Model (NSM) was first presented in 1972 (Alligood, 2014). It was created by Betty Neuman for education purposes, “to provide unity, or a focal point, for student learning” (as cited in Smith & Parker, 2015, p. 182). Although the model was influenced by other theories existing at that time or developed simultaneously, it has some specific features and ideas which make it valuable and significant for contemporary nursing. In fact, it is one of the most applied models in nursing popular among specialists. It predetermined the innovative development of nursing (Neuman & Fawcett, 2011).

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Analysis of Basic Components and Major Relationships in the Theory

According to Neuman, her model is ” a unique, open systems-based perspective that provides a unifying focus for approaching a wide range of nursing concerns” (Neuman & Fawcett, 2011, p. 3). A distinguishing feature of Neuman’s System Model is its dynamics. It is grounded on the lasting relations of patients with the environments and their stress factors.

Similar to other models and theories, NSM includes four nursing paradigms. Speaking of person, the model treats a human being as a whole. A person consists of many layers, each of them includes five subsystems or variables (Alligood, 2014). They are physiological, psychological, sociocultural, spiritual, and developmental subsystems with their particular functions (Neuman & Fawcett, 2011). These subsystems are also connected with certain determinants of health. As for the environment, it is treated as a combination of internal and external forces.

They surround a human being and are the sources of intrapersonal, interpersonal, and extrapersonal stressors (Neuman & Fawcett, 2011). The paradigm of health in Neuman’s interpretation is associated with wellness. The author defines health and wellness as “the condition in which all parts and subparts (variables) are in harmony with the whole of the client” (Neuman & Fawcett, 2011, p. 12). As for the nursing as a paradigm, it is treated as a “unique profession concerned with all of the variables affecting clients in their environment” (Neuman & Fawcett, 2011, p. 328). Nursing is also considered a preventive intervention aimed to minimize stressors that surround a person.

The major components of NSM include basic structure (basic factors common to people), lines of resistance, lines of defense, stressors, reconstruction, reaction, interventions, and three levels of prevention (Neuman & Fawcett, 2011, p. 13). Stressors influence the basic structure of energy resources. They get through the lines of defense and resistance and condition various reactions. Stressors can be identified and classified (for example, those of loss, pain, cultural change, etc.). There can be one stressor or several of them at the same time. Thus, getting through the lines of defense and resistance, stressors condition reaction. The degree of reaction can be influenced by some intra, inter, or extra personal factors.

Interventions are aimed to reduce or prevent the action of stressors. These interventions depend on the degree of reaction, resources, goals, and anticipated outcome (Neuman & Fawcett, 2011, p. 13). NSM includes three levels of prevention. Primary prevention is connected with the reduction of stressors occurrence and makes the flexible line of prevention stronger. Secondary prevention is related to the normal line of defense and means early case finding and treatment of symptoms (Neuman & Fawcett, 2011, p. 13). Tertiary prevention is connected with the reconstruction and includes “readaptation, re-education to prevent future occurrences, and maintenance of stability” (Neuman & Fawcett, 2011, p. 13).

The relevance of the Theory

The model comprises some nursing theories developed earlier or simultaneously with NSM. They include theories of Optimal Client System Stability and of Prevention as Intervention by Neuman; Theory of Adolescent Vulnerability by Cazzell; theories of Moderation of Stress Levels in Women in Multiple Roles and of Maternal Student Role Stress by Gigliotti; Theory of Infant Exposure to Tobacco Smoke by Stephens & Knight; and Theory of Well-Being for Fatigue in Diabetics by Casalenuovo (Alligood, 2014).

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Neuman’s System Model can be used in various spheres. The author created it for education purpose to apply in nursing colleges. For about forty years, NSM was developing and changing. At present, its significance is broader than Neuman intended in the beginning. Areas of practice where the NSM can be applied include but are not limited to AIDS management, anxiety, breast cancer, cognitive impairment, critical care, diabetes, intensive care, orthopedics, pediatrics, postoperative conditions (Alligood, 2014).

Moreover, it is often used as the theoretical basis for research in healthcare and medicine. Thus, Bourdeanu and Dee (2013) provided an assessment of chemotherapy-induced nausea and vomiting in women with breast cancer based on a Neuman systems model framework. Cobb (2012) investigated the level of prediction of health status in adults living with HIV-disease with the help of spirituality using Neuman’s systems model study. Lowry (2012) presented a qualitative descriptive study of spirituality guided by the Neuman systems model.

Theory Summary: Strengths and Limitations

The universal character of Newman’s model can be treated as both strength and limitation. On the one hand, the possibility to apply it in various health disciplines provides a chance to introduce a consistent approach to the patient. On the other hand, the fact that the model is suitable for many disciplines makes it not explicitly nursing thus reducing its value for distinguishing nursing from other fields.

Nevertheless, NSM has more strengths than limitations. One of the main strengths of this model is its flexibility and adaptability. Consequently, it can be applied in various spheres of nursing including administrative, educational, and practical. Another strong point of NSM is its logical and consistent structure. Its presentation in a diagram makes it more comprehensible than the others. One more strength of NSM is its focus on primary prevention which includes health promotion. Finally, the definitions of key components provided by Neuman are clearly set and understandable. However, the other terms used need more clarification to be properly understood. It makes a limitation of the model. Moreover, it would be useful to provide a more careful differentiation of interpersonal and extrapersonal stressors mentioned in the model.


Generally speaking, the nursing theories and models developed in the twentieth century have a significant impact on the contemporary health care system on the whole and nursing in particular. Neuman’s System Model is among the most important and most widely used today. It is a universal model that provides guidelines for various spheres of nursing including administration and practicing nurses. Firstly developed as an educational aid, it transformed into a functioning framework aimed to assist caregivers dealing with stressors.

The model explains the mechanism of stressors’ impact on an individual, the possibilities of protective mechanisms, and the levels of prevention. Stressors of the environment negatively influence an individual and threaten the wellbeing which is compared to health in NSM. The model empowers nurses and other medical staff to protect clients from stressors or reduce their harmful effects. Thus, with proper knowledge and careful application, the model can be useful in contemporary nursing.


Alligood, M.R. (2014). Nursing theory: Utilization and application (5th ed.). St.Luuis, MS: Elsevier Mosby.

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Bourdeanu, L., & Dee, V. (2013). Assessment of chemotherapy-induced nausea and vomiting in women with breast cancer: A Neuman systems model framework. Research and Theory for Nursing Practice, 27(4), 296-304.

Cobb, R. K. (2012). How well does spirituality predict health status in adults living with HIV-disease: A Neuman systems model study. Nursing Science Quarterly, 25(4), 347-355.

Lowry, L. W. (2012). A qualitative descriptive study of spirituality guided by the Neuman systems model. Nursing Science Quarterly, 25(4), 356-361.

Neuman, B., & Fawcett, J. (2011). The Neuman Systems Model (5th ed.). Upper Saddle River, NJ: Pearson.

Smith, M.C., & Parker, M.E., (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: F.A. Davis Company.

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