General Description of the Theory
The nursing theory under analysis is Neuman systems model developed in 1970 by Betty Neuman, a counselor, professor, and community health nurse. This theory belongs to the middle-range nursing theories, as it includes enough variables to provide a solid abstract description of phenomena and, at the same time, it can be verified through testing and guides nursing practice strategies and theory-based research (Flaherty, 2013).
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Betty Neuman was born in 1924 in Lowel, Ohio. Betty’s father was a farmer who died from the chronic renal disease when she was eleven years old. Betty’s mother was a midwife who became the first inspiration for her to devote her life to medicine in general and nursing in particular. Thus, her childhood taught her the value of responsibility and self-reliance that laid the basis for her future nursing career (“Betty Neuman,” 2013).
From the early age, she was interested in the concepts of human behavior. During the World War II, she worked as an aircraft technician but later, she decided to join the Cadet Nursing Corps program focused on providing accelerated nursing education. After eighteen months of training, in 1947, she graduated from People’s Hospital School of Nursing in Akron, Ohio, with honors and obtained the diploma as a Registered Nurse (“Betty Neuman,” 2013).
After visiting her relatives in California, Betty decided to start her career there. She changed multiple professions. She worked as a head nurse at Los Angeles County General Hospital, a school nurse, an industrial nurse, and a clinical instructor at the University of Southern California Medical Center in Los Angeles (UCLA) specializing in the areas of communicable diseases, critical care, and medical-surgical nursing. In 1957, Betty completed a Bachelor of Science in Nursing (BSN) with a double major in psychology and public health from UCLA. In a short time, she married and helped her husband establish his medical practice. Her only child was born in 1959 (“Betty Neuman,” 2013).
In 1966, Betty completed her Master of Science in public health consultation and mental health from UCLA. In half a year, she was hired as a department chair in the graduate program at UCLA. Her teaching methods were highly evaluated, and she decided to develop a nursing model. She did not write a book at that time yet, but she had already developed her concepts known to Sr. Callista Roy and Joan Riehl-Sisca who mentioned them in their book called Conceptual Models of Nursing Practice in 1971.
Then, in 1972, Betty published an article entitled “A model for teaching total person approach to patient problems” which served as a draft of her model. For ten years, she was refining her concepts and finally, in 1982, she published her book called “The Neuman System Model: Application to Nursing Education and Practice” (“Betty Neuman,” 2013).
In 1985, Betty received a doctorate from Pacific Western University in clinical psychology. Being the first who defined nursing roles in mental health, Donna Aquilina and Betty Neuman created a position of a nurse counselor in Los Angeles community crisis centers. In 1988, Betty founded the Neuman Systems Model Trustees Group, Inc. which focused on the preservation of her nursing theory for the community. In 2009, she resigned from the position of the director but still serves as a consultant (“Betty Neuman,” 2013).
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Thus, being interested in human behavior from her childhood and being inspired by her mother’s profession as a midwife, Betty Neuman firmly decided that she would devote her life to the nursing profession, and her experiences as a nurse only reinforced her determination. Her model was also influenced by the works of the philosophers Cornu and de Chardin on wholeness in the system, the biologist Von Bertalanffy and the philosopher László on their general system theory, the psychologist Lazarus on his stress and coping theory, and the endocrinologist Seyle on his stress theory (Flaherty, 2013).
The authors who first mentioned Betty Neuman’s Systems Model were Sr. Callista Roy and Joan Riehl-Sisca in 1971, which was a crucial reference to her work. After Neuman’s theory was recognized, numerous researchers began referring to it and using it in the studies and practices. One of the most prominent of them was Jacqueline Fawcett who referred to Betty Neuman’s Systems Model multiple times in her studies beginning from 1982 (Flaherty, 2013).
The Neuman Systems Model regards the client as an open system that responds to the environment in general and various stressors in it in particular. The client variables are spiritual, developmental, sociocultural, psychological, and physiological. The client system comprises the basic structure which is protected by lines of resistance (“The Neuman Systems Model,” 2013).
Stressors are extra-, intra-, and interpersonal and occur from the created, internal, and external environments. The standard level of health is determined as the normal line of defense (LOD) which is under the protection of the flexible line of defense. When stressors breach the flexible line of defense, the invasion of the system has occurred, and the activation of the lines of resistance begins, thereby resulting in the system moving towards a disease on an illness-wellness continuum. Thus, if there is enough energy, the system along with the normal line of defense will be restored at, above, or below their previous level (“The Neuman Systems Model,” 2013).
In her theory, Betty Neuman uses deductive reasoning. In general, deductive reasoning starts with a certain principle, then provides specific examples and checks whether the idea applies to them. Thus, Neuman claims that the purpose of nursing is to facilitate the stability of client system, analyzes stressors and how the client responds to them and provides specific examples of her ideas concerning these issues (“The Neuman Systems Model,” 2013).
Major Concepts of the Theory
Major concepts of Betty Neuman’s Systems Model include:
- Content (the person’s variables in interaction with the external and internal environment encompass the whole system).
- Central core
- The common factors of client survival in unique characteristics represent basic system energy resources.
- The basic structure consists of the normal temperature range, ego structure, organ weakness or strength, response pattern, and genetic structure.
- Homeostasis happens when there is more energy than the system is using.
- A homeostatic body system is always in a quick process of compensation, feedback, output, and input, which lead to balance (Turner & Kaylor, 2015).
- A degree to reaction (a degree of system instability caused by stressor invasion of the LOD).
- Entropy (a process of the energy depletion that moves the system towards disease or possible death).
- Flexible LOD (a mechanism that protects the normal LOD from invasion).
- Normal LOD (a representation of the client’s state of wellness).
- The line of resistance (a set of concentric rings that surrounds the core structure) (Turner & Kaylor, 2015).
- Output and input (information, energy, and matter that are exchanged between environment and the client).
- Negentropy (a process of energy conservation which increases complexity and organization, thereby moving the system towards wellness).
- Open system (a system where feedback, input, and output are in interaction).
- Intervention (the determinant for entry of the nurse and client to healthcare system).
- Reconstitution (the maintenance and return of system stability, which follows the stressor reaction treatment and may result in lower or higher level of wellness).
- Stability (a state of harmony that requires adequate energy exchange).
- Stressors (extra- (work pressure), intra- (emotions), and interpersonal (expectations) environmental factors that may disrupt the stability of the system) (“Betty Neuman’s System Model,” 2013).
- Illness (a state of insufficiency and unsatisfied disrupting needs).
- Wellness (a condition when all parts of the system are in harmony with the whole client’s system).
- Prevention (a focus on keeping stress responses and stressors themselves from having a negative effect on the body).
- Primary prevention (happens before the system’s reaction to a stressor, thereby promoting and maintaining the person’s health and wellness).
- Secondary prevention (happens after the system’s reaction to a stressor and focuses on the protection of the central core from damage by reinforcing the internal lines of resistance).
- Tertiary prevention (happens after the secondary prevention implementation and focuses on providing support to the client and additional energy to the system) (Flaherty, 2013).
The author is consistent when she uses her concepts and terms. She begins with explaining more general and major concepts of her theory and ends with the description of the subconcepts and concepts with narrower meaning. Additionally, she uses a holistic systems-based approach to the client care, addresses all philosophical claims, and explicitly defines all the concepts and propositions.
The basic assumptions of Betty Neuman’s Systems model include:
- Every client system is unique and a combination of characteristics and factors having a particular range of responses within the basic structure.
- There are multiple stressors, and they differ in their potential for breaking through the client’s normal LOD.
- Certain interrelationships of client variables can influence the protection capacity of the flexible LOD.
- The normal LOD can be considered a standard from which health deviation can be measured (“Betty Neuman’s System Model,” 2013).
- When the flexible LOD cannot protect the client, an environmental stressor breaches through the normal LOD.
- The client is a dynamic combination of the variables’ interrelationships.
- LOR or the internal resistance factors are implicit within every client system and focus on stabilizing the client to the state of wellness.
- Primary prevention is applied in identification and elimination of client’s possible risk factors.
- Secondary prevention is a reaction to a stressor and elimination of its negative effects.
- Tertiary prevention takes place when reconstitution begins and maintaining factors return to primary prevention.
- Being a system, the client constantly and dynamically exchanges energy with the environment (“Betty Neuman’s System Model,” 2013).
Four Nursing Paradigms
Betty Neuman describes in her theory the four concepts of the nursing metaparadigm. Regarding the first concept focused on human beings, she states that a human being is a complete person as a client system, where the person is a multidimensional layered being (Turner & Kaylor, 2015). Every layer contains five subsystems or person variables:
- Physiological – relates to the function of the body and its physiochemical structure.
- Psychological – relates to emotions and mental processes.
- Sociocultural – relates to relationships and cultural and social activities and expectations.
- Spiritual – relates to the importance of spiritual beliefs.
- Developmental – relates to the processes regarding the lifespan development (Flaherty, 2013).
Regarding the second concept focused on the environment, she distinguishes three forces that surround a person and interact with each other:
- The internal environment is located within the client system.
- The external environment is located outside the client system
- The created environment is created by the client unconsciously and serves as a symbol of the wholeness of the system (“Betty Neuman’s System Model,” 2013).
The third metaparadigm concept that is focused on health is described by Betty Neuman in the following way:
- Health is equal to wellness.
- Health is a condition when all variables are in harmony with the client.
- The client system approaches illness and death when the energy available is less than needed. The client system approaches wellness when the energy available is more than needed (Flaherty, 2013).
Concerning the fourth metaparadigm concept, namely nursing, Betty Neuman states the following:
- Nursing is a unique profession that deals with all the variables and influences a person’s response to a stressor.
- The task of nursing is to address a person as a whole.
- The purpose of nursing is to maintain a maximum level of health by stabilizing the patient system and reducing stressors.
- The role of the nurse is to react to stressors and implement primary, secondary, and tertiary interventions (Turner & Kaylor, 2015).
Overall, the theory explains all the concepts clearly and consistently. However, the difference between extrapersonal and interpersonal stressors is not quite clear and requires additional illustrative examples.
The General Use of the Theory in Nursing
Betty Neuman’s Systems Model is used in many areas of nursing. It is applied to the clinical practice, administration of healthcare services, research, and education. Globally, the practitioners of her theory recognize it as an effective method for creating positive clients outcomes. The practitioners of this theory try to help patients heal spiritually, mentally, and physically by reducing or eliminating various types of stressors described by Dr. Neuman (Fawcett & Foust, 2017).
Thus, they monitor the levels of client LOD and identify negative deviations from it, assess patients’ resources such as body temperature, emotional characteristics, genetic makeup, physical health, mental health, and stressor response patterns that help them cope with stressors taking into account the five client variables (Khatiban, Oshvandi, Borzou, & Moayed, 2016).
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A Specific Example of the Use of the Theory
A vivid example of the use of this theory in clinical practice is the treatment of a patient with multiple sclerosis (MS). Dr. Neuman’s Systems Model provides a reliable guidance for nursing practice in managing this patient taking into account unpredictability and complexity of MS. Thus, concerning collecting data and findings, a nurse identifies stressors that affect the patient. The patient is an active individual whose career is connected with physical education. Based on the assessment of stressors and psychological and physiological findings, the nursing diagnosis of a threat to wellness is a decrease in muscle strength, overall stamina, and coordination due to the diagnosis of MS. Then, the patient and nurse negotiate goals (Russi & Brown, 2015).
The expected outcome focuses on the patient redefining the old parameters and accepting the new ones which make the patient refuse from their highly valued concepts of autonomy, fitness, and strength. Primary and secondary interventions are focused on the nurse exploring the patient’s feelings about symptoms and diagnosis. The patient develops a therapeutic relationship with a nurse and shares their feelings and grief about the inevitable refusal from physical career and attempts to find new ways of demonstrating personal strength. After that, the nurse and patient establish long-term objectives concerning the adaptation to MS, changing the patient’s career, and discussing further intervention (Russi & Brown, 2015).
Betty Neuman. (2013).
Betty Neuman’s System Model. (2013). Web.
Fawcett, J., & Foust, J. B. (2017). Optimal aging: A Neuman Systems Model perspective. Nursing Science Quarterly, 30(3), 269-276.
Flaherty, K. M. (2013). Neuman Systems Model in nursing practice. In nursing theory: Utilization & application (pp. 200-222). St. Louis, Missouri: Elsevier.
Khatiban, M., Oshvandi, K., Borzou, S. R., & Moayed, M. S. (2016). Outcomes of applying Neuman System Theory in intensive care units: A systematic review. Journal of Critical Care Nursing, 9(4), 1-7.
Russi, A. E., & Brown, M. A. (2015). The meninges: New therapeutic targets for multiple sclerosis. Translational Research, 165(2), 255-269.
The Neuman Systems Model. (2013). Web.
Turner, S. B., & Kaylor, S. D. (2015). Neuman Systems Model as a conceptual framework for nurse resilience. Nursing Science Quarterly, 28(3), 213-217.