Betty Neuman’s Theory and Implementation in Nursing


Various theories of nursing care center on the person as the primary target for nursing practice. For example, the theorists Roy and Neuman have similar representations of patients in their theoretical frameworks. However, other aspects of their teachings, connected to the assessment, diagnosis, and intervention, are different. This paper aims to identify one assumption of Betty Neuman’s systems model theory and investigate ways to implement this system in nursing care practices by using a specific example, the case of Mr. Reynolds.

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Betty Neuman’s Theory and Assumptions

The Neuman systems model theory focuses on the concept of adaptive and developmental stability, arguing that humans always exchange their energy with the surrounding environment (Alligood, 2014). One of the fundamental assumptions of this theory is based on the existence of various stressors that influence individuals and their well-being (Sitzman & Eichelberger, 2015). There are known, unknown, and universal stressors that have different effects on persons and their levels of stability and defense.

Stressors can be intrapersonal, interpersonal, or extrapersonal. Intrapersonal stressors deal with occurrences inside the patient’s internal environment, usually connected to such aspects as age or genetic predisposition. Interpersonal stressors include situations and events that happen outside of a person’s internal environment, such as relationships or occupations. Finally, extrapersonal stressors are factors that affect a person in indirect ways. The presence of stressors in an individual’s life exposes them to disturbances in the balance of their health and well-being. For this reason, nursing professionals have to identify these stressors in order to help patients. By finding and evaluating various stressors, nurses can render care that is relevant to the personal factors of the patient’s situation.

Structure of Applied Care

The structure of nursing care includes the completion of five essential steps: assessment, diagnosis, planning, intervention, and evaluation. In her theory, Neuman distinguishes three levels of prevention which act as intervention modes for nurses to use in their practice to deal with various stressors and help patients to maintain their well-being (Alligood, 2014). First of all, primary prevention is connected to general knowledge which may be applied in any assessment (Sitzman & Eichelberger, 2015). This step includes finding possible stressors, evaluating the levels of their effect, and determining ways to mitigate or reduce their influence on a person. This level of prevention can be used in one’s assessment as it includes the process of finding relevant information about a patient. During this step, nurses should evaluate not only the stressors which are visibly affecting a patient but also existing factors that might influence one’s well-being in the future, which makes this step important in the evaluation of one’s future state of health.

Secondary prevention looks at the reaction of an individual to the identified stressors with the goal of outlining the symptoms, ranking various types of intervention according to their priority, and finding the right treatment. These steps are necessary to reach a diagnosis, create a plan of treatment for a patient, and intervene to mitigate the effects of different stressors. The creation of a scheme should account for all current stressors which are affecting a patient and changing his or her condition.

Finally, tertiary prevention is related to planning and evaluation as it explores the concepts of reconstitution and maintenance of factors to support a person’s well-being. This step examines the effects of secondary prevention and evaluates the results of treatment. Tertiary prevention is also aimed at finding ways to protect a patient on their journey to recovery (Ahmadi & Sadeghi, 2017). Nurses should help patients to conserve their energy and support their existing strengths.

Examples of Interventions

According to Khatiban, Oshvandi, Borzou, and Moayed (2016), the implementation of the three levels of prevention helps nurses to accelerate the improvement of their patients. One can identify a number of stressors in the case of Reynolds. First of all, Reynolds’ age along with his history of past illnesses outlines the fact that primary prevention should include education on the topics of well-being and health maintenance. The history of Coronary Artery Disease and Diabetes Mellitus is a stressor that affects the patient’s ability to recover. Therefore, care should accommodate his current state and provide him with the necessary treatment. It is also important for nurses to account for losses experienced by the patient and evaluate their emotional state on this basis prior to delivering new information. This type of stressor could affect his heart condition and worsen his state. The patient needs emotional support. His recent reconnection with his daughter is also an aspect that should be taken into consideration. Her presence may be a positive factor that will improve the patient’s well-being. Providing education for Reynolds’ daughter on the topics of eldercare and social support may also be a possible type of intervention.

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Finally, the concept of tertiary prevention should be utilized to maintain the result of recent surgery. For this reason, nursing care should include such types of intervention as support of existing strengths and assistance with the patient’s rehabilitation. If one views the patient’s hip surgery as a result of secondary prevention, then the patient’s care should include actions to support his rehabilitation from this surgery.


Ahmadi, Z., & Sadeghi, T. (2017). Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal–Experimental, Translational and Clinical, 3(3), 1-8.

Alligood, M. R. (2014). Nursing theorists and their work (8th ed.). St. Louis, MS: Elsevier Health Sciences.

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), e8886.

Sitzman, K., & Eichelberger, L. W. (2015). Understanding the work of nurse theorists (3rd ed.). Burlington, MA: Jones & Bartlett Publishers.

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