neuman systems partial
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H O L Y A N G E L U N I V E R S I T YG r a d u a t e S c h o o l o f N u r s i n g
In Partial Fulfillment of Requirements for GSNATFN
“Betty Neuman’s Systems Model”
Theory, Application, and Analysis
Presented To:
Marietta H. Gaddi, RN, PhD
Submitted By:
Joe Anne Mae A. Maniulit, RN
September 27, 2011
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BETTY NEUMAN: SYSTEMS MODEL
HISTORY OF THE THEORIST
Betty Neuman, a theorist credited to be a pioneer in nursing involvement in
mental health, was born in 1924 in a village in Washington Country in Lowell Ohio along
the Muskingum River. She was the middle child of the family, with two brothers. At the
age of eleven, her father had died from Kidney disease after several hospitalizations.
From these experiences, Neuman’s father had always spoke highly of the nurses who
cared for him, and this strongly affected her inspiration in becoming a nurse (Sitzman &
Eichelberger, 2011).
She grew up in a rural, farming community, which helped develop her passion for
caring and helping people in need as well as having a love for the land. Having lost her
father at such a young age, she could not afford to attend nursing school straight after her
high school graduation, so she had worked as an aircrafts instrument repair technician,
draftsperson, and a short order cook while saving for her nursing education, and helped
support her mother and her two brothers as well (Sitzman & Eichelberger, 2011). She
completed her initial nursing education with honors at People’s Hospital School of
Nursing (now General Hospital) in 1947 at Akron, Ohio (Tomey & Alligood, 2004).
Briefly after completing this degree, she then moved to Los Angeles, California and
gained experiences in a variety of nursing roles which included Hospital Staff, Head
Nurse, School nurse, and industrial nursing. She was also able to gain experience in
clinical teaching (in areas such as medical-surgical nursing, communicable disease, and
critical care nursing) in what is now known as the University of Southern California
Medical Center, in Los Angeles.
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As she had lived in a farm, Neuman was accustomed to always helping others in
need and this sparked her interest in human behavior. This interest continuously fueled
her studies and her theories in the development of the Systems Model. She attended
University of California in Los Angeles (UCLA) with a double major in public health and
psychology (Nicoll, 2008). She was able to complete her Bachelors of Science in Nursing
in 1957, after which she helped establish and maintain her husband’s medical practice
(McQuiston & Webb, 2008). She received her Masters Degree in mental health and
public health consultation in 1966 from the same university. She later received her
doctoral degree in clinical psychology from Pacific Western University in 1985. Betty
Neuman received her Honorary Doctorate of Letters from Neumann College, Aston,
Pennsylvania in 1992, and her Honorary Membership in the American Academy of
Nursing in the following year (Nicoll, 2008). In 1998, she received her Honorary
Doctorate of Science from Grand State Valley University in Michigan (McQuiston &
Webb, 2008).
Dr. Neuman, who was passionate about creating her systems model, continuously
worked to improve the model so that it may be integrated into the various field of nursing
practice. Today, her book on the system’s model currently has five revised editions, with
the fifth published this year (with co-author Jacqueline Fawcett). The fourth and fifth
editions of the book posed for further developments of the theory, offering an integrative
review of the model for areas of nursing such as application for practice, education,
research, and administration (Tomey & Alligood, 2004).
The System’s Model was widely accepted, not only in the nursing community, but
also in the other health disciplines because of its wide scope. This acceptance also caused
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a magnitude of international activities inspired by the Systems Theory, as it has been
cited on multiple occasions in international publications; it is the framework of many
researches, as well as the basis of post-graduate paper presentations (Tomey & Alligood,
2004).
THEORY ANALYSIS
Theory Creation Timeline
Before Neuman had began to work on her Systems model, she developed her first
teaching and practice model in the late 1960’s and this model is cited in her first book
publication Consultation and Community Organization in Community Mental Health
Nursing (published in the spring edition in 1972). She later designed a conceptual model
for nursing in 1970 the graduate students of UCLA who wanted a course emphasizing
breadth (range or scope) rather than depth. The model was first created to integrate the
student’s understanding of the variables within each client which has a wider scope than
that of the medical model. The model included theories and concepts from behavioral
science, which was used for problem identification and problem prevention. This model
was published in 1972 in Nursing Research, and Neuman spent a decade afterwards to
define and refine the various aspects of the model in preparation for her book, The
Neuman Systems Model: Application to Nursing Education and Practic (Tomey &
Alligood, 2004).
Theoretical Sources for the Creation of the Theory
“Health is a condition in which all parts and subparts are
in harmony with the whole of the client.”
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The concept of the Systems Theory was born in the early 1970, during a graduate
class, when it was asked, “how can nurses organize vast knowledge needed to deal with
complex human situations that require nursing care? (Meleis, 2011)” From this question,
Neuman tried her first attempt to answer with the adoption of many different theories,
concepts, as well as her own philosophies of health, wellness, and the role of the nurse
(Tomey &Alligood, 2011). With this, she worked at building, what she considers, a
wellness-oriented model and articulated a number of assumptions about client systems,
environmental stressors, their responses to stress, lines of resistance and defense, health,
energy, and wellness (Meleis, 2011). Dr. Betty Neuman integrated and synthesized her
knowledge of various disciplines in the creation of the model, especially those related to
mental health. All in all, she used the general systems theory, the Gestalt theory, Hans
Selye’s definition of stress, the conceptual model of Caplan, the philosophical views of
Pierre de Chardin, and Karl Marx(Tomey & Alligood, 2004).
General Systems Theory Her primary basis is the use of the general systems
model. A deeper view of the system defines that the world is composed of many systems,
and these systems are in constant interaction with one another. In an abstract way, these
systems are not just an influence, but rather, they are interrelated. The term “General
Systems” does not necessarily have a “precise definition,” as it is utilized by not only the
health science but other sciences as well (Checkland, 1997). However, in this theory, the
term systems refers to the client holistically (or wholistically as refined in later editions of
Neuman’s Theory), and this will be later discussed in the definitions of key terms and
concepts.
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The Gestalt Theory The Gestalt theory is one of German origin, with the term
“die gestalt” meaning “shape,” “essence,” or “a shape in its entirety or complete form.”
The Gestalt theory is usually defined as “a whole is greater than the sum of its parts.” In
Psychology, the Gestalt Effect is defined as the ability of the mind to recognize whole
forms from a set of lines or curves. In the same aspect that psychologist utilizes Gestalt to
seek the mind set of an individual, Neuman also uses this description to help explain the
dynamic interaction between an individual and their present situation and how this
interaction, in turn, defines the experience and the patient’s behavior.
Hans Selye’s General Adaptation Syndrome Focuses on the individual’s
reactions to stress which include alarm, resistance and exhaustion. Neuman utilizes the
definition of stress as a “non-specific response of the body to any demand made upon it,”
this response--- in the Systems theory is made without regard to the nature of the
problem. With this, stressors can be defined as either positive or negative (Tomey &
Alligood, 2004).
Caplan’s Conceptual Model is a model adapted by Neuman in which she
integrated the three different prevention levels. Primary prevention, as defined in her own
theory, is reducing the possibility of an encounter with a stressor or strengthening the
organism to decrease the reaction to the stressor if the interaction does occur (Tomey &
Alligood, 2004).
Pierre Tielhard deChardin & Karl Marx who is of French descent, is a Jesuit
priest and philosopher. He theorized that human beings are continually evolving to an
“Omega Point” or rather a state of perfection. In this theory, developed by deChardin in
The Future of Man (1950) states that a higher form of existence does exist; this higher
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form of existence includes higher level of material complexity and consciousness. To
deChardin, the search and movement towards an Omega point is something which must
occur and cannot be undone. Neuman mainly uses the philosophy derived from
deChardin on the “wholeness of life,” and integrates this into her definition of the
“wholistic client approach.” Marxist philosophy the properties or attributes of parts are
determined in part by larger wholes within dynamically organized systems (Callinicos,
2010). With this adopted philosophy, Neuman was able to confirm in her theory that the
patterns created by the whole also influence the awareness of a single part (Tomey &
Alligood, 2004).
Basic Assumptions (Neuman, 1995)
1. Nursing clients are dynamic; they have both unique and universal characteristics
and are in constant energy exchange with environment, both internal and external
2. The relationship between client variables (physiological, psychological,
sociocultural, developmental, and spiritual) influences a client’s prospective
mechanisms and determines a client’s response.
3. Clients present normal range of responses to the environment that represent
wellness and stability.
4. Stressors attack the flexible line of defense, then normal lines of defense
5. Nurses’ actions are focused on primary, secondary, and tertiary prevention.
Major Concepts, and Definitions
1. Person/Client – the person, family, group, or community, are the client or client
system. When discussing a system with more than one member, the relationships
between members must be clearly defined to establish boundries on who is
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included in the system (Meleis, 2011).The Client is a dynamic composite of
interrelationships or five interacting variables of physiological, psychological,
sociocultural, developmental, and spiritual factors.
2. Environment – Identified as the internal and external factors in which the client is
both affected and can affect (McQuiston & Webb, 2008). The relationship
between the person and the environment is reciprocal. Stressors are an important
concept of the environment and are described as the forces which have the
potential to alter a system’s stability (Neuman & Fawcett, 2011).
3. Health – Health, in Neuman’s model, is a continuum of wellness. A state of
health is considered to be a state of stability, in that the needs of all the systems
are being met (Neuman, 1995). The client is in a state of either wellness or illness
at any given point of time (Tomey & Alligood, 2004)
4. Nursing – This has been defined by Neuman as “A unique profession in that it is
concerned with all of the variables affecting an individual’s response to stress
(Tomey & Alligood, 2004).” The focal point of nursing is to keep a client’s
system stable, through the use of accurate assessment of the various stressors and
their possible effects (Sitzman & Eichelberger, 2011).
5. Wholistic Client Approach – This is a view where the client is see as an open ,
dynamic, system, and the focus of nursing intervention is to identify problems or
possible problems which may evolve from a thorough understanding of a client’s
unique environmental stressors (Tomey & Alligood, 2004). The system model
considers all of the systems, and how their variables relate and affect one another,
in physical, psychological, social, and spiritual faces (Neuman, 1995). The term
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holistic was changed to wholistic to avoid confusion and to enhance the
understanding that the term referred to a person in his or her entirety (Tomey &
Alligood, 2004).
6. Open System – Elements are in constant exchange within a complex organization.
Stress and reaction to stress are major elements to an open system (Meleis, 2011).
7. Created environment – Unconscious mobilization of all system variables towards
system integration, stability, and integrity (McQuiston & Webb, 2008).
8. Content – All variables of man in interaction with the environment comprise the
whole system of the client (Neuman & Fawcett, 2011).
Physiological -Body structure or function
Psychological – Mental processes, functioning, and emotions
Sociocultural – refers to relationships, cultural functions, and activities
Spiritual – refers to the influence of spiritual beliefs
Developmental – refers to the developmental processes in life.
9. Stressors – Produce either a positive or negative effect on the system, and are
described to potentially affect the stability of the client system:
Interpersonal – Between individuals
Extapersonal – outside an individual
Intrapersonal – within an individual
10. Basic or Core Structure – The basic survival factors or energy resources of the
client. These are common in all organisms, and include:
Normal temperature range – the ability to maintain homeostasis in regard
to temperature.
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Genetic Structure – Bodily features
Response pattern – homeostatic functioning of body systems
Organ Strength or weakness – the ability of particular organs to endure
stress.
Ego Structure – the “I” or personal essence.
Knowns or commonalities – value system
11. Input and Output – Matter, energy, or information exchanged between systems
12. Feedback – Matter, energy, or information for future input for a corrective action
to change, enhance, or stabilize a system (Tomey & Alligood, 2004).
13. Negentrophy – Energy utilization towards wellness (Sitzman & Eichelberger).
14. Entrophy – Energy depletion, leading towards illness or death (Sitzman &
Eichelberger).
15. Stability – Ability to cope with stressors and meet the demands of the various
interrelated systems. It is functional harmony or balance; the maintenance of the
integrity of the whole system (Meleis, 2011).
16. Wellness – When parts of a client system interact in harmony
17. Illness – disharmony between client systems as a result of unmet needs in varied
degrees.
18. Flexible lines of defense – In the conceptual model, this is the outer most circle,
symbolized by a dotted line to emphasize the elasticity of the line of defense in a
person’s system. A flexible line of defense is what keeps a system free of
stressors or allows the ability to cope with stressors without the core of the system
being affected negatively. The flexible line of defense is dependent upon variables
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such as sleep, the quality or quality of stressors, and the nutritional status of the
person. If it is penetrated, the normal line of defense follows. The relationship of
the five content or variables can affect the quantity in which individuals can
defend against stressors.
19. Normal Line of Defense – This is the concentric circle which represents the usual
wellness level, or how an organism has changed over time in response to coping.
This represents the overall stability state of an individual, maintained over time,
which is why it is represented by a solid circle. The normal line of defense is
dependent upon the client’s abilities and his or her environment. It also includes
the client’s attributes such as: intelligence, attitudes, problem solving abilities,
and coping abilities. An example of the normal line of defense is callous
formation in response to integumentary stress.
20. Lines of Resistance – Protects the core of a system or client, the core which is
represented by the survival needs all organisms have in common. The line of
resistance is activated when the stressor penetrates the normal line of defense.
One such example given by Neuman of this line in action is the increase of the
white blood cell count in response to infection or a foreign body.
21. Degree of reaction – The amount of energy needed to fully respond to a stressor.
22. Prevention as Intervention – Intervention are purposeful actions to help the client
retain, attain, or maintain system stability.
a. Primary – Carried out when a stressor is suspected or identified. This does
not mean that a problem exists, however, a factor in the client system can
indicate the presence of possible future factors. As such, the nurse
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intervenes in a manner to reduce, if not totally avoid, the negative effect of
the stressor.
b. Secondary – This is given after symptoms of stress occur. The point of
nursing intervention at this rate is to reduce the reaction of the stress upon
the client system and to use the internal and external resources of the
client to strengthen the client’s resistance and stabilization.
c. Tertiary – Occurs after active treatment and focuses on readjustment
towards optimal client stability. A primary goal with this level of
prevention is to strengthen the client system to prevent the reoccurrence of
the stressful event. Tertiary prevention leads back to primary prevention in
a circular fashion, as learned responses from the event may help the client
avoid the stressor—and therefore the effect of the stress—in the future.
23. Reconstitution – this occurs if resistance is successful or effective. It may occur
in any portion of the system (Tomey & Alligood, 2011). Reconstitution either
strengthens a line of defense for the system or it returns the system to a normal
level of functioning (Nicoll, 2008).
Betty Neuman’s Systems Model
Betty Neuman Systems Model represents the whole of the
individual, including the correlations of complex systems of
an individual, as wells as interacting with and responding to
the environment and environmental stressors. It also represents
how systems interact simultaneously, just as stressors may occur at the same
time or during any given point of time. A person is an open system, always changing and
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A
B
D
C
Stressors
Stressors
E
F
G
Neuman’s Systems Model 13
evolving, to a state of perfection or an omega point, and in order to achieve this, a client
system must maintain stability.
Strengths of the Theory
There are many strong points to the Neuman’s theory which allows for its
flexibility in nursing as well as other health related disciplines. One such strength is that
it was founded on sound theoretical basis and philosophies, instead of the use of theories
formulated from nursing research that have yet to be proven. Although in 1972, the
version utilizing the model had only weak empirical evidence, as it was collected only
from students of her Masteral class, further publicized researches using the model
strengthened the model’s effectiveness. Adding to this, a total of 100 studies between
1989 and 1993 were said to have used the framework as a guiding basis for research
(Tomey & Alligood, 2004).
Another characteristic of the theory adding to its strength are the clarity of the
concepts (Nicoll, 2008). Although they are abstract, they are still concepts in which
nurses are very familiar with. The concepts are complex, sometimes overlapping, and
broad in spectrum, however they are presented and explained in a logical manner and can
easily be used in any clinical setting (Tomey & Alligood, 2004). The model today
continues to guide nurses in terms of gathering assessment data and the implementation
of preventive intervention (Meleis, 2011).
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References
1. Callincios, A. (2010). The revolutionary ideas of karl marx. London: Bloomsbury.
2. Checkland, P. (1997). Systems thinking, systems practice. Chichester: John Wiley & Sons, Ltd.
3. McQuiston, C., & Webb, A. (2008). Foundations of nursing theory: contributions of 12 key theorists. (Vol. 13). University of Michigan: Sage Publications.
4. Meleis, A. (2011). Theoretical nursing: development and progress. (5 ed.). New York: Lippincott Williams & Wilkins.
5. Nicoll, L. (2008). Perspectives on nursing theory. University of Michigan: Lippincott.
6. Neuman, B. (1995). The neuman systems model. (3 ed). University of Michigan: Appleton & Lange.
7. Neuman, B., & Fawcett, J. (2011). The neuman systems model. (5 ed). New York: Pearson.
8. Sitzman, K., & Eichelberger, L. (2011). Understanding the work of nurse theorists: a creative beginning. (2 ed.). New York: Jones & Bartlett Publishers.
9. Tomey, A., & Alligood, M. (2004). Nursing theorists and their work. (3 ed.). Singapore: Elsevier (Singapore) PTE Ltd.
10. http://nursingtheories.blogspot.com/2008/07/betty-neumans.html
11. http://neumansystemsmodel.org/NSMdocs/neuman_systems_model_trustees.htm#Betty M. Neuman, R.N., B.S.N.
12. http://www.neumann.edu/academics/undergrad/nursing/archives.asp
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