betty Neuman's theory

1. Betty Neuman’s Health
Care Systems Model
Team Saturn
Ralph Quinones RN
Karen Roy RN
NRS430
Grand Canyon University
February 2009

2. Content
 Overview of Neuman’s Health Care Systems
Model
 Client System Concept Model
 How Neuman’s Health Care Systems Model
Views the Four Metaparadigm
 Three Ways Neuman’s Health Care Systems
Model Could be Used to Improve Nursing
Practice
 Neuman’s Systems Model Concept Map

3. Overview of Neuman’s Health Care
Systems Model
 Published in 1972 as “A Model for Teaching
Total Person Approach to Patient Problems”
in nursing research
(currentnursing.com/nursing_theory,2009).
 The goal is to provide a holistic overview of
human beings (patheyman.com, 2009).
 The focus is the client system and the
interaction of this system with the
environment (Newman,2005).

4. Overview of Neuman’s Health Care
Systems Model
 Purpose of nursing action is to best retain, attain and
maintain optimal client system health or wellness
using the three preventions as intervention to keep
the system stable (Hood & Leddy, 2006, p. 156).
 Focuses on stress reduction and addresses how
stress, and the individual’s response to it affects the
development, maintenance, and restoration of health
(Hood et al., p. 112).
 Client stability depends on the depth of stressor
penetration into the client system (Hood et al., p.
156).

5. Client System
 A Client system consists of multiple layers & a
central core:
Central core- basic structure and energy reserves.
Flexible lines of defense- adaptive responses that
fluctuate and protect from stressor penetration
Normal lines of defense- conscious adaptation
response that fluctuate and protect the core form
stressors.
Lines of resistance- protection factors activated when
stressors have penetrated the normal line of defense,
usually unconscious in nature.
(Hood et al., p. 113)

6. Client Stressors
 Stressors may be positive or negative, and
of three types:
Intrapersonal- arising from within the person.
Interpersonal- arising between two or more
persons.
Extrapersonal- arising from the external
environment.
(Hood et al., p. 113)

8. How Neuman’s Health Care Systems
Model Views the Four Metaparadigm
The four metaparadigm are:
 Person or persons (the recipient of nursing
care)
 Environment (physical and social)
 Health (a process or state)
 Nursing (goals, roles, and functions)
(Hood et al., p. 106)

9. Metaparadigm One: Person
1. Person or client system can be
individuals, families, groups, &
communities
(Hood et al., p.113).
 A composite of physiological, psychological,
sociocultural, developmental, & spiritual
variables in interaction with the internal and
external environment (Hood et al., p.114)

10. Metaparadigm Two: Environment
2. Environment includes all internal and
external factors of influences surrounding
the identified client or client system (Hood
et al., p.114).
Internal environment – Within the human
body.
External environment – Outside the human
body.
Created environment – Client perceptions of
the internal and external environments
(Hood et al., p.113).

11. Metaparadigm Three: Health
3.Health is a continuum of wellness to illness.
Wellness- dynamic equilibrium of the normal
line of defense, where stressors are
successfully overcome or avoided by the
flexible line of defense.
Illness- state when a stressor breaks through
the normal line of defense and causes a
reaction with client system’s line of resistance
(Hood et al., p. 113)

12. Metaparadigm Four: Nursing
4.Nursing is prevention as intervention.
Primary- Interventions to promote health.
Secondary- Occurs once a stressor
penetrates the normal lines of defense or
lines of resistance.
Tertiary- Restoration of balance
(rehabilitation).
(Hood et al., p. 113)

13. Three Ways Neuman’s Health Care
Systems Model Could be Used to
Improve Nursing Practice
1. Emphasize the client within the system
perspective, holistically, and multi-
dimensionally.
2. Utilized in nursing education at all entry
levels (diploma, associates, and
baccalaureate).
3. Nursing research: Project a role for
nursing during catastrophic events at
the local community, city, county, state,
interstate, national and global levels.

14. 1.Emphasize the Client
Emphasize the client within the system
perspective, holistically, and multi-
dimensionally.
 Treating the client system and not just the
diagnosis allows implementation of the model
into nursing practice, therefore, allowing
nurses to retain, attain and maintain optimal
client system stability by initiating the three
layers of prevention as intervention, and
reducing the effects of stressors
(Hood et al., p.156).

15. 2. Utilized in Nursing Education
Utilized in nursing education at all
entry levels (diploma, associates,
and baccalaureate).
The model assists students to carry out
in-depth assessments, categorize
comprehensive data, and plan
specificinterventions with clients as
holistic beings (SLSU, 2008).

16. 2. Utilized in Nursing Education
Students who could envision the
connection between Neuman’s Model
and North American Nursing Diagnosis
Association (NANDA) nursing
diagnosis through the nursing process
would be better able to choose
appropriate nursing diagnoses for
client care (McHolm & Geib, 1998).

17. 2. Utilized in Nursing Education
Neuman envisions a three stage nursing process:
1. Nursing Diagnosis- based of necessity in a thorough
assessment, and with consideration given to five
holistic variables in three stressor areas.
2. Nursing Goals- these must be negotiated with the
patient, and take account of patients’ and nurse’s
perception of variance from wellness.
3. Nursing Outcomes- Considered in relation to 5
holistic variables, and achieved through primary,
secondary, and tertiary interventions (NT, 2009).

18. 3. Nursing Research
Nursing research: Project a role for
nursing during catastrophic events
at the local community, city, county,
state, interstate, national and global
levels.
Fawcett (2001) studied two hundred
published literatures integrating the
Neuman model and concluded that the
majority of researchers were focusing
on prevention and interventions.

19. 3. Nursing Research
Researchers are using this model to
determine appropriate interventions to
strengthen the lines of resistance to
prevent further dysfunction within
community systems
(Stanhope & Lancaster, 2003).

20. 3. Nursing Research
Example 1:
Flu epidemic at state client system level.
Primary intervention- vaccination of at risk groups
Secondary intervention- mass flu vaccination for all
whom wish.
Tertiary intervention- flu vaccination predicted to be
reduced related to limited resources. Implement
interstate and national resources to re-supply the
lines of resistance and defense before further
penetration of stressors occur.

21. 3. Nursing Research
Example 2:
Current financial meltdown results in 533,00 jobs
lost in 11/2008 (Bernstein & Shierholz, 2008).
 Research on communities losing a major source of
employment to identify stressors and to devise
interventions to maximize client system stability.
 Over time, chronic health problems develop because
of these stressors and lead to poor nutrition,
postponement of medical care, and depression
(Stanhope & Lancaster, 2003). Ultimately a
chronically ill community could result.

22. Neuman’s Systems Model Concept Map
Client Environment Health
Stressors
Intrapersonal Extrapersonal
Interpersonal
Nursing
Sociocultural
Psychological
Spiritual Developmental
Physiological
Internal
Created
External Wellness Illness Prevention
Primary
Tertiary
Secondary
Client System
Central Core Lines of Resistance
Normal Lines
Flexible Lines
Nursing Process
Diagnosis
Goals
Outcomes

23. References
Bernstein, J., Shierhoz, H., (2008). Economic Policy Institute: Job losses accelerate at alarming
rate in November. Retrieved January 20, 2009, from the World Wide Web:
http://epi.org/publications/entry/webfreatures_econindicators_jobspict_20081205/
Fawcett, J., (2001). Neuman Systems Model-Based Research: An Integrative Review
Project.Retrieved January 19, 2009, from the World Wide Web:
http://nsqpub.com/cgi/content/abstract/14/3/231
Hood, L. J., & Leddy, S. K. (2006). Conceptual Bases of Professional Nursing (6th ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.
McHolm, F., Geib, K., (1998). Application of the Neuman systems model to teaching health
assessment and nursing process. Retrieved January 20, 2009, from the World Wide Web:
http://findarticles.com/p/articles/mi_qa3836/is_/ai_n8792656
Neuman Systems Model. (n.d). Retrieved January 17, 2009 from
http://www.patheyman.com/essays/neuman
Newman, D. (2005). Complex patient needs: Nursing models can help! Journal of Christian
Nursing, 22(1), 33-38.
Nursing Theories: A companion to nursing theories and models. (2009). Retrieved on January
19-20, 2009 from
http://currentnursing.com/nursing_theory/application_Betty_Neuman’s_model.htm
Southern Luzon State University, (2008). Theoretical Foundations of Nursing: Betty Neuman
(System Model in Nursing Practice). Retrieved January 19, 2009, from the World Wide Web:
http://slsu-coam.blogspot.com/2008/09/betty-neuman-system-model-in-nursing.html
Stanhope, M., Lancaster, J., (2003). Community & Public Health Nursing(6th ed.). St. Louis,
MO: Elsevier Health Sciences