BETTY NEUMANN’S SYSTEM MODEL THEORY .pptx

Moderator:
Ms. Tarika Sharma
Assistant Professor
CON, ILBS,
New Delhi, India
Presented by:
Mr
. Shashi Prakash
M.Sc. Nursing 1st Year
CON, ILBS,
New Delhi, India
BETTY NEUMANN’S THEORY
12/5/2020 BETTY NEUMANN’S THEORY 1

Objectives
• Explore credentials, theoretical sources, and historical
perspective of Betty Neuman
• Review concepts/definitions and concept map
• Critique theory
• Examine the Neuman Systems Model’s acceptance by the
nursing community
• Demonstrate NSM’s use through case

BETTY NEUMANN’S SYSTEM MODEL
• Betty Neumann’s system model provides a
comprehensive, flexible, holistic and system based
perspective for nursing.
• It focuses attention on the response of
the client system to actual or potential
environmental stressors.

BETTY NEUMANN’S SYSTEM MODEL
• The use of primary, secondary and tertiary nursing
prevention intervention for retention, attainment, and
maintenance of optimal client system wellness.

Background and History of Theory

HISTORY AND BACKGROUND OF THE
THEORIST
•Betty Neumann was born in 1924, in Lowel,
Ohio.
•Completed B.Sc. nursing in 1957, and M.S. in
Mental Health Public health consultation, from
UCLA in 1966.
•She holds a Ph.D. in clinical psychology.

THEORIST
•The models was initially developed, in response to
graduate nursing students expression of a need for
course content, that would expose them to breadth of
nursing problems, prior to focusing on specific nursing
problem areas.

THEORIST
•The model was published in 1972 as “A Model for
Teaching Total Person Approach to Patient Problems” in
Nursing Research.
•It was refined, and subsequently published in the first
edition of Conceptual Models for Nursing Practice, in
1974, and in the second edition in 1980.

“It is important to state that neither
was I knowledgeable about nursing
models nor had a clear trend yet
begun in nursing for developing
models. The Neuman Systems
Model was developed strictly as a
teaching aid”
- Betty Neuman, 2002
• Betty Neuman as keynote speaker at the University of
Maine, Fort Kent, 2004.

Neuman with Sister Callista Roy | neumansystemsmodel.org

Neuman with her colleagues | neumansystemsmodel.org

Awards and Honors of Betty Neuman
• Betty Neuman has done many things including a nurse,
educator, health counselor, therapist, author, speaker,
and researcher.
• Honorary Doctorate of Letters, Neumann College,
Aston, PA (1992)
• Honorary Member of the Fellowship of the American
Academy of Nursing (1993)
• Honorary Doctorate of Science, Grand Valley State
University, Michigan (1998)

Neuman honored with Distinguished Service Medal | www.walsh.edu

DEVELOPMENT OF THE MODEL
•Neumann’s model was influenced by a variety of
sources.
•The philosophy writers de Chardin and cornu (on
wholeness in system).
•Von Bertalanfy, and Lazlo on general system theory.
•Selye on stress theory.
•Lararus on stress and coping.

NEUMANN’S WORK & THE CHARACTERISTICS
OF A THEORY
•Theories can be the bases for hypotheses, that can be
tested.
•Theories contribute to and assist in, increasing the
general body of knowledge within the discipline, through
the research implemented to validate them.

OF A THEORY
• Theories connects the interrelated concepts in such a
way, as to create a different way of looking at a
particular phenomenon.
• Theories must be logical in nature .
• Theories should be relatively simple yet generalizable.

OF A THEORY
•Theories can be utilized by the practitioner, to guide and
improve their practice.
•Theories must be consistent with other validated
theories, laws and principles but will leave open
unanswered questions, that need to be investigated.

BASIC ASSUMPTIONS OF NEUMANN’S
THEORY
Sunday, February 12,2017
13

BASIC ASSUMPTIONS
1. Each client system is unique, a composite of factors
and characteristics within a given range of responses
contained within a basic structure.
I amunique

2. Many known, unknown and universal stressors
exist. Each differ in it’s potential for disturbing a
client’s usual stability level or normal Line of Defense.
BASIC ASSUMPTIONS

3. Stressors both universal and known; some are unique to
the client. They have potential to disturb equilibrium, thus
causing a change in priority of needs at any given moment.
BASIC ASSUMPTIONS
Stressors disturbs the
normal equilibrium

4. Man is a composite of the interrelationship of the four variables
(biological, psychological, socio-cultural and developmental) which
are at all times present.
BASIC ASSUMPTIONS

BASIC ASSUMPTIONS
5. Each client/ client system has evolved a normal range of
responses to the environment that is referred to as a normal Line
of Defense. The normal Line of Defense can be used as a
standard from which to measure health deviation.

6. When the flexible Line of Defense is no longer capable of
protecting the client/ client system, against an environmental
stressor, the stressor breaks through the normal Line of
Defense.
BASIC ASSUMPTIONS

Primary Prevention
Secondary Prevention
Tertiary Prevention
BASIC ASSUMPTIONS

7.Primary prevention relates to general knowledge
applied to clients assessment to identify stressors before
they occur.
8.Secondary prevention relates to symptomatology. These
are interventions generally initiated after an encounter
with a stressor.
9.Tertiary prevention relates to the adaptive process, as
reconstitution begins and moves back towards primary
prevention. These are the interventions initiated after
treatment.
BASIC ASSUMPTIONS

MAJOR CONCEPTS OF NEUMANN'S THEORY

FOUR MAJOR CONCEPTS
Person
Environment
Health
Nursing

1.PERSON
Each layer consists of five person variable or subsystems:
Physiological- Refer to the physiochemical structure and
function of
processes
the body. Psychological- Refers to mental
and emotions. Socio-cultural- Refers to
relationships; and social/cultural expectations and activities.
Spiritual- Refers to the influence of spiritual beliefs.
Developmental- Refers to those processes related to
development over the lifespan.

2.ENVIRONMENT
The internal environment exists within the client
system. The external environment exists outside
the client system.
A created environment which is an environment that is
created and developed unconsciously by the client and is
symbolic of system wholeness.

3.HEALTH
Neuman sees health as being equated
with wellness. She defines health/wellness
as “the condition in which all parts and
subparts (variables) are in harmony with the
whole of the client (Neumann, 1995)”.

3.HEALTH
The client system moved toward
wellness when more energy is
available than is needed.
The client system moves toward illness
and death when more energy is needed
than is available.
.

4. NURSING
Neuman sees nursing as a unique
profession that is concerned with all of
the variables, which influence the
response a person might have to a
stressor
. The person is seen as a whole,
and it is the task of nursing to address
the whole person.

4. NURSING
Neuman defines nursing as “action
which assist individuals, families and
groups to maintain a maximum level
of wellness, and the primary aim is
stability of the patient/client system,
through nursing interventions to
reduce stressors.’’

4. NURSING
• The role of the nurse is seen in terms of degree of reaction to stressors, and
the use of primary, secondary and tertiary interventions.
Tertiary
Prevention
Secondary
Prevention
Primary
Prevention

Secondary
prevention
Tertiary
prevention
Stressors
Reaction
Interventions
Reconstitution
Stressors
Stressors
Basic structure
and Line of
Defense
The Neuman System Model (3rd edition,1995)
Primary
preventio
n

RESEARCH - 1
• Effectiveness of health education about the risk factors of
Hepatitis B & C infection and knowledge regarding prevention
of transmission is helpful in decreasing the Hepatitis B & C
infection among adults in community.
• Govinda
• A study was done to assess the risk factors and effectiveness of
health education of Hepatitis B & C infection and knowledge
regarding prevention of transmission among adults.

Cont…
• • Material and method: Sample consisted of 500
adult attending a selected clinic at Delhi Government
Dispensary, Chhatarpur, Delhi, and their knowledge
were assessed using structured questionnaire.
• Results: The findings showed that adult had least
knowledge in the domain prevention of transmission
of Hepatitis B & C infection among adults in community.
• In this research study the author used Conceptual
Framework based on Betty Neuman’s System Model
(2002).

Secondary prevention
• Determines cases of
Hep. B & C
• Treatment of
symptoms
Tertiary prevention
• Reeducation to prevent
future occurences
• Prevention of complication
• Re- adaptation
Stressors
Intrapersonalfactors
• Age
• Gender
Interpersonalfactors
• Education
• Monthly income
Reaction
Individual assessment
of variables:
Time of encounter of
risk factors of Hepatitis
B & C
Interventions
Development & distribution
of educational pamphlet on
prevention of transmission of
Hepatitis B & C
Reconstitution
Prevention of disease
• transmission
• consequences
Stressors
Extrapersonalfactors
Religion, Occupation,
Immunization, Status of
family members,
Risk factors for Hep. B &
C:
Medical, family, work.
social. personal care
history.
Basic structure
and Line of
Defense
Primary prevention
Distribution ofedu.Pamphlet
amongadultswithgoalof
• Promoting immunization
againstHep.B
• Preventing transmission &
riskfactorsofHep.B&C
Basic Structures
• Normal temperature range
• Genetic Structure
• Response pattern
• Ego structure
• Origin strength or
weakness
• Known or commonalities
Conceptual Framework based on Betty Neuman’s System Model (2002)
 Not included
in the study

RESEARCH - 2
• Assessment and comparision of Cognitive Function and
Depression level among patients with Chronic Liver Disease and
Healthy Controls.
• Lincy Varghese
• A study was done in this area to fulfill the gap of practice as well
as to facilitate the nursing personnel to support clinician in this
challenging area.

Cont…
• Material and method: Sample consisted of 220
subjects (110 patient with CLD and 110 healthy
controls), and their cognitive function and depression
level were assessed by using Modified Mini Mental
Status Examination & Beck Depression Inventory.
• Results: The findings showed that the patient with CLD
had poor cognitive function and severe depression
compared to healthy controls.
• In this research study the author used Conceptual
Framework model of cognitive function & depression level
in CLD based on Betty Neuman’s System Model
(2002).

Secondary
prevention
• Early detection of
cognitive
impairment and
depression
• Treatment
Tertiary
prevention
Stressors
• Diagnosis of CLD
• Need of treatmentand
follow up
Degree of
Reaction
• Assess cognitive
function with 3MS
• Assess depression
with BDS Reconstitution
Basic structure
and Line of
Defense
Primary
prevention
Client factors
• Age
• Gender
• Marital status
• Educational status
• Income status
• Causes of liver disease
• Duration of CLD
• Cirrhosis
• Vitamin supplement
• Minimal Hepatic
Encephalopathy
Conceptual Framework model of cognitive function & depression level in CLD based on
Betty Neuman’s SystemModel (2002).
 Not included
in the study

STAGES OF NURSING PROCESS
(BY NEUMAN)
Nursing
Diagnosis
Nursing Goal
Nursing
Outcome

(BY NEUMAN)
1. NURSING DIAGNOSIS
• It depends on acquisition of appropriate database; the diagnosis
identifies, assesses, classifies, and evaluates the dynamic interaction of
the five variables.
• Variances from wellness (needs and problems) are determined by
correlations and constraints through synthesis of theory and data base.
• Broad hypothetical interventions are determined, i.e. maintain flexible
line of defense.

(BY NEUMAN)
2. NURSING GOALS
• These must be negotiated with the patient, and take account of patient’s and
nurse’s perceptions of variance from wellness.
3. NURSING OUTCOMES
• Nursing intervention using one or more preventive modes.
• Confirmation of prescriptive change or reformulation of nursing goals.
• Short term goal outcomes influence determination of intermediate and long
– term goals.
• A client outcome validates nursing process.

NEUMANN’S SYSTEM MODEL FORMAT

ACCEPTANCE BY THE NURSING COMMUNITY
PRACTICE
EDUCATION
RESEARCH
ADMINISTRATION
PRACTICE

PRACTICE
FAMILY THERAPY
,
PUBLIC HEALTH,
REHABILITATION,
AND HOSPITAL
NURSING.
THE SUB
SPECIALTIES
INCLUDE
PULMONARY,
RENAL, CRITICAL
CARE, AND
HOSPITAL MEDICAL
UNITS.

•As a curriculum guide for a
conceptual framework oriented
more toward wellness than toward
a medical model and has been used
at various levels of nursing
education.
reference
•Developing a frame of
centered on holistic care.
EDUCATION

•The identification of
congruence between the
client’s perception of stressors
and the Method of collecting
and analyzing data for
identifying client problems.
care giver’s perception of
client stressors.
RESEARCH
• Case management of
patients.
• Total quality management is
used to prepare health care
administrators for future.
ADMINISTR
ATION

Case example-1
Radha a young woman age 19 years old.
newly married (married only for 3 months)
She is pregnant
Her husband is unemployed.
Her IPR with mother in law is not good.
She is under weight

Case example cont..
Intrapersonal stresses.
◦ Her poor nutritional status
◦ Emotional status
Interpersonal stress
◦ Relationship with mother in law
Extra personal
◦ unemployment of husband

Case example cont..
Flexible line of defense
◦ Suffering from poor nutritional status.
◦ Lacks enough sleep due to the nature of her work
The normal line of defense
◦ Uncaring attitude toward her pregnancy.
◦ Her coping abilities are also affected.

Case example cont..
• Nursing diagnosis
Nutritional imbalance r/t financial constraints
Knowledge deficit regarding pregnancy and care r/t
being primigravida and young age
Anxiety r/t pregnancy, job, family relations
• Goals
To improve the nutritional status
To ensure a safe motherhood

Case example cont..
• Outcomes
Primary prevention
◦ Educate their family on the importance of having
good nutrition.
◦ Suggested some nutritious but cheap food choices.
◦ Possible alternative jobs that would not jeopardize
her health and that of her unborn baby.

Case example cont..
• Outcomes
Secondary prevention
◦ Advised to seek pre-natal check-up
◦ Make use of the available services of the nearby
health center.
Tertiary prevention
◦ supporting and commending the positive
behavioral changes exhibited by the couple

Case Example-2:
• Mr. Mango Man is a 38 year-old business executive. His
colleagues describe him as hard working, perfectionist,
and very dedicated to work. His day starts by leaving
the house very early from Delhi to Noida and begins
work by delegating various tasks with firm expectations
and deadlines that somewhat impossible to meet. He
usually responds with pressure and intimidating
remarks for works not perfectly done. He smokes and
drinks alcohol whenever he is stressed. Recently, the
company experienced continuous dropped in their sells
and his bosses started to put blame to him.

continuation…
• Mr. Mango Man began exhibiting weird mannerisms and
behaviors that appear strange to his family and people
around him. He misses breakfast and lunch very often
and sleeps very late at night while doing work. He has
no time anymore for his family and focuses to hard on
meeting deadlines and his preconceived objectives.
Because of these weird changes in him, the company
decided to temporarily relieve him from his position as
executive manager. A week later, he started to have
periods of mania and depression. His family becomes
worried and called up the hospital to seek assistance
after he locked himself in the room, refusing to eat, and
most of the time quiet and staring blankly on the wall.
Later, he developed pneumonia.

Applying Neuman’s System Model
•Using Neuman’s System Model in the above situation,
the identified possible stressors that contributed to Mr.
Mango Man condition were as follows: work, personality,
and attitude. Mr. Mango Man is not anymore able to
handle the stressors and that had caused the
“breakdown” of his lines of defense.
• Without seeking help from his family and friends, he
was not able to maintain his flexible line of defense and
brought instability to his system.

C
O
C
O
R
R
E
E
Work-related stressors
Effects on Normal Line of Defense:
•exhibiting weird
mannerisms and behaviors
•periods of mania and depression
Effects on Flexible Line of
Defense:
•sleeps very late at night
•misses breakfast and lunch
•responds with pressure and
intimidating remarks for works not
perfectly done
•smokes and drinks alcohol
whenever he is stressed
Primary Prevention:
•Stress management activities
•Relaxation techniques
•Anger-management
techniques
•Smoking cessation
Tertiary Prevention
•Re-assessing patient’s ability to
independently perform and maintain
variables of health.
•Regular consult to psychologist.
•Maintaining client’s support
system
Effects on Lines of Resistance:
•weakened immune
response
•developed pneumonia
Secondary Prevention
•Medication (to treat
symptoms)
•Opportunities to verbalize feelings and
concerns

Applied and adapted to
Nursing education
Nursing research
Nursing practice
Family therapy
Public health
Rehabilitation
Hospital nursing
Applications of Newman’s system model

Education
As a curriculum guide for a conceptual framework
At various levels of nursing education.
Helps prepare students for developing a frame of
reference centered on holistic care.

Research input
• A study to assess the effectiveness of a structured health
teaching regarding BSE on knowledge, attitude and
practices of close relatives of breast cancer patients.
• Jose J, Sharma K, Srivastava A (2010)
Intrapersonal stressors -family history, old age,
nulliparity, early menarche, late menopause
Interpersonal - inadequate knowledge regarding the
warning signs, lack of access to health info
Extrapersonal- costly preventive and therapeutic options,
increased financial burden, increased hospital visits

Research input
Primary prevention- structured teaching regarding
BSE, motivation for BSE performance
Secondary prevention- BSE, Motivation for BSE and
screening in HRGs
Tertiary prevention- psycho support, effective
communication, strengthening coping skills (not
studied)

Neuman’s Work & the Characteristics of a
Theory
Theory
Theory
• Connect the interrelated
concepts in such a way as
to create a different way
of looking at a particular
phenomenon
• Must be logical in nature
Betty Neuman
• The interrelationships
between the concepts of
person, health, nursing
and society/environment
are repeatedly mentioned
throughout the model
• There is a logical
sequence in the process of
nursing

Theory
Theory
• Be relatively simple yet
generalizable
• Can be the bases for
hypotheses that can be
tested
Betty Neuman
• Terms used are easily
identifiable & for the
most part have
definitions that are
broadly accepted
• High level & breadth of
abstraction lends to
theory development

Theory
Theory
• Can be utilized by the
practitioner to guide &
improve their practice
Betty Neuman
• Assessment/intervention
instrument together with
comprehensive guidelines
for its use with the
nursing proces

STRENGTHS
• Included clients as holistic being
• It gives clear direction for interventions
• Permits flexibility
• Facilitated cultural considerations
• Provided a nursing focus as opposed to medical focus
• Provided a framework to study individual illness &
reaction to stressors
• Considered the created environment

LIMITATION
• Neuman has explained nicely about the prevention but
the other factors that will help in reconstitution as well
as maintenance of the stability of client like, peer
group, family, and many others are not explained.
• Values inherent in nursing in relationship to role of
patients in maintaining & promoting health are not
addressed.

NEUMAN’S SYSTEM MODEL CONCEPT MAP:
CLIENT
SPIRITUAL
PHYSIO
LOGICAL
DEVELOP
MENTAL
PSYCHO
LOGICAL
SOCIO
CULTURAL
CLIENT SYSTEM
CENTRAL FLEXIBLE
CORE LINES
NORMAL
LINES
LINES OF
RESISTANCE
ENVIRONMENT
INTERNAL
EXTERNAL
CREATED
HEALTH
WELLNESS ILLNESS
NURSING
PREVENTIO
N
PRIMARY
SECONDARY
TERTIARY
NURSING
PROCESS
DIAGNOSIS
GOALS
OUTCOMES
NEUMAN’S SYSTEMS
MODEL CONCEPT
MAP
STRESSORS
INTRAPERSONAL INTERPERSONAL EXTRAPERSON
AL

SUMMARY
Introduction of theory
History and background of theorist
Development of model
Characteristics of theory
Basic assumptions
Major concepts
Applications in nursing practice
Neuman’s & characteristics of a theory
Strengths & limitations

CONCLUSION
“Health is a condition in which all parts and subparts are
in harmony with the whole of the client.”
“The future of the Newman System Model looks bright”
Dr Neuman (1997)

Case Simulation
• Barry Stinson 60-year-old male presents to surgical
staging area for bilateral knee replacement surgery.

Case Simulation
• https://youtu.be/WEY9pxxcxSQ

Comparison of NSM with two other nursing
theories / models

Comparison
Rogers
(1970)
Science of
Unitary
Human
Beings
Neuman
(1970)
Neuman’s
System
Model
Roy (1970)
Roy’s
Adaptation
Model

Contemporaries of one another
Martha
Rogers
Betty
Neuman
Sister Callista
Roy

Each Define the Metaparadigm Concepts: :
• Person
• Health
• Environment
• Nursing

Each Used in Nursing:
• Practice
• Administration
• Education

Meets Fawcett’s criteria eligibility:
• Rogers
• Roy?
• Neuman?

Theories derived from:
Martha
Rogers
• Six Grand
theories and
12 Middle-
range theories
based on SUHB
Betty
Neuman
• Two Grand
Theories and
Three Middle-
range theories
based on NSM
Sister
Callista
Roy
• One Grand
theory and
Nine
Middle-
range
theories
based on
RAM

Goal of Nursing
To Promote Human Betterment wherever People Are, on Planet Earth or in
Outer Space.
To Facilitate Optimal Wellness for the Client Through Retention, Attainment, or
Maintenance of Client System Stability.
To Promote Adaptation for Individuals and Groups in the Four Adaptive Modes,
Thus Contributing to Health, Quality of Life, and Dying with Dignity by Assessing
Behavior and Factors That Influence Adaptive Abilities and by Intervening to
Expand those Abilities and to Enhance Environmental Interactions.

Overview
Focus is on unitary, irreducible human beings
& their environments.
Focus is on wellness of client system in
relation to environmental stressors and
reactions to the stressors.
Focus is on human adaptive system responses
and environmental stimuli, which are
constantly changing.

Worldview
Reflects the simultaneous action
worldview
Reflects the reciprocal
interaction worldview
Reflects the reciprocal
interaction worldview

Rogers
Roy
Neuman
Selection Rationale

Discussion of the Nurse as the Client
• Galloway (1993) offered an informative NSM-based self-analysis of
her practice with a mentally and physically impaired infant. She
stated:
• “Through analyzing my role as a student nurse in a difficult clinical
situation, I learned that I not only adapted well but also
experienced personal growth. I did not avoid the reality of my
situation; rather, I worked within the difficulties it presented.
Understanding the importance of identifying and expressing
emotions, I did not deny my positive and negative feelings. By
using effective coping mechanisms and introducing alternative
methods as necessary to deal with stressors, I achieved a positive
result. Although my flexible line of defense contracted slightly due
to the influence of specific negative variables, it buffered effectively
so that my underlying normal line of defense was not penetrated.”

Steps taken to ensure the Continued
Evolution of the NSM
• Establishment of the NSM Trustees Group
• Support & promote the NSM through scholarly work &
professional forums
• Establishment of the NSM Archives at Neumann College in
Aston, Pennsylvania
• Facilitates access to important documents
• Establishment of the Neuman Institute
• Enhance continuation of NSM-based scholarly work

Evaluation: Recapitulation
1. What are the 9 Assumptions of Betty Neuman’s Nursing Theory?
2. What Are Stressors in Betty Neuman’s Nursing Theory?
3. What Are the Strengths of Betty Neuman’s Nursing Theory?
4. What Are the Weaknesses of Betty Neuman’s Nursing Theory?

In a one whole sheet of paper
write an essay about ‘Theory
Critique of Neuman’s
System Model”.
Submit it before 10/12/2020
before 5 PM on my table.

References
• Navdeep Kaur Brar, HC Rawat. Textbook of Advanced
Nursing Practice. New Delhi: Jaypee Brothers Medical;
2015. 553-62.
• Potter A Patricia, Perry G Anne (1992) Fundamentals Of
Nursing –Concepts Process & Practice. 3rd ed. London
Mosby Year Book.
• George B. Julia . Nursing Theories- The base for
professional Nursing Practice , 3rd ed. Norwalk, Appleton
and Lange. 1989.
• Neuman, B. (1996). The Neuman systems model in
research and practice. Nursing Science Quarterly, 9(2), 67-
70.
• Neuman, B. (1995). The neuman systems model (3rd ed.).
In McEwen, M. and Wills, E. (Ed.). Theoretical basis for
nursing. USA: Lippincott Williams & Wilkins.

Cont…
• Alligood, M.R. & Tomey, A.M. (2010). Nursing Theorists and
Their Work 7th Edition. Maryland Heights, Missouri: Mosby
Inc.
• Photo and diagram courtesy of Neuman Systems Model Inc.
www.neumansystemsmodel.org Last updated 2011.
• Mc. Even M, Wills EM. Theoretical basis for Nursing. 2nd ed.
USA: Lippincott Williams & Wilkins. 200
• www.nurses.info/nursing_theory_person_neuman_betty
• http://currentnursing.com/nursing_theory/Neumann.html
• www.neumansystemsmodel.org/

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