Neuman’s System Model

World View: Reciprocal Interaction World View

• A holistic, multidimensional approach to the client as a system
• Wholeness is based upon the interrelationship of variables
• Change is reflected with the belief that the client changes constantly

Category of Knowledge:  Neuman’s model is client-focus and is an open system model that views nursing as being primarily concerned with defining appropriate action in stress-related situations or in possible reactions of the client system. Characteristics include:

• System: individuals, families, communities, and social issues
• Integration of Parts: the interrelationship of physiological, psychological, sociocultural, developmental, and spiritual variables
• Environment: all the factors that affect the client system
• Boundary: regarded as dynamic and changing constantly and as having different factors (time, place, events) –two lines of defense; flexible and normal and the lines of resistance represents the boundaries
• Tension, Stress, Strain, and Conflict: stressors are defined as tension and can lead to instability
• Steady State: essentially stable over time
• Feedback: the self-regulating system that facilitates maintenance of the desired state of health or goal.

Content of the Nursing Model; concepts and nonrelational propositions

Human Beings: viewed as client/client system -regarded as an open system that interacts with the internal and external environment. It has 4 dimensions; individual (the client) & groups -family, community, social issue

• Interacting Variables (5) dimensions: physiological (bodily structure, internal function), psychological (mental processes), sociocultural variable (conditions. influences), developmental (age-related functions), spiritual (beliefs, practices)
• Basic Structure (the central core): survival factors that are common to human beings; temperature, genetic structure, response pattern, organ strength, weakness, ego structure, knowns or commonalities (interacting variables are embedded or occur simultaneously). The basic structure is surrounded by the outer rings:  3rd<- 2nd <- 1st
  • 1. Normal Line of Defense: wellness level yet evolving a response to stressors, dynamic (expands over time or diminishes).
    2. Flexible Line of Defense: outer boundary of the client system that protects the normal line of defense, also dynamic.
    3. Lines of Resistance: protect the basic structure and support return of the client system

Environment (4 Components)

• Internal: all internal and intrapersonal stressors
• External: all interacting forces
• Created environment: unconscious factors, especially psycho-social and determines the response to stressors
• Stressors (3 components): tension production stimuli or forces occurring within internal/external environmental boundaries of the client system:
  1. 1. 1. Intrapersonal: yourself and the environment
        2. Interpersonal: between people i.e. spouse, children
        3. Extrapersonal: social policies or financial concerns

Health: 4 unidimensional factors

1. Health/Wellness/Optimal Client System Stability: health is the best possible wellness at any given time, unmet needs to reduce client wellness condition
2. Variances from wellness: the difference between usual wellness and determined by comparing health to the current state.
3. Illness: state of insufficient needs met
4. Reconstitution: successful mobilization of client resources, dynamic (can progress beyond previous wellness or to a lower level)

Nursing: prevention as an intervention and has 3 dimensions;

1. Primary: relates to general knowledge; prevention is the retention of wellness
2. Secondary: ranks priorities and treatment to reduce complications; prevention is to protect the BASIC structure and strengthen the internal Line of Defense, treating symptoms
3. Tertiary: (back to baseline) resources and maintenance factors that will set the client back towards primary prevention; prevention begins at any point after stability has occurred.

Neuman viewed nursing as a unique profession that is concerned with all the variables affecting a client’s response to stressors. The 3 dimensions of Prevention as Intervention represent nurse actions in which the GOAL of NURSING includes optimal wellness for the client by retention, attainment, or maintenance with interventions that will reduce stressors that will affect the optimal functioning.

Neuman’s Practice Methodology:  Systems Model Nursing Process Format (3 components)

1. Nursing Diagnosis: nursing process for the stressors, get client perception/awareness
2. Nursing Goals: propose, prioritize interventions and goals
3. Nursing Outcomes: implements the 3 levels of interventions

Relational propositions that link ALL 4 (nursing, human being, environment, health) metaparadigm concepts: The major concern for nursing is keeping the client system stable through accuracy both in assessing the effects and possible effects of environmental stressors and in assisting client adjustments required for an optimal wellness level.

Additional Information & References

• An Outline of Dr. Neuman’s System by Current Nursing
• Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis by NCBI
• Dr. Betty Neuman’s Website