The Neuman Systems Model views the client as an open system that interacts with stressors in the environment. It focuses on stressors, the client's reaction, and factors that reconstitute stability. The client system has lines of defense that protect a basic structure. Nursing interventions aim to retain, restore, or maintain stability through primary, secondary, and tertiary prevention. Betty Neuman developed this holistic nursing theory building on general systems theory and stress theory.

1. BETTY NEUMAN’S NURSING THEORY
INTRODUCTION
The Neuman systems model is a nursing theory based on the individual's relationship to stress, the
reaction to it, and reconstitution factors that are dynamic in nature. The theory was developed
by Betty Neuman, a community health nurse, professor and counselor. The central core of the
model consists of energy resources (normal temperature range, genetic structure, response pattern,
organ strength or weakness, ego structure, and knowns or commonalities) that are surrounded by
several lines of resistance, the normal line of defense, and the flexible line of defense. The lines of
resistance represent the internal factors that help the patient defend against a stressor, the normal
line of defense represents the person's state of equilibrium, and the flexible line of defense depicts
the dynamic nature that can rapidly alter over a short period of time
Three words frequently used concerning stress are inevitable, painful, and intensifying. It is
generally subjective and can be interpreted as the circumstances of conceivably threatening and out
of their control. A nursing theory developed by Betty Neuman is based on the person’s relationship
to stress, response, and reconstitution factors that are progressive in nature. The Neuman Systems
Model presents a broad, holistic, and system-based method to nursing that maintains a factor of
flexibility. It focuses on the patient system’s response to actual or potential environmental stressors
and maintains the client system’s stability through primary, secondary, and tertiary nursing
prevention interventions to reduce stressors.
BIOGRAPHY OF BETTY NEUMAN
Born in Lowel, Ohio in 1924, Betty Neumann earned her diploma
as a Registered Nurse in 1947 from the Peoples Hospital School
of Nursing in Akron, Ohio. She went on to complete her Bachelor
of Science in Nursing in 1957 and her Master of Science in Mental
Health, both from the University of California-Los Angeles in
1966. She also earned a Ph.D. in clinical psychology from Pacific
Western University in 1985. In 1992, Neumann was given an
Honorary Doctorate of Letters at the Neumann College in Aston,
Pennsylvania. Finally, in 1998, the Grand Valley State University
in Michigan gave her an Honorary Doctorate of Science.

2. CAREER OF BETTYNEUMAN
After earning her Master degree, Neuman began working as a nurse. Specifically, she was a pioneer
in nursing involvement in community mental health. While she was developing her systems model,
she was working as a lecturer at the University of California-Los Angeles in community health
nursing. Due to her work in nursing, Neuman was named as an Honorary Member of the Fellowship
of the American Academy of Nursing.
Betty Neuman’s first book, The Neuman Systems Model, was published in 1982. The book
included nursing process format and care plans, and was a total approach to client care. Newer
editions were published in 1989, 1995, 2002, and 2010.
After the publication of her model, Neuman spent her time educating nurses and professors about
it through her work as an author and speaker.
BETTY NEUMAN’S CONTRIBUTION TO NURSING THEORY: NEUMAN
SYSTEMS MODEL
In 1970 she began developing her Systems Model as a way to teach introductory nursing to students
by giving them a holistic view of patients that included the physiological, psychological,
sociological, and developmental aspects. It was first developed as a graduate course guide, and in
1972, the May/June edition of Nursing Research published “A model for teaching total person
approach to patient problems.” In 1974, Neumann’s model was refined and published in Conceptual
Models for Nursing Practice. It was classified as a systems model, and was titled “The Betty
Neumann Health-Care Systems Model: A Total Person Approach to Patient Problems.” In this
publication, the term “patient” was replaced with the term “client.”
The Neumann Systems Model is based on the patient’s relationship to stress, reaction to it, and
reconstitution factors that are dynamic. The Neumann Systems Model is universal in nature, which
allows it to be adapted to a variety of situations, and to be interpreted in many different ways.
The central philosophy of Neumann’s nursing theory consists of energy resources that are
surrounded by three things: several lines of resistance, which represent the internal factors helping
the patient fight against a stressor; the normal line of defense, which represents the patient’s
equilibrium; and the flexible line of defense, which represents the dynamic nature that can rapidly
change over a short time.

3. In the Neumann Systems Model, the nurse’s role is to keep the system’s stability by using three
levels of prevention. The first is primary prevention, which protects the normal line and strengthens
the flexible line of defense. The secondary prevention is used to strengthen the internal lines of
resistance, which reduces the reaction and increases resistance factors. Finally, tertiary prevention
readapts, stabilizes, and protects the patient’s return to wellness after treatment.
DEVELOPMENT OF THE MODEL
 Neumann's model was influenced by a variety of sources.
 The philosophy writer s DeChardin and Cornu (on wholeness in system).
 Von Bertalanfy and Lazio on general system theory.
 Selye on stress theory.
 Lararus on stress and coping.
BASIC ASSUMPTIONS
 Each client system is unique, a composite of factors and characteristics within a given range
of responses contained within a basic structure.
 Many known, unknown and universal stressors exist. Each differ in its potential for
d1sturb1ng a client's usual stability level or normal line of defense (LOD)
 The particular inter-relationships of client variables at any point in time can affect the
degree to which a client is protected by the flexible line of defense (LOD) against possible
reaction to stressors.
 Each client/ client system has evolved a normal range of responses to the environment that
is referred to as a normal LOD. The normal LOD can be used as a standard from which to
measure health deviation.
 When the flexible LOD is no longer capable of protecting the client/ client system against
an environmental stressor, the stressor breaks through the normal LOD
 The client whether in a state of wellness or illness, is a dynamic composite of the inter-
relationships of the variables. Wellness is on a continuum of available energy to support the
system in an optimal state of system stability
 Implicit within each client system are internal resistance factors known as (lines of
resistance) LOR, which function to stabilize and realign the client to the usual wellness
state.

4.  Primary prevention relates to G.K. that is applied in client assessment and intervention, in
identification and reduction of possible or actual risk factors.
 Secondary prevention relates to symptomatology fallowing a reaction to stressor,
appropriate ranking of intervention priorities and treatment to reduce their noxious effects.
 Tertiary prevention relates to adjusted processes taking place as reconst1tut1on begins and
maintenance factors move the back in circular manner toward primary prevention.
 The client as a system is in dynamic, constant energy exchange with the environment.
CONCEPTS
Content: the variables of the person in interaction with the internal and external environment
comprise the whole client system
Basic structure/Central core: Common client survival factors in unique individual characteristics
representing basic system energy resources.
The basic structure, or central core, is made up of the basic survival factors that are common to the
species.
 These factors include normal temperature, range and genetic structure-response pattern.
Organ strength or weakness, ego structure.
 Stability or homeostasis, occurs when the amount of energy that is available exceeds that
being used by the system,
 A homeostatic body system is constantly in a dynamic process of input, Output, feedback
and compensation which leads to a state of balance.

5. NEUMAN SYSTEMS MODEL
Betty Neuman Describes The Neuman Systems Model As “A Unique, Open-System-Based
Perspective That Provides A Unifying Focus For Approaching A Wide Range Of Concerns. A
System Acts As A Boundary For A Single Client, A Group, Or Even Several Groups; It Can Also
Be Defined As A Social Issue. A Client System Interaction with the environment delineates the
domain of nursing concerns.”
The Neuman Systems Model views the client as an open system that responds to stressors in the
environment. The client variables are physiological, psychological, sociocultural, developmental,
and spiritual. The client system consists of a basic or core structure that is protected by lines of
resistance. The usual health level is identified as the normal defense line protected by a flexible line
of defense. Stressors are intra-, inter-, and extra personal in nature and arise from the internal,
external, and created environments. When stressors break through the flexible line of defense, the

6. system is invaded, and the lines of resistance are activated. The system is described as moving into
illness on a wellness-illness continuum. If adequate energy is available, the system will be
reconstituted with the normal defense line restored at, below, or above its previous interventions
occur through three prevention modalities. Primary prevention occurs before the stressor invades
the system; secondary prevention occurs after the system has reacted to an invading
stressor; tertiary prevention occurs after secondary prevention as reconstitution is being established.
ASSUMPTIONS
The following are the assumptions or “accepted truths” made by Neuman’s Systems Model:
Each client system is unique, a composite of factors and characteristics within a given range of
responses.
Many known, unknown, and universal stressors exist. Each differs in its potential for disturbing a
client’s usual stability level or normal line of defense. The particular interrelationships of client
variables at any point in time can affect the degree to which a client is protected by the flexible line
of defense against possible reaction to stressors.
Each client/client system has evolved a normal range of responses to the environment 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.
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.
Whether in a state of wellness or illness, the client is a dynamic composite of the variables’
interrelationships. Wellness is on a continuum of available energy to support the system in an
optimal system stability state.
Implicit within each client system is internal resistance factors known as lines of resistance, which
function to stabilize and realign the client to the usual wellness state.
Primary prevention relates to general knowledge applied in client assessment and intervention in
identifying and reducing or mitigating possible or actual risk factors associated with environmental
stressors to prevent a possible reaction.

7. Secondary prevention relates to symptomatology following a reaction to stressors, an appropriate
ranking of intervention priorities, and treatment to reduce their noxious effects.
Tertiary prevention relates to the adjectives processes as reconstitution begins and maintenance
factors move the client back in a circular manner toward primary prevention.
The client as a system is in dynamic, constant energy exchange with the environment.
MAJOR CONCEPTS OF NEUMAN SYSTEMS MODEL
This section will define the nursing metaparadigm and the major concepts in Betty Neuman’s
Neuman Systems Model.
Human being
The human being is an open system that interacts with internal and external environment forces or
stressors. The human is constantly changing, moving toward a dynamic state of system stability or
illness of varying degrees.
Environment
The environment is a vital arena that is germane to the system and its function. The environment
may be viewed as all factors that affect and are affected by the system. In Neuman Systems Model
identifies three relevant environments: (1) internal, (2) external, and (3) created.
The internal environment exists within the client system. All forces and interactive influences that
are solely within the client system’s boundaries make up this environment.
The external environment exists outside the client system.
The created environment is unconsciously developed and is used by the client to support protective
coping.
Health
In Neuman’s nursing theory, Health is defined as the condition or degree of system stability and is
viewed as a continuum from wellness to illness. When system needs are met, optimal wellness

8. exists. When needs are not satisfied, illness exists. When the energy needed to support life is not
available, death occurs.
Nursing
Nursing’s primary concern is to define the appropriate action in situations that are stress-related or
concerning possible reactions of the client or client system to stressors. Nursing interventions aim
to help the system adapt or adjust and retain, restore, or maintain some degree of stability between
the client system variables and environmental stressors, focusing on conserving energy.
Open System
A system in which there is a continuous flow of input and process, output and feedback. It is a
system of organized complexity, where all elements are in interaction.
Basic Structure and Energy Resources
The basic structure, or central core, comprises those basic survival factors common to the species.
These factors include the system variables, genetic features, and strengths and weaknesses of the
system parts.
Client Variables
Neuman views the individual client holistically and considers the variables simultaneously and
comprehensively.
The physiological variable refers to the structure and functions of the body.
The psychological variable refers to mental processes and relationships.
The sociocultural variable refers to system functions that relate to social and cultural expectations
and activities.
The developmental variable refers to those processes related to development over the lifespan.
The spiritual variable refers to the influence of spiritual beliefs.
Flexible line of defense
A protective accordion-like mechanism that surrounds and protects the normal line of defense from
invasion by stressors.

9. Normal line of defense
An adaptation level of health developed over time and is considered normal for a particular
individual client or system; it becomes a standard for wellness-deviance determination.
Lines of resistance
Protection factors are activated when stressors have penetrated the normal line of defense, causing
reaction symptomatology.
SUB CONCEPTS OF NEUMAN SYSTEMS MODEL
Stressors
A stressor is any phenomenon that might penetrate both the flexible and normal lines of defense,
resulting in either a positive or negative outcome.
Intrapersonal stressors are those that occur within the client system boundary and correlate with the
internal environment.
Interpersonal stressors occur outside the client system boundary, are proximal to the system, and
impact the system.
Extra personal stressors also occur outside the client system boundaries but are at a greater distance
from the system than are interpersonal stressors. An example is a social policy.
Stability
A state of balance or harmony requiring energy exchanges as the client adequately copes with
stressors to retain, attain, or maintain an optimal health level, thus preserving system integrity.
Degree of Reaction
The amount of system instability resulting from stressor invasion of the normal line of defense.
Entropy
A process of energy depletion and disorganization moving the system toward illness or possible
death.

10. Negentropy
An energy conservation process that increases organization and complexity, moving the system
toward stability or a higher degree of wellness.
Input/ Output
The matter, energy, and information exchanged between the client and environment entering or
leaving the system at any point in time.
Reconstitution
Following treatment of stressor reaction, the return and maintenance of system stability may result
in a higher or lower wellness level.
Prevention as Intervention
Intervention modes for nursing action and determinants for both client and nurse entry into the
health care system.
Primary prevention occurs before the system reacts to a stressor; it includes health promotion and
wellness maintenance. Primary prevention focuses on strengthening the flexible line of defense
through preventing stress and reducing risk factors. This intervention occurs when the risk or hazard
is identified but before a reaction occurs. Strategies that might be used include immunization, health
education, exercise, and lifestyle changes.
Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing
symptoms. Secondary prevention focuses on strengthening the internal lines of resistance and, thus,
protects the basic structure through appropriate treatment of symptoms. The intent is to regain optimal
system stability and conserve energy in doing so. If secondary prevention is unsuccessful and reconstitution
does not occur, the basic structure will be unable to support the system and its interventions, and death will
occur.
Tertiary prevention occurs after the system has been treated through secondary prevention
strategies. Its purpose is to maintain wellness or protect the client system reconstitution by
supporting existing strengths and preserving energy. Tertiary prevention may begin at any point
after system stability has begun reestablished (reconstitution has begun). Tertiary prevention tends
to lead back to primary prevention. (Neuman, 1995)

11. Strengths and Weaknesses
Betty Neuman reports her nursing model was designed for nursing but can be used by other health
disciplines, which have pros and cons. As a strength, if multiple health disciplines use Neuman’s
System Model, a consistent approach to client care would be facilitated. As a con, if the model is
useful to various disciplines, it is not specific to nursing. It thus may not differentiate the practice
of nursing from that of other disciplines.
Strengths
The Neuman Systems Model’s major strength is its flexibility for use in all areas of nursing –
administration, education, and practice.
Neuman has presented a view of the client equally applicable to an individual, a family, a group, a
community, or any other aggregate.
The Neuman Systems Model, particularly presented in the model diagram, is logically consistent.
The emphasis on primary prevention, including health promotion, is specific to this model.
Once understood, the Neuman Systems Model is relatively simple and has readily acceptable
definitions of its components.
Weaknesses
The major weakness of the model is the need for further clarification of the terms used.
Interpersonal and extra personal stressors need to be more clearly differentiated.
Analysis
The delineation of Neuman’s three defense lines was not clearly explained. In reality, the individual
resists stressors with internal and external reflexes, which were made complicated by the
formulation of different resistance levels in Neuman’s open systems model.
Neuman made mention of energy sources in her model as part of the basic structure. It can be more
of help when Neuman has enumerated all the energy sources that she is about. With such, new

12. nursing interventions regarding the provision of the client’s needed energy can be conceptualized.
The holistic and comprehensive view of the client system is associated with an open system. Health
and illness are presented on a continuum with the movement toward health described as negentropic
and toward illness as entropic.
STAGES OF NURSING PROCESS (BY NEUMANN)
NURSING DIAGNOSIS
 It depends on acquisition of appropriate database, the diagnosis identifies, assesses,
classifies and evaluates the dynamic interaction of the five variables
 Variance from wellness are determined by correlations and constrains through synthesis of
theory and database.
 Broad hypothetical interventions are determine.
NURSING GOALS
These must be negotiated with the patient and take account of patients and nurses perception of
variance from wellness.
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 validates nursing process.
NEUMANN’S SYSTEM MODEL FORMAT
Neumann’s nursing process format designates the following categories of data about the client
system as the major areas of assessment.
Assessment
 Potential and actual stressors.
 Condition and strength of basic structure factors and energy sources.
 Characteristics of flexible and normal line of defense s, line of resistance, degree of reaction
and potential for reconstitution.

13.  Interaction between client and environment.
 Life process and coping factor.
 Perceptual difference between car giver and the client
Nursing diagnosis
 The data collected are then interpreted to condition and formulate the nursing diagnosis.
 Health seeking behavior.
 Activity intolerance.
 Ineffective coping.
 Ineffective thermoregulation.
Goal
In Neumann’s systems model the goal is to keep the client system stable.
Planning
Planning is focused on strengthening the lines of defense and resistance.
Implementation
The goal of stabilizing the client system is achieved through three modes of prevention
Primary prevention: actions taken to retain stability.
Secondary prevention: actions taken to attain stability.
Tertiary prevention: actions taken to maintain stability.
Evaluation
The nursing process is evaluated to determine whether equilibrium is restored and a steady state
maintained.
Acceptance by the nursing community
 Neumann’s model has been described as a grand nursing theory by Walker and Avant.
 Grand theories can provide a comprehensive perspective for nursing practice, education and
research and Neumann’s model.

14. Practice
 The Neumann systems model has been applied and adapted to various specialties including
family theory, Public health, rehabilitation and hospital nursing.
 The sub specialties include pulmonary, renal, critical care and hospital medical units. One
of the model’s strength is that it can be used in a variety of settings.
 Using the conceptual model permits comparison of a nurses interpretations of a problem
with that of the patients. So the patient and nurse do not work on two separate problems.
 The role of nurse in the model is to work with the patient to move him as far as possible
along continuum towards wellness.
 Because this model requires individual interaction with the total health care system. It is
indicative of the futuristic direction of the nursing profession is taking.
 The patient is being relabeled as a consumer with individual needs.
Education
 The model has also been widely accepted in academic circles.
 It has often been selected as a curriculum guide for a conceptual framework, oriented more
towards wellness than toward a medical model and has been used at various levels of nursing
education
 One of the objectives for nursing graduates is to demonstrate ability to use Neumann health
care system in nursing practice. This helps to prepare the students for developing a frame
of reference centered on holistic care.
 Acceptance by the nursing community for education therefore is evident.
Research
 A study was published by Riehl and Roy to test the usefulness of the Neumann model in
nursing practice.
 There are 2 major objectives of the study.
 To test the model tool for its usefulness as a unifying method of collecting and analyzing
data for identifying client problems.
 To test the assessment tool for its usefulness in the identification of congruence between the
clients perception of stressors and the care giver’s perception of client stressors.

15.  Result indicated that the model can help categorize data for assessing and planning care and
for guiding decision making.
 Neumann’s model can easily generate nursing research.
 It does this by providing a framework to develop goals for desired outcomes. Acceptance
by the nursing community for research by applying this model is in beginning stage and
positive.
NEUMANN AND THE CHARACTERISTICS OF A THEORY
Theories connect the interrelated concepts in such a way as to create a different way of looking
at a particular phenomenon.
 The Neumann model represents a focus on nursing interest in the total person approach to
the interaction of environment and health.
 The interrelationships between the concepts of person, health, nursing and society are
repeatedly mentioned throughout the Neumann model and are considered to be basically
adequate according to the criteria.
Theories must be logical in nature
 Neumann’s model in general presents itself as logically consistent
 There is a logical sequence in the process of nursing where in emphasis on the importance
of accurate data assessment in basic to the sequential steps of the nursing process.
Theories should be relatively simple yet generalizable
 Neumann’s model is fairly simple and straight forward in approach.
 The terms used are easily identifiable and for the most part have definitions that are broadly
accepted.
 The multiple use of the model in varied nursing situations is testimony in itself to its broad
applicability.
 The potential use of this model by other health care disciplines also attests to its
generalizability for use in practice.
 One drawback in relation to simplicity is the diagrammed model since it presents over 35
variables and tends to awesome to the viewer.

16. Theories can be utilized by the practitioner to guide and improve the practice
 One of the most significant attribute of the model is the assessment/interventions instrument
together with comprehensive guidelines for its use with the nursing process.
 These guidelines have provide a practical resource for many nursing practitioners and have
been used extensively in a variety of setting in nursing practice, education and
administration.
Theories must be consistent with other validated theories, laws and principles but will leave
open unanswered questions that need to be investigated
 In general, there is no direct conflict with other theories.
APPLICATION OF BETTY NEUMANN’S SYSTEMS MODEL
Objectives
 To assess the patient condition by the various methods explained by the nursing theory.
 To identify the needs of the patient.
 To demonstrate an effective communication and interaction with the patient.
 To select a theory for the application according to the need of the patient.
 To apply the theory to solve the identified problems of the patient.
 To evaluate the extent to which the process was fruitful.
NURSING PROCESS BASED ON SYSTEM MODEL
Assessment
Neumann’s first step of nursing process parallels the assessment and nursing diagnosis of the six
phase nursing process. Using system model in the assessment phase of nursing process the nurse
focuses on obtaining a comprehensive client data base to determine the existing state of wellness
and actual reaction to environmental stressors.
Nursing diagnosis
The synthesis of data with theory also provides the basis for nursing diagnostic statement should
reflect the entire client condition.
Outcome identification and planning

17. It involves negotiation between the care giver and the client or recipient of care. The overall goal
of the care giver is to guide the client to conserve energy and to use energy as a force to move
beyond the present.
Implementation
Nursing action re based on the synthesis of a comprehensive database about the client and the theory
that are appropriate to the clients and caregiver’s perception and possibilities for functional
competence in the environment. According to this step the evaluation confirms that the anticipated
change has occurred. Immediate and long range goals are structured in relation to the short term
goals.
Evaluation
Evaluation is the anticipated or prescribed change that has occurred. It is not met the goals are
reformed.
REFERENCES
Recommended resources and references for this nursing theories guide.
1. Alligood, M. R.; “Nursing Theory-E-Book: Utilization & Application”; 2013; Elsevier
Health Sciences.
2. Neumann, B. “The Neumann systems model in research and practice”; 1996; Nursing
Science Quarter; Pg. 67-70.
3. Neumann, B.; “The Neumann systems model”; Edition III; 1995; In McEwen, M. and Wills,
E. Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
4. Shabeer .Basheer and S. Yaseen Khan; “A concise text book of Advanced Nursing
Practice”; Edition I; 2012; Emmess medical publisher; Pg.402-420.

21. REFERENCES
Alligood, M. R. (2013). Nursing Theory-E-Book: Utilization & Application. Elsevier Health
Sciences.
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.