Betty neuman system theory

1. Dr. Sudha A. Raddi
Principal, Institute of Nursing Sciences
KAHER, Belagavi
“BETTY NEUMAN’S SYSTEMS MODEL”
29.07.2020
KLE ACADEMY OF HIGHER EDUCATION & RESEARCH
Accredited ‘A’ Grade by NAAC (2nd Cycle) Placed in Category ‘A’ by MHRD (GoI)
INSTITUTE OF NURSING SCIENCES,BELAGAVI

2. BETTY NEUMAN
"Health is a condition in which all
parts and subparts are in harmony
with the whole of the client.”

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

4. BACKGROUND
 Born 1924 in Lowell, Ohio
 Received her RN Diploma in 1947
After Graduating…
-Gained experience as a floor nurse
-Worked as a school nurse
-Worked as a clinical instructor
• 1957-UCLA BScN Majored in psychology and public health
• 1966-UCLA Completed Masters
• 1985-Pacific Western University. Received Doctorate in Clinical Psychology

5. NEUMAN’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.

6. NEUMAN’S WORK & THE CHARACTERISTICS 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.

7. 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 am unique
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.

8. 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.
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

9. 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

10. METAPARADIGM
Person
 Health
 Environment
 Nursing

11. PERSON
 The Neuman model is based on the philosophy that each person is a
layered multidimensional being
 Each layer in the model consists of 5 person variables or subsystems
- Physiological
- Psychological
- Socio-cultural
- Spiritual
- Developmental

12. PERSON

13. HEALTH
 Neuman views health as wellness
 “The condition in which all parts and subparts (variables) are in harmony
with the whole of the client” (Neumann, 1995)
 Equated with stability of normal lines of defense

14. HEALTH

15. ENVIRONMENT
 The mixture of the internal and external forces that surround a person and
how they interact at any time
 Include intrapersonal, interpersonal and extra-personal stressors –which
can affect the normal line of defense and the stability of the system
 Internal environment- within the client system
 External environment- outside the client system

16. ENVIRONMENT

17. NURSING
 The person is seen as a whole, therefore the nursing focus should be on the whole
person
 Neumann defines nursing as “an 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.’’
 Which jobs the nurse does is in relation to the degree of reaction to the stressors as
well as the level of prevention
-Primary
-Secondary
-Tertiary

18. LEVELS OF PREVENTION
Primary
• Occurs before the system reacts to a stressor
• It can strengthen a person but can also weaken the environment
• Ex. Health Promotion, Injury Prevention
Secondary
• Occurs after the stressor has effected the environment
• Focuses on preventing damage to internal core
Tertiary
• Occurs after the system has been treated through secondary prevention measure
• Focus on support

19. CORE
Normal Line of Defense
(Secondary Prevention)
Lines of Resistance
(Tertiary Prevention)
Health
CORE
Health
Health
CORE
Health
Health
CORE
Health
Health
CORE
Health
HealthHealth
Flexible Line of Defense
(Primary Prevention)
LEVELS OF PREVENTION

20. FLEXIBLE LINE OF DEFENSE
20
• It forms the outer boundary of the defined client system.,
whether a single client , a group or a social issue.
• The flexible line of defense is depicted as the outer , broken
circle surrounding the normal line of defense.
• It acts as a protective buffer system for the client’s normal
stable state.

21. • It ideally prevents stressor invasion of the client system, keeping the system free
from stressor reactions.
• As it expands away from the normal line of defense greater protection is provided,
as it draws closer , less protection is available. When the normal line of defense is
rendered ineffective in particular to a stressor impact, a reaction will occur within the
client system e.g. coping patterns, lifestyle factors,& beliefs system influences.
FLEXIBLE LINE OF DEFENSE

22. NORMAL LINE OF DEFENSE
• The flexible line of defense protects the normal line of defense.
• This line represents what the client has become, the state to which the
client has evolved over time or the wellness level. It is dynamic in terms of
it’s ability to become & remain stabilized to deal with life stressors over
time, thus protecting the basic structure & system integrity.

23. LINE OF RESISTANCE
• This line is activated following invasion of the normal line of defense by
environmental stressors
• This line of resistance contain certain known & unknown internal &
external resource factors that support the clients basic structure & normal
defense line .e.g. body mobilization of white blood cells or activation of
immune system mechanisms, it’s ineffectiveness leads to energy depletion
& death

24. LINE OF DEFENSE &RESISTANCE
24
• Life style, coping, client expectations , motivation are all
inherent within the lines of defense & resistance,
ultimately protecting basic structure.

25. MODEL
 The Neuman systems model reflects the nature of living organisms as
open systems and interaction with each other and the environment.
 Throughout the model, Neuman incorporates her own philosophical beliefs
and mainly mental health clinical experience.

26. #Thursday, July 18, 2013 32
Primary
prevention
Secondary
prevention
Tertiary
prevention
Stressors
Reaction
Interventions
Reconstitution
Stressors
Stressors
Basic
structure
and Line
of
Defense
TheNeumanSystemModel (3 rd edition, 1995)

28. EXAMPLE
"A study to identify stress, coping strategies, quality of
life and lived experiences of women with pregnancy
induced hypertension (PIH) in selected hospitals of
Belgaum, Karnataka".

29. JALOWIEC’S COPING STRATEGIES
INTRA PERSONAL STRESSORS
 Age
 Parity
 Stress
 Presence of PIH
INTER PERSONAL STRESSORS
 Type of family
 Socio economic status
 Educational status
 Relationship with spouse, in
laws, nurses, doctors
EXTRAPERSONAL STRESS
 Family Support/conflicts
 Illness of family members
 Unpleasant situation
Reaction manifestations
1. Physiological
2. Psychological
3. Social as measured by
stress & stress manifestation
assessment scale
PRIMARY PREVENTION
 Self awareness
 Ventilation of feeling
 Rest
 Family and social support
SECONDARY PREVENTION
 Teach coping skills
 Counselling
 Reduction of stressors from
environment
 Proper diet
 Family and social support
 Mediation Exercise
TERTIARY PREVENTION
 Rehabilitation in terms of
teaching coping skills
STRESSORS
Health status of
women with PIH
Outcome
Decreased stress
Reduction in stress level
Stress and manifestation continue
Jalowiec’s Coping responses
 Confrontative
 Evasive
 Optimistic
 Fatalastic
 Emotive
 Palliative
 Supportive
 Self reliant
Physical domain
Psychological domain
Social domain
Environmental domain
Quality of life
Lived experiences
ADMINISTRATION OF WHO QOL-BREF
IDENTIFYING THE PHENOMENON
INTERPRETATION OF SCORES
STRUCTURING THE PHENOMENON SIGNIFICANT THEMES
FIG. 1 : CONCEPTUAL FRAMEWORK BASED ON BETTY NEUMAN’S SYSTEMS MODEL, STRESS & COPING MODEL & NURSING PROCESS MODEL Key :  Area not included
--- in the study
1. Normal Line of defense
2. Line of resistance
3. Flexible line of defense 


I
II
III
ASSESMENT PLANNING IMPLEMENTATION EVALUATION



ADMINISTRATION OF
JALOWIEC’S COPING SCALE
IV
1 2 3
Effectiveness
of coping styles
Good or poor
QOL
Mild
Moderate
Severe
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30. CASE STUDY
• Sunita Patil is a 20-year-old Nursing Student at KLE University.
• Her classmates describe her as hard working, perfectionist and very dedicated to her
schoolwork.
• She does very well in school, and always keeps on top of her work load.
• Sunita’s day starts off very early because she has to drive into town from Khanapur
to the College.
• Her day at College usually consists of intense studying, classes and preparing for
clinical.
• Sunita usually responds well with College pressures and always tries to keep a
positive outlook. When Sunita gets stressed she tends to have problems sleeping
and loses the desire to eat properly.

31. CASE STUDY CONTD..
Recently, clinical and school assignments have become overwhelming and Sunita has begun to
fall behind. Sunita started to withdraw from social activities and her attendance in class was
dropping. Her friends and teachers were beginning to worry about her success in the nursing
program. Because of these weird changes some of her professors offered her small extensions
on assignments in hopes that it would relieve some of her stress. When it became more obvious
that further measures needed to be taken Sunita’s friends contacted her parents to let them know
of her unusual behaviors. Sunita’s family then become very worried and bring her to the hospital
to seek assistance for her recent behaviors, low self-esteem, and a serious lack of nutrition.

32. Using Neuman’s system model in the case study, the identified possible stressors that
contributed to Sunita’s condition were as follows:
• Preparing for and attending clinical, tests and assignments.
• Sunita is not anymore able to handle the stressors and that had caused the
“breakdown” of her lines of defense.
• Without seeking help from her family and friends, she was not able to maintain her
flexible line of defense and brought instability to her system.
CASE STUDY ANALYSIS

33. “When you are a Nurse you know that everyday you will touch a life
or a life will touch yours”
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