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11
Betty Neuman’sSystemsBetty Neuman’sSystems
ModelModel
Mr.VIJAYREDDY.B.VMr.VIJAYREDDY.B.V
M.Sc (N),PGDHA,PGCDE.M.Sc (N),PGDHA,PGCDE.
Asst.Prof,DYPU,KOP,INDIAAsst.Prof,DYPU,KOP,INDIA..

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

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IntroductionIntroduction
 Neumans systems model is unique system basedNeumans systems model is unique system based
perspective that provides a unifying focus forperspective that provides a unifying focus for
approaching a wide range of nursing concerns.approaching a wide range of nursing concerns.
 The model is dynamic because it is based on theThe model is dynamic because it is based on the
client’s continuous relationship to environmentalclient’s continuous relationship to environmental
stress factors, which have a potential for causing astress factors, which have a potential for causing a
reaction, or obvious symptomatic reaction to stress,reaction, or obvious symptomatic reaction to stress,
or could affect reconstitution following Rx of stressor could affect reconstitution following Rx of stress
reactionreaction

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Introduction contd……Introduction contd……
 Betty Neuman described her theory/model inBetty Neuman described her theory/model in
1974 & published it in1982.1974 & published it in1982.
 It is a complex systems model with focus onIt is a complex systems model with focus on
stress reactions & stress reduction.stress reactions & stress reduction.
 This model is developed for use by any healthThis model is developed for use by any health
profession , not only just nursing. The model isprofession , not only just nursing. The model is
predominantly wellness oriented & holistic.predominantly wellness oriented & holistic.

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 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

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Client systemClient system
 The person is viewed as a client or clientThe person is viewed as a client or client
system. The client may be an individual , asystem. The client may be an individual , a
family , a group, a community. Morefamily , a group, a community. More
specifically client system represents anspecifically client system represents an
individual, a person.individual, a person.
 The client system is a composite of fiveThe client system is a composite of five
interacting variables :interacting variables :

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Client system contd….Client system contd….
Physiological- refers to bodily structure & internalPhysiological- refers to bodily structure & internal
functionfunction
Psychological- refers to mental processes &Psychological- refers to mental processes &
interactive environmental effects, both internally &interactive environmental effects, both internally &
externally.externally.
Socio cultural – refers to combined effects of socialSocio cultural – refers to combined effects of social
cultural conditions, & influences.cultural conditions, & influences.
Developmental – refers to age-related developmentalDevelopmental – refers to age-related developmental
processes & activities.processes & activities.
Spiritual – refers to spiritual beliefs & influences.Spiritual – refers to spiritual beliefs & influences.

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CORE Lines of Resistance
Normal Line of Defense
Flexible Line of Defense
CORE
Normal Line of DefenseNormal Line of DefenseNormal Line of Defense
Person Continued

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Basic structureBasic structure
 The basic structure or the central core consistsThe basic structure or the central core consists
of basic survival factors, such a geneticof basic survival factors, such a genetic
features.e.g., maintenance of normalfeatures.e.g., maintenance of normal
temperature.temperature.
 The flexible line & normal line of defense &The flexible line & normal line of defense &
the lines of resistance- function essentiallythe lines of resistance- function essentially
as protective mechanisms for the basicas protective mechanisms for the basic
structure to preserve client system integrity.structure to preserve client system integrity.

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 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

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CORE
Flexible Line of Defense
Normal Line of Defense
Lines of Resistance
Health
CORE
Harmony StabilityBalance
Health
Wellness
Health
CORE
Harmony StabilityBalance
Health
Wellness
Health
CORE
Harmony StabilityBalance
Health
Wellness
Health
CORE
Harmony StabilityBalance
Health
Wellness
Health
CORE
Harmony StabilityBalance
Health
Wellness
Health
CORE
Harmony StabilityBalance
Health
Wellness
Health Continued

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CORE
S
T
R
E
S
S
O
R
S Extrapersonal
S
T
R
E
S
S
O
R
S
Lines of Resistance
Normal Line of Defense
Flexible Line of Defense
Intrapersonal
Interpersonal
Extrapersonal
Intrapersonal
Interpersonal
Extrapersonal
Intrapersonal
Interpersonal
Extrapersonal
Intrapersonal
CORE

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Flexible line of defenseFlexible line of defense
 It forms the outer boundary of the definedIt forms the outer boundary of the defined
client system., whether a single client , a groupclient system., whether a single client , a group
or a social issue.or a social issue.
 The flexible line of defense is depicted as theThe flexible line of defense is depicted as the
outer , broken circle surrounding the normalouter , broken circle surrounding the normal
line of defense.line of defense.
 It acts as a protective buffer system for theIt acts as a protective buffer system for the
client’s normal stable state.client’s normal stable state.

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Flexible line contd.Flexible line contd.
 It ideally prevents stressor invasion of the clientIt ideally prevents stressor invasion of the client
system, keeping the system free from stressorsystem, keeping the system free from stressor
reactions.reactions.
 As it expands away from the normal line of defenseAs it expands away from the normal line of defense
greater protection is provided, as it draws closer , lessgreater protection is provided, as it draws closer , less
protection is available. When the normal line ofprotection is available. When the normal line of
defense is rendered ineffective in particular to adefense is rendered ineffective in particular to a
stressor impact, a reaction will occur within the clientstressor impact, a reaction will occur within the client
system e.g. coping patterns, lifestyle factors,& beliefssystem e.g. coping patterns, lifestyle factors,& beliefs
system influences.system influences.

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Normal line of defense.Normal line of defense.
 The flexible line of defense protects theThe flexible line of defense protects the
normal line of defense.normal line of defense.
 This line represents what the client hasThis line represents what the client has
become, the state to which the client hasbecome, the state to which the client has
evolved over time or the wellness level. It isevolved over time or the wellness level. It is
dynamic in terms of it’s ability to become &dynamic in terms of it’s ability to become &
remain stabilized to deal with life stressorsremain stabilized to deal with life stressors
over time, thus protecting the basic structure &over time, thus protecting the basic structure &
system integrity.system integrity.

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Line of resistanceLine of resistance
 This line is activated following invasion of theThis line is activated following invasion of the
normal line of defense by environmental stressors.normal line of defense by environmental stressors.
 This line of resistance contain certain known &This line of resistance contain certain known &
unknown internal & external resource factors thatunknown internal & external resource factors that
support the clients basic structure & normal defensesupport the clients basic structure & normal defense
line .e.g. body mobilization of white blood cells orline .e.g. body mobilization of white blood cells or
activation of immune system mechanisms, it’sactivation of immune system mechanisms, it’s
ineffectiveness leads to energy depletion & death.ineffectiveness leads to energy depletion & death.

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Line of defense & resistance.Line of defense & resistance.
 Life style, coping, client expectations ,Life style, coping, client expectations ,
motivation are all inherent within the lines ofmotivation are all inherent within the lines of
defense & resistance , ultimately protectingdefense & resistance , ultimately protecting
basic structure.’basic structure.’

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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

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 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

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InterventionsInterventions
 They are based onThey are based on
 Degree of reactionDegree of reaction
 ResourcesResources
 GoalsGoals
 Anticipated outcome.Anticipated outcome.

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Nursing InterventionNursing Intervention
 Nursing interventions can occur before or afterNursing interventions can occur before or after
stressors at all levels of prevention.stressors at all levels of prevention.
 Client is viewed as an open system interactingClient is viewed as an open system interacting
with the environment through interpersonal &with the environment through interpersonal &
extra personal factors.extra personal factors.

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Primary
• Occurs before the system reacts to
a stressor
• It can strengthen a person
• 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

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PreventionPrevention
Primary prevention- Reduce possibility of encounterPrimary prevention- Reduce possibility of encounter
with stressors.with stressors.
 Strengthen flexible line of defense.Strengthen flexible line of defense.
Secondary prevention- Early case findingsSecondary prevention- Early case findings
 Rx of symptoms.Rx of symptoms.
Tertiary prevention- Re adaptationTertiary prevention- Re adaptation
 Reeducation to prevent future occurrencesReeducation to prevent future occurrences
 Maintenance of stability.Maintenance of stability.

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Brittany Smith is a 20-year-old
Nursing Student at Nipissing 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. Brittany’s day starts off very
early because she has to drive into town from Powassan to the
school. Her day at school usually consists of intense studying,
classes and preparing for clinical. Brittany usually responds
well with school pressures and always tries to keep a positive
outlook. When Brittany gets stressed she tends to have problems
sleeping and loses the desire to eat properly.

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Using Neuman’s system model in the case study, the
identified possible stressors that contributed to Brittany’s
condition were as follows:
Preparing for and attending clinical, tests and
assignments.
Brittany 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.

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Recently, clinical and school
assignments have become overwhelming and Brittany has
begun to fall behind. Brittany 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, Brittany’s friends
contacted her parents to let them know of her unusual
behaviors. Brittany’s family then became very worried and
bring her to the hospital to seek assistance for her recent
behaviors, low self-esteem, and a serious lack of nutrition.

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