Neumann Systems Model The Neuman Systems Model (NSM) provides a comprehensive and holistic framework for understanding and organizing nursing care. Developed by Betty Neuman, this model offers a systems-based approach that integrates multiple theoretical perspectives to guide nursing education, practice, and research. This article discusses the Neuman Systems Model, its purpose, and its applications, while also exploring its core concepts, including nursing, environment, health, and the tools used to implement the model in evidence-based practice.
Neuman Systems Model
The Neuman Systems Model (NSM) is a theoretical framework that views the patient as an open system that responds to both internal and external stressors. The model incorporates a broad, comprehensive systems approach to address the various factors influencing a patient’s health. It emphasizes a holistic approach, wellness orientation, client perception, and motivation, as well as a systems perspective that explores the interaction of variables within the environment (Neuman, 2001, p. 12).
Theoretical Underpinnings
The philosophical and theoretical foundations of the NSM include:
- General Systems Theory: Developed by von Bertalanffy (1968), this theory provides the basis for understanding how the components of a system interact with one another.
- Gestalt Theory: Emphasizes the perception of the whole rather than individual parts (Pearls, 1973).
- Field Theory: Focuses on understanding human behavior in the context of the environment (Edelson, 1970).
- Prevention Interventions: Caplan’s (1964) typology of prevention interventions emphasizes the need for primary, secondary, and tertiary prevention strategies.
- Stress and Adaptation Theory: Seyle’s (1950) theory of stress and adaptation and Lazarus and Folkman’s (1984) theory of stress and coping provide a framework for understanding how clients respond to stressors.
Two primary components underlie the NSM: exploring the client’s responses to stressors and identifying the nurse’s preventive interventions to help the client manage these stressors. The model’s ultimate goal is to assist the client in achieving an optimal state of wellness.
Neuman System Model and Nursing Graduates
The Neuman Systems Model was first developed by Betty Neuman to help graduate students at the University of California, Los Angeles, conceptualize a systems approach to health care. The model is grounded in Neuman’s personal philosophy and theoretical perspectives and her experience as a consultant in public health and community mental health nursing (Walker, 2004). Since its development in 1970, the model has been widely used by practitioners, educators, and researchers nationally and internationally.
Purpose of the Model
The NSM aligns with the concepts of the nursing metaparadigm—person, environment, health, and nursing—that undergird most grand theories in nursing. The primary components of the model include stressors, lines of defense and resistance, levels of prevention, and five client system variables (basic structure, interventions, internal and external environment, and reconstitution). All these concepts have been thoroughly defined by Neuman in his texts (Neuman, 1982, 1989, 1995, 2001).
What is Nursing According to the Neuman System Model?
Neuman describes nursing as a unique profession concerned with the interrelationship of all variables affecting a client’s potential or actual response to stressors. The uniqueness of nursing lies in the way the discipline organizes and utilizes its knowledge (Neuman, 1989, p. 24).
In the NSM, the nurse acts as an intervener, using three levels of prevention (primary, secondary, and tertiary) to reduce the client’s exposure to stressors or mitigate the impact of those stressors. The ultimate goal is to help the client system retain stability.
Concerns of the Neuman System Model
The NSM refers to the client as the “client system,” which could be an individual, group, family, or community. The focus is on wellness and fostering a collaborative relationship between the client and the caregiver (nurse). The client or client system consists of five interrelated variables:
- Physiological
- Psychological
- Sociocultural
- Developmental
- Spiritual
The spiritual variable was added to the model in 1989 to better reflect Neuman’s holistic belief about humans (Neuman, 1989). These variables are surrounded by various lines of defense and resistance. According to Neuman, a client’s normal line of defense is dynamic, evolves over time, and contains the client’s usual range of responses to stressors, reflecting their usual wellness level (Neuman, 2001, p. 18).
Furthermore, the client system has internal lines of resistance that protect the client’s basic structure or system integrity. If these defenses are ineffective, system energy depletion and eventual death may occur (Neuman, 2001, p. 18).
What is Environment According to the Neuman System Model?
The environment, according to Neuman, consists of internal, external, and created environments:
- Internal Environment: Comprised of forces within the client, identified by Neuman as intrapersonal stressors.
- External Environment: Composed of interpersonal and extra-personal stressors.
- Created Environment: Added in 1989 to reflect Neuman’s holistic perspective. The created environment is unconsciously developed by the client to protect against intra, inter, and extra-personal stressors and maintain system stability (Neuman, 1989, p. 12).
What is Health According to the Neuman System Model?
Health, according to the NSM, is equated with living energy and is determined by the degree of harmony among the five client variables and basic structure factors, on a continuum from wellness to illness. The degree of wellness is determined by the amount of energy required to retain, attain, or maintain system stability (Neuman, 2001, p. 12).
Applications of the Neuman System Model
The NSM is widely used in nursing practice, education, and increasingly in research, particularly among students in master’s and doctoral programs. An integrative review of NSM-based research conducted by Fawcett and Giangrande (2001) found 200 research reports focused on general information, scientific merit, and the NSM. The majority of these studies were related to clinical nursing topics (75%), followed by nursing administration (14%), nursing education (9%), and continuing education (2%).
The focus on practice-oriented questions suggests that the NSM may help address concerns that evidence-based practice threatens the foundation of nursing’s theoretical perspective on theory-guided practice (Walker & Redman, 1999).
Neuman Model Instruments
Several instruments have been developed and utilized in conjunction with the NSM. Gigliotti and Fawcett (2001) reviewed 212 research reports and identified various instruments explicitly linked to the NSM, often used for different purposes:
- Beck Depression Inventory
- State-Trait Anxiety Inventory
- Norbeck Social Support Questionnaire
- Dynamap
- Carter Center Institute Health Risk Appraisal
- Health Status Questionnaire
These instruments measure various concepts related to stressors, lines of defense, prevention interventions, and other middle-range concepts in the NSM. Of these instruments, 59 were classified as standardized (with sufficient evidence of validity and reliability testing), and 62 were considered non-standardized (Gigliotti & Fawcett, pp. 153-154).
Use in Evidence-Based Practice
To enhance and facilitate future research related to the NSM, Neuman and Fawcett (2001) have established a set of guidelines for NSM-based research. Fawcett and Giangrande (2001, pp. 136-137) also encourage collaborative research and cluster studies that examine related phenomena.
For instance, one researcher might explore the impact of interpersonal or extra-personal stressors on some of the five client variables, while another researcher might study the impact of intra- or interpersonal stressors on the same variables using the same sample of study participants.
Gigliotti and Fawcett (2001, pp. 166-169) also emphasized the need for more attention to the validity of existing instrumentation and examining the utility of instruments used in NSM-based clinical practice, focusing on their research potential in clinical and educational tools.
Conclusion
The Neuman Systems Model offers a comprehensive framework that integrates a systems approach to nursing, focusing on the client’s responses to stressors and the nurse’s preventive interventions to maintain system stability. The model’s holistic perspective, encompassing physiological, psychological, sociocultural, developmental, and spiritual variables, provides a solid foundation for nursing practice, education, and research.
By understanding and applying the Neuman Systems Model, nurses can enhance their practice, contribute to evidence-based research, and improve patient outcomes through a structured, comprehensive approach to care. As a result, the NSM continues to be a valuable tool in the evolving landscape of nursing care, education, and research.