defense, the system is invaded and the lines of

resistance are activated and 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 line of defense restored at, below, or
above its previous level.

Nursing 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.

Major Concepts of Neuman Systems Model

Betty Neuman’s Nursing Theory
In this section, we will define the
Three words frequently used in relation
nursing metaparadigm and the major concepts in
to stress are inevitable, painful and intensifying.
Betty Neuman’s Neuman Systems Model.
It is generally subjective, and can be interpreted
as the circumstances one regards as conceivably Human being
threatening and out of their control. A nursing
theory developed by Betty Neuman is based on Human being is viewed as an open
the person’s relationship to stress, the response system that interacts with both internal and
to it, and reconstitution factors that are external environment forces or stressors. The
progressive in nature. The Neuman Systems human is in constant change, moving toward a
Model presents a broad, holistic and system- dynamic state of system stability or toward
based method to nursing that maintains a factor illness of varying degrees.
of flexibility. It focuses on the response of the
Environment
patient system to actual or potential
environmental stressors and the maintenance of The environment is a vital arena that is
the client system’s stability through primary, germane to the system and its function. The
secondary, and tertiary nursing prevention environment may be viewed as all factors that
intervention to reduce stressors. affect and are affected by the system. In Neuman
Systems Model identifies three relevant
What is the Neuman Systems Model?
environments: (1) internal, (2) external, and (3)
Betty Neuman describes the Neuman created.
Systems Model as “a unique, open-system-based
The internal environment exists within
perspective that provides a unifying focus for
the client system. All forces and interactive
approaching a wide range of concerns. A system
influences that are solely within boundaries of
acts as a boundary for a single client, a group, or
the client system make up this environment.
even a number of groups; it can also be defined
as a social issue. A client system in interaction The external environment exists outside
with the environment delineates the domain of the client system.
nursing concerns.”
The created environment is
The Neuman Systems Model views the unconsciously developed and is used by the
client as an open system that responds to client to support protective coping.
stressors in the environment. The client variables
are physiological, psychological, sociocultural, Health
developmental, and spiritual. The client system
consists of a basic or core structure that is In Neuman’s nursing theory, Health is
protected by lines of resistance. The usual level defined as the condition or degree of system
of health is identified as the normal line of stability and is viewed as a continuum from
defense that is protected by a flexible line of wellness to illness. When system needs are met,
defense. Stressors are intra-, inter-, and optimal wellness exists. When needs are not
extrapersonal in nature and arise from the satisfied, illness exists. When the energy needed
internal, external, and created environments. to support life is not available, death occurs.
When stressors break through the flexible line of
Nursing Lines of resistance

The primary concern of nursing is to Protection factors activated when

define the appropriate action in situations that stressors have penetrated the normal line of
are stress-related or in relation to possible defense, causing a reaction synptomatology.
reactions of the client or client system to
stressors. Nursing interventions are aimed at
helping the system adapt or adjust and to retain,
restore, or maintain some degree of stability
between and among the client system variables
and environmental stressors with a focus 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 Stricture and Energy Resources

The basic structure, or central core, is

made up of 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.

Normal line of defense

An adaptational level of health

developed over time and considered normal for a
particular individual client or system; it becomes
a standard for wellness-deviance determination.