The Betty Neuman Systems Model:
A Total Person Approach
This model attempts to assist individuals, families, and groups to attain and maintain a
maximum level of total wellness by purposeful interventions. These are aimed at
reduction of stress factors and adverse conditions which either affect or could affect
optimal functioning in a given client’s situation.
This model presents a comprehensive systems-based conceptual framework for nursing.
It views the individual who is subject to the impact of stressors, reaction to stress and
factors of reconstitution. It is considered a wellness model and illustrates the composite
of five interacting variable-physiological, psychological, sociocultural, developmental and
spiritual.
The Assumptions of the Model
1. Even though each individual is viewed as unique, he/she is also a composite of
common “knowns” or characteristics within a normal given range of response.
2. There are many known stressors. Each stressor is different in its potential to disturb
the individual‘s equilibrium or normal line of defense. Also, the variables of
physiologic, psychologic, sociocultural and developmental affect the degree to which
an individual is able to use his/her flexible line of defense against possible reaction
to a single stressor or combination of stressors.
3. Each individual, over time, has developed a normal range of resistance, which is
referred to as a normal line of defense.
4. When the cushioning, accordion -like effect of the flexible line defense is no longer
capable of protecting the individual against a stressor, the stressor breaks through the
normal line of defense. The interrelationship of variables (physiologic, psychologic,
sociocultural, development and spiritual) determines the degree of the organism’s
reaction to the stressor.
5. Each person has an internal set of resistance factors (lines of resistance), which
attempt to stabilize and return him/her to their normal line of defense, should stress
break through it.
6. Environment is broadly defined as all internal and external factors or influences
surrounding the client/client system.
7. Health is viewed on a continuum of wellness and illness. Health is equated with
optimal system stability changing within a normal range throughout the life span.
8. Nursing is seen as a unique profession in that it is concerned with all the variables
affecting an individual’s response to stressors. The aim of the total person approach
is to provide a unifying focus for approaching varied nursing problems and for
understanding the basic phenomenon: man and his environment.
9. Preventions as Interventions: Begin at any point at which a stressor is either
suspected or identified. There are three levels of preventions/interventions:
a. Primary Prevention relates to general knowledge that is applied to individual
patient assessment in an attempt in an attempt to identify and allay the possible
risk factors associated with stressors to retain wellness.
b. Secondary prevention relates to symptomatology, appropriate ranking of
instruction priorities and treatment to attain wellness.
c. Tertiary Prevention relates to the adaptive process as reconstitution or return
to wellness begins, and moves back in a circular manner toward primary
prevention.
Explanation of The Model
The total person framework is an open systems model of 2 components-stress and
reaction to it. The individual (client/client system) represented by a set of concentric
circles or rings, is an open system in interaction with his/ her total interface with the
environment, i.e., man is a system capable of intake of extrapersonal and intrapersonal
factors from the external environment. He interacts with this environment by adjusting
himself to it, or adjusting the environment to himself.
By a process of interaction and adjustment, the individual maintains varying degrees of
harmony and balance between his internal and external environment.
Stressors are tension - producing with the potential of causing disequilibrium, situational
and maturational crises, or the experience of stress within an individual’s life.
The above interaction – adjustment process contains the variables that make up the
flexible line of defense that defends against these stressors. Influencing factors would
include an individual’s basic physiologic structure or condition, sociocultural background,
developmental state, spiritual dimension, cognitive skills, mental processes and
relationships, age and sex.
Stressors, reactions and reconstitution factors can be viewed as intra-, inter-, or extra-
personal in nature, i.e.
1. Intrapersonal-forces occurring within the in individual, e.g. conditioned
responses.
2. Interpersonal-forces occurring between on or more individual. e.g. role
expectations.
3. Extra personal-forces occurring outside the individual, e.g. financial
circumstances.
What might be classified as a noxious stressor for one individual might not be for another.
Time of occurrence, the individual’s past and present conditions, nature and intensity of
the stressor, amount of energy required for the organism to adapt are all variables.
However, one might be able to predict positive adjustment based on past healthy coping
behavior in a similar situation, all factors being equal.
Graphically, the model is depicted by a series of concentric rings surrounding a central
core. The series of concentric rings surrounding the core structure vary in size and
distance from the center. The further away the rings are the more protection is provided.
The flexible line of defense is shown by the outer, broken circle. It is accordion-like and
acts like a buffer system for the client’s normal or stable state thus keeping the client
system free from stressor reactions. The more it expands away from the normal line of
defense, the greater the protection and as it draws closer, less protection is provided.
The normal line of defense is depicted as solid line or circle. It is essentially what the
individual has become over time, or the “normal” or usual, steady state. When the normal
line of defense has been penetrated, symptoms of instability or illness occur, caused by
one or more impacting stressors.
The lines of resistance are flexible and made internal factors that help to defend against
a stressor, e.g., the body’s mobilization of WBC’s or immune response mechanisms when
needed.
The central core consists of basic survival factors common to all members of the species.
Examples are the mechanism for maintenance of a normal temperature range, a genetic
response pattern, the strengths and weaknesses of the various body parts and organs.
However, each person has certain unique or baseline characteristics within the species
range of commonalities.
All client systems have five variable areas with varying degrees of development and a
wide range of interactive styles and potential. The first four are commonly understood and
the fifth dimension was added to the model in 1989 and still requires description:
• Physiological – refers to the bodily structure and function
• Psychological – refers to the mental processes and relationships
• Sociocultural – refers to the combined social and cultural functions
• Developmental –refers to life developmental processes
• Spiritual – refers to spiritual belief system influences
The author of this model believes the spirit controls the mind, the mind controls the body;
the spiritual variable positively or negatively effects of is affected by other variables such
as grief or loss (psychological), affects the will to live and as an energy source in change
and optimal system stability.
p,evenlion
• Reduce
possibility
of
encounter
wilh
stressors
•
Strengthen
flexible
line
of
defense
Secondary
prevention
•
Early
case-finding
and
•
Treatment
of
symptoms
Tertiary
prevention
•
Readaplation
•
Reeducation
to
prevent
future
occun-ences
•
Maintenance
of
stability
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Stressors
•
Identified
•
Classlfled
as
to
knowns
or
possiblllties,
I.e.,
•Loss
•Pain
•
Sensory
deprivation
• Cultural
change
Intra
Inter
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factors
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Reaction
•
Individual
lntelvenlng
variabtes,
i.e.,
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slruclure
Idiosyncrasies
•
Na1ural
and
learned
resistance
•
Time
of
encounter
wilh
stressor
Intra
Inter
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Personal
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factors
Interventions
• Can
occur
before
or
after
resistance
lines
are
penetrated
in
both
reacion
and
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Reconslilulion
• Could
begin
at
any
degree
or
level
of
reaction
•
Range
of
possibHity
may
extend beyond
normal
line
of defense
reconstilUtion
phases
~
• Interventions are
based
on:
Intra
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Degree
of
reaclion
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l
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•Goals
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outcome
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factors
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NOTE:
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Basic
slruclure
• Basic
factors
common
to
an
organisms,
I.e.,
•
Normal
temperature
range
,
•
Genetic
structure
•
Response
pattern
•
Organ
strength
or
weakness
•Ego
structure
•
Knowns
or
commonalities
Stressors
•
More
than
one
stressor
could
occur
simuttaneously•
• Same stressors
could
vary
as
to
Impact
or
reaction
• Normal defense line varies
with
age
and
development
• Physiologlcal,
psychological,
sociocultural,
developmental,
and
spiritual variables occur
and
are
considered
simultaneously
in
each
client
concentric
circle
Figure
16--1.
The
Neuman Systems Model.
(From Neuman, B. (1995).
The Neuman
Systems
Model
(3rd ed)
(p.
17). Norwalk, CT:
Appleton
&
Lange.)
