Betty Neuman: Neuman Systems Model

Betty Neuman (1924 – present) is a nursing theorist who developed the Neuman Systems Model. She gave many years perfecting a systems model that views at patients holistically. She inquired theories from several theorists and philosophers and applied her knowledge in clinical and teaching expertise to come up with the Neuman Systems Model that has been accepted, adopted, and applied as a core for nursing curriculum in many areas around the world.

Biography of Betty Neuman

Early Life

Betty Neuman was born in 1924 near Lowell, Ohio. She grew up on a farm which later encouraged her to help people who are in need. Her father was a farmer who became sick and died at the age of 36. Her mother was a self-educated midwife, that led the young Neuman to be always influenced by the commitment that took her away from home from time to time. She had one older brother and a brother who was younger which makes her the middle child among her siblings. Her love for nursing started when she took the responsibility of taking care of her father which later created her compassion in her chosen career path.

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As a young girl, she attended the same one-room schoolhouse that her parents had attended and was excited when she went to a high school that had a library. She was always engaged and fascinated with the study of human behavior. During World War II, she had her first job as an aircraft instrument technician. In 1947, she received her RN Diploma from Peoples Hospital School of Nursing, Akron, Ohio.

Nursing Career of Betty Neuman

Betty Neuman
Betty Neuman

Betty Neuman moved to California and worked in a variety of capacities as a hospital nurse and head nurse at Los Angeles County General Hospital, school nurse, industrial nurse, and clinical instructor at the University of Southern California Medical Center, Los Angeles.

In 1957, she received a baccalaureate degree in public health and psychology with honors. Amidst her hectic life as a nurse, she also managed to work as a fashion model and learned to fly a plane. She got married, supported her husband’s medical practice, and had their daughter in 1959.

She also earned a master’s degree in mental health, public health consultation in 1966 from the University of California, Los Angeles (UCLA). After her graduation, she was hired as a department chair in the UCLA School of Nursing graduate program. Neuman developed the first community mental health program for graduate students in the LA area from 1967 to 1973.

Betty Neuman
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In 1985, Betty Neuman concluded a doctoral degree in clinical psychology at Pacific Western University. She was a pioneer of nursing involvement in mental health. She and Donna Aquilina were the first two nurses to develop the nurse counselor role within community crisis centers in Los Angeles.

Neuman persisted to start a private practice as a marriage and family therapist, specializing in Christian counseling. She is a Fellow of the American Association of Marriage and Family Therapy and of the American Academy of Nursing. Until 2009, she was the director of the Neuman Systems Model Trustees Group, Inc. that she established in 1988, and still attends as a consultant. The Trustees Group was created to preserve and maintain the message of her nursing theory for the health care community.

Works of Betty Neuman

Neuman with Sister Callista Roy |

In 1970, Betty Neuman designed a nursing conceptual model to expand students’ understanding of client variables beyond the medical model. Her teaching programs at UCLA paved the way for developing her nursing model. During those times, she did not write a book but made her concepts known to Joan Riehl-Sisca and Sr. Callista Roy and incorporated them in their 1971 book, Conceptual Models for Nursing Practice.

In 1972, Neuman published a draft of her model. She developed and improved the concepts and published her book, The Neuman System Model: Application to Nursing Education and Practice, in 1982. Further revisions were made in later editions. As a speaker and author, she spent countless hours teaching and explaining the many concepts and aspects of the model to students and professors.

Neuman has also been involved in numerous publications, paper presentations, consultations, lectures, and conferences on application and use of the model. She worked as a consultant nationally and internationally concerning the implementation of the model for nursing education programs and for clinical practice facilities.

Awards and Honors of Betty Neuman

Betty Neuman

Betty Neuman has done many things including a nurse, educator, health counselor, therapist, author, speaker, and researcher. Throughout the years, she earned many awards and honors including several honorary doctorates and was an honorary member of the American Academy of Nursing. The profound effect of her work on the nursing profession is well known throughout the words

  • Honorary Doctorate of Letters, Neumann College, Aston, PA (1992)
  • Honorary Member of the Fellowship of the American Academy of Nursing (1993)
  • Honorary Doctorate of Science, Grand Valley State University, Michigan (1998)

She was honored by President Richard Jusseaume and Provost Dr. Laurence Bove with the Walsh University Distinguished Service Medal, which is awarded to those who have contributed outstanding professional or voluntary service to others within the national, regional or local community.

Neuman honored with Distinguished Service Medal |

In an annual Nursing Research Day sponsored by Walsh’s Phi Eta Chapter of Sigma Theta Tau, Byers School of Nursing Dean Dr. Linda Linc granted Neuman with the first annual Neuman Award, named in her honor, for outstanding service in the nursing profession.

Betty Neuman’s Nursing Theory

Three words frequently used in relation to stress are inevitable, painful and intensifying. It is generally subjective, and can be interpreted as the circumstances one regards as conceivably threatening and out of their control. A nursing theory developed by Betty Neuman is based on the person’s relationship to stress, the response to it, and reconstitution factors that are progressive in nature. The Neuman Systems Model presents a broad, holistic and system-based method to nursing that maintains a factor of flexibility. It focuses on the response of the patient system to actual or potential environmental stressors and the maintenance of the client system’s stability through primary, secondary, and tertiary nursing prevention intervention to reduce stressors.

What is the Neuman Systems Model?

Betty Neuman describes the Neuman Systems Model as “a unique, open-system-based perspective that provides a unifying focus for approaching a wide range of concerns. A system acts as a boundary for a single client, a group, or even a number of groups; it can also be defined as a social issue. A client system in interaction with the environment delineates the domain of nursing concerns.”

The Neuman Systems Model views the client as an open system that responds to stressors in the environment. The client variables are physiological, psychological, sociocultural, developmental, and spiritual. The client system consists of a basic or core structure that is protected by lines of resistance. The usual level of health is identified as the normal line of defense that is protected by a flexible line of defense. Stressors are intra-, inter-, and extrapersonal in nature and arise from the internal, external, and created environments. When stressors break through the flexible line of 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.


The following are the assumptions or “accepted truths” made by Neuman’s Systems Model:

  • Each client system is unique, a composite of factors and characteristics within a given range of responses.
  • Many known, unknown, and universal stressors exist. Each differs in its potential for disturbing a client’s usual stability level or normal line of defense. The particular interrelationships of client variables at any point in time can affect the degree to which a client is protected by the flexible line of defense against possible reaction to stressors.
  • 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.
  • 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.
  • The client, whether in a state of wellness or illness, is a dynamic composite of the interrelationships of the variables. Wellness is on a continuum of available energy to support the system in an optimal state of system stability.
  • Implicit within each client system are internal resistance factors known as lines of resistance, which function to stabilize and realign the client to the usual wellness state.
  • Primary prevention relates to general knowledge that is applied in client assessment and intervention, in identification and reduction or mitigation of possible or actual risk factors associated with environmental stressors to prevent possible reaction.
  • Secondary prevention relates to symptomatology following a reaction to stressors, appropriate ranking of intervention priorities, and treatment to reduce their noxious effects.
  • Tertiary prevention relates to the adjustive processes taking place as reconstitution begins and maintenance factors move the client back in a circular manner toward primary prevention.
  • The client as a system is in dynamic, constant energy exchange with the environment. (Neuman, 1995)

Major Concepts of Neuman Systems Model

In this section, we will define the nursing metaparadigm and the major concepts in Betty Neuman’s Neuman Systems Model.

Human being

Human being is viewed as an open system that interacts with both internal and external environment forces or stressors. The human is in constant change, moving toward a dynamic state of system stability or toward illness of varying degrees.


The environment is a vital arena that is germane to the system and its function. The environment may be viewed as all factors that affect and are affected by the system. In Neuman Systems Model identifies three relevant environments: (1) internal, (2) external, and (3) created.

  • The internal environment exists within the client system. All forces and interactive influences that are solely within boundaries of the client system make up this environment.
  • The external environment exists outside the client system.
  • The created environment is unconsciously developed and is used by the client to support protective coping.


In Neuman’s nursing theory, Health is defined as the condition or degree of system stability and is viewed as a continuum from wellness to illness. When system needs are met, optimal wellness exists. When needs are not satisfied, illness exists. When the energy needed to support life is not available, death occurs.


The primary concern of nursing is to define the appropriate action in situations that are stress-related or in relation to possible 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 culturalexpectations 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.

Lines of resistance

Protection factors activated when stressors have penetrated the normal line of defense, causing a reaction synptomatology.

Subconcepts of Neuman Systems Model


A stressor is any phenomenon that might penetrate both the flexible and normal lines of defense, resulting in either a positive or negative outcome.

  • Intrapersonal stressors are those that occur within the client system boundary and correlate with the internal environment.
  • Interpersonal stressors occur outside the client system boundary, are proximal to the system, and have an impact on the system.
  • Extrapersonal stressors also occur outside the client system boundaries but are at a greater distance from the system that are interpersonal stressors. An example is social policy.


A state of balance or harmony requiring energy exchanges as the client adequately copes with stressors to retain, attain, or maintain an optimal level of health thus preserving system integrity.

Degree of Reaction

The amount of system instability resulting from stressor invasion of the normal line of defense.


A process of energy depletion and disorganization moving the system toward illness or possible death.


A process of energy conservation that increases organization and complexity, moving the system toward stability or a higher degree of wellness.


The matter, energy, and information exchanged between the client and environment that is entering or leaving the system at any point in time.


The return and maintenance of system stability, following treatment of stressor reaction, which may result in a higher or lower level of wellness.

Prevention as Intervention

Intervention modes for nursing action and determinants for entry of both client and nurse into the health care system.

  • Primary prevention occurs before the system reacts to a stressor; it includes health promotion and maintenance of wellness. Primary prevention focuses on strengthening the flexible line of defense through preventing stress and reducing risk factors. This intervention occurs when the risk or hazard is identified but before a reaction occurs. Strategies that might be used include immunization, health education, exercise, and lifestyle changes.
  • Secondary prevention occurs after the system reacts to a stressor and is provided in terms of existing symptoms. Secondary prevention focuses on strengthening the internal lines of resistance and, thus, protects the basic structure through appropriate treatment of symptoms. The intent is to regain optimal system stability and to conserve energy in doing so. If secondary prevention is unsuccessful and reconstitution does not occur, the basic structure will be unable to support the system and its interventions, and death will occur.
  • Tertiary prevention occurs after the system has been treated through secondary prevention strategies. Its purpose is to maintain wellness or protect the client system reconstitution through supporting existing strengths and continuing to preserve energy. Tertiary prevention may begin at any point after system stability has begun to be reestablished (reconstitution has begun). Tertiary prevention tends to lead back to primary prevention. (Neuman, 1995)

Strengths and Weaknesses

Betty Neuman reports her nursing model was designed for nursing but can be used by other health disciplines, which both has pros and cons. As a strength, if multiple health disciplines use the Neuman’s System Model, a consistent approach to client care would be facilitated. As a con, if the model is useful to a variety of disciplines, it is not specific to nursing and thus may not differentiate the practice of nursing from that of other disciplines.


  • The major strength of the Neuman Systems Model is its flexibility for use in all areas of nursing – administration, education, and practice.
  • Neuman has presented a view of the client that is equally applicable to an individual, a family, a group, a community, or any other aggregate.
  • The Neuman Systems Model, particularly presented in the model diagram, is logically consistent.
  • The emphasis on primary prevention, including health promotion, is specific to this model.
  • Once understood, the Neuman Systems Model is relatively simple, and has readily acceptable definitions of its components.


  • The major weakness of the model is the need for further clarification of terms used.
  • Interpersonal and extrapersonal stressors need to be more clearly differentiated.


The delineation of Neuman’s three defense lines were not clearly explained. In reality, the individual resists stressors with internal and external reflexes which were made complicated with the formulation of different levels of resistance in the open systems model of Neuman.

Neuman made mention of energy sources in her model as part of the basic structure. It can be more of help when Neuman has enumerated all sources of energy that she is pertaining to. With such, new nursing interventions as to the provision of needed energy of the client can be conceptualized.

The holistic and comprehensive view of the client system is associated with an open system. Health and illness are presented on a continuum with movement toward health described as negentropic and toward illness as entropic. Her use of the concept of entropy is inconsistent with the characteristics of entropy which is closed, rather than an open system.

See Also

Related articles for this nursing theory guide:


Recommended resources and references for this nursing theories guide.

  • Alligood, M. R. (2013). Nursing Theory-E-Book: Utilization & Application. Elsevier Health Sciences.
  • Neuman, B. (1996). The Neuman systems model in research and practice. Nursing Science Quarterly9(2), 67-70. [Link]
  • Neuman, B. (1995). The neuman systems model (3rd ed.). In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.

External Links

Biography written by Wayne, G.

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