Neumann Nursing Theory: A Holistic Approach to Client's Defence to Stressors

Explore the Neumann nursing theory proposed by Betty Neumann in 1972, focusing on a holistic approach to client's defence to stressors. Understand the model's components, application in nursing practice, and its impact on patient recovery and stability.

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NURSING THEORIES
Contents
INTRODUCTION.......................................................................................................................................2
BODY.........................................................................................................................................................3
CONCLUSION...........................................................................................................................................8
REFERENCES............................................................................................................................................9

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INTRODUCTION
This assignment focuses on one of several nursing theories. Nursing theories help in guiding the
nurses in their work. In this assignment, we will discuss Neumann nursing theory or model
which was proposed by Betty Neumann in 1972 which is a holistic, flexible systemic model
focusing on client's defence to stressors. It is an approach which provides in-depth information
and knowledge of nursing and increasing client’s defence to stressors (Broadbent, 2014).
Neumann wrote a book named the Neumann system model: application to nursing education and
practice including the system model theory which was released in 1972 and has been modified
over the years. In 1989 environment factor was added which was included as the fifth variable in
this theory. The theory is a holistic, flexible system based on patient perspective. It focuses on
how the patient perceives and deals with actual and potential environmental stress. Primary to
tertiary prevention are included in its steps to retain, maintain, attainment and intervention for
holistic treatment of clients. In this assignment, we will discuss and study this theory in detail
and will talk about its application in nursing practice (Alligood, 2014).

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BODY
This theory is a holistic approach where the client is viewed as an open system reacting to both
external and internal stressors. It consists of a basic central stricture which has concentric circles
and each of these concentric circles is made of five variables which are to be considered I a
client. The first variable is physiological which talks about the normal body function and
structure of the client. The second variable is psychological which mentions the mental status
and emotions of the client. Third are the socio-culture which involves relationships and social or
functional culture and activities. Fourth is spiritual where a patient is tested for its spiritual
belief. Fifth is the development which includes the development of a person through his lifetime
and the developmental processes he has gone through (Alligood, 2017).
Structure has a central core which involves basic survival factors which are:
1. Genetic structure
2. Normal temperature range
3. Ego structure
4. Response pattern
5. Organ strength and weakness
The patient is considered as an open system and is constantly changing. Stability happens when
the energy exceeds that of the system. The body is in balance when there are dynamic changes in
feedback, input, output and compensation (Farrell, 2015).
Another important feature of this model is the flexible line of defence. This feature is outer
border of a normal line of defence and the core structure of this model. It protects individual
from various stressors and depends on nutritional status, sleep patterns and quantity and quality
of stress. If this line of defence fails to protect then line of resistance is activated. The normal
line of defence, on the other hand, is usual defence level of the client. It can change depending
on the attitude of a person and also their response towards the environment. The line of
resistance comes into play when external stressors attack the normal line of defence.
Reconstitution is another part of the model that comes into play when environmental stressors
invade or attack the normal line of defence. It can bring the lower level of stability by expanding

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the normal line of defence; it can revert back to the same stability before the illness (Betty,
2011). Stressors are mainly divided into 3 types
1) Intrapersonal- it deals with stressors inside individual
2) Interpersonal- it is when stressor is present between individual
3) Extra personal- when stressor is present outside an individual
This model helps to understand the stressors and its impact on the health client and helps reduce
stress. Stressors are forces that disrupt the stability of client. For every stress, there is a reaction
given by the client and its nature decides the line of defence then the client tries dealing with
stress by primary, secondary and tertiary interventions to bring about stability (Masters, 2014).
1) Primary intervention- it occurs before the stressor attacks the client. it helps in increasing
strength and fighting stress to bring about stability.
2) Secondary prevention- it happens when system reacts to the stressor and will prevent
damage by strengthening the line of resistance.
3) Tertiary stressor- it occurs after secondary prevention is done to the system. It protects
the client by strengthening energy and facilitates reconstitution.
The diagram given below explains every entity of this system model and provides the brief
understanding of what has been discussed above.

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There are certain factors that help in understanding this system. In order to know better one must
understand it properly. Neumann has made it very simpler and each step in this model is clearly
described which allows the nursing staff to understand it better and apply it better. For example
people these days suffer greatly from job stress which has major effects on their health. The
nurses can identify such clients and grade them in the situation according to the study model
(Aronowitz, 2016). Like, in this case, external stressors invaded the normal line of defence and
now patient requires secondary prevention. So all of these have to be kept in mind and certain
goals should be set by nursing staff to relieve stress and work accordingly to help the patient gain
stability. Another important factor is learning the language of the model. It is easier for the
medical staff to understand the language as it includes physiological and psychological changes
etc. which is easier for medical staff to understand (Fawcett, 2016).
I applied this theory when I worked as subacute nurse in an institution. Now I kept this in mind
that every patient is different and stressor perceived by every patient is different, their reaction
towards stressor is different like what might work for one may not work for another. Being a

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nurse I have to deal with patients who are in their recovery phase, in this phase stressors play the
major role as it can help in recovery or make the condition more worst. The first thing I did was
checked what sort of stressor did the patient go through whether it was emotional or external and
then laid down my prevention plan considering patient physiological, psychological, socio-
culture, spiritual state and observing the depth of attack of the stressor. One important thing is
that the caregiver and patient should work together and understand norms of this model to bring
about health (Ahmadi, 2017). So I laid down goals and improved communication with patient to
understand situation better and take measures to improve the situation and bring back stability
and balance of the patient. Client also plays important role in maintaining health. As mentioned
by Neumann the model includes patient’s physiological as well as psychological and spiritual
status that influences the stressors. Clients or patients should actively take part in their recovery
and should work towards attaining good health and stability. In nursing promotion of good
behavior is important in preventing illness, so one must focus on communication skills and
setting up goals to work for maintaining stability of patient. This theory also has certain
drawbacks as mention in the theory the most important thing in this model is to understand the
behavior and psychological condition of the patient and understanding the situation of the patient
and what type of stressor they are dealing with and if the nursing staff fails in understanding the
patient and situation right it can affect the prevention plan and will have negative effect on the
patient. Instead of bringing the patient to stability patient will get more conscious about the
situation and this will affect the equilibrium of patient (Memmott, 2017). in my opinion the best
part of the theory is that it sees person as a whole system and does not focus on one aspect of the
person like patient’s entire body is studied all of its physiological status his development,
psychology and relationship with other human beings and keeping this in mind further
prevention plan is suggested after studying the model clearly (Lee, 2014). This gives an
advantage for caretakers to understand person as whole and work accordingly as to what is best
for them. An example can be given to understand this theory better, there was this case of a 36
year old Freya who is a mother of 2 kids and recently shifted to Texas because of her husband’s
transfer. She reports that ever since she shifted from Toronto she is facing lot o problems and is
not able to focus on anything. She was unhappy with the shifting as she had to lave her family
and friends and move to this new place. She started to go under depression, left her teaching job
and became an insomniac. She reported that she consumed medicines prescribed by her

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physician which was the reason for her to be insomniac. In this new place she was not able to
find her place and was sinking in stress (Konstantinos, 2015). After studying her situation we
realize she is suffering from 3 types of stressors
1) Intrapersonal- concerning with her depression and being insomniac
2) Interpersonal- lack of close ones near her to share her feelings and her irritated behavior
due to lack of sleep
3) Extra personal- shifting of place
All of these stressors occurred in a short span which affected Freya’s normal line defense and her
ability to fight illness. She gave in without coping with the situation and this let to depression.
There are certain goals that can be adopted to improve Freya’s condition and bring her to
stability. Firstly instead of depending on her medication she is supposed to cope with situation on
her own without mediation (Fawcett, 2015). Firstly in secondary prevention we can ask her to
take medications which making her insomniac to be taken in the morning and then talking to her
about eliminating depression. In tertiary prevention we will focus on anxiety attacks and how we
can control them and will understand every aspect of depression to help eliminate it and also
reducing chances of future depression attack. Her progress is carefully observed and all the
changes occurring in intrapersonal, interpersonal and extra personal factors are noted and this
will give us clear understanding of her progress towards wellness (Bauer, 2014)

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CONCLUSION
In this assignment, we studied Neumann theory which is a holistic approach to understanding the
stressors and getting the client to stability. As mentioned in the assignment this theory proved to
be very helpful for recovery of the patient. in any recovery period, stress deteriorates patient's
condition so improving the patient situation by adapting to this theory has turned out to be
helpful (Reuvers, 2017). This assignment gave us the clear understanding of this theory and how
it can be applied in the workplace. It also explained benefits and drawbacks of the theory that can
be seen in applying this theory in the workplace. It is very easy to understand for a medical
professional as it is explained very well by Neumann. It is not hard to apply either. The best part
of the theory is that it sees every patient as a whole system and not focuses on one part. All of
this information gave us the brief description of Neumann theory and it should be applied in
every institution to provide for better results (Betty, 2011).

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REFERENCES
 Ahmadi, Z., & Sadeghi, T. (2017). Application of the Betty Neuman systems model in
the nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal–
Experimental, Translational and Clinical, 3(3), 2055217317726798.
 Alligood, M. R. (2014). Nursing theorists and their work. Elsevier Health Sciences.
 Alligood, M. R. (2017). Introduction to Nursing Theory: Its History and Significance.
Nursing Theorists and Their Work-E-Book, 1.
 Aronowitz, T., & Fawcett, J. (2016). Thoughts About Social Issues: A Neuman Systems
Model Perspective. Nursing science quarterly, 29(2), 173-176.
 Bauer, J. S. (2014). The use of stress reduction techniques in nursing education.
 Betty Neuman's system model. (2011). Retrieved from
currentnursing.com/nursing_theory/nueman.
 Broadbent, M. (2014). Nursing theories and conceptual frameworks. In Fundamentals of
Nursing, 3rd Australian Edition (pp. 40-56). Pearson Education Australia.
 Farrell, C. (2015). Nursing developments and policy influences. Advanced Nursing
Practice and Nurse-led Clinics in Oncology, 1.
 Fawcett, J. (2015). Evolution and Use of Formal Nursing Knowledge. Advancing Your
Career Concepts in Professional Nursing, 33.
 Fawcett, J. (2016). Applying Conceptual Models of Nursing: Quality Improvement,
Research, and Practice. Springer Publishing Company.
 Konstantinos, K. (2015). The Role of Nurses in the Systemic Therapy of Mental
Diseases. American Journal of Nursing, 4(2-1), 84-87.
 Lee, S. W. (2014). Overview of nursing theory. Japanese Journal of Nursing and Health
Sciences, 12(2), 58-67.
 Masters, K. (2014). Nursing theories: A framework for professional practice. Jones &
Bartlett Publishers.

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 Memmott, R. J., Marett, K. M., Bott, R. L., & Duke, L. (2017). Use of the Neuman
Systems Model for interdisciplinary teams. Online Journal of Rural Nursing and Health
Care, 1(2), 58-73.
 Neuman, Betty RN, PhD. (2011). Neuman Systems Model. Retrieve from The Neuman
Systems Model website: http://neumansystemsmodel.org/index.html
 Reuvers, J. A. (2017). Moral Distress and Resilience in Nursing: The Code is the Cor.