Life Story of Betty Neuman
Betty Neuman (1924–2022) was a visionary nurse theorist, educator, and mental health advocate whose Neuman Systems Model revolutionized how nurses understand and care for patients—as dynamic beings influenced by stressors and environments.
Early Life & Education
- Born September 11, 1924, near Lowell, Ohio, and raised on a farm, where she developed a deep empathy for others.
- Earned her RN diploma in 1947 from Peoples Hospital School of Nursing in Akron, Ohio.
- Completed a BS in Public Health and Psychology (1957) and an MS in Mental Health and Public Health Consultation (1966) from UCLA.
- Later earned a PhD in Clinical Psychology from Pacific Western University in 1985.
Career & Contributions
- Worked as a staff nurse, head nurse, school nurse, and industrial nurse in California.
- Became a clinical instructor and later department chair at UCLA’s graduate nursing program.
- Developed the first community mental health nursing program for graduate students in Los Angeles.
- Founded the Neuman Systems Model Trustees Group in 1988 to promote her theory globally.
The Neuman Systems Model (1970)
- Views patients as open systems interacting with internal and external stressors.
- Emphasizes five interrelated variables: physiological, psychological, sociocultural, developmental, and spiritual.
- Introduced concepts like:
- Flexible Line of Defense: temporary buffer against stress.
- Normal Line of Defense: baseline health.
- Lines of Resistance: internal mechanisms to restore stability.
- Focuses on three levels of prevention: primary, secondary, and tertiary.
Honors & Legacy
- Passed away peacefully on May 28, 2022, at age 97, leaving behind a legacy of holistic, patient-centered care.
- Received multiple honorary doctorates and was named an Honorary Fellow of the American Academy of Nursing.
- Her model has been adopted in nursing curricula worldwide, influencing care in acute, community, and mental health settings.
Betty Newmans System Model
The Assumptions of the Model
- 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.
- There are many known stressors. Each stressor is different in its potential to disturb the individual ‘s equilibrium or normal line of defence. 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 defence against possible reaction to a single stressor or combination of stressors.
- Each individual, over time, has developed a normal range of resistance, which is referred to as a normal line of defence.
- When the cushioning, accordion -like effect of the flexible line defence is no longer capable of protecting the individual against a stressor, the stressor breaks through the normal line of defence. The interrelationship of variables (physiologic, psychologic, sociocultural, development and spiritual) determines the degree of the organism’s reaction to the stressor.
- 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 defence, should stress break through it.
- Environment is broadly defined as all internal and external factors or influences surrounding the client/client system.
- 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.
- 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.
- 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.
Betty Neuman’s Systems Model
Client as an Open System:
The patient (individual, family, or community) constantly interacts with internal and external stressors.
Variables of the Client System:
- Physiological – Physical health
- Psychological – Emotions, mental health
- Sociocultural – Culture, family, and society
- Developmental – Age-related and growth changes
- Spiritual – Beliefs and values
Lines of Defense and Resistance:
- Flexible Line of Defense (FLD) – First protective buffer against stress
- Normal Line of Defense (NLD) – Usual health baseline
- Lines of Resistance (LR) – Internal defenses activated when stressors penetrate NLD
Types of Stressors:
- Intrapersonal: Inside the individual (pain, fear)
- Interpersonal: Between individuals (family conflict, communication issues)
- Extrapersonal: External environment (financial issues, hospital environment)
Prevention as Intervention:
- Primary: Prevent stressor impact
- Secondary: Early detection and treatment
- Tertiary: Recovery and prevention of complications
Application of Betty Neuman’s Systems Model
Comprehensive Assessment
- Identify physiological, psychological, sociocultural, developmental, and spiritual needs.
- Assess stressors in the environment and their impact on the client system.
- Determine the strength of lines of defense (resilience or vulnerability).
Nursing Diagnosis and Planning
- Identify diagnoses based on stressor impact (e.g., pain, anxiety, social isolation).
- Determine which level of prevention to focus on.
Nursing Interventions
- Primary Prevention:
- Health promotion, patient education, vaccination, environmental safety.
- Secondary Prevention:
- Early detection (vital signs, screening), prompt treatment, and stress reduction.
- Tertiary Prevention:
- Rehabilitation, counseling, lifestyle modification, and follow-up to prevent relapse.
Evaluation
- Assess if the patient system returns to or maintains stability.
- Modify interventions according to stressor response and patient recovery.
Case Scenario 1: Postoperative Patient with Surgical Stress
Scenario:
Mr. A, 50 years old, is on postoperative day 2 after an appendectomy. He reports moderate pain (6/10), is anxious about recovery, and has limited mobility. His family is worried and frequently asks questions, creating environmental stress.
Possible Stressors
- Intrapersonal: Pain, anxiety
- Interpersonal: Family anxiety, frequent questioning
- Extrapersonal: Hospital noise, bright lights, lack of sleep
Nursing Diagnosis
- Acute Pain related to surgical incision and tissue trauma.
- Anxiety related to hospital environment and postoperative uncertainty.
Nursing Interventions Using Neuman’s Model
Primary Prevention (Before stressor impacts fully)
- Educate patient and family about expected recovery process.
- Provide quiet environment to reduce anxiety.
Secondary Prevention (During active stressor response)
- Administer prescribed analgesics and non-pharmacologic pain relief (e.g., relaxation techniques).
- Assess anxiety using rating scales and provide emotional support.
Tertiary Prevention (After treatment to prevent recurrence)
- Encourage early mobilization and teach deep-breathing exercises to promote healing.
- Involve family in supportive care and discharge planning.
Case Scenario 2: Elderly Stroke Patient in Home Care
Scenario:
Mrs. B, 72 years old, had a recent ischemic stroke with left-sided weakness. She is now receiving home nursing care, but the house is cluttered, lighting is poor, and she feels socially isolated. She expresses fear of falling.
Possible Stressors
- Intrapersonal: Physical limitation, fear of falling
- Interpersonal: Limited family support, loneliness
- Extrapersonal: Unsafe home environment (clutter, poor lighting)
Nursing Diagnosis
- Risk for Injury (Fall) related to impaired mobility and unsafe environment.
- Social Isolation related to physical limitation and reduced social interaction.
Nursing Interventions Using Neuman’s Model
Primary Prevention
- Modify home environment: Remove clutter, improve lighting, provide non-slip mats.
- Educate patient and family on fall prevention strategies.
Secondary Prevention
- Assess gait and balance regularly.
- Assist with mobility exercises and provide a walker if needed.
Tertiary Prevention
- Connect patient with community support or therapy groups to reduce isolation.
- Continue physical therapy to enhance recovery and independence.
REFERENCES
- Memmott, Rae Jeanne; Kevin M. Marett; Randy L. Bott; Lee Duke (Summer 2000). “Use of the Neuman Systems Model for Interdisciplinary Teams”. Online Journal of Rural Nursing and Health Care. Archived from the original on November 28, 2012. Retrieved August 24, 2012.
- Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.). Mosby, Philadelphia, 2002
- George JB. Nursing Theories: The Base for Professional Nursing Practice,5th ed. New Jersey: Prentice Hall;2002.
- Yaqoob A, Jan R, Rattani S, Kumar S. Betty Neuman System Model: A Concept Analysis. Insights Depress Anxiety. 2023; 7: 011-015.
- Alligood M R, Tomey A M. Nursing Theory: Utilization &Application .3rd ed. Missouri: Elsevier Mosby Publications; 2002.
- Neuman B and Reed KS. A Neuman systems model perspective on nursing in 2050. Nurs Sci Q. 2007;20 (2):111-113.
- Fawcett J and Gigliotti E. Using conceptual models of nursing to guide nursing research: The case of the Neuman systems model. Nurs Sci Q. 2001;14(4):339-345.
- Hannoodee S, Dhamoon AS. Nursing Neuman Systems Model. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560658/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
