Betty Neuman’s Nursing Theory Explained


Betty Neuman’s nursing theory sees human beings as being open systems. Each person interacts with external and internal environmental forces and stresses. This causes humans to be in a state of constant change, attempting to find systemic stability in some way. The need for stability can all cause humans to move toward an illness of varying degrees as well.

Each environment, according to Neuman, is a vital arena. Its influences help to influence the factors that each person will use to move toward their preferred state. Nurses can help to promote stability by influencing those factors in favor of the patient.

The 9 Assumptions of Betty Neuman’s Nursing Theory

Neuman sees each client system as being unique. It is a combination of characteristics and factors that have created a range of responses within each patient. This idea leads to the 9 assumptions that this nursing theory makes.

1. Each patient has evolved a normal set of responses to their environment to create a defensive matrix. Discovering where these defenses lie can allow nurses to apply a better standard of care when health deviations occur.

2. Unknown stressors exist in every environment. Each unknown stressor offers the potential of reducing the progress being made toward systemic stability. Relationships between nurse and patient can become a stressor as well, which affects the quality of defense that can be used to cope within a difficult environment.

3. When patients are unable to adapt to varying environmental stressors, that influence can break through the rest of their defenses and affect patient health in an immediately negative way.

4. Patients, whether they are well or they are ill, are a composite of their relationships to the variables of their environment. This means wellness occurs when an optimal state of systemic stability can be maintained.

5. Each environmental system also offers lines of resistance that attempt to keep each patient at their optimal state of wellness.

6. Prevention must be based on the general knowledge a nurse obtains from a patient through assessment and intervention. By identifying risk factors and reducing those risks, environmental stressors can be stopped before they interrupt a wellness state.

7. Secondary preventions that relate to symptoms can be treated by addressing the physical response to a stressor while also working to eliminate the stressor at the same time.

8. Adjustive processes can be implemented to help patients maintain their current state of wellness as they work to improve their defenses.

9. All humans are a system that is in a constant and dynamic energy exchange with their environments.

What Are Stressors in Betty Neuman’s Nursing Theory?

Stressors are an integral component of Betty Neuman’s nursing theory. Her definition of a stressor is this: it is any phenomenon that may penetrate a patient’s defensive mechanisms. A stressor can provide either a positive or a negative outcome.

Neuman identifies three specific types of stressors that may be present in the environment of a patient at any given time.

  • Intrapersonal stressors. These are the stressors which occur within a patient boundary. They will directly correlate with the internal environment of the patient.
  • Interpersonal stressors. These occur outside of the established patient defensive boundary. They have a certain proximity to the patient and will impact it, but from an external approach instead of an internal approach.
  • Extrapersonal stressors. These are also external stressors, but they occur with a greater distance than interpersonal stressors.

An example of an intrapersonal stressor would be a person’s internal reaction to seeing themselves in the mirror. A person having a bad hair day and suffering from an outbreak of acne may have a negative impression of themselves. On the other hand, someone might look in the mirror, think they look fantastic, and this creates a positive outcome despite the fact that the stressor penetrated that person’s defensive network.

As for interpersonal stressors, these are the events that occur directly around an individual. The temperature of a room could be a stressor. How loud a TV is playing could be a stressor as well. From a nursing standpoint, the quality of care through the assessment process could also be an interpersonal stressor for a patient.

Extrapersonal stressors are events that occur in society at some level which a patient or a nurse may not have any control over. The US government passing laws to change how Medicare or Medicaid funding is distributed would be an example of this stressor. These stressors can be localized or be a global stressor.

What Are the Strengths of Betty Neuman’s Nursing Theory?

The primary strength of the nursing model that Neuman presents is that it can be used in all areas of nursing. Nurses work in administrative positions and educational environments in addition to providing people with direct care. Unlike other models, every nurse has the ability to use this model to promote patients toward a state of optimal wellness.

This theory is also unique because it can be equally applied to any person or group. The intent is to show that human beings are an open system, but the concepts offered through the theory can be applied to families, neighborhood groups, large communities, or any other defined demographics.

It is a logically consistent theory as well, placing a need on primary prevention and health promotion to each patient. The goal of this theory is to show people that they can choose to work toward a state of optimal wellness by taking more control over their current environments.

This allows for nurses to be consistent in the care that they provide to their patients, no matter what their position may be. There are fewer gaps in communication because the defintions being used are already standard ideas in nursing.

What Are the Weaknesses of Betty Neuman’s Nursing Theory?

The primary weakness of this nursing theory is that it can be difficult for those outside of this field to understand what is being discussed. Understanding what the various lines of defense happen to be for each patient, along with what stressors happen to be present in an environment, can make the assessment process more difficult when first implementing this theory.

When there is added difficulty to the nursing process, then it becomes more difficult to implement a plan that can take a person back to optimal wellness.

When human beings are treated as individuals, nursing becomes more effective. When nurses locate and offer resources to reduce environmental stressors, patients can move toward wellness with more consistency. It is more of a holistic approach than other theories, but Betty Nueman’s nursing theory also provides a comprehensive view of health and illness.

Open systems are always in a state of movement. Neuman offers us an opportunity to encourage that movement to be toward wellness instead of illness.