The Neuman Systems Model was developed by Betty Neuman in 1970 and

relates to the client in holistic terms, as it gives a framework for the development
of comprehensive diagnoses, determination of appropriate interventions and
evaluation of outcomes (Alligood, 2014, p. 207). Neuman has a basic philosophy of
helping each other live and developed this systems model with the idea of
wellness-focused care serving as the foundation of nursing care (Alligood, 2014,
p.200).
When I think of the Celtic Knot the first thing that comes to mind is the word
intertwined- a concept which serves as the foundation for the Neuman Systems
Model. As you can see, each part of the center knot is weaved together so that one
cannot tell where one part ends and another begins. Betty Neuman believes that
what constitutes person functions in much the same way- the variables are
intertwined to the point that they cannot be distinguished from the whole. This
would indicate that when we care for patients, each variable would have to be
considered and addressed in relation to illness because each part is interwoven with
the next. The circle surrounding the Celtic Knot is symbolic of the protective ring
that Neuman believes guards each persons basic structure. When the integrity of
the ring is fully compromised, the basic structure is vulnerable to illness or even
death. In general terms, the Neuman Nursing Systems Model is holism at its most
basic- caring for all aspects of the patient, and not just the physical body, in order to
achieve or maintain optimum health. However, Neuman prefers to replace the word

holistic with wholistic to distinguish that the client is more than the sum of the
parts, as well as that those parts are all interrelated (Alligood, 2014).
Now, that you have a visual of how the Neuman Systems Model works, lets
breakdown each component:
1. Person: Person is defined in terms of 5 variables: physiological, psychological,
developmental, sociocultural and spiritual. Each variable is intertwined with the next
to comprise one whole entity. Therefore, each variable must be addressed when
caring for the client, because they are interrelated and interdependent (Alligood,
2014).
2. Environment: Environment and person are a synergistic relationship and are
looked at in terms of internal, external and created. Internal is what is happening
within the person; external is what is around the person; and created is defined as
the clients individual perception of what is happening. As such, the nurse must
factor in all three aspects of the clients environment, (also termed stressors) and
how they relate back to each of the 5 variables of person when planning care.
(Alligood, 2014, p. 205).
3. Health: Wellness is viewed as a sort of balancing act achieved when there is
either a balance or surplus of energy in the system, while illness is defined as an
energy deficit within the system (Alligood, 2014). Neuman believes that there are
three protective rings that surround patients basic structure which are in place to
guard against stressors (Alligood, 2014, p.204). Referring back to the picture,
imagine that the black line outlining the outside of the circle is the first ring, which
Neuman names the flexible line of defense. This line is continually changing and
adapting and may best be thought of in terms of lifestyle changes or coping
mechanisms. Next, (the middle green portion of the circle) is the normal line of
defense. This would be relative to your baseline level of wellness- whats normal
for you. Lastly, (the inner black outline) are the lines of resistance, or the defense
mechanisms- think immune system- that kicks in when the person comes in contact
with a stressor. According to Neuman, once the lines of resistance are penetrated,
energy is depleted and imbalance, or illness, occurs. If the line continues to be
ineffective the end result is death.
4. Nursing: According to the Neuman System Model, the role of the nurse is to assist
the patient in achieving or maintaining system balance, which is accomplished
through the incorporation of patient, environment and health.
This model could be easily applied to any area of practice, whereas the nurse
would 1). Consider each of the 5 variables of person to achieve a wholistic

assessment; 2) Identify the actual, as well as potential, stressors in the areas of

interpersonal, intrapersonal and extrapersonal environmental factors; and 3)
incorporate variables and how they relate to the stressors into client-specific
interventions (Alligood, 2014).
Reference
Alligood, M.R. (2014). Nursing theory: Utilization & application (5th ed.). St.
Louis, MO: Elsevier.