How it started
The Neuman systems model was created by Betty Neuman (1924–2022). Raised on an Ohio farm, she lost her father to kidney disease when she was young, worked in hospital, school, and industrial nursing, and earned a master's in mental health consultation at UCLA. In 1970 she built a teaching framework to help UCLA graduate students see patients as whole persons rather than bundles of separate physical and psychological problems; she and colleague R. J. Young published it in Nursing Research in 1972.
The model borrows from several fields: the open system from von Bertalanffy's general systems theory, stressors and responses from Hans Selye's stress research, and the three levels of prevention from psychiatrist Gerald Caplan, plus the holism of Gestalt theory. Beginning with the first book in 1982 and running through a fifth edition in 2011, it grew to cover families and communities as well as individuals.
The basic structure and lines of defense
Neuman drew the client system as concentric circles. At the center is the basic structure—core survival resources like temperature regulation, genetics, and ego structure. Around it are the lines of resistance, internal factors such as immune responses that kick in when a stressor gets through. Next comes the normal line of defense, the person's usual level of wellness built up over time. The outermost ring, the flexible line of defense, expands and contracts quickly with things like sleep and nutrition, buffering the normal line. The client is understood as a whole in which five variables interact: physiological, psychological, sociocultural, developmental, and spiritual.
Stressors and prevention as intervention
Stressors can be intrapersonal (anger), interpersonal (role expectations), or extrapersonal (job loss, disasters). When a stressor breaks through the flexible and normal lines, symptoms appear, and the lines of resistance protect the core while the system reconstitutes. Nursing interventions track this sequence: primary prevention identifies risks and strengthens the flexible line; secondary prevention supports the lines of resistance through early detection and treatment once symptoms appear; tertiary prevention supports readaptation and prevents recurrence after reconstitution. Treating prevention as the intervention is why the model is a favorite in community and public health nursing.
An example
For a middle-aged office worker newly diagnosed with hypertension, the nurse would assess work stress (interpersonal/extrapersonal), a taste for salty food (intrapersonal), and family support (sociocultural); then plan primary prevention (stress management, diet teaching), secondary prevention (home BP monitoring, medication adherence), and tertiary prevention (watching for complications, sustaining lifestyle changes). As an assessment tool it resembles the Roy adaptation model, but organizing care by prevention level is uniquely Neuman's.
Strengths and limitations
Its holistic, prevention-first approach works for individuals, families, communities, and interdisciplinary teams, and it has been widely used as a curriculum framework in the U.S., Canada, and Europe. On the other hand, the boundaries between the lines of defense and resistance are abstract and hard to measure, and stressors are cast mostly as negative.
See also
Nursing theory · Roy adaptation model · Johnson behavioral system model · General systems theory · General adaptation syndrome
FAQ
- Flexible vs. normal line of defense?
- The normal line is the person's usual, relatively stable wellness level; the flexible line shifts quickly with sleep, nutrition, and stress and acts as a buffer protecting the normal line.
- Is this the same as Margaret Newman's theory?
- No. Margaret Newman's "health as expanding consciousness" is a different theory. This page covers Betty Neuman's systems model.
Sources reviewed: 2026-10-26
References
- Neuman, B., & Young, R. J. (1972). A model for teaching total person approach to patient problems. Nursing Research, 21(3), 264–269.
- Neuman, B., & Fawcett, J. (Eds.). (2011). The Neuman Systems Model (5th ed.). Upper Saddle River, NJ: Pearson.
- Selye, H. (1956). The Stress of Life. New York: McGraw-Hill.
- Alligood, M. R. (Ed.). (2021). Nursing Theorists and Their Work (10th ed.). Elsevier.