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CHAPTER 16 Betty Neuman 287

Neuman links the four essential concepts of person,
Health environment, health, and nursing in her statements
Neuman considers her work a wellness model. She regarding primary, secondary, and tertiary prevention.
views health as a continuum of wellness to illness Neuman’s earlier publications stated basic assump-
that is dynamic in nature and is constantly changing. tions that linked essential concepts of the model.
Neuman states that “Optimal wellness or stability These statements have been recognized as proposi-
indicates that total system needs are being met. A tions and serve to define, describe, and link the con-
reduced state of wellness is the result of unmet sys- cepts of the model. Numerous theoretical assertions
temic needs” (2011c, p. 328). have been proposed, tested, and published, as noted
throughout Neuman and Fawcett (2011).
Environment
Neuman defines environment as all the internal and
external factors that surround and influence the client Logical Form
system. Stressors (intrapersonal, interpersonal, and Neuman used deductive and inductive logic in devel-
extrapersonal) are significant to the concept of envi- oping her model. As previously discussed, Neuman
ronment and are described as environmental forces derived her model from other theories and disci-
that interact with and potentially alter system stability plines. The model is also a product of her philosophy
(2011c, p. 327). and of observations made in teaching mental health
Neuman (1995) identifies three relevant environ- nursing and clinical counseling (Fawcett, Carpenito,
ments: (1) internal, (2) external, and (3) created. The Efinger, et al., 1982).
internal environment is intrapersonal, with all interac-
tion contained within the client. The external environ- Applications by the Nursing
ment is interpersonal or extrapersonal, with all factors
arising from outside the client. The created environment Community
is unconsciously developed and is used by the client to Alligood (2010) clarifies that a conceptual model pro-
support protective coping. It is primarily intrapersonal. vides a frame of reference, while a grand theory pro-
The created environment is dynamic in nature and poses direction or action that is testable. The Neuman
mobilizes all system variables to create an insulating Systems Model is both a model and a grand nursing
effect that helps the client cope with the threat of envi- theory. As a model, it provides a conceptual frame-
ronmental stressors by changing the self or the situation. work for nursing practice, research, and education
Examples are the use of denial (psychological variable) (Freese, Russell, Neuman, & Fawcett, 2011; Louis,
and life cycle continuation of survival patterns (develop- Neuman, Gigliotti, et al., 2011; Newman, Lowry, &
mental variable). The created environment perpetually Fawcett, 2011). As a grand theory, it proposes ways of
influences and is influenced by changes in the client’s viewing nursing phenomena and nursing actions that
perceived state of wellness (Neuman, 1995, 2011b). are assumed to be true but may form propositions for
testing (Neuman, 2002a).
The model serves equally well for all levels of
Theoretical Assertions nursing education and for a wide variety of practice
Theoretical assertions are the relationships among the areas. It adapts well transculturally and is used fre-
essential concepts of a model (Torres, 1986). The quently for public health nursing in other countries.
Neuman model depicts the nurse as an active partici- The model is used extensively in the United States,
pant with the client and as “concerned with all the Canada, and Holland. It has been used throughout
variables affecting an individual’s response to stress- the world (Australia, Brazil, Costa Rica, Denmark,
ors” (Neuman, 1982, p. 14). The client is in a recipro- Egypt, England, Finland, Ghana, Holland, Hong
cal relationship with the environment in that “he Kong, Iceland, Japan, Korea, Kuwait, New Zealand,
interacts with this environment by adjusting himself Portugal, Puerto Rico, the Republic of China, Spain,
to it or adjusting it to himself” (Neuman, 1982, p. 14). Sweden, Taiwan, Wales, and Yugoslavia).