NEUMAN’S SYSTEM MODEL AND

APPLICATION
Yuli Isnaeni
Bagian Ilmu Keperawatan Komunitas
isnaeniyuli.kd@gmail.com
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 OUTLINE
• Mengenal Biografi Betty Neuman
• Mengetahui Teori Betty Neuman
• Mengetahui Aplikasi dalam asuhan
keperawatan
Ibu Betty Neuman
 Biografi Betty Neuman
• Betty Neuman lahir di Lowell Ohio tahun 1924
• Anak seorang petani dan ibu rumah tangga
Pendidikan :
• Hospital School of Nursing (General Hospital Akron
Ohio) 1947
• University of California tahun 1957 (bid psikologi)
• University of California 1966 (master bid kes mental
dan kes mas)
• Ohio University (Adm Pendidikan Tinggi)
 Karya buku yang diterbitkan
• Model Whole Person Approach dipublikasikan
padatahun 1972
• A model of teaching total person approach
to patient problem dalam riset
• keperarawatan
• Conceptual Models For Nursing Practice edisi 1
tahun 1974 dan edisi 2 tahun 1980
• Tahun 1986 The Neuman Systems Model
4 KONSEP UTAMA TEORI KEPERAWATAN
• Keperawatan mempunyai berbagai teori
keperawatan dengan penjelasan yang berbeda-
beda sesuai disiplin yang dimilikinya
• Namun, semua teori menjelaskan 4 konsep
sentral yakni manusia, lingkungan,
keperawatan dan kesehatan
 Overview of Major Nursing Theorist
Tujuan
Mempelajari efek stress dan
reaksinya dalam
perkembangan dan
pemeliharaan kesehatan
Komponen
Person : sistem kline terdiri dsri variabel
fisiologi, psikologi, sosial budaya dan
lingkungan
Lingkungan : lingkungan internal dan
eksternal memperngaruhi klien setiap saat
Kesehatan : sehat da sakit merupakan bagian
dari kehidupan sebagai person
Keperawatan : profesi yang unik dengan
seluruh variabel yang memperngaruhi respon
individu terhadap stress
 MAJOR CONCEPTS
• Human being is viewed as an open system that
interacts with both internal and external
environment forces or stressors.
• Manusia sistem terbuka yang berinteraksi dgn
lingkungan internal dan eksternal “stressor”
• The human is in constant change (selalu berubah),
moving toward a dynamic state of system stability
or toward illness of varying degrees.
 MAJOR CONCEPTS
• The environment is a vital arena that is
germane to the system and its function.
• Lingkungan merupakan arena penting
berkaitan erat dengan sistem dan fungsinya
• The environment may be viewed as all factors
that affect and are affected by the system.
 MAJOR CONCEPTS
• The internal environment exists within the
client system.
• All forces and interactive influences that are
solely within boundaries of the client system
make up this environment.
• The external environment exists outside the
client system.
 MAJOR CONCEPTS
• Health is defined as the condition or degree of
system stability and is viewed as a continuum
from wellness to illness.
• When system needs are met,
optimal wellness exists.
• When needs are not satisfied, illness exists.
• When the energy needed to support life is not
available, death occurs.
 MAJOR CONCEPTS
• The primary concern of nursing is to define the
appropriate action in situations that are stress-
related or in relation to possible reactions of
the client or client system to stressors.
 MAJOR CONCEPTS
• Nursing interventions are aimed at helping the
system adapt or adjust and to retain, restore, or
maintain some degree of stability between and
among the client system variables and
environmental stressors with a focus on
conserving energy.
• Intervensi keperawatan bertujuan membantu
beradaptasi atau menyesuaikan diri,
memulihkan atau memelihara stabilitas antara
variabel sistem klien dan stresor
 MAJOR CONCEPTS
• Open System

A system in which there is a continuous flow

of input and process, output and feedback.

• It is a system of organized complexity, where

all elements are in interaction.
 Input-Process-output and feedback
Input Proses Output Feedback

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SMK metode, media dan strategi berbahasa Inggris
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 The Neuman’s System Model : aplikasi
pada keluarga
• Dapat diaplikasikan pada keluarga, sebagai
panduan dalam memberikan asuhan
keperawatan keluarga
• Keluarga dipandang sebagai sistem terbuka
yang berinteraksi secara konstan dengan
lingkungan
• Keluarga yang adaptif : sukses menyesuaikan
dengan lingkungan
 The Neuman’s System Model : aplikasi
pada keluarga
• Nemuan’s model dipilih karena komponen
utama model ini adalah stress dan reaksi
terhadap stres dan pengalaman keluarga
dalam menghadapi berbagai stres yang
berhubungan dengan sakit
• Stressor selama menjalani peran sakit dan cara
mengatasi stres juga dibahas dalam model ini
 Teori Betty Neuman
• The Neuman Systems Model views the client as
an open system that responds to stressors in the
environment (Model Neuman memandang klien
sebagai sistem yang terbuka yang merespon
stesor dari lingkungan)
• Variabel klien : fisiologi,psikologi, physiological,
sosial budaya, perkembangan dan spiritual
• Sistem klien terdiri dari individual, family and
community
Stress dalam pandangan Betty Neuman
• Intrafamily stressor : terjadi dalam unit
keluarga-interaksi individu dalam keluarga
(proses penyelesaian masalah keluarga,
perubahan gaya hidup, masalah fisik/sakit)
• Interfamily stressor : terjadi antara keluarga dan
keluarga dekat (mertua-menantu, tetangga,
teman, group)
• Extrafamily : terjadi dengan keluarga jauh atau
lingkungan tidak langsung (isu sosial dan politik)
 Teori Betty Neuman
• Sistem klien terdiri struktur dasar (basic/core
structure) yang dilindungi oleh garis
perlindungan resisten
• Keadaan beresiko ditunjukkan sebagai garis
pertahanan normal, dan keadaan sehat
dilindungi garis pertahahan fleksibel
• Stressors are intra-, inter-, and extrapersonal
in nature and arise from the internal,
external, and created environments
 Teori Betty Neuman
• Proses interaksi dan penyesuaian keluarga
tergantung pada garis pertahanan (lines of
defense), baik biologi, psikologi, sosial budaya,
perkembangan dan spiritual.
• jika stressor menerobos garis pertahanan
normal, keseimbangan adalah terganggu dan
berbagai macam respon terjadi
• di samping itu, jika garis resistance diaktifkan,
maka ada upaya untuk mengembalikan klien
atau keluarga dalam fungsi normal
 Teori Betty Neuman
• When stressors break through the flexible line of
defense, the system is invaded and the lines of
resistance are activated and the system is
described as moving into illness on a wellness-
illness continuum.
• If adequate energy is available, the system will be
reconstituted with the normal line of defense
restored at, below, or above its previous level.
 Nursing Intervention
• Nursing interventions occur through three
prevention modalities.
• Primary prevention occurs before the stressor
invades the system;
• Secondary prevention occurs after the system
has reacted to an invading stressor;
• Tertiary prevention occurs after the system has
reacted to an invading stressor; and tertiary
prevention occurs after secondary prevention
as reconstitution is being established.
 Referensi
• Christensen & Kenney, 1995. Mosby-Year
Book.Inc. St. Louis , Missouri.
Neuman’s Model System

BAGIAN KEDUA
4 KONSEP UTAMA TEORI KEPERAWATAN
• Keperawatan mempunyai berbagai teori
keperawatan dengan penjelasan yang berbeda-
beda sesuai disiplin yang dimilikinya
• Namun, semua teori menjelaskan 4 konsep
sentral yakni manusia, lingkungan,
keperawatan dan kesehatan
 Overview of Major Nursing Theorist
Tujuan
Mempelajari efek stress dan
reaksinya dalam
perkembangan dan
pemeliharaan kesehatan
Komponen
Person : sistem kline terdiri dsri variabel
fisiologi, psikologi, sosial budaya dan
lingkungan
Lingkungan : lingkungan internal dan
eksternal memperngaruhi klien setiap saat
Kesehatan : sehat da sakit merupakan bagian
dari kehidupan sebagai person
Keperawatan : profesi yang unik dengan
seluruh variabel yang memperngaruhi respon
individu terhadap stress
 Non Nursing Theories used in nursing
• Teori sistem umum
• Teori kebutuhan dasar manusia menurut
Maslow
• Teori berubah
 MAJOR CONCEPTS
• Human being is viewed as an open system that
interacts with both internal and external
environment forces or stressors.
• Manusia sistem terbuka yang berinteraksi dgn
lingkungan internal dan eksternal “stressor”
• The human is in constant change (selalu berubah),
moving toward a dynamic state of system stability
or toward illness of varying degrees.
 MAJOR CONCEPTS
• The environment is a vital arena that is
germane to the system and its function.
• Lingkungan merupakan arena penting
berkaitan erat dengan sistem dan fungsinya
• The environment may be viewed as all factors
that affect and are affected by the system.
 MAJOR CONCEPTS
• The internal environment exists within the
client system.
• All forces and interactive influences that are
solely within boundaries of the client system
make up this environment.
• The external environment exists outside the
client system.
 MAJOR CONCEPTS
• Health is defined as the condition or degree of
system stability and is viewed as a continuum
from wellness to illness.
• When system needs are met,
optimal wellness exists.
• When needs are not satisfied, illness exists.
• When the energy needed to support life is not
available, death occurs.
 MAJOR CONCEPTS
• The primary concern of nursing is to define the
appropriate action in situations that are stress-
related or in relation to possible reactions of
the client or client system to stressors.
 MAJOR CONCEPTS
• Nursing interventions are aimed at helping the
system adapt or adjust and to retain, restore, or
maintain some degree of stability between and
among the client system variables and
environmental stressors with a focus on
conserving energy.
• Intervensi keperawatan bertujuan membantu
beradaptasi atau menyesuaikan diri,
memulihkan atau memelihara stabilitas antara
variabel sistem klien dan stresor
 MAJOR CONCEPTS
• Open System

A system in which there is a continuous flow

of input and process, output and feedback.

• It is a system of organized complexity, where

all elements are in interaction.
 Input-Process-output and feedback
Input Proses Output Feedback

Lulusan SMA- Pembelajaran dengan berbagai Lulus 99% Kemampuan

SMK metode, media dan strategi berbahasa Inggris
perlu ditngkatkan
 MAJOR CONCEPTS
• Basic Structure and Energy Resources
The basic structure (struktur dasar), or central
core (inti pusat), is made up of those basic
survival factors common to the species.
• These factors include the system variables,
genetic features, and strengths and
weaknesses of the system parts.
 MAJOR CONCEPTS
• Client variables
Newman views the individual client holistically
and considers the variables simultaneously and
comprehensively.
 MAJOR CONCEPTS
Variable Clients are :
• The physiological variable refers to the structure
and functions of the body.
• The psychological variable refers to mental
processes and relationships.
• The sociocultural variable refers to system
functions that relate to social and cultural
expectations and activities.
 MAJOR CONCEPTS
• Variable Clients are :
• The developmental variable refers to those
processes related to development over the
lifespan.
• The spiritual variable refers to the influence of
spiritual beliefs.
 MAJOR CONCEPTS
• Flexible line of defense
A protective accordion-like mechanism that surrounds and
protects the normal line of defense from invasion by stressors.
Mekanisme akordeon-seperti pelindung yang mengelilingi dan
melindungi garis pertahanan normal dari invasi oleh stres

• Normal line of defense

An adaptational level of health developed over time and
considered normal for a particular individual client or system; it
becomes a standard for wellness-deviance determination.
Tingkat adaptational kesehatan dikembangka dari waktu ke
waktu dan dianggap normal untuk klien individu tertentu atau
sistem; menjadi standar untuk penentuan kesehatan-
penyimpangan
 MAJOR CONCEPTS
• Lines of resistance
Protection factors activated when stressors
have penetrated the normal line of defense,
causing a reaction synptomatology. (Neuman,
1995) faktor perlindungan diaktifkan bila stres
telah menembus garis pertahanan normal,
menyebabkan synptomatology reaksi.
 Subconcepts
• Stressors
A stressor is any phenomenon that might penetrate
both the flexible and normal lines of defense,
resulting in either a positive or negative outcome.
Intrapersonal stressors are those that occur within
the client system boundary and correlate with the
internal environment.
 Subconcepts
• Interpersonal stressors occur outside the client
system boundary, are proximal to the system, and
have an impact to the system.

Extrapersonal stressors also occur outside the

client system boundaries but are at a greater
distance from the system than are interpersonal
stressors. An example is social policy.
 Subconcepts
• Stability
A state of balance or harmony requiring energy
exchanges as the client adequately copes with
stressors to retain, attain, or maintain an
optimal level of health thus preserving system
integrity.
 Subconcepts
• Degree of Reaction

The amount of system instability resulting from

stressor invasion of the normal line of defense.
 Subconcepts
• Entropy
A process of energy depletion and disorganization moving the
system toward illness or possible death.
Sebuah proses penipisan energi dan disorganisasi memindahkan
sistem ke arah penyakit atau kematian mungkin.

• Negentropy
A process of energy conservation that increases organization and
complexity, moving the system toward stability or a higher degree
of wellness.
sebuah proses konservasi energi yang meningkatkan organisasi
dan kompleksitas, memindahkan sistem ke arah stabilitas atau
tingkat yang lebih tinggi kesehatan.
 Subconcepts
• Input/output
The matter, energy, and information exchanged
between client and environment that is entering or
leaving the system at any point in time.

Reconstitution
The return and maintenance of system stability,
following treatment of stressor reaction, which
may result in a higher or lower level of wellness.
 Subconcepts
• Prevention as intervention
Intervention modes for nursing action and
determinants for entry of both client and nurse
into the health care system.
• mode intervensi untuk tindakan keperawatan
dan penentu untuk masuk dari kedua klien dan
perawat ke dalam sistem perawatan
kesehatan.
 Subconcepts
• Primary prevention occurs before the system reacts
to a stressor; it includes health promotion and
maintenance of wellness.
• Primary prevention focuses on strengthening the
flexible line of defense through preventing stress
and reducing risk factors.
• This intervention occurs when the risk or hazard is
identified but before a reaction occurs.
• Strategies that might be used include immunization,
health education, exercise, and lifestyle changes.
 Subconcepts
• Secondary prevention occurs after the system reacts to a
stressor and is provided in terms of existing symptoms.
• Secondary prevention focuses on strengthening the
internal lines of resistance and, thus, protects the basic
structure through appropriate treatment of symptoms.
• The intent is to regain optimal system stability and to
conserve energy in doing so.
• If secondary prevention is unsuccessful and reconstitution
does not occur, the basic structure will be unable to
support the system and its interventions, and death will
occur.
 Subconcepts
• Tertiary prevention occurs after the system has been
treated through secondary prevention strategies.
• Its purpose is to maintain wellness or protect the
client system reconstitution through supporting
existing strengths and continuing to preserve energy.
• Tertiary prevention may begin at any point after
system stability has begun to be reestablished
(reconstitution has begun). Tertiary prevention tend
to lead back to primary prevention. (Neuman, 1995)
 Asumptions
• Each client system is unique, a composite of factors and
characteristics within a given range of responses.
Many known, unknown, and universal stressors exist.
Each differs in its potential for disturbing a client’s usual
stability level or normal line of defense. The particular
interrelationships of client variables at any point in time
can affect the degree to which a client is protected by
the flexible line of defense against possible reaction to
stressors.
 Asumptions
• Each client/client system has evolved a normal range of
responses to the environment that is referred to as a
normal line of defense. The normal line of defense can
be used as a standard from which to measure health
deviation.
When the flexible line of defense is no longer capable of
protecting the client/client system against an
environmental stressor, the stressor breaks through the
normal line of defense.
 Asumptions
• The client, whether in a state of wellness or illness,
is a dynamic composite of the interrelationships of
the variables. Wellness is on a continuum of
available energy to support the system in an
optimal state of system stability.
Implicit within each client system are internal
resistance factors known as lines of resistance,
which function to stabilize and realign the client to
the usual wellness state.
 Asumptions
• Primary prevention relates to general knowledge that is
applied in client assessment and intervention, in
identification and reduction or mitigation of possible or
actual risk factors associated with environmental
stressors to prevent possible reaction.

Secondary prevention relates to symptomatology

following a reaction to stressors, appropriate ranking of
intervention priorities, and treatment to reduce their
noxious effects.
 Asumptions
• Tertiary prevention relates to the adjustive
processes taking place as reconstitution begins
and maintenance factors move the client back
in a circular manner toward primary
prevention.

The client as a system is in dynamic, constant

energy exchange with the environment.
(Neuman, 1995)
 Asumptions
• Strengths/Weaknesses
• Newman reports that the model was designed but
can be used by other health disciplines, which can
be viewed as either a strength or weakness. As a
strength, if multiple health disciplines use the
model, a consistent approach to client care would
be facilitated. As a weakness, if the model is useful
to a variety of disciplines, it is not specific to
nursing and thus may not differentiate the practice
of nursing from that of other disciplines.
 Asumptions
• Strengths:
The major strength of the model is its flexibility for use in all areas of
nursing – administration, education, and practice.
Neuman has presented a view of the client that is equally applicable to an
individual, a family, a group, a community, or any other aggregate.
The Neuman Systems Model, particularly presented in the model diagram,
is logically consistent.
The emphasis on primary prevention, including health promotion is specific
to this model.
Once understood, the Neuman Systems Model is relatively simple, and has
readily acceptable definitions of its components.
 Asumptions
• Weakness:

The major weakness of the model is the need

for further clarification of terms used.
Interpersonal and extrapersonal stressors need
to be more clearly differentiated.