Betty Neuman built her model around a question about reserves: not what is wrong with this person, but how much do they have left to withstand what is coming.
Background
Neuman was born on September 11, 1924 on a farm near Lowell, Ohio, and traced her interest in nursing to caring for her father through a long illness as a girl.
She took her diploma at the People's Hospital School of Nursing in Akron in 1947, moved to California, and completed a bachelor's in public health nursing in 1957 and a master's in mental health at UCLA in 1966. She was among the first American nurses to work as a community mental health clinician, and later took a doctorate in clinical psychology.
The systems model
Neuman was teaching community mental health at UCLA in 1970 when students asked for a framework broad enough to organize the whole of what they were seeing before they specialized. What she wrote for them, first titled the Total Person Approach to Patient Problems, was published in 1972 and became the Neuman Systems Model.
It pictures the person as a basic structure of survival factors — organ function, genetic endowment, temperature range, ego structure — surrounded by concentric rings.
- The flexible line of defence is the outermost, an accordion-like buffer that expands and contracts with sleep, nutrition and recent stress. It is why the same infection floors one person and not another.
- The normal line of defence is the person's usual state of wellness, their baseline.
- The lines of resistance are the internal protective factors mobilized when a stressor has broken through — immune response, coping mechanisms, support.
Stressors are intrapersonal, interpersonal or extrapersonal, and nursing acts to strengthen the lines or to reduce the stressor.
Why the structure mattered
The model organizes nursing action into three levels of prevention, which is what made it usable outside hospitals:
- Primary prevention before a stressor penetrates, strengthening the flexible line.
- Secondary prevention after penetration, treating symptoms and shoring up the lines of resistance.
- Tertiary prevention during recovery, restoring stability and preventing recurrence.
Most nursing frameworks of the period assumed an existing problem. Neuman's put prevention inside the model rather than beside it, which is why her work has been adopted so widely in public health nursing, occupational health, school nursing and community practice, and used as a curriculum framework in nursing programmes in more than a dozen countries.
The flexible line of defence has also had a second life in explaining nurses to themselves. A workforce running on inadequate sleep, skipped meals and constant demand has a compressed flexible line, which is a serviceable account of what happens in nurse burnout.
Neuman died on May 28, 2022, aged 97.
Related
Sources
- Remembering Betty Neuman (September 11, 1924 – May 28, 2022). Nursology. Accessed September 9, 2026.
- The Neuman Systems Model, Betty Neuman, first published 1972. Accessed September 9, 2026.
- Betty M. Neuman papers. Barbara Bates Center for the Study of the History of Nursing, University of Pennsylvania. Accessed September 9, 2026.