is a decrease in the signs or symptoms, or a reversal
of the reaction to stressors, when the lines of resist-
ance are effective. The system reconstitutes itself or
system stability is returned. The level of wellness
may be higher or lower than it was prior to the
stressor penetration. When the lines of resistance
are ineffective, energy depletion and death occur
(Neuman, 1995).
Basic Structure
The basic structure at the central core structure
consists of factors that are common to all organisms.
Neuman offered the following examples of basic
survival factors: temperature range, genetic struc-
ture, response pattern, organ strength or weakness,
ego structure, and commonalities (Neuman, 1995).
Five Client Variables
Neuman has identified five variables that are con-
tained in all client systems: physiological, psycho-
logical, sociocultural, developmental, and spiritual.
These variables are present in varying degrees of
development and in a wide range of interactive
styles and potential. Neuman offers the following
definitions for each variable:
Physiologicalrefers to bodily structure and func-
tion.
Psychologicalrefers to mental processes and rela-
tionships.
Socioculturalrefers to combined social and cultural
functions.
Developmental refers to life-developmental
processes.
Spiritual refers to spiritual belief influence.
(Neuman, 1995, p. 28)
Neuman elaborated on the spiritual variable in
order to assist readers in understanding that the
variable is an innate component of the basic struc-
ture. While this variable may or may not be ac-
knowledged or developed by the client or client
system, Neuman views the spiritual variable as
being on a continuum of development that pene-
trates all other client system variables and supports
the client’s optimal wellness. The client-client sys-
tem can have a complete unawareness of the
spiritual variable’s presence and potential, deny its
presence, or have a conscious and highly developed
spiritual understanding that supports the client’s
optimal wellness.
Neuman explained that the spirit controls the
mind, and the mind consciously or unconsciously
controls the body. The spiritual variable affects or is
affected by a condition and interacts with other
variables in a positive or negative way. She gave the
example of grief or loss (psychological state), which
may inactivate, decrease, initiate, or increase spir-
ituality. There can be movement in either direction
of a continuum (Neuman, 1995). Neuman believes
that spiritual variable considerations are necessary
for a truly holistic perspective and for a truly caring
concern for the client-client system.
Fulton (1995) has studied the spiritual variable
in depth. She elaborated on research studies that
extend our understanding of the following aspects
of spirituality: spiritual well-being, spiritual needs,
spiritual distress, and spiritual care. She suggested
that spiritual needs include (1) the need for mean-
ing and purpose in life; (2) the need to receive love
and give love; (3) the need for hope and creativity;
and (4) the need for forgiving, trusting relation-
ships with self, others, and God or a deity, or a
guiding philosophy.ENVIRONMENT
The second concept identified by Neuman is the
environment. Figure 18–3 illustrates this. Neuman
defined environmentbroadly as “all internal and ex-
ternal factors or influences surrounding the identi-
fied client or client system” (Neuman, 1995, p. 30).
Neuman has identified and defined the following
environmental typology or classification of types
for her model:Internal environment—intrapersonal in nature.
External environment—inter- and extrapersonal in
nature.
Created environment—intra-, inter-, and extraper-
sonal in nature. (Neuman, 1995, p. 31)The internal environment consists of all forces
or interactive influences contained within the
boundaries of the client-client system. Examples of
intrapersonal forces are presented for each variable.Physiological variable—degree of mobility, range of
body function.
Psychological and sociocultural variables—attitudes,
values, expectations, behavior patterns, coping
patterns.CHAPTER 18 Betty Neuman:The Neuman Systems Model and Global Applications 287