and University of Ottawa. Model strengths that
were reported include the holistic approach, which
addressed levels of prevention that guided the
student to focus on the client in his or her own
environment. The model also assisted the student
to carry out in-depth assessments, to categorize
comprehensive data, and to plan specific interven-
tions with the client. Students reported some diffi-
culty in understanding the complexity of the model
and the developmental and spiritual variables.
Students also reported that it was not always
easy to differentiate between the lines of defense
and resistance or to assess the degree of stressor
penetration.
The Neuman Model is also being used in educa-
tional institutions in South Australia, the United
Kingdom, and Sweden (Engberg, 1995; McCulloch,
1995; Vaughan & Gough, 1995). McCulloch (1995)
reported that a survey of all Australian university
programs showed that four undergraduate pro-
grams used the model as the major organizational
curriculum framework, and another 16 programs
introduced undergraduate and postgraduate stu-
dents to the Neuman Model as one of several mod-
els. Vaughan and Gough (1995) found that many
nursing and midwifery students chose to use the
model in their own practice in the United Kingdom.
They also reported that Avon and Gloucestershire
College of Health used the model as the guiding
principle behind curriculum development for child
care. Engberg (1995) reported that most colleges
throughout Sweden use the Neuman Systems
Model as the theoretical framework in the module
of primary health in nursing education.
APPLICATION OF THE NEUMAN SYSTEMS
MODEL TO NURSING PRACTICE
The Neuman Systems Model is being used in di-
verse practice settings. In the United States, the
model is used to guide practice with clients with
cognitive impairment, meeting family needs of
clients in critical care; to provide stable support
groups for parents with infants in neonatal inten-
sive care units; and to meet the needs of home care-
givers, with emphasis on clients with cancer,
HIV/AIDS, and head traumas. The model is used in
psychiatric nursing, gerontological nursing, peri-
natal nursing, and occupational health nursing
(Bueno & Sengin, 1995; Chiverton & Flannery,
1995; McGee, 1995; Peirce & Fulmer, 1995; Russell,
Hileman, & Grant, 1995; Stuart & Wright, 1995;
Trepanier, Dunn, & Sprague, 1995; Ware &
Shannahan, 1995).
Internationally, the model is being used in
Canada, the United Kingdom, Sweden, the
Netherlands, New Zealand, Australia, Jordan, Israel,
Slovenia, and several East Asian countries (e.g.,
Japan, Korea, and Taiwan). Practice areas include
community/public health care (Betty Neuman, per-
sonal communication, January 10, 1999; Beddome,
1995; Beynon, 1995; Craig, 1995a; Damant, 1995;
Davies & Proctor, 1995; Engberg, Bjalming, &
Bertilson, 1995; Felix, Hinds, Wolfe, & Martin, 1995;
Vaughan & Gough, 1995; Verberk, 1995).NURSING ADMINISTRATION AND
THE NEUMAN SYSTEMS MODEL
The Neuman Systems Model has been used in di-
verse nursing administration settings in the United
States. These settings include a community nursing
center, psychiatric hospital, a continuing care re-
tirement community, and Oklahoma State Public
Health Nursing (Frioux, Roberts, & Butler, 1995;
Rodriguez, 1995; Scicchitani, Cox, Heyduk,
Maglicco, & Sargent, 1995; Walker, 1995a).
Poole and Flowers (1995) demonstrated how the
model is used in case management of pregnant
substance abusers. Kelley and Sanders (1995) pre-
sented an assessment tool that intertwines the
management process, the Neuman Systems Model,
and environmental dimensions. Walker (1995b)
demonstrated how the model and total quality
management are used to prepare health-care ad-
ministrators for the future.NURSING RESEARCH AND
THE NEUMAN SYSTEMS MODEL
Gigliotti (1997) acknowledged that the Neuman
Model’s use as a guide in directing nursing educa-
tion and clinical practice has received much na-
tional and international attention. However, the
model’s use as a guide to nursing research and the
generation of nursing theory based on the research
is in the early stages of development, although
growing. To facilitate the use of nursing research
with the Neuman Systems Model, Meleis (1995)
has elaborated on principles and approaches that
may be used to develop a futuristic agenda to vali-
date the Neuman Systems Theory.CHAPTER 18 Betty Neuman:The Neuman Systems Model and Global Applications 291