1. Betty Neuman and Imogene King
By Michelle Petty

2. Betty Neuman
Systems Model
Imogene King
Theory of Goal Attainment
• No initial intention to develop a
conceptual model
• Compiled a course guide for
graduate students at UCLA with
the intention of expanding the
viewpoint of nursing beyond the
medical model
• Initial intention to develop a
conceptual framework
• Framework based on her belief
that theoretical knowledge must
be present to advance the
nursing profession
(Fawcett & DeSanto-Madeya, 2013; Sieloff & Messmer, 2014; Lawson, 2014)

3. MAJOR CONCEPTS
A HOLISTIC SYSTEM-BASED APPROACH
 Wholistic Approach - client is a whole whose parts are in dynamic interaction
 Open System – system is open with continuous flow between input, output, and
feedback
 Environment – internal and external forces on the client
 Client System – physiological, psychological, sociocultural, developmental, and
spiritual variables
 Health – a continuum of wellness to illness
 Stressors – tension producing stimuli
 Degree of Reaction – system instability
 Prevention as Intervention – purposeful action
 Reconstitution – after treatment return to stability
(Lawson, 2014)

4. MAJOR CONCEPTS
A CONCEPTUAL SYSTEM OF GOAL ATTAINMENT
 Health – dynamic life experiences of a human being with the
optimum use of one’s resources and continual adjustments to
stressors
 Nursing – is the process of action, reaction, and interaction on both
the part of the nurse and the patient with perceptions of each being
communicated
 Self – thoughts and feelings that constitute one’s awareness, the
sum of all one is, the separation of one’s inner world from the outer
world
(Sieloff & Messmer, 2014)

5. ASSUMPTIONS Human Beings – need to strike a balance between their internal and external
environments to reach a state of harmony
 Spirituality – strength and development of spirituality empowers the client
 Environment – internal and external stimuli are neutral; the client’s encounter
with the stimuli determines outcomes
 Human Beings and Environment – clients are dynamic and are in a constant
energy exchange with their environments
 Health – represents stability
 Nursing – the goal is to obtain the optimal wellness level for the client
(Fawcett & DeSanto-Madeya, 2013)

6. ASSUMPTIONS
 Human Beings – are unique, holistic, of intrinsic worth, and capable
of rational thinking and decision making on behalf of their health
 Open Systems – exhibit an exchange of energy and information and
are goal directed; are essential in studying the wholeness of nursing
 Nurse-Client Interactions – perceptions of the nurse and the client
affect the interaction process; goals, needs, and values of both the
nurse and the client affect the nursing process; health providers
have a responsibility to share pertinent information regarding one’s
health to enable them to make decisions about one’s care
(Fawcett & DeSanto-Madeya, 2013)

7. EXPECTED OUTCOMES
Primary
• Preventing stressors
• Providing resources
• Support coping
• Decrease stressors
• Motivate towards
wellness
• Coordinate and
intergrade theories
• Education
• Stress as positive
intervention
Secondary
• Protecting client
• Optimizing resources
• Facilitating reaction to
stressors
• Involving client in
goals
• Facilitating treatment
• Support efforts
• Advocacy and
integration
• Preventative
intervention
Tertiary
• Attain/maintain
wellness during
reconstitution
• Educate as needed
• Support client
goals
• Coordinate services
• Preventative
interventions
The nurse evaluates outcomes by: confirming attainment with the client; reformulating
goals with the client if needed; setting long-term goals in relation to the short-term
outcomes (Fawcett & DeSanto-Madeya, 2013)

8. (Lawson, 2014)

9. EXPECTED OUTCOMESThe nurse and client should communicate and set goals together and then work
together to achieve the goals set through action:
• Perception – perceptions formed by the nurse and the client
• Judgment – mental judgments are made about one another
• Action – sequence of behaviors to control the situation and attain goals
• Reaction – each person reacts to the other’s perceptions
• Disturbance – (diagnosis phase) interaction, concerns addressed, data recorded (history,
physical exam, tests)
• Mutual goal setting – nurse and client interact to set goals
• Exploration of means to achieve goals - interaction to explore means to achieve goals
• Agreement on means to achieve goals – interaction to agree on means toward goals
• Transaction – nurse and client carry out measures to achieve goals
• Attainment of goals – expressed by client’s state of health and ability to function in roles
Was goal attained why or why not?
(Fawcett & DeSanto-Madeya, 2013)

10. (Sieloff & Messmer,
2014)
King used this diagram to
demonstrate her idea of
systems as a whole versus
isolated parts.

11. (Sieloff & Messmer, 2014)
Building off of her conceptual
systems model and using
observations of nurse-patient
interactions King derived her
theory of goal attainment.

12. NEUMAN’S SYSTEMS MODEL VS KING’S THEORY OF GOAL ATTAINMENT
Similarities
 Both are systems theories
 Both focus on the client as an
individual
 Both focus on internal and external
stressors as well as client reaction
 Both are flexible to changes in client
goals secondary to evaluation and
assessment of current health state
 Both focus on educating the client
Differences
 Neuman’s model emphasizes holistic
care and King’s theory is goal oriented
 Neuman’s model is geared toward the
nurse’s perspective and King’s is goal
attainment from the client’s
perspective
 Neuman’s focus is on interventions
while King’s is communication
 Neuman’s model is more psychosocial
while King’s is more environmental
(internal and external stressors)
(Fawcett & DeSanto-Madeya, 2013)

13. REVIEW OF A STUDY
 Purpose: To explore the meaning of spirituality, describe the relationship of
spirituality and health, identify client expectations of nurses regarding
spirituality, evaluate Neuman’s definition of spirituality, and to validate the
Neuman systems model as a credible framework for guiding holistic nursing
practice.
 Type of Study: Qualitative data analysis
 Applying the Theory: Statements made by clients during a taped interview
regarding spirituality and wellness were compared to statements made by
Neuman regarding her theory of spirituality on clients and their health. The two
data sets were then evaluated for similarities and differences.
 Conclusions: This study demonstrated that spirituality is significant in the lives
of aging individuals and that spirituality becomes more important to one’s state of
health as they get older. This study reported the analysis as being congruent with
the Neuman systems model and supported it’s validity as a credible model for
nurses in rendering holistic care of spirit, mind, and body for the client.
(Lowry, 2012)

14. REVIEW OF A STUDY
 Purpose: To apply the use of Neuman’s systems model for advanced practice
nurses to develop and implement interventions to decrease the potential for
cardiovascular problems in clients with multiple risk factors.
 Type of Study: This study was a data analysis in which current data of Filipino
American risk factors for CHD was plugged into Neuman’s systems model to
demonstrate an effective method of CAD risk reduction for Filipino Americans.
 Applying the Theory: Intrapersonal, interpersonal, and extrapersonal stressors
were identified for the client population. As well as any situations that would
threatened the lines of defense.
 Conclusions: The study proposed that early identification of clients at risk for
CHD should be the focus of primary prevention. Secondary prevention should
focus on treating the symptoms of CHD and to prevent any progression of the
disease. Tertiary prevention should focus on support and education to help
maintain wellness.
(Angosta, Ceria-Ulep, & Tse, 2014)

15. REVIEW OF A STUDY Purpose: To assess and validate King’s theory of goal attainment when applied to
specific issues within family healthcare.
 Type of Study: A data analysis of three previous studies that applied King’s
theory of goal attainment to specific populations within family healthcare.
 Applying the Theory: Using King’s ideas of communication, in specific family
healthcare situations (families with a mentally-ill child, a child with type-1
diabetes or asthma, or a family member with COPD), to progress families through
purposive interactions to transaction.
 Conclusions: Applying King’s theory of goal attainment is an effective tool in
family healthcare situations and for goal attainment. The concepts of King’s goal
attainment theory are helpful in understanding the individuals, interpersonal
processes, and the social context of clients and their families.
(Alligood, 2010)

16. REVIEW OF A STUDY Purpose: To apply understanding to King’s theory of goal attainment in an effort
to facilitate positive changes in nursing.
 Type of Study: Review and comparison of research based studies
 Applying the Theory: King’s theory of goal attainment was adopted as the
standard of care to be implemented by hospital nursing staff and to help define
their philosophy, guide their documentation, and implement the plan of care. The
use of King’s concepts of perception, communication, interaction, and transaction
helped guided the studies.
 Conclusions: King’s theory of goal attainment can be useful in large settings such
as a hospital. Adopting a standard of theory based care has been proven to
improve client outcomes.
(Messmer, 2006)

17. MY POINT OF VIEW
Neuman’s systems theory and King’s theory of goal attainment have been proven
effective when applied to nursing practice. Both have shown themselves to be
versatile, valid, and beneficial in promoting and maintaining client health.
Neuman’s systems theory is a holistic view of the client and emphasizes the
importance of mind, body, and spirit when promoting and maintaining health.
Neuman’s theory is geared toward the nurse’s perspective of what the client needs.
King’s theory of goal attainment is goal oriented and emphasizes the need and
importance of communication and perceptions on behalf of the client and nurse.
King’s theory puts emphasis on goal setting and attainment from the clients
perspective.
(Fawcett & DeSanto-Madeya, 2013; Sieloff & Messmer, 2014; Lawson, 2014)

18. MY POINT OF VIEW
 Neuman’s systems theory appeals to me on a more natural level. I innately feel
that human beings are holistic and I approach them that way in my personal life
and as a nurse. I also have a deep spiritual belief instilled in me and I have found
that in times of stress it has guided me when all else has failed.
 King’s theory of goal attainment challenges me more. I find it just as valid as
Neuman’s systems theory but I feel that the level of communication and self
perception, King’s model represents, takes more energy on my part and could be
easily skipped over or pushed aside secondary to any time constraints. I also feel
that I actively nurse from my prospective of what I feel the client needs and I
could benefit, as a nurse, by applying King’s ideas of deriving goal setting and
attainment more from the client’s perspective.

19. A PROPOSAL FOR FUTURE WORK
 I believe that Neuman’s systems theory would benefit from application based
studies that look at specific types of religion and spiritual beliefs, as well as
studies that look at how spirituality is derived. In doing so Neuman’s systems
theory’s spirituality component could be more defined and easier to apply to
specific client needs and education.
 I think merging the two systems would create an even stronger conceptual
framework. Wouldn’t it be interesting to see the merging of strong nursing
theories?

20. Alligood, M. R. (2010). Family healthcare with King’s theory of goal attainment. Nursing Science
Quarterly, 23(2), 99-104. doi: 10.1177/0894318410362553
Angosta, A. D., Ceria-Ulep, C. D., & Tse, A. M. (2014). Care delivery for Filipino Americans using
Neuman systems model. Nursing Science Quarterly, 27(2), 142-148. doi: 10/1177/0894318414522605
Lawson, T. G. (2014). Systems Model. In M. R. Alligood (Ed.), Nursing theorists and their work (8th ed.,
pp. 281-302). St. Louis, MO: Elsevier/Mosby.
Lowry, L. W. (2012). A qualitative descriptive study of spirituality guided by the Neuman systems
theory. Nursing Science Quarterly, 25(4), 356-361. doi: 10.1177/0894318412457052
Fawcett, J. & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation
of nursing models and theories (3rd ed., pp. 138-178, 80-110). Philadelphia, PA: F. A. Davis
Company.
Messmer, P. R. (2006). Professional model of care: using King’s theory of goal attainment. Nursing
Science Quarterly, 19(3), 227-228. doi: 10.1177/0894318406289887
Sieloff, C. L. & Messmer, P. R. (2014). Conceptual systems and middle-range theory of goal
attainment. In M. R. Alligood (Ed.), Nursing theorists and their work (8th ed., pp. 158-208).
St. Louis, MO: Elsevier/Mosby.