How to discuss Theories for Advanced Nursing Practice

How to discuss Theories for Advanced Nursing Practice

Theories for Advanced Nursing Practice

In today’s rapidly changing and demanding healthcare system, employees are required to work more intensely and deliver more. While working towards delivering the best care possible, workplace stress may expose the individual to inefficiencies that can affect their normal way of life. The Centers for Disease Control and Prevention (CDC) (2021) explains that healthcare workers have always faced the challenge of stress as part of their work. In most cases, healthcare worker stress includes the harmful physical and emotional responses that happen when the requirements of a job do not match the capabilities, resources, or needs of the worker. To effectively deliver quality healthcare services, it is crucial that employees manage work-related stress.

Interest in the Concept

Occupational stress has been a long-standing concern in the healthcare industry. I believe stress is among the many reasons why the quality of healthcare services provided remains poor in most institutions. To understand how people learn and cope with stress, it is crucial to learn the different conceptualizations of stress and how to cope with stress. During my studies, I have observed that stress is viewed as a response, a stimulus, and a transaction. As a response, stress is observed to be a defensive mechanism that follows the stages of alarm, resistance, and exhaustion (Hersch et al., 2016). Individuals respond differently to stress and this explains the difference in adaptation observed among people working in the same environment. As a stimulus, stress originates from change and adjustment in work. A change in life experiences may be interpreted as a negative or positive experience based on cognitive and emotional factors. I believe understanding these concepts can greatly influence how individuals respond to stress.

Everyone experiences stress to some degree, but the response to that stress, however, makes a big difference. Sometimes dealing with stress involves changing the situation and at other times it may require the individual to change how they respond to the situation. My interest in the concept of stress begins from my general perspective of nursing and its relationship to quality care. Nursing is perceived as a strenuous job because of the amount of work available and the diversity of patient populations served. I believe the attempt to deliver quality healthcare is hindered by work-related stress, especially among nurses. Despite this being a crucial element that affects healthcare worker performance, minimal efforts are available to ensure nurses work in a stress-free environment (Hersch et al., 2016). The result is poor service delivery to patients, burnout among professionals, and other adverse outcomes that translate to poor quality healthcare services.

Concept Relationship to Nursing Practice

Nursing is perceived as a strenuous job with high and complicated demands. Recent studies have demonstrated that the complexity of nursing care provided to patients combined with too much responsibility with little authority contributes to work-related stress. Occupational stress may affect the quality of life of the provider and significantly reduce the quality of care provided. Nurses working in stressful environments may make the wrong choices concerning their lives or during care delivery to patients impacting quality outcomes. For example, a nurse under stress can make the wrong choice during medication administration leading to adverse outcomes including the death of the patient. A stressed nurse may fail to communicate care to others leading to problems with continuity of care that can also impact patient outcomes. For those in positions to make decisions in healthcare, stress may hinder the ability to make the right choices leading to poor management.

Caring is an interpersonal procedure defined by expert nursing, interpersonal sensitivity, and intimate relationships, including positive communication and implementation of professional knowledge and skills (Kopsén & Sjöström, 2020). Stress, up to a certain point, will improve the nurses’ performance by ensuring they dedicate themselves to patients. The problem arises when the pressure to perform becomes too much and this causes harm. Stressed nurses may fail to provide services that are based on the caring aspect of nursing. It may affect how the nurses view patients, fellow nurses, and other healthcare providers. Compromised relationships due to stress mean that crucial aspects like interprofessional collaboration, communication, and teamwork are affected leading to poor outcomes. Lastly, stress may trigger psychological problems among healthcare providers causing compromised health patterns and behavior changes. The individuals may fail to connect with reality and have challenges with happiness and home life.


Definition of the Concept

The concept of focus in this discussion is ‘stress’ and its relationship to the healthcare profession. The oxford dictionary (2021) defines stress as pressure or worry caused by problems in someone’s life. Another definition from the Cambridge dictionary defines stress as a great worry caused by a difficult situation, or something that causes this condition.

The concept of stress, especially in the working environment is an area that is widely discussed in the literature. It is observed that stress improves performance and quality of life because it is healthy and essential. Moustaka and Constantinidis (2010) define stress as a state, not an illness, which may be experienced as a result of exposure to a wide range of work demands and in turn, can contribute to an equally wide range of outcomes, which may concern the employee’s health and be an illness or an injury, or changes in his/her behavior and lifestyle. Apart from this definition, the CDC (2021) defines work stress as the harmful physical and emotional responses that happen when the requirements of a job do not match the capabilities, resources, or needs of the worker. Work-related stress is observed to damage the individual’s physical and mental health while high levels can cause low productivity. Sarafis et al (2016) define occupational stress as a situation wherein job-related factors interact with an employee, changing his/her psychological and physiological condition in a way that the person is forced to deviate from normal functioning.

Attributes or Characteristics of Concept

Many researchers view stress as a mechanism designed to maintain the stability of the body’s physiological functioning. In nursing practice, stress may be caused by various factors related to the nature of the profession like the ethical dilemmas and demands of the patients (Hersch et al., 2016). Sometimes workplace anxiety and tension, continuous interaction with different people, and lack of support from colleagues can elicit stress. The manifestation of stress can be categorized into physical, psychological, emotional, and behavioral signs. Physically, stressed individuals experience symptoms like weight loss, high blood pressure, menstrual changes, or infections. Psychological manifestations of stress include difficulty with concentration, increased anxiety, and trouble remembering. Emotionally, individuals with stress become angry, moody, and irritated. Lastly, behavioral changes during stressful situations include lack of pleasure and relying on drugs to cope.

Theory Description, Analysis, and Evaluation

The theory of focus in this discussion is Betty Neuman’s system model. The theory is based on the individual’s relationship to stress, the reaction to stress, and the reconstitution factors that are dynamic in nature. The theory focuses on the patient system’s response to actual or potential environmental stressors while maintaining stability through the primary, secondary, and tertiary prevention strategies (Akhlaghi et al., 2020). The Neuman systems model views the patient as an open system that responds to stressors in the environment. Thus theory ascertains that the patient contains a basic core that is protected by lines of defense. For instance, the usual health represents the normal defense line and is protected by a flexible defense line. When stressors break through the flexible lines of defense, the system is invaded and activation of lines of resistance occurs.

Major Concepts

Human being. The theory ascertains that the human being is an open system that interacts with both internal and external environmental stressors. This system constantly changes and moves towards a dynamic state of stability or illness of varying degrees. The theory also indicates that the human being is a total person characterized by different variables including physiological, psychological, sociocultural, spiritual, and developmental variables.

Environment. Neuman defines the environment as s all the internal and external forces surrounding the client, influencing and being influenced by the client at any point in time (Ahmadi & Sadeghi, 2017). The environment includes all factors that are affected by the system and includes the internal, external, and created environments. The internal environment is composed of all forces that are entirely within the client system’s boundaries. The external environment exists outside the client’s system while the created environment is unconsciously developed and used to support protective coping.

Health. Neuman’s theory views health as the condition or degree of stability and a continuum from wellness to illness. It is observed that when the system needs are met, optimal wellness exists and when the needs are not satisfied, illness exists. Under the concept of health, death occurs when the energy needed to support life is not available.

Nursing. Neuman’s theory demonstrates that nursing is concerned with the whole person. Neuman views nursing as a unique profession that is concerned with all the variables affecting an individual’s response to stress. While providing care, the primary aim of nursing is to define the appropriate action in situations that are stress-related or concerning possible reactions of the client or client system to stressors (Ahmadi & Sadeghi, 2017). To achieve this goal, Neuman’s theory highlights a three-step nursing process that includes nursing diagnosis, nursing goals, and nursing outcomes. While working towards meeting the goal, Neuman stresses the importance of involving patients/families in redesigning their care. Collaboration between the provider and the patient is crucial during the primary, secondary and tertiary prevention levels.

Relationship Between Concepts

The four concepts in Neuman’s theory are related because they are used to understand how patients are affected by stress. For instance, nurses understand that human beings are constantly moving towards a state of stability, and illness/wellness becomes part of their journey. During wellness and illness, the environment plays a critical role in response to stress. The internal, external, and created environments influence how people behave and respond to stress. Regarding the concept of health, people define and perceive health differently. The interaction between the environment and people leads to the establishment of stability and a continuum from wellness to illness. As these factors interact, nursing is observed to care for the patient to restore normal health. Modifications are required in the environment and the individual to bring about wellness or response to stress.

Explanation of Theory

Neuman’s theory views individuals as a system made up of physiological, sociocultural, spiritual, developmental, and psychological subparts. The theory identifies the concept f stress to be crucial in influencing the health of individuals. The theory is logical because it identifies its major and minor concepts with a clear definition of each. For example, the major concepts include the human being, nursing, environment, and health. The theory explains each of these concepts, related factors, and how they influence stress management. Neuman’s theory is logical because it incorporates all aspects of a theory including a description of the assumptions leading to the development of the theory.

One of the advantages of Neuman’s theory is the clarity of concepts. Within the model, the scope and definitions are clear and well defined, through the compartmentalization of the separate concepts of the model. The author has defined the four nursing paradigms that form the major concepts and included subconcepts like stressors, stability, and entropy. The theory clearly identifies a three-step nursing process that can be used during its application in nursing practice. Additionally, the four paradigms of the system model allow it to be applied to several different circumstances, depending on the nature of the clients, and the stressors within the environment.

Conceptual Framework for Research and Practice

The article selected for this discussion involves the application of Neuman’s theory in nursing care of patients with multiple sclerosis (MS). This condition is observed to manifest in ways that have disabling functional consequences for patients leading to significant reductions in their quality of life and the ability of individuals to carry out their roles and job tasks (Ahmadi & Sadeghi, 2017). Neuman’s theory is used in the management of patients with MS using the three levels of prevention; primary, secondary, and tertiary. During the study, a patient with MS was selected and the three levels of the nursing process were used to determine the stressors. Nursing diagnosis, nursing goals, and nursing outcomes were formulated and the three levels of prevention were used to formulate a nursing care plan for the patient. Additionally, Neuman’s theory was used to classify the patient’s stressors into interpersonal and intrapersonal stressors.

Upon the utilization of Neuman’s theory, the researchers were able to formulate a nursing care plan for the selected patient. For instance, the physiological variable formed the central theme with nursing diagnoses focusing on stress and anxiety, disruption of self-concept, changes in sexual pattern, and loneliness among many others (Ahmadi & Sadeghi, 2017). The findings from the study indicate that Neuman’s theory can be crucial in guiding stress management in patients with MS. It was observed that communication with nurses and family members reduced the patient’s concerns. The patient became aware of resting between activities to avoid boredom and also became aware of the impact of stress on the progress of her disease (Ahmadi & Sadeghi, 2017). Despite the positive results, the study findings cannot be generalized to multiple populations and cultures. The study focused on one patient from an urban area in Iran.

Implications for Practice

Neuman’s theory is consistent with the current nursing standards of professional performance in various aspects. The theory demonstrates the quality of practice standards because it incorporates new knowledge of providing nursing care to achieve desired outcomes. The theory seeks to educate patients about the management of stress and other stressors to improve their quality of life. The theory promotes the use of the nursing process to guide patient care through the utilization of steps like the nursing diagnosis, nursing goals, and nursing outcome setting.

Neuman’s theory contributes to nursing knowledge and impacts nursing practice through the concepts of primary, secondary, and tertiary prevention. It gives nurses an opportunity to care for patients and improve their health outcomes through disease prevention. The theory allows for efficient and effective client interactions leading to improved outcomes.


Ahmadi, Z., & Sadeghi, T. (2017). Application of the Betty Neuman systems model in the nursing care of patients/clients with multiple sclerosis. Multiple Sclerosis Journal – Experimental, Translational and Clinical3(3), 2055217317726798.

Akhlaghi, E., Babaei, S., & Abolhassani, S. (2020). Modifying stressors using Betty Neuman system modeling in coronary artery bypass graft: A randomized clinical trial. Journal of Caring Sciences9(1), 13–19.

Centers for Disease Control and Prevention. (2021). The National Institute for Occupational Safety and Health (NIOSH): Work stress.

Hersch, R. K., Cook, R. F., Deitz, D. K., Kaplan, S., Hughes, D., Friesen, M. A., & Vezina, M. (2016). Reducing nurses’ stress: A randomized controlled trial of a web-based stress management program for nurses. Applied Nursing Research : ANR32, 18–25.

Köpsén, S., & Sjöström, R. (2020). Patients’ Experiences of a Stress-Management Programme in Primary Care. Journal of Multidisciplinary Healthcare13, 207–216.

Moustaka, E., & Constantinidis, T. C. (2010). Sources and effects of work-related stress in nursing. Health Science Journal4(4), 210.

Oxford Learner’s Dictionary. (2021). Oxford learner’s

Sarafis, P., Rousaki, E., Tsounis, A., Malliarou, M., Lahana, L., Bamidis, P., Niakas, D., & Papastavrou, E. (2016). The impact of occupational stress on nurses’ caring behaviors and their health related quality of life. BMC Nursing15, 56.

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