Understanding the impact of stressors on a patient’s well-being

Betty Neuman’s Systems Model is a nursing theory that provides a framework for understanding how stressors can impact a patient’s overall well-being. It takes a holistic approach to patients and treats them as individuals rather than a list of symptoms. The philosophy behind it is that each patient is a layered multidimensional being whose layers consist of variables such as physiological, psychological, socio-cultural, spiritual and developmental layers. The model provides nurses with guidelines on how to consider the patient holistically and understand how external and internal stressors can impact their physical and mental health.

Physiological variables

In the Neuman Systems Model, physiological variables refer to the internal physical factors that influence an individual’s stability and response to stressors. These stressors can include genetic predispositions, body systems, vital signs, hormonal changes and immune responses, among others.


An individual’s genetic predispositions can affect their physiological response to stressors. Genetic factors can influence susceptibility to certain diseases, immune system functioning, metabolism and other physiological processes. Nurses can help patients and their families with a history of certain illnesses make healthy lifestyle changes to reduce the likelihood that these genetic diseases will affect the patient’s health and start reversing harmful effects throughout the generations.

Body systems

Each body system plays a vital role in maintaining stability. Variables related to body systems, such as cardiovascular, respiratory, musculoskeletal, gastrointestinal and endocrine systems, can impact the body’s ability to adapt and respond to stressors. Looking at each patient as an individual rather than treating those with similar symptoms the same way requires taking into account the individual’s capacity to fight off certain illnesses.

Vital signs

Vital signs, including heart rate, blood pressure, respiratory rate, body temperature and oxygen saturation, provide objective measurements of a person’s physiological functioning. These variables help nurses assess a patient’s physical stability and response to stressors. This can also provide an indication of an underlying problem that may need to be addressed before the primary treatment plan can be put into effect.

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Hormonal balance is crucial for maintaining physiological stability. Hormones produced by various endocrine glands, such as cortisol, adrenaline, insulin, and thyroid hormones, have significant effects on metabolism, stress response, mood regulation and overall physiological homeostasis.

Immune response

The immune system defends the body against pathogens and maintains immune homeostasis. Variables related to immune function, such as white blood cell count, inflammation markers, and autoimmune disorders, influence the body’s ability to resist and recover from stressors.

Neurological factors

The nervous system plays a vital role in coordinating physiological responses. Variables related to brain function, neural pathways, neurotransmitters and the autonomic nervous system can influence an individual’s response to stressors and their overall physiological stability.

Resilience and adaptation

Physiological variables such as general health status, energy levels and capacity for self-regulation contribute to an individual’s resilience and ability to adapt to stressors. These variables determine how well a person can maintain stability and recover from disruptions.

Psychological variables

In Neumann’s systems model, psychological variables refer to internal factors that influence an individual’s response to stress and adaptation.


This is how individuals interpret and make sense of stressful events or situations. This includes their attention, interpretation and appraisal of events.

Coping strategies

This refers to the cognitive and behavioral efforts individuals employ to manage and adapt to stressful situations. This can include problem-solving, seeking support or engaging in avoidance.

Cognitive appraisal

This is an individual’s evaluation and interpretation of stressors in terms of their significance and implications. This includes their assessment of the demands and resources available to cope with the stressor. A patient may be under the impression that the stressors are just a part of life and that they can’t do anything about them, which could lead them to ignore guidance from nurses and other healthcare professionals.

Emotion regulation

This is how individuals regulate or manage their emotional responses to stressful events. It can include strategies such as distraction, cognitive reappraisal and emotional expression.


Self-esteem is one’s overall evaluation of one’s worth and value as a person. It can influence how individuals cope with stress and perceive their ability to handle challenges. Low self-esteem can deter a patient from following suggestions to improve their health and quality of life because they may not feel that they are worth the effort.

Personality traits

Individual differences in personality characteristics can impact how individuals perceive and respond to stress. Traits such as extraversion, neuroticism and conscientiousness can influence coping strategies and adaptation.


These are the internal drives and desires that influence individuals’ engagement with their environment. Motivation can impact how individuals allocate their resources, engage in problem-solving and persist in the face of stress.

Socio-cultural variables

Socio-cultural variables include things such as individual cultures and beliefs that may affect how a patient views certain medical practices and may lead to a rejection of conventional medical plans.

Cultural beliefs and practices

Different cultures have their own beliefs and practices related to health and illness. These beliefs can influence a person’s perception, understanding and response to their health issues. For example, some cultures may rely more on traditional or alternative medicine, while others may place a greater emphasis on modern medical interventions.

Social support systems

Social support plays a crucial role in a person’s overall well-being. The presence and quality of social support networks, such as family, friends, and community, can impact an individual’s ability to cope with stressors and make positive health choices. Neuman’s theory recognizes the significance of social support as a protective factor against stressors and guides nurses in finding proper resources for their patients so they can get the support they need to heal. If a lack of support is an obvious hindrance to attaining a healthy lifestyle, a nurse can advocate for the necessary resources to be put in place in a community to provide that support.

Socio-economic status

Socioeconomic factors, such as income, occupation, and education level, can significantly affect an individual’s access to healthcare resources and health literacy, as well as their ability to engage in preventive healthcare practices. Neuman’s theory acknowledges the influence of socio-economic status on a person’s health-seeking behaviors and their ability to maintain a state of optimal wellness. Access to necessities such as adequate medication or healthy foods can prevent a patient from being able to follow lifestyle suggestions and hinder their progress. Nurses can help a patient get in touch with organizations that can help so they can follow their medical plan.

Gender roles and expectations

Societal expectations and gender roles can shape an individual’s perception of health, illness and caring responsibilities. For example, traditional gender roles may dictate that women are primarily responsible for the well-being of the family, and this can affect their personal health management. Neuman’s theory considers the impact of gender roles on an individual’s health behaviors and stress management.

Health disparities

Socio-cultural variables contribute to health disparities among various population groups. Factors such as race, ethnicity and language barriers can create unequal access to healthcare services and influence health outcomes. Neuman’s theory recognizes the importance of identifying and addressing these disparities to promote equal access to healthcare resources and ensure the provision of holistic care.

Spiritual beliefs and practices

Spiritual beliefs and practices vary among individuals and can influence their perception of health, illness and healing. These beliefs might include religious affiliations, spiritual rituals, meditation practices and personal philosophies. Neuman’s theory recognizes the importance of addressing and respecting individuals’ spiritual beliefs as it can impact their overall well-being. This method provides guidelines for nurses on providing not just physical care but spiritual care as well.

Meaning and purpose

A person’s spiritual beliefs often provide a sense of meaning, purpose, and connection to something greater than oneself. Understanding an individual’s spiritual orientation can help healthcare providers tailor their care so it aligns with their values and preferences, providing a sense of purpose and promoting holistic well-being.

Coping and resilience

Spirituality can serve as a source of comfort, strength and hope during times of stress, illness or loss. Engaging in spiritual practices, seeking support from a religious community, or finding solace in personal beliefs can contribute to an individual’s coping mechanisms and resilience. Neuman’s theory recognizes the potential influence of spirituality on an individual’s ability to adapt and navigate through challenging circumstances.

Moral and ethical considerations

Spirituality can shape an individual’s moral and ethical framework, influencing their decisions, values and behaviors related to health and care. Understanding a person’s spiritual beliefs can help healthcare providers support their autonomy, respect their values, and ensure that care is delivered in a manner that is consistent with their moral and ethical principles.

Connectedness and transcendence

Spirituality often involves seeking a connection to something beyond the individual self, such as the divine, nature or the universe. This sense of connectedness and transcendence can promote a broader perspective on health and well-being, emphasizing the interconnection between the physical, emotional and spiritual aspects of an individual. Neuman’s theory recognizes the importance of addressing spiritual dimensions to foster a holistic approach to nursing care.

Developmental barriers and age-related changes

Developmental variables consider the physical, cognitive, emotional and social changes that occur across an individual’s lifespan. Different stages of development, such as infancy, childhood, adolescence, adulthood and older adulthood, present unique challenges and growth opportunities. Neuman’s theory recognizes the impact of these age-related changes on an individual’s vulnerability to stressors and their ability to cope and adapt.

Developmental milestones

Each developmental stage is accompanied by specific milestones and tasks that individuals need to accomplish to progress to the next stage. For example, in infancy, developmental milestones include achieving motor skills, language acquisition and social interaction. Neuman’s theory appreciates the importance of understanding these milestones to assess an individual’s level of wellness and provide appropriate nursing interventions.

Psychosocial stages

A theory known as Erikson’s theory of psychosocial development identifies eight stages, each associated with a specific psychosocial conflict or challenge. These stages range from infancy to old age and highlight the crucial areas of identity, autonomy, intimacy, generativity and integrity. Neuman’s theory incorporates the consideration of these psychosocial stages as they influence an individual’s response to stressors and their overall well-being.

Social and cultural influences

Developmental variables also account for the influence of social and cultural factors on an individual’s development. Socio-cultural environments play a significant role in shaping norms, expectations and values related to health, education, and social roles.

Neuman’s theory recognizes that social and cultural factors can impact the development and functioning of individuals. As such, the Bachelor of Science in Nursing (BSN) program offered by the University of Indianapolis places a greater emphasis on the theories governing nursing practice as a comprehensive approach to enhancing the quality of care at a macro level. UIndy’s accelerated BSN degree clearly stands out in the comparison of ABSN vs BSN programs, with its shorter time frame for completion, fully online coursework, 1:1 preceptorship model and an excellent opportunity to network with the Ulndy nursing community of service-oriented learners.

Life transitions and events

Significant life transitions and events, ranging from becoming a parent or starting a new job to experiencing loss or retirement, can have a profound impact on an individual’s development. These transitions often require adjustments and may present new stressors or challenges. Neuman’s theory recognizes these transitions as potential sources of stress and emphasizes the importance of supporting individuals through these periods of change.

By taking Neuman’s theory into account and treating patients holistically, nurses can assess and treat them based on the impact of stressors on their lives. This helps nurses develop a treatment plan that is specifically designed for that patient in collaboration with their loved ones. There is a better chance of recovery when a patient is empowered to take their health into their own hands and has a say in what types of treatments they undergo.