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Stressors in five client populations: Neuman systems model-based literature review


  • Carole Ann Skalski BS RN,

  • Louisa DiGerolamo AAS RNC,

  • Eileen Gigliotti PhD RN

Eileen Gigliotti,
College of Staten Island,
City University of New York,
2800 Victory Boulevard,
Marcus Hall,
Staten Island,
New York 10314,


Aim.  This paper reports a literature review identifying and categorizing client system stressors in Neuman systems model-based studies.

Background.  To date, literature reviews related to the Neuman systems model have focused broadly on all concepts of the model. The concept of stressors has been selected by the Neuman Systems Model Research Institute as the focus for an initial collaborative research project.

Method.  Cooper's five-stage integrative review method was used: problem formulation, data collection, data evaluation, analysis and interpretation, and dissemination. The Neuman systems model research literature from 1983 to February 2005 was searched using Fawcett's Neuman systems model bibliography and a follow-up review of the CINAHL database using the keywords ‘Neuman systems model’ and ‘stressors’. A total of 87 studies published as journal articles or book chapters between 1983 and 2005 were reviewed; 13 of the 87 studies met the definition of ‘stressor studies’.

Findings.  Stressors were identified in five client populations: caregivers, cancer survivors, ICU patients in intensive care units, care receivers, and parents whose children were undergoing day surgery. The most common data collection method was the interview, and investigator-developed interview guides were most often used. Evidence of categorization of intra-, inter- and extra-personal stressors was present. The following overall stressors were identified: burden of responsibility (caregivers); awareness of vulnerability (cancer survivors); being overwhelmed (patients in intensive care units); loss of control (parents); and frustration with role changes (care receivers).

Conclusions.  These data could form the basis for nursing practice as well as future research within a collaborative environment. Given the existing body of knowledge concerning Neuman system model-derived middle range theory concepts in the caregiver population, the middle-range theory of caregiver role strain could be tested empirically.