See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/373132977

Betty Neuman System Model: A Concept Analysis

Article in Insights on the Depression and Anxiety · August 2023

DOI: 10.29328/journal.ida.1001036

CITATIONS READS

0 2,784

4 authors, including:

Adnan Yaqoob Salma Amin Rattani

Aga Khan University, School of Nursing and Midwifery Karachi Aga Khan University
58 PUBLICATIONS 41 CITATIONS 28 PUBLICATIONS 128 CITATIONS

SEE PROFILE SEE PROFILE

All content following this page was uploaded by Adnan Yaqoob on 19 August 2023.

The user has requested enhancement of the downloaded file.

 Review Article More Information

*Address for correspondence: Adnan Yaqoob,

Betty Neuman System Model: A Concept Ph.D. Student, School of Nursing and Midwifery,
Aga Khan University, Vice-Principal, Nursing
Education, Shaukat Khanum Memorial Cancer
Analysis Hospital & Research Centre Lahore, Pakistan,
Email: adnan.yaqoob@scholar.aku.edu

Adnan Yaqoob1,2*, Rafat Jan3, Salma Rattani4 and Santosh Submitted: July 24, 2023
Approved: August 03, 2023
Kumar5 Published: August 04, 2023
1
Ph.D. Student, School of Nursing and Midwifery, Aga Khan University, Pakistan How to cite this article: Yaqoob A, Jan R,
2
Vice-Principal, Nursing Education, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Rattani S, Kumar S. Betty Neuman System
Model: A Concept Analysis. Insights Depress
Lahore, Pakistan
Anxiety. 2023; 7: 011-015.
3
Professor, School of Nursing and Midwifery, Aga Khan University, Pakistan
4
Associate Professor, School of Nursing and Midwifery, Aga Khan University, Pakistan DOI: 10.29328/journal.ida.1001036
5
Assistant Professor, Institute of Nursing and Midwifery, Jinnah Sindh Medical University, Pakistan https://orcid.org/0000-0003-3712-1116

Copyright license: © 2023 Yaqoob A, et al.

This is an open access article distributed under
Abstract the Creative Commons Attribution License,
which permits unrestricted use, distribution, and
Introduction: Nursing theories are critical as they drive nursing education, practice, and research. Neuman
Systems Model (NSM) considers a person a complete system with integrated psychological, physiological, reproduction in any medium, provided the original
spiritual, social, and developmental components. Nurses give their patients physical, emotional, and psychological work is properly cited.
assistance and are subjected to mental and physical pressure due to these responsibilities, impacting their
Keywords: Application of NSM; NSM Concept
health, psychological well-being, and interpersonal relationships. This paper aims to perform a concept analysis
of stressors proposed in NSM about lines of defense and the level of preventive interventions that can affect a Analysis; Walker & Avant; Knowledge Genera-
person’s well-being. Further, this paper discusses knowledge generation through NSM’s applicability to preventing tion
exhaustion and burnout among nurses.

Methodology: This theoretical attempt is carried out using the theory analysis approach suggested by
Walker and Avant (2019).
OPEN ACCESS
Discussion: Nursing is a career that requires a great deal of dedication and personal engagement. Nurses
are subjected to recurrent stresses due to technological advances and rising demands. Burnout occurs when
nurses get discouraged and have less compassion for the patients due to recurrent burdens. Stress and burnout
are two of the most common reasons for nurses to quit hospitals. The NSM is concerned with stresses that may
affect a person’s health and well-being (prediction). Nurses assist patients at the most vulnerable and challenging
times, such as surgical procedures, traumas and personal and physical losses.

Conclusion: The NSM enables the investigation of preventative and protective treatments. Because of the
model’s flexibility, it may be used in a wide range of nursing situations. Administrative, hospitals, clinics, and
other nurses can benefit from this paradigm. Evaluating the many distinct elements contributing to burnout is also
feasible. The model’s client factors of physiological, sociocultural, developmental, and spiritual characteristics are
used to achieve this. Viewing the individual as an open system that responds to environmental stimuli encourages
the existence of stressors that might lead to burnout.

Introduction nursing preventative interventions that focus on existing or

potential environmental stressors and the patient system’s
The NSM de ines nursing as a discipline concerned with reaction [2]. The interventions aim to retain, achieve, and
de ining appropriate behaviours in stressful situations or maintain a person’s well-being. Primary prevention identi ies
in the reactions of a “client–client system” that puts the and reduces potential or actual risk factors. In contrast,
individual at the Centre of the nursing model [1]. The model secondary prevention involves putting the right actions
is a one-of-a-kind approach to nursing that focuses on in order and lowering the negative impacts of an invading
various critical domains. In healthcare settings, providers stressor. The tertiary preventive intervention attempts to
try to reduce stressors to help heal mentally, physically, and restore the person’s well-being and maintain factors subjected
spiritually [1]. In the realm of nursing or any other discipline to adjustment processes.
in the healthcare ield, it can be successfully applied to an
individual, family, and community. Some signi icant aspects of the NSM include the human,
environment, health, wellness, and sickness, fundamental
The NSM provides a holistic, system-based approach to structure and energy resources, client variables, lexible line
problem-solving through primary, secondary, and tertiary of defense, normal line of defense, and lines of resistance.

https://doi.org/10.29328/journal.ida.1001036 www.depanxietyjournal.com 011

Betty Neuman System Model: A Concept Analysis

According to NSM, humans are considered open systems that purpose, as well as the identi ication of the theory’s category
continuously interact with internal and external factors and and underlying assumption [6]. Historically in 1970, NSM
environmental stressors [3]. The human body is in a constant was developed for graduate students to assist them in
state of luidity, ranging from a dynamic form of system understanding patients’ needs [7]. The NSM is a systemic
stability to varied degrees of sickness. approach to wellness-focused care that combines the system’s
thinking and holism [7]. However, Personal experiences, open
The environment, which is a crucial arena relevant to the
systems theories, environmental stressor constructs, holism,
system and its function, has an impact on the human system.
gestalt theories of environment-person interaction, and the
Neuman added physiological, sociocultural, developmental,
notion of preventative interventions all inspired Neuman’s
spiritual, and psychological aspects to the client system [1].
approach [7].
The lexible line of defense is the irst protective line that
inhibits stressors from penetrating and reaching the normal Neuman had worked on the existing system model for
line of defense. A typical degree of health a person or system almost 40 years. Since 1980, the concept of the environment
has established through time is the normal line of defense. has been expanded and de ined. A unique spiritual variable has
The normal line of defense can be described as the system’s been included and described, whereas the term client replaced
hardiness against the stressors that the system faces. When the term patient, and descriptions of model components and
the system’s hardiness fails in combating the stressors, interactions among these components have been provided [7].
lines of resistance are triggered and function as defensive The latest version of the NSM includes the original schematic
mechanisms [4].
and situates the conceptual elements of person, environment,
Purpose of analysis health, and nursing within the nursing metaparadigm [7].

This paper aims to perform a concept analysis of stressors Examining the meaning of the theory
proposed in NSM about lines of defense and the level of
In the second part of the theory analysis method, the
preventive interventions that can affect a person’s well-being.
language used in theory is evaluated by identifying concepts
Further, this paper discusses knowledge generation through
and statements, their de initions, and the links between ideas
NSM’s applicability to preventing exhaustion and burnout
presented in the assertions [6]. In this section, we will discuss
among nurses.
the notions of stressors faced by a nurse as a client and their
Methodology effects on lines of defense in the NSM to develop a deeper
understanding of the concepts.
A theory articulates a series of propositions relating to a
critical question in a ield delivered as a meaningful whole Neuman describes three possible intervention modes
[5]. It is necessary to do a theory analysis to thoroughly unique to the client systems’ actual or projected reaction
understand the phenomenon’s connection and practical to stress. These interventions are classi ied as primary,
application [6]. This theoretical attempt is carried out using secondary, and tertiary since they are dynamic and cyclical. All
the theory analysis approach suggested by Walker and three intervention modalities can be applied simultaneously
Avant [6]. The key reason for choosing this strategy is that to have a synergistic impact. These three preventions in NSM
it is a thorough procedure bene icial to a student new to aim to optimize the client’s well-being or system stability.
theory analysis. Other causes include its methodological
approach, which allows for a more objective examination of In addition, Intrapersonal, interpersonal, and extra-
the theory by identifying its strengths and weaknesses [6]. personal stressors can affect client system stability.
Walker and Avant’s proposed a theory analysis process that Intrapersonal stressors are those stressors that arise within
includes: a) identifying the theory’s origins, b) examining the the client’s system boundaries. Intrapersonal stresses
theory’s meaning, c) analyzing the theory’s logical adequacy, such as atherosclerosis and the resulting hypertension are
d) determining the theory’s usefulness, e) determining the instances of a client’s intrapersonal stressors. On the other
degree of the theory’s generalizability and parsimony, and f) hand, interpersonal stressors are external stresses that occur
determining the theory’s testability. This part will examine near the client system’s limitations. The client’s function in
the NSM concerning stressors causing burnout among nurses the family, caregiver attitudes, and friendship relations, to
through Walker and Avant’s six-step theory analysis technique mention a few, are all sources of stress.
(2019).
In contrast, extra personal stressors happen beyond
Discussion the client’s unique environment. For instance, community
resources, inancial situations, and the client’s work are all
Identifying the origins of the theory
examples of extrapersonal pressures. These three stressors
It is the initial phase in theory analysis, and it focuses may be recognized by nurses in every workplace due to the
on the evolution of the theory in terms of its creation and complexity of human beings [7].

https://doi.org/10.29328/journal.ida.1001036 www.depanxietyjournal.com 012

Betty Neuman System Model: A Concept Analysis

Nursing is a career that requires a great deal of dedication Several types of research have supported hardiness as a
and personal engagement. Nurses are subjected to recurrent personality trait that mediates a person’s stress response.
stresses due to technological advances and rising demands. Hardiness minimizes disorder in personnel exposed to high-
Burnout occurs when nurses get discouraged and have less stress levels Kobasa [11]. Another study on hardiness and
compassion for the patients due to recurrent burdens. Stress nursing discovered that nurses with the personality trait of
and burnout are two of the most common reasons for nurses to toughness had decreased job stress [12]. Nurses with the
quit hospitals. Burnout was de ined as physical and emotional personality trait of hardiness may be able to cope better
exhaustion characterized by negative attitudes, a poor with job pressures and experience less burnout. Hardiness
professional self-concept, and a loss of patient empathy [8]. may cushion the consequences of stress, which is crucial for
In addition, low energy, persistent tiredness, weakness, and nurses and nurse administrators to understand. Promoting
weariness are all indicators of physical depletion. Negative and teaching resilient attributes to staff nurses as a method
attitudes about oneself, job, and life are signs of mental
of maintaining competent, compassionate nurses may
exhaustion. Detached concern for patients, intellectualization
be advantageous to nurses and nursing management as
of dif icult situations, distancing from patients and coworkers,
preventive interventions to secure the basic structure from
and reliance on other staff members for support are all signs
the threat of being damaged.
of mental exhaustion. Finally, melancholy, helplessness,
hopelessness, and imprisonment are all symptoms of On the other hand, low career advancement, excessive
emotional weariness [9]. work pressure, and a lack of supervisor support are all
Dealing with death and dying, requests from clients and stressors that contribute to burnout [14]. The personality
family members, and insuf icient staf ing are stressors that trait of hardiness is an element of the normal line of defense,
nurses face. These stressors exist inside an organizational according to the NSM. The normal line of defense comprises
structure that depletes motivation and morale [10]. Burnout features that develop through time and help a person deal
may also be caused by several stressors, such as a lack of with stress more ef iciently. Over time, hardy people have
control, insigni icant support for crucial choices, and a lack evolved greater coping mechanisms and are less susceptible
of client gratitude [8]. Hospital and nursing management, to stress impacts [15].
staff educators, and nurses all have a role in sustaining the
lexible line of defense, which is especially important since Similarly, personal factors may also play a role in burnout.
they directly in luence the nurse’s well-being, retention, and Non-assertiveness in interacting with others, health issues,
productivity [8]. little social support, and family demands are just a few
examples. Burnout is a multifaceted condition with well-
In recent years, hardiness (resistance in NSM) has been de ined causes rather than a simple one-dimensional sickness
proposed as a burnout-resistant trait. Hardiness is a collection [16]. According to the NSM, burnout results from stresses
of personality traits that enable a person to withstand a variety in iltrating all protection lines (1995). The client/client
of stressors. It was initially researched by Kobasa [11], who system becomes unstable due to this in iltration, and the
discovered that it is a set of attitudes, beliefs, and behavioral core may get exhausted, and burnout will occur if the system
inclinations that allow a person to adjust to a stressful cannot reconstruct the lines of defense.
situation and avoid experiencing a response. Hardiness has
three components, according to Kobasa [11]: commitment, Analyzing the logical adequacy of the theory
control, and challenge [12]. These traits are assumed to be
Logical adequacy is all about a model’s capacity to create
inherited in a person’s personality, although research shows
predictions independent of its content and the degree
that they may be learned and developed through time [8].
of agreement among the discipline’s academics on those
First and foremost, commitment is the ability to trust predictions [6]. It also entails analyzing if the information is
in the reality of one’s own identity and to engage in life. logically sound and whether any defects exist [6]. When seen
Commitment permits a nurse to think about others rather than from a broad perspective, the theory’s scope, content, and
just themself. This way of thinking instils a feeling of purpose, context make sense and appear suited for application. Nursing
which helps to reduce stress. Nurses who have a sense of and well-being are essential concepts ingrained in all nursing
control seek reasons for their experiences in life. Seeking an aspects and are acceptable and suf icient.
explanation helps nurses consider why something occurs
and how it relates to their responsibilities. As a result, this Nurses’ clinical work can bring personal serenity and
positive thinking could strengthen the lexible line of defense professional harmony but also lead to tiredness and burnout.
to control stressors. However, the challenge can be found in Because of the pressures inherent in the nursing sector,
the concept that the environment is constantly changing and resilience has been identi ied as an essential quality. The NSM
that a stressor may be viewed as an opportunity for progress is concerned with stresses that may affect a person’s health
rather than a danger to one’s security. A personality type and well-being (prediction). Nurses assist patients at the most
that resists stress and is called “hardy” comprises several vulnerable and challenging times, such as surgical procedures,
features [13]. traumas, and personal and physical losses. Nurses give their

https://doi.org/10.29328/journal.ida.1001036 www.depanxietyjournal.com 013

Betty Neuman System Model: A Concept Analysis

patients physical, emotional, and psychological assistance been used in multiple conditions and populations due to the
in all of this. Nurses are subjected to mental and physical emphasis on prevention. It has also developed a wide range of
pressure due to these responsibilities, impacting their health, practical applications that may be utilized to care for people
psychological well-being, and interpersonal relationships. of all ages [18].

The NSM can assist nurses in improving their stress Parsimony: A theory must give clear and straightforward
management in the workplace. Age, life experience, education, explanations of a complex phenomenon, as well as precise
and spirituality impact a nurse’s capacity to recover quickly, relational statements that do not overlap or harm the theory’s
adapt to stressors, and be exceptionally active in dealing content or structure, to be parsimonious [6]. Additional
with dif icult situations. By describing the link between the terms (Patient-Client & Health-Wellbeing in NSM) have been
whole and its parts, the consequences of circumstances, and adopted to clarify the theory’s ideas. Moreover, stepwise
the client’s interaction with their environment, NSM provides concepts are thoroughly discussed in NSM to ensure the
a framework for comprehending the concept of adversity. approach is understood.
Relevant principles and hypotheses that help clarify the client
Determining the Testability of the Theory: The
system’s reaction to the environment and endorse nursing
testability of a theory is a measure of its ability to generate
strategies unique to the reconstitution process can potentially
hypotheses and inform research [6]. This section of the study
improve the client system in all domains, resulting in a higher
also analyses whether the hypothesis is supported by evidence
level of well-being and health within the framework of the
and/or has changed [6]. The NSM may be used to examine a
model. When nurses understand the individual-environment
variety of hypotheses.
relationship better, they can make better clinical decisions,
provide assistance tailored to the client and their family, and Well-being and nurses’ burnout are two research
have a better chance of assisting the client in returning to a methodologies relevant to this paper. Psychological
state of wellness, which is the ultimate goal. considerations signi icantly affect a person’s ability to cope
and save energy. This includes motivation, objectives, needs,
Determining the usefulness of the theory
expectations, personality type, coping skills, and resource
The theory analysis process’s fourth step entails evaluating utilization. The elements that might impact the degree of
the availability of theory-generated research, determining the burnout in nurses can be compared. The NSM considers
theory’s relevance in addressing the clinical problem, and the surrounding environment, the requirement to analyze
assessing the theory’s potential to inform nursing practice [6]. the environment, and the impact of stressors growing
The NSM provides a clear understanding for nurses to identify or decreasing. This thought process may lead to a better
stressors affecting them. While using an NSM paradigm to understanding of the stressful circumstances contributing
conceptualize clinical nursing, a nurse should be evaluated to nursing burnout and how to address them. Primary
through the stressors s/he faces as a professional demand. prevention of future health problems is the emphasis of the
This interplay with the system’s part and subpart gradually NSM. It acknowledges the importance of avoiding nurse
adapts for the development of resistance (hardiness) to those burnout concerns.
stressors from management, patients, and colleagues that
Strengthening lines of resistance is a strategy used in
promote consistency in the system [17].
secondary prevention for this analysis that may include stress
The theory’s utility may be measured in four ways: it is reduction workshops, recognition and reward, mentor and
potential for application in practice, research, teaching, and different social programs, and management and working
administration. The Betty NSM and its holistic approach have environment improvements. In this analysis, tertiary
become particularly practical and effective for clients suffering prevention corresponds to a return to a state of well-being
from complex stress that affects numerous elements, such following the treatment of nursing burnout. The NSM focuses
as the individual, the child, adolescents, older people, and on a person’s stress connection, reaction, and reconstitution
elements. Qualitative research is the most appropriate
the family. The model leads the nurse’s function, assisting in
investigation approach because the model examines
decision-making and applying the model’s primary concepts
participants’ ideas and feelings. Qualitative research aims to
and assumptions to facilitate interventions and care.
ind answers to a question by following a series of methods
Defining the degree of generalizability and parsimony and collecting data.
of the theory
This strategy is excellent for acquiring cultural
Generalizability: Examining the theory’s boundaries and information such as beliefs, attitudes, and social practices.
analyzing the data that backs it up can assist in evaluating The researcher’s purpose with this strategy is to gain
whether it is generalizable [6]. The NSM has aroused access to the participants’ feelings and ideas about their
international interest. According to the literature, practitioners stressors. Qualitative research determines why people have
continue to work on the concept in various situations. It has particular sentiments or attitudes that in luence their actions

https://doi.org/10.29328/journal.ida.1001036 www.depanxietyjournal.com 014

Betty Neuman System Model: A Concept Analysis

[19]. In this way, ethnography is an excellent qualitative www.nursing- theory.org/theories-and-models/neuman-systems-

model.php
approach. Ethnography studies groups, organizations, teams,
community behaviours, social interactions, and perceptions 3. Gonzalo A. Betty Neuman. 2011. Retrieved May 16, 2019. https://
nursingtheories. weebly .com/betty-neuman.html
[20]. Ethnography aims to create a comprehensive picture of
people’s attitudes and behaviours. Participant observation, in- 4. Reed KS. Betty Neuman: The Neuman systems model. Newbury Park,
Calif: Sage Publications. 1993.
depth observation, and focus groups are additional qualitative
methods for this concept. Researchers can measure nonverbal 5. Meleis AI. Theoretical nursing: Development and progress (5th ed.).
Philadelphia: Lippincott. 2012.
expressions of sentiments through participant observation,
which aids in a better understanding of actions and activities 6. Walker LO, Avant KC. Strategies for theory construction in nursing. 6th
ed. New York (US): Pearson. 2019.
[21-23]. In-depth interviews are used to gather information
about people’s personal history. Focus groups help generate 7. Neuman B, Fawcett J.The Neuman systems model (5th ed.). Upper
Saddle River, NJ: Pearson. 2011.
comprehensive overviews of a group’s primary concerns.
8. Tierney MJ, Lavelle M. An investigation into modification of personality
Furthermore, the NSM, which uses the three lines of hardiness in staff nurses. J Nurs Staff Dev. 1997 Jul-Aug;13(4):212-7.
defense as indicators, may be utilized to assess this nursing PMID: 9287629.

burnout initiative. The objective is to keep participants from 9. Oehler JM, Davidson MG, Starr LE, Lee DA. Burnout, job stress,
reaching the line of resistance, which is engaged by primary anxiety, and perceived social support in neonatal nurses. Heart Lung.
1991 Sep;20(5 Pt 1):500-5. PMID: 1894530.
prevention during the invasion of a stressor. The NSM may
also complete the project evaluation by including primary, 10. Drucker PF. The new productivity challenge. Harv Bus Rev. 1991 Nov-
Dec;69(6):69-9. PMID: 10114929.
secondary, and tertiary preventative interventions. In the
published reports, secondary preventive methods have been 11. Kobasa SC. Stressful life events, personality, and health: an inquiry
into hardiness. J Pers Soc Psychol. 1979 Jan;37(1):1-11. doi: 10.1037/
used to alleviate current burnout symptoms experienced by 0022-3514.37.1.1. PMID: 458548.
nurses, according to the utilization of tertiary prevention.
12. Collins MA. The relation of work stress, hardiness, and burnout
This might reveal whether primary and secondary burnout among full-time hospital staff nurses. J Nurs Staff Dev. 1996 Mar-
prevention strategies are helpful. Apr;12(2):81-5. PMID: 8715623.
13. Tartasky DS. Hardiness: conceptual and methodological issues. Image
Conclusion J Nurs Sch. 1993 Fall;25(3):225-9. doi: 10.1111/j.1547-5069.1993.
tb00786.x. PMID: 8225356.
When evaluating how well the NSM its the notion of
stressors and hardiness, it is regarded as appropriate because 14. Boyle A, Grap MJ, Younger J, Thornby D. Personality hardiness, ways
of coping, social support and burnout in critical care nurses. J Adv
of its holistic perspective and foundation on environmental Nurs. 1991 Jul;16(7):850-7. doi: 10.1111/j.1365-2648.1991.tb01767.x.
elements connected to well-being. The NSM enables the PMID: 1918650.
investigation of preventative and protective treatments. 15. Sortet JP, Banks SR. Hardiness, job stress, and health in nurses. Hosp
Because of the model’s lexibility, it may be used in a wide Top. 1996 Spring;74(2):28-33. doi: 10.1080/00185868.1996.11736054.
range of nursing situations. Administrative, hospitals, clinics, PMID: 10158721.
and other nurses can bene it from this paradigm. Evaluating 16. Stechmiller JK, Yarandi HN. Predictors of burnout in critical care
the many distinct elements contributing to burnout is nurses. Heart Lung. 1993 Nov-Dec;22(6):534-41. PMID: 8288457.
also feasible. The model’s client factors of physiological, 17. Fawcett J. Analysis and evaluation of nursing theories. Philadelphia: F.
sociocultural, developmental, and spiritual characteristics A. Davis Company. 1993.
are used to achieve this. Viewing the individual as an open 18. Pajnkihar M, McKenna HP, Štiglic G, Vrbnjak D. Fit for Practice:
system that responds to environmental stimuli encourages Analysis and Evaluation of Watson’s Theory of Human Caring. Nurs
Sci Q. 2017 Jul;30(3):243-252. doi: 10.1177/0894318417708409.
the existence of stressors that might lead to burnout.
PMID: 28899271.
Limitations 19. Sutton J, Austin Z. Qualitative Research: Data Collection, Analysis, and
Management. Can J Hosp Pharm. 2015 May-Jun;68(3):226-31. doi:
• This concept paper utilized only one method of analysis 10.4212/cjhp.v68i3.1456. PMID: 26157184; PMCID: PMC4485510.
to ease the understanding of new learners. 20. Reeves S, Kuper A, Hodges BD. Qualitative research methodologies:
ethnography. BMJ. 2008 Aug 7;337:a1020. doi: 10.1136/bmj.a1020.
• This paper involves the majority of old references due PMID: 18687725.
to the original sources of the Betty Neuman system
21. Kawulich B. Forum: Qualitative Social Research. Participant
model. Observation as a Data Collection Method. 2005; 6(2).
22. McElroy AM. Burnout--a review of the literature with application to
References cancer nursing. Cancer Nurs. 1982 Jun;5(3):211-7. PMID: 6919458.
1. Smith MC, Parker ME. Nursing theories & nursing practice (Fourth
edition.). Philadelphia, PA: FA Davis Company. 2015. 23. Simoni PS, Paterson JJ. Hardiness, coping, and burnout in the nursing
workplace. J Prof Nurs. 1997 May-Jun;13(3):178-85. doi: 10.1016/
2. Petiprin A. Systems Theory. 2016. Retrieved May 15, 2019. http:// s8755-7223(97)80069-5. PMID: 9167407.

https://doi.org/10.29328/journal.ida.1001036 www.depanxietyjournal.com 015

View publication stats