Application of Neuman’s Systems Model on Anxiety of Older Adults Waiting for Colonoscopy


1 Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

2 Department of Gastroenterology and Hepatology, Mazandaran University of Medical Sciences, Sari, Iran


Background: Older adults waiting for colonoscopy are anxious due to the lack of knowledge about the procedure, its preparations, and aftercare. Objectives: The aim of this study was to evaluate the effect of the Neuman systems model (NSM) on anxiety of older adults waiting for colonoscopy. Methods: A pre- and postintervention study was conducted on 72 older adults who were waiting for colonoscopy. The participants were randomly allocated to either a control (n = 36) or an intervention group (n = 36). The intervention was performed in four steps, namely determining the potential and actual stressors, setting the goals, nursing interventions, and evaluation, according to the four-step nursing process in the NSM. A need assessment checklist based on the NSM and the Geriatric Anxiety Scale was completed before and after the intervention. Data analysis was performed using Fisher’s exact, independent, and paired t-tests. Results: At baseline, the mean score of total anxiety was 35.66 ± 7.58 in the intervention group and 35.29 ± 6.52 in the control group. After the intervention, these values changed to 26.71 ± 7.48 and 34.06 ± 7.23. Before the intervention, there was no statistically significant difference between the anxiety scores of the two groups in cognitive, affective, and somatic dimensions and total anxiety scores (P > 0.05). However, after the intervention, statistically significant differences were found between the two groups in the mean scores of the aforementioned components (P < 0.001). Conclusion: Implementing an educational program based on NSM reduced anxiety in older adults waiting for colonoscopy. Nurses should be trained about the NSM to be able to use similar programs in reducing the anxiety of patients waiting for colonoscopy.


1. Eliopoulos C. Gerontological Nursing. 8th ed. Philadelphia:
Walters Kluwer Health. Lippincott Williams & Wilkins
(Publisher); 2013.
2. Sargazi M, Salehi S, Sargazi V. Status sdscreening examinations
of elderly people admitted to hospital in Zahedan. J Holist NursMidwifery 2014;24:20-6.
3. Dolatkhah R, Somi MH, Bonyadi MJ, Asvadi Kermani I,
Farassati F, Dastgiri S. Colorectal cancer in Iran: Molecular
epidemiology and screening strategies. J Cancer Epidemiol
4. Lin OS. Performing colonoscopy in elderly and very elderly
patients: Risks, costs and benefits. World J Gastrointest Endosc
5. Hashimoto T, Osada T, Goto SP, Sakamoto N, Murakami T,
et al. Increasing use of colonoscopy over a decade has detected
an increased prevalence of colorectal tumors on the elderly.
J Gastrointest Dig Syst 2016;6:2-7.
6. Wolf AM, Fontham ET, Church TR, Flowers CR, Guerra CE,
LaMonte SJ, et al. Colorectal cancer screening for average-risk
adults: 2018 guideline update from the American Cancer Society.
CA Cancer J Clin 2018;68:250-81.
7. Alizadeh A, Rostamnejhad M, Baladast M, Esfehani maraghe S,
Shahnazi T, Safari N, et al. Colonoscopy and biopsy values in
determining the etiology of chronic diarrhea. J Ilam Univ Med
Sci 2013;21:118-24.
8. Trevisani L, Zelante A, Sartori S. Colonoscopy, pain and fears:
Is it an indissoluble trinomial? World J Gastrointest Endosc
9. Hsueh FC, Chen CM, Sun CA, Chou YC, Hsiao SM, Yang T.
A study on the effects of a health education intervention on
anxiety and pain during colonoscopy procedures. J Nurs Res
10. Day LW, Velayos F. Colorectal cancer screening and
surveillance in the elderly: Updates and controversies. Gut
Liver 2015;9:143-51.
11. Banihashem N, Alijanpour E, Basirat M, Shokri Shirvany J,
Kashifard M, Taheri H, et al. Sedation with etomidate-fentanyl
versus propofol-fentanyl in colonoscopies: A prospective
randomized study. Caspian J Intern Med 2015;6:15-9.
12. Yekefallah L, Ashktorab T, Ghorbani A, Pazokian M, Azimian J,
Samimi R. Orlando’s nursing process application on anxiety
levels of patients undergoing endoscopy examination. Int J
Epidemiol Res 2017;4:53-60.
13. Parker J, Kennedy P. Factors predictive of distress in people
awaiting a lower gastro-intestinal endoscopy. Psychol Health
Med 2010;15:26-33.
14. De Oliveira PP, Amaral JG, Rodrigues AB, da Silva MR,
Onofre PS. Nursing process to men with laryngeal cancer based
on Neuman model. Enfermería Global 2017;16:188-207.
15. Hannoodee S, Dhamoon AS. Nursing neuman systems model.
In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing;
2020. Available from
NBK560658/. [Last Accessed on 2020 Jul 25].
16. Lawson TG. Systems model. In: Alligood MR, editor. Nursing
Theorists and Their Work. 9th ed. St. Louis: Elsevier; 2018.
17. Kabore T, Fongwa MN. Lazrd J. Predictable risk factors for prehypertension among adults using neuman systems model. MOJ
Public Health 2018;7:288-95.
18. Sultan B. Application of betty neuman theory in care of stroke
patient. Ann Nurs Pract 2018;5:1092.
19. Cha JM, Kozarek RA, La Selva D, Gluck M, Ross A,
Chiorean M, et al. Risks and benefits of colonoscopy in
patients 90 years or older, compared with younger patients. Clin
Gastroenterol Hepatol 2016;14:80-60.
20. Gould CE, Segal DL, Yochim BP, Pachana NA, Byrne GJ,
Beaudreau SA. Measuring anxiety in late life: A psychometric
examination of the geriatric anxiety inventory and geriatric
anxiety scale. J Anxiety Disord 2014;28:804-11.
21. Bolghan-Abadi M, Segal DL, Coolidge FL, Gottschling J.
Persian version of the Geriatric Anxiety Scale: Translation and
preliminary psychometric properties among Iranian older adults.
Aging Ment Health 2013;17:896-900.
22. Khatiban M, Oshvandi K, Borzou SR, Moayed MS. Outcomes
of applying neuman system theory in intensive care units:
A systematic review. Crit Care Nurs 2016;9:e8886.
23. Alligood MR. Nursing Theory: Utilization and Application. 5th
ed. St. Louis: Elsevier Inc.; 2014.
24. Ahmadi Z, Sadeghi T. Application of the betty neuman
systems model in the nursing care of patients/clients
with multiple sclerosis. Mult Scler J Exp Transl Clin
25. Nasiry Zarrin Ghabaee D, Bagheri-Nesami M, Abbaspour H.
Application of neuman systems model in nurse anesthetists
to reduce patients’ anxiety level: A randomized clinical trial.
J Mazandaran Univ Med Sci 2015;25:122-31.
26. Sadat Hosseini A, Cheraghi M, Shali M, Javaheri F. Neuman
theory application in solution of Iranian nursing education and
care challenges. Iran J Syst Rev Med Sci 2020;1:1‑14.