Coping with the loneliness imposed by COVID-19 in light of Betty Neuman’s theory

Contributor Loredana Mihu (Portugal)

I share my experience about the nursing care I provided to patients infected with COVID-19 during their hospital stay. The patients admitted to my service are mostly elderly. This is a particularly vulnerable population, either due to chronic disease, comorbidities that condition their physical and psychological dependence, and above all due to the frailty they present. All of these aspects can be aggravated by successive episodes of hospitalization, which are considered moments of stress and anxiety for the patient and the family(1).

During the pandemic, at a time when there was an exponential increase in hospitalizations for COVID-19, my service was one of those that felt the effects of this increase. We tried to make sure that the nursing care was the same, but unfortunately there were small gaps. It was very complicated to establish a therapeutic relationship with the patient, because we all had almost total coverage – only our eyes were visible, and this when the glasses didn’t fog up. The patient no longer knew who was who, he or she was sad to be hospitalized and isolated in the ward. Sharing space with other patients, losing much of their privacy, and on top of all this, they couldn’t receive visitors either.

The patients with more autonomy could understand why there were no visits; the big problem was the most fragile patients. Those who thought they had been abandoned, left in the hospital, often asked about their partners, children, grandchildren. One way that we nurses on the team tried to fill this gap was through video calls! The fact that the patient saw the relative instantly changed their attitude, they gained an incentive, to face the disease in a different way and promote a better clinical recovery.

Betty Neuman considers the system/individual, made up of its variables (physiological, psychological, socio-cultural, developmental, and spiritual) that are in dynamic interaction and whose changes can provoke reactions on them(2). Neuman describes the Systems Model by the existence of three lines around the individual. The line of resistance, the normal line of defense and the outermost line, the flexible line of defense. The stressors that affect the patient can be of intrapersonal, interpersonal and extra personal origin. When a stressor reaches the patient’s normal line of defense, relationships occur between its variables to protect him from the stressor effects. When the strength of these variables is not sufficient, the stressor penetrates the line of defense, and the patient is affected by the stressor. Three ways of preventing stressors have thus been defined(4).

Primary prevention occurs when a stressor is suspected or identified(3). The elderly patient with covid-19, when hospitalized, is exposed to stressors such as anxiety, loneliness in the hospitalization and concern about the health status. In this phase there is no reaction, but the degree of risk is already known, so the individual’s normal line of defense is strengthened to reduce the possibility of reaction, that is, stressors are prevented.

Secondary prevention corresponds to the early detection of stressful factors(2). When the patient is hospitalized, he or she doesn’t know what is going to happen; they can’t communicate with the family who stayed at home, they can’t see the family because visits have been restricted. All these factors cause a reaction in the patient which is anxiety, sadness, loss of appetite, refusal to communicate with the nursing team; they may even refuse some care. In this phase, we nurses have to implement interventions in order to improve the patient’s well-being. Promoting communication with the family through phone calls and video calls has proven to be an asset in improving the patient’s overall condition.

Tertiary prevention is used after the individual has recovered from the stress reactions(2). This process circles back to primary prevention, an example being the avoidance of stressors that are harmful to the person and the family. At this level of prevention, we can anticipate our interventions, so that in a future situation, we are able to provide more quality to the hospitalization of elderly patients with COVID-19(.3)

Considering Neuman’s systems model, our goal, as nurses, is to achieve the balance of the system, in this case, the balance of the elderly patient hospitalized with COVID-19, through the implementation of appropriate interventions, to reduce the stress factors and adverse conditions affecting them, thus achieving a faster recovery and avoiding similar future situations.


  1. Águila-Gordo, D., Martínez-Del Río, J., Mazoteras-Muñoz, V., Negreira-Caamaño, M., Nieto-Sandoval Martín de la Sierra, P., & Piqueras-Flores, J. (2021). Mortalidad y factores pronósticos asociados en pacientes ancianos y muy ancianos hospitalizados con infección respiratoria COVID-19. Revista espanola de geriatria y gerontologia, 56(5), 259–267.
  2. Tomey, A. & Alligood, M. (2016). Nursing Theorist and their Work; (9th Edition); Elsevier 
  3. Almino, R. H. S. C., Oliveira, S. S. de, Lima, D. M. de, Prado, N. C. da C., Mercês, B. M. O., & Silva, R. A. R. da. (2021). Occupational stress in the context of COVID-19: analysis based on Neuman’s theory. Acta Paulista de Enfermagem, 34.
  4. Neuman, B. & Fawcett, J. (2011). The Neuman Systems Model. (5th edition), Boston: Pearson.

About Loredana Mihu

I have finished my Nursing Degree in 2018, at the School of Health of the Portuguese Red Cross (ESSCVP). One month after, I start working in a Dialysis Clinic. In 2019, I started working as a general nurse, in an acute medicine department, at Hospital Garcia de Orta, EPE, Portugal. Since the beginning of the pandemic, I have worked in a campaign hospital with COVID-19 patients, and as soon as the vaccine came out, I worked in a Vaccine Centre. Presently, I am doing a Master’s Degree in critical care nursing, at Health Sciences Institute, UCP Lisbon. This post was made in the nursing theories curricular unit, with the pedagogical supervision of Professor Zaida Charepe (PhD, Associate Professor).

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