Categories: Uncategorized

Huawei Case Study

Comments from Customer

Please find two attachments, 1- Huawei case to be used in this report and 2-Old Apple case example. Please see the outline and all written sections from solved Apple case and do the same analysis for Huawei. Follow the same Apple solved case structure and written style from page 1 to page 15.

sample paper

Don't use plagiarized sources. Get Your Custom Essay on
Huawei Case Study
For $10/Page 0nly
Order Essay

Table of Contents
Introduction
1-1 Brief Statement of the Problem ……………………………………………………………… 1
1-2 The Purpose of the Report ……………………………………………………………………. 1
Analysis
2-1 PESTLE Analysis of Apple Inc. ……………………………………………………………. 2
2-2 Competition Structure …………………………………………………………………………. 5
2-3 SWOT Analysis …………………………………………………………………………………. 6
2-4 Marketing Strategy and Market Segmentation in Apple Inc ………………………. 9
2-5 The Marketing Mix …………………………………………………………………………… 10
Conclusion
3-1 Alternative Solutions…………………………………………………………11
3-2 Recommendations ……………………………………………………………………………. 15
3-3 Exhibit………………………………….……………………….………………16
1
Introduction
1-1 Brief Statement of the Problem
Apple Inc. is believed to be the leading tech company, because of its market capitalization, and according to some researches, Apple continues to thrive in all the categories it created and popularized. Although Apple seems to always be on the top, its biggest problem lies with the leadership, which is the management. After Steve jobs, who was the genius man behind the company’s creativity, success and innovation died, Tim Cook took over as the new CEO. These adjustments in Apple’s management proved to be a big problem. This is because according to various researches Tim Cook is known to be good at operational excellence, while Jobs was known for his innovation. This report is also directly linked to another problem that affects their marketing, and that is their premium pricing on their products. Apple’s products are known to be very expensive, although this is an added advantage to the company’s income and revenue, it sometimes affects their marketing. This is because in the recent years many companies have emerged, therefore creating a stiff competition. When some of these companies offer lower prices on the same products, this automatically affects Apple.
1-2 The Purpose of the Report
The main purpose of this report is to focus on the main problem facing Apple in their marketing as seen in the case assignment paper by David B. Yoffie. It deeply analyses the problem by tackling various aspects of the company and how the problems have affected the company as a whole. It also aims at giving solutions and recommendations to the problems listed.
2
Analysis
One of the Apple’s problems that I noted based on the case assignment paper is on the side of the management. One of the biggest competitors of Apple in the 1984 was IBM, which entered in the pc market by 1981. Since the PCs made by IBM had gained a big market share it made Apple to introduce their Macintosh in the year 1984.But despite their breakthrough in the industry, their net income dropped by 62% between the years 1981 and 1984. This was because of the small sale they had made with their Macintosh. This made the company to be on a crisis, but the biggest problem was with the management, and because of this, the then CEO that is Jobs was forced out in 1985. John Sculley took the CEO position, although he greatly tried to rescue the company, the fact was that he could not be able to fill the space that Jobs had filled. Under his management, Apple tried to lower their prices so as to appeal to a large market just like IBM was doing. Despite his undeniable efforts Apple’s gross margin fell to 34%. Because of this drop, the company replaced John Sculley with Michael Spindler. Michael failed immensely and he was replaced by Gilbert Amelio. But it was under Amelio’s management that the company lost its momentum in 1995.It is believed that the company was bankrupt in 1995. It was until in 1997 when the company sort help from Steve jobs, who then brought Apple back to its former glory. It was under the rule of Jobs since 1997 to 2011 that the company enjoyed one of its biggest success. It is very evident that the failures that had been faced by the company were as a result of management. It is quite clear no one could be able to fill the shoes of Jobs. Despite the company changing CEOs every time it failed, this did not help. It was until when Jobs became a CEO again.
2-1 PESTLE Analysis of Apple Inc.
This is analysis of the external factors that play an important role in conducting research before starting a new project. Apple is composed of very important resources and
3
great potential in the business and the world market. Although it consists of great capabilities and potential, there are various aspects in the environment that causes great threat that interferes with the progress and success of the company. From the case assignment paper is quite clear that Apple operates under a very competitive environment. The electronic industry is very competitive, that’s why it is advisable for all the companies in it to always come up with innovative and effective strategies that will make them stand out. This analysis focuses more on the: Political factors, Economic Factors, Sociocultural factors, Technological factors, Legal factors, Environmental factors.
Political Factors
Major revenue for the Apple Company usually comes from the outside countries, their International sales account to more than 62 percent of the revenue. Therefore, this means that any political revolt in the countries where they market their products will bring a negative effect to the Apple’s success. For example, in the year 2010, Apple faced great political pressure when many cases about suicide were reported. The case was registered against Apple’s leading supplier that is Foxconn which is based in Taiwan. They were sued for forcing the workers to work long hours without rest. One of the biggest manufacturer and market for Apple is China, but with the obstruction in the political environment of China it definitely forces the manufacturing of the Apple’s products to be low.
Economic Factors
Because the company greatly relies on their premium pricing strategy, this means that whenever there is an economic crisis, it can greatly have a negative impact on the Apple’s return on equity (Exhibit 1a). For example, during the 2013 global slowdown, Apple’s economic growth was hit badly, there was a direct impact on the company, since the return on equity dropped by 9% from 2012 to 2014. When the rate of inflation in the United States had increased, Apple was greatly affected as it was forced to reverse a large amount of money.
4
Sociocultural Factors
The Apple Company is subject to the impact of the socio and sociocultural factors. Different researches show that there is a great incline in the usage of the virtual world which is a great factor to Apple. The other factor that affects Apple is the current lifestyle. Apple is known to be the biggest brand in the world. Many people are attracted to the name, and with the social status this brand carries with it. But because of its high prices only the higher in class can be able to purchase it. This company’s products are mainly manufactured in China where they believe there is low cost of labour, instead of creating job opportunities in its home country. This can greatly affect the appeal of the company.
Technological Factors
It’s evident that the technological external factors directly provide opportunities for the company. When it comes to earning revenues, Apple’s stakes of information technology are always higher. But with so many companies that depend on technologies having emerged, Apple is facing a great competition. The companies that are the direct competitors of Apple when it comes to manufacturing products technological include; Samsung and Google. Researches show that these companies are now providing products and services similar to Apple’s, therefore they stand to be a great threat.
Legal factors
There are legal factors in the external environment that creates problems and threatens Apple as a company. The United State government has come to a realization of the privacy issues or matters that are linked to the use of the digital technology today. Therefore by seeing that opportunity, the government have inflicted more privacy laws and regulations on companies such as Apple. This might be an opportunity for Apple to improve and develop the privacy features found in their products. But at the same time it acts as a threat and a
5
problem, since it limits the company from manufacturing and introducing products that include the transmission of private details or information.
Environmental Factors
Some environmental factors can greatly affect the company’s revenue and income. Some reports say that, the company has been experiencing problems with the disposal of their electronic devices that are not in a working position. With this problem of disposing these devices especially the ones with lithium batteries, has forced the company to incur a lot of expenses. This means that for the company to avoid environmental pollution in the future they will have to incur a lot of expense that will cost them a great deal.
2-2 Competition Structure
Although Apple is considered as the leading in the electronic industry, there have been many companies that have been emerging in the same industry. This means that Apple has stiff competitors, who have proven to have a great effect on the company. Some of these great competitors include Samsung, Google, Lenovo, Huawei and LG (Exhibit 7a). For example, according to the case assignment when it comes to the sales of smartphones, in the year 2014 there was a great competition in different companies. The Apple’s iPhone faced stiff competition from Android that was produced by Google. With so many manufacturers emerging in the market and preferring to use the android, this became a great rival to Apple.
Since Apple prefer using the premium pricing strategy, the many new entrants in the industry saw a big opportunity in the market especially to the people who cannot afford Apple’s products, therefore they offered low prices in their products. Thus, with these new entrants who offered lower prices, the Apple’s IOS market share dropped gradually. Therefore, one of the biggest competitors of Apple has been Google with their development of the android.
6
When looking at the manufacture of handsets and electronic appliances, the biggest competitor of Apple in this category Samsung. They were known for making electronic appliances, TV, PCs, computers and laptops. And in 2011 Samsung was named the volume leader when it introduced the Android based galaxy handset.
2-3 SWOT Analysis
This analysis focuses more on revealing Apple’s internal strengths and weaknesses as well as its opportunities and threats.
Strengths
They create and sustain their brand loyalty by manufacturing complimentary products. There is a reason why most of the loyal customers of Apple prefer to use all the Apple products instead of buying different products from different manufactures. This is because Apple manufactures complimentary products, meaning that for one product to be complete the other product must be used. For example, an iPhone cannot be complete if not paired together with iTunes and Apple App Store. With this all the products manufactured by Apple usually create a halo effect, meaning every product compliments the other. Therefore, many consumers will prefer to purchase products from Apple instead from various companies, this has to be one of the strongest advantage Apple has over other companies.
Their advertising capabilities and marketing strategy is another strength the company possess. This is because it helps to create awareness of the brand and this in return increases the demand for the products. According to (Newlands, 2016) the 2015 annual advertising budget for the company was 1.8 billion US dollars. Its advertising budget is believed to not be the highest when compared to its competitors. But what makes Apple to stand out in its advertising, is its simplicity and its effective use of the budget. When compared to Samsung
7
Company, Apple’s budget on advertising is quite lower, but its brand still gets better recognition compared to Samsung
The other strengths of Apple include its strong and wide distribution channels in the United States. This helps them to deliver products to their consumers all over the nation compared to their competitors. The other strength is strong cash flow and large revenues.
Weaknesses
The premium price strategy is one of the major weaknesses of this company. This is because there is a stiff competition in the market, with companies emerging who are offering lower prices to the same products Apple manufactures.
The other weakness is the fact that Apple Company over relies on the iPhone sales. The sales of iPhone are the greatest generators of Apple’s revenue (Exhibit 1b). With changes and great competitors in the smartphone industry, Apple will faces great challenges
The other weakness is how their IOS is incompatible with other OS. It’s very evident that Apple uses its own designs hardware that is very different and incompatible with the hardware of other manufactures. This sometimes adversely affects the company, since it can be hard for someone who uses the IOS to use other OS and vice versa.
Opportunities
It is believed that the Internet of Things (IoT) might grow significantly in the future. This is a great opportunity for Apple because already owns a software platform that is originally its own, and through this they can manage information from connected devices. This is a great opportunity since it’s believed that more than 25 billion devices are connected to the internet, and it might rise.
The smartphone and tablet market are expected to increase and enlarge all over the world. This is a great opportunity for the company to increase their market share in the world.
8
The market for the health related wearable gadgets is expected to increase in the future. In 2014, Apple introduced the Apple Watch which is believed to be a wearable device. Therefore, with its market being expected to grow, this will be a big breakthrough for the company.
Threats
Stiff competition from other competitors together with the new entrants in the industry are some of the threats for Apple Inc. This puts pressure on the company’s market share and income. Some of its biggest competitions in the computing sector come from IBM, HP, Dell and Microsoft. When it come to the smartphone industry, some of its biggest competitors include Samsung and Google. Bearing in mind, Apple’s products are overpriced, their biggest threat is now from the low priced android devices which might force them out of the market.
The other big threat to the company is the strong United States dollar. The currency exchange rate usually has a great impact on any big organization or company, including Apple. Most of the Apple’s revenue is believed from outside countries. Since the United States dollar is expected to rise, this means that Apple’s revenue might be affected. This is because when the revenue from the outside countries is converted to the U.S dollar, they revenue might decrease.
The lawsuits the company has been involved in might have a negative impact on the brand’s reputation.
2-4 Marketing Strategy and Market Segmentation in Apple Inc
According to Forbes magazine, Apple was the winner of CMO Survey Award for Marketing Excellence in 2012.And according to other researches, this company has been at the top list since the early 2000.Therefore for Apple Company to always be on the top and so
9
successful in its endeavours, it means that it has a great marketing strategy. Thus the question is, why is Apple Inc. a great marketer?
It all started with the incorporation of the company in 1977, when its advisor at the time created a marketing philosophy with three main points. Even after 40 years, this marketing philosophy is very crucial in helping the Apple to create and obtain large profit from the loyal consumers of its products. The first philosophy is empathy where the company comprehends the needs of its customers better than any other organization. The next point is focus, through this their main aim is to eliminate and exclude any unimportant and unnecessary opportunities. This helps them to focus on the only few things that they set to do, and they actually do a good job. The last point is imputing, according to Apple, they believe that, people always judge a book by its cover. Therefore, this means that, the consumers will label the quality and innovativeness of product according to the way a company presents its quality and innovativeness. Thus, Apple Company believes that if they create products of high value and sophistication, they will directly impute this high quality and sophistication to its loyal customers. According to Carmi Levi who is the Vice president of marketing in a multinational agency, he believes that the marketing of Apple usually forms a distinguishing factor by placing it as a solution organization, compared to other tech companies. In its marketing, Apple usually incorporates the idea of simplicity and intuitiveness. This is because the company believes that too much information is too ordinary and is not appreciated or welcomed by people. Apple prefers their commercials to have just a simple background with music in it, a background that is not exaggerated. The product strategy is believed to be the backbone of the marketing strategy of the company. Apple’s products usually possess a high level of intuitiveness and are known to be user friendly. Their products also have innovative features alongside unique designs, and this is one reason why Apple has a great advantage over its predecessors. The other addition to their marketing strategy is the
10
fact that they develop and promote complimentary products and services. Every product that is manufactured by Apple usually compliments the other, therefore they end up creating a halo effect. That’s why many loyal Apple product consumers usually stick with every product of this brand instead of buying different products from different manufacturers.
2-5 The Marketing Mix
 Products
Apple’s products are characterized by their simplicity and intuitiveness. Their strategy is to create the best products which are user friendly and generates great user experience. When it comes to their products they believe that manufacturing products that will be desired by their consumers is better that what the consumer thinks he/she wants. Some of its products include the Mac book, iTunes, iPad, iPod, Apple TV, iPhone which have greatly built and strengthened the company’s image (Exhibit 1b).
 Promotion
In their promotion, Apple usually integrates simplicity. They believe that little information and direct messages with simplicity are better than too much information and flashy messages.
 Price
Because Apple’s products are differentiated, they usually incorporate the premium price strategy. This strategy is believed to be the biggest advantage to the Company. With this strategy, Apple Company gets the highest profit and Revenues instead of a big market share. This means that they usually produce and manufacture high end products and always price them highly. When it comes to Apple’s pricing strategy, they are always on the lead, since they have no competition.
11
 Place/People
On this other tool that proves to be very crucial in Apple’s marketing, this Company usually have strict rules as to the people and places that will sell and distribute their products. This is so because Apple usually targets the premium customers. Therefore, for it to ensure great dominance on its distribution, Apple usually approves only selected number of stores and people to sell and distribute their products. This method usually form exclusivity that is the distribution of the products is limited to some places. But this greatly help Apple to still maintain strengthen their high end image.
Conclusion
3-1 Alternative Solutions
A- Dynamic Pricing
One of the best alternative solution that can be used in replacing Apple’s premium pricing strategy is by implementing dynamic pricing. By implementing the dynamic pricing any organization can be able to provide or offer the appropriate pricing to the right consumers at the right and appropriate time. Through this strategy Apple can be able to offer relatively lower prices on some of their products so that they can attract more customers. And then offer higher services on other products and services. They can alternate their prices according to seasons and the kind of customer segment they are dealing with.
Pros of Dynamic Pricing
It helps in increasing the market share of a company. By applying this method of pricing, Apple is guaranteed to increase its market share. This is because this method of pricing caters for almost every type of a customer, from the low income to high income consumer. Therefore, ensuring the market share increases.
12
It propels the profit margin and a company’s revenue. Dynamic pricing ensures that all the type of consumers in the market are catered for. That is a company can offer high prices on the consumers who are willing and ready to pay it, but at the same time cater for the other customers in the market by offering lower prices or discounts on the same products and services.
The other advantage of this method of pricing is that it can greatly help in utilization. That is it can help in boosting the demand for a company’s products and services. It’s evident that demand can vary from day to day, therefore a company can be assured to run every single day instead of some days or some seasons when they implement this type of pricing. For example, when demand is low Apple can decide to offer discounts on their products and when demand is high, the company can offer relatively high prices. This ensures that a company is experiencing demand on their products at all times.
Cons of Dynamic Pricing
Dynamic pricing on the other hand can bring confusion to the customers. This is because when consumers are greatly vexed on the situation that is the changing of the pricing each now and then, they can choose to purchase the same products from another company that offers fixed price and not dynamic. This definitely can negatively affect the market share of an organization.
By applying this method of pricing will result to the marketing activities increasing. That is a great marketing presence will be required in the market so that whenever prices change, it is communicated.
It will greatly require the company that implements this method to always monitor its competitors, to see if the prices are similar.
13
B- Situational leadership
Usually situational leadership is considered to be flexible. That is leadership and management should be able to adapt with the present working environment and the then required needs of a company. Therefore, Apple’s CEO Tim Cook should apply the situational leadership. His leadership should be able to connect with the existing environment and the needs of the company.
Pros of Situational Leadership
This type of leadership is considered to be easy and simple to use. This is because a leader, in this case the CEO of Apple is supposed to evaluate the situation of the company in a given time and then choose the type of leadership to apply. Every situation and for different needs of a company to be met, it requires different type of leaderships.
Through this leadership style, it makes sure that there is flexibility in the management therefore making the company more flexible. For example, Apple Company is not very flexible since it chooses to concentrate on a few lines of products instead of being flexible on the products and services they offer. This style of leadership can greatly help them to be flexible.
Cons of Situational Leadership
This type of leadership can create a lot of confusion on the workers directly dealing with the leader. This is because with every situation and Company’s need, the leader’s leadership and management might change drastically. Therefore, it becomes hard for the workers and the outside environment to determine when and how the leader might change.
This leadership style can take away the leaders or CEO’s focus from the long term goal of a company. This is because the leader will be focused more on searching for the next leadership style to apply instead on focusing on the Company’s goal.
14
C- New Product Innovation (Innovation)
It’s quite clear that Apple’s revenue and gross margin majorly relies on the sales of the iPhone. This company is also known to have a few lines of products. Therefore, they should try to innovate new products that might capture the customer’s attention, instead of relying on the iPhone.
Pros of Product Innovation
One major advantage is that it can help in increasing the market share. By innovating new products that can greatly cater for the existing needs of the consumers, it can ensure that the demand goes beyond the target market, therefore increasing a company’s market share. When the market share is increased, the involved company definitely gains market power.
It helps in creating a wide range of products. Apple only have a few lines of products, therefore innovation can greatly help them in manufacturing new and quality products that can be essential to their consumers. This can greatly increase their profit and revenue.
Cons of Product Innovation
Innovation can be extremely costly. When innovating new products it’s obvious that a significant amount of time and resources will be used. Therefore, any company thinking of innovation might send approximately 4% of their revenue.
There is a big risk of innovating new products and introducing them into the market. Consumers might not accept them, therefore this can negatively impact the Company’s revenue and profit. This can also result to a company wasting their time and also wasting money on resources.
15
3-2 Recommendations
The Apple’s organizational culture usually helps in supporting the company’s leadership, since it consists of key factors that support the business. Apple’s organizational culture is composed of the creativity, innovation, secrecy and top-notch excellence. One of the benefits of these features when combined together they help to support the leadership of the company, they also help the company to stand out and be ahead of its competitors. Therefore, the Company’s competition advantage is propelled by these features of the organizational culture.
I think the best solution for Apple is that it should try to implement the dynamic pricing in their products. That is they should try to offer the appropriate price on the right consumers at the right and appropriate time. This method will enable them to cater for all types of consumers in the entire market, despite their income. With this type of pricing they are guaranteed of a wide range of market share and increased revenues.
Tim Cooks who is the CEO of Apple can greatly benefit the Company when he implements and applies the situational leadership. This can help him to ensure that every need of the Company and every situation being experienced by the Company is taken care of through the right strategies that might require different types of leaderships.
I would recommend the Apple Company to effectively use their popular brand in producing new product line. Apple’s brand is the largest and the most popular globally, therefore they can use it to their advantage in manufacturing and introducing new products.
16
3-3 Exhibits
17

case study

Short Report
Application of the Betty Neuman systems
model in the nursing care of patients/clients
with multiple sclerosis
Zakieh Ahmadi and Tabandeh Sadeghi
Abstract
Objective: This study aimed to assess the application of the Betty Neuman systems model to the care of
patient/clients with multiple sclerosis.
Methods: This clinical study resulted from the application of the nursing process to a patient/client
admitted with multiple sclerosis in the neurological ward of a hospital in an urban area of Iran.
Results: A patient/client was evaluated according to the Neuman model. Intrapersonal stressors (physiological,
psychological, socio-cultural, and spiritual), interpersonal stressors (being away from family and
children) and extra-personal stressors (aggression and psychological pressure from the spouse) were
found. Based on the examination, 12 nursing diagnoses based on the taxonomy of the North American
Nursing Diagnosis Association International, and nursing care based on three levels of prevention that
are important in the view of Neuman, are presented. The results were used in the classification of nursing
interventions and the classification and nursing outcomes respectively.
Conclusions: The results suggest the desirability of care and patient/client satisfaction in the evaluation
of nursing care based on the Neuman model. The model can be used as a framework to help nurses care
for patients/clients. Thus, the application of this model and other models is recommended in the nursing
care of patients/clients.
Keywords: Multiple sclerosis, patient/client care, nursing models, Neuman systems model
Date received: 14 April 2017; accepted: 23 July 2017
Introduction
Multiple sclerosis (MS) is an autoimmune disease
of the central nervous system (CNS) characterized
by brain inflammation, demyelination, and axonal
loss, which occurs primarily between the ages of
2040 years.1 MS is the most prevalent inflammatory
2 and the second most common cause of neurological
disability in working-age adults. Since it
usually strikes in the prime of life, frequently progresses
to disability, and has no cure, MS can have a
strong emotional impact not only on those who
suffer from it, but also on the healthcare team.3
The range of symptoms that occur in MS can have
disabling functional consequences for patients and
lead to significant reductions in their quality of life
and the ability of individuals to carry out their roles
and job tasks.4
The goal of early disease management is to intervene
before irreversible neuronal destruction happens, to
delay the progression of disability, and to improve
the quality of life.5 Currently, there is no known cure
for MS, and the treatment goal of MS is the prevention
of permanent neurological damage.6 Thus, the
nature of the disease poses an obvious need for interdisciplinary
services. Nurses have to play a key role
in the interaction with patients/clients and their
families to improve the patient/client’s health.7 The
purpose of nursing care is to improve the quality of
life of patients/clients.8 An effective way to promote
nursing care is by applying nursing theories.9
The clinical use of nursing models and theories helps
develop nursing knowledge.10 It is an important step
to achieve the goals that guide the practical
Multiple Sclerosis Journal
Experimental, Translational
and Clinical
July-September, 2017; 18
DOI: 10.1177/
2055217317726798
! The Author(s), 2017.
Reprints and permissions:
http://www.sagepub.co.uk/
journalsPermissions.nav
Correspondence to:
Tabandeh Sadeghi
Department of Pediatric
Nursing, School of Nursing
and Midwifery; Non-
Communicable Diseases
Research Center, Rafsanjan
University of Medical
Sciences, Rafsanjan, Iran,
Jomhori St, Rafsanjan
7718796755, Iran.
t.b_sadeghi@yahoo.com
Zakieh Ahmadi,
Department of Medical
Surgical Nursing, School of
Nursing and Midwifery.
Hormozgan University of
Medical Sciences, Bandar
Abbas, Iran
Tabandeh Sadeghi,
Department of Pediatric
Nursing, School of Nursing
and Midwifery; Non-
Communicable Diseases
Research Center, Rafsanjan
Creative Commons CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/
licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on
the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
application of clinical and educational research.11
A wide variety of situations and phenomena make
a certain degree of flexibility necessary in the selection
of the models and nursing theories according to
the circumstances.12 The Betty Neuman systems
model is one theory that provides guidance at three
levels of prevention.13
Neuman systems model
The Neuman systems model is based on a general
system theory and reflects the nature of living organisms
as open systems in interaction with each other
and with the environment. Within the Neuman model,
the client may be an individual, a family, a group, a
community, or a social entity. An important assumption
of the Newman theory is: ‘‘each client system is
unique, a composite of factors and characteristics
within a given range of responses.’’13 [p. 285]
The human being is a total person, characterized by
five variables: these include physiological, psychological,
socio-cultural, spiritual, and developmental
variables.14 The physiological variable refers to body
structure and function. The psychological variable
refers to mental processes in interaction with the
environment. The socio-cultural variable refers to
the effects and influences of social and cultural conditions.
The spiritual variable refers to spiritual
beliefs and influences. The developmental variable
refers to age-related processes and activities.13
An individual organism is said to have a central
‘‘core’’ of basic survival mechanisms, such as temperature
control, ego, and organ function.12 The core
is protected by lines of defence. The outer layer is the
flexible line of defence, and is variable, responding to
the particular stressor. The inner or ‘‘normal’’ line of
defence represents the state of wellness and adaptation
of the individual. It is generally stable. The lines
of resistance represent the internal factors that determine
an organism’s response to a stressor. Stressors
(intrapersonal, interpersonal, and extra-personal) are
significant to the concept of environment and are
described as environmental forces that interact with,
and potentially alter, system stability.15 Intrapersonal
factors include interactions contained within the
client, such as conditioned responses. Interpersonal
factors arise from interaction between two or more
individuals, such as role expectation. Extra-personal
factors comprise all interactions occurring outside the
client, such as financial circumstances.16
Neuman defines the environment as all the internal
and external forces surrounding the client, influencing
and being influenced by the client at any point
in time. She identifies three relevant environments:
internal, external, and created.12 The internal influences
are contained within the boundaries of the client’s
system in other words, they are intrapersonal in
nature. The external influences exist outside the
client; and the created environment is unconsciously
developed and is used by the client to support protective
coping.17 She views health as a continuum of
wellness to illness that is dynamic in nature and is
constantly changing. Optimal wellness exists when
the total system needs are completely met and illness
exists at the opposite end of the continuum from
wellness and represents a state of instability and
energy depletion.12
Neuman believes that nursing is concerned with
the whole person. She views nursing as a unique
profession and believes that it is concerned with all
the variables affecting an individual’s response to
stress. The primary aim of nursing is the stability
of the client system. This is achieved through nursing
intervention to reduce the stressors. Neuman’s process
contains three basic parts: nursing diagnosis,
nursing goals, and nursing outcomes. Neuman stresses
the importance of identifying the client’s and the
caregiver’s perceptions and collaboration between
the client and the caregiver in all stages of the
process. She identifies three levels of intervention:
primary, secondary, and tertiary (Table 1). Primary
prevention takes place even before the client system
can respond to a stressor that the purpose is to
reduce the possibility of encounter with the stressor.
Secondary prevention takes place after the client
system responds to a stressor. Tertiary prevention
occurs after the active treatment or secondary prevention
stage that it focuses on readjustment toward
optimal client system stability.13 This paper demonstrates
the application of the Betty Neuman systems
model to the care of patients/clients with MS.
Method
This clinical study resulted from the application of
the nursing process mediated by the nursing theory
of Betty Neuman to the care of patients/clients with
MS in a neurological ward of a hospital in an urban
area of Iran. One patient was studied in this study.
In the first stage of the nursing process, an interview
was drawn up with the purpose of guiding the research
and determining the stressors. This clinical study was
about single patient.
After the assessment and data collection, 12 nursing
diagnoses were established according to the taxonomy
of the North American Nursing Diagnosis
Multiple Sclerosis Journal—Experimental, Translational and Clinical
University of Medical
Sciences, Rafsanjan, Iran
Department of Pediatric
Nursing, Rafsanjan
University of Medical
Sciences, Iran
2 www.sagepub.com/msjetc
Association International (NANDAI), and nursing
care based on three levels of prevention that are
important in view of Neuman, was presented. The
diagnoses were:
1. Disruption of the concept of ‘‘self’’ associated
with the disease, decreased muscle strength,
power and weakness,
2. Not tolerating any activity associated with
weakness, fatigue and irritability,
3. Stress and anxiety associated with being away
from children and family, disease and aggression
of the spouse,
4. Eating disorder, eating less than what the body
needs, anorexia and nausea,
5. Risk of trauma and falls in association with
visual and movement disorders, weakness,
and dizziness,
6. Disturbance in bowel habits associated with
illness, weakness, and disability,
7. Changes in sexual pattern associated with fatigue
and depression,
8. Disorders in sleep pattern associated with an
urge for urination, headache, and flushing,
9. Disorder in reading and writing associated with
visual disturbances and vertigo,
10. Impaired skin integrity in association with
drugs and associated complications,
11. Urinary dysfunction associated with the disease
and bladder nerve damage,
12. Avoiding loneliness associated with being
away from children and family.
Experience reports
Evaluation of patients/clients to classify types of
stress is posed by Neuman.
Intrapersonal stressors
Intrapersonal stressors include the following needs:
physiological, developmental, psychological, sociocultural,
and spiritual.
.Physiological
Neurological: dysfunctions of this system include
severe headache and vertigo that worsens in light,
weakness and walking disorders due to muscle
weakness, blurred vision and double vision, seizures,
heaviness in the head, and sometimes inability in
gripping objects with hands and as a result, dropping
the object, minor burning and tingling sensation in
hands and feet, which worsens during an attack.
Gastrointestinal: dysfunctions of this system
include loss of appetite, early satiety, weight loss
in recent months, and impairment of bowel movements
in the form of constipation, and occasional
nausea and vomiting.
Respiratory: the respiratory rate was normal and
lung auscultation was clear.
Genitourinary: difficulty in urination, dripping
urination.
Dermatological: dry and red skin with spots on
the face, and sometimes severe scalp irritation,
especially during anxiety and under psychological
pressure.
Table 1. Summary of Betty Neuman’s nursing process steps.
A. Nursing diagnosis
1. Database and assessment
Identification, classification, and evaluation of interactions among five client variables
Identification of stressors and resources in the intra-, inter-, and extra-personal areas
Identification and differentiation of client and caregiver perceptions
Attempt to resolve perceptual differences
2. Actual or potential variances from wellness
(These are what most other theorists call ‘nursing diagnoses’)
B. Nursing goals
1. Expected outcomes, specific desirable behavioral responses to deal with the actual or potential
variances from wellness (decided jointly by the client and the caregiver)
2. Planned interventions, specific actions of the client, the caregiver or others to effect the expected
outcomes
C. Nursing outcomes
1. Actual interventions
2. Evaluation and goal reformulation
Analysis of specific client responses
Determination of the attainment of expected outcomes
If incomplete attainment, determination of cause of non-attainment
Goal reformulation as needed
Ahmadi and Sadeghi
www.sagepub.com/msjetc 3
Table 2. Nursing process adapted according to the Neuman theory for the multiple sclerosis (MS) patient/client.
Type of patient/
client variable
Nursing diagnoses Aim Level of
prevention
Interventions
Physiological Not tolerating any activity
associated with weakness,
fatigue, and
irritability
Helping the patient/client
carry out activities
without depending on
others
Secondary Avoiding exposure to environments
with high temperatures,
taking hot showers, eating
heavy foods, too many activities,
hunger and stress, which
exacerbate fatigue.
Exercise and sports, such as
swimming and simple gestures,
as much as tolerated
Reduction in ambient noise
Avoiding too much work, resting
between work periods, and
getting adequate sleep
Compliance with energy saving
techniques, such as sitting
while showering, and brushing
teeth
Cold shower, sucking ice, using
ice packs or wet towel, when
feeling hot
Physiological Eating disorder, eating less
than what the body
needs, anorexia and
nausea
Improving the quality of
the patient/client’s
appetite, nutrition, and
proper diet
Secondary Avoidance of irritant materials
and odors
Resting before each meal to
minimize weakness
Eating in a quiet and clean
environment and devoting
enough time to it
Eating frequent meals in small
amounts
Gentle position-changing to
avoid nausea
Avoiding fatty foods, like butter,
sauces, and nuts
Avoiding fluid intake during
food intake to prevent early
satiety
Avoiding foods that contain
caffeine, such as tea, coffee,
and spicy food.
Physiological Risk of trauma and falls in
association with visual
and movement disorders,
weakness and
dizziness
Avoiding trauma, injury,
and controlling the situation
during weakness
and dizziness
Primary Availability of necessary supplies,
and avoiding disorganization
and chaos
Using appropriate shoes and
slippers
Sufficient ambient light
Keeping calm and avoiding rush
during work
Avoiding abrupt changes in a
situation to avoid dizziness
Sitting during dizziness
(continued)
Multiple Sclerosis Journal—Experimental, Translational and Clinical
4 www.sagepub.com/msjetc
Table 2. Continued
Type of patient/
client variable
Nursing diagnoses Aim Level of
prevention
Interventions
Physiological Disturbance in bowel
habits associated with
illness, weakness, and
disability
Improving the patient/client’s
defecation pattern
Secondary Assigning regular hours for
defecation, preferably an hour
after meal
Encouraging to eat high-fiber
foods such as bran, bread,
fruits, and fresh herbs
Increasing fluid intake during
the day
Activity, as much as possible
Physiological Disorders in sleep pattern,
associated with an urge
for urination, headache,
and flushing
Improving the status and
quality of sleep and rest
Secondary Reducing fluid intake in the
evening to avoid waking up at
night
Refraining from beverages containing
caffeine
Creating a quiet and peaceful
environment
Using cooling devices
Using proper cover
Physiological Disorder in reading and
writing associated with
visual disturbances, and
vertigo
Encouraging the patient/
client to use the
remaining abilities and
prevent the progression
of weakness and
faintness
Secondary
and
tertiary
Protecting eyes from sunlight
Emphasizing and encouraging
the patient/client to regularly
have a visual check-up
Resting the eyes and preventing
eye fatigue
Avoiding exposure to severe
light
Physiological Impaired skin integrity in
association with drugs,
and associated
complications
Maintaining tissue
integrity
Secondary
and
tertiary
Avoiding exposure to severe
sunlight
Encouraging the use of protective
clothing, such as hats, and
gloves
Recommending the use of
gloves when working with
detergent
Recommending brushing hair
gently and not using rough
combs
Avoiding the use of chemical
hair colors
Cold showers to stop itching
Physiological Urinary dysfunction, associated
with the disease
and bladder nerve
damage
Improving the patient/client’s
defecation pattern
Secondary
and
tertiary
Avoiding beverages containing
caffeine
Not limiting fluid intake due to
damage to the kidneys
Reducing fluid intake after
sunset
Pouring hot water on the perineal
area to stimulate urination
(continued)
Ahmadi and Sadeghi
www.sagepub.com/msjetc 5
Table 2. Continued
Type of patient/
client variable
Nursing diagnoses Aim Level of
prevention
Interventions
Encouraging to consume at least
eight glasses of fluids during
the day and reduce it before
sunset
Encouraging good hygiene to
prevent urinary tract
infections
Psychological Disruption of the concept
of ‘self’ associated with
the disease, decreased
muscle strength, power,
and weakness
1. Encouraging the
patient/client to talk
about beliefs and parameters,
such as the
concept of ‘‘self”,
power and self-efficacy.
2. Helping the patient/
client find incentives to
continue with life and
activities despite limitations
of power and
energy.
Secondary
and
tertiary
Allowing the patient/client to
express feelings, moods, and
behavior
Encouraging her to talk to other
patient/clients with MS and
participate in meetings conducted
by the Centre for
Special Diseases (MS)
Meeting children
Encouraging physical activity as
much as muscle strength
allowed
Psychological Stress and anxiety associated
with being away
from children and
family, disease, and
aggression of the spouse
Helping the patient/client
control and reduce her
stress and anxiety
Secondary Learning relaxation techniques
and distraction of negative
ideas
Personal contact and phone calls
to children and family
Encouraging patient/clients to
attend MS sports classes
Psychological Changes in sexual pattern
associated with fatigue,
and depression
Helping the patient/client
have a proper and satisfactory
relationship, as
much as possible
Secondary
and
tertiary
Family counseling
Encouraging clients to consider
the sexual needs of her spouse
to reduce stress
Rest between activities to avoid
boredom
Talking to the spouse about
emotional support to patient/
clients
psychological Avoiding loneliness, associated
with being away
from children and
family
Promoting patient/client’s
support and getting rid
of loneliness
Secondary Encouraging phone calls with
children during their absence
Encouraging the patient/client to
continue participating in
Qur’anic, sports, and art
classes
Encouraging the patient/client to
interact and communicate
with neighbors to get rid of
loneliness
Some variables including socio-cultural, psychological, and physiological variables may interact, and therefore are not repeated in the table
under the related variable.
Multiple Sclerosis Journal—Experimental, Translational and Clinical
6 www.sagepub.com/msjetc
Musculoskeletal: weakness in arms and legs, radiating
pain in the shoulder and chest, imbalance and
dizziness during attacks.
Hearing: stuffiness in the ear.
Sight: blurred vision, double vision, fluttering
objects in the visual field, reduced visual field,
inability to see beyond a distance of about 78m.
Psychological. The patient/client cannot express any
feelings about the disease, but is depressed and anxious,
looks tired and bored. In the case study, irritability
and mental pressure by the patient/client’s
husband were considered as intrapersonal factors
that caused stress. Following stress and family dissociation,
she was constantly agitated and anxious.
She needed intense mental family support.
Socio-cultural. The patient/client participates in artistic
activities and believes that she will be mentally
calm. But the patient/client cannot participate in
sports classes, held by the MS center, due to problems
of transportation and distance.
Developmental. She has been successfully engaged
in meeting developmental needs appropriate to a
middle-aged adult, for example: preparing for
menopause.
Spiritual. Considers herself a religious person. She
believes in God and prays. She participates in religious
ceremony.
Interpersonal stressors
These include (a) being away from family due to long
distance; (b) being away from children due to remote
education place; and (c) extra-personal stressors.
Results
The nursing results were used for the classification
of nursing interventions and the classification of nursing
outcomes respectively (Table 2).
Discussion
MS is a chronic disorder with no definite cure. So,
the goal of treatment is to control the signs and
symptoms, prevent further progress, and ensure
better compliance from the patient/client.
1. Communication with nurses, spouse, and
family, and getting the opportunity to express
her feelings about her situation somewhat
reduced the patient/client’s concerns, which
stemmed from her desire to get attention.
She stated that the hope for a bright future
for her children was the incentive for the rest
of her life.
2. The patient/client mentioned techniques that
she was taught to maintain her energy levels.
She became aware of the importance of resting
between activities to avoid boredom and stated
that she would try to consider resting in
between work.
3. When the patient/client became aware of the
impact of stress on the progress of her disease,
she was determined to reduce the amount of
stress in her life. Her family was also consulted
and asked to put family tensions aside to help
her.
4. The patient/client named several types of foods
that she should avoid, like fatty and spicy food,
and decided to avoid situations that decreased
her appetite, and thus, improved her nutritional
status.
5. The patient/client’s awareness of the measures
to avoid trauma caused her to avoid walking
during vertigo attacks and sit down until she
felt better.
6. The patient/client named several foods containing
fiber that helped improve the defecation
pattern. She stated that she used soaked
figs to improve her situation.
7. With regard to training to prevent fatigue, the
patient/client could do it over time, and also
understood that this could be a reason for her
spouse’s aggression. So, she decided to pay
more attention to the needs of her husband.
8. The patient/client uses proper coverage and
cooling equipment during sleep. Regarding
consumption of tea before bedtime, she
decided to cut the use of caffeine.
9. The patient/client used to go for visual examination,
but the visit intervals were long.
Considering the importance of this issue, she
decided to shorten the intervals of visit and
used protective clothing for her eyes, such as
sunglasses, when she went out into the sun.
10. She stated that she could not use gloves while
using detergents. She decided to bathe in warm
water instead of cold water.
11. The patient/client stated that she followed all
the necessary hygienic measures to prevent
urinary tract infections. She also decided to
limit the consumption of beverages containing
caffeine.
12. According to the patient/client’s statement, she
had the enthusiasm and interest to continue
participating in training classes, and she felt
lonely if she did not do so.
Conflicts of interest
The author(s) declared no potential conflicts of interest
with respect to the research, authorship, and/or
publication of this article.
Ahmadi and Sadeghi
www.sagepub.com/msjetc 7
Funding
The author(s) received no financial support for the
research, authorship, and/or publication of this
article.
References
1. Karagkouni A, Alevizos M and Theoharides TC. Effect
of stress on brain inflammation and multiple sclerosis.
Autoimmun Rev 2013; 12: 947953.
2. Mitsonis CI, Zervas IM, Mitropoulos PA, et al.
The impact of stressful life events on risk of relapse
in women with multiple sclerosis: A prospective
study. Eur Psychiatry 2008; 23: 497504.
3. Patwardhan M, Matchar D, Samsa G, et al. Cost of
multiple sclerosis by level of disability: A review of
literature. Mult Scler 2005; 11: 232239.
4. Toosy A, Ciccarelli O and Thompson A. Symptomatic
treatment and management of multiple sclerosis. Handb
Clin Neurol 2014; 122: 513562.
5. Leist T, Hunter SF, Kantor D, et al. Novel therapeutics
in multiple sclerosis management: Clinical applications.
Am J Med 2014; 127: S2.
6. Ruto C. Care of patient/clients with multiple sclerosis.
AORN J 2013; 98: 281293.
7. Halper J and Holland NJ. Comprehensive nursing care
in multiple sclerosis. Third ed. New York: Springer
Publishing Company, 2011.
8. Ghanbari A, ParsaYekta Z, FaghihZadeh S, et al.
Application in self care model to determine the influencing
factors on QOL and patient/client’s metabolic
condition. Daneshvar, Scientific-research Journal of
Shahed University [Persian] 2004; 11: 74-65.
9. Sampaio FAA, Aquino PDS, Araujo TLD, et al.
Nursing care to an ostomy patient/client: Application
of the Orem’s theory. Acta Paul enferm 2008; 21:
94100.
10. Sadeghnejad Forotaghe M, Vanaki Z and Memarian R.
The effect of nursing care plan based on
‘‘Roy Adaptation model’’ on psychological adaptation
in patient/clients with diabetes type II. Evidence Based
Care Journal [Persian] 2011; 1: 520.
11. Hamedanizadeh F, Mahmoudzadeh Zarandi F,
Ebadi A, et al. Effectiveness of implementation of
Orem self-care program on headache indices in
Migraineur [Persian]. Kowsar Medical Journal 2010;
15: 155161.
12. Knight JB. The Betty Neuman systems model applied
to practice: A client with multiple sclerosis. J Adv
Nurs 1990; 15: 447455.
13. Alligood MR and Marriner-Tomey A. Nursing
theorists and their work: Utilization & application.
Elsevier Health Sciences. St. Louis: Mosby, 2014,
pp.281293.
14. Graham MM, Lindo A, Bryan V, et al. Factors associated
with stress among second year student nurses
during clinical training in Jamaica. J Prof Nurs 2016;
32: 383391.
15. Fulbrook PR. The application of the Neuman systems
model to intensive care. Intensive Care Nurs 1991; 7:
2839.
16. Bourdeanu L and Vivien D. Assessment of
chemotherapy-induced nausea and vomiting in
women with breast cancer: A Neuman systems
model framework. Res Theory Nurs Pract 2013; 27:
296304.
17. Navarro DJ. The impact of shift work on diabetes selfmanagement
activities. DNP Thesis. School of
Nursing. University of Nevada, Las Vegas, USA,
2015.
Multiple Sclerosis Journal—Experimental, Translational and Clinical
8 www.sagepub.com/msjetc

admin

Recent Posts

Economic Debate #3- Progressive Income Tax – The Homework Helper

Economic Debate- Progressive Income Tax For this Economic Debate, we are going to discuss the…

2 years ago

MKT 6120 – Marketing Management – Davis Learning Engagement #7

TOPIC: Going Global Discussion Thread 1 (initial post due Wednesday for full credit) Please note:…

4 years ago

jvjvjhvjhvhjvj

Assignment Topic This week will culminate in the creation of a narrated PowerPoint to create…

4 years ago

Students are supposed to select a technological organization of their choice.

The Assignment must be submitted on Blackboard (WORD format only) via allocated folder. Assignments submitted…

4 years ago

Increases the risk of wildfires

you need to post your 2-page information flier to share with your Final Project Group.…

4 years ago

Statistics for Technology management

discussion: Discuss the methods used at your company to measure and ensure quality products and…

4 years ago