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Influences in Nursing
Dorothy Johnson has had an influence on nursing through her publications since the 1950s. Her publications included 4 books, more than 30 articles in periodicals, and many papers, reports and proceedings, and monographs. She believed nursing had a body of knowledge reflecting both the science and art 1959 she proposed that knowledge of the science of nursing necessary for effective nursing can included a synthesis of key concepts drawn from basic and applied sciences 1961 Johnson proposed that nursing care facilitated the clients maintenance of a state of equilibrium She proposed that clients were stressed by a stimulus of either an external or internal nature. Johnson recognized two areas of focus for nursing care that are based in giving back to the client to a state of equilibrium, or balance 1. Nursing care should lessen stimuli that are stressors 2. Nursing care should offer support of the clients normal defenses and adaptive processes 1968 Johnson first proposed her model of nursing care as the fostering of the efficient way and effective behavioral functioning in the patient to present illness She stressed the importance of research-based knowledge about the effect of nursing care on clients. 1980 Johnson made in print her conceptualization of the Behavioral System Model for Nursing. This is the first work published by Johnson that defines her definitions of the Behavioral System Model.
Metaparadigm in Nursing
Nursing
An external regulatory force acting to preserve the organization of the patients behavior by means of imposing regulatory mechanism or by providing resources while the patient is under stress An art and science that supplies assistance both before and during system balance disturbance and therefore requires knowledge of order, disorder, and control Based on this definition there are four goals of nursing are to assist the patient: 1. Whose behavior commensurate with social demands. 2. Who is able to modify his behavior in ways that it supports biological imperatives 3. Who is able to benefit to the fullest extent during illness from the physicians knowledge and skill. 4. Whose behavior does not give evidence of unnecessary trauma as a consequence of illness
Person
A person has two major systems: the biological system and the behavioral system Nursings focus is the behavioral system The person as a behavioral system has patterned, repetitive, and purposeful ways of behaving that link the person to the environment Is an elusive state that is affected by social, psychological, biological and physiological factors The individual is striving to retain some balance or equilibrium
Health
The individuals goal is to sustain the entire behavioral system efficiently and effectively but with an adequate amount of flexibility to return to an acceptable balance if a malfunction disrupts the original balance Consists of all the factors that are not part of the individuals behavior but influence the system, some of which can be manipulated by the nurse to achieve the health goal for the patient. The behavioral system attempts to maintain equilibrium in response to environmental factors by adjusting and adapting to the forces that impinge on it.
Environment
Theoretical Source
Nightingale The BSM springs from Nightingale's belief that nursing's goal is to help individuals prevent or recover from disease or injury Nursing should focus on the individual and not the disease itself Talcott Parsons acknowledged in early developmental writing presenting concepts of then BSM Systems Theory and Rapoport, Chinn and Buckley used their concepts and definitions
Theoretical Assertions
The theory addresses two major components: (1) the patient and (2) nursing. The patient is a behavioral system with seven interrelated subsystems Each subsystem can be described and analyzed in terms of structure and functional requirements. The four structural elements that have been identified include: 1. drive or goal - motivation for the behaviors 2. set - normal behavior a client prefers to meet goal; predisposition to act; 3. choice - available options a person has to meet goals; alternatives for action; 4. behavior - it will produce an observable outcome which is the individuals behavior Each of the subsystems has the same three functional requirements: 1. Protection protection from unwanted stimuli 2. Nurturance - through appropriate input of supplies from the environment 3. Stimulation - by experiences, behaviors that enhance growth and prevent stagnation
The system and subsystems tend to be self-maintaining and self-perpetuating as long as internal and
external conditions remain orderly and predictable. If the conditions and resources necessary in their functional requirements are not met, or the interrelationships among the subsystems are not harmonious, dysfunctional behavior results. The responses by the subsystems are developed through motivation, experience, and learning and are influenced by biological, psychological, and social factors. The behavioral system attempts to achieve balance by adapting to internal and environmental stimuli.
The behavioral system manages the environment. It appears to be active and not passive. The nurse is external to and interactive with the behavioral system. A state of instability in the system results in need for nursing intervention. Identification of the source of the problem in the system leads to appropriate nursing action that results in the maintenance or restoration of behavioral system balance.
Internal stressors (+) or (-) - Learning - Experience - Maturation - Other changing factors (biological, psychological, sociological)
A state of being stretched or strained and can be viewed as an end-product of a disturbance in equilibrium. Can be constructive in adaptive change or destructive in inefficient use of energy, hindering adaptation and causing potential structural damage Stressor Internal or external stimuli that produce tension and result in a degree of instability. Stimuli may be positive in that they are present; or negative in that something desired is absent.
6. Achievement Subsystem Attempts to manipulate the environment Functions to master and control the self or the environment to some standards of excellence Areas of achievement behavior include intellectual, physical, creative, mechanical and social skills 7. Aggressive/Protective Subsystem functions in self and social protection and preservation This follows the line of thinking of ethologists such as Lorenz and Feshbach rather than the behavioral reinforcement school of thought, which contends that aggressive behavior is not only learned, but has a primary intent to harm others. Society demands that limits be placed on modes of self-protection and that people and their property be respected and protected
Analysis
Simplicity Johnsons theory is relatively simple in relation to the number of concepts. A person is described as a behavioral system composed of seven subsystems. Nursing is an external regulatory force. However, the theory is potentially complex because there is a number of a possible interrelationship between and among the behavioral system, its subsystems, and the forces impinging on them. Generality Relatively unlimited when applied to sick individuals, but it has not been used as much with well individuals or groups. Perceives a person as a behavioral system comprised of seven subsystems, aggregates of interactive behavioral systems.
Nursings special responsibility for health is derived from its unique social mission. Nursing needs to concentrate on developing preventive nursing to fulfill its social obligations.
Empirical Precision Empirical precision improves when the subconcepts and the relationships between and among the subconcepts become better defined and empirical indicators are introduced to the science. The units and the relationships between the units in Johnsons theory are consistently defined and used. The clarity of definitions in the subsystems improves the models empirical precision. Derivable Consequences Guides nursing practice, education, and research; generates new ideas about nursing; and differentiates nursing from other health professions. The theory clearly differentiates nursing from medicine, although the concepts overlap with the psychosocial professions. Provides a conceptual framework for nursing education, practice and research. Practitioners and patients have judged the resulting nursing actions to be satisfactory.
References: Tomey, A. & Alligood, M. (2002). Nursing theorists and their work. (5th ed.). Mosby Inc. George, J. Nursing theories: The base for professional nursing practice. (5th ed.). Pearson Prentice Hall McEwen, W. & Wills, E. Theoretical basis for nursing. (2nd ed.). Lippincott Williams & Wilkins. Octaviano, E. & Balita, C. Theoretical foundation of Nursing: The Philippine perspective. Ultimate Learning Series http://www.mc.vanderbilt.edu/biolib/hc/biopages/djohnson.html