NU 500 Advanced Nursing Theory October 21, 2009

Biographical Information  Born August 21 st, 1919, in Savannah, Georgia  Professional nursing career began in 1942 when she graduated from Vanderbilt University in Nashville, TN with her BSN  Was the top student in her class and received the prestigious Vanderbilt Founder’s Medal  Most professional experiences involved teaching although she was a staff nurse at the Chatham-Savannah Health Council from 1943 to  Returned to Vanderbilt in 1944 as an instructor and an assistant professor in pediatric nursing.

 Received her MPH in 1948 from Harvard University  Taught at UCLA starting in 1949 where she served as an assistant professor of pediatric nursing, associate professor of nursing, and a professor nursing until her retirement as Professor Emeritus in  In 1955 and 1956, she was a pediatric nursing advisor assigned to the Christian Medical College School of Nursing in Vellore, South India.  From 1965 to 1967 she chaired the committee of the California Nurses’ Association that developed a position statement on specifications for the clinical specialist.  Dorothy and one of her classmates, Lulu K. Wolf Hassenplug, developed the first four year generic basic nursing program in the US at UCLA.

 Publications include 4 books, more than 30 articles, and many report, proceedings, and monographs. First began thinking about her model in the 1940’s when she was teaching.  First presented her basic ideas for Behavioral System Model (BSM) in her 1959 journal article “A Philosophy of Nursing,” and in her 1961 journal article, “The Significance of Nursing Care.”  Did not present her entire conceptual model in literature until she authored a book chapter in Riehl and Roy’s second edition book Conceptual Models for Nursing Practice.  Before the book publication, the only public records of the model were of a paper she presented at Vanderbilt in 1968 titled “One Conceptual Model of Nursing.”  She did not present any major revisions in her model after the book chapter. She did discuss and provide more detail in her 1990 book chapter “The Behavioral System Model for Nursing.”

 Received many awards but was proudest of 1975 Faculty Award from the graduate students at UCLA, the 1977 Lulu Hassenplug Distinguished Achievement Award from the California Nurses’ Association, and the 1981 Vanderbilt University School of Nursing Award for Excellence in Nursing.  Moved to Florida after her retirement and lived there until she passed away in 1999.

“Although nurses perform functions related to delegated medical care, the essence of nursing, it’s central mission, should lie in “nursing care.” “When the latter is defined, when the specific goals are articulated, then we will be able to speak of a science of nursing.” (Johnson)  Asserted that what differentiates nursing from medicine and other health sciences is its perspective of a nursing client as a behavioral system.  Her conceptualization of nursing is based on the premise that nursing has a unique, independent contribution to healthcare that is distinct from its delegated dependent contributions. All contributions delegated to nurses and unique to patient care and cure are significant, but, as professionals, nurses are obligated to articulate and communicate to the public their primary mission and their nursing goals as well as their secondary mission that is delegated from medicine.

 Stems from Nightengale’s belief that nursing’s goal is to help individuals prevent or recover from disease or injury. Nursing focuses on the basic needs of the person and has concern for relationship between the person and the environment. It is concerned about the person who is ill and not the illness.  Is based on a pre-existent body of knowledge and is developed from a number of different disciplines including psychology, sociology, and ethnology.  Uses concepts from other disciplines including social learning, motivation, sensory stimulation, adaptation, tension, and stress.  Relies heavily on the “systems theory. “ A system consists of interrelated parts functioning as a whole.  Goal of the model is to maintain and restore balance in the patient by helping him achieve a more optimal level of functioning.  Johnson used observations of behavior over many years to formulate a general theory of man as a behavioral system. The model focuses on social behavior.  Behavior is the sum total of biologic, social, cultural, and psychological behaviors. It is goal oriented and goals are an organizing framework for all behavior.  Is a conceptual grand theory

 A behavioral system, composed of 7 subsystems (each of which have a structural and functional component), in which the functional outcome is observed behavior.  A behavioral system with patterned, repetitive, and purposeful ways of behaving that link him to the environment. An individual’s specific response patterns form an organized and integrated whole.  A person is a system of interdependent parts that requires some regularity and adjustment to maintain a balance.

 “An external regulatory force which acts to preserve the organization and integration of the patient’s behaviors at an optimum level under those conditions in which the behaviors constitutes a threat to the physical or social health, or in which illness is found.  Does not depend on medical authority but is complimentary to medicine.  Goal of nursing care emphasizes balance, order, stability, and maintenance of the integrity of the patient.  Focuses on the behavioral system whereas medicine focuses on the biological system.

 Perceived by Johnson as an elusive, dynamic state influenced by biological, psychological, and social factors.  It is desired value by health professionals and focuses on the person rather than the illness.  Is reflected by the organization, interaction, interdependence, and integration of the subsystems of the behavioral system. One attempts to achieve a balance in this system, which will lead to functional behavior.  Lack of balance in the structural or functional requirements of the subsystems leads to poor health.  Is not defined explicitly by Johnson

 Consists of all the factors that are not part of the individual’s behavioral system but influence the system, some of which can be manipulated by the nurse to achieve the health goal for the patient.  Behavioral system attempts to maintain equilibrium in response to environmental factors by adjusting and adapting to the forces that impinge on it. Excessively strong environmental forces disturb the behavioral system balance and threaten the person’s stability. An unusual amount of energy is required for the system to reestablish equilibrium in the face of continuing forces. When the environment is stable, the individual is able to continue with successful behaviors.  Has 2 dimensions: internal and external environment.  Is not well defined by Johnson.

 There are 7 behavioral subsystems that comprise each individual. Each of theses subsystems has a functional (3 components) and structural (4 components) requirements to them.  Motivational drives direct the activities of these subsystems which are continually changing because of maturation, experience, and learning and are influenced by biological, psychological, and social factors.  Systems and subsystems tend to be self-maintaining and self- perpetuating as long as internal and external conditions remain orderly and predictable, the conditions and resources necessary to meet their functional requirements are met, and the interrelationships among the subsystems remain harmonious. If these conditions are not met (i.e. illness), malfunction is apparent in behavior which in part becomes disorganized, erratic, and nonfunctional. When there is a disturbance, nursing care is indicated.  Input and output are components of all seven subsystems.

 Attachment or affiliative- provides survival and security. Consequences are social inclusion, intimacy, and formation and maintenance of a strong social bond.  Dependency - Consequences are approval, attention or recognition, and physical assistance.  Eliminative - function is elimination in terms of when, how, and under what conditions the individual eliminates waste.  Ingestive -function is appetite satisfaction in terms of when, how, what, how much, and under what conditions the individual eats, all of which is governed by social and psychological considerations as well as biological requirements for food and fluids.  Sexual- dual functions of procreation and gratification. Includes, but not limited to, courting and mating. Begins with the development of gender role identity and includes range of sex role behaviors.  Achievement- function is control or mastery of self or environment to some standard of excellence. Includes intellectual, physical, creative, mechanical, and social skills.  Aggressive/protective- function is protection and preservation.

STRUCTURALFUNCTIONAL  Drive or goal -the motivation for behavior  Set -the individual’s predisposition to act in certain ways to fulfill the function of the subsystem.  Choice -the individual’s total behavioral repertoire for fulfilling subsystem functions, which encompasses the scope of action alternatives from which the person can choose.  Action -the individual’s actual behavior in a situation. It is the only structural element that can be observed directly; all other elements must be inferred from the individual’s actual behavior and from the consequences of that behavior.  Protection- from noxious influences with which the system cannot cope  Nurturance- through the input of appropriate supplies from the environment  Stimulation- to enhance growth and prevent stagnation

 Significance: meets in part. She clearly defines person and nursing. She does not clearly define environment, health and illness explicitly. Inferences have to be made about what she meant in regard to these topics. Johnson acknowledges the contributions of other theorists, specifically Nightingale, and other disciplines.  Internal consistency: meets. The context and content of the theory are congruent. They reflect semantic clarity and consistency and reflects structural consistency.  Parsimony: meets. Theory content is stated clearly and concisely.  Testability: meets. There are several research instruments, practice tools, descriptive studies and correlation studies to apply the theory with.  Empirical Adequacy: meets. Findings from studies are congruent with the concepts and propositions of the grand theory. Theoretical assertions are congruent with empirical evidence for middle- range theories.  Pragmatic Adequacy- meets. Is useable in everyday practice especially as one fully understands the vocabulary. Is used as a basis for nursing practice at the UCLA Neuropsychiatric Institute and Hospital.

JOHNSON(1980’S )  Human Being: Client/client system Environment:  All internal, external and created factors  Behaivoral system  Internal and external environment NEUMAN (1970) Roy (1970’s) Adaptive system Internal and external stimuli

NEUMAN JOHNSON Health: “wellness” all parts of client are in harmony or balance Nursing: Concerned with all stressors, even potential Purposeful balance and stability An external regulatory force Roy State of adaptation -process of promoting integrity Support and promote pt adaptation

World view Neuman Reciprocal world view Johnson Reciprocal world view Roy Reciprocal world view

Johnson: Client is a behaivoral system 7Behaivoral subsystems, each with 4 structural components and a function -client is an individual Roy Client is an adaptive system -2 adaaptive subsystems and 4 adaptive models Neuman Physiological, psychological, sociological, develepmental, and spiritual variables. Client represented as central structure, lines of defense and resistance. Client is biopsychocsocial, person can be broken down into parts for study/care, system’s theory, holistic view of client, client interacts with environment, client is center focus, nursing facilitates client’s progress toward some balance, weak definition of nurse-patient relations, psychological, biological and sociological aspects of the client are recognized

 Actual Interview of Ms. Johnson by Jacqueline Fawcett!

 Fawcett, J. (2005). Contemporary Nursing Knowledge: Analysis and Evaluation of Nursing Models and Theories (2 nd ed.). Philadelphia: F.A. Davis.