Martes, Marso 20, 2012

Dorothy E. Johnson

Behavioral System Model
“Each individual has a predisposition to act, with reference to the goal, in certain ways rather than in other ways.”
Getting to know her:
  • Born in Savannah, Georgia in August 21, 1919
  • Youngest in a family of seven
  • Her father was the superintendent of a shrimp and oyster factory and her mother was very involved and enjoyed reading.
  • Obtained her Bachelor of Science in nursing degree from Vanderbilt University, Nashville and Tennessee
  • Masters in Public Health from Harvard University in Boston, Massachusetts.
  • Education career was in Pediatric Nursing at the University of California, Los Angeles.
  • Johnson was proudest of the 1975 Faculty Award from graduate students.
  • 1977- Lulu HassenplugDistinguished Achievement Award from the California Nurses’ Association.
  • She withdrew from the academe as a Professor Emeritus at January 1, 1978
  • 1981- Vanderbilt University School of Nursing Award for Excellence in Nursing.
  • Died in February 1999 at the age of 80
Getting to know the theory:
  • The creation of her theory began in the 1940′s when she began to teach.
  • She began to use different ways to build and present knowledge and began to change her practice based on the outcomes.
  • In 1950′s she was influenced nursing through her publications. She early advocate of Nursing as a Science and Art.
  • In 1961, Johnson proposed that nursing care facilitated the client’s maintenance of state of equilibrium.
  • 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 projected that clients were “stressed” by a stimulus of either an internal or external nature.
  • In 1992, Johnson uttered that much of her thinking was influenced by Florence Nightingale’ book, Notes on Nursing.
Meta paradigm in Nursing:

Person
Two major systems:
  1. Biological System–medicine’s focus
  2. Behavioral System–nursing’s focus
Health
  • Supports the idea that the individual is attempting to maintain some balance or equilibrium.
Environment
  • Relates to the environment in which the individual exists.
  • Influenced by all events in the environment.
Nursing
  • Primary goal is to foster equilibrium within the individual, which allows for the practice with individuals at any point in the health-illness continuum.
ASSUMPTIONS
There are several layers of assumptions that Johnson makes in the development of conceptualization of the behavioral system model viz.
  • Assumptions about system
  • Assumptions about structure
  • Assumptions about functions
Assumptions about system

There are 4 assumptions of system:
  1. First, there is “organization, interaction, interdependency and integration of the parts and elements of behaviors that go to make up the system ”
  2.  A system “tends to achieve a balance among the various forces operating within and upon it’, and that man strive continually to maintain a behavioral system balance and steady state by more or less automatic adjustments and adaptations to the natural forces impinging upon him.”
  3. A behavioral system, which both requires and results in some degree of regularity and constancy in behavior, is essential to man who is to say, it is functionally significant in that it serves a useful purpose, both in social life and for the individual.
  4. Last, “system balance reflects adjustments and adaptations that are successful in some way and to some degree.”.
Assumptions about structure and function of each subsystem
  • “from the form the behavior takes and the consequences it achieves can be inferred what “drive” has been stimulated or what “goal” is being sought”
  • Each individual has a “predisposition to act with reference to the goal, in certain ways rather than the other ways”. This predisposition is called as “set”.
  • Each subsystem has a repertoire of choices or “scope of action”
  • The fourth assumption is that it produce “observable outcome” that is the individual’s behavior.
Each subsystem has three functional requirements
  1. System must be “protected” from noxious influences with which system cannot cope”.
  2. Each subsystem must be “nurtured” through the input of appropriate supplies from the environment.
  3. Each subsystem must be “stimulated” for use to enhance growth and prevent stagnation.
  • These behaviors are “orderly, purposeful and predictable and sufficiently stable and recurrent to be amenable to description and explanation”

    7 Behavioral Subsystem

    • Attachment or affiliative subsystem: “social inclusion intimacy and the formation and attachment of a strong social bond.”
    • Dependency subsystem: “approval, attention or recognition and physical assistance”
    • Ingestive subsystem: “the emphasis is on the meaning and structures of the social events surrounding the occasion when the food is eaten”
    • Eliminative subsystem: “human cultures have defined different socially acceptable behaviors for excretion of waste ,but the existence of such a pattern remains different from culture to Culture.”
    • Sexual subsystem:” both biological and social factor affect the behavior in the sexual subsystem”
    • Aggressive subsystem: “ it relates to the behaviors concerned with protection and self-preservation Johnson views aggressive subsystem as one that generates a defensive response from the individual when life or territory is being threatened”
    • Achievement subsystem: “ provokes behavior that attempt to control the environment intellectual, physical, creative, mechanical and social skills achievement are some of the areas that Johnson recognizes”.

      Representation of Johnson’s Model


      Goal —– Set — Choice of Behavior — Behavior


      • Affiliation
      • Dependency
      • Sexuality
      • Aggression
      • Elimination
      • Ingestion
      • Achievement

      Nursing process

      Assessment

      Grubs developed an assessment tool based on Johnson’s seven subsystems plus a subsystem she labeled as restorative which focused on activities of daily living. An assessment based on behavioral model does not easily permit the nurse to gather detailed information about the biological systems:

      • Affiliation
      • Dependency
      • Sexuality
      • Aggression
      • Elimination
      • Ingestion
      • Achievement
      • Restorative

      Diagnosis

      Diagnosis tends to be general to the system than specific to the problem. Grub has proposed 4 categories of nursing diagnosis derived from Johnson’s behavioral system model:
      • Insufficiency
      • Discrepancy
      • Incompatibility
      • Dominance

      Planning and implementation

      Implementation of the nursing care related to the diagnosis may be difficult because of lack of clients input in to the plan. the plan will focus on nurses actions to modify clients behavior, these plan than have a goal ,to bring about homeostasis in a subsystem, based on nursing assessment of the individuals drive, set behavior, repertoire, and observable behavior. The plan may include protection, nurturing or stimulation of the identified subsystem.

      Evaluation

      Evaluation is based on the attainment of a goal of balance in the identified subsystems. If the baseline data are available for an individual, the nurse may have goal for the individual to return to the baseline behavior. If the alterations in the behavior that are planned do occur, the nurse should be able to observe the return to the previous behavior patterns. Johnson’s behavioral model with the nursing process is a nurse centered activity, with the nurse determining the clients needs and state behavior appropriate for that need.

      Johnson’s and Characteristics of a theory

      • Interrelate concepts to create a different way of viewing a phenomenon – Concepts in Johnson’s theory are interrelated.
      • Theories must be logical in nature- Johnson’s theory is logical in nature.
      • Theories must be simple yet generalizable – The theory is simple.
      • Theories can be bases of hypothesis that can be tested – Research studies are conducted applying Jonhson’s theory.
      • Theories contribute to and assist in increasing the body of knowledge within the discipline through the research implemented to validate them.
      • Theories can be utilized by practitioners to guide and improve their practice.
      • Theories must be consistent with other validated theories, laws and principles but will leave unanswered questions that need to be investigated.

      Limitation

      • Johnson does not clearly interrelate her concepts of subsystems comprising the behavioral system model.
      • The definition of concept is so abstract that they are difficult to use.
      • It is difficult to test Johnson’s model by development of hypothesis.
      • The focus on the behavioral system makes it difficult for nurses to work with physically impaired individual to use this theory.
      • The model is very individual oriented so the nurses working with the group have difficulty in its implementation.
      • The model is very individual oriented so the family of the client is only considered as an environment.
      • Johnson does not define the expected outcomes when one of the system is affected by the nursing implementation an implicit expectation is made that all human in all cultures will attain same outcome –homeostasis.
      • Johnson’s behavioral system model is not flexible.

      Summary

      Johnson’s Behavioral system model is a model of nursing care that advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness. The patient is defined as behavioral system composed of 7 behavioral subsystems. Each subsystem composed of four structural characteristics i.e. drives, set, choices and observable behavior.
      Three functional requirement of each subsystem includes
      • (1) Protection from noxious influences,
      • (2) Provision for the nurturing environment, and
      • (3) stimulation for growth.
      Any imbalance in each system results in disequilibrium .it is nursing role to assist the client to return to the state of equilibrium.
References:
Balita, Carl & Octaviano, Eufemia F.  Theooretical foundation of Nursing: The Philippine Perspective (p. 108-113)
http://dorothyjohnson.wetpaint.com/

Created by:
Kimberly B. Navales
Erica Kane L. Salilin

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