Dorothy Johnson Model Presentation revision

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Dorothy Johnson's Behavioral System Model in Nursing Practice: 

Group 5 Dorothy Johnson's Behavioral System Model in Nursing Practice

Inspiration for the Behavioral System Model : 

Inspiration for the Behavioral System Model Florence Nightingale Grand Theorist: Nursing Hans Selye Endocrinologist: Father of Stress Talcott Parsons Sociologist: Social Action Theory Model was also inspired by behavioral scientists in psychology, sociology, and ethnology and System Theory scientist .

Dorothy Johnson’s Perspective: 

Dorothy Johnson ’ s Perspective

Major Concepts: 

Attachment- Affiliative Subsystem Dependency Subsystem Ingestive Subsystem Eliminative Subsystem Sexual Subsystem Achievment Subsystem Aggressive-Protective Subsystem Equilibrium Major Concepts

The Four Metapardigms: 

The Four Metapardigms External force that acts to impose temporary regulatory/ control mechanisms / providing resources while patient is experiencing stress Is a behavioral system with patterned repetitive, and purposeful ways of behaving that link the person and the environment The organization, interaction, interdependence and integration of the subsystem of the behavioral system (the person). All the factors that are not a part of the Individuals behavioral system, but influence it.

central theme/concepts of the nursing theorist : 

“ The Behavioral System Model ” this model was developed from a philosophical perspective and was inspired by Florence Nightingale ’ s book Notes on Nursing ; and influenced Hans Selye the “ Father of Stress ” ; and Talcott Parsons Social Action Theory which stressed a structural-functional approach. Theory relied on the work of behavioral scientists in psychology, sociology and ethnology and system theory. The model is reflective of her mostly academic professional career. The central theme of the model is based on nursing contributing to patient welfare through “ efficient and effective behavioral functioning in the person, both to prevent illness and during and following illness. central theme/concepts of the nursing theorist

describes or defines the traditional four metaparadigm : 

Nurse - External force that acts to impose temporary regulatory/ control mechanisms / providing resources while patient is experiencing stress Person - Is a behavioral system with patterned repetitive, and purposeful ways of behaving that link the person and the environment Health - The organization, interaction, interdependence and integration of the subsystem of the behavioral system (the person). Environment - All the factors that are not a part of the individuals behavioral system, but influence it. describes or defines the traditional four metaparadigm

Dorothy Johnson’s Behavior Model: 

Johnson ’ s Definition of Nursing: “ an external regulatory force which acts to preserve the organization and integration of the patients 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. ” Dorothy Johnson ’ s Behavior Model

7 Subsystems: 

7 Subsystems Attachment-goal attached- form relationship and social bonds. Dependency- attention, recognition, physical assistance. Ingestion- intake of nutrients to obtain knowledge. Eliminative- eliminate waste and to express knowledge. Sexual- to procreate, to have sexual relationships, to develop gender based identity. Achievement- mastery or control of some aspect of the environment. Aggressive-Protective- protect oneself to respond to threats.

Concept: 

Goal- become healthy Set- one ’ s predisposition Choice of behavior- how they decide to achieve goal Behavior- physical manifestation Concept

Theory on wellness or illness : 

One ’ s behavior and attitude toward their wellness and illness can directly affect their ability to feel well or get well. Based on Johnson ’ s definition, “ nursing is an external regulatory force which acts to preserve the organization and integration of the patients 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. ” (Treece, 1982) A representation of Johnson ’ s model is to have a “ goal ” , “ set ” , “ choice of behavior ” , then “ behavior ” . If a person is sick, their goal is to become healthy. The set describes one ’ s predisposition to achieve their goal. The set will likely influence how they behave in order to become healthy. The behavior is the actual manifestation of their path to reach their goal. This model is basically a plan of action mentally, that comes to life physically through a person ’ s own behavior. Theory on wellness or illness

article that demonstrates the nursing theory : 

Journal of the American Psychiatric Nurses Association Volume 3, Issue 3, June 1997, Pages 73–80 The Johnson Behavioral Systems Model as a framework for patient outcome evaluation. This theory was put into practice by Poster, Dee, Randell in their work titled “ The Johnson Behavioral System as a Framework for patient outcome evaluation published in the journal of the American psychiatric nurses association 1997, the study was done in Los Angeles neuropsychiatric hospital in LA.Ca. In this study the authors evaluated medical records of 380 patients. They use the predicted outcome instrument developed by the author based on DJBSM and found out that by using a conceptual framework such that of DJBSM they increased the overall projected outcome by 80%. The nursing theoretical framework made it possible to prescribed nursing care as a distinction from medical care. article that demonstrates the nursing theory

article that demonstrates the nursing theory : 

Person - Johnson viewed person as a behavioral system with patterned, repetitive, and purposeful ways of behaving that link the person with the environment. Society - In Johnson ’ s theory, the environment consists of all the factors that are not part of the individual ’ s behavioral system, but that influence the system. Health - It is reflected by the organization, interaction, interdependence ,and integration of the subsystems of the behavioral system. Nursing - An art and a science, nursing supplies external assistance both before and during system balance disturbance and therefore requires knowledge of order, disorder, and control article that demonstrates the nursing theory The four major concepts

Philosophical basis: 

FLORENCE NIGHTINGALE ( NOTES IN NURSING ) Relationship between the ill person and his environment. Prevent disease or injury reducing stress support natural adaptive process Philosophical basis

Conceptual basis: 

a) Parsons social action theory(1951,1964) = 1) By functionalism it means that every observable social behavior has a function to perform 2) Structuralism it means social behaviors are expressions of deep underlying structures in the social system. b) Rapoport ’ s system theory (1968) A system is a whole that function as a whole by virtue of interdependence of its parts. Johnson conceptualized the person as a behavioral system with interrelated subsystem. c) She use concepts from other discipline such as social learning, motivation, sensory stimulation, adaptation, behavioral modification, change process, tension, and stress to expand her theory. Conceptual basis

Conceptual basis: 

1) Attachment or affilliative subsystem based on citation from the work of Ainsworth and Robson 2) Dependency subsystem Was based on the work of Heathers, Gerwitz, Rosenthal 3) Ingestive subsystem and Eliminative subsystem Supported by the work of Walile, Mead, and sears 4) Sexual subsystem Based on the work of Kagan, and resnik 5) Achievement subsystem Atkinson, Feather, Crandell in which they explained that physcial, creative, mechanical, and social skills are manifested by achievement behavior. 6) Aggressive subsystem Supported by Lorenz and Feshback Conceptual basis

strengths: 

strengths Theories Interrelate concepts to create a different way of viewing phenomenon- concepts in Johnson ’ s theory are consistently interrelated. Theories must be logical in nature - so is Johnson ’ s theory Theories must be simple yet generalized . Johnson ’ s theory is simple. Theories can be basis of hypotheses that can be tested- some research studies are conducted applying Johnson ’ s theory Johnson ’ s theory provided contribution and assisted in increasing body Of knowledge within the discipline thus allowing future researchers the ability to retest and clarify assumptions that lack clarity 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 .

Theory applied : 

Education - used and utilized in nursing education curriculum in US, Canada and Australia. Administration - to structure administration departments of clinical agencies. Research - been conducted in various patient populations. Clinical Setting - used in inpatient , outpatient and community settings. The model is used to develop nursing interventions for the patients. Theory applied

Theoretical Assertion: 

7 Subsystems 1. Attachment- Affiliative 2. Dependency 3. Ingestive 4. Eliminative 5. Sexual 6. Achievement 7. Aggressive-Protective Theoretical Assertion

Johnson’s Behavioral System Model: 

Johnson ’ s Behavioral System Model Internal stressor + or – Experience Maturation Health Change Process Dynamic Environment Nursing action Nurture Protect stimulate Structure Drive Set, choice Dynamic equilibrium A dynamic Behavioral System Person,group,family Stress tolerance External Stressors + or - Tension Health or Illness Cue SUBSYSTEM Attachment/Affilliative Achievement Sexual Aggressive Dependency Ingestive/Eliminative

4 Structural Requirement: 

1. Drive or Goal – the motivation for behavior 2. Set – a person ’ s predisposition to act in a certain way to fulfill the function of the subsystem 3. Choice – a person ’ s repertoire of actions from which choices can be made 4. Action or Observable behavior 4 Structural Requirement

3 functional Requirement: 

1. Protection from noxious influences 2 . Nurture through input from the environment 3 . Stimulation for growth and prevention from stagnation 3 functional Requirement

Logical Form: 

1. Identify the behavioral system 2. Explain the properties and behavior of the system 3. Explain the properties and behavior of the subsystem as a part or function of the system Logical Form

limitations/weaknesses: 

limitations/weaknesses Johnson ’ s theory is broad and complex to a number of possible interrelationships among the behavioral system, thus more empirical work is needed. The definition of concept is so abstract that they are difficult to use. The model is very individual oriented so nurses working with the group have difficulty in its implementation. Use of family ,group and communities are limited. The model does not focus well or address the paradigm of health promotion and disease prevention. Limited publication of Johnson ’ s theory and research has hindered the pervasiveness of the behavioral model.

limitations/weaknesses: 

The theory lacks proactive approach. It focuses on the nursing care of the hospitalized and ill stricken patient and does not address health promotion, primary prevention, or disease prevention. The theory focuses on how human behavior responses to stress or illness but does not incorporate the nursing process (assessment, diagnosis, planning, and implementation). Limited publication and research has hindered the credibility of her theory. limitations/weaknesses

Compatibility with Nursing Practice: 

Nursing as external force to preserve patient behavior to an optimal level by imposing temporary regulatory mechanism while patient is experiencing behavior system imbalance (Brown, 2006) Yes, Johnson ’ s behavioral model has been tested and implemented in research, administration, and nursing practice. The model clearly identified the goal of nursing which is to maintain, and restore equilibrium for the patients while they in distress. Compatibility with Nursing Practice

Acceptance by the Nursing Community : 

Practice : Develop a self-report and observational instrument The implementation of the instrument. Education: C enter on the patient as a behavioral system and its dysfunctions . K nowledge from the social and behavioral disciplines and the physical and biological sciences. Research: E xplain and identify behavioral system disorders. I nfluences to the researcher to choose between two options. 1.Examine the functioning of the system and subsystems. 2.Investigating methods of gathering diagnostic data. Acceptance by the Nursing Community

How does the theory address the priority of patient care : 

3 Functional R equirements: 1. Protection from noxious influence 2. Provision for nurturing environment 3. Stimulation for growth How does the theory address the priority of patient care

Theory application: 

72 year old male , widower who recently move into a residential facility after he was discharged from an acute hospital due to fall injury . History of CHF , HTN, Atrial Flutter, and DM II. On several anti-hypertensive, anti -CHF, anti -diabetic and anti-coagulant medications. Recent hospitalization secondary to syncope thus sustaining fall injury. Theory application

7 Subsystem Behavioral Assessment: 

Achievement: Plumber for 40 years; living independently until recently when he moved to a residential facility. Attachment-Affiliative: Patient is a widower whose only living relative is his only daughter. Aggressive-Protective: Worries about his personal belongings in his apartment and his daughter ’ s multiple medical problems. Dependency: Due to recent fall injury and inability to manage his multiple medications, he was deemed unsafe to live by himself. 7 Subsystem Behavioral Assessment

7 Subsystem Behavioral Assessment: 

Ingestive : Since the patient move to a residential facility, he has been depressed and has decreased appetite. Eliminative : Patient is continent of bladder and bowel ; needs assistance in going to the bathroom, as provided by the caregivers in the group home and a bedside commode that he uses at night. Sexual : Patient has been widowed for 20 years and has not remarried. 7 Subsystem Behavioral Assessment

Environmental Assessment: 

Residential facility caregivers provide 24 hour supervision. Medication management to be provided in the facility. Bedside commode, walker, hospital bed, shower chair. CNA visit for personal care: bathing, dressing and other ADL assistance. Home Health Nurse. Environmental Assessment

Structural Components : 

Drive: Patient has a supportive daughter who plans on visiting him several times a week and if allowed will go out to lunch with him. Set: Able to accept and had participated in the decision that it is now unsafe for him to be living independently. Choice: His choice to allow help and assistance from caregivers, CNA and home health nurse. Actions: Participating in his ADL ’ s, interacting with other residential facility residents; have asked daughter to secure his personal belongings. Structural Components

Functional Requirements: 

Protection : Safety mechanisms in place. Nurturance : Caregivers, his daughter, CNA, Home health nurse. Stimulation : Socialization , frequent visit by his daughter who live in the same city. Functional Requirements

Further development: 

Johnson ’ s theory and ideas have helped changed the focus of nursing graduate programs from teaching and administration to clinical nurse specialist and nurse practitioner programs (Johnson & Weber 2005). Johnson ’ s theory have helped to distinguish nursing and promote professionalism and has been used as a guide for nursing education programs at the University of Colorado, University of California, University of Hawaii and California State University. The Behavioral Model has been used to structure administration departments of clinical agencies. At UCLA Neuropsychiatric Institute and Hospital, researchers Lewis and Randell developed a nursing diagnostic system based on Johnson Behavioral Model. Glennin (1980) developed standards for nursing practice for hospitalized patients receiving acute care based on the Behavioral Model Further development

Further development: 

Derdarian researched the use Johnson ’ s model and found that by using the behavioral model nurses developed more quality nursing diagnosis, more specific interventions, improved evaluation of outcomes and discharge plans (Fawcett, 1995). Research based on Johnson ’ s model has been conducted in various patient populations including the visually impaired, elementary school children, and cancer patients (Johnson & Weber 2005). Several researchers have developed tools to measure the concepts proposed in the behavioral Model. The behavioral model has also been used by Herbert (1989) to guide the care of a stroke patient suffering from hemiplegia (Fawcett, 1984). Further development

critique: 

Clarity: Johnson does not clearly interrelate her concepts of subsystems comprising the behavioral system model. Specificity or Generality : the model is very individual oriented so the nurses working with the group have difficulty in its implementation. Simplicity: the definition of concept is so abstract that they are difficult to use. Accessibility : the focus on the behavioral system makes it difficult for nurses to work with physically impaired individual to use this theory. Scope: 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 Model is not flexible. critique

Qsen competencies: 

Using the Institute of Medicine (2003) competencies for nursing, QSEN faculty have defined pre-licensure and graduate quality and safety competencies for nursing and proposed targets for the knowledge, skills, and attitudes to be developed in nursing pre-licensure programs for each competency: Patient-Centered Care : Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs. Teamwork & Collaboration : Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care. Evidence Based Practice : Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care Qsen competencies

Qsen competencies: 

Quality Improvement : Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems. Safety : Minimizes risk of harm to patients and providers through both system effectiveness and individual performance. Informatics : Use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Led by a national advisory board and distinguished faculty, QSEN pursues strategies to build will and develop effective teaching approaches to assure that future graduates develop competencies in patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. Qsen competencies

summary: 

Johnson ’ s Behavioral system is a model of nursing care that advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness. Patient is define as BEHAVIORAL SYSTEM composed of 7 behavioral subsystems: Achievement Attachment-Affiliative Aggressive –Protective Dependency Ingestive Eliminative Sexual Each subsystem composed of four structural characteristics: Drive Set Choices Observable Behavior summary

summary: 

Three functional requirement of each subsystem includes: Protection from noxious influences (Johnson, 1980) Provision for the nurturing environment (Johnson, 1980) Stimulation growth (Johnson, 1980) Any imbalance in each system results in disequilibrium. It is nursing role to assist the client to return to the state of equilibrium. summary

summary: 

Using Quality and Safety Competencies (Institute of Medicine) for Nursing Patient-Centered Care: patient or designee as source control and partner. Evidence-Based Practice: integrate current evidence with clinical expertise and patient/family preference. Quality Improvement: use data to monitor outcomes of care processes and use improvement methods. Safety: minimizes risk of harm to patients and provider. Informatics: use information and technology to communicate, manage knowledge, mitigate error and support decision-making. QSEN pursues strategies to develop effective teaching approaches to assure future graduates. summary

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