Dorothy-Johnson.pdf

LET US PRAY BEHAVIORAL SYSTEM MODEL (BSM)1968 DOROTHY E. JOHNSON August 21, 1919-February 4, 1999 Screengrab from Johnson's interview about her Behavioral Systems Model TOPIC LEARNING OUTCOME: At the end of this class the learner should be able to: Discuss the importance and purpose of Doro...

LET US PRAY BEHAVIORAL SYSTEM MODEL (BSM)1968 DOROTHY E. JOHNSON August 21, 1919-February 4, 1999 Screengrab from Johnson's interview about her Behavioral Systems Model TOPIC LEARNING OUTCOME: At the end of this class the learner should be able to: Discuss the importance and purpose of Dorothy Johnson’s theory of Behavioral System Model. Discuss the different metaparadigm of Behavioral System Model theory. Simplify the main ideas of the theory presented by relating it to everyday situations.  CREDENTIALS AND BACKGROUND August 21, 1919: Born in Savannah, Georgia, USA 1938: Received A.A. from Armstrong Junior College in Savannah, Georgia 1942: Received BSN from Vanderbilt University in Nashville, Tennessee 1948: Received MPH (Master of Public Health) from Harvard University in Boston, Massachusetts  CREDENTIALS AND BACKGROUND 1944-1949: Assistant Professor of Pediatric Nursing at Vanderbilt University 1949-1978: Assistant Professor of Pediatric Nursing, an Associate Professor of Nursing, and a Professor of Nursing at UCLA January 1979: Professor Emeritus at UCLA February 4, 1999: Passed away in Key Largo, Florida, USA (80 years old) THEORETICAL SOURCES Heavily influenced by Florence Nightingale’s book Notes on Nursing(Johnson, 1992) 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 is acknowledged in early developmental writing presenting concepts of then BSM Systems Theory Rapoport, Chinn, von Bertalanffy and Buckley. Johnson used their system theory, concepts and definitions. BEHAVIORAL SYSTEM MODEL Defined Nursing as “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 behavior constitutes a threat to the physical or social health, or in which illness is found.” States that “each individual has patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual.” MAJOR CONCEPTS AND DEFINITIONS BEHAVIOR – “the output of intraorganismic structure and processes as they are coordinated and articulated by and responsive to changes in sensorial stimulation.” SYSTEM – “that which that function as a whole by virtue of the interdependence of its parts.” BEHAVIORAL SYSTEM – encompasses the patterned, repetitive and purposeful ways of behaving. These ways of behaving form an organized and integrated functional unit that determines and limits the interaction between the person and his/her environment and establishes the relationship of the person to the objects, events and situations within his/her environment MAJOR CONCEPTS AND DEFINITIONS 7 IDENTIFIED BEHAVIORAL SUBSYSTEM 1. Attachment-Affiliative - the “social inclusion intimacy and the formation and attachment of a strong social bond provides survival and security. 2. Dependency – is the “approval, attention or recognition and physical assistance.” 3. 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. MAJOR CONCEPTS AND DEFINITIONS 7 IDENTIFIED BEHAVIORAL SUBSYSTEM (Cont) 4. Eliminative - is elimination in terms of when, how, and under what conditions the individual eliminates waste. 5. Sexual- is 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. 6. Achievement - function is control or mastery of self or environment to some standard of excellence. Includes intellectual, physical, creative, mechanical, and social skills. 7. Aggressive- Protective - function is protection and preservation. MAJOR CONCEPTS AND DEFINITIONS EQUILIBRIUM – a stabilized but more or less transitory, resting state in which the individual is in harmony with himself and with his environment. FUNCTIONAL REQUIREMENTS AND SUSTENAL IMPERATIVES – to develop and maintain stability function requirement should be supplied. Environment supplies sustenal imperatives such as protection, nurturance, and stimulation. MAJOR CONCEPTS AND DEFINITIONS REGULATION/CONTROL – implies that deviations will be detected and corrected. There is self-regulation by the client. The nurse can act as a temporary external regulatory force to preserve the organizations and integration of the client’s behavior at optimal level in situations of illness. TENSION – “a state of being stretched or strained and can be viewed as end-product of a disturbance in equilibrium” (Johnson, 1961b) STRESSOR – internal or external stimuli that produces tension and result in a degree of instability. MAJOR ASSUMPTIONS Nursing Person Health Environment  NURSING “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 biological balance, order, stability, and maintenance of the integrity of the patient. Focuses on the behavioral system whereas medicine focuses on the biological system.  PERSON 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.  HEALTH 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. Lack of balance in the structural or functional requirements of the subsystems leads to poor health. Is NOT defined explicitly by Johnson  ENVIRONMENT 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. THEORETICAL ASSERTIONS Each subsystem is categorized in terms of: Structural Requirements 1. Drive or goal- ultimate consequence of behavior. 2. Set-a tendency to or predisposition to act in a certain way. a. Preparatory- what a person usually attends to. b. Perseverative- habits one maintain in a situation. 3. Choice- the behavior a patient sees himself as being able to use in any given situation. 4. Action or the behavior of an individual THEORETICAL ASSERTIONS Functional Requirements (Sustenal Imperatives) 1. Protection 2. Nurturance 3. Stimulations Each of the subsystem have the same 3 functional requirements The subsystems are developed through motivation, experience and learning and influenced by biological, psychological and social factors. ACCEPTANCE BY NURSING COMMUNITY PRACTICE - Used in inpatient, outpatient, community settings, and nursing administration. - Does NOT use the term Nursing Process. Assessment, disorders, treatment, and evaluation are concepts referred to in Johnson’s work - Used for the development of several assessment instrument EDUCATION - Can be utilized in nursing education. A curriculum based on a person as a behavioral system would have definite goals and course planning. ACCEPTANCE BY NURSING COMMUNITY Research - Johnson identified the important areas of research: 1. Study of behavioral system as a whole which include stability and change, organizations and interactions and effective regulatory and control mechanisms. 2. Study of subsystems including identification of additional subsystem - Used as a conceptual framework - Used in clinical practice FURTHER DEVELOPMENT Johnson acknowledge that the knowledge base for use of her model was incomplete. Gaps in knowledge offered challenges in for educators and practitioners. Preventive nursing and preventive medicine and disorders must be identified and explicated before approaches to prevention can be developed. Needs to identify nursing actions that facilitates appropriate functioning of the system toward disease prevention and health maintenance Consist yet of undefined subsystems. CRITIQUE Clarity – Simple but comprehensive. Include all areas of nursing practice and provide guidelines for nursing research and education. Simplicity – Complex. There are a number of possible interrelationships among the behavioral system, its subsystem and the environment. More empirical work is needed. Generality – Extensively used with people who are ill or face the threat of illness. Its used with family, groups and community is limited. Accessibility – The units and the relationships between the units are consistently defined, thus an adequate degree of empirical precision has been demonstrated in research using this theory. IMPORTANCE Johnson’s theory guides nursing practice, education and research. Differentiates nursing from other health professions by focusing on behavior rather than biology. Provides a conceptual framework for nursing education, practice and research - has directed questions for nursing research - appropriate for development of nursing curriculum - resulting nursing actions is satisfactory  THANK YOU! GOOD LUCK TO YOUR LONG QUIZ AND MIDTERM EXAMS!