NU 500

Advanced Nursing Theory

October 21, 2009
 Born August 21st, 1919, in Savannah,
Georgia
Biographical
Information 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
Founders Medal
Most professional experiences
involved teaching although she was a
staff nurse at the Chatham-Savannah
Health Council from 1943 to 1944.
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
1978.
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 1940s 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 Roys 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, its 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 Nightengales belief that
nursings 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 individuals 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 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.
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 individuals
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 persons 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.
STRUCTURAL FUNCTIONAL
Drive or goal-the motivation for behavior Protection-from noxious
Set-the individuals predisposition to act

in certain ways to fulfill the function of

influences with which the
the subsystem. system cannot cope
Choice-the individuals total behavioral

repertoire for fulfilling subsystem

Nurturance-through the
functions, which encompasses the scope input of appropriate supplies
of action alternatives from which the from the environment
person can choose.
Action-the individuals actual behavior in Stimulation-to enhance
a situation. It is the only structural growth and prevent
element that can be observed directly; all
other elements must be inferred from the stagnation
individuals actual behavior and from the
consequences of that behavior.
 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(1980S
NEUMAN (1970) Roy (1970s)
)
Human Being:
Client/client Behaivoral Adaptive system
system system
Environment:
All internal, Internal and Internal and
external and external external stimuli
created factors environment
NEUMAN JOHNSON Roy

Health:
wellness all parts Purposeful balance State of adaptation
of client are in and stability -process of
harmony or promoting integrity
balance
Nursing:
Concerned with all An external Support and
stressors, even regulatory promote pt
potential force adaptation
 World view
Neuman Johnson Roy
Reciprocal Reciprocal Reciprocal
world world world
view view view
 Johnson:
Client is a behaivoral system
7 Behaivoral 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

Client is biopsychocsocial, person can be broken down

into parts for study/care, systems theory, holistic view
of client, client interacts with environment, client is
center focus, nursing facilitates clients progress toward
some balance, weak definition of nurse-patient
relations, psychological, biological and sociological
aspects of the client are recognized
Neuman
Physiological, psychological,
sociological, develepmental, and
spiritual variables.
Client represented as central structure,
lines of defense and resistance.
 Actual Interview of Ms. Johnson by Jacqueline
Fawcett!
 Fawcett, J. (2005). Contemporary Nursing
Knowledge: Analysis and Evaluation of
Nursing Models and Theories (2nd ed.).
Philadelphia: F.A. Davis.