PPT of Johnson

Reporters: Amelie Rose R. Robles & Marion Kaz P. Alayon

At the end of this class the students would be able to:

Relate life history of Dorothy Johnson Identify and explain briefly the theoretical sources

of Johnson’s Theory Enumerate Johnson’s Metaparadigm in Nursing Explain the acceptance of this theory by the Nursing

Community Analysis and application of the theory to present

day situation (nursing practice, nursing education and nursing research)

04/08/23 Reporters: Amelie Rose R. Robles & Marion Kaz P. Alayon

Born August 21, 1919, in Savannah Georgia

Died Feb. 1999 at 80 years old

B. S. N. from Vanderbilt University in Nashville, Tennessee, in 1942; and her M.P.H. from Harvard University in Boston, Massachusetts in 1948.


Influenced nursing through her publications since the 1950’s

Most of her education career was in Pediatric Nursing at the University of California, L.A.

She withdrew from the Academe as a Professor Emeritus in January 1, 1978

An early advocate of Nursing as a Science and an art


1961: she proposed that nursing care facilitated the client’s maintenance of a state of equilibrium. She recognized 2 areas of focus for nursing care:

1.) nursing care should lessen stimuli (stressors)

2.) nursing care should offer support of the client’s normal defenses and adaptive process


Influences in the development of her Model:

Nightingale: focused more on the primary needs of the patient rather than the disease process.

In the 1950s – 1960s there was an escalating number of observational studies on child and adult behavior patterns available.


General Systems Theory

1968: she first proposed her model of nursing care as the nurturing of the competent and helpful behavioral functioning in the patient to avoid illness.

1980: printed her conceptualization of the Behavioral System Model for Nursing.




Behavior the output of intraorgasmic structures and processes as they are coordinated and articulated by and responsive to changes in sensory stimulation.

System a whole that functions as a whole by virtue

of the interdependence of its parts (Rapaport); there is organization, interaction and interdependence of parts (Chinn)

Subsystems a minisystem with its own particular

goal and function that can be maintained as long as its relationship to other subsystems and the environment is not disturbed.


Equilibrium a stabilized but more or less transitory, resting state in which the individual is in harmony with himself and his environment; it is not synonymous with state of health since it may be found either in health or illness.

Tension a state of being stretched or strained and can be viewed as an end-product of a disturbance in equilibrium; can be constructive or destructive.

Stressor internal or external stimuli that produce tension and result in a degree of instability


Johnson believes each individual has patterned, purposeful, repetitive ways of acting that comprise a behavioral system specific to that individual. These actions and behaviors form an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relationship of the person to the objects, events, and situations in the environment. These behaviors are “orderly, purposeful and predictable and sufficiently stable and recurrent to be amenable to description and explanation”.


The theory addresses two major components:

the patient nursing

Each system can be described and analyzed in terms of structure and functional requirements.


4 structural elements:drive or goalset, predisposition to actchoice, alternatives for actionbehavior

3 functional requirements:protectionnurturancestimulation


the system and subsystems tend to be self-maintaining and self-perpetuating as long as internal or external conditions are orderly and predictable.

the responses to the subsystems are developed through motivation, experience, and learning and are influenced by biological, psychological and social factors.




Attachment / Affiliative Subsystem Earliest response system to expand in a person Allows social inclusion, closeness and a pattern

and continuance of a strong public bond.

Dependency Subsystem Dependency behaviors are actions that trigger

nurturing behaviors from other individuals in the environment.

The product is consent, interest or appreciation, and physical support


Ingestive Subsystem the emphasis is on the meaning and structures

of the social events surrounding the occasion when food is eaten

Eliminative Subsystem 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 Imitates behaviors related to procreation or

reproduction. Both biological and social factors are involved.

Aggressive subsystem Relates to behaviors concerned with defense

and self-preservation.


Achievement Subsystem Contains behaviors that attempt to control the

environment. Intellectual, physical, imaginative, mechanical

and communal skills are some areas Johnson distinguishes




Simplicity The theory is straightforward in relation

to the number of concepts. However, it is potentially complex since there is a number of a possible interrelationship between and among the behavioral systems, its subsystems, and the forces drawing them.


Generality It is relatively limitless when applied to sick

individuals, but it has not been used as much with the well individual or groups. A person is the sum of interactive behavioral systems. In later publications, Johnson emphasized the role of nurses in the preventive healthcare of individuals and for the society. She stated that Nursing needs to focus on developing preventive nursing to fulfill its social obligations.


Empirical Precision So far, a moderate degree of empirical

precision has been demonstrated in research using Johnson’s model. However, throughout Johnson’s writings, terms such as balance, stability, and equilibrium, adjustments and adaptations, disturbances, disequilibrium and behavioral disorders are used interchangeably, which confuse their meanings. The clarity of definitions in the subsystems improves the model’s empirical precision.


Derivable Consequences Johnson’s model guides nursing practice, education and

research; generates new ideas about nursing; and differentiates nursing from other professions. By focusing on Behavior rather than biology it clearly differentiates nursing from medicine although the concepts overlap with the psychosocial professions. The theory has directed questions for nursing research. It has been analyzed and judge to be appropriate as a basis for development of nursing curriculum. Practitioners and patients have judged the resulting nursing actions to be satisfactory. The theory has good potential for continued use in nursing to achieve valued nursing goals.


Jose, 8 weeks old, was brought into the clinic for a routine check-up. He presents with no weight gain since his check-up at age 4 weeks. His mother states that she feeds him but does not seem to eat much. He sleeps 4-5 hours between feedings. His mother holds him in her arms without making trunk – to – trunk contact. When assessed by the nurse, it was noted that his mother never looks and speaks at Jose. She states that he was a planned baby but she never realized how much work an infant could be. She says her mother has told her she was not a good mother because Jose is not gaining weight as he should. She states that she has not called the nurse when she knew that Jose was not gaining weight because the nurse would think that she was a bad mother just as her own mother thought she was.


Because of the nature of this problem, a decision is made to use a tool that specifically focuses on parent-infant interaction during a feeding situation. Thus the Nursing Child Assessment Feeding scale is used during a feeding that takes place at a normal feeding time for Jose. Jose cries at the beginning of the feeding and turns toward his mother’s hand when she touches his cheek. His mother does not speak to Jose or in any verbal way acknowledge his hunger. When Jose slightly chokes on some formula, she does not remove the bottle from his mouth. His mother does not describe any of the environments to Jose nor does she stroke his body or make eye contact with him. Jose does not reach out to touch his mother nor make any vocalizations. The assessment scale indicates that both mother and baby are not giving signals to each other at a level at which they can respond appropriately.


All subsystems should be involved. Affiliative subsystem▪ -focuses on the specific behaviors manifested

by Jose to indicate attachment to his mother.Dependency subsystem

▪ - focuses on the specific behaviors manifested by Jose to signal his mother to his needs.


Insufficient development of the affiliative subsystem

Insufficient development of the dependency subsystem


Focuses on developing the mother’s awareness of the meaning of Jose’s infrequent cues.

Further assistance needs to be given in helping the mother in communicating with her infant.

The nurse should place herself in Jose’s role and talk for him to his mother.


Two Criteria: Jose’s weight gains or losses are

carefully assessed. The mother- infant contact can be

reassessed again using the Nursing Child Assessment Feeding Scale, which allows for comparison of the observation with a series of succeeding observations.


References:

Theoretical Foundations of Nursing: The Philippine Perspective by Octaviano, E.F. & Balita, C.E

Fundamentals of Nursing (5th Edition) by Kozier, B., Erb, G., Blais, K. & Wilkinson, J.

Nursing Theorists and their Work (5th Edition) by Tomey, Ann Marriner, Alligood, Martha Raile


Documents

PPT of Johnson