Unitary Human Beings

(Martha Rogers)

"Professional practice in nursing seeks to promote

symphonic interaction between man and environment,
to strengthen the coherence and integrity of the
human field, and to direct and redirect patterning of
the human and environmental fields for realization of
maximum health potential."

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Life and works of Roger's
Martha Elizabeth Rogers, the eldest of four children of Bruce Taylor Rogers
and Lucy Mulholland Keener Rogers. Was born on May 12, 1914 in Dallas, Texas.
She started her college in 1931-1933 at the University of Tennessee and earned her
degree in nursing at Knoxville General Hospital School of Nursing in 1936. And in
1937 she obtained her degree of Science from George Peabody College in
Nashville. Her other degrees included Masters of Art's degree in public Health
Nursing Supervision in 1945, Masters of Public Art's degree in 1952, and Doctor of
Science in 1954.

Her early nursing practice was in rural public health nursing in Michigan and
her visiting nurse supervision, education and practice in Connecticut. She
established the Visiting Nurse Service of Phoenix, Arizona. And for 21 years, she
was a professor and head of the Division of Nursing at New York University. She
continued her duties as a professor until she became Professor Emerita in 1979.
She held this title until her death on March 13, 1994 at the age of 79.

Major Concepts and Sub-Concepts

In 1971, Rogers conceptual model of nursing tested on a set of basic

assumptions that described the life process in human beings wholeness, openness,
undirectionality, pattern and organization, sentence and thought characterized the
life process.

Rogers changed her wording from that unitary man to unitary human being to
remove concept of gender.Rogers postulated four building blocks for her model:
•Energy field
•A universe of open system
•Pattern
•Four dimentionality

Energy Field

An energy field constitute the fundamental unit of both the living and non living. Two
fields are identified:
•The Human Field
• Is define as an irreducible, indivisible, pandimensional energy field.

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 •Environmental field
•Is defined as an irreducible, pandimensional energy field identified by
pattern and integral with the human field.

Sub-concepts in the theory

The Rogerian model emerged from a broad historical base and has moved to
the forefront as scientific knowledge has evolved. Understanding the concepts and
principles of the Science of Unitary Human Beings requires a foundation in general
education, a willingness to let go of the traditional, and an ability to perceive the
world in a new and creative way. The abstract ideas expounded in the Rogerian
model and their congruence with modern scientific knowledge spur new and
challenging theories that further the understanding of the unitary human being.

Major Assumptions
1. "Man is unified whole possessing his own integrity and manifesting characteristics
more than and different from the sum of his part"
.

2. "Man and environment are continuously exchanging matter and energy with one
another".(openness)

3. "The life process evolves irreversibly and unidirectionally along the space-time
continuum".(helicy)

4. "Pattern and organization identify man and reflect his innovative wholeness".
(pattern and organization)

5. "Man is characterized by the capacity of abstraction and imagery, language and

thought, sensation, and emotion"(sentient, thinking being)

Proposition

•Rogers (1986) believed that knowledge development within her model was a
"never-ending process" using "a multiplicity of knowledge from many sources.. to
create a kaleidoscope of possibilities"

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 •Fawcett identified the following three rudimentary theories developed by
Rogers from the Science of Unitary Human Beings:
1. Theory of accelerating evolution
2. Theory of rhythmical correlates of change
3. Theory of paranormal phenomena

Nursing
Is a learned profession and both a science and an art. Rogerian nursing focuses on
concern with people and the world in which they live a natural fit for nursing care, as
it encompasses people and their environments. The purpose of nursing is to promote
healthy and well being for all persons.

Person

Rogers defines person as an open system in continuous process with open system
that is the environment.
Man is unified whole possessing his own integrity and manifesting characteristics
that are more than and different from sum of his part.

Health

Rogers uses the term health in many of her earlier writings without clearly defining
the term.She uses the term passive health to symbolize wellness and the absence of
disease and major illness (Rogers 1970).

Environment

Rogers defines environment as an irreducible. Pan dimensional energy field

identified by pattern and manifesting characteristics different from those of the parts.
Environmental and human fields are identified by wave patterns manifesting
continuous mutual change.

Analysis of the Theory

Clarity

•There were early criticism of the model with comments such as difficult to
understand principles, lack of operational definitions, and inadequate tools for
measurement.
•Rogers ideas continue to demonstrate clarity for nursing research with human
beings of all ages.

Simplicity

Ongoing studies and work within the model have served to simplify and clarify some
of the concepts and relationships. However, when the model is examined in total
perspective, some still classify it as complex.

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With only three principles, a few major concepts, and five assumptions, Rogers has
explained the nature of man and the life process.

Generality

Rogers conceptual model is abstract and therefore generalizable and powerful. It is

broad in scope, providing a framework for the development of nursing knowledge
through the generation of grand and middle-range theories.

Education

Rogers clearly articulated guidelines for the education of nurses within the Science
of Unitary Human Beings. Rogers discusses structuring nursing education programs
to teach nursing as a science and as a learned profession.

Practice

The Rogerian model is a abstract system of ideas from which to approach the
practice of nursing.
Rogers model, stressing the totality of experience and existence, is relevant in
today’s health care is more important than episodic illness and hospitalization.

Research

Rogers conceptual model provides a stimulus and direction for research and theory
development in nursing science.
Fawcett, who insists that the level of abstraction affects direct empirical observation
and testing, endorses the designation of the Science of Unitary Human Beings as a
conceptual model rather than a grand theory.

Activity Please complete the table below.

Theorist Theory Conceptual Man Environment Health Nursing

Model/Framework
Martha
Rogers

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 Dorothea Elizabeth Orem 
Self-Care Deficit Nursing Theory

Biography of Dorothea E. Orem

Dorothea Elizabeth Orem (July 15, 1914 – June 22, 2007) was one of America’s
foremost nursing theorists who developed the Self-Care Deficit Nursing Theory,
also known as the Orem Model of Nursing.

Her theory defined Nursing as “The act of assisting others in the provision and
management of self-care to maintain or improve human functioning at home level of
effectiveness.” It focuses on each individual’s ability to perform self-care, defined as
“the practice of activities that individuals initiate and perform on their own behalf in
maintaining life, health, and well-being.”

Self-Care Theory

Dorothea Orem’s Self-Care Deficit Theory focuses on each “individual’s ability to

perform self-care, defined as ‘the practice of activities that individuals initiate and
perform on their own behalf in maintaining life, health, and well-being.'” The Self-
Care or Self-Care Deficit Theory of Nursing is composed of three interrelated
theories: (1) the theory of self-care, (2) the self-care deficit theory, and (3) the
theory of nursing systems, which is further classified into wholly compensatory,
partial compensatory and supportive-educative.

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Works of Dorothea Orem

Dorothea Orem helped publish the “Guidelines for

Developing Curricula for the Education of Practical
Nurses” in 1959.

The 6th edition of Nursing: Concepts of Practice,

published by Mosby in January 2001.
In 1971 Orem published Nursing: Concepts of
Practice, the work in which she outlines her theory of
nursing, the Self-care Deficit Theory of Nursing. The
success of this work and the theory it presents established Orem as a leading
theorist of nursing practice and education.

She also served as chairperson of the Nursing Development Conference Group, and
in 1973 edited that group’s work in the book Concept Formalization in Nursing.

She authored many other papers and during the 1970s and 1980s spoke at
numerous conferences and workshops around the world. The International Orem
Society was founded to foster research and the continued development of Orem’s
theories of nursing.

The second edition of Nursing: Concept of Practice was published in 1980. Orem
retired in 1984 but she continued to work on the third edition which was published in
1985; fourth edition of her book was completed in 1991. She continued to work on
the conceptual development of Self-Care Deficit Nursing Theory.

Orem continued to be active in theory development. She completed the 6th edition of
Nursing: Concepts of Practice, published by Mosby in January 2001.

Dorothea Orem’s Self-Care Deficit Theory

There are instances wherein patients are encouraged to bring out the best in
them despite being ill for a period of time. This is very particular in rehabilitation

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settings, in which patients are entitled to be more independent after being cared for
by physicians and nurses. Through these, the  Self-Care Nursing
Theory or the Orem Model of Nursing was developed by Dorothea Orem between
1959 and 2001. It is considered a grand nursing theory, which means the theory
covers a broad scope with general concepts that can be applied to all instances of
nursing.

Major Concepts of the Self-Care Deficit Theory

Self-Care

Self-care is the performance or practice of activities that individuals initiate and

perform on their own behalf to maintain life, health, and well-being.

Self-Care Agency

Orem’s Self-Care Theory: Interrelationship among concepts.

Self-care agency is the human’s ability or power to engage in self-care and is
affected by basic conditioning factors.

Basic Conditioning Factors

Basic conditioning factors condition or affect the value of the therapeutic self-care
demand and/or the self-care agency of an individual at particular times and under
specific circumstances. Ten factors have been identified:

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  Age
 Gender
 Developing state
 Health state
 Pattern of living
 Health care system factors
 Family system factors
 Sociocultural Factors
 Availability of Resources
 External Environmental Factors

Therapeutic Self-Care Demand

Orem’s Self-Care Theory – Conceptual Framework.

Therapeutic Self-care Demand is the totality of “self-care actions to be performed for
some duration in order to meet known self-care requisites by using valid methods
and related sets of actions and operations.”

Self-Care Deficit

Self-care Deficit delineates when nursing is needed. Nursing is required when an

adult (or in the case of a dependent, the parent or guardian) is incapable of or limited
in the provision of continuous effective self-care.

Nursing Agency

Nursing Agency is a complex property or attribute of people educated and trained as

nurses that enables them to act, to know, and to help others meet their therapeutic
self-care demands by exercising or developing their own self-care agency.

Nursing System

Nursing System is the product of a series of relations between the persons:

legitimate nurse and legitimate client. This system is activated when the client’s
therapeutic self-care demand exceeds available self-care agency, leading to the
need for nursing.

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Theories

The Self-Care or Self-Care Deficit Theory of Nursing is composed of three

interrelated theories: (1) the theory of self-care, (2) the self-care deficit theory,
and (3) the theory of nursing systems, which is further classified into wholly
compensatory, partial compensatory and supportive-educative.

Theory of Self-Care

This theory focuses on the performance or practice of activities that individuals

initiate and perform on their own behalf to maintain life, health and well-being.

Self-Care Requisites

Self-care Requisites or requirements can be defined as actions directed toward the

provision of self-care. It is presented in three categories:

Universal Self-Care Requisites

Universal self-care requisites are associated with life processes and the
maintenance of the integrity of human structure and functioning.

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 1. The maintenance of a sufficient intake of air
2. The maintenance of a sufficient intake of water
3. The maintenance of a sufficient intake of food
4. The provision of care associated with elimination process and excrements
5. The maintenance of a balance between activity and rest
6. The maintenance of a balance between solitude and social interaction
7. The prevention of hazards to human life, human functioning, and human well-
being
8. The promotion of human functioning and development within social groups in
accord with human potential, known human limitations, and the human desire
to be normal
Normalcy is used in the sense of that which is essentially human and that which is
in accord with the genetic and constitutional characteristics and the talents of
individuals. Six defining attributes of normalcy were identified:

1. Having adequate resources to provide for the basic necessities of life.

2. Being able to perform activities of daily living and those activities consistent
with personal interest.
3. Accepting and adjusting to a new normal
4. Maintaining one’s health through making decisions about and implementing
care for oneself.
5. Engaging in fulfilling interpersonal relationships
6. Being safe – not harming or being harmed by self or others

Developmental self-care requisites

Developmental self-care requisites are “either specialized expressions of universal

self-care requisites that have been particularized for developmental processes or
they are new requisites derived from a condition or associated with an event.”

1. Provision of condition that promote development.

2. Engagement in self-development.
3. Prevention of or overcoming effects of human conditions and life situations
that can adversely affect human development.

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Health deviation self-care requisites

Health deviation self-care requisites are required in conditions of illness, injury, or

disease or may result from medical measures required to diagnose and correct the
condition.

1. Seeking and securing appropriate medical assistance

2. Being aware of and attending to the effects and results of pathologic
conditions and states
3. Effectively carrying out medically prescribed diagnostic, therapeutic, and
rehabilitative measures
4. Being aware of and attending to or regulating the discomforting or deleterious
effects of prescribed medical measures
5. Modifying the self-concept (and self-image) in accepting oneself as being in a
particular state of health and in need of specific forms of health care
6. Learning to live with the effects of pathologic conditions and states and the
effects of medical diagnostic and treatment measures in a lifestyle that
promotes continued personal development

Theory of Self-Care Deficit

This theory delineates when nursing is needed. Nursing is required when an adult (or
in the case of a dependent, the parent or guardian) is incapable of or limited in the
provision of continuous effective self-care. Orem identified 5 methods of helping:

1. Acting for and doing for others

2. Guiding others
3. Supporting another
4. Providing an environment promoting personal
development in relation to meet future
demands
5. Teaching another

Theory of Nursing System

This theory is the product of a series of relations

between the persons: legitimate nurse and legitimate
client. This system is activated when the client’s

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therapeutic self-care demand exceeds available self-care agency, leading to the
need for nursing.

Wholly Compensatory Nursing System

This is represented by a situation in which the individual is unable “to engage in

those self-care actions requiring self-directed and controlled ambulation and
manipulative movement or the medical prescription to refrain from such activity…
Persons with these limitations are socially dependent on others for their continued
existence and well-being.”

Example: Care of a newborn, care of client recovering from surgery in a post-

anesthesia care unit

Partial Compensatory Nursing System

This is represented by a situation in which “both nurse and perform care measures
or other actions involving manipulative tasks or ambulation… [Either] the patient or
the nurse may have a major role in the performance of care measures.”

Example: Nurse can assist postoperative client to ambulate, Nurse can bring a meal
tray for client who can feed himself

Supportive-Educative System

This is also known as supportive-developmental system, the person “is able to

perform or can and should learn to perform required measures of externally or
internally oriented therapeutic self-care but cannot do so without assistance.”

Example: Nurse guides a mother how to breastfeed her baby, Counseling a

psychiatric client on more adaptive coping strategies.

Dorothea Orem’s Theory and The Nursing Process

The Nursing Process presents a method in determining self-care deficits and to

define the roles of persons or nurse to meet the self-care demands.

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Assessment

 Diagnosis and prescription; determine why nursing is needed. Analyze and

interpret by making a judgment regarding care.
 Design of a nursing system and plan for delivery of care.
 Production and management of nursing systems.
Step 1 – Collect Data in Six Areas

1. The person’s health status

2. The physician’s perspective of the person’s health status
3. The person’s perspective of his or health health
4. The health goals within the context of life history, lifestyle, and health
status.
5. The person’s requirements for self-care
6. The person’s capacity to perform self-care

Nursing Diagnosis & Care Plans

Step 2

 The nurse designs a system that is wholly or partly compensatory or

supportive-educative.
 The two actions are: (1) Bringing out a good organization of the
components of patients’ therapeutic self-care demands. (2) Selection of
combination of ways of helping that will be effective and efficient in
compensating for/overcoming patient’s self-care deficits.

Implementation & Evaluation

Step 3

 Nurse assists the patient or family in self-care matters to achieve identified

and described health and health-related results. Collecting evidence in
evaluating results achieved against results specified in the nursing system
design.
 Actions are directed by etiology component of nursing diagnosis.

Analysis of the Self-Care Deficit Theory

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There is a superb focus of Orem’s work which is self-care. Even though there is a
wide range of scope seen in the encompassing theory of nursing systems, Orem’s
goal of letting the readers view nursing care as a way to provide assistance to
people was apparent in every concept presented.

From the definition of health which is sought to be rigid, it can now be refined by
making it suitable to the general view of health as a dynamic and ever-changing
state

The role of the environment to the nurse-patient relationship, although defined by

Orem was not discussed.

The role of nurses in maintaining health for the patient was set by Orem with great
coherence in accordance with the life-sustaining needs of every individual.

Although Orem viewed the importance of the parents or guardian in providing for
their dependents, the definition of self-care cannot be directly applied to those who
need complete care or assistance with self-care activities such as the infants and the
aged.

Major Assumptions

1. People should be self-reliant, and responsible for their care, as well as others
in their family who need care.
2. People are distinct individuals.
3. Nursing is a form of action. It is an interaction between two or more people.
4. Successfully meeting universal and development self-care requisites is an
important component of primary care prevention and ill health.
5. A person’s knowledge of potential health problems is needed for promoting
self-care behaviors.
6. Self-care and dependent care are behaviors learned within a socio-cultural
context

Critique
Clarity

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The terms Orem used are defined precisely. The language of theory is consistent
with the 21st century language used in action theory and philosophy. The terminology
of the theory is congruent throughout. The term self-care has multiple meanings
across disciplines.

Simplicity

Orem’s theory is expressed in a limited number of terms. These terms are defined
and used consistently in the expression of the theory. Orem’s general theory, the
SCDNT, comprises four constituent theories: self-care, dependent care, self-
deficit deficit and nursing systems.

Generality

Orem commented on the generality or universality, of the theory as follows:

“The self-care deficit theory of nursing is not an explanation of the individuality of a

particular concrete nursing practice situation, but rather the expression of a singular
combination of conceptualized properties or features common to all instances of
nursing. As a general theory, it serves nurses engaged in nursing practice, in
development and validation of nursing knowledge and in teaching and learning
nursing.”

Accessibility

As general theory, SCDNT provides a descriptive explanation of why persons require

nursing and what processes are needed for the production of required nursing care.
The concepts of the theory are abstractions of the entities that represent the proper
object of nurses in concrete nursing practice situations.

Importance

The self-care deficit nursing theory differentiates the focus of nursing from other
disciplines. Although other disciplines find the theory of self-care helpful and
contribute to its development, the theory of nursing systems provides a unique focus
for nursing.

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Activity Please complete the table below.
Theorist Practice Education Research
Theory Conceptual Perso Environment Health Nursing
Model/Framework n
Dorothea
Orem

17
 SYSTEM FRAMEWORKS AND THEORY OF GOAL ATTAINMENT

IMOGENE M. KING

 Imogen King was born in 1923, and she’s youngest of three children.
 She received her basic nursing education from St. John’s Hospital School of
Nursing in St. Louis, Missouri, graduated in 1945.
 Her B.S in Nursing and education with minors in philosophy and chemistry
(1958) and M.S. in nursing (1957) are from St. Louis University and her Ed.D.
(1961) is from teacher college Columbia University, New York.
 She has done postdoctoral study in research design, statistic, and computers
(King, 1986b)

KING’S ATTAINMENTS:

 King has had experience in nursing as an administrator, an educator and a

practitioner.
 She has been a Faculty member at St. John’s Hospital School of Nursing St.
Louis; Loyola University, Chicago; and the University of South Florida.
 She served as Director of the school of Nursing at the Ohio State University,
Columbus.
 She was an assistant Chief of the Research Grants Branch, Division of
Nursing, Department of Health, Education, and Welfare in the mid-1960s and
on the Defense Advisory Committee on Women in the Services for the
Department of Defense in the early 1970s.
 She is professor emeritus from the University of South Florida and continues
to consult and work on the further application of her theory.
 She has been actively involved in the establishment of the King International
Nursing
 Group, headquartered at Oakland University’s School of Nursing.

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Toward a theory of Nursing (1971), King clearly state she was proposing a
conceptual framework for nursing and not a nursing theory.

As she denoted in the title, her purpose was to help move toward a theory for
nursing.

The function of a conceptual system is to give support for arranging ideas or concept
into a grouping that provides meaning.

KING’S CONCEPTUAL SYSTEM

PERSONAL SYSTEM

The relevant concept of personal system are:

 Perception is presented as the major concept of personal system, the concept

that influences all behavior or to which all other concept are related.
 Self are the dynamic person who is an open system, and whose action are
oriented toward achieving goals.
 Growth and Development include changes in behavior at the cellular and
molecular levels in individuals.
 Body image is characterized as very personal and subjective, acquired or
learned, dynamic and changing as the person redefine self. Body image is
part of each stage of growth and development.
 Space is characterized as universal because everyone has some concept of
it. It may be personal and subjective.
 Time as characterized as universal and inherent in life processes; rational or
dependent on distance and the amount of information occurring.

INTERPERSONAL SYSTEM

The relevant concept of interpersonal system are:

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  Interaction is characterized by values; mechanism for stablishing human
relationships.
 Communication are that is verbal or nonverbal situational; perceptual;
transactional; irreversible, or moving forward in time; personal; and dynamic
(King, 1981/1990a)
 Transaction, for this conceptual system, are derived from cognition and
perceptions and not from transactional analysis. King (1981/1990a) define
transaction as a series of exchanges between human beings and the
environment that include observable behavior that seek to reach goals of
worth to the participants.
 Role include reciprocity in that a person may be a giver at one time and at a
taker at another time, with a relationship between two or more individuals who
are functioning in two or more roles that are learn social complex and
situational (King, 1981/1990a).
The nurse’s role can be defined as interacting with one or more others in a
nursing situation in which the nurse as professional uses the skills, knowledge
and values identified as belonging to nursing to identity goals with others and
help them achieve the goals.
 Stress is universal dynamic as result of open system being in continuous
exchange with the environment. King (1981/1990a) define stress as an ever
changing condition in which an individual, through environmental interaction,
seeks to keep equilibrium to support growth, development and activity.

SOCIAL SYSTEMS

Social system is a structured large group in a system that includes the roles,
behaviors, and practices defined by the system for the purposes of sustaining
desirable attributes and for creating methods to maintain the practices and rules of
the system (King, 1981/1990a)

The relevant concept of social system are:

 Organization is characterized by a structure that orders position, activities and

includes formal and informal arrangements of people to gain both personal
and organizational goals.

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 Authority include that is observable through the regularity, direction, and
responsibility for actions it provides.
 Power is characterized as universal, situational (i.e., not a personal attributes
but existing in the situation), necessary in the organization, influence by
resources in a situation, dynamic, and goal directed (King, 1981/1990a).
 Status characteristic as situational, position dependent, and reversible. King
(1981/1990a) defines status as the relationship of one’s place in a group to
others in the group or of a group to other groups. She also identifies that the
status is accompanied by advantages, accountabilities, and requirements.
 Decision making is characterized as necessary to provide order in an
individual’s or group living and working, universal, individual, personal,
subjective, situational, a continues process, and goal directed.

KING’S THEORY OF GOAL ATTAINMENT

The major elements of King’s middle range Theory of Goal attainment are
seen “in the personal systems in which two people, who are usually strangers,
come together in a health care organization to help and be helped to maintain a
state of health that permits functioning in roles” (King, 1981/1990a, p. 142).

The theory’s focus in interpersonal systems reflects King’s belief that the
practice of nursing is differentiated from that of other health professions by what
nurses do with and for individuals.

MAJOR CONCEPT OF THEORY GOAL ATTENMAINT ARE:

Interaction is the observable verbal and nonverbal goal directed behaviors

of two or more people in mutual presence and includes perception and
communication (King 1981/1990a).
Perception is reality as seen by each individual (1981/1990a).
Communication is the exchange of information between people that may
occur during a face to face meeting, through electronic media, and through
the written word (King, 1981/1990a).

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 Transaction is a series of exchanges between human being and their
environment that include observable behaviors that seek to reach goals of
worth to the participants (King, 1981/1990a)
Role is defined as a set of expected behaviors (King, 1981/1990a).
Related to role is the position held by the person, the rights and
responsibilities associated with the position.
Stress is an ever changing condition in which an individual, through
environmental interaction, seek to keep equilibrium to support growth and
development and activity.
Growth and Development can be defined as the ever occurring changes in
behavior and at the cellular and molecular levels in individuals. These
changes serve to move the person from potential to achievement (King,
1981/1990a).
Space exist in every direction and is the same in all directions. Space
includes that physical area named territory. Space defined by the
behaviors of those individuals who occupy it (King, 1981/1990a).
Health is not stated as a concept in theory but is identified as the goal for
nursing (King, 1990b). King (1986a) indicates the outcome is an
individual’s state of health or ability to function in social roles.

KING’S THEORY AND NURSING METAPARADIGM

NURSING

o As the nurse and client using action, reaction, and interaction in a

health care situation to share information about their perception of each
other and situation.
o Communication enables them to set goals and choose the methods for
meeting the goals (King, 1981/1990a).

o Nursing’s domain includes promoting, maintaining, and restoring

health, and caring for the sick, injured, and dying.

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 o Professional nurse is to interpret information in what is known in the
nursing process to plan, implement, and evaluate nursing care for
individuals, families, groups, and communities.

HEALTH

o As “dynamic life experiences of a human being which implies

continuous adjustment to a stressor in the internal and external
environment through optimum use of one’s resources to achieve
maximum potential for daily living” (King, 1989, p. 152).
o As “dynamic state of an individual in which change is constant and
ongoing and may be viewed as the individual’s ability to function in his
or her usual roles (King, 1990b, p. 76)
o As a functional state and illness as an interference with that functional
state.

ENVIRONMENT and SOCIETY

o As major concept in King’s conceptual system but are not specifically

defined in her work.
o King extended the ability to interact in goal setting and selection of
means to achieve the goal to include mutual goal setting with family
members in relation to clients and families.

o Activity Please complete the table below.

Theorist Practice Education Research

Theory Conceptual Person Environment Health Nursing
Model/Framework
Imogene
king

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 SYSTEMS MODEL

Betty Neuman

LIFE & WORKS

 Born in 1924, in Lowel, Ohio.

 BS in nursing in 1957 at Peoples Hospital School of Nursing (now General
Hospital)
 MS in Mental Health Public health consultation, at University of California,
Los Angeles in 1966;
 Ph.D. in clinical psychology at Pacific Western University in 1985
 Was a pioneer of nursing involvement in mental health
 She and Donna Aquilina were the first two nurses to develop the nurse
counsellor role within community crisis centers in Los Angeles
 She developed, taught, and refined a community mental health programs for
post-master’s level nurses at UCLA.
 She developed and published her first explicit teaching and practice model
for mental health consultation in the late 1960’s before the creation on her
system model.
 Neuman designed a nursing conceptual model for students at UCLA in 1970
to expand their understanding of client variables beyond the medical model.
 Since developing the Neuman systems model, Neuman has been involved in
numerous publications, paper presentations, consultations, lectures, and
conferences on application and use of the model.
 She is a fellow of the American Association of Marriage and Family Therapy
and of the American Academy of Nursing
 She taught nurse continuing education at UCLA and in community agencies
for 14 years and was in private practice as a licensed clinical marriage and
family therapist, with an emphasis on pastoral counselling.

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 Major Concepts

Betty Neuman (2011b) describes the Neuman systems model as follows:”The

Neuman systems model is a unique, open systems-based perspective that
provides a unifying focus for approaching a wide range of concerns. A systems
acts as a boundary for a single client, a group or even a number of groups; it can
also be defined as a social issue. A client system in interaction with the
environment delineates the domain of nursing concerns” (p.3)

Wholistic Approach

 The Neuman systems model is a dynamic open systems approach to

client care originally developed to provide unifying focus for defining
nursing problems and for understanding the client in interaction with the
environment.
 The client as a system maybe defined as a person, family, group,
community, or social issue (Neuman, 2011c)
 Clients views as wholes whose parts are in dynamic interaction.
 The model considers all variables simultaneously affecting the client
system: Physiological, psychological, sociocultural, developmental, and
spiritual.
 She changed the term holistic to wholistic in the second edition to enhance
understanding of the term as referring to the whole person (B. Neuman,
personal communication, June 20, 1988)
Open system

 A system is open when “there is a continuous flow of input and process,

output, and feedback.”
 “Stress and reaction to stress are basic components” of an open system
(Neuman, 2011c, p, 328)
Function or Process

 The client as a system exchanges “energy, information, and matter with the
environment as well as other parts and sub-parts of the system” as it uses
available energy resources “to move toward stability and wholeness”
(Neuman, 2011c, p. 328 ;)
Input and Output

 The matter, energy, and information exchanged between client and

environment that is entering or leaving the system at any point in time.
Feedback

 System output in the form of “matter, energy, and information serves as

feedback for future input “for corrective action to change, enhance, or stabilize
the system” (Neuman, 2011c, p. 327)

25
Negentropy

 A process of energy conservation that increase organization and complexity,

moving the system toward stability or a higher degree of wellness.
Stability

 A state of balance of harmony requiring energy exchanges as the client

adequately copes with stressors to retain, attain, or maintain an optimal level
of health thus preserving system integrity.
Environment

 As defined by Neuman, “the environment consists of both internal and

external forces surrounding the client, influencing and being influenced by the
client, at any point in time” (Neuman, 2011c, p. 328)
Created Environment

 Is developed unconsciously by the client to express system wholeness

symbolically.
 Its purpose to provide perceptual protection for client system functioning and
to maintain system stability” (Neuman 2011, p. 327)
Client System

 Is “a composite of five variables (physiological, psychological, sociocultural,

developmental, and spiritual) in interaction with the environment”
 “ The physiological variables refers to body structure and function”
 The psychological variable refers to mental processes, in interaction with the
environment.
 The sociocultural variable refers to the effects and influences of social cultural
conditions.
 The developmental variable refers to age-related processes and activities.
 The spiritual variables refers to spiritual beliefs and influences” (Neuman
2011c p. 16)
Basic Structure

 The common client survival factors in unique individual characteristics

representing basic system energy resources.
 The basic structure, or central core, is made up of the basic survival factors
which include: normal temp. Range, genetic structure. - Response pattern.
Organ strength or weakness, ego structure.
 Stability, or homeostasis, occurs when the amount of energy that is available
exceeds that being used by the system.
 A homeostatic body system is constantly in a dynamic process of input,
output, feedback, and compensation, which leads to a state of balance.

26
Lines of Resistance

 The series of broken rings that surrounds the basic structure.

 Protection factors activated when stressors have penetrated the normal LOD,
causing a reaction symptomatology. E.g. mobilization of WBC and activation
of immune system mechanism
Norman Line of Defense

 The normal line of defense is the model’s outer solid circle

 It represents the “adaptational level of health developed over the course of
time and serves as the standard by which to measure wellness deviation
determination”
Flexible Line of Defense

 A protective, accordion like mechanism that surrounds and protects the

normal LOD from invasion by stressors.

27
BASIC ASSUMPTIONS

 Each client system is unique, a composite of factors and characteristics within

a given range of responses contained within a basic structure.
 Many known, unknown, and universal stressors exist. Each differs in its
potential for disturbing a client’s usual stability level or normal LOD (Line of
Defense).
 The particular inter-relationships of client variables at any point in time can
affect the degree to which a client is protected by the flexible LOD against
possible reaction to stressors.
 Each client/ client system has evolved a normal range of responses to the
environment that is referred to as a normal LOD. The normal LOD can be
used as a standard from which to measure health deviation.
 When the flexible LOD is no longer capable of protecting the client/ client
system against an environmental stressor, the stressor breaks through the
normal LOD
 The client whether in a state of wellness or illness, is a dynamic composite of
the inter-relationships of the variables. Wellness is on a continuum of
available energy to support the system in an optimal state of system stability.
 Implicit within each client system are internal resistance factors known as
LOR, which function to stabilize and realign the client to the usual wellness
state.
 The client as a system is in dynamic, constant energy exchange with the
environment.
Prevention

 Primary prevention - relates to G.K. that is applied in client assessment and

intervention, in identification and reduction of possible or actual risk factors.
 Secondary prevention - relates to symptoms following a reaction to stressor,
appropriate ranking of intervention priorities and treatment to reduce their
harmful effects.
 Tertiary prevention - relates to changing processes taking place as
reconstitution begins and maintenance factors move the back in circular
manner toward primary prevention.

28
 Analysis of the Model

Clarity

Neuman model presents show lack clarity in the way that some of words are
complicated.

“The model’s essential concepts of client, environment, health, and nursing

are congruent with traditional understanding of the nursing metaparadigm.
However, some authors have criticized lack of clarity, calling for concepts to
be defined more completely”

Alligood, M.R (2018, p. 239)

Generality

The theory shows generality because in her model the most important
concept in interventions and preventions in nursing practice.

“The model’s systematic broad scope allows it to be useful to nurses and to

other health care professionals working with individuals, families, group, or
communities in health care settings.”

Alligood, M.R (2018, pg.240)

Simplicity

The model concept is complex but in logical manner.

“Multiple interrelationships exist among concepts, and variable overlap to

some degree. Distinction between concepts tend to blur at several points, but
loss of theoretical meaning would occur if they were separated completely”

Alligood, M.R (2018, pg.239)

Accessibility

The Neuman systems model is easy to access because there’s a lot resources
available in the internet and also there are book that already been published related
in her model.

“The model has been tested and is used extensively to guide nursing research.”

Alligood, M.R (2018, pg.240)

Importance

Neuman’s conceptual model includes guidelines for the professional nurse for
assessment of the client system, use of the nursing process, and implementation of

29
preventive interventions, which are all important to delivery of care. The focus on
primary prevention and interdisciplinary care is futuristic and serves to improve
quality of care.

References:

 Alligood, M.R(2018,) Credentials and background of the theorist, Nursing

theorist and their works, 9th Edition.(2018, pg. 231)
 Alligood, M.R(2018,)Major concepts and definition, Nursing theorist and their
works,9th edition.(pp.232-234)
 Alligood, M.R(2018,)Major assumption, Nursing theorist and their works,9 th
edition.(pp.234-236)
 Alligood, M.R(2018,)Critique, Nursing theorist and their works,9 th edition.
(pp.239-240)
Book:

 Martha Raile Alligood, Nursing theorist and their works 9 th edition.

Other source:

 http://currentnursing.com/nursing_theory/Neuman

 http://nurseslabs.com

o Activity Please complete the table below.

Theorist Practice Education Research

Theory Conceptual Person Environment Health Nursing
Model/Framework
Betty
Newman

30
 Callista Roy Adaptation Model

Credentials and Background of the Theorist

 Nurse theorist, writer, lecturer, researcher, and teacher

 Professor and nurse theorist at the Boston College of Nursing in Chestnut Hill
 Born at Los Angeles on October 14, 1939
 Bachelor of Arts with major in nursing – Mount St. Mary’s College, Los
Angeles in 1963
 Master’s degree program in pediatric nursing – University of California, Los
Angeles in 1966
 Master’s and PhD in Sociology in 1973 and 1977 from the University of
California
 Work with Dorothy E. Johnson to develop a conceptual model for nursing
 Develop the basic concepts of the model, at the University of California from
1964-1966
 RAM begun operationalizing her model in 1868 as a basis of curriculum at at
Mount St. Mary’s College
 1970 – The model was implemented in Mount St. Mary’s School titled
“Adaptation: A Conceptual Framework for Nursing
 1983 – She was made chair of the nursing both at the Mt. St. Mary’s College
and University of Portland
 1985 – She was Robert Wood Johnson postdoctoral fellow at the UC, San
Francisco, as a clinical nurse scholar in neuroscience (develop a study about
interventions for cognitive recovery in head injuries)
 1991 – Roy published several books, chapters and periodical articles and
presented numerous lectures and work shops in relation to her Nursing
Adaptation Theory (Roy and Andrews, 1991)
 1999 – where she published the newer version of her Adaption Theory
 A member of Sigma Theta Tau
 Received prestigious awards

Theoretical Sources

Roy’s Adaptation model for Nursing was derived in 1964 from Harry Helson’s
Adaptation Theory – adaptive responses are a function of incoming stimulus and the
adaptive level

Roy combines Helson’s work with Rapport’s definition of system and views the person
as an adaptive system

31
 Sister Callista Adaptaion Model

Stimulus

Focal Stimulus – the degree of change or stimulus most immediately

confronting the person and the one to which the person must make an adaptive
response, that is the factor that precipitates behaviour

Contextual Stimulus – all other stimuli present that contribute to the behaviour
caused or precipitated by the focal stimuli

Residual Stimulus – Factors that may be affecting behaviour but whose efforts
are not validated

Coping Mechanisms

Coping Processes – are innate or acquired way of interacting with the changing
environment

Innate Coping Mechanisms – are genetically determined or common to the species

and are generally viewed as automatic processes; humans don’t have to think about
them

Acquired Coping Mechanisms – are developed through strategies such as

learning. The experiences encountered throughout life contribute to customary
responses

Sub-Systems

Regulator Subsystem – is a major coping process involving the neural, chemical

and endocrine systems.

Cognator Subsystem – is a major coping process involving four cognitive-

emotive
Channels: perceptual and information processing, learning, judgement, and
emotion.

Responses

Adaptive Responses – are those that promote integrity in terms of the goals of
human systems.

Ineffective Responses – are those that do not contribute to integrity in

terms of the goals of the human system.

32
Adaptive Modes

Physiological Mode – involve the body’s basic needs and ways of dealing with
adaptation in regard to fluid and electrolytes; activity and rest; elimination;
nutrition; circulation and oxygen; and regulation; which include the senses,
temperature and endocrine regulation.

Self-Concept Mode – the composite of beliefs and feelings that one holds about
oneself at a given time. It is formed from perceptions, particularly of other’s
reactions, and directs one’s behaviour. (physical self and personal self)

Role Function Mode – role function is the performance off duties based on
given positions in society.

Interdependence Mode – involves one’s relations with significant others

and support systems. In this Mode one maintains psychic integrity by
meeting needs for nurturance and affection

Assumption

Scientific Assumptions

 Systems of matter and energy progress to higher levels of complex self-

organization.

 Consciousness and meaning are constitutive of person and environment

integration.

 Awareness of self and environment is rooted in thinking and feeling.

 Humans, by their decisions, are accountable for the integration of creative

processes.

 Thinking and feeling mediate human action.

 System relationships include acceptance, protection and fostering of

interdependence.

 Persons and the earth have common patterns and integral relationships.

 Persons and environment transformations are created in human

consciousness.

33
  Integration of human and environment meanings results in adaptation.

Philosophical Assumptions

 Persons have mutual relationships with the world and God.

 Human meaning is rooted in an omega point convergence of the universe.

 God is ultimately revealed in the diversity of creation and is the common

destiny of creation.

 Persons are human creative abilities of awareness, enlightenment and faith.

 Persons are accountable for the processes of deriving, sustaining and

transforming the universe.

34
 Evaluation of the Theory

Clarity – logical; claims to follow a holistic view but leaves out “spiritual, humanistic,
and existential aspects of being a person; has a clearly defined nursing process and
can be useful in guiding clinical practice

Simplicity – has several major concepts and subconcepts and numerous relational
statements; they were clearly defined

Generality – generalisable to all settings in nursing practice, but is limited in scope

because it primarily addresses the concept of person-environment adaptation and of
human beings.

Empirical Precision – Testable hypothesis have been derived from the model like
capable of generating new information through hypothesis-testing.

Importance - The model has inspired the development of many middle-range

nursing theories and of adaptation instruments. Sister Callista Roy continues to
refine the adaptation model for nursing research, education and practice.

35
 o Activity Please complete the table below.

Theorist Practice Education Research

Theory Conceptual Person Environment Health Nursing
Model/Framework
Sr.
Callista
Roy

36
 BEHAVIORAL SYSTEM MODEL

Dorothy E. Johnson

(1919 – 1999)

PERSONAL BACKGROUND

 Born August 21, 1919 in Savannah, Georgia

 Associates degree in 1938 from Armstrong Junior College in Savannah
Georgia
 Her bachelor of science degree in nursing from Vanderbilt University in
Nashville, Tennesse (1942)
 1948 her masters of public health degree from Harvard University in Boston.
 Death in February 1999 at the age 80.

PROFESSIONAL BACKGROUND

 Johnson’s professional’s experiences involved mostly teaching, although she

was a staff nurse at the Chatham Savannah Health Council from 1943 to
1944.
 Assistant professor of pediatrics at Vanderbilt University.
 Assistant professor of pediatrics nursing, an associate professor of nursing,
and a professor of nursing at the University of California.
 Pediatric nursing advisor for the Christian Medical School of Nursing in
Vellore, South India.
 Chairperson on the California’s Nurses Association that developed a position
statement for specifications for clinical specialist.
 Publications include four books, more than 30 articles, and many other
papers, reports, proceedings and monographs.

THEORETICAL SOURCES

 Influenced heavily 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.
 Used her work of behavioral scientist, psychology, sociology, and ethnology to
develop her seven subsystems.
 Also relied on the system theory and used concepts and definitions from
Rapport, Chin, von Bertalanffy and Buckley

37
MAJOR CONCEPTS AND DEFINITIONS
Behavior

 Is the output of intraorganismic structures and processes as they are

coordinated and articulated by and responsive to changes in sensory
stimulation
 Focused on behavioral affected by the actual or implied presence of other
social beings that has been shown to have major adaptive significance.
(Johnson 1980)

System

 “A system is a whole that functions as a whole virtue of the interdependence

of its parts” (Johnson 1980).

Behavioral system

 Encompasses the patterned, repetitive, and purposeful ways of behaving.

 Behaving from an organized and integrated functional unit that determines
and limits the interaction between the person and his or her environment and
establish the relationship of the person to the objects, events and situations
within his or her environment.

Subsystems

 A mini system maintained in relationship to the entire system when it or the

environment is not disturbed.

THE SEVEN SUBSYSTEMS

Attachment or affiliative subsystem

 Attachment or affiliative subsystem is the “social inclusion intimacy and the

formation and attachment of a strong social bond.” It is probably the most
critical because it forms the basis for all social organization. On a general
level, it provides survival and security. Its consequences are social inclusion,
intimacy, and the formation and maintenance of a strong social bond

Dependency subsystem

 Promotes helping behavior that calls for a nurturing response.

 Its consequences are approval, attention or recognition, and physical
assistance.
 Dependency behavior evolves from almost total dependence on others to a
greater degree of dependence on self.

38
Ingestive subsystem

 Has to do with when, how, what, how much, and under what condition we eat”
 It serves appetitive satisfaction (Johnson, 1980)

Eliminative subsystem

 It addresses “when, how, and under what conditions

 The social and psychological factors viewed as influencing the biological
aspects of this subsystem and may be, at times, in conflict with eliminative
subsystem.(Loveland-Cherry & Wilkerson, 1983)

Sexual subsystem

 Have the dual functions of procreation and gratification.

 Response system begins with the development of gender role identity and
includes the broad range of sex-role behaviors(Johnson, 1980)

Aggressive Protective subsystem

 The subsystem function is protection and preservation.

 Society demands that limits be placed on modes of self-protection and that
people and their property be respected and protected (Johnson, 1980)

Achievement subsystem

 Its function is control or mastery of an aspect of self or environment to some

standard of excellence. Areas of achievement behavior include intellectual,
physical, creative, mechanical, and social skills. (Johnson, 1980)

Equilibrium

 Stated that equilibrium is a key concept in nursing’s specific goal.

 “A stabilized but more or less transitory, resting state in which the individual is
in harmony with himself and with his environment “ (p.65).

Functional Requirements and Structural Imperatives

 For the subsystem to develop and maintain stability, each must have a
constant supply of function requirements. . The environment supplies sustenal
imperatives such as protection, nurturing, and stimulation.

Regulation/ Control

 Implies that deviations will be detected and corrected.

Tension

39
  The concept of tension is defined as a state of being stretched or strained and
can be viewed as an end-product of a disturbance in equilibrium” (Johnson,
1961, p. 10)

Stressor

 Internal or external stimuli that produce tension and result in a degree of

instability.

JOHNSON’S BEHAVIORAL SYSTEM MODEL

STRUCTURAL COMPONENT OF A SOCIAL SYSTEM

Goal – ultimate consequence of behavior in it

Set – one’s predisposition to act in a certain way

Choice of behavior – represent the behavior a patient sees himself or herself as

being able to use in any given situation.

Behavior – physical manifestation or the behavior of an individual.

THE FOUR METAPARDIGMS

Nursing

40
  Nursing goal is to maintain and restore the person’s behavioral system
balance and stability or to help the person achieve a more optimum level of
balance and functioning
 Nursing is seen as “an external regulatory force which acts to preserve the
organization and integration of the patient’s behavior at an optimal level by
means of impossible temporary regulatory or control mechanism or by
providing resources while patient is experiencing stress or behavioral system
imbalance.”(Brown, 2006)
 An art and science, nursing supplies external assistance both before and
during system balance disturbance and therefore requires knowledge of
order, disorder, and control.(Herbert, 2989; Johnson, 1980)

Person

 Nursing’s goal is to maintain and restore the person’s behavioral system

balance and stability or to help the person achieve more optimum level of
balance and functioning.
 Johnson views human beings as having two major systems: the biological
system and the behavioral system. It is the role of medicine to focus on the
biological system, whereas nursing’s focus is the behavioral system.
 The concept of human being was defined as a behavioral system that strives
to make continual adjustments to achieve, maintain, or regain balance to the
steady-state that is adaptation.

Health

 Reflected by the organization, interaction, interdependence, and integration of

subsystem of the behavioral system (Johnson, 1980).
 An individual attempts to achieve a balance in this system, which leads to
poor health.
 A lack of balance in the structural or functional requirements of the
subsystems leads to poor health.
 One focuses on the behavioral system and system balance and stability,
effective and efficient functioning, and behavioral system imbalance and
instability.

Environment

 The environment consists of all the factors that are not part of the individual’s
behavioral system, but that influence the system. The nurse may manipulate
some aspects of the environment so the goal of health or behavioral system
balance can achieved for the patient (Brown, 2006)

41
  Determines and limits the interaction between the person and their
environment and establishes the relationship of the person to the objects,
events and situations in the environment”.(Johnson, 1978)

ASSUMPTION
Johnson makes multiple assumptions in three main areas.

 System
 Subsystem
 Functional requirements

CRITIQUE
Clarity

 Johnson's theory is comprehensive and broad enough to include all areas of

nursing practice and provide guidelines for research and education. The
theory is relatively simple in relation to the number of concepts. A person is
described as a behavioral system composed of seven systems. Nursing is an
external regulatory force.

Simplicity

 The theory is potentially complex because there are a number of possible

interrelationships among the behavioral system, it subsystems, and the
environment. Potential relationships have been explored, but more empirical
work is needed (Brown, 2006).

Generality

 Johnson’s theory has been used extensively with people who are ill or face
the threat of illness. Its use with families, groups, and communities is limited.
Johnson perceived a person as a behavioral system composed of seven
subsystems, aggregates of interactive behavioral systems. Initially, Johnson
did not clearly address no illness situations or preventive nursing (D. Johnson,
curriculum vitae, 1984). In later publications, Johnson (1992) emphasized the
role of nurses in preventive health care of individuals and for society. She
stated, “Nursing’s special responsibility for health is derived from its unique
social mission. Nursing needs to concentrate on developing preventive
nursing to fulfill its social obligations” (Johnson, 1992, p. 26).

Accessibility

42
  Accessibility is achieved by identifying empirical indicators for the abstract
concepts of model. Empirical precision improves when the sub concepts and
the relationships between and among them become better defined and
empirical indicators are introduced to the science. The units and the
relationships between the units in Johnson’s theory are consistently defined.
Thus, an adequate degree of empirical precision has been demonstrated in
research using Johnson’s theory. Although some of Johnson’s writings used
terms such as balance, stability, equilibrium adaptation, disturbances,
disequilibrium, and behavior disorders interchangeably, the programs of
research of Dee, Deridarian, Holaday, Lovejoy, and Poster operationally
defined terms and were consistent in their use. The clarity of these definitions
and the clarity of the definitions of the subsystems add to the theory’s
empirical precision (Brown, 2006).

Importance

 Johnson’s theory guides nursing practice, education, and research; generates

new ideas about using; and differentiates nursing from other health
professions. By focusing on behavior rather than biology, the theory clearly
differentiates nursing from medicine; although the concepts overlap with those
of the psychosocial professions. Johnson’s Behavioral System Model
provides a conceptual framework for nursing education, practice, and
research. The theory has directed questions for nursing research. It has been
analyzed and judged appropriate as a basis for the development of a nursing
curriculum. Practitioners and patients have judged the resulting nursing
actions to be satisfactory (Johnson, 1980). The theory has potential for
continued utility in nursing to achieve valued nursing goals.

Johnson’s theory guides nursing;

 Practice
–used in an inpatient, outpatient and community setting. The model is used to
develop nursing interventions for the patients.
 Education
– used and utilized in nursing education by understanding human behavior’s
role in health maintenance. A curriculum based on a person as a behavioral
system would have definite goals and straight forward course planning.
 Research
– “identify and explain the behavioral system disorders which arise in
connection with illness, and develop the rationale for the means of
management” (p. 7)

- Generates new ideas about nursing; and differentiates nursing from other
health profession.

43
REFERENCES

Alligood, M., & Tomey, A. (2018). Nursing theorists and their work, ninth
edition. Singapore: Elsevier Inc.

Angelo Gonzalo, BSN, RN – (2014, September) Dorothy Johnson: Behavioral

System Model Retrieved from https://nurseslabs.com/dorothy-e-johnsons-behavioral-
system-model/

o Activity Please complete the table below.

Theorist Practice Education Research

Theory Conceptual Perso Environment Health Nursing
Model/Framework n
Dorothy
E.
Johnson

44