GRAND NURSING THEORIES BASED ON HUMAN NEEDS

1. GRAND NURSINGTHEORIES BASED ON HUMAN NEEDS Group IV Arley T. Panes, RN Rhodora P. Andoy, RN Arlene O. Garcia, RN Mary Lou P. de Gracia, RN

2. The Theorists Florence Nightingale (Environment Theory) Faye G. Abdellah (Typology of Nursing Problems) Virginia Henderson (Definition of Nursing) Dorothea E. Orem (Self-Care Deficit Nursing Theory)

3. The Theorists 5. Dorothy Johnson (Behavioral Systems Model) 6. Betty Neuman (Systems Model)

4. DOROTHY E. JOHNSONBehavioral Systems Model I. Background of the Theorist: Received Associate Degree in Arts from Armstrong Junior College, Savannah, Georgia, 1938. B. S. in Nursing � Vanderbilt University, Nashville, Tenn., 1942. M. S. in Public Health from Harvard Univ., Boston, 1948. Nursing Faculty, UCLA 1949 - 1977 Also worked as a staff nurse and advisor to schools of nursing.

5. DOROTHY E. JOHNSONBehavioral Systems Model II. PHILOSOPHICAL UNDERPINNINGS, PURPOSE & MAJOR CONCEPTS: 1968 � first proposed model to foster the �efficient & effective behavioral functioning in the patient to prevent illness� 1980 � published Behavioral Systems Model in Conceptual Models for Nursing Practice.

6. DOROTHY E. JOHNSONBehavioral Systems Model II. PHILOSOPHICAL UNDERPINNINGS, PURPOSE & MAJOR CONCEPTS: Based on Florence Nightingale�s belief that nursing is designed to help people prevent or recover from illness or injury. Derived portions of her theory from the works of: - Selye on Stress - Grinker�s Theory of Human Behavior - Buckley & Chin on Systems Theory

7. Johnson�s Model & the 4 Concepts of the Nursing Metaparadigm: PERSON Is an open, interrelated system identified by actions & behaviors that are regulated & controlled by biological, psychological, & sociological factors. Continually strives to maintain a steady state by adapting & adjusting to environmental forces that cause an imbalance threatening the person�s physical, social or psychological integrity. Is an individual composed of 7 open & interactive subsystems; a disturbance in 1 usually affects the others. Is unique, possessing an individual & distinguishing set of behaviors .

8. Johnson�s Model & the 4 Concepts of the Nursing Metaparadigm: 2. ENVIRONMENT Is not specifically designed by Johnson; she refers to person�s internal & external environment but does not explain what they are. Interacts with the person.

9. Johnson�s Model & the 4 Concepts of the Nursing Metaparadigm: 3. HEALTH Is defined as balance & stability of a person�s behavioral system; instability or illness, is not addressed directly but can be inferred as a malfunction or the behavioral system. Is demonstrated by orderly, purposeful, predictable behavior that effectively & efficiently manages a person�s relationship to the environment.

10. Johnson�s Model & the 4 Concepts of the Nursing Metaparadigm: 4. NURSING Views the patient as a behavioral system. Is an external regulatory force that acts to preserve optimal organization & integration of a patient�s behavior when the patient encounters a threat to physical or social health. Is indicated only when a system becomes unstable; the goal of nursing is to maintain or restore behavioral system balance & stability & integrated subsystem functioning.

11. Johnson�s Model & the 4 Concepts of the Nursing Metaparadigm: 4. NURSING Uses outside regulatory control mechanisms, such as teaching, setting limits on behavior, & providing needed environmental resources. Requires a strong background in the physical & social sciences.

12. DOROTHY E. JOHNSON SEVEN (7) SUBSYSTEMS

13. DOROTHY E. JOHNSONBehavioral Systems Model III. CONTEXT FOR USEFULNESS & NURSING IMPLICATIONS Damus (1980), Dee (1990) & Holaday (1980) described situations in which Johnson�s model has been used to direct nursing practice. Benson (1997) used Johnson�s model as a framework to describe the impact of fear of crime on an elder person�s health, health-seeking behaviors, & quality of life. Fruehwirth (1989) applied Johnson�s model to assess and intervene in a group of caregivers for individuals with Alzheimer�s disease. Used as a curriculum guide for a number of schools of nursing (Grubbs, 1980; Johnson, 1980, 1990). Adapted for use in hospital situations (Dee, 1990) Inspired the work of 2 grand nursing theorists, Betty Neuman & Sr. Callista Roy (both her students).

14. DOROTHY E. JOHNSONBehavioral Systems Model IV. EVIDENCE OF EMPIRICAL TESTING/TESTABILITY More than 20 research studies have been identified using Johnson�s model. (Ex: Turner-Henson, 1992, used it as a framework to examine how mothers of chronically ill children perceived the environment, i.e., whether it was supportive, safe, and accessible). Poster, Dee & Randell (1997) used Johnson�s theory as a conceptual framework in a study of client outcome evaluation; they found that the nursing theory made it possible to prescribe nursing care and to distinguish it from medical care. Derdiarian & Schobel (1990) used the model to develop an assessment tool for individuals with acquired immunodeficiency syndrome. Derdiarian (1990) examined the relationship between aggressive/protective subsystem & the other six model subsystems.

15. DOROTHY E. JOHNSONBehavioral Systems Model V. PARSIMONY Johnson (1980) was able to explicate her entire model in a single short chapter in an edited book. Relatively few concepts are used in the theory, and they are commonly used terms. The relationships are clear thus the model is considered to be parsimonious.

16. DOROTHY E. JOHNSONBehavioral Systems Model POINTS TO REMEMBER: The model advocates fostering efficient & effective behavioral functioning in a patient. The patient is a behavioral system composed of 7 subsystems. An imbalance in any subsystem results in disequilibrium. Each subsystem has functional & structural requirements. The nurse intervenes to restore, maintain, or attain behavioral system balance & stability at the highest possible level for the individual.

18. BETTY NEUMANI. Background of the Theorist:

19. BETTY NEUMANI. Background of the Theorist:

20. BETTY NEUMANSYSTEMS MODEL II. PHILOSOPHICAL UNDERPINNINGS, PURPOSE & MAJOR CONCEPTS: Neuman's model was influenced by a variety of sources, but most particularly: The philosophy of writers such as deChardin Gestalt theory Hans Selye's General Adaptation Syndrome General Systems Theory (Von Bertalanfy & Lazlo)

21. BETTY NEUMANSYSTEMS MODEL METAPARADIGM 1. Person The person is a layered multidimensional being. Each layer consists of five person variables or subsystems: Physical/Physiological Psychological Socio-cultural Developmental Spiritual The above variables function in time to attain, maintain, or retain system stability. The model is based on the client�s reaction to stress as it maintains boundaries to protect client stability.

22. NEUMAN SYSTEMS MODEL

26. BETTY NEUMANSYSTEMS MODEL METAPARADIGM 2. ENVIRONMENT The environment is seen to be the totality of the internal and external forces which surround a person and with which they interact at any given time. These forces include the intrapersonal, interpersonal and extrapersonal stressors which can affect the person's normal line of defense and so can affect the stability of the system.

27. BETTY NEUMANSYSTEMS MODEL The internal environment exists within the client system. The external environment exists outside the client system. Neuman also identified a created environment which is an environment that is created and developed unconsciously by the client and is symbolic of system wholeness.

28. BETTY NEUMANSYSTEMS MODEL METAPARADIGM 3. HEALTH continuum from wellness to illness, dynamic in nature, that is constantly subject to change where optimal wellness or stability, indicates that total system needs are being met.

29. BETTY NEUMANSYSTEMS MODEL METAPARADIGM 4. NURSING a unique profession concerned with all variables affecting clients in their environment.

30. THREE STEP NURSING PROCESS (NEUMAN, 1995) NURSING DIAGNOSIS � assumes that the nurse collects an adequate database from which to analyze variances from wellness to make the diagnoses. NURSING GOALS � determined by negotiation with the client and appropriate prevention as intervention strategies are decided. NURSING OUTCOMES � confirmation of prescriptive change or reformulation of nursing goals is evaluated. The findings feed back into the system as applicable.

31. BETTY NEUMANSYSTEMS MODEL III. CONTEXT FOR USE/USEFULNESS AND NURSING IMPLICATIONS Neuman�s model has been used extensively in nursing education & nursing practice. Recent examples are the following: Application of the model to direct nursing practice in a pediatric hospital (Torakis & Smigielski, 2000). Application of the model by nurse anesthetists (Martin, 1996). Application of the model to teach health assessment and the nursing process in an undergraduate nursing program (McHolm & Gieb, 1998) Also used to guide nursing practice for the management of a number of health conditions including depression (Hassell, 1996), lung disease (Narsavage, 1997) & linear scleroderma (Fuller & Hartley, 2000).

32. BETTY NEUMANSYSTEMS MODEL IV. EVIDENCE OF EMPIRICAL TESTING/ TESTABILITY The Neuman model is not testable as a whole but it gives rise to directional hypotheses that are testable in research. Thus, it has been used as a conceptual framework extensively in nursing research, and aspects of the model have been empirically tested. (McEwen & Wills, 2002)

33. BETTY NEUMANSYSTEMS MODEL V. PARSIMONY/SIMPLICITY The Neuman model is complex, and many parts of the model function in various ways. It cannot be considered parsimonious because the description of the model�s parts can be confusing. The model also hints at unstated elements that may interact and affect outcomes of the model. The definitions are overlapping in some cases, and the assumptions (propositions) are multileveled and difficult to keep separate. (McEwen & Wills, 2002)

34. BETTY NEUMANSYSTEMS MODEL POINTS TO REMEMBER: Neuman�s Systems Model is a total person approach to nursing that provides a multidimentional view of the person as an individual. The person is viewed as an open, dynamic system in constant interaction with the environment. Surrounding the person�s basic core structure are lines of resistance, a normal line of defense, & a flexible line a defense, w/c attempt to combat the effect of stressors. The nurse uses specific interventions based on the degree of reaction to the stressor. Neuman�s nursing process consists of 3 steps � nursing diagnosis, nursing goals & nursing outcomes.

35. REFERENCES Heyman, Patrick and Sandra Wolfe, patheyman.com. University of Florida, 2000. McEwen, Melanie and Evelyn M. Wills (2002). Theoretical basis for nursing. Philadelphia: Lippincott Williams & Wilkins. Wesley, Ruby and Marylou McHugh (1992). Springhouse Notes: Nursing theories and models. Pensylvania: Springhouse Corp.