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Chapter 5

Statement of Intent

This chapter provides a brief overview of each of three important 20th century nursing theorists: Wiedenbach, Henderson, and Hall. The content of the chapter has been taken from that written by scholars who have studied or worked with these theorists and who wrote chapters about each for the first edition of Nursing Theories and Nursing Practice. For a wealth of additional information on these nurses, scholars, researchers, thinkers, writers, practitioners, and educators, please consult the separate reference and bibliography sections at the end of the chapter.

Chapter 5

Key Terms

Focus on patient

Important influences on nursing theory development

Prescriptive theory

Goal-directed care

Motivating factors

Cure

Trade vs. profession

Definition of nursing

Caring based

Definitions of nursing

Professional practice

Nursing practice theory

Dynamic nursing

Care

Core

Therapeutic effect

Nursing functions

Basic nursing care

Chapter 5

Objectives

On completion of this chapter, students will be able to:

23 Describe the historical, educational, and career trajectories of each theorist.

24 Describe the impact that Wiedenbach, Henderson, and Hall had on the development of nursing knowledge.
25 Discuss the relevance of the basic principles proposed by these theorists to the current practice of nursing.
26 Identify the major contribution that each theorist to the development of nursing knowledge.

27 Explore and describe each theorist’s unique approach and process of developing a theoretical framework for nursing practice.
28 Examine the theoretical perspectives of each theory and identify commonalities and differences among the theories.

Chapter 5

Outline

Introducing the Theorists

Ernestine Wiedenbach

Virginia Henderson

Lydia Hall

Introducing the Theories

Ernestine Wiedenbach

Prescriptive Theory

Central Purpose

Nurse’s Goals

Virginia Henderson

Function of Nursing

Definition of Nursing

Fourteen Components of Basic Nursing Care Lydia Hall
Hall’s Care, Cure, and Core Model

Care

Cure

Core

Practice Applications

Ernestine Wiedenbach

A Concept of Dynamic Nursing

Virginia Henderson

Basic Principles of Nursing Care (1960)

The Nature of Nursing (1966)

Functions Pertaining to the Care of Patients

Definition of Nursing

Lydia Hall

Practice Exemplars

Practice Exemplar Wiedenbach

Practice Exemplar Henderson

Practice Exemplar Hall

Summary

References

Chapter 5

Questions for Classroom Discussion

23 Virginia Henderson has been referred to as the modern-day Florence Nightingale. Examining Henderson’s 14 components of basic nursing care, identify parallels in her theoretical structure that are consistent with Nightingale’s theory of nursing.
24 Wiedenbach emphasized that the nurse’s goals are grounded in the nurse’s philosophy, or “those beliefs and values that shape one’s attitude toward life, toward fellow human beings, and toward herself.” Write a paragraph for each of the following philosophic considerations that are relevant for nursing practice:

23 What is the nature of human beings?

24 What is the nature of nursing?

25 What is the focus of nursing?

Chapter 5

Multiple-Choice Questions

(Answers appear in bold)

0 Wiedenbach explains her prescriptive theory in her book, Meeting the Realities in Clinical Teaching (1969). Select the answer that represents the BEST explanation of her perspective theory.
A. Nursing process allows the nurse to employ a standard process in selecting appropriate interventions.

B. Account must be taken of the motivating factors that influence the nurse not only in doing what she does but also in doing it the way she does it with the realities that exist in the situation in which she is functioning.

C. This theory proposes 14 functional components of basic nursing care.

D. Nursing entails the diagnosis and treatment of illness.

0 Weidenbach proposes that there are three ingredients essential to the prescriptive theory. Select the ONE answer that is NOT one of these essential ingredients.
A. The nurse’s central purpose in nursing is the nurse’s professional commitment.

B. The prescription indicates the broad general action that the nurse deems appropriate to fulfillment of her central purpose.

C. The reality of nursing is that the charge of the nurse is to implement the orders

prescribed by the physician.

D. The realities are the aspects of the immediate nursing situation that influence the results the

nurse achieves through what she does.

256⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ̀̀ĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀЀĀȀ⸀ĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀĀᜀ Which of the following theorists coined the term “basic nursing care”? A. Wiedenbach

0 Henderson

1 Hall

2 None of the above.

23 Which of the following theorists founded the Loeb Center? A. Wiedenbach
B. Henderson

23 Hall

24 None of the above.

23 Based on the assumption that nursing has a unique function, Henderson believed which of the following?
A. Nursing functions to follow and implement the prescribed regimen of the physician.

B. Nursing independently initiates and controls activities related to basic nursing care.

C. It is not necessary to limit nursing activities to nursing care because nurses should be

responsive to all patient needs.

D. All of the above

23 Henderson identified 14 components of basic nursing care that reflect needs pertaining to personal hygiene and healthful living. These components of basic nursing care include all of the following EXCEPT:
A. Move and maintain desirable postures.

B. Communicate with others in expressing emotions, needs, fears, or opinions.

C. Do not involve the patient in decisions of care so that the patient may get better rest.

D. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities.

23 In 1990 the Sigma Theta Tau (International Honor Society of Nursing) library was named in honor of which of the following nursing theorists?
A. Nightingale B. Weidenbach C. Orlando
D. Henderson

23 Weidenbach, Henderson, and Hall made a significant impact on nursing theory in the 20th Century because they each:
A. Examined nursing practice and explored nurse–patient interactions. B. Used nursing practice as the basis for their theory development.

C. Defined ways nursing is thought about, practiced, and research. D. A & C

E. All of the above

23 Lydia Hall drew on her expertise of which of the following practice areas in developing her Care, Cure, and Core Model?
A. Critical care B. Pediatrics

5888 Rehabilitation

5889 Gerontology

0 A significant value of the contributions of Wiedenbach, Henderson, and Hall is that each of them was concerned with the unique aspects of nursing’s supportive role to physician medical practice.
A. True

B. False

11. Lydia Hall believed CARE was the sole function of nurses, whereas CORE and CURE were shared with other members of the health team.
0 True

1 False
Chapter 5: Twentieth-Century Nursing Case Study: Ernestine Weidenbach, Virginia Henderson, and Lydia Hall’s Contributions to Nursing Theory and Their Use in Practice Instruction: Read the case study and answer the questions that follow.
Janice went to see her urologist because she was experiencing burning when she urinated. She felt an urgent need to go and frequently ran to the bathroom only to discover her bladder held very little fluid. The morning of her appointment, Janice saw blood in her urine. She was becoming increasingly uncomfortable and anxious. When she arrived at the doctor’s office, the nurse spoke with her about how she was feeling and the symptoms she was experiencing. While waiting for the doctor, Janice shared with the nurse that her mother had died at the age of 50 from complications of bladder cancer and that she was afraid she was genetically programmed to die young from the same type of cancer.
0 Weidenbach guides us to explore each patient‘s unique perception of his or her condition or situation. What is the unique way in which Janice perceives her bladder problems?
1 From Henderson’s perspective, how might the nurse address Janice’s anxiety?

2 Develop a plan of care for Janice from the perspective of Weidenbach, Henderson, and/or Hall.
Guided Response (Answer) for Instructors:

0 For Weidenbach, the focus of practice is the experiencing individual, that is, the individual for whom the nurse is caring, and the way he and only he perceived his condition or situation.
0 Henderson conceptualized the nurse as a substitute for the patient’s lack of necessary will, strength, or knowledge to attain good health and to complete or make the patient whole.
0 Hall believed during the rehabilitation phase of an illness experience, professional nurses were the best prepared to foster the rehabilitation process, decrease complications and recurrences, and promote health and prevent new illnesses.
1 Encourage students to compare and contrast questions each theory might guide the nurse to ask.
Weidenbach: Compare situations identifying where there are differences, assist the patient to articulate concerns discuss genetic links to bladder cancer with the doctor, and provide education regarding common causes of the symptoms the patient is experiencing.
Henderson: Review 14 components of basic nursing care. The components Eat and Drink adequately and Eliminate body wastes are particularly relevant in this case study.
Hall: How might the nurse help Janice prevent complications and promote healing?

.

Chapter 6

Statement of Intent

This chapter provides a brief overview of each of these early scholars and their conceptualization of nursing and the nurse–patient relationship. Their work situated the focus of nursing from performance of tasks to engagement in a therapeutic relationship designed to facilitate health and healing.

Chapter 6

Key Terms

Nurse–patient relationship

Interpersonal process

Therapeutic communication

Self awareness

Supervision

Phases of the nurse patient relationship

Interpersonal

Subjects

Human-to-Human Relationship Model

Therapeutic use of self

Hope

Motivation

Empathy

Rapport

Dehumanization

Illness

Dynamic nurse–patient relationship

Helplessness

Directive assistance

Nursing process

Value

Independent role of nursing

Chapter 6

Objectives

On completion of this chapter, students will be able to:

0 Describe the historical, educational, and career paths of each theorist.

1 Discuss the impact Peplau, Travelbee, and Orlando had on the practice of nursing.

2 Describe the basic components of each theorist’s model.

3 Identify the commonalities and differences between the theories

4 Discuss the application of each theoretical model to clinical research

Chapter 6

Outline

Part One: Peplau’s Nurse–Patient Relationship

Introducing the Theorist

Overview of Theory: Nurse–Patient Relationship

Components

Central to All Nursing Care

Goal

Key Components

Nurse:

Acceptance

Therapeutic Communication (Verbal and Nonverbal)

Self-awareness via Supervision

Relationship:

Interpersonal

Objective and Focused on Need of Patient

Growth Promoting, Forward Movement

Time Limited

Phases of the Nurse–Patient Relationship

Orientation Phase

Working Phase

Resolutions Phase

Applications

Research

Practice Exemplar

Part Two: Travelbee’s Human-to-Human Relationship Model

Introducing the Theorist: Travelbee

Overview of Theory: Human-to-Human Relationhsip Model Mid-range Theory
Components

Nursing Care: Five Stages

Observation

Interpretation

Decision-making

Action (nursing intervention)

Appraisal (evaluation)

Phases of Progression of Spiritual and Emotional Needs Original Encounter
Emerging Identities

Empathy

Sympathy

Rapport

Practice Application

Phase Three: Orlando’s Theory of Dynamic Nurse–Patient Relationship

Introducing the Theorist: Orlando

Overview of Theory: Dynamic Nurse–Patient Relationship

Purpose of Nursing

Components of Theory

Practice Application

Chapter 6

Questions for Classroom Discussion

0 Orlando’s theory can serve as a philosophy as well as a theory. Describe how you would use this theory /philosophy in your nursing practice.
1 What modifications or refinement do you suggest that would make Travelbee’s theory more applicable and useful to contemporary nursing practice?

Chapter 6

Multiple-Choice Questions

(Answers appear in bold)

0 Peplau’s publication, in 1952, Interpersonal Relations in Nursing, presented her framework for the practice of psychiatric nursing. The publication:

A. Resulted in a paradigm shift in this field of nursing. B. Presented revolutionary ideas.
C. Was not well received when it was first published.

D. All of the above.

2. Peplau’s goal for her input into nursing knowledge and practice was to:

A. Prepare nurse psychotherapists, referring to this training as “talking to patients.”

B. Demonstrate to the medical community that nurses could practice independently.

C. Develop a method for theory development.

D. Link psychosocial and medical nursing.

3. Peplau viewed nursing interventions as those that:

A. Supported the implementation of physician medical orders.

B. Reflected the wants and desires of the patient.

0 Are soundly based on bio-medical knowledge.

1 Assisted patients in gaining interpersonal and intellectual competencies evolved through the nurse–patient relationship.

0 Peplau required her students to engage in unflinching self-scrutiny, examining their own verbal and nonverbal communication and its effect on the nurse–patient relationship.

0 True

1 False

0 Forchuk’s research of Peplau’s nurse–patient relationship was focused on which phase of the nurse–patient relationship?

A. Orientation Phase

B. Working Phase

C. Resolution Phase

0 Travelbee’s model uses the word “patient” to describe the individual in need of nursing care. A. True

B. False

7. According to Travelbee, dehumanization occurs when:

A. The ill person is left alone to find meaning to his illness experience.

B. The term patient is used to label or categorize a person.

C. One treats the ill person with an emotional detachment.

D. All of the above

0 The nursing tasks of hope and motivation are key assumptions to which of the following theorists?

0 Peplau

1 Orlando

2 Travelbee

3 Forchuk

5888 According to Orlando, professional nurses function in an independent role from physicians and other health care providers.

0 True

1 False

10. One of the most important contributions of Orlando’s work is:

A. The values of the human transaction

B. The enormous research based on her theory

C. The phases of the nurse–patient relationship

D. The instillation of hope and motivation
Chapter 6: Nurse–Patient Relationship Theories: Hildegard Peplau, Joyce Travelbee, and Ida Jean Orlando
Instructions: Read the case study and answer the questions that follow.

Ann, a community nurse, made an afternoon home visit with Susan and her father. After the death of her mother, Susan had growing concerns about her father living alone. “I worry about my father all the time. He is becoming more forgetful and he has trouble seeing. Mom used to take of him. I am not sleeping and I am irritable around him. Yesterday I shouted at him because he wouldn’t let me help him with his laundry. I felt terrible! I am at my wits’ end! My brothers and sisters do not want to put dad in a nursing home but they are not willing to help out. As usual, they have left me with all the responsibility. I work part time and have two small children to care for. Susan’s father, Sam, sat quietly with tears filling his eyes. He was well nourished and well groomed but would not make eye contact. Nurse Ann noticed that the house was clean and orderly. A tray in front of the TV had the remains of a ham sandwich and glass of ice tea. Mail was piled up, unopened on a small table near the front door. There was only one car in the driveway and the yard was in need of attention.

0 What questions do the theories of Peplau, Travelbee, and Orlando guide the nurse to consider in caring for Susan and Sam?
1 How might Peplau’s concepts of participant–observer, spectator–observer, and random observer guide the nurse in this case study? From Travlebee’s perspective, how might Ann prevent dehumanizing Susan and Sam? How might Orlando’s focus on alleviating helplessness inform Ann’s approach to Susan and Sam?
2 Develop a family plan of care from the perspective of Peplau, Travelbee, and/or Orlando.
Guided Response (Answer) for Instructors:

0 Peplau, Travelbee, and Orlando explicated the nature and importance of the nurse–patient relationship. Their work moved the focus of nursing from the performance of a set of tasks to engagement in a therapeutic nurse–patient relationship designed to facilitate patient health and healing. Each theorist has a unique definition of nursing that informs a nursing focus.
0.0 Peplau’s primary focus is to assist patients in gaining interpersonal and intellectual competencies that evolved through the nurse–patient relationship. She required her students to engage in unflinching self-scrutiny, examining their own verbal and nonverbal communication and its effect on the nurse–patient relationship which was an early form of reflective practice. Ask students to reflect on the case study and identify assumptions that they immediately make about the situations and then using the concepts of participant–observer, spectator–observer, and random observer guide them in exploring those assumptions.
0 Travelbee asserts that through the therapeutic use of self and the integration of evidence-based knowledge, the nurse provides quality patient care that can foster the patient’s trust and confidence in the nurse (Travelbee, 1971). She sees the role of the nurse as assisting persons to experience hope in order to cope with the stress of illness and suffering (Travelbee, 1971). Orlando defines the focus of nursing as responding to individuals who suffer or anticipate a sense of helplessness; it is focused on the process of care in an immediate experience; it is concerned with providing direct assistance to individuals in whatever setting they are found for the purpose of avoiding, relieving, diminishing, or curing the individual’s sense of helplessness. (Orlando, 1972). Encourage students to identify concepts of importance in the case study from the perspective of each theorist and explore the literature using these key concepts to develop a sense of the variety of approaches to the nursing care of this family.

Chapter 7

Statement of Intent

The intent of this chapter is to provide an introduction to the historical, educational, and career pathway of nursing theorist Myra Levine and an overview of her Conservation Model. The goal of the Conservation Model is to promote adaptation and maintain wholeness using the principles of conservation.

Chapter 7

Key Terms

Conservation

Organismic

Adaptation

Organismic Responses

Wholeness

Environmental Fit

Redundancy

Internal and External Environment

Environmental Challenges

Therapeutic Intervention

Chapter 7

Objectives

On completion of this chapter, students will be able to:

0 Discuss the historical, educational, and career pathway of nursing theorist Myra Levine.

1 Identify the basic components of the Conservation Model.

2 Discuss the application of the Conservation Model to nursing practice.

3 Compare and contrast Levine’s use of the concepts: structural, social, and personal integrity.

4 Explore and discuss the impact of the Conversation Model to provide a foundation for the future of nursing practice.

Chapter 7

Outline

Part One

Introducing the Theorist

Introducing the Theory

Foundations of Clinical Nursing

The Composition of the Conservation Model

Goal

Components

Adaptation

Conservation

Wholeness

Health, Person, Environment, Nursing

The Model

Philosophical Assumptions and Values of the Conservation Model

Values

Part Two

Applications to Nursing Practice

Case Study

Using the Levine Conservation Model, the nurse’s goal is to promote wholeness in the context of Missy’s pregnancy.
Assessment

Structural and Integrity

Social Integrity

Trophigcognoses

Hypothesis

Nursing Interventions

Organismic Responses

Use of Conservation Model in the 21st Century

The Model Modified for Use in Community-Based Care Summary
Chapter 7

Questions for Classroom Discussion

3 Levine stated that unless the “theory can be interpreted by the how nurse who reaches the patient wherever nursing is practiced, theory will remain a questionable entity … theory should teach nurses what they are.” Divide in to small groups and discuss how you think Levine’s theory can be interpreted into nursing practice. Identify the barriers you perceive to utilizing the theory in current nursing practice.
4 Levine proposes a major proposition of the conservation principles as: “The individual is always within an environment milieu, and the consequences of his awareness of his environment persistently influence his behavior at any given moment.” Provide a clinical example/senerio that demonstrates this proposition.

5 Divide students into small groups. Provide groups with a clinical case study. Have groups then address and develop strategies for applying Levine’s steps in the nursing process: Assessment, trophicognosis, hypothesis, interventions, and evaluation.

Chapter 7

Multiple-Choice Questions

(Answers appear in bold)

0 Levine identified two concepts critical to the use of her model: A. Back and forth
B. Dynamic and static

C. Adaptation and Wholeness

D. Risk and risk management

3 As an organizing framework for nursing practice, the goal of the Conservation Model is to: A. Guide the nurse to focus on the influences and responses at the organismic level.
B. Promote adaptation and maintain wholeness using the principles of conservation.

C. Provide a framework for nursing interventions to improve the patient’s condition (therapeutic) or to promote comfort (supportive) when change in the patient’s condition is not possible.

D. All of the above

E. None of the above

3. Levine defines adaptation as:

A. The process whereby the patient maintains integrity within the realities of the environment

B. The process of change with conservation being the outcome of adaptation

C. The process of making the best of a bad situation

D. A and B

E. All of the above

0 Levine proposes that health and disease are patterns of: A. Internal and external mitigating factors
B. Adaptive change

C. An individual response that may change over time in response to new situations, new life challenges, aging; or social, political, economic, and spiritual factors

D. B and C

E. A and B

3 The interventions of the Conservation Model that are designed to return the patient to wholeness are based on the assumption the intervention must attend to:
A. The conservation of energy

B. Structural, personal, and social integrities C. Promote adaptation

D. All of the above

0 Levine rejected the notion that energy can be manipulated and transferred from one human to another as in therapeutic touch.

3 True

4 False

7. According to Levine, the environment:

A. Includes both the internal and external environment of the individual.

B. Completes the wholeness of the individual.

C. Includes those factors that impinge on and challenge the individual.

D. A and B

E. All of the above

8. The conservation of personal integrity acknowledges the individual as:

3 One who strives for recognition, respect, self-awareness, humanness, self-hood, and self-determination

4 A social being who functions in a society that helps to establish boundaries of the self

5 Recognizing that the individual resides within a family, a community, a religious group, an ethnic group, a political system, and a nation
6 Dependent on an intact defense system (immune system) that supports healing and repair

0 Levine viewed the person as a holistic being and proposed that the experience of wholeness is the foundation of all human enterprises.

0 True

1 False

0 An organismic response is a change in behavior or change in the level of functioning during an attempt to adapt to the environment. The organismic responses are intended to:
A. Sustain social interaction

B. Enhance the fight-or-flight response

C. Maintain the patient’s integrity

D. Maintain inflammation
Chapter 7: Levine Case Study

Instructions: Read the case study and answer the questions that follow.

As a nurse working in a mental health facility, you are responsible for the care of Jane, a young woman in her mid-20s who has been admitted with a diagnosis of paranoid schizophrenia. Jane has a health history of repeated hospitalizations. Her first admission occurred when she was a young teenager.
Jane tells you she was always very shy growing up, and that she did not have many friends. However, Jane did play the piano when she was an adolescent and found playing the piano comforting. It was the only engaged activity she participated in during her teenage years.

Jane told the nurse that when her mother and father divorced, she became more withdrawn and preferred to remain alone. Further conversation revealed that she did not feel motivated to pursue goals or activities in school. She felt persecuted and interpreted events with no reference to reality. She eventually lost interest in the piano as the symptoms of the disease resulted in being unable to associate letters with the musical notes. She has recently stated she felt little purpose in her life.
0 The core or central concept of Levine’s Theory is conservation. What might this mean for Jane?
1 How does Jane adapt to the internal and external environment?

2 What nursing interventions might ground the nurse in caring for Susan from Levine’s perspective?
Guided Response (Answer) for Instructors:

0 The nurse accomplishes the goals of the model through the conservation of energy, structure, personal, and social integrity. Conservation of energy: Adequate rest, nutrition, and exercise.
Structural activity: A plan of care will promote specific interventions of self-care and maintenance of personal hygiene. Conservation of personal integrity: Recognize and protect the patient’s space needs, includes patient respect and his or her self-determination. Conservation of social integrity: Help the individual to preserve his or her place in a family.

0 There is a continuous dynamic, open interaction between the internal and external environment. This interaction provides the basis for holistic thought and the view of the individual as whole. During the assessment process there may be a collection of challenging facts or in observation and interview there may be challenges to the internal and external environment … using the four conservation principles of energy, structure, personal, or social integrity. The nursing diagnosis gives the challenging facts meaning. Patients with schizophrenia have disturbed body temperature regulation; in the heat of summer, they may dress for winter. In the heat of summer they may dress for winter. Patients with schizophrenia may also have difficulty with personal hygiene. Weight gain may be a reason some patients do not take their medicines.
1 Historicity refers to the notion that adaptive responses are partially based on personal and genetic past history. Music therapy is a choice, by the nurse, as an adaptation response for the patient. This approach builds on Susan’s past history of playing the piano before her illness. What is the meaning of playing the piano for Susan?

Chapter 8

Statement of Intent

The intent of this chapter is to offer a systems approach to nursing practice. Dorothy Johnson’s theoretical model was the first to provide both a guide to understanding and a guide to action. These two ideas—understanding seen first as a holistic, behavioral system process mediated by a complex framework and second as an active process of encounter and response—are central to the work of other theorists who followed her lead and developed conceptual models for nursing practice.

Chapter 8

Key Terms

Systems Theory

Developmental Theory

Wholeness and Order

Stabilization

Reorganization

Hierarchic Interaction

Dialectical Contradiction

Behavioral Subsystems

Subsystem

Structural Components

Internal/External Environment

Internal Structures

Health

Behavioral System Balance

Structural and Functional Stresses

Behavioral System Imbalance

Regulatory and Control Measures

Nursing

Nursing Therapeutics

Chapter 8

Objectives

On completion of this chapter, students will be able to:

3 Discuss paradigmatic origins of Johnson’s Model

4 Discuss the five core principles of Dorothy Johnson’s Behavioral Systems Model.

5 Identify the eight subsystems of Dorothy Johnson’s Behavioral Systems Model and discuss their interrelationship.
6 Describe Johnson’s definition of person, environment, health, and nursing.

7 Discuss the role of the Behavioral Systems Model in nursing practice, administration, research, and education.

Chapter 8

Outline

Introducing the Theorist

Overview of Dorothy Johnson’s Behavioral System Model Five Core Principals
Wholeness and Order

Stabilization

Reorganization

Hierarchic Interaction

Dialectical Contradiction

Major Concepts of the Model

Person

Subsystems

Health

Nursing and Nursing Therapeutics Practice Applications
Practice-Focused Research

Education

Nursing Practice and Administration

The Practice Exemplar

Subsystems

Environmental Assessment

Evaluation

Summary

Chapter 8

Questions for Classroom Discussion

0 Johnson viewed health as efficient and effective functioning of the system, and as behavioral system balance and stability. Behavioral system balance and stability are demonstrated by observed behavior that is purposeful, orderly, and predictable. Consider a clinical-practice situation that demonstrates Johnson’s model of health. Describe the purposeful, orderly, and predictable behaviors that are utilized and how these behaviors contribute to establishing balance and stability.
1 Identify at least three ways in which Johnson’s Behavioral Systems Model can inform current nursing practice.
2 What do you consider to be the drawbacks with the application of Johnson’s model to contemporary nursing practice?

Chapter 8

Multiple-Choice Questions

(Answers appear in bold)

3 Johnson integrated a complex knowledge set in the development of her Behavior System Model. Johnson has noted that her theory evolved from:
A. Philosophical ideas B. Theory and research C. Her clinical background

D. All of the above

0 A number of existing theories were integrated into Johnson’s development of the Behavior System Model. The PRIMARY theoretical foundation for the model are:
A. Transpersonal theory

B. Florence Nightingale’s theory of nursing C. Existential theory
D. Systems theory and developmental theory

3 Johnson proposed five core principals of systems thinking. These core principals include which set of answers?
A. Person, environment, health, nursing, nursing therapeutics B. Being, becoming, angst, choice, actualization
C. Wholeness and order, stabilization, reorganization, hierarchic interaction, and

dialectical contradiction

D. Peace, harmony, balance, stability, perpetuation

0 Johnson proposes that each subsystem is composed of at least four structural components that interact in a specific pattern. These parts are:
A. Person, environment, health, nursing

B. Goal, set, choice, and action

C. Preparation, readiness, action, review

D. Approach. disorganization, orientation, engagement

3 Johnson viewed health as efficient and effective functioning of the system, and as behavioral system balance and stability. Behavioral system balance and stability are demonstrated by observed behavior that is:
A. Chaotic, random, and unpredictable B. Permeable, malleable, and flexible

C. Purposeful, orderly, and predictable

D. Predetermined, fixed, sequential, and static

0 The overall representation of Johnson’s model can be viewed as a behavioral system within an environment.

0 True

1 False

3 From a behavioral system perspective, homeorhesis is a more important stabilizing process than homeostasis. In homeorhesis the system stabilizes around:
A. A trajectory rather than a set point

B. Self-righting tendencies that can occur over time

C. Development or adaptation of the behavioral system

D. All of the above

E. None of the above

0 Johnson conceptualized a nursing client as: A. An interpersonal–integrative system
B. Independent of the environment

C. A behavioral system

D. Being comprised of mind–body–spirit

3 Two components of each subsystem include choice and action. Johnson refers to choice as the individuals’s repertoire of alternative behaviors in a situation that will best meet the goal and attain the desired outcome.

0 True

1 False

0 According to Johnson, individuals are said to achieve efficient and effective behavioral functioning in all of the following, EXCEPT:
A. Their behavior is commensurate with social demands.

B. They are able to fit within the mainstream of society and follow the orders of the

physician in order to regain their health.

C. They are able to modify their behavior in ways that support biologic imperatives.

D. They are able to benefit to the fullest extent during illness from the physician’s knowledge

and skill.
Chapter 8: Dorothy Johnson’s Behavioral System Model and Its Applications

Instructions: Read the case study and answer the questions that follow.

The preoperative area was busy. Five patients were waiting for their 7 A.M. surgeries. Over to one side was Angela, lying quietly on the stretcher holding her stuffed toy. The pink fluffy bunny was small enough to comfort a 5-year-old girl and snuggle next to her neck. As the circulating nurse for Angela’s case came to take Angela back to the operating room she noticed the red heart that had been drawn on the plaster cast. The heart was in the center of the long leg cast and had the inscription “daddy’s big girl” in the center. The cast also had brightly colored flowers with smiling faces in the middle with the names Josey, Billy, Chelsea and Pepper taking up the remaining area. Angela hadn’t looked at the nurse yet, but was petting her bunny with her left hand. This motion made the IV machine beep. The nurse glanced at Angela’s toes— no swelling, pink, and since Angela was griping the edge of her cast with her toes the nurse knew that all toes were moving without difficulty. A noise cased the nurse to turn and see a tall woman with long red hair rush toward Angela. At this moment, Angela cried out “Mommy, you came! Look at Bunny!” As the nurse looked from Angela and the bunny toward the woman, another stuffed animal peeped from the woman’s hand. Angela was ecstatic “Eeyore! You brought me Eeyore!” Angela turned to the nurse, saying, “Now I can have my surgery. But they can’t break my daddy’s heart. I’m sending it to him in Rock” Angela’s mother turned to the nurse, winked, and said quietly “Iraq.” Angela smiled and put her right thumb in her mouth but quickly stopped. Her eyes opened wider, “Oh I’m a big girl I don’t suck my thumb anymore.”

0 Based on this case study, how would the nurse describe the holistic versus the particulate importance of Johnson’ model?
0 How might Johnson’s model guide the nurse in recognizing the importance of environment in this case study?
1 What would the homeorrhesis focus of this model provide in this case study?

0 Johnson’s model is a holistic, behavioral system process mediated by a complex framework and is an active process of encounter and response. The model incorporates five core principles of system thinking: wholeness and order, stabilization, reorganization, hierarchic interaction, and dialectical contradiction.
1 The behavioral system and the environment are linked by interactions and transactions. We define the person (behavioral system) as comprised of subsystems and the environment as comprised of physical, interpersonal (e.g., father, friend, mother, sibling), and sociocultural (e.g., rules and mores of home, school, country, and other cultural contexts) components that supply the substantial imperatives (Grubbs, 1980; Holaday, 1997; Johnson, 1990; Meleis, 1991).
2 From a behavioral system perspective, homeorrhesis is a more important stabilizing process than is homeostasis. In homeorrhesis, the system stabilizes around a trajectory rather than a set point.
Ask students to consider what actions the nurse would undertake to clarify the dialectical contradiction in this case study. Johnson emphasizes the importance of the principle of dialectical contradiction as the motivational force for behavioral change. Johnson (1980) described these as drives and noted that these responses are developed and modified over time through maturation, experience, and learning. A person’s activities in the environment lead to knowledge and development. However, by acting on the world, each person is constantly changing it and his or her goals, and therefore changing what he or she needs to know.