Table 7-2 Concepts in Johnson’s Behavioral System Theory Concept Definition
Behavioral system Man is a system that indicates the state of the system through behaviors Boundaries The point that differentiates the interior of the system from the exterior Function Consequences or purposes of actions Functional requirements
Input that the system must receive to survive and develop
Homeostasis Process of maintaining stability Instability State in which the system output of energy depletes the energy needed to maintain
stability Stability Balance or steady state in maintaining balance of behavior within an acceptable
range Stressor A stimulus from the internal or external world that results in stress or instability Structure The parts of the system that make up the whole System That which functions as a whole by virtue of organized independent interaction of
its parts Subsystem A minisystem maintained in relationship to the entire system when it or the
environment is not disturbed Tension The system’s adjustment to demands, change or growth, or to actual disruptions Variables Factors outside the system that influence the system’s behavior, but which the
system lacks power to change
Source: Grubbs (1980).
Relationships Johnson (1980) delineated seven subsystems to which the model applied. These are as follows:
1. Attachment or affiliative subsystem—serves the need for security through social inclusion or intimacy 2. Dependency subsystem—behaviors designed to get attention, recognition, and physical assistance 3. Ingestive subsystem—fulfills the need to supply the biologic requirements for food and fluids 4. Eliminative subsystem—functions to excrete wastes 5. Sexual subsystem—serves the biologic requirements of procreation and reproduction 6. Aggressive subsystem—functions in self and social protection and preservation 7. Achievement system—functions to master and control the self or the environment
Finally, there are three functional requirements of humans in Johnson’s (1980) model. These are:
1. To be protected from noxious influences with which the person cannot cope 2. To be nurtured through the input of supplies from the environment
3. To be stimulated to enhance growth and prevent stagnation
Usefulness That Johnson’s model is useful for nursing practice and education has been verified in several articles and chapters. Damus (1980), Dee (1990), and Holaday (1980) described situations in which Johnson’s model has been used to direct nursing practice. Other authors have used the theory to apply to various aspects of nursing. For example, 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, and quality of life. Fruehwirth (1989) applied Johnson’s model to assess and intervene in a group of caregivers for individuals with Alzheimer disease.
Testability Parts of Johnson’s model have been tested or used to direct nursing research. Indeed, more than 20 research studies have been identified using Johnson’s model. Turner-Henson (1992), for example, used Johnson’s model 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, and 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 and Schobel (1990) used Johnson’s model to develop an assessment tool for individuals with AIDS.
Aspects of Johnson’s model have been tested in nursing research. In one study, Derdiarian (1990) examined the relationship between the aggressive/protective subsystem and the other six model subsystems.
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. Additionally, the relationships are clear; therefore, the model is considered to be parsimonious.
Value in Extending Nursing Science Johnson’s model has been used in nursing practice and research to a significant extent. In addition, her work has been used as a curriculum guide for a number of schools of nursing (Grubbs, 1980; Johnson, 1980, 1990), and it has been adapted for use in hospital situations (Dee, 1990). Finally, her work inspired the work of at least two other grand nursing theorists, Betty Neuman and Sister Calista Roy, who were her students.
Betty Neuman: The Neuman Systems Model Since the 1960s, Betty Neuman has been recognized as a pioneer in the field of nursing, particularly in the area of community mental health. She developed her model while lecturing in community mental health at UCLA and first published it in 1972 under the title “A Model for Teaching the Total Person Approach to Patient Problems” (Neuman & Fawcett, 2011). Since that time, she has been a prolific writer, and her model has been used extensively in colleges of nursing, beginning with Neumann College’s baccalaureate nursing program in Aston, Pennsylvania. Numerous other nursing programs have organized their curricula around her model both in the United States and internationally (Neuman & Fawcett, 2011).
The major elements in this review of the Neuman Systems Model are taken from the fifth edition of her book (Neuman & Fawcett, 2011), with references to earlier writings to show development of the model over time. The model was deductively derived and emanated from requests of graduate students who wanted assistance with a broad interpretation of nursing.
Neuman’s model uses a systems approach that is focused on the human needs of protection or relief from stress (Neuman & Fawcett, 2011). Neuman believed that the causes of stress can be identified and remedied through nursing interventions. She emphasized the need of humans for dynamic balance that the nurse can provide through identification of problems, mutually agreeing on goals, and using the concept of prevention as intervention. Neuman’s model is one of only a few considered prescriptive in nature. The model is universal, abstract, and applicable for individuals from many cultures (Neuman & Fawcett, 2011).
Background of the Theorist Betty Neuman was born in 1924 on a farm near Lowell, Ohio. In 1947, she earned her nursing diploma from People’s Hospital School of Nursing, Akron, Ohio, and moved to California shortly thereafter. She earned a bachelor’s degree in nursing from UCLA and also studied psychology and public health. In 1966, she earned a master’s degree in mental health and public health consultation, also from UCLA, and then earned her doctorate in clinical psychology in 1985 from Pacific Western University. She worked as a hospital staff nurse, a head nurse, and an industrial nurse and consultant before becoming a nursing instructor. She has taught medical-surgical nursing, critical care, and communicable disease nursing at the University of Southern California Medical Center in Los Angeles and at other colleges in Ohio and West Virginia (Lawson, 2014; Neuman & Fawcett, 2011).
Philosophical Underpinnings of the Theory Neuman used concepts and theories from a number of disciplines in the development of her theory. In her works, she referred to Chardin and Cornu on wholeness in systems, von Bertalanffy and Lazlo on general systems theory, Selye on stress theory, and Lazarus on stress and coping (Neuman & Fawcett, 2011).
Major Assumptions, Concepts, and Relationships
Concepts Neuman (Neuman & Fawcett, 2011) adhered to the metaparadigm concepts and has developed numerous additional concepts for her model. In her work, she defined human beings as “client system” . . . “a composite of five interacting variable areas . . . physiological, psychological, sociocultural, developmental, and spiritual” (Neuman & Fawcett, 2011, p. 16). The ring structure is a “basic structure of protective concentric rings, for retention attainment or maintenance of system stability and integrity. . . ” (Neuman & Fawcett, 2011, p. 16). Environment to Neuman is a structure of concentric rings representing the three environments, internal, external, and created environments, all of which influence the client’s adaptation to stressors. Health is defined as “a continuum; wellness and illness are at opposite ends. . . . Health for the client is equated with optimal system stability that is the best possible wellness state at any given time” (p. 23). “Variances from wellness or varying degrees of system instability are caused by stressor invasion of the normal line of defense” (p. 24). Finally, in the nursing component, the major concern is to maintain client system stability through accurately assessing environmental and other stressors and assisting in client adjustments to maintain optimal wellness. Table 7-3 lists selected additional concepts from Neuman’s model, and Figure 7-2 offers a visual representation.
Table 7-3 Concepts in Neuman Systems Model Concept Definition
Basic structure Basic survival factors common to human beings; they are located in the central core and represent basic client system energy resources.
Boundary lines The flexible line of defense is the outer boundary of the client system. Degree of reaction The amount of system instability resulting from stressor invasion of the normal line
of defense. Feedback The process within which matter, energy, and information provides feedback for
corrective action to change, enhance, or stabilize the system. Flexible line of defense
A protective, accordion-like mechanism that surrounds and protects the normal line of defense from invasion by stressors.
Input/output The matter, energy, and information exchanged between client and environment that is entering or leaving the system at any point in time.
Lines of resistance Protection factors activated when stressors have penetrated the normal line of defense, causing a reaction symptomatology.
Negentropy A process of energy conservation that increases organization and complexity, moving the system toward stability or a higher degree of wellness.
Normal line of defense
An adaptational level of health developed over time and considered normal for a particular individual client or system; it becomes a standard for wellness–deviance determination.
Open system A system in which there is a continuous flow of input and process, output, and feedback. It is a system of organized complexity where all elements are in interaction.