Nursing Conceptual Model

Module 8
Dorothy Johnsons
Callista Roy
Betty Neuman
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Dorothy Johnson: Behavioral System Model

BACKGROUND

• Dorothy Johnson was born on August 21, 1919, in Savannah, Georgia.

• She was the youngest of seven children. Her father was the superintendent of a
shrimp and oyster factory, and her mother was very involved and enjoyed
reading.
• In 1938, she finished her associate’s degree at Armstrong Junior College in
Savannah, Georgia. Due to the Great Depression, she took a year off from
school to be a governess, or teacher, for two children in Miami, Florida.
• This was when she began to realize her love for children, nursing, and
education.

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• Dorothy Johnson’s professional nursing career began in

1942 when she graduated from Vanderbilt University School
of Nursing in Nashville, Tennessee.
• She was the top student in her class and received the
prestigious Vanderbilt Founder’s Medal.
• In 1948, she received her master’s in public health from
Harvard University in Boston, Massachusetts.

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Introduction

• Johnson’s theory and her related writings reflect her

knowledge about both development and general systems
theories.
• The combination of nursing, development, and general
systems introduces some of the specifics into the rhetoric
about nursing theory development that make it possible
to test hypotheses and conduct critical experiments

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4 Goals of Nursing
• To assist the patient whose behavior is proportional to
social demands.
• To assist the patient who is able to modify his behavior in
ways that it supports biological imperatives.
• To assist the patient who is able to benefit to the fullest
extent during illness from the physician’s knowledge and
skill.
• To assist the patient whose behavior does not give
evidence of unnecessary trauma as a consequence of
illness

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Concepts and Definition
Behavior as expressed by the
behavioral and biological
scientists; that is, the output of
intra organismic structures and
processes as they are coordinated
and articulated by and responsive
to changes in sensory stimulation.
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A system is a whole that
functions as a whole by virtue
of the interdependence of its
parts, that there is
“organization, interaction,
interdependency, and
integration of the parts and
elements
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A behavioral system is a patterned,
repetitive, and purposeful ways of
behaving.
These ways of behaving form an
organized and integrated functional
unit that determines and limits the
interaction between the person and his
or her environment and establishes the
relationship of the person to the
objects, events, and situations within
his or her environment.
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A subsystem is “a mini system
with its own particular goal and
function that can be maintained
as long as its relationship to the
other subsystems or the
environment is not disturbed”
Stressor
Internal or external stimuli that
produce tension and result in a
degree of instability
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Subsystem of Behaviors
• Subsystem are parts of the
behavioral system.
• It carry out specialized
task/function needed to
maintain the integrity of the
whole system
• It has a set of behavioral
responses that re developed
through motivation,
experience and learning
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Subsystem 4 structural components

• The goal of a subsystem is defined as the desired result or

consequence of the behavior
• The behavioral set is a predisposition to act in a certain way in a
given situation
• Choice refers to the individual’s repertoire of alternative behaviors
in a situation that will best meet the goal and attain the desired
outcome
• The concern is with the efficiency and effectiveness of the
behavior in goal attainment. Actions are any observable responses
to stimuli.

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Functional Subsystem

• Protection from noxious stimuli influences with

which the system cannot cope
• Nurturance through the input of appropriate
supplies form environment
• Stimulation to enhance growth and prevent
stagnation

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Metaparadigm Concepts

Human being” as having two Environment is any factor

major systems, the biological influencing the behavioral
system and the behavioral subsystem manipulated by
system. It is role of the medicine the nurse to achieve health
to focus on biological system
where as Nursling's focus is the
behavioral system

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Metaparadigm
Nursing is an external regulatory
Health is the lack of force which acts to preserve the
balance in the structural organization and integration of the
or functional patient’s behaviors at an optimum
requirements of the level under those conditions in
subsystems leads to which the behaviors constitutes a
poor health threat to the physical or social
health, or in which illness is found.

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Application to Nursing
By elderly people, those from the age of 65 and above, most of which have retired.
These people are normally seen as a bother to their loved ones as their needs increase
from the normal. They thus need more care which cannot be provided at home so
they are often taken to nursing homes where they can get the proper care. Because of
old age and stress from retirement. These people have difficulty coping with the
changes around them and their behavior changes. Some become aggressive while
others develop mental problems making long-term nursing homes the best to take
proper care of these individuals.

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• Nurses have to pay keen attention to such aggressive behavior and identify which of the
seven subsystems is not functioning properly thus help these patients restore balance in their
systems.
• It could be dependence, the attachment, or the aggressive causing a change in behavior. The
dependence in the sense that the patient who was used to taking care of himself now finds it
frustrating when he has to rely on others for all his needs.
• The attachment comes in when the patient struggles to form new relationships at the care
facilities and being kept away from the existing relationships.
• Normally the patient plays a role in the behavioral system model of treatment but in dealing
with mental complications, especially the ones accompanied by aggressive behavior. Most
of the effort is required from the part of the nurse who has to be patient with the patient.

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Sister Callista Roy Adaptation Model

BACKGROUND

• Sister Callista L. Roy (born October 14, 1939) is a nursing

theorist, professor, and author.
• She is known for her groundbreaking work in creating the
Adaptation Model of Nursing.
• She received her Bachelor of Arts Major in Nursing from Mount
Saint Mary’s College in Los Angeles in 1963 and her master’s
degree in nursing from the University of California in 1966.

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• After earning her nursing degrees, she began her sociology

education, receiving both a master’s degree in sociology in 1973
and a doctorate in sociology in 1977 from California.
• She developed the model’s basic concepts while she was a
graduate student at the University of California from 1964 to 1966.
• She was an associate professor and chairperson of the Department
of Nursing at Mount Saint Mary’s College until 1982 and was
promoted to the professor’s rank in 1983 at both Mount Saint
Mary’s College and the University of Portland. 

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• The RAM focuses on the inter relatedness of four

adaptive systems
• It focuses on persons coping(adaptative)abilities in
response to constantly to changing environment
( Lopes, Pagliuca, Araujo,2006)
• Nursing can promote effective coping by asking” How
can I modify this patient’s environment to facilitate his
adaptation (Chitty & Black, 2011)

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Major Concepts and Definition
A system is “a set of parts
connected to function as a
whole for some purpose
and that does so by virtue
of the interdependence of
its part
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“Adaptation level
represents the condition
of the life processes
described on three levels
as integrated,
compensatory, and
compromised”
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Types of Stimuli

• Focal Stimulus is the degree of change or stimulus

more immediately confronting the person and the
one to which the person must make adaptive
response
• Contextual Stimuli are present to contribute to the
behavior caused or precipitated by the focal stimuli
• Residual Stimuli are factors that may be affecting
behavior but whose efforts are not validated

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Innate Coping Mechanisms Innate coping

mechanisms “are genetically determined or
Coping
common to the species and are generally
Processes “are viewed as automatic processes; humans do
innate or not have to think about them”
acquired ways
of interacting
with the Acquired coping mechanisms “are developed
changing through strategies such as learning. The
environment” experiences encountered throughout life
contribute to customary responses to
particular stimuli”

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Subsystem
Regulator subsystem is a The cognator is a major
major coping mechanism coping subsystem responds
which responds to complex processes of
automatically through perception and information
physiological adaptive processing, judgement and
mode, responds emotions 
automatically through
neural, chemical, and
endocrine coping
processes
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Implication to Nursing Practice, Education and Research
Nursing Practice
• Features of the discipline
provides direction for practice
• It considers goals, values, the
client and practitioner
intervention
• Uses the steps in Nursing
Process of used: Assessment,
Nursing Diagnosis, The goal is
set, Intervention and Evaluation
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Education Research
• The model is a valuable to The model generates many
analyze distinctions between testable hypothesis tested to
nursing and medicine practice and theory
• The model has been
implemented as basis of
curriculum development in
Associate degree program,
baccalaureate and higher
degree program
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Metaparadigm

People, both individually and Health is the reflection of

in groups, as holistic adaptive personal and environmental
systems, complete with coping interactions that are
processes acting to maintain adaptive.
adaptation and to promote
person and environment
transformations

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Metaparadigm

Environment are conditions, The goal of nursing was the first

circumstances, and influences major concept of her nursing
surrounding and affecting the model to be described. She
development and behavior of identifies the unique function of
individuals and groups nursing in promoting health

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Application to Nursing

A 23-year-old male patient is admitted with a fracture of C6 and C7

that has resulted in quadriplegia. He was injured during a football
game at the university where he is currently a senior. His career as
a quarterback had been very promising. At the time of the injury,
contract negotiations were in progress with a leading professional
football team.
1. Use Roy’s criteria to identify focal and contextual stimuli for each
of the four adaptive modes.
2. Consider what adaptations would be necessary in each of the
following four adaptive modes: (1) physiological, (2) self-
concept, (3) interdependence, and (4) role function.

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Betty Neuman: System Model

BACKGROUND

• Betty Neuman was born in 1924 near Lowell, Ohio.

• She grew up on a farm which later encouraged her to help
people who are in need.
• Her father was a farmer who became sick and died at the age of
36.
• Her mother was a self-educated midwife that led the young
Neuman to be always influenced by the commitment that took
her away from home from time to time.

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• In 1957, she received a baccalaureate degree in public health and

psychology with honors.
• She also earned a master’s degree in mental health, public health
consultation in 1966 from the University of California, Los Angeles
(UCLA).
• After her graduation, she was hired as a department chair in the UCLA
School of Nursing graduate program
• In 1985, Betty Neuman concluded a doctoral degree in clinical
psychology at Pacific Western University. She was a pioneer of nursing
involvement in mental health.

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•  Neuman Systems Model as “a unique, open-system-based

perspective that provides a unifying focus for approaching a
wide range of concerns.
• A system acts as a boundary for a single client, a group, or
even several groups;
• it can also be defined as a social issue.
• A client system in interaction with the environment delineates
the domain of nursing concerns.”

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Betty Neuman’s Systems Model

• Neuman System Model focuses on the different stressors
patients have and ways to relieve the stress from the
different stressors.
• The model also focus on how the patient may react to the
stress.
• Internal and external affects the patient are stressors
• The role of the nurse is the to keep the system stable
through out the three level of prevention; primary,
secondary, and tertiary.

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Concepts and Definition
Wholistic Approach
• Clients are viewed as
wholes whose parts are in
dynamic interaction.
• The model considers all
variables simultaneously
affecting the client system:
physiological, psychological,
sociocultural,
developmental, and spiritual
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Open System
A system is open when
there is a continuous flow of
input and processes,
output, and feedback.
Stress and reaction to
stress are basic
components of an open
system
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Function or Process
The client as a system
exchanges energy,
information, and matter with
the environment as well as
other parts and subparts of
the system as it uses
available energy resources
to move toward stability and
wholeness
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Input and Output
For the client as a system,
input and output are the
matter, energy, and
information that are
exchanged between the
client and the environment
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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
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Client System
The client system is a
composite of five variables
(physiological,
psychological, sociocultural,
developmental, and
spiritual) in interaction with
the environment.
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5 types of stressor
• Physiological stressors

• Psychological stressors

• Socio-cultural stressors

• Developmental stressors

• Spiritual stressors

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Level of Prevention

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Major Assumptions
Nursing is concerned with the whole The client system is a dynamic composite
person. She views nursing as a “unique of interrelationships among physiological,
profession in that it is concerned with all psychological, sociocultural,
of the variables affecting an individual’s developmental, and spiritual factors
response to stress

Health as a continuum of wellness Environment as all the internal and

to illness that is dynamic in nature external factors that surround and
and is constantly changing. influence the client system. Stressors
(intrapersonal, interpersonal, and
extrapersonal)

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Application to Nursing
Mr ABC, a 47 year old male was admitted in COIVD -19 ward, was admitted though
emergency department after being referred from a private hospital. The presenting chief
complaints of the patient were fever for 9 days associated with chills and rigors and
shortness of breath for 6 days. There was no history of orthopnea or paroxysmal
nocturnal dyspnea [PND] or cough or hemoptysis, but complained of some epigastric
discomfort. He also complained of loss of appetite and wheezing. However there was
documented weight loss
Comprehensive nursing care was provided by a team of nursing personnel posted in
COVID unit. Nursing care was given to the patient as per the identified stressors and
his reaction to the stressors.

Identify the stressors and reactions of Mr. ABC to COVID-19. as to physiological,

psychological, developmental,socio- cultural and spiritual

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Thank you!

Do you have any questions?