Public Health or Community Nursing

Public Health or Community Nursing Theories and Models

  • Neuman’s Systems Model
  • Nightingale’s Environment Theory
  • Orem’s Self-Care Deficit Nursing Theory
  • Pender’s Health Promotion Model
  • Rogers’ Theory of Unitary Human Beings
  • Roy’s Adaptation Model of Nursing
  • Erickson’s Modeling and Role Modeling Theory
  • King’s Theory of Goal Attainment
  • Orlando’s Nursing Process Discipline Theory
  • Peplau’s Theory of Interpersonal Relations
  • Parse’s Human Becoming Theory
  • Kolcaba’s Theory of Comfort
  • Watson’s Philosophy and Science of Caring
  • Roper-Logan-Tierney’s Model for Nursing Based on a Model of Living
  • Helvie’s Energy Theory and Nursing

Barker’s Tidal Model of Mental Health Recovery

Barker’s Tidal Model of Mental Health Recovery is a middle-range theory of nursing that can be used as the basis for interdisciplinary health care. The main focus of the model is on helping individual patients create their own voyage of discovery.

Phil Barker defines the Tidal Model as “a philosophical approach to the discovery of mental health. It emphasises helping people reclaim the personal story of mental distress, by recovering their voice. By using their own language, metaphors and personal stories people begin to express something of the meaning of their lives. This is the first step towards helping recover control over their lives.” It provides a nursing care practice framework for the exploration of the patient’s need for nursing and the provision of individually-tailored care plans. The theory states that an individual’s mental well-being is dependent on his or her individual life experiences, including his or her sense of self, perceptions, thoughts, and actions.

The main philosophical metaphor is drawn from chaos theory. That is, the unpredictable, yet unbounded, nature of human behavior and experience is compared to the dynamic flow and power of water and the tides of the sea.

There are six key philosophical assumptions in Barker’s Tidal Model:

  • a belief in the virtue of curiosity
  • recognition of the power of resourcefulness, instead of focusing on problems, deficits, or weaknesses
  • respect for the patient’s wishes instead of being paternalistic
  • acceptance of the paradox of crisis as opportunity
  • acknowledging that all goals must belong to the individual patient
  • the virtue of pursing elegance: the simplest possible means should be sought

In order for the nurse to begin the process of engagement using the Tidal Model, the following needs to be accepted:

  • recovery is possible
  • change is inevitable
  • ultimately, the patient knows what is best for him or her
  • the patient possesses all the resources he or she needs to begin the recovery journey
  • the patient is the teacher, while the helpers are the pupils
  • the helper needs to be creatively curious, and to learn what needs to be done to help the person

The process of engaging with the patient takes place in three different domains: self, world, and others. The nurse explores these dimensions to increase awareness of the situation in the present and determine what needs to occur at that moment.

The self domain is where people feel their world of experiences. This includes an emphasis on making people feel more secure, and the nurse helps the patient develop a security plan to reduce threats to the patient or those around him or her.

The world domain is where the patient holds his or her story. The nurse uses a specific form of inquiry to explore the story collaboratively, revealing its hidden meanings, the patient’s resources, and to identify what needs to be done to help the patient recover.

The others domain represents the different relationships of the patient, including past, present, and future. This includes the nurse as well as other members of the health care team, friends, family, and other supporters.

The Ten Commitments of the Tidal Model are the values it expresses. They are:

  1. Value the voice-the patient’s story is paramount
  2. Respect the language-allow the patient to use his or her own language
  3. Develop genuine curiosity-show interest in the patient’s story
  4. Become the apprentice-learn from the patient you are helping
  5. Reveal personal wisdom-a patient is an expert in his or her own story
  6. Be transparent-help ensure that the patient understands exactly what is being done
  7. Use the available toolkit-the patient’s story contains valuable information as to what works and what does not work
  8. Craft the step beyond-the nurse and the patient work together in order to construct an appreciation of what needs to be done “now”
  9. Give the gift of time-time is the midwife of change, and the key is using the time properly
  10. Know that change is constant-this is a common experience for all people

There are also twenty competencies associated with the ten commitments. They assist with the auditing of recovery practice by creating practice-based evidence for the theory. There are two for each commitment, and they focus on competencies in practice.,

The Tidal Model of Mental Health Recovery uses the theme of water throughout. It describes how patients in distress can become “shipwrecked” emotionally, physically, and spiritually. The experience of health and illness is a fluid phenomenon rather than a stable one, and life is considered a journey gone through on an ocean of experience.

The theory proposes that in mental health nursing, the factors having to do with psychiatric crisis can be cumulative as well as diverse. It states that by appreciating the water metaphor, nurses can gain a better understanding of the patient’s immediate situation and the inevitability of change. Through this, the nurse can be guided to care with the patient beginning his or her journey in a shipwrecked state caused by life problems. Following the rescue, exploration can begin to find out what caused the “storm” in the first place, then figure out what needs to be done in order to “set sail” again.

Casey’s Model of Nursing

Anne Casey is an English nurse who developed a nursing theory known as Casey’s Model of Nursing. The model was developed in 1988 while she was working in pediatric oncology at the Great Ormond Street Hospital in London.

Casey’s Model of Nursing focuses on the nurse working in partnership with the child and his or her family. It was one of the earliest attempts to develop a nursing model designed specifically for child health nursing.

The five aspects of this nursing theory are child, family, health, environment, and the nurse.

The philosophy of Casey’s model is that the best people to care for the child are the members of the family, with health care professionals assisting. This necessitates a relationship between the parent(s) and nurse.

Energy Theory and Nursing

Dr. Carl O. Helvie is an RN who has developed a new theory for the practice of nursing. Dr. Helvie specializes in alternative medicine treatments and his theory is designed to support this type of care. However, his nursing theory can be applied to any type of nursing care. He holds a PhD in nursing practice.

Alternative medical treatment involves the use of energy to treat the client. Depending on the treatment, the practitioner may be releasing blocks to the body’s natural energy paths, increasing the body’s energy to respond to an illness or improving the body’s general state of being. Energy is the key to alternative nursing care.

Drawing upon his lifetime of practice in the nursing field, Dr. Helvie developed his theory around 8 points of action. These 8 points are all necessary to make a successful intervention using the energy theory. This nurse theorist first used his theory on individuals, families and then community health nursing. His theory consists of the following 8 points:

1.Humans are open energy systems.
2. The environment of each human is energy.
3. Each person exchanges energy with the environment.
4. All persons continually try to adapt holistically to exchanges of energy.
5. Energy needs vary with time and each situation.
6. Adaptation to energy exchanges determines the level of health of each person.
7. As humans move toward illness, they usually require help to regain their former level of energy.
8. Health practitioners assist high-risk individuals to maintain or regain holistic exchange of energy.

Humans Are Open Energy Systems

Each person has three types of energy operating simultaneously. These are bound, kinetic and potential energy. Bound energy is the parts of the body that form it, such as cells, organs and systems. Kinetic energy is the energy that flows through the body such as blood sugar or oxygen. Potential energy is stored energy systems that the body can draw on for future use. An open energy system draws on the environment to produce energy. Each person requires input from the environment to provide all the body’s energy needs.

Environment of Humans is Energy

Besides the internal energy of each individual, they are also surrounded by energy outside of their bodies. This energy can be broken up into different types of energy in the environment, even though they are related to each other. These energies are: chemical, physical, psychological and biological. Chemical energy is found in food, oxygen, pollutants, medicine, cigarettes and other compounds that can be ingested. Physical energy is found in entities such as heat, light, radiation and wind. Biological energy is found in living systems such as bacteria, animals, plants, fungi, and allergens. Psychological energy is found in such things as love, hate, prayer, healing actions or familial support. A community has its own energy found in the services and support available for the individual.

Exchanging Energy with the Environment

When each us exchanges energy with the environment, the exchange centers on input and output. The input is what we take in from the environment. This can be food, heat, light, infections, anger, love or any other aspect that our bodies take in. The other consideration is the output, which can run to carbon dioxide, feces, sweat, pollution and spit. One way to improve energy flow is to look at the input and output and measure it against know standards when the client was healthy.

Trying to Adapt to Energy Change

All humans experience changes to their environment. Negative change would be those changes that upset the healthy state of the body such as injury, illness, job loss, or unwanted changes to a relationship. Negative change is usually not wanted or chosen by the individual involved. Positive change would be those changes that do change the body, yet they are welcomed by the individual. Such things as a new job, weight loss, and learning can all lead to change perceived as welcome by the individual. Negative or positive change can necessitate temporary changes that last until the body is restored to its normal condition. Negative and positive change can be good or bad. This is determined by the response to this change which is indicated by the energy flows that the body is able to generate.

Energy Needs Vary with Each Situation

Different stages of life require different inputs and generate different outputs. Most of these stages are documented, and it is known what to expect. For example, it is known what changes to energy a pregnant woman needs vs. a young woman who is not pregnant. An elderly person will often eat much less than a busy young person who is also an athlete. The ability to obtain the needed energy that these changes require can be a challenge in some situations. This can result in the body performing at less than the ideal energy peak. Some changes can lead to bodily damage that is so severe the body cannot adapt to it, even with support.

Adaption to Change Determines Health

Over time, each individual experiences shortages and excesses of energy. Their response to these changes determines where on the health continuum a person lands. They may move for a short time down the continuum to less healthy and then return on their own to normal or with medical intervention to their previous state. However, if someone has more than one negative change at a time, such as having bronchitis with an already compromised lung system, the person may never be able to move back toward their previous healthy condition.

Continuum Movement Usually Requires Assistance

Once a person has moved down the continuum to the unhealthy side, the individual may require assistance to return to their previous state of health. This may be from a health practitioner or it could be from a family or community member. Usually, some sort of help is needed to return the body’s energy to normal. If the body could adapt on its own, it will usually do so in a short period of time. The longer the body spends in an unhealthy position on the health continuum, the more likely they are to need assistance.

Health Practitioners Need to Assist High-Risk Individuals

Health workers such as nurses should be assisting those individuals that are most high-risk at being unable to return to a normal condition on their own. This becomes apparent from the history of the client and reactions of clients in a similar position. Nurses should make sure that needy clients receive the additional care that they require vs. someone who has a temporary disfunction.

The Nursing Process

To provide care using the energy theory, nurses apply the nursing process. Using the energy theory, the first step of the process is to obtain a past history including their past problems with energy exchange. They also discus the client’s current level of energy exchange and energy level.

Next, the client is assessed by the nurse. This involves taking data about the client and then comparing them to standard norms. This assessment determines where on the health continuum the patient currently stands. Normal would be in the middle; a movement to either end indicates an over supply of energy or a lack of energy being absorbed by the body.

Once the state of the patient’s energy level is quantified, the nurse makes one or more diagnoses concerning the client. From these, goals and objectives are designed that will be used to return the client to health or at least return the client to the best state possible. The goals and objectives are developed with the client in mind, as he or she must be able to fulfill the goals to meet the objectives.

At the end of the treatment process, the nurse looks at the success of the interaction with the client and uses these results to apply to the next interaction. Successful goals should be carried forward; goals that were unobtainable should be dropped by the nurse in future cases.

Dr.Carl O. Helvie’s energy theory can be used with any use of the nursing process. However, it is most effective for alternative therapists who base their treatments on energy flowing through the body. This includes nurses, herbalists, acupuncturists, healers, physicians and chiropractors.

Source:

Helvie, C. (1998) Advanced Practice Nursing in the Community, Thousand Oaks, California: Sage Publishing Co.

Humanistic Model

Many models or approaches to nursing look at the patient as a whole person rather than simply an illness or injury. This approach, called a holistic or humanistic approach, helps foster mental and emotional health in addition to physical health.

Humanistic nursing theories have a foundation in the belief that patients can grow in a healthy and creative way. The model was created by Josephine Paterson and Loretta Zderad. Paterson and Zderad believed nursing education should be founded in experience,
and that a nurse’s training should focus as much on the nurse’s ability to relate to and interact with patients as a scientific and medical background.

This approach to nursing places an emphasis on the nurse-patient relationship, in which both people influence the outcome of the nursing interventions. The function of the nursing approach shows that the relationship between the nurse and patient has as much to do with the patient’s healing as medical interventions. Humanistic nursing focuses closely on how the relationship between the patient and nurse develops in addition the patient’s physical and mental health.

The humanistic model of nursing looks at the patient as an individual, and each situation as unique. In this nursing approach, there is no formulaic method or process in order to care for patients. Each patient is assessed and treated on a case-by-case basis.

The Humanistic Model of Nursing is an approach to nursing that encompasses a number of individual theories, including Patricia Benner’s From Novice to Expert Model of Nursing and Jean Watson’s Theory of Caring.

Benner’s From Novice to Expert Model of Nursing proposes that a nurse can gain knowledge and skills without ever learning the theory behind it. Benner explains that the development of knowledge in applied disciplines such as medicine and nursing is composed of the extension of practical knowledge through research and the characterization and understanding of the “know how” of clinical experience. The theory explains the five levels of nursing, which are: novice, advanced beginner, competent, proficient, and expert. How nurses approach patients is dependent on the level of expertise of the nurse.

In Watson’s Theory of Caring, nursing is “concerned with promoting health, preventing illness, caring for the sick and restoring health.” Watson believes that holistic health care is central to the practice of nursing, and defines nursing as “a human science of persons and human health-illness experiences that are mediated by professional, personal, scientific, esthetic, and ethical human transactions.” Watson’s model contains seven assumptions about care and caring, as well as ten primary carative factors. It places the patient in the
context of the family, community, and culture, and the focus of the practice is on the patient rather than the technology.

Health as Expanding Consciousness

Newman’s Health as Expanding Consciousness arose from Rogers’ Theory of Unitary Human Beings. It was stimulated by concern for those for whom health as the absence of disease or disability is simply not possible. The model has progressed to include the health of all people, regardless of the presence or absence of disease. Newman’s theory asserts that every person in every situation, no matter how disordered and hopeless it seems, is part of the universal process of expanding consciousness. This is a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people, as well as the world.

Margaret A. Newman was influenced by Martha Rogers’ Theory of Unitary Human Beings, Itzhak Bentov’s Concept of the Evolution of Consciousness, Arthur Young’s Theory of Process, and David Bohm’s Theory of Implicate as she developed her model of nursing.

The Health as Expanding Consciousness theory makes the following assumptions:

  • Health encompasses conditions described as illness, or, in medical terms, pathology.
  • These pathological conditions can be considered a manifestation of the total pattern of the patient.
  • The pattern of the individual patient that eventually manifests itself as pathology is primary, and exists prior to structural or functional changes.
  • Removal of pathology will not, in itself, change the pattern of the individual patient.
  • If becoming ill is the only way an individual patient’s pattern is able to manifest itself, then that is health for that individual patient.
  • Health is an expansion of consciousness.

According to Newman, “the theory of health as expanding consciousness was stimulated by concern for those for whom health as the absence of disease or disability is not possible. Nurses often relate to such people: people facing the uncertainty, debilitation, loss and eventual death associated with chronic illness. The theory has progressed to include the health of all persons regardless of the presence or absence of disease. The theory asserts that every person in every situation, no matter how disordered and hopeless it may seem, is part of the universal process of expanding consciousness – a process of becoming more of oneself, of finding greater meaning in life, and of reaching new dimensions of connectedness with other people and the world.”

Patients are open to the whole energy system of the universe, as well as constantly interacting with the energy. This process of interaction allows people to evolve their individual patterns of whole. According to Newman, understanding the patient’s pattern is essential. The pattern recognition is the expanding consciousness. The manifestation of disease depends on the pattern of the patient, so the pathology of the diseases exists before the symptoms begin to appear. Because of this, removal of the disease symptoms does not change the individual structure.

Newman redefines nursing according to her nursing process of recognizing the individual in relation to the environment, and it is a process of the understanding of consciousness. The nurse’s understanding of people helps them use the power within to develop the higher level of consciousness. Therefore, it helps to realize the disease process, its recovery, and its prevention.

She also explains the interrelatedness of time, space, and movement. Time and space are the temporal pattern of the patient, and they have a complementary relationship. People are constantly changing through time and space, and it shows a unique pattern
of reality.

The theory explains that health and illness are synthesized as health. That is, the fusion of one state of being (disease) with its opposite (non-disease) results in what can be considered health. In this model, the human is unitary. He or she cannot be divided into parts, and is inseparable from the larger unitary field. People are individuals, and human beings are, as a species, identified by their patterns of consciousness. The person does not possess consciousness. Instead, the person is consciousness. People are centers of consciousness with an overall pattern of expanding consciousness. The environment is described as a “universe of open systems.”

In this model, nursing is “caring in the human health experience.” It is seen as a partnership between the nurse and patient, with both growing in the “sense of higher levels of consciousness.”

Newman’s theory is considered a grand nursing theory. She states that people cannot be divided into parts. Health is central to the theory, and is seen as a process of a developing awareness of the individual self and the person’s environment. She also states that “consciousness is a manifestation of an evolving pattern of person-environment interaction.”

Newman’s Health as Expanding Consciousness Theory is beneficial because it can be applied in any setting and “generates caring interventions.” However, its drawbacks are that it is abstract, multidimensional, and qualitative, and there is little discussion
on environment within the model.

Modeling and Role Modeling Theory

The Modeling and Role Modeling Theory was developed by Helen Erickson, Evelyn M. Tomlin, and Mary Anne P. Swain. It was first published in 1983 in their book Modeling and Role Modeling: A Theory and Paradigm for Nursing. The theory enables nurses to care for and nurture each patient with an awareness of and respect for the individual patient’s uniqueness. This exemplifies theory-based clinical practice that focuses on the patient’s needs.

The theory draws concepts from a variety of sources. Included in the sources are Maslow’s Theory of Hierarchy of Needs, Erikson’s Theory of Psychosocial Stages, Piaget’s Theory of Cognitive Development, and Seyle and Lazarus’s General Adaptation Syndrome.

The Modeling and Role Modeling Theory explains some commonalities and differences among people.

The commonalities among people include:

  • Holism, which is the belief that people are more than the sum of their parts. Instead, mind, body, emotion, and spirit function as one unit, affecting and controlling the parts in dynamic interaction with one another. This means conscious and unconscious processes are equally important.
  • Basic needs, which drive behavior. Basic needs are only met when the patient perceives they are met. According to Maslow, whose hierarchical ordering of basic and growth needs is the basis for basic needs in the Modeling and Role Modeling Theory, when a need is met, it no longer exists, and growth can occur. When needs are left unmet, a situation may be perceived as a threat, leading to distress and illness. Lack of growth-need satisfaction usually provides challenging anxiety and stimulates growth. Need to know and fear of knowing are associated with meeting safety and security needs.
  • Affiliated Individuation is a concept unique to the Modeling and Role Modeling Theory, based on the belief that all people have an instinctual drive to be accepted and dependent on support systems throughout life, while also maintaining a sense of independence and freedom. This differs from the concept of interdependence.
  • Attachment and Loss addresses the idea that people have an innate drive to attach to objects that meet their needs repeatedly. They also grieve the loss of any of these objects. The loss can be real, as well as perceived or threatened. Unresolved loss leads to a lack of resources to cope with daily stressors, which results in morbid grief and chronic need deficits.
  • Psychosocial Stages, based on Erikson’s theory, say that task resolution depends on the degree of need satisfaction. Resolution of stage-critical tasks lead to growth-promoting or growth-impeding residual attributes that affect one’s ability to be fully functional and able to respond in a healthy way to daily stressors. As each age-specific task is negotiated, the person gains enduring character-building strengths and virtues.
  • Cognitive Stages are based on Piaget’s theory, and are the thinking abilities that develop in a sequential order. It is useful to understand the stages to determine what developmental stage the patient may have had difficulty with.

The differences among people include:

  • Inherent Endowment, which is genetic as well as prenatal and perinatal influences that affect health status.
  • Model of the World is the patient’s perspective of his or her own environment
    based on past experiences, knowledge, state in life, etc.
  • Adaptation is the way a patient responds to stressors that are health- and growth-directed.
  • Adaptation Potential is the individual patient’s ability to cope with a stressor.This can be predicted with an assessment model that delineates three categories of coping: arousal, equilibrium, and impoverishment.
  • Stress is a general response to stressful stimuli in a pattern of changes
    involving the endocrine, GI, and lymphatic systems.
  • Self-Care is the process of managing responses to stressors. It includes
    what the patient knows about him or herself, his or her resources, and his or
    her behaviors.
  • Self-Care Knowledge is the information about the self that a person has
    concerning what promotes or interferes with his or her own health, growth,
    and development. This includes mind-body data.
  • Self-Care Resources are internal and external sources of help for coping
    with stressors. They develop over time as basic needs are met and developmental
    tasks are achieved.
  • Self-Care Action is the development and utilization of self-care knowledge
    and resources to promote optimum health. This includes all conscious and unconscious
    behaviors directed toward health, growth, development, and adaptation.

In the theory, modeling is the process by which the nurse seeks to know and understand the patient’s personal model of his or her own world, as well as learns to appreciate its value and significance. Modeling recognizes that each patient has a unique perspective of his or her own world. These perspectives are called models. The nurse uses the process to develop an image and understanding of the patient’s world from that patient’s unique perspective.

Role modeling is the process by which the nurse facilitates and nurtures the individual in attaining, maintaining, and promoting health. It accepts the patient as he or she is unconditionally, and allows the planning of unique interventions. According to this concept, the patient is the expert in his or her own care, and knows best how he or she needs to be helped.

This model gives the nurse three main roles. They are facilitation, nurturance, and unconditional acceptance. As a facilitator, the nurse helps the patient take steps toward health, including providing necessary resources and information. As a nurturer, the nurse provides care and comfort to the patient. In unconditional acceptance, the nurse accepts each patient just as he or she is without any conditions.

The basic theoretical linkages used in nursing practice for this model are: developmental task resolution (residual) and need satisfaction are related; basic need status, object attachment and loss, growth and development are all interrelated; and adaptive potential and need status are related.

According to the theory, the five goals of nursing intervention are to build trust, promote the patient’s positive orientation, promote the patient’s control, affirm and promote the patient’s strengths, and set mutual, health-directed goals.

Modeling refers to the development of an understanding of the patient’s world, while role modeling is the nursing intervention, or nurturance, that requires unconditional acceptance. This model considers nursing as a self-care model based on the patient’s perception of the world, as well as his or her adaptation to stressors.

When it comes to research, the following are some theoretical propositions presented by the model:

  • The individual’s ability to contend with new stressors is directly related
    to the ability to mobilize resources needed.
  • The individual’s ability to mobilize resources is directly related to their need deficits and assets.
  • Distressors are unmet basic needs; stressors are unmet growth.
  • Objects that repeatedly facilitate the individual patient in need take on
    significance for that individual patient. When this occurs, attachment to the significant object occurs.
  • Secure attachment produces feelings of worthiness.
  • Feelings of worthiness result in a sense of futurity.
  • Real, threatened, or perceived loss of the attachment object results in morbid grief.
  • Basic need deficits co-exist with the grief process.
  • An adequate alternative object must be perceived as available in order for the patient to resolve his or her grief process.
  • Prolonged grief due to an unavailable or inadequate object results in morbid grief.
  • Unmet basic and growth needs interfere with growth processes for the patient.
  • Repeated satisfaction of basic needs is a prerequisite to working through developmental tasks and resolution of related developmental crises.
  • Morbid grief is always related to need deficits.

Health Behavioral Theory

The Behavior System Model of Nursing was developed by Dorothy E. Johnson. It stresses the importance of research-based knowledge about the effect of nursing care on patients. When she first proposed the theory in 1968, she explained that it was to foster “the efficient and effective behavioral functioning in the patient to prevent illness.”

Johnson explains four major concepts in her nursing model.

  1. The human being has two major systems: the biological and behavioral systems. The role of medicine is to focus on the biological system, while nursing’s focus is on the behavioral system.
  2. Society relates to the environment in which the patient exists; a patient’s behavior is directly influenced by the environment and events that occur in the environment.
  3. Health is a purposeful adaptive response to internal and external stimuli in order to maintain stability and control. The responses include physical, mental, emotional, and social realms.
  4. The primary goal of nursing is to foster equilibrium in the individual patient. One focus of nursing concerns the organized and integrated whole, but the major focus is on maintaining balance in the behavioral system during an illness in the biological system.

The assumptions made by the theory fall into three categories: assumptions about system, assumptions about structure, and assumptions about function.

There are four assumptions about system. They are:

  1. There is “organization, interaction, interdependency, and integration of the parts and elements of behaviors that go to make up the system.”
  2. A system “tends to achieve a balance among the various forces operating within and upon it,” and patients continuously strive to maintain balance in their behavioral systems by automatic adjustments and changes to the natural forces.
  3. A behavioral system, which requires some measure of regularity and constancy in behavior, is essential to the patient in that it has an important purpose in social life, as well as for the individual.
  4. “System balance reflects adjustments and adaptations that are successful in some way and to some degree.”

There are also four assumptions about structure and function of each subsystem. First, “from the form the behavior takes and the consequences it achieves can be inferred what ‘drive’ has been stimulated or what ‘goal’ is being sought.” Each individual has a
“predisposition to act with reference to the goal, in certain ways rather than other ways, “which is called a “set.” Each subsystem has a range of choices called a “scope of action.” Finally, it produces an “observable outcome,” which is the patient’s behavior.

Johnson identifies seven subsystems in the Behavioral System Model. They are:

  1. Attachment or affiliative subsystem, which is “social inclusion intimacy and the formation and attachment of a strong social bond.”
  2. Dependency subsystem, which is the “approval, attention or recognition and physical assistance.”
  3. Ingestive subsystem, in which “the emphasis is on the meaning and structures of the social events surrounding the occasion when the food is eaten.”
  4. Eliminative subsystem, which states that “human cultures have defined different socially acceptable behaviors for excretion of waste, but the existence of such a pattern remains different from culture to culture.”
  5. Sexual subsystem, which is both a biological and social factor that affects behavior.
  6. Aggressive subsystem, which relates to the behaviors concerning protection and self-preservation, generating a defense response when there is a threat to life or territory.
  7. Achievement subsystem, which provokes behavior that tries to control the environment.

Each subsystem also has three functional requirements. Each subsystem must be protected from noxious influences that the system cannot cope with; each subsystem must be nurtured with appropriate supplies from the environment; and each subsystem must be stimulated for use in order to enhance growth and protect from stagnation. These behaviors are “orderly, purposeful and predictable and sufficiently stable and recurrent to be amenable to description and explanation.”

Johnson defined nursing as “an external regulatory force which acts to preserve the organization and integration of the patients behaviors at an optimum level under those conditions in which the behaviors constitutes a threat to the physical or social health,
or in which illness is found.”

She stated that nursing is “concerned with man as an integrated whole and this is the specific knowledge of order we require.” She also identified four goals of nursing, which are to assist the patient:

  1. whose behavior is in proportion with social demands.
  2. who is able to modify his behavior in order to support biological imperatives.
  3. who is able to benefit to the fullest extent during illness from the physician’s knowledge and skill.
  4. whose behavior does not give evidence of unnecessary trauma as a consequence of illness.

In terms of the nursing process, the Behavioral System Model is best applied in the evaluation phase, during which time the nurse can determine whether or not there is balance in the subsystems of the patient. If a nurse helps a patient maintain an equilibrium of the behavioral system through an illness in the biological system, he or she has been successful in the role.

Lydia Hall Theory

The Care, Cure, Core Theory of Nursing was developed by Lydia Hall, who used her knowledge of psychiatry and nursing experiences in the Loeb Center as a framework
for formulating the theory. It contains three independent but interconnected circles: the core, the care, and the cure.

The core is the patient receiving nursing care. The core has goals set by him or herself rather than by any other person, and behaves according to his or her feelings and values.

The cure is the attention given to patients by medical professionals. Hall explains in the model that the cure circle is shared by the nurse with other health professionals, such as physicians or physical therapists. These are the interventions or actions geared toward treating the patient for whatever illness or disease he or she is suffering from.

The care circle addresses the role of nurses, and is focused on performing the task of nurturing patients. This means the “motherly” care provided by nurses, which may include comfort measures, patient instruction, and helping the patient meet
his or her needs when help is needed.

In all the circles of the model, the nurse is present. The focus of the nurse’s role is on the care circle. This is where she acts as a professional in order to help the patient meet his or her needs and attain a sense of balance.

Holistic Nursing

Holistic Nursing Theories and Models

  • King’s Theory of Goal Attainment
  • Neuman’s Systems Model
  • Rogers’ Theory of Unitary Human Beings
  • Nightingale’s Environment Theory
  • Hall’s Care, Cure and Core Theory
  • Parse’s Human Becoming Theory
  • Roy’s Adaptation Model of Nursing
  • Johnson’s Behavior System Model
  • Orem’s Self-Care Deficit Nursing Theory
  • Erickson’s Modeling and Role Modeling Theory
  • Newman’s Health as Expanding Consciousness Theory
  • Watson’s Philosophy and Science of Caring
  • Humanistic Model
  • Helvie’s Energy Theory and Nursing