A body or collection of knowledge that is of most use in giving definitions and explanation to the profession of nursing is referred to as a nursing theory. Theories are based on assumptions made up of models, concepts, definitions, and propositions. Croyle (2005) defines a good theory as one that is logical, supported by a past research in the same field, consistent with everyday observations. Florence Nightingale is seen as the forerunner of nursing theories although she never really came up with any theory in action today. She wrote a book about her nursing experiences giving way to numerous nursing theories. This paper is about the utilization and application of a nursing theory in addressing a clinical issue. Of particular interest is Dorothy Johnson’s Behavioral systems model (Johnson, 1980). This paper attempts to identify a clinical problem in the society and apply the principles of Johnson’s theory in finding the solution to the problem. The issue identified is aggressive behavior in the elderly living in long-term care nursing homes.
In the nursing profession, theories form a very vital part of the system. The main aim of nursing theories is description, explanation, and prediction of nursing phenomenon. A good theory in this field therefore ensures better patient care, professionalism, and better communication between nurses and above all provides guidance on further research and education in the field. A good theory has provisions for foundations of the nursing practice to help in the generation of further knowledge and giving good direction to the field. A theory shows what we already know and what we need to find out thus in nursing, it plays a central role in caring for patients. Theories thus go a long way in the development of the profession.
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Dorothy Johnson is the proponent of the Behavioral Systems model. Born in Georgia on the 21st of august 1919, she received her A.A in 1938 from Armstrong Junior College. In 1942, she graduated from the Vanderbilt University with a B.S.N. she got her M.P.H. from Harvard University in 1948. She was involved in teaching pediatric nursing at Vanderbilt University before joining the University of California in Los Angeles.
Johnson (1980) states that the eight subsystems of behavior are interdependent, interactive and integrated at the same time. According to her, humans are behavioral systems made up of the following seven subsystems: the achievement deals with setting and attaining goals while the affinitive forms relationships with others. The aggressive/protective has the function of responding to threats and providing protection to one’s self while the dependency subsystem obtains necessary feedback about the self and goes ahead to recognize the need to depend on others. Whereas the eliminative part expresses feelings to the outside world and is involved in the elimination of wastes from the body system, the ingestive is involved in the intake of the ever so valuable nutrients and acquiring knowledge. The sexual subsystem is for recreation, development of gender based identity and having sexual relationships with others. In other words, the seven subsystems need to be in good conditions and in action for a normal healthy human being. Interaction between the seven subsystems is in turn interrelated and connected such that they influence each other in delivering their various duties.
However, the seven subsystems do not go it alone as they are also acted on, significantly, by external factors. For Johnson, the environment is the main external factor as it includes anything and everything outside the person in question. The physical, socio-cultural and to some extent even the economic factors form part of the external actors on the subsystems. Aggressive behavior is a social issue and the society forms the major part of the external environment. The main role played by nurses is thus helping the affected individual return to the normal balance of the seven subsystems. To achieve the possible ultimate functioning behavior, the nurses at the care facilities have to make the social environment of the patients comfortable so they feel at ease.
When the subsystem fails to develop fully and/or does not get sufficient supply of something, it easily falls out of balance. At other times there is discrepancy meaning that the subsystem is not doing enough to attain the end goal, which is being in the best state. Conflict between the components of the subsystem is not good for the body just as much as one of the subsystems being dominant in action over the rest. They are the major causes of imbalance in the subsystem that results in people not feeling well and consequently falling ill. In the case of aggressive behavior, the aggressive subsystem is dominant over the other subsystems. When this energy is not channeled in the right direction clinical issues arise. These can be witnessed in form of violence, or aggressive language (Croyle, 2005).
Regulation of behavior is the best way for the person to get back the balance hence is well again. The nurses at the care facilities for the elderly have to pay attention to any changes in the behavior of their patients. Alteration of the internal as well as external environment while n some cases stimulation of the recovery process goes a long way in aiding the patient to return to the normal balance. The unfamiliar environment in the facilities sometimes causes aggressive behavior, especially amongst the elderly in the care facilities. Elderly people at the facilities need the nurses to help with the aggressive behavior (Croyle, 2005).
It is Johnson’s belief that the basic responsibility of the nurse is to support the patient restore balance when lost and in case of imbalance then, achieve the status quo, which would mean return to normal balance. Nurses, therefore, need to be patient with patients with aggressive behavior if they are to get to the cause of the problem. Most aggressive behavior is caused by anger and emotional stress. It is thus upon the nurse to create conducive external environment for the patient to open up. Thanks to research and the advancement of science, it is now easier to identify and pinpoint where the problem comes from.
In her analysis and development of the theory, Johnson did not fail to mention the contribution and effects of the environment to the body. Here the environment is divided into external and internal, the internal being the subsystems while the external include anything outside the body. On health, the theory holds that a healthy person is one with a perfect balance and stability in the operations of the seven subsystems. The nurse has a role to play in the regulation of the balance whenever there is instability in the system.
External and internal environments are the main causes of aggression or aggressive behavior. Various parts of the body contribute differently to aggressive behavior. The brain is the major controller of aggressive behavior. The brain is in charge of controlling expression of both automatic and behavioral components of aggression. This includes violent behavior and vocal expression. The brain picks up signals from both the external and internal environments and expresses them in form of aggression. Whenever the individual feels threatened or uncomfortable, they become aggressive in their talk, throwing insults, and demeaning words. It becomes worse when they turn violent to release the anger they have inside.
By elderly people, we mean 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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There are numerous long-term care facilities ranging from mental institutions for the mentally handicapped to nursing homes where there are available facilities to assist them in their daily livelihoods. Most of these facilities are homes to the elderly and those with terminal illnesses. Of the seven subsystems, the aggressive part of their systems is more active than the rest. They thus face life-changing issues and try their level best to deal with the emotional as well as mental challenges. Nurses in these facilities are particularly faced with dealing with mental issues that come with aggression.
Behavioral problems often arise from the patient’s effort to deal with his emotions or simply express them. The behavior ranges from repeating questions or phrases, humming, pacing up and down, to repetitive behavior. Aggressive behavior includes throwing things, punishing language and even hitting (Parker, 2001).
Nurses in these institutions 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.
Ones the subsystem causing the change in behavior has been identified, the nurse goes ahead to ensure conducive external environment to aid the patient to full recovery. The patient has to feel comfortable in the care facility because any irritation or discomfort agitates them. The patient is incapable of controlling their feelings or emotions and may be aggressive in expressing what they feel. The nurse therefore has a duty to stimulate the internal environment to be peaceful through the external. It is not easy to take care of mentally ill patients because the problem lies within their minds.
The best way to help the patient is by finding out what changed in their past behavior. What happened before they became ill is crucial in determining the problem and adjusting the environment in an attempt to direct the patient to recovery of the balance in the subsystem. Depression is one of the commonest common mental-health problems in health facilities. Loneliness, fear of death, helplessness, frustration, anger, and hopelessness are some of the challenges of post-retirement faced by the elderly. Depression has many symptoms one of them having trouble falling asleep (Parker, 2001). These symptoms are often seen as complications and most people try treating them instead of observing change of behavior in the individual and restoring balance.
Depression can be solved by improving the external environment of the patient. Mavis et al (2011) states that anti-depressants are available and can be used to treat depression. He continues to state that the elderly always have difficulties with their carers thus adding more problems to the recovery process. The nurse should involve the patient in support groups; give medication to stimulate recovery of the internal environment, and involving them in activities that spark their interests. Individual therapy and interaction with loved ones is vital for the recovery of these patients. Depression is a mental complication and just like others, it affects the mind. The nurses have a responsibility to try to stimulate the mind in the right direction to encourage quick recovery and development of the mental system.
Mavis (2011) confirms that some of the causes of depression include illness, loneliness, an adverse life-event, and even some medication. According to him, depression is an insight to more cognitive problems that the elderly have to deal with. This is where the environment comes in. the internal, (subsystems), have to be kept in balance. The external environment helps the patient fit in properly and be free with the nurses. The patient opens up easily to discuss problems when the surrounding is to his comfort. Nurses have to help them fit in to the care centers.
In conclusion, the behavioral system theory is very useful in the treatment of mental illnesses. The mind is affected by the body’s subsystems and ensuring restoration of balance in the subsystems will go a long way in treatment of mental illnesses especially among the elderly. Not being able to express their feelings to the carers is a big problem to the resolution of aggressive behavior. Improving their environment and making the patient comfortable calms them down and thus improve the internal environment as well.
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