Melkamu tulbake lema

By Group Two
Ababo Demeke
Okaso Orkaido
Melkamu Tulbake
Melikenesh Nigatu
Tamene Demisse
Group Assignment on Interactional Theories
1

Objectives
 At the end of this session the learner will be able to :
Describe the background of the theorists
Explain philosophical underpinnings, purpose & major concepts of the
theories
List the nursing metaparadigm of the theories
State theories context for use/usefulness and nursing implications
Describe evidence of empirical testing/ testability of the theories
Discuses the Parsimony/simplicity of the theories
Mention the points to be remembered in the theories
2

Outline
Interactional theories:
Peplau(1952)
King (1968)
Johnson (1959)
Orlando (1961)
Travelbee (1966)
Paterson and Zderad (1976)
3

Introduction
 People can derive satisfaction from interpersonal relationships,
 An absence of meaningful relationships can lead to loneliness, even within a
network of social relationships.
 Interpersonal relationships form the basic building blocks for good nursing.
 The quality of care received by patients was related to the quality of the
interpersonal relationships they had with nurses.
 Patients value interpersonal relationships very highly and that this is often
what leads to high patient satisfaction.
4

THEORIES OF HILDEGARD
E. PEPLAU (1952)
5

Background of the Theorist
 Peplau was born in reading, Pennsylvania to immigrant parents of
German descent, gustav (illiterate, hardworking father) and otyllie
peplau (oppressive, perfectionist mother) on September 1, 1909).
 Diploma program in Pottstown Hospital school of nursing, PA, 1931
 BA in Interpersonal Psychology, Bennington College, 1943
 MA in Psychiatric Nursing, Columbia University, 1947
 Doctoral in Curriculum Development, Columbia University, 1953
 She was also certified in psychoanalysis by the William aklanson
white institute of new York city.
6

 She worked as:
 A graduate of the Pottstown hospital ,
 A staff nurse in pennsylvania & newyork city &Army nurse crops,
 An advisor to the WHO,
 A visiting professor at universities in Africa, Latin America, Belgium
and US.
 A consultant to the US. Surgeon general, the U.S. air force, and the
national institute of mental health.
 Government policy making groups.
 President of ANA from 1970-1972, and as second vice president
from 1972-1974.
7

 Peplaus lifelong work was largely focused on extending Sullivan's
interpersonal theory for use in nursing practice.
 She was a prolific writer, and was well known for her presentations,
speeches, and clinical training workshops.
 Peplau was a tireless advocate for advanced education for psychiatric
nurses.
 She thought that nurses should provide truly therapeutic care to
patients, rather than the custodial care that was prevalent in the mental
hospitals of that era.
8

Philosophical Underpinnings of the Theory
The need for partnership between nurse and client is very substantial in
nursing practice.
This definitely help nurses and health care providers develop more
therapeutic intervention in clinical setting
Through these, peplau developed her interpersonal relations
theory” in 1952
Assumptions
 Peplaus interpersonal relations theory assumptions are:
1. Nurse and the patient can interact.
9

2. Both the patient and nurse mature as the result of the therapeutic
interaction.
3. Communication and interviewing skills remain fundamental nursing
tools
4. Nurses must clearly understand themselves to promote their clients
growth and avoid limiting their choices to those that nurses value
10

Major concept
 Nurse should apply principles of human relations to the problems that
arise at all levels of experience
 Peplaus theory explains the phase of interpersonal process, roles in
nursing situations and method for studying nursing as an interpersonal
process
 Nursing is therapeutic in that it is a healing art, assisting an individual
who is sick or in need of healthcare
 The nurse and the patient work together so that both become mature
and knowledgeable in the process.
11

 Roles of nurses include primary role such as stranger, teacher, resource
person, counselor, surrogate & leader and secondary role such as
technical expert, mediator, safety agent, researcher, tutor & manager of
environment
 Nursing is an interpersonal process because it involves interaction
between two or more individuals with a common goal.
 The attainment of goal is achieved through the use of a series of steps
and patterns. These phases are:
12

1. Orientation phase: involves engaging the client in treatment,
providing explanation & information and answering question.
2. Identification phase: begins when the client works independently
with the nurse, expresses feeling and begin to feel stronger.
3. Exploitation phase: the clients make full use of the services offered.
4. Resolution phase: the client no longer needs professional services
and gives up dependent behaviour.
13

Peplaus theory and nursing metaparadigm
 Her theory defines the metaparadigm concepts of nursing as follows:-
 Man : an organism that “strives in its own way to reduce tension
generated by needs.” The client is an individual with a felt need.
 Health: “a word symbol that implies forward movement of personality
and other ongoing human processes in the direction of creative,
constructive, productive, personal and community living.”
 Environment: “existing force outside the organism and in the context
of culture from where customs and beliefs are acquired”.
14

 Nursing: “human relationship between an individual who is sick, or in
need of health services and a nurse specially educated to recognize and
to respond to the need for help.”
15

Usefulness
 Her models has proved greatly used by later nurse theorists & clinicians
in developing more sophisticated & therapeutic nursing interventions.
 Her theory help in developing nursing process.
 The concept is highly applicable to care of psychiatric patients.
 Enables nurses to know what they are doing and why they are doing it
by providing a framework for what the nursing professions entails
(chamberlain collage of nursing, 2015).
 Guide nursing practice by attempting to describe, explain, and create a
foundation for everything the term nursing encompasses.
16

Testability
 The theory is consistent, testable and displays scientific integrity.
 Many researches are performed based on Peplaus theory. For instance:
 Hays. D. (1961) phases and steps of experimental teaching to patients
of a concept of anxiety
 Burd .S.F. develop and test a nursing intervention framework for
working with anxious patients: students developed competency in
beginning interpersonal relationship
17

Parsimony
Peplaus theory is parsimonious
Its simplicity increased the importance and use of this theory in
modern health care system.
Contribute to the creation of an environment characterized by
improved cooperation and mutual understanding (smith and parker,
2015).
This theory can be easily interpreted even by inexperienced
specialists.
18

Points to be remembered
 Peplaus interpersonal relations theory focus on therapeutic relationship
by using problem solving techniques for the nurse and patient to
collaborate on to meet patient’s need.
 She define nursing as: “human relationship between an individual who
is sick, or in need of health services and a nurse specially educated to
recognize and to respond to the need for help.
19

Imogene M. King: King’s conceptual system
and theory of goal attainment and transaction
process
20

Background of the Theorist
 Imogene King - born in 1923.
 Bachelor in science of nursing from St. Louis University in 1948
 Master of science in nursing from St. Louis University in 1957
 Doctorate from Teacher’s college, Columbia University.
 Theory describes a dynamic, interpersonal relationship in which a person
grows and develops to attain certain life goals.
 Factors which affects the attainment of goal are: roles, stress, space & time
21

22
 King search for literature in nursing and other behavioral science fields by using
inductive and deductive reasoning.
 The von Bertalanffy General Systems Model is acknowledged to be the basis for
King’s work
 She fined the general systems theory from the behavioral sciences.
 She presented formalized conceptual system
 Personal
 Interpersonal
 Social systems
 She also presented Theory of Goal Attainment, derived from the personal and
interpersonal systems .
 Theory of Goal Attainment specifically addresses how nurses interact with
patients to achieve health goals.

Assumptions
 The Theory of Goal Attainment lists several assumptions relating to
individuals, nurse–client interactions, and nursing.
 When describing individuals, the model shows that
1. Individuals are social, sentient, rational, reacting beings and
2. Are controlling, purposeful, action oriented, and time oriented in their
behavior (King,1995b)
23

 Regarding nurse–client interactions, King (1981) believed that
1. Perceptions, Goals, needs, and values of the nurse and client influence the
interaction process;
2. Individuals have a right to knowledge about themselves;
3. Individuals have a right to participate in decisions that influence their lives,
health, and community services;
4. Individuals have a right to accept or reject care; and
5. Goals of health professionals and goals of recipients of health care may not
be congruent.
24

 With regard to nursing, King (1981, 1995b) wrote that
1. Nursing is the care of human beings;
2. Nursing is perceiving, thinking, relating, judging, and acting the behavior
of individuals who come to a health care system;
3. A nursing situation is the immediate environment in which two individuals
establish a relationship to cope with situational events; and
4. The goal of nursing is to help individuals and groups attain, maintain, and
restore health.
If this is not possible, nurses help individuals die with dignity.
25

Major Concepts
26
Perception :The process of human transactions with environment.
 It involves organizing, interpreting, and transforming information from
sensory data and memory.
Communication :A process by which information is given from one person to
another. It involves intrapersonal and interpersonal exchanges.
Interaction :A process of perception and communication between person and
environment and between person and person.
Transaction: A process of interactions in which human beings communicate
with the environment to achieve goals that are valued; transactions are goal-
directed human behaviors.

Metaparadigm
 King’s Theory of Goal Attainment defines the metaparadigm concepts of
nursing as well as a number of additional concepts those are as follows:
Nursing
 A process of action, reaction, and interaction whereby nurse and client share
information about their perceptions in the nursing situation.
 The nurse and client share specific goals, problems, and concerns and
explore means to achieve a goal.
Health:Implies continuous adjustment to stressors in the internal and external
environment through optimum use of one’s resources to achieve maximum
potential for daily living.
27

Individuals
 Social beings who are rational and sentient.
 Persons exhibit common characteristics such as
 The ability to perceive
 To think and to feel
 To choose between alternative courses of action
 To set goals and to select the means to achieve goals
 To make decisions.
Environment
 The background for human interactions. It is both external to, and internal to, the
individual
28

Usefulness
 King’s Theory of Goal Attainment has enhanced nursing education.
 In Sweden, King’s model was used to organize nursing education.
 King’s conceptual system is an organizing guide for nursing practice.
 Hughes, Lloyd, and Clarke (2008) found King’s model “a radical approach to
process of nursing . . . in the United Kingdom” (p. 48).
 They found King’s transaction process especially suited to nursing information
systems.
30

Testability
 Parts of the Theory of Goal Attainment have been tested, and a number of research
studies reported in the literature used the model as a conceptual framework.
 For example, recent research by Falcao, Guedes, and da Silva (2006), who
employed the theory of goal attainment, studied arterial hypertension and
adherence to prescribed therapy in Brazil.
 Khowaja (2006) tested clinical pathways in transurethral resection of the prostate.
Findings indicated a significant improvement in outcomes with the clinical
pathway using King’s interacting systems framework.
 A study in South America by Souza, De Martino, and Lopes (2007) identified
nursing diagnoses of hemodialysis patients with King’s conceptual system as the
referent
31

Parsimony
 The theory is not parsimonious because it have:
Numerous concepts
 Multiple assumptions
Many statements, and
Many relationships on a number of levels.
 This complexity, however, mirrors the complexity of human transactions for
goal attainment.
 The model is general and universal and can be the umbrella for many
midrange and practice theories.
32

Value in extending nursing science
 In addition to application in practice and research described previously.
 King’s work has been the basis for development of several middle range nursing
theories like Rooda (1992) model for multicultural nursing practice.
 King’s Systems Framework was reportedly used by Alligood (2000) and Doornbos
(2000) to develop a theory of personal system empathy, and to derive a middle
range theory of family health respectively.
 King’s conceptual system and theory have been used internationally in many
countries, as well as in numerous university nursing programs and have provided a
foundation for many research studies.
 Her work has extended nursing science by its usefulness in education, practice, and
research across international boundaries (King, 2001; Sieloff, 2006).
33

Josephine Paterson & Loretta Zderad
Humanistic Nursing Theory
34

Background of the Theorists
 Josephine Paterson and Loretta Zderad are from the United States.
 They both earned their first diplomas in nursing, then Bachelor’s degrees in
nursing education before continuing to graduate programs.
 Their career as nursing academics got started in the 1950s when they were
both employed at Catholic University where they met.
 They continued to work together and remained friends for the next 40 years.
 They later continued on to their doctorate degrees in the 1960s.
35

 They believed nursing education should be founded in experience, Each patient
is assessed and treated on a case-by-case basis
 They began to define and reflect on their nursing practice experience, and
synthesize a new theory: Humanistic Nursing Theory.
 By 1971, they had begun to define their theory and what it was that made it
unique as an approach to nursing.
 They then began to research other nurses’ experiences and used their theory as a
perspective and method for nurses to examine their experiences.
 Through this, their goal was to develop it into theoretical propositions, which
could serve as guides for nursing practitioners.
36

 Paterson and Zderad describe the 11 essences as underlying elements and are
capable of withstanding variations due to culture, geography, the scope of
practice, and other variable factors that exist in nursing.
 These 11 essences are:
1. Awareness
2. Openness
3. Empathy
4. Caring
5. Touching
6. Understanding
7. Responsibility
8. Trust,
9. Acceptance
10. Self-recognition, and
11. Dialogue”
37

The Humanistic Theory Assumptions
 The nurse presents themselves as a helper ready to assist the patient.
 The nurse is open to understanding how the patient feels with the intention of
improvement.
 Openness is an essential quality for humanistic nursing dialogue.
 Paterson and Zderad developed the five phases of the nursing process: these
are found in the next slide
38

1. Preparation of the Nurse Knower for Coming to Know - Nurse takes risks
and has an open mind. “Accepting the decision to approach the
unknown openly”.
2. Nurse Knowing of the Other Intuitively- Nurse tries to understand the other
3. Nurse Knowing the Other Scientifically- Nurse goes from intuition to
analysis. The analysis is the sorting, comparing, contrasting, relating,
interpreting, and categorizing.
4. Nurse Complementarily Synthesizing Known Others – Nurse increased
understanding of their owned learned experiences
5. Succession within the Nurse from the Many to the Paradoxical One- Nurse
takes the information gleaned and applies it in the practical clinical
setting.
39

Nursing Paradigm
Person
 Are viewed as open energy fields with special life experiences.
 As energy fields, they are greater than and different from the sum of their
parts and cannot be predicted from knowledge of their parts.
 Human beings are viewed as being holistic in nature.
Health
 Nursing act has to do with the quality of a person’s living and dying (well-
being and more-being ).
 Nursing’s concern is not merely with a person’s well-being but with his more-
being, with helping him become more humanly possible in his particular life
situation.
40

Environment
 Environment represents the place where the service is delivered, the
community, or the world.
 The environment can be understood as the time and space in which the
nursing experience takes place.
 The nurse and the patient may be interacting within the same actual time
span, but the time may feel very different to the nurse and client.
 Their experiences of time are unique to their understanding of the situation.
41

Nursing
 Paterson and Zderad define nursing as a “lived experience between human
beings”.
 They emphasize the importance of the nurse being aware of herself and of the
client as unique human.
 They refer to this as a “reciprocal call and response” that is achieved through
an awareness of the nurse’s own worldview, values, understanding, and
responses, and responding to the others’ responses and knowledge.
 Through understanding the self and the other, the nurse can engage in an
authentic, therapeutic exchange of experience, understanding, and of being.
42

Implications For Nursing/ Usefulness
 The philosophical perspectives of humanistic nursing theory are relevant to the
practice of hospice and palliative care nursing .
 By being with and doing with hospice and palliative nurses can work with
patients to achieve their final goal in the last phase.
 Humanistic Nursing Theory applies both Humanism and Existentialism to
nursing theory.
43

Parsimony
 The theory is parsimony because the concepts of the theory are easily
understood which allows it to be applied appropriately to different situations.
 The theory can be applied to a wide range of nursing application for example:
palliative nursing, hospices nursing, oncology and community health nursing.
44

 Use of core concepts from Humanistic Nursing Theory can provide a
unifying language for planning care and description of investigations.
 Future research efforts in hospice and palliative nursing should define
and evaluate these concepts for efficacy in practice settings.
45

Theory of Ida Jean Orlando Pelletier (August 12,
1926 - November 28,2007)
46

Background of the theorists
 The firs generation Irish - American born on August 12, in 1926.
 In 1947 she received a nursing diploma from avenue hospital nursing
school new York.
 In 1954 she received bachelor degree in FH nursing from St. john’s
university
 she completed her masters of arts in mental health consultation from
teachers college, Colombia university.
 She also worked intermittently and sometimes concurrently as staff nurse
- as general hospital supervisor
- an assistant director teacher of several courses.
47

Cont…
 Ida Jean Orlando retired from nursing in 1992.
 After becoming well-educated, researching over 2,000 nurse-patient
interactions, and coming up with a theory that changed nursing
 she was recognized as a “Nursing Living Legend” by the
Massachusetts Registered Nurse Association
 Ida Jean Orlando died on November 28, 2007, at the age of 81.
48

Philosophical underpinnings of theory
 stresses the reciprocal relationship between patient and nurse.
 What the nurse and the patient say and do affects them both.
 She views nursing’s professional function as finding out and meeting the
patient’s immediate need for help.
 Also described her model as revolving around the five major interrelated
concepts:
49

Cont..
 Deliberative Nursing Process that allows nurses to formulate an effective
nursing care plan that can also be easily adapted when and if any complexity
comes up with the patient.
 The Deliberative Nursing Process has five stages:
 Assessment
 Diagnosis
 Planning
 Implementation and
 Evaluation .
50

Assumptions:
1.When patients cannot cope with their needs on their own, they become
distressed by feelings of helplessness.
2.In its professional character, nursing adds to the distress of the patient.
3.Patients are unique and individual in how they respond.
4.Nursing offers mothering and nursing analogous to an adult who mothers and
nurtures a child.
5.The practice of nursing deals with people, the environment, and health.
51

Cont..
6.Patients need help communicating their needs; they are uncomfortable and
ambivalent about their dependency needs.
7.People can be secretive or explicit about their needs, perceptions, thoughts,
and feelings.
8.The nurse-patient situation is dynamic; actions and reactions are influenced
by both the nurse and the patient.
9.People attach meanings to situations and actions that aren’t apparent to
others.
52

Cont..
10.Patients enter into nursing care through medicine.
11.The patient cannot state the nature and meaning of his or her distress without
the nurse’s help or him or her first having established a helpful relationship with
the patient
12.Any observation shared and observed with the patient is immediately helpful
in ascertaining and meeting his or her need or finding out that he or she is not in
need at that time.
13.Nurses are concerned with the needs the patient is unable to meet on his or
her own
53

Major Concepts & Nursing Metaparadigm
 The nursing metaparadigm consists of four concepts:
 person, environment, health, and nursing.
 Only included three in her theory of Nursing Process Discipline: person,
health, and nursing.
Human Being
 The concept of human as she emphasizes individuality and the dynamic
nature of the nurse-patient relationship.
 humans in need are the focus of nursing practice.
54

Cont…
Health
 Health is replaced by a sense of helplessness as the initiator of a necessity
for nursing.
 stated that nursing deals with individuals who require help.
Nursing
 Nursing as unique and independent in its concerns for an individual’s need
for help in an immediate situation.
 The efforts to meet the individual’s need for help are carried out in an
interactive situation and
 in a disciplined manner that requires proper training.
55

Sub concepts
 Ida Jean Orlando described her model as revolving around the following five
major interrelated concepts:
 the function of professional nursing
 presenting behavior
 immediate reaction
 nursing process discipline and
 improvement
56

Cont..
The function of Professional Nursing
 The function of professional nursing is the organizing principle.
 means finding out & meeting the patient’s immediate needs for help
Presenting Behavior
 Presenting behavior is the patient’s problematic situation.
Immediate Reaction
 The immediate reaction is the internal response.
 The patient perceives objects with his or her five senses
57

Cont..
Nurse Reaction
 The patient’s behavior stimulated a nurse’s reaction, which marks the
nursing process discipline’s beginning.
Improvement
 The resolution to the patient’s situation.
 The nurse’s actions are not evaluated. Instead, the result of his or
her actions is evaluated to determine whether their actions served to
help the patient communicate his or her need for help and how it was
met
58

Usefulness
 Focuses on how to produce improvement in the patient’s behavior. Evidence
of relieving the patient’s distress is seen as positive changes in the patient’s
observable behavior.
 The Deliberative Nursing Process helps nurses achieve more successful
patient outcomes such as fall reduction.
 Theory remains a most effective practice theory that is especially helpful to
new nurses as they begin their practice.
59

Testability
 The guarantee that patients will be treated as individuals is very much
applied in theory of the Deliberative Nursing Process.
 The model also guides the nurse to evaluate her care in terms of objectively
observable patient outcomes.
 Used for both clinical and administrative practice in to acute care hospital
(Schmieding 1984) in operating rooms (Rosental 1996
60

Parsimony
 The theory is parsimonious
 nurses apply care plan for patient care plan
 It emphasis the critical importance for the patients participation in the
nursing process
61

 Theory focuses on the interaction b/n the nurse and patient
 Perception
 Validation
 The use of nursing process to produce positive outcomes /patient
improvement
 Key focus was to define the function of nursing.
 stresses the reciprocal relationship between patient and nurse.
62

Back ground of the theorist
 Joyce travelbee was born in 1926 and is known for her work as a nursing
theorist.
 In 1956, she earned her bachelor of science in nursing degree from
louisiana state university.
 She was given a master of science in nursing degree in 1959 from Yale
university.
 She worked as a psychiatric nursing instructor at the Depaul hospital
Affiliate school in new Orleans, Louisiana.
 Worked later in charity hospital school of nursing in Louisiana state
university, new york university and the university of Mississippi
 She died in 1973 at the age of 47.
64

Philosophical underpinning of the theory
 "Actually there are no patients. There are only individual human beings
in need of care, services and assistance of other human beings“
 From her experiences working with Catholic charity institutions, she felt
that
 Compassion was lacking in nursing care.
 If nurses experience personal sufferings they would be better able to help
patient deal with illness and suffering.
 These experiences of travelbee led her to formulate a theory where caring
about the patient is central.
65

Concepts
 Patient- individual human beings in need of the care, services, assistance of
other human beings.
 Pain- "Pain itself is not observable, only it's effects are noted."
 Suffering- "a feeling of displeasure, an experience that varies in intensity,
duration and depth.
 Hope- is a mental state characterized by the desire to gain an end or
accomplish a goal combined with some degree of expectation that what is
desired or sought is attainable
 Hopelessness- devoid of hope
66

 Communication- is a process which can enable the nurse to establish a human-
to-human relationship and thereby fulfill the purpose of nursing.
 Interaction- contact during which two individuals have reciprocal influence on
each other and communicate verbally/ non-verbally.
 Nurse-Patient Interaction- contact between a nurse and an ill person and both
individuals perceive each other in a stereotyped manner.
 Therapeutic Use of Self- Ability to use one's personality consciously and in full
awareness in an attempt to establish relatedness and to structure nursing
intervention.
 It requires self-understanding, self-insight and understanding of the dynamics of
human behavior.
67

Assumptions
 “The purpose of nursing is achieved through the establishment of a human
to human relationship”.
 The human condition is shared by all human beings and is dichotomous in
nature.
 Most people, at one time or another and in varying degree , will experience
joy, happiness and love.
 “All persons, at some time in their lives will be confronted by illness and
pain.
68

 The quality and quantity of nursing care delivered to an ill human being
is greatly influenced by the nurse’s perception of the patient.
 Illness and suffering are spiritual encounters as well as emotional-physical
experiences.
 The communication process enable nurse to establish a human to human
relationship.
 Individuals can be assisted to find meaning in experience of illness and
suffering.
69

Paradigm & Metaparadigm
 Nursing is an interpersonal process whereby the professional nurse
practitioner assists an individual, family or community to prevent or cope
with experience or illness and suffering, and if necessary to find meaning in
these experiences.”
 Health: Travelbee defined health by the criteria of subjective and objective
health
 Subjective health - an individually defined state of well being in accord
with self-appraisal of physical-emotional-spiritual status
 Objective health - absence of discernible disease, disability or defect as
measured by physical examination, laboratory tests and assessment by
spiritual director or psychological counselor
 Person: person is defined as a human being. Both the nurse and the patient
are human beings.
 Environment: -Environment is not clearly defined
70

Phases of Interaction:
The five phases of nurse-patient interaction are:
 Original encounter: Nurse's first impressions of the ill person and vice
versa.
 Emerging Identities: The beginning of the relationship between the nurse
and the individual in which they perceive each other as unique.
 Empathy: The ability to share in person's experience.
 Sympathy: When the nurse wants to lessen the cause of the individual's
suffering.
 Rapport: A process, a happening, an experience, or series of experiences,
undergone simultaneously by the nurse and the recipient of her care.
71

Human-To-Human Relationship Model
72
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Usefulness
Clinical Setting
 Helps inform how nurse can build relationships
 Help setting goals for nurses
 Has been influential in hospice care with helping patients find meaning in
their eminent death
Academics
 influenced current nursing curriculum.
 She emphasized communication as a therapeutic tool
 Due to this theory the focus of nursing education has changed from sign,
symptoms and intervention- to a more holistic care approach.
73

Research
 This theory is used in research to explore how patient gain meaning after a
recent diagnosis and illness
 Applied in the theory of caring cancer patients
Nursing practice
 Used in identifying patient’s uniqueness and problem; Using
nursing intervention to lessen patient suffering and illness;
Gaining patient trust by therapeutic use of self.
74

Parsimony
75
 Not simple
 Contains different variables.
 Multiple variables exist to define our being human, thus separating us via
the level of distress and suffering.
 How humans define or accept their distress and suffering is multifaceted

Testability
 Travelbee’s human to human relation ship theory maintains its future as a
practical therapeutic communication model that can be applied in every filed
of nursing.
 Despite this future, it has not been used in graduate thesis studies.
 In addition, the number of studies using the theory is quit limited, and it has
often been used in short case studies.
 Contributing to the literature by supporting the theory with experimental and
quantitative studies can be an important gain.
76

Points to remember
 Travelbee’s grand theory of Human-to- Human Relationships provides nurses
with a foundation necessary to connect therapeutically with other human
beings.
 Nurses who want to contribute to the filed of communication and empathy,
which are considered the basis of nursing, especially in psychiatric nursing,
can be recommended to use this theory.
 "Nurses perceive and understand the uniqueness of every ill human being and
therefore facilitate their finding meaning in suffering.
 This should facilitate the attribution of meaning or at least a better
understanding of humans’ symptom burden and illness.
77

Back Ground of the Theorist
• Johnson was born August 21, 1919, in Savannah, Georgia.
• Finished her B. S. N. from Vanderbilt University in Nashville, Tennessee, in
1942.
• She worked briefly as a public health nurse and in 1944 returned to Vanderbilt
as an instructor in Pediatric Nursing.
• Finished her M.P.H. from Harvard University in Boston in 1948.
• She retired at January 1, 1978 and remained active in retirement as a speaker
and advocate for nursing education.
• She died in February 1999.
79

Philosophical Underpinnings
 Johnson stated that Nightingale’s work inspired her model.
 Nightingale’s philosophical leanings prompted Johnson to consider the person
experiencing a disease more important than the disease itself (Johnson, 1990).
 She reported that she derived portions of her theory from the works of Selye
on stress, Grinker’s theory of human behavior, and Buckley and Chin on
systems theories (Johnson, 1980, 1990).
80

Assumptions
 There are four assumptions about human behavioral subsystems.
 It is the belief that drives serve as focal points around which behaviors are
organized to achieve specific goals.
 It is assumed that behavior is differentiated and organized within the
prevailing dimensions of set and choice.
 It is the specialized parts or subsystems of the behavioral system
are structured by dimensions of goal, set, choice, and actions; each has
observable behaviors.
 Finally, interactive and interdependent subsystems tend to achieve and
maintain balance between and among subsystems through control and
regulatory mechanisms (Grubbs, 1980)
 This all assumptions show the health environment interaction.
81

Purpose
 The purpose of theory is describe, explain and predict phenomenon of
nursing.
 It 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.
 It provides the functions of nursing practices,
 to generate further knowledge and indicate direction that nursing should
develop in the future.
82

Major concepts and definitions
 Behavior
• The output of intra-organismic structures and processes as they are coordinated
and articulated by and responsive to changes in sensory stimulation.
• Johnson focuses on behavior affected by the actual or implied presence of
other social beings that has been shown to have major adaptive significance.
 System
• definition of system, Johnson (1980) stated, “A system is a whole that which
functions as a whole by virtue of the interdependence of its parts”.
• A person strives to maintain balance in these parts through adjustments and
adaptations to the impinging forces.
83

Cont...
Equilibrium
• A key concept in nursing’s specific goal.
• It is defined as a stabilized but more or less transitory, resting
state in which the individual is in harmony with himself and with
his environment.
Tension
• A state of being stretched or strained and can be viewed as an
end-product of a disturbance in equilibrium.
Stressor
• Internal or external stimuli that produce tension and result in a
degree of instability.
• Stimuli may be positive in that they are present; or negative in
that something desired is absent.
84

Behavioral System Model
 Each individual has patterned, purposeful, repetitive ways of acting that
comprise a behavioral system specific to that individual.
 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.
85

Cont...
 A person as a behavioral system tries to achieve stability and
balance by adjustments and adaptations that are successful to
some degree for efficient and effective functioning.
 The system is usually flexible enough to accommodate the
influences affecting it.
86

Cont...
 Subsystem
• 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.
• The seven subsystems are open, linked, and interrelated where input and
output are components
• Motivational drives direct the activities of these subsystems, which are
continually changing through maturation, experience and learning.
• The system described appear to exist cross culturally and are controlled by
biological, psychological, and
sociological factors.
87

Johnson’s Behavioral Subsystem
1. Attachment or afflictive subsystem:-serves the need for security
through social inclusion or intimacy.
2. Dependency subsystem:-behaviors designed to get attention,
recognition, and physical assistance
3. Ingestion 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
89

Relationship between subsystems:-
90

Cont..
91
 Three functional requirement of each subsystem includes
1. Protection from noxious influences,
2. Provision for the nurturing environment, and
3. stimulation for growth.

Metaparadigm in Nursing
Nursing
• She 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”
92

Cont...
 Based on this definition there are four goals of nursing are to assist the
patient:-
1. Whose behavior commensurate with social demands.
2. Who is able to modify his behavior in ways that it supports biological
imperatives
3. Who is able to benefit to the fullest extent during illness from the physicians
knowledge and skill.
4. Whose behavior does not give evidence of unnecessary trauma as a
consequence of illness.
93

Cont...
Person
 A person has two major systems: the biological system and the behavioral
system
 Nursing’s focus is the behavioral system
 The person as a behavioral system has patterned, repetitive, and purposeful
ways of behaving that link the person to the environment.
Health
 Is an elusive state that is affected by social, psychological, biological and
physiological factors.
 The individual is striving to retain some balance or equilibrium
 The individual’s goal is to sustain the entire behavioral system efficiently and
effectively.
94

Cont...
Environment
 Consists of all the factors that are not part of the individual’s behavior but
influence the system, some of which can be manipulated by the nurse to
achieve the health goal for the patient.
 The behavioral system attempts to maintain equilibrium in response to
environmental factors by adjusting and adapting to the forces that impinge on
it.
95

Usefulness
 Practice
The BSM was used to develop a self-report and observational
instrument to be carried out with the nursing process.
1. Grubbs (1980) – developed an assessment tool and a nursing process
sheet based on Johnson’s seven subsystems.
2. Holaday (1980) – used the theory to develop an assessment tool when
caring for children. This tool allowed the nurse to objectively describe
the child’s behavior and to guide nursing action
3. Derdiarian (1990) – investigated the effects of using two system
assessment instruments on patient and nurse satisfaction.
 The implementation of the instrument provided a more comprehensive
and organized step to assessment and intervention, thereby increasing
patient and nurse satisfaction with care.
97

Cont...
 Education
 A core curriculum based on a person as a behavioral system would have
definite goals and clear course planning.
 The study would center on the patient as a behavioral system and its
dysfunction, which would necessitate the use of the nursing process.
 Research
 Nursing research is vital to explain and identify behavioral system disorders
which rise in relation with illness, and develop good reasoning for the means
of management.
98

Cont...
 The theory resulting form the BSM influences to the researcher to choose
between two options:-
1. Examine the functioning of the system and subsystems by focusing on the
Basic Sciences
2. Investigating methods of gathering diagnostic data or problem solving
activities as these influences the behavioral system.
99

Testability
 Parts of Johnson’s model have been tested or used to direct nursing research.
 Poster, Dee, and Randell (1997) used Johnson’s theory as a conceptual
framework in a study of client outcome evaluation.
 In one study, Derdiarian (1990) examined the relationship between the
aggressive/protective subsystem and the other six model subsystems.
100

Parsimony/simplicity/
 Simplicity
 The theory is potentially complex because there is a number of a possible
interrelationship among the behavioral system, its subsystems, and the
environment.
 Potential relationship have been explored, but more empirical work is
needed (Brown, 2006)
101

Summary(points to be remembered)
 Johnson’s Behavioral system model is a model of nursing care that
advocates the fostering of efficient and effective behavioral functioning in
the patient to prevent illness. The patient is defined as behavioral system
composed of seven (7) behavioral subsystems. Each subsystem composed
of four (4) structural characteristics i.e. drives, set, choices
and observable behavior.
 Three (3) functional requirement of each subsystem includes
1. Protection from noxious influences,
2. Provision for the nurturing environment, and
3. stimulation for growth.
 Any imbalance in each system results in disequilibrium. It is nursing role
to assist the client to return to the state of equilibrium.
102

References
1. Butts, J., & Rich, K. (2017). Philosophies and theories for advanced nursing practice 3rd ed. New York
2. Angelo Gonzalo, Hildegard Peplau: personal relations theory, march 5, 2021
3. George B. Julia, nursing theories- the base for professional nursing practice, 3rd ed. Norwalk, Appleton & Lange
4. Humanistic nursing theory. ppt (slideshare.net)
5.. Josephine Paterson & Loretta Zderad Humanistic Nursing Theory
6. Theoretical Basis for NURSINGE D I T I O N 3
7. Orlando, I. J. (1972). The discipline and teaching of nursing process. In George, J. (Ed.). Nursing theories: the base
for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
8. Orlando, I. J. (1990). The dynamic nurse-patient relationship: Function, process, and principles. In George, J. (Ed.).
Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange
9 . Travelbee J. Interpersonal aspects of nursing. 2nd ed. Philadelphia, PA: F. A. Davis Company.;
1971. [Google Scholar]
10. Travelbee J. Human-to-human relationship model. 2013 Retrieved
from http://currentnursing.com/nursing_theory/Joyce_Travelbee.html.
11. Tomey, A. & Alligood, M. (2002). Nursing theorists and their
work. (5th ed.). Mosby Inc.
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