Introduction
The development of medicine and the formation of nursing as an independent profession has led to the creation of nursing models, the application of which has made it possible to develop not only the theory but also the practice of nursing. At present, many models of nursing have been developed. The terms “model” and “theory” are often used synonymously in the literature. However, the peculiarity of the model is that it allows highlighting the elements that are relevant to the problem and excluding those that are irrelevant.
Nursing is a science that contains its scientific theories (models), which study all the possible behaviors of nurses when working with a patient. The need for philosophical reflection on nursing has arisen because new terms have been and are increasingly appearing in professional nursing communication, changing ways of thinking that are being developed, discussed, and philosophized. They are being discussed even now as society’s norms and values, the legal and regulatory framework (constitution, laws, bylaws), and the state of the national economy are changing. Problems arise, the solution of which will help to find harmony and coordinated action between medical workers, the patient, and society. There is a need to obtain not only a new quality of knowledge but also to comply with the principles underlying the spiritual values of medical professionals accumulated over many centuries.
A nurse’s ethical duties in working with a patient are a certain range of actions that are unconditional to perform (respect the patient and his right to self-determination, reveal his will regarding something; do no harm; keep your word; and cooperate with the patient). Cooperating with the patient means working together to solve his health problems. The relationship between healthcare providers and patients must be a partnership. In modern medicine, a partner’s reliability often determines the success of a treatment, surgery, diagnostic, or preventive procedure. Nurses participate in treatment and contribute to a very important part. In such a relationship, a team is formed – an association of people connected by constant joint work or activity.
History
Historically, there was no clear description of nursing models, even in foreign literature, until the early 1970s. The different models reflect the existing concepts of nursing in different countries. This makes it possible to assess their advantages and disadvantages and to choose from each model what is applicable in the context of a particular country. The content of each model depends on the level of economic development of the country, its policies, generally accepted values, health care system, and religion, as well as on the philosophy and beliefs of the individual or group of people who develop the model. Each model reflects differences in the authors’ understanding not only of the term “nursing” but also of the concepts of “patient,” “health,” and “environment”. Nursing as a specialty was formed in the mid-nineteenth century. For about the first five centuries A.D., nursing care consisted mainly of performing hygienic measures and creating comfortable conditions for the needy, the homeless, and the sick.
Nursing Models
Different models highlight different health problems (Smith, 2019). For example, some models represent problems as dysfunction of anatomical organs or physiological systems. Authors of other models also see the source of problems in that the person cannot change his or her behavior depending on the circumstances, suggesting that this occurs due to functional and structural stresses (D. Johnson model). Some models consider the nursing process quite simple: the problem – determination of the nature of the nursing intervention. Others are more complex: defining the problem, researching it (examining its nature), and determining the nursing intervention’s nature. Models also have different priorities for patient assessment. In the 19th century, F. Nightingale believed that the goal of nursing care was to create conditions for the patient to feel comfortable, the best hygienic conditions to maintain impaired function(Riegel et al., 2021). The authors of almost all models believe that the goals should be the visible aspects of human behavior and other measurable parameters and coordination with the patient. Achievement of the goals is determined by how the patient evaluates progress toward the goal and what he or she manages to do on his or her own. Authors of some models believe that incremental goals (short-term, intermediate, and long-term) should be set. Role of the nurse. Some models view the nurse solely as a physician’s assistant, the next as a patient advocate, the third as a full-time caregiver, and the fourth as a person who changes the patient’s behavior.
Model D. Johnson
Johnson believed that it was necessary to move away from physician influence over people and turn the attention of nursing to the analysis of patient behavior. According to D. Johnson’s model, nursing care should focus on correcting human behavior and its adequacy during periods of impairment and recovery (Holaday, 2021). A patient has a set of interconnected subsystems of behavior, each of which strives for equilibrium. D. Johnson defines that each subsystem’s action consists of the person’s aspiration based on experience to achieve certain goals. The result of action depends on how the person perceives his behavior and how much he can change it. Man is predisposed to two basic types of behavior:
- created by actions and objects immediately around the person;
- created by past habits.
Sources of problems include illness, stress, lifestyle, and behavioral changes caused by attitudes based on past and present experiences with the environment. All of these can unbalance the subsystems of a person’s behavior. Nursing care should be aimed at restoring their balance: “Johnson’s behavioral model is useful in modifying and correcting unstable behavior”(Payamani et al., 2020, p. 1). The nurse’s role is complementary to, but not dependent on, that of the physician. The nurse is assigned the role of a specialist who restores balance to the subsystems that regulate human behavior in times of psychological and physical crisis or stress.
Description of the Problem Associated with the Model
Since the source of the patient’s problems is the functional and structural stress associated with the disease, the problem will be the patient’s aversion to the stages of treatment or the new way of life (Holaday, 2021). These changes in behavior may make it difficult or impossible to treat the patient.
For example:
A young man in an institution for a shin bone fracture does not want to walk with crutches despite a doctor’s prescription. In particular, in the example, the nurse should determine whether the young person has been in a similar situation. If he has been in this situation, the patient has structural (organic) changes. Otherwise (if the behavior is atypical for this young person), we can conclude that these changes are functional.
A 30-year-old woman suffers from constant constipation and is overweight. In this case, it is necessary to determine the nature of the changes in the digestive and excretory subsystems. The nursing intervention will aim at restoring the balance in these subsystems in order, on the one hand, to limit the amount of food, change the physical activity and, on the other hand, make the diet rational and encourage the patient to regain control over herself. Thus, D. Johnson’s model helps to solve this behavioral problem and facilitate the patient’s treatment.
Unique Understanding and Application of the Model
Because this nursing model aims to balance the patient’s behavioral system, the D. Johnson model is very important. The patient has many behavioral and psychological problems, including a worsening of the disease and a long recovery. This model can be used as a basis for evidence-based practice to address the patient’s poor psychological state. The nurse should take care of the patient’s psychological state by conducting conversations that rid the patient of his old, wrong beliefs and replace them with new, more realistic ones. The unique insight of this model is that it does not look at the person’s needs but the person’s behavior.
The human body is a unity of soul and body. Moreover, any illness is a problem of the whole person, consisting not only of the body but also of the mind, feelings, and emotions. Doctors are well aware that the effectiveness of medical treatment depends largely on the patient’s belief in recovery and trust in the doctors treating him. An optimistic attitude towards life and a positive inner state, at times more effective than medication, contributes to recovery: “Optimism, or the expectation that good things will happen, may provide a buffer against despair, and motivate adaptive goal engagement and coping”(Provost et al., 2022, para 4). Conversely, poor physical well-being affects a person’s mood, thoughts, and behavior. Sometimes the body expresses its physiological processes in the language of feelings: fear, despair, sadness, and joy.
Conclusion
I believe that controlling patient behavior is very important in nursing. The patient should be responsible for taking measures to preserve and promote his health; seek medical care promptly; while under treatment, and comply with the treatment regime, including the one determined due to his/her temporary disability. Failure to comply with these measures and change the patient’s behavior during treatment causes many problems and impedes healing. Johnson’s model clearly describes the nurse’s responsibilities, explains the reasons for the patient’s behavior, and suggests ways to solve problems. That is why I believe this model is appropriate for addressing this problem.
References
Holaday, B. (2021). Dorothy Johnson: Behavioral system model. Nursing Theorists and Their Work E-Book, 270.
Payamani, F., Cheraghi, F., Borzou, S. R., Hojjatoleslami, S., & Khatiban, M. (2020). Nursing process based on Johnson’s behavioral system model in patients with multiple sclerosis: Case report. Journal of Nursing Education, 9(2), 19-26. Web.
Provost, S. E., Griffin, M. L., Hilton, B. T., McHugh, R. K., Taghian, N. R., Trinh, C. D., & Weiss, R. D. (2022). Correlates of optimism among patients in substance use disorder inpatient treatment. The American Journal on Addictions. Web.
Riegel, F., Crossetti, M. D. G. O., Martini, J. G., & Nes, A. A. G. (2021). Florence Nightingale’s theory and her contributions to holistic critical thinking in nursing. Revista Brasileira de Enfermagem, 74.
Smith, M. C. (2019). Nursing theories and nursing practice. FA Davis.