Nursing theories are an essential component of nursing practice. The various nursing theories that have been developed over time attempt to explain the world around us. Through the various concepts that they advance, the theories make propositions that project a view of phenomena, in the process creating interrelationships that enable the designing of appropriate medical interventions that promote an individuals health. This paper compares two nursing theories exploring their backgrounds; philosophical underpinnings; the major assumptions, concepts, and relationships; and their clinical applications. The first theory is the Behavioral System Model, a grand theory advanced by Dorothy Johnson in 1968. The second one is the Postpartum Depression Theory, a middle-range theory advanced by Cheryl Beck in 1992. Through making the comparison, the paper will demonstrate the different levels of usefulness and applications of the nursing theories and their effectiveness in promoting health care for individuals.
Background of the Theories
Both of the theories under consideration were developed in the 20th century by practicing nurses. They have, thus, been in application for some time now and continually get refined as time goes by. Johnsons Behavioral System Model, on the one hand, was first proposed in 1968 by Dorothy Johnson. The theory is greatly influenced by the work of Florence Nightingale, especially her writings in Notes on Nursing. The theory is categorized as a nursing grand theory and advocates for the fostering of efficient and effective behavioral functioning in a patient to promote an individuals health and prevent illness. Johnsons model conceptualizes a human body as being comprised of two major systems; the biological and the behavioral systems. Human beings are defined as behavioral systems that strive to make continual adjustments and other adaptations to maintain or regain homeostasis, the state of balance. According to Johnson, it is the duty of the nurse to assess and recalibrate the behavior of the patient to achieve well-being. She posits that while it is the role of medicine to treat the biological malfunctions, nursing should, instead, focus on addressing the malfunctions in the behavioral system. According to this model, therefore, the nurses primary task is to establish a measure of regularity and constancy in behavior, an essential component towards patient recovery.
Becks Postpartum Depression Theory, on the other hand, was first proposed in 1992 by Cheryl Tatano Beck. The theory, unlike Johnsons model, is categorized as a middle-range nursing theory indicating that it has a narrower scope and higher applicability in nursing practice. Becks Postpartum Depression Theory posits that there is a significant gap in maternal care, especially with regards to maternal blues, which if untreated compromises the well-being of the mother and the family around her. Beck established that most of the early discharge mothers experience maternal blues during the first week after delivery which adversely affects their quality of life. Beck developed the theory after conducting an extensive study of postpartum depression in women who had been discharged early from hospitals. The findings led her to believe that releasing the mothers early exacerbated the risks of developing maternal blues at home. She also established that more often than not the symptoms of maternal blues manifest themselves within a week postpartum. Beck, therefore, proposed that nurses should conduct assessments to observe for any signs of maternity blues, postpartum psychosis, and postpartum depression in pregnant mothers. They should design the necessary interventions for mothers who exhibit the symptoms since they are likely to harm themselves, their babies, or other members of the family.
Despite being inherently different in development and scope, Becks Postpartum Depression Theory and Johnsons Behavioral System Model essentially have a similar philosophical underpinning. The theorists may not have expressed their foundations succinctly, but the root of the theories evidently is the systematic evaluation and assessment of a human body. Both theorists conceptualize the human body as a system, comprised of different components and environments with each affecting the others in a multi-contextual basis. Consequently, both theories advocate for a holistic approach to health care, although Johnsons does so at a higher abstraction level.
Becks Postpartum Depression Theory defines a human being as an organism existing within different environments including the physical, psychological, and emotional. These are intertwined as one and do affect one another. As such, a patient cannot be deemed fit for discharge simply because she is physiologically fit, the psychological and emotional state of the patient must also be taken into consideration. The philosophical underpinning of this theory, therefore, is the body as a system and the appropriation of the holistic approach to health care.
Johnsons Behavioral System Model is different in that it defines a human being as a behavioral system; however, it still appropriates a system perspective nevertheless. The presence or absence of illness, therefore, symbolizes the state of the behavioral system. All the relationships that exist in the body are meant to achieve the state of balance, otherwise referred to as homeostasis. At this stage, there is an efficient and effective behavioral functioning in the patient to prevent illness. For homeostasis to be achieved, a holistic approach to care that transcends the physical needs to address the behavioral and psychological must be used, just like in Becks model. Johnson proposed that nursing interventions must be two-fold; first, they should reduce the stressful stimuli that cause the disequilibrium and, secondly, support the natural and adaptive processes for health recovery. Therefore, while Johnson does not succinctly express the interrelationships, it still promotes the assessment and interventions of other aspects of health such as emotional, behavioral, and psychological, to achieve health promotion.
Major Assumptions, Concepts, and Relationships
The two theories have different assumptions, concepts, and relationships. Johnsons Behavioral System Models assumptions and relationships are quite complex and difficult to follow since, being a grand nursing theory, it explains them at a rather higher abstractive levels. Johnson made several assumptions, some about system, and others about the structure and functions of subsystems. The first assumption about the system is that there is an interaction, interdependency, and integration of the different elements of behaviors that comprise the system. Secondly, the system essentially works to achieve balance among the various forces influencing it. As such, an individual is in perpetual strive to achieve a behavioral system balance. The third assumption is that a behavioral system not only requires but also fundamentally results from the degree of regularity and constancy in behavior and is useful for a person to lead a healthy life. The last assumption is that system balance essentially reveals the adjustments and adaptations that have been made and that have been successful, at least to some extent.
Johnson also made another set of assumptions about the structure and functions of each subsystem. The first one is that the form of the behavior and the consequences achieved as a result point to the stimuli or the objective that is being sought. Secondly, each is predisposed to act in a certain way rather than the other in a quest to achieve a set goal. Thirdly, each subsystem has a range of choices, otherwise referred to as the scope of action. Lastly, each subsystem produces an observable outcome which manifests itself as an individuals outward behavior.
Becks Postpartum Depression Theorys assumptions are more clear and easier to understand. However, unlike Johnsons which are listed, Becks are to be inferred from the theory. The first major assumption is that nursing consists of interpersonal interactions between the nursing professionals and their patients to accomplish optimum health. Secondly, a person as a whole comprises of biological, sociological, and physiological components that must be attended to in tandem to achieve optimum health. Lastly, contexts, including environments, are essential influencers of homeostasis.
Despite having varied assumptions, at least with regards to how they are expressed, the two theories have similar concepts. Both essentially leverage the concepts of the meta-paradigm of nursing that include the person or human being, the society or environment, health, and nursing. In both, the human being is at the center of the nursing interventions and is considered as having multiple systems. In Johnsons theory the human being is made up of biological and behavioral systems while in Becks the human being is made up of physiological, emotional, and psychological systems. The second major concept is the society which relates to the environment within which an individual exists. According to Johnsons theory, an individuals health is influenced by the events in the environment. The same sentiments are echoed by Beck in her theory where the environment determines the physiological as well as the psychological well-being of an individual. The third major concept is health which is essentially defined by both theorists as the purposeful adaptive response. Both theorists assert that physical, mental, emotional, and social adaptation is required to achieve homeostasis and comfort. The last major concept is nursing, whose primary objective is to foster equilibrium within an individual.
With regards to the relationships, Johnsons Behavioral System Model has relatively unclear relationships as compared with Becks Postpartum Depression Theory. In fact, the vague relationship between the various concepts has been one of the perceived weakness of Johnsons theory. Johnson fails to overtly interrelate her concepts of subsystems constituting the behavioral system model. Furthermore, Johnsons model fails to define the expected outcomes when one of the subsystems is impacted by a nursing intervention. The model only makes an implicit expectation that all human beings, regardless of the culture, will attain a similar outcome, in the form of homeostasis. Becks Postpartum Theory, on the other hand, establishes clear relationships between its concepts. For instance, there is a relationship between perceived stress, social support, self-esteem, and postpartum depression. The theory also clearly delineates the expected outcomes depending on the level of nursing intervention.
Clinical Usefulness and Nursing Science Testability
Both of the theories have significant clinical usefulness. Johnsons Behavioral System Model is critical and can be utilized by practitioners to guide and improve their practice. It provides an apt framework that promotes a holistic approach to care. It also promotes the use of a body of knowledge generated through research to design effective care. However, some scholars have challenged the scope of its applicability since it is very individual-oriented. The nurses working with groups cannot apply the model. Johnson clearly did not consider how the model can be applied to consider families, groups, and communities. The focus is on the behavior of a single person tilting the nursing focus to psychological care. Furthermore, being a grand theory means that it has Johnsons model has limited testability.
Becks theory, on the other hand, is not only clinically useful but also has an enhanced testability. The Postpartum Depression Theory and the tests it proposes can be applied to improve the welfare of mothers who have just given birth. As for its testability, it can be subjected to further empirical research which would involve direct and indirect observation or experience. Qualitative methods including measurable explanations and predictive outcomes can be used to interrogate the validity of the theory. Becks model has a qualitative inquiry paradigm, which is highly consistent with nursings value. Additionally, it is an apt example of an empirical theory which has been developed comprehensively to the extent of designing a Postpartum Depression Predictors Inventory (PDPI). Unlike Johnsons Behavioral System Model, therefore, Becks Postpartum Depression Theory has an enhanced testability in nursing.
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Use in Nursing Practice
Despite being limited to an individual, Johnsons Behavioral System Model has some applicability in nursing practice since it can be generalized across the lifespan and cultures. The theory can be applied to any individual regardless of the gender, religious belief, age, and ethnicity among other demographic characteristics. Applying this theory means that nurses consider the behavior of the patient and how the behavior promotes maladaptive responses. These may include the nursing interventions geared towards nurturance, stimulation, protection, regulation, and promotion of control.
A specific instance of how it could be applied in my clinical setting is through enhancing stimulation. I often operate in the wards hosting the terminally ill and at times I take care of cancer patients. To promote positive coping, I would sometimes endeavor to afford them the things that stimulate them, whether it is music, drawing or dancing. However, as it can be seen, Johnsons models applicability in nursing practice is limited largely because the theory does not meet the scientific substance for practice. It needs to be subjected to further tests especially on its concepts, propositions, and assumptions.
Becks Postpartum Depression Theory, on the other hand, has an enhanced applicability and usefulness in nursing practice. Beck developed the theory while serving as a nurse and she noted that it is often possible to identify the women at highest risk of postpartum depression at the prenatal stage. Early patient awareness can be instituted at different levels. For instance, pamphlets and other educational materials can be issued freely at the pediatric offices and wards. Also, they can be stocked at the OBGYN offices and prophylactic antidepressants prescribed for mothers with severe postpartum depression signs immediately after delivery.
In my clinical setting, Becks theory is being applied every day. Nurses who are tending to the pregnant mothers observe their behaviors and moods to determine the risk of postpartum depression. They also conduct one on one interviews either prenatally or upon discharge to assess the psychological health of the mother. In some instances, paper and electronic surveys containing the PPD risk factors are issued to expectant mothers to gauge their risk of sinking into postpartum depression. Those that show increased risk are placed under extensive surveillance after delivery or are advised to adopt stress-relieving practices or taught how to identify and report any signs of postpartum depression to safeguard their well-being and that of the child.
Of the two theories, Becks Postpartum Depression Theory is the most parsimonious. Unlike Johnsons Behavioral System Theory, it is simple to understand as it does not use a lot of resources and explanations. Furthermore, unlike Johnsons model, Becks theory does not introduce new assumptions that have not been used on the subject of nursing care before. Johnsons theory introduces a series of assumptions, some of which are difficult to comprehend. Becks theory exhibits aesthetic quality which is conspicuously absent in Johnsons model.
It is evident that nursing theories are an essential part of nursing practice. The different levels of nursing theories serve different functions. The grand theories such as Johnsons Behavioral System Model have a wider scope and are pertinent to all instances of nursing. Middle range theories such as Becks Postpartum Depression Theory have a narrower scope and present concepts at a lower level of abstraction. Although very different in their formation and application, both of these theories conceptualize a human body as a complex system made up of different components that have to be addressed in tandem to achieve well-being in an individual. However, Becks theory is seemingly more applicable in nursing practice than Johnsons model. It also has an enhanced nursing science testability and usefulness as compared with Johnsons Behavioral System Model. Overall, Becks Postpartum Depression Theory looks to be the more expedient of the two theoretical nursing models.