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344 UNIT III Nursing Conceptual Models

subsystems. Her findings supported the proposition have the general conception of the realm in which we
that the subsystems are interactive, interdependent, work, i.e., the phenomena of interest to the profession
and integrated; therefore, Derdiarian supported and the kinds of questions to be asked, it will be
Johnson’s contention that “changes in a subsystem re- possible for them to work together in a systematic
sulting from illness cannot be well understood with- fashion to build a cumulative body of knowledge.”
out understanding their relationship to changes in the Primarily, the theory has been associated with indi-
other subsystems” (Johnson, 1980, p. 219). viduals. However, Johnson believed that groups of
Damus (1980) tested the validity of Johnson’s the- individuals, such as families and communities, could
ory by comparing serum alanine aminotransferase be considered groups of interactive behavioral sys-
(ALT) values in patients who had various nursing di- tems. With the current emphasis on quality care,
agnoses and had been exposed to hepatitis B. Damus health promotion, and illness and injury prevention,
correlated the physiological disorder of elevated ALT theory derived from the model recognizing behav-
values with behavioral disequilibrium and found that ioral disorders in these areas is possible.
disorder in one area reflected disorder in another area. It should be noted that preventive nursing (to
Nurse researchers have demonstrated the useful- prevent behavioral system disorder) is not the same as
ness of Johnson’s theory in clinical practice. Most of preventive medicine (to prevent biological system
these studies have been conducted with individuals disorders), and disorders in both cases must be iden-
with long-term illnesses or chronic illnesses, such as tified and explicated before approaches to prevention
those with urinary incontinence, chronic pain, can- can be developed. At this point, not even medicine
cer, acquired immunodeficiency syndrome, compas- has developed many specific preventive measures
sion fatigue, and psychiatric illnesses (Alexander, (immunizations for some infectious diseases and pro-
2006; Colling, Owen, McCreedy, et al., 2003; Coward tection against some vitamin deficiency diseases are
& Wilkie, 2000; Derdiarian, 1988; Derdiarian & notable exceptions). A number of general approaches
Schobel, 1990; Grice, 1997; Holaday, Turner-Henson, to better health, including adequate nutrition, safe
& Swan, 1996; Holaday & Turner-Henson, 1987; water, and exercise, are applicable, contributing to
Martha, Bhaduri, & Jain, 2004). Studies have docu- prevention of some disorders.
mented the effectiveness of using the model with Riegel (1989) reviewed the literature to identify
children, adolescents, and the elderly population. major factors that predict “cardiac crippled behaviors
Based on extensive practice, instrument development, or dependency following a myocardial infarction”
and research, Holaday (1980) concluded that users of (p. 74). Social support, self-esteem, anxiety, depres-
Johnson’s theory are provided with a guide for plan- sion, and perceptions of functional capacity were
ning and giving care based on scientific knowledge. considered the primary factors affecting psychologi-
cal adjustment to chronic coronary heart disease. This
emphasized the effect of social support or nurturing
Further Development on the structure and function of the dependency sub-
Johnson (1982) acknowledged that the knowledge system. Johnson stated, “If care takers were aware of
base for use of her model was incomplete, and she how their behaviors and family behaviors interact
offered a challenge to researchers to complete her with patients to encourage dependency behaviors at
work. She thought that the directions provided by the the beginning of illness, they could easily prevent
model for curriculum development were clear. How- many dysfunctional problems” (D. Johnson, personal
ever, the gaps in knowledge offered challenges for communication, 1996).
educators as well as practitioners. Johnson (1989) Further development is indicated to identify nurs-
identified a dream for nursing’s growth as a scientific ing actions that facilitate appropriate functioning of
discipline. “Since we have specified nursing’s special the system toward disease prevention and health
contribution to patient—our explicit, ideal goal in maintenance. Rather than expending energy develop-
patient care, nursing’s growth as a scientific discipline ing nursing interventions in response to the conse-
should be rapid—even explosive. When our scientists quences of disequilibrium, nurses need to learn how