Middle Range Nursing Theories

Nursing is a critical profession that aims at improving the quality of life and health of individuals, communities and societies. Nursing outcome is significantly influenced by the knowledge of the contemporary health problems, dynamics and the evolving health challenges in the modern society. Meleis (2010) argues that nursing knowledge development is key to the improvement of the quality of life. To achieve the highest level of knowledge application in nursing, application of nursing theories becomes the most critical part of nursing. Nursing theories are significant in identifying the nursing problems, and finding solutions to the problems with the aim of achieving the best desired health outcome. There are many nursing theories that have

been applied in nursing practice in the modern day nursing practice. Middle-range theories have been applied in nursing to address nursing challenges, especially among the vulnerable members of society (Meleis, 2010).

The middle-range theories comprises of many theories and models that are applicable in nursing. Of more significance, theories are anchored on assumptions made up of concepts, definitions, concepts, and propositions that area arrived at after extensive research studies. For theories to be valid, they must be logically linked to past research in the field of study and show high level of consistency to the everyday life. Theories attempt describe, explain, and predict a nursing phenomenon. In essence, nursing theory provides guidance on further research and education in the field with aim of achieving better patient care, professionalism in service provision and effective communication models (Meleis, 2010). While there are many theories that can be applied in nursing to improve the quality of nursing care, this study will focus on Johnson's Behavior System Model. The principles and models of this theory can be effectively applied in nursing practice to solve the problems identified in the nursing

field.
Discussion
This section contains a deeper analysis of the Johnson’s Behavioral Theory in relation to its application in nursing practice. The focus is to enable the reader to understand the theory in its entirety.
Theory and Theorist’s Background
Theorist’s Background
The theory of behavioral systems model was proposed by Dorothy Johnson. Johnson was born Georgia in August 1919. She went to school and obtained her A. A in 1938 from the famous Armstrong junior College (Alligood, 2017). Ten years later, Johnson graduated from Harvard with M.P.H. Johnson was practiced teaching pediatric nursing at Vanderbilt University for sometimes. She later joined the University of California in Los Angeles (Alligood, 2017).
Concerns that the theory addresses
Patients’ behaviors while in the nursing homes and other health facilities are the immediate indicators of inner conflicts within the internal environment. Patents that exhibit aggressive behaviors in hospital settings are expressing elements of imbalance in their subsystems, which directly affect their health. As such, application Johnson’s Behavioral Theory in nursing will play a critical role in bringing back the patient’s subsystem balance by controlling their behaviors.
Theory Description
This section will discuss the concept of the theory, its application, and the relationship between the theory and the four nursing concepts.

Major Concepts
Johnson observed the behaviors of human, especially patients and came up with the model with the primary objective of fostering the effective and efficient behavioral functioning in the patients to treat illnesses.

According to Johnson, most patients fall sick or increase the disease risk factors because of their behaviors. In her theory, she reiterated that there the subsystems of human behaviors are interdependent, interactive and integrated simultaneously (Fawcett, 1984).

Johnson’s model was based on the assumption that human behavior system is made up of seven key subsystems. These include the achievement, the protective, dependency, eliminative, ingestive, affirmative, and the sexual. These subsystems have a distinctive role in the behavior of a person. According to the model, the achievement subsystem deals with setting and achievement of goals, while the protective subsystem deals with threats to one’s life (Fawcett, 1984). The affirmative subsystem is crucial for the formation of relationships while the dependency subsystem obtains the feedbacks about the self and recognizes the need to defend one another. Whereas the ingestive subsystem plays a key role in the intake of nutrients, the eliminative subsystem plays the roles of expressing the feelings to the outside world and the acquisition of knowledge. Finally, the sexual subsystem is vital in the reproductive health. John postulates that these subsystems do not work independently, but depends on each

other for the effective functioning of humanity. The functionality of these subsystems depends heavily on the environment and other external factors. These external factors include physical, cultural, and economic factors that act on the person (Fawcett, 1984). Johnson believes that the environment is the primary contributor to the behavior of a person.

Theory Evaluation
This section will evaluate the assumptions of the theory and how the assumptions are linked to the four nursing metaparadigms
Assumptions of the Selected Theory
Johnson’s theory is anchored on two critical aspects of the environment in relation to the body; the external and internal environment. The internal environment is the seven subsystems while the external environment is made up of the outside world. In essence, the surrounding where the patient lives is also critical for the patient’s health stability. The theory states that a healthy person should display balance and stability on operations of the subsystems mentioned above. Whenever the patient shows any signs of instability or imbalance, the nurse must use his knowledge and skills in nursing to restore the balance in the patient (Smith, & Parker, 2015).
The theory gives the nurse an opportunity to apply the knowledge on how each part of the body contributes differently to aggressive behavior in the patients. According to this model, the brain is the major part of the body that controls behavior. It controls both expressions of automatic and behavioral components of aggression such as vocal and violent behaviors. For instance, when a patient feels pain, he may start talking carelessly or even becoming violent with the people around him. At times, the patient may feel threatened and exhibit an aggressive behavior that is specifically meant to protect his territory (Smith, & Parker, 2015). More often than not, they may use demeaning terms, throw tantrums, or completely refuse to talk. This may show an imbalance in the internal environment.

Association with Four Metaparadigms of Nursing
The four concepts of the nursing metaparadigm include a person, environment, health, and nursing. These concepts are critically important in nursing;
The patient (person): Any theory nursing theory must lead to positive health outcome in the patient for it to be applied in nursing (Fawcett, 2016).
Environment: This is one major concept that determines the healing process of the patient. Therefore, nursing theories must consider the significance of the environment in the process of caring for the patients.
Health: the health concept is key in nursing as the practice entails caring for individuals with health challenges. It is, therefore, prudent that nursing theories lead to quality health.
Nursing: Nursing is significantly important in informing the need for theories.
Theories are there to reinforce the nursing knowledge and skills to enhance delivery of services to the patients. Johnson's Behavior System Model has a description of all the four concepts of nursing (Fawcett, 2016). It entails the duties and responsibility of the nurse, the contributions of the environment and the expected health outcomes in the patients.
Theory Critique
The theory is universally accepted as a remedy for behavioral changes in patients. It provides a clear nursing framework that details the strategies that the nurse may use to help patients with behavioral challenges in healthcare settings. However, the nursing theory has some flaws with regards to biases of the application of the theory. The theory can only be applicable in correcting subsystem imbalance caused by internal and external factors of around the patient. In essence, the theory can be applied in a specific category of patients; the patients that experience behavioral changes due to change in environment.
Application of Johnson's Behavior System Model
Johnson's Behavior System Model has been widely accepted as a means of helping patients to normalize their behaviors by using different nursing skills. The application of this model is discussed in details below: