Nursing: Johnson’s Model and Kolcaba’s Theory
Introduction
Nursing theories play a critical role in influencing nurses’ everyday practice as they provide theoretical knowledge that guides nurses’ principles of work. Numerous nursing theories exist to offer nurses frameworks, according to which they need to organize their interaction with patients. In this context, researchers and theorists distinguish between grand and middle-range theories (McEwen & Wills, 2019). Grand theories propose wide and complete frameworks combining various nursing concepts and presenting a structure for nurses to address. Middle-range theories have a narrower scope, and their principles are easier to be applied in nursing practice as these theories are less abstract in comparison to grand theories. The example of a grand theory to be discussed in this paper is Dorothy Johnson’s Behavioral System Model, according to which a patient is viewed as a behavioral system to be positively affected by nurses’ actions. The middle-range theory for comparison is Katherine Kolcaba’s Theory of Comfort, according to which the key concept of holistic care is a patient’s comfort. The purpose of this paper is to provide an overview of Johnson’s model and Kolcaba’s theory and compare their philosophical backgrounds, assumptions, and clinical applications.
Background of the Theories
Johnson’s Behavioral System Model
Dorothy Johnson presented her complete model in the 1990s although she had been working on its principles since the 1950s, being a prominent educator and a researcher. The theoretical model was developed as a result of applying other theories’ principles to practice. The theorist intended to create an effective nursing theory to be followed by many nurse students and practitioners. The first principles of the model were formulated in 1968 when Johnson identified the two main concepts of her model: a person as a behavioral system and nursing affecting the person (McEwen & Wills, 2019). Thus, the major theoretical idea that Johnson has formulated is that a human should be viewed as a behavioral system, and one of the tasks of nursing care is to address this human’s specific needs. This system is also composed of certain subsystems with their needs (Cheng & Luo, 2020). Theoretical ideas were developed as part of curricula for nurses, and they were published as separate articles and chapters.
Kolcaba’s Theory of Comfort
Katherine Kolcaba had conducted the concept analysis of the concept of comfort and then formulated the Theory of Comfort. Thus, the generation of the theory was started in the late 1980s, and the complete theory was presented in 1994. To create her vision of comfort in the field of nursing, Kolcaba focused on analyzing this concept concerning different health-related disciplines (McEwen & Wills, 2019). Finally, she stated that there are three specific types of comfort which are relief, ease, and transcendence, which are available for patients (Oliveira et al., 2020). These concepts were later developed in the context of Kolcaba’s nursing theory widely applied in nursing practice.
Philosophical Underpinnings of Two Theories
Johnson’s Behavioral System Model
It is important to note that Johnson’s model is based on the philosophical and theoretical ideas associated with the works of other researchers and theorists, including Nightingale and Grinker, among others. Thus, following Nightingale’s ideas, Johnson chose to focus on a patient and their needs and experiences rather than on disease. The importance of a patient was accentuated in Nightingale’s statements and then reflected in Johnson’s theory. When thinking about Nightingale’s principles, Johnson also became interested in guaranteeing a patient’s effective behavioral functioning. The purpose of care, in this case, was to prevent stress and the development of diseases affecting a person’s systems (McEwen & Wills, 2019). In addition to being inspired by the works on the role of a patient and their experience in the nursing process, Johnson was interested in studying systems to explain a patient as a behavioral system (Karkhah et al., 2020). The works by Grinker, as well as Buckley and Chin, influenced the theorist’s formulation of her vision of behavioral systems and subsystems in the context of her theory.
Kolcaba’s Theory of Comfort
When discussing the philosophical underpinnings of Kolcaba’s Theory of Comfort, it is important to note that it is based on grand nursing theories addressing human needs. This impact of the grand theories is observed referring to the main idea of Kolcaba that comfort in nursing practice should be viewed as the satisfaction of a patient’s human needs for well-being (McEwen & Wills, 2019). Thus, in different clinical situations, patients require holistic care to cover their needs and achieve some type of comfort and health.
Major Assumptions, Concepts, and Possible Relationships
Johnson’s Behavioral System Model
In the context of Johnson’s model, it is possible to determine the four key assumptions. The first assumption is that drives can influence a person’s behavior when achieving a certain goal. The second important assumption is that a person’s behavior is usually determined by the dimensions of the available set and choice. Furthermore, the third assumption is that subsystems are also determined by dimensions of choice, sets, and goals. In addition, the theorist also formulated the fourth assumption, according to which subsystems use regulatory mechanisms to achieve balance in functioning as a unified behavioral system (McEwen & Wills, 2019). As a result, the focus is on the organization and balance of subsystems in the context of one behavioral system.
One should state that the key concepts discussed in Johnson’s theory are correlated with the nursing metaparadigm concepts. Thus, Johnson accentuated the concept of a human being in her theory and defined a human as a behavioral system seeking to reach some balance in functioning. Health is viewed by the theorist as being the opposite of disease, and it is a state of regularity, control, adaptation, and constancy in a person’s behavior. The environment was not defined by Johnson, but it is associated with stressors. Finally, nursing is viewed from the perspective of its regulatory power and the ability to influence a person’s health (Karkhah et al., 2020). In addition, the system is a complex of components of subsystems that can function as a unity, and a patient is a large behavioral system.
The relationships in Johnson’s model can be discussed by examining how different subsystems are related to a larger behavioral system. In this context, the theorist determined seven important subsystems, which include the affiliative subsystem, the dependency subsystem, the ingestive subsystem, the eliminative subsystem, the sexual subsystem, the aggressive subsystem, and the achievement subsystem (McEwen & Wills, 2019). Each of these subsystems has a specific purpose to contribute to the functioning of the whole behavioral system. For example, the achievement subsystem allows a person to control oneself and the surroundings to achieve some profits. As a result, when a person suffers from some stress or other negative factors, all the subsystems in the behavioral system generate some feedback to the environment that allows for adaptation and successful functioning.
Kolcaba’s Theory of Comfort
Before determining the key assumptions of Kolcaba’s theory, it is necessary to define the main concepts she used to develop her theoretical knowledge. Thus, the first concept is comfort which is defined as the satisfaction of human needs. These needs that determine the types of comfort are relief, ease, and transcendence, as it was stated earlier. The associated concepts are needs, drives, and stimuli because needs are formed when certain stimuli or drives influence a person and prevent him or her from achieving comfort (McEwen & Wills, 2019). As a result, comfort should be viewed as a direct result of nursing care associated with the health of a patient. In this context, the theorist also developed such concepts as comfort measures, health-seeking behaviors, along with institutional integrity, among others. The assumptions that are based on the utilization of these concepts are that, if nurses work on promoting comfort to address a person’s needs, his or her health-seeking behaviors also improve. Furthermore, when having certain unaddressed needs, patients require their satisfaction and achievement of comfort being engaged in health-seeking behaviors.
In addition to the theory’s assumptions, it is also necessary to discuss its relationships and propositions. Thus, according to the theory’s principles, it is expected that nurses should recognize patients’ comfort needs and propose certain interventions to address these needs. The measure of the effectiveness of such interventions is the achievement of comfort in patients in the form of relief, ease, and transcendence (Oliveira et al., 2020). Furthermore, nurses and patients should agree on health-seeking behaviors, and these behaviors are usually designed to achieve patients’ comfort. The combination of health-seeking behaviors and a comfortable outcome leads to patients’ satisfaction with nursing care. These principles based on the major concepts presented the main framework of Kolcaba’s Theory of Comfort.
Clinical Applications, Usefulness, Value to Nursing, and Testability
Johnson’s Behavioral System Model
Although Johnson’s model is a grand nursing theory, it can be easily applied in clinical settings. Applications are associated with changes in nurses’ actions related to their perceptions of patients as suffering from stressors and certain environmental drives and reacting to them as behavioral systems, which have particular levels of functioning. Furthermore, its usefulness is supported by other researchers, theorists, and practitioners as many authors used the Behavioral System Model as a theoretical framework in their studies (Karkhah et al., 2020). The reason is the appropriateness of this theory to explain how nurses can affect patients’ health-seeking behaviors. This aspect also influenced the testability of the theory, as it was tested in studies on perceiving environments, nursing care, and subsystems (McEwen & Wills, 2019). It is also important to focus on the value of Johnson’s model in extending the scope of nursing science. Thus, in addition to using this theory in clinical practice, the Behavioral System Model is utilized in nursing education as part of a curriculum. In this context, as an educator, Johnson influenced Betty Neuman, who developed theoretical ideas referring to Johnson’s principles.
Kolcaba’s Theory of Comfort
Kolcaba’s theory is characterized by a high level of applicability to clinical situations and settings because it is presumed that a nurse’s role is to address patients’ needs and promote their comfort in stressful environments. This theory is highly adaptable to diverse patients, and the focus is on identifying needs and proposing effective interventions to address them (McEwen & Wills, 2019). Furthermore, the high level of the theory’s applicability accentuates its usefulness as patients with different health statuses and needs can receive high-quality and appropriate care in the context of this model.
In addition, the testability and measurability of the theory are also significant because of the possibility to apply different comfort measures, and this theory was also used as a framework in different studies. Many researchers applied the General Comfort Questionnaire and its adapted versions in their studies to assess the level of comfort in patients of different ages. The main focus was on using comfort measures to determine patients’ satisfaction and work with their health needs (McEwen & Wills, 2019). While discussing the value of this theory in extending nursing knowledge, it is possible to state that the Theory of Comfort inspired other theorists and authors of middle-range theories to develop their ideas and present them in the form of a theoretical system.
Parsimony Related to the Theories
Johnson’s Behavioral System Model
According to the principle of parsimony, it is expected that Johnson’s Behavioral System Model will utilize comparably simple concepts to explain the phenomena and relationships between them in a theory. Still, in this context oversimplification is also not required and not supported. Johnson’s model can be regarded as rather parsimonious because the theorist used only several concepts to formulate assumptions and relationships (McEwen & Wills, 2019). Furthermore, these concepts are clear, and discussed relationships are uncomplicated.
Kolcaba’s Theory of Comfort
When assessing parsimony concerning Kolcaba’s Theory of Comfort, it is possible to conclude that this theory is rather simple and parsimonious. The reason is that the idea of comfort is widely known and easily understandable by people. Additional concepts used by Kolcaba include patients’ healthcare needs, interventions, intervening variables, enhanced comfort, health-seeking behaviors, and integrity (McEwen & Wills, 2019). In this context, only ideas related to interventions, intervening variables, and integrity can require additional explanation. Still, the overall theory’s structure is rather simple and understandable.
Comparison of Using Both Theories in Nursing Practice
In nursing practice, grand theories and middle-range theories are used differently because of these theories’ scope and possibilities for application. In clinical practice, Johnson’s Behavioral System Model is applied when nurses interact with patients to understand what needs (related to different subsystems) should be addressed by nursing care. Nurses evaluate the work of a patient’s different subsystems and determine behavioral patterns. From this perspective, it is possible to state that this theory is rather effective to be applied when it is essential to conduct the behavioral assessment of a patient concerning his or her subsystems’ functioning. The needs of a patient become the focus of a nurse’s assessment to conclude what subsystems should be addressed to receive some care (Cheng & Luo, 2020). It is important to find out whether there is some imbalance in a patient’s behavioral system and its components. Therefore, Johnson’s theory is applied in nursing practice for assessment in the context of holistic care.
In contrast to the application of Johnson’s Behavioral System Model for assessment during nurses’ interviews with patients, Kolcaba’s Theory of Comfort is used for more concrete cases. Thus, the Theory of Comfort can be applied in various clinical situations when patients need to achieve comfort and cope with stressors. For example, if the application of a grand theory is rather general, the application of a middle-range theory can be observed in a variety of clinical cases (Oliveira et al., 2020). The example can be associated with a situation when a patient after surgery requires rest in a comfortable and quiet room, but noise and other stressors can prevent a patient from resting. In this case, a nurse is required to determine stressors and implement specific interventions for achieving relief and enhanced comfort for a patient. Despite their differences associated with theory levels, Johnson’s Behavioral System Model and Kolcaba’s Theory of Comfort are actively applied in nursing practice.
Examples Applying Both Theories in a Clinical Setting
The effectiveness and popularity of the discussed theories can be determined with the help of presenting the examples of applying Johnson’s Behavioral System Model and Kolcaba’s Theory of Comfort in a particular clinical setting. In an intensive care unit and then in a rehabilitation ward, for example, it is possible to refer to Johnson’s theory when discussing the experiences of the selected patient. The patient can suffer from physical dependence because of the limited movement caused by traumas and subsequent surgery. As a result, a nurse should pay attention to addressing the patient’s needs associated with his dependency subsystem as the patient requires physical assistance (McEwen & Wills, 2019). Furthermore, the patient experiences problems with taking meals without the help of a caregiver. As a result, the ingestive subsystem of the patient is also negatively affected, and much attention should be paid to responding to the patient’s needs. From this perspective, the situation of providing care for a patient who is limited in movements can also be regarded by a nurse concerning Johnson’s Behavioral System Model.
The examples of applying Kolcaba’s Theory of Comfort to clinical settings are also frequent. For instance, when interacting with the patient from an intensive care unit, a nurse can notice that the patient has problems with sleep, and feels exhausted and stressed despite positive outcomes associated with a treatment plan. The nurse should communicate with the patient to learn what stressors prevent him from feeling comfortable and having a good sleep pattern. Having learned details about all the factors that can cause discomfort to the patient, a nurse should work on eliminating them with the help of certain interventions and modifying intervening variables. The desired outcome, in this case, is the patient’s comfort.
Conclusion
Grand and middle-range nursing theories can significantly influence nurses, their knowledge, behaviors, and perceptions. Additionally, these theories can also be applied to nursing practice, affecting nurses’ decision-making, problem-solving, reactions, and views. In this context, the application of grand theories, such as Dorothy Johnson’s Behavioral System Model, can be more difficult than the application of middle-range theories, such as Katherine Kolcaba’s Theory of Comfort. The cause is in an abstract character of grand theories, but this statement is not appropriate when discussing Johnson’s model. The comparison of these theories has indicated that both theoretical models are easily applied to nursing practice, and they can effectively guide nurses’ activities.
References
Cheng, Y., & Luo, Y. W. (2020). The application progress of Johnson’s Behavior System Model. Journal of Engineering Research and Application, 10(3), 39-42. Web.
Karkhah, S., Ghazanfari, M. J., Norouzi, M., Khaleghdoust, T., Dahka, S. M., & Taheri, Z. (2020). Designing a nursing care plan based on Johnson’s behavioral model in patients with wrist joint hematoma: A case study. Research Square, 2020, 1-10. Web.
McEwen, M., & Wills, E. M. (2019). Theoretical basis for nursing (5th ed.). Wolters Kluwer.
Oliveira, S. M. D., Costa, K. N. D. F. M., Santos, K. F. O. D., Oliveira, J. D. S., Pereira, M. A., & Fernandes, M. D. G. M. (2020). Comfort needs as perceived by hospitalized elders: An analysis under the light of Kolcaba’s theory. Revista Brasileira de Enfermagem, 73(S3), 1-8. Web.