The behavioral system model (BSM) generated by Dorothy Johnson in 1968 intended to develop effective and efficient behavioral functioning in the patient to curb sickness. Ghanbari and Pouy (2018) observe that the behavioral theory was influenced by Nightingale’s opinion, which highlighted that nurses should help people prevent diseases and concentrate on the patient (p. 632). Her main concept was that nurses must acquire specific knowledge to enable them to perceive a person as an integrated individual whole and to assist the one in returning to the state of equilibrium. The Neuman systems model (NSM) is an approach that appeared after the BSM and was originated by Betty Neuman in 1972. Khatiban, Oshvandi, Borzou, and Moayed (2016) say that Neuman emphasized prevention as an essential nursing activity for protecting patients, with the aim of reinforcing their defense and resistance line and improving health and coping ability. Both the BSM and NSM have influenced nursing practice and research to a great extent. They have also been used as a curriculum guide for quite a number of nursing schools. However, the BSM is more preferred in hospital situations than the NSM, and its use is highly recommended in the clinical environment as a framework for determining the problems of patients and designing proper care plans because the second approach has several parts that make it not easily applicable in nursing practice.
Behavioral System Model
This model stresses the grandness of research-based knowledge with regard to the effect of nursing care on patients. Dorothy Johnson explained the need for nurturing effective and efficient behavioral functioning in the client to prevent sickness (as cited in Ghanbari & Pouy, 2018). Ghanbari and Pouy (2018) state that the goal of the BSM is that nurses should be trained to focus on attaining specific knowledge that empowers them to take care of the individual not only as a patient but as an integrated whole (p. 632). The model views nursing as an outside monitoring force, which works to reestablish, preserve, or attain the behavioral system balance and vigorous stability for a person at the maximum level possible (Fawcett, 2017, p. 78). Johnson’s nursing goals are to help patients to commensurate their behavior with social demands and modify them to support biological imperatives. It will make them benefit fully from the healthcare provider’ knowledge and skills fully during the period of sickness, and their behaviors will not give evidence of unnecessary trauma as a result of the disease. The BSM has subsystems, which are components of the behavioral system, as Ghanbari and Pouy (2018) put it (p. 632). The affiliate subsystem is social inclusion intimacy present in a patient. It naturally attaches the latter to social bonds. The dependency subsystem is the attention for which the patient yearns during physical assistance. The ingestive component is the emphasis of the person on social surrounding events when eating food. The eliminative subsystem is the connection of the patient to the surrounding when excreting wastes. The sexual element is a social factor that naturally affects patient behavior. The aggressive subsystem makes the patient create a defensive reaction when his or her life or territory is in danger. Finally, the achievement component is intellectual, physical, imaginative, mechanical, and social behavior created when the person is trying to control the surroundings.
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My rationale for using the BSM within the nursing paradigms of the human being, society, health, and nursing is that it focuses on the individual as the main element and the role of medicine to attend to his or her biological system, whereas nursing should focus on his or her behavioral side. Society relates to the environment where the human being resides and his or her behavior is shaped by environmental events (Fawcett, 2017). Health, whether physical, mental, emotional, or social is a purposeful adaptive reaction to both internal and external stimuli that regulate stability and comfort. The crucial goal of nursing is to achieve equilibrium in the patient and the integrated whole, as well as to focus on maintaining balance in the behavior system when sickness occurs.
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The Difficulty in Developing a Care Plan and Determining Patient Problems in Practice
The BSM can be implemented in a clinic, and nurses can use it to deal with the challenge of designing a suitable care plan and identifying problems of their patients. Ghanbari and Pouy (2018) used the model and investigated its clinical application to Zeinab, a child suffering from acute lymphoblastic leukemia in the clinical environment (p. 633). The researchers applied nursing processes of behavioral systems and seven subsystems as described in the BSM to their patient. After designing a BSM care plan and using it for a period of 10 days, Ghanbari and Pouy (2018) noticed that Zeinab had grown in confidence, her appetite, rational skills, and life daily routines had improved tremendously, and she showed no signs of fatigue, bleeding, and fever. Ghanbari and Pouy (2018) confirm that problems of Zeinab were a sign of instability as described in the BSM that required a nursing intervention (p. 634). They concluded that the case study proved the application of nursing processes based on the model in the clinical setting. The researchers affirm that the BSM matches the clinical environment perfectly and can be adopted in hospitals as the main framework for developing care plans and determining patients’ problems.
Neuman Systems Model
The NSM focuses on the human needs for protection and relief from anxiety. As cited in Khatiban et al. (2016), Neuman articulates that sources of anxiety can be identified and resolved by nursing interventions. She highlighted that needs of humans can be balanced by nurses who provide care by identifying problems and using prevention as an intervention. Khatiban et al. (2016) further indicate that Neuman observed the four metaparadigms and advanced more concepts that take a person as a client system, who is composed of physiological, sociocultural, developmental, and spiritual variables. The environment to the theorist is a structure of concentric rings representing internal, external, and created environments, all of which influence client’s adaptation to stressors. Neuman described health as a continuum with wellness and sickness at opposite ends (Khatiban et al., 2016). Lastly, she saw nursing as a chief component concerned with preserving client system stability through meticulously evaluating environmental stressors that help the client adjust and maintain optimal wellness.
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How the BSM and NSM Complement Each Other
The NSM complements the BSM. Both models have been widely used in nursing practice and research to a significant extent. Khatiban et al. (2016) articulate that they have promoted nursing education, as nursing programs have structured their curricula around both models internationally. Nickitas and Frederickson (2015) also state that the National League of Nursing requires the use of a conceptual model as the basis for a curriculum (p. 191). The BSM has been largely adapted for use in hospital situations, while the NSM has greatly influenced the mental health community.
Analysis and Comparison of the BSM and NSM
The environment is the core concept in the BSM and NSM. In the former, it is a dwelling place for humans, and their behaviors are influenced by events in the environment. The adaptation model is also recognizable in the NSM represented in internal, external, and created environments. This model hinges on the assumption that human beings and the environment interact regularly (Khatiban et al., 2016). However, environmental systems are characterized by numerous changes which have inherent effects on human health (Ghanbari & Pouy, 2018, p. 632). In order to cope with such environmental dynamics, an individual must develop an effective mechanism of adaptation. The systems that help a person to adapt are categorized into three groups. These are social, psychological, and biological mechanisms. Each of these categories plays a massive role in the attainment of wellness and overall health of a person.
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In line with the environmental framework, it is essential to look at the definition of the environmental concept in the two nursing theories. In the BSM, external and internal factors interact with the person and frequently influencing health and wellness (Ghanbari & Pouy, 2018). These perspectives are also evident in the concept definition provided for the environment metaparadigm in the NSM. In the model, the environment is also presented as an elaborate system characterized by external and internal systems (Khatiban et al., 2016). The latter is evident within an individual, while the former is outside the patient. Despite this similarity, the definitions of the environment metaparadigm have distinctions in the two nursing theories. In the NSM, the third dimension of this core concept has been identified. It pertains to the created environment and applies to environmental systems, which individuals establish unconsciously. This framework is absent in the BSM. It presents the environment as a component that has massive implications for the behavior of individuals.
The NSM cannot be used in determining patients’ problems and developing the proper care plan because it is a sophisticated model as compared to the BSM. Khatiban et al. (2016) emphasize that the former has been initially developed to be an educational model and many parts of it function in numerous ways, unlike the BSM which has seven behavior subsystems. The description of NSM parts can be confusing; therefore, the model is cannot be used for solving the problem in clinical settings.
Nursing theories are among the earliest of many theories. The original nursing models relied upon the philosophical school of thought of the time, considered a person as a biopsychosocial being, and majorly focused on meeting the needs of the patient. The BSM and the NSM have demonstrated how human needs can be considered in direct patient care by forestalling or predicting them and determining any desirable outcomes. Many nurses all over the world in a variety of settings use these models and theories to direct care for their patients. It is worth noting that succeeding generations of nursing theorists can undoubtedly base their models and theories on both the BSM and NSM. Indeed, these two conceptual models are building blocks for the entire profession of nursing.