Theory Week 4

Complete this week’s assigned readings, chapters 7,8,9. After completing the readings, post a short reflection, approximately 1 paragraph in length, discussing your thoughts and opinions about one or several of the specific topics covered in the textbook readings.

As a reminder, no scholarly sources are required and students do not have to reply to a classmate’s original post. This post does not have an end date but please make an effort to complete your post before next week’s discussion post is posted and/or due in order to avoid falling behind.

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Chapter 7
Dorothy Johnson’s Behavioral System Model and Its Applications

Developed by Bonnie Pope, and S. Gordon (2010)

Updated by D. Gullett (2014)

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On completion of this chapter, students will be able to:
Discuss paradigmatic origins of Johnson’s Model

Discuss the five core principles of Dorothy Johnson’s Behavioral Systems Model.

Identify the eight subsystems of Dorothy Johnson’s Behavioral Systems Model and discuss their interrelationship.

Describe Johnson’s definition of person, environment, health, and nursing.

Discuss the role of the Behavioral Systems Model in nursing practice, administration, research, and education.

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Introducing the Theorist Dorothy Johnson

Born August 21, 1919, in Savannah, Georgia
Serves as faculty member
Vanderbilt University School of Nursing
UCLA 1949–1978
Died in 1999
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Education

Earned an Associates in Arts Degree from Armstrong Junior College in Savannah, Georgia in 1938
Earned a Bachelor of Science in Nursing degree from Vanderbilt University in 1942.
Earned a Master of Public Health degree from Harvard in 1948
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Johnson Behavioral System Model (JBSM) Overview

Evolved from philosophical ideas, theory, and research; her clinical background; and many years of thought, discussions, and writing
Influences:
Florence Nightingale
Systems theory
Developmental theory
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Five Core Principals

Wholeness and Order
Stabilization
Reorganization
Hierarchic Interaction
Dialectical Contradiction
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Wholeness and Order
Developmental analogy of wholeness and order is continuity and identity.
Continuity and change can exist across the life span.
Continuity is in the relationship of the parts rather than in their individuality.
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Stabilization

Dynamic systems respond to contextual changes by either a homeostatic or homeorhetic process.
Set point maintained by altering internal conditions to compensate for changes in external conditions.
Nurses act as external regulators.
Monitor patient response, looking for successful adaptation to occur.
Nurses intervene to help patient restore behavioral system balance.
Intervention is not needed if behavioral system balance returns.
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Reorganization
Occurs when the behavioral system encounters new experiences in the environment that cannot be balanced by existing system mechanisms
Nurse acts to provide conditions or resources essential to help the accommodation process:
May impose regulatory or control mechanisms to stimulate or reinforce certain behaviors
May attempt to repair structural components
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Hierarchic Interaction
Hierarchies, or a pattern of relying on particular subsystems, lead to a degree of stability.
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Dialectical Contradiction
Motivational force for behavioral change
Drives/responses developed and modified over time through maturation, experience, and learning
Environmental domains that the person is responding to include the biological, psychological, cultural, familial, social, and physical setting
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Dialectical Contradiction (continued)
Faced with illness or the threat of illness, the person needs to resolve (maintain behavioral system balance of) a cascade of contradictions between goals related to:
Physical status, social roles, and cognitive status.
Nurses’ interventions:
Focus on restoring behavioral system balance
Leading to a new level of development
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Major Concepts of the Model

Person
Subsystems
Health
Nursing and nursing therapeutics
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Person

Viewed as an open system with organized, interrelated, and interdependent subsystems.
The whole of the human organism (system) is greater than the sum of its parts (subsystems).
Wholes and parts create a system with dual constraints: Neither has continuity and identity without the other.
Nursing client viewed as a behavioral system
Behavioral systems are orderly, repetitive, and organized
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Human Behavior Is

Orderly, purposeful, and predictable
Functionally efficient and effective most of the time
Sufficiently stable and recurrent to be amenable to description and exploration
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Subsystems
Are parts of the behavioral system
Carry out specialized tasks/functions needed to maintain the integrity of the whole system
Manage system relationship to the environment
Have a set of behavioral responses that are developed and modified through motivation, experience, and learning
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Each Subsystem

Is composed of at least four structural components that interact in a specific pattern
Goal
Set
Choice
Action
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Goal

This is defined as the desired result or consequence of the behavior.
The basis for the goal is a universal drive whose existence can be supported by scientific research.
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Behavioral Set

Is a predisposition to act in a certain way in a given situation
Represents a relatively stable and habitual behavioral pattern of responses to particular drives or stimuli
Represents learned behavior and is influenced by knowledge, attitudes, and beliefs
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Behavioral Set Components
Perseveration
Consistent tendency to react to certain stimuli with the same pattern of behavior
Preparation
Functions to establish priorities for attending or not attending to various stimuli
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Choice
Refers to the individual’s repertoire of alternative behaviors in a situation that will best meet the goal and attain the desired outcome.
The greater the behavioral repertoire of alternative behaviors in a situation, the more adaptable the individual.
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Action

Observable action of the individual
Concern is with the efficiency and effectiveness of the behavior in goal attainment.
Actions are observable responses to stimuli.
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The Johnson Model Proposes

For behavior to be maintained, it must be protected, nurtured, and stimulated.
Protection from noxious stimuli that threaten the survival of the behavioral system
Nurturance, which provides adequate input to sustain behavior
Stimulation to continue growth of the behavior and counteracts stagnation
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The Johnson Model (continued)

Deficiency in any or all of these functional requirements
Threatens the behavioral system as a whole or the effective functioning of the particular subsystem with which it is directly involved.
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Health

Behavioral system balance or stability
Demonstrated by observed behavior that is purposeful, orderly, and predictable.
Behavior maintained when it is efficient and effective in managing the person’s relationship to the environment
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Environment

Consists of all elements that are not a part of the individual’s behavioral system but influence the system and can serve as a source of sustenal imperatives
Manipulated by the nurse to achieve health
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External Environment

May include people, objects, and phenomena that can potentially permeate the boundary of the behavioral system
External stimulus forms an organized/meaningful pattern that elicits a response from the individual
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Internal Environment

Internalized intervening variables:
Physiology, temperament, ego, age and related developmental capacities, attitudes, and self-concept
General regulators
Variables that influence set, choice, and action
Key areas for nursing assessment
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Nursing and Nursing Therapeutics
Nursing is “a service that is complementary to that of medicine and other health professions, but which makes its own distinctive contribution to the health and well-being of people.”
Nursing views patients as behavioral systems, and medicine views patients as biological systems.
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Specific Goal of Nursing Action Is

“to restore, maintain, or attain behavioral system balance and stability at the highest possible level for the individual” (Johnson, 1980, p 214)
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Diagnostic Classifications

Insufficiency:
Exists when a subsystem is not functioning or developed to its fullest capacity due to inadequacy of functional requirements
Discrepancy:
Exists when a behavior does not meet the intended conceptual goal.
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Diagnostic Classifications (continued)

Incompatibility:
Exists when the behaviors of two or more subsystems in the same situation conflict with each other to the detriment of the individual
Dominance:
Exists when the behavior of one subsystem is used more than any other, regardless of the situation or to the detriment of the other subsystems
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Nursing Therapeutics

Attempt to repair damaged structural units by altering the individual’s set and choice
Impose regulatory and control measures
Supply or help the client find his or her own supplies of essential functional requirements
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The Nurse May Provide

Nurturance
Stimulation
Protection
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The Nurse-Client Relationship

The nurse and the client negotiate the treatment plan.
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References

Johnson, D. E. (1980). The behavioral system model for nursing. In: J. P. Riehl & C. Roy (Eds.), Conceptual models for nursing practice (2nd ed., pp. 207–216). New York, NY: Appleton-Century-Crofts.

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Chapter 8
Dorothea Orem’s Self-Care Deficit Theory

Developed by S. Gordon and C. Kain (2010)

Updated by D. Gullett (2014)

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On completion of this chapter, students will be able to:
Describe Orem’s Theory of Self-Care Deficit.

Identify the proper object of nursing identified in Orem’s Theory of Self-Care Deficit.

List the abilities of humans to affect their health as identified by Orem.

Compare and contrast self-care agency and dependent-care agency.

Identify and describe major constructs of the Self-Care Deficit Nursing Theory.

Describe the theoretical linkages between the Theory of Self-Care, Theory of Dependent Care, Theory of Self-Care Deficit, and Theory of Nursing Systems.

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Chapter Purpose

Discuss the integration of views of humankind within views of nursing
Discuss the differentiate individual and generally held nurse-specific views of human beings as part of developing viable nursing science
Provide insight into model building and theory development using exemplars from the Self-Care Deficit Nursing Theory
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Nursing is Commonly Viewed as:

Human health service
Implies two categories of human beings:
Those who need nursing service
Those who produce nursing service
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Nursing as a Human Health Service

Service implies nursing is a helpful activity
Health indicates that the thrust of the service is the structural and functional integrity of persons served
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General Theories of Nursing

Gives names and roles to the two categories of human beings
Attributes distinct potential and actual human powers, properties and actions of each human
Identifies the interactions among the types of human beings and their powers, properties and actions
Specifies the broad structural features of the processes that produce nursing
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Integration of Views of Human Beings

General views
You can study and think about human beings and their situations without thinking about nursing.
Nurse-specific views
You cannot study and think about nursing without incorporating nursing-specific views of human beings.
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Nursing Science

Knowing and seeking to extend and deepen knowing by:
Understanding both the structure of the processes of nursing
Understanding the internal structure, constitution, powers, properties, and nature of those who require nursing
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Comprehensive General Nursing Theories Address

What nurses do
Why they do it
Who does what
How they do it
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Valid General Nursing Theories

Set forth nursing’s professional-technical features specific to the production of nursing
Provides articulation with interpersonal features of nursing and sets standards for safe effective interpersonal systems
Point to the legitimacy of, or the need for change in, societal-contractual systems
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Model Building and Theory Development

Nursing-specific views of human beings are necessary for understanding and identifying
(1) When and why individuals need and can be helped through nursing
(2) The structure of the processes through which the nursing help needed is determined and produced
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Self-Care Deficit Nursing Theory (SCDNT)

Began with formulations about the reasons why individuals (the patient)
Need nursing and
Can be helped through nursing
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Central Idea

Mature human beings have learned and continue to learn to meet some or all components of their own TSCDs and the TSCDs of their dependents (those for whom the dependent care agent assumes or has responsibility for meeting TSCDs).
Self-care and dependent care (i.e., care delivered by someone other than the individual for the individual) are time-specific entities produced by individuals.
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Self-Care Deficit Nursing Theory

Human properties and powers:
Individuals have a continuing demand for self-care
Therapeutic Self-Care Demand (TSCD)
Care for self that must be learned and deliberately performed
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Theory of Self-Care

Individuals have the human power to develop and exercise capabilities to know and meet Therapeutic Self-Care Demands using
Self-Care Agency (SCA)
First, investigate or identify what can or should to be done.
Second, decide what can be done.
Third, produce the care.
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Theory of Dependent Care

Assumptions relate to the nature of interpersonal action systems and social dependency.
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Nursing Is Needed:

When Therapeutic Self-Care Demands exceed an individual’s Self-Care Agency because of health state or health-care–related conditions
Self-Care Deficit (SCD)
TSCD > SCA = SCD = Nursing Required
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TSCD and SCA

Vary qualitatively and quantitatively over time
Identified as patient variables
Real or potential existence of a health-related care deficit relationship between care demand and the power of agency is the reason nursing is required
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Nurse Agency

Critical power operative in nursing
The power of nurses to think about, design and produce nursing care for others
Investigation of Nurse Agency and the capabilities and conditions for its exercise are critical components of nursing science
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Nurses Must Have Knowledge and Skills

Investigating and calculating individual’s TSCD
Determining degrees and development of SCA
Estimating potential for regulation of the exercise or development of SCA
Identify, perform, and support an individual’s SCD when indicated
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Nursing Triad of Interrelated Action Systems

Professional-Technical
Necessary for the production of nursing–dependent on the interpersonal system
Interpersonal
Interaction and communication necessary for design and production of nursing
Societal
Established by the specifying contracting parties and their legitimate relationships
Societal-contractual system
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Broader Views of Human Beings

Nurse-specific views of human beings fit within broader views of human beings.
Orem identifies five broad views of human beings that support the development of the constructs of Self-Care Deficit Nursing Theory.
Broader views come into play when nurses think about and produce nursing.
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View of Person

Human beings are:
Embodied with inherent rights
At once a self and a person
Person-as-agent
Central to understanding and integrating the other views of human beings
Subsumes all other views
Essential to understanding nursing as a triad of systems
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View of User of Symbols

Individual human beings are persons who use symbols to:
Stand for things
Attach meaning to them
Formulate and express ideas
Communicate ideas and information to others
Essential to understanding the nursing interpersonal system
Necessary for nurse-patient communication
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View of Organism

Individuals viewed as unitary living beings who grow and develop biological characteristics of homo sapiens during known stages of the human life cycle.
Requires knowledge of biology, psychology, human physiology, environmental physiology, pathology, and other sciences.
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View of Object

Human beings are viewed as having the status of object subject to physical forces whenever they act to protect themselves against such forces.
Requirement for protective nursing care.
Taken when nurses provide care for infants, young children, or adults unable to control their positions and movements in space and contend with environmental physical forces.
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Conclusion

Nursing-specific views of human beings are differentiated from general views of human beings.
General views (human beings as energy fields, living health, or culture-oriented or as caring beings) are helpful in understanding humankind but do not and cannot support viable nursing science.
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Chapter 9

Imogene King’s Theory of Goal Attainment

Developed by S. Gordon (2010)

Updated by D. Gullett (2014)

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On completion of this chapter, students will be able to:

Describe the evolution of King’s theory from her personal writings.

Identify and discuss a variety of literature related to King’s theory.

Describe various settings and populations in which King’s Conceptual System (KCS) and middle range theory have been applied.

Discuss future applications of KCS and middle range theory as it relates to an evidence based practice.

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Theory of Goal Attainment Initial Ideas

Problems and prospect of knowledge development in nursing
Lack of professional nursing language
Atheoretical nursing phenomena
Limited concept development
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Original Levels of Interaction

Human being (or individual or person)
Perception
Communication
Interpersonal relations
Health
Social institutions
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Philosophical Underpinning

Von Bertalanffy’s General Systems Theory
Refutes logical positivism and reductionism
Proposes isomorphism and perspectivism in knowledge development
Wholeness, systems in interaction
Organized complexity as whole systems
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Conceptual System

A concept is an organization of reference points
Provides structure for organizing multiple ideas into meaningful wholes
Shows unity and relationships among concepts
Consists of individual systems, interpersonal systems, and social systems
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Developing a Concept

1) Review, analyze, and synthesize research literature related to concept.

2) From the review, identify the characteristics (attributes) of the concept.

3) From the characteristics, write a conceptual definition.

4) Review literature to select an instrument or develop an instrument.

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Developing a Concept (continued)

5) Design a study to measure the characteristic or concept.

6) Select the population to be sampled.

7) Collect data.

8) Analyze and interpret data.

9) Write results of findings and conclusions.

10) State implications for adding to nursing knowledge.

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King’s Conceptual System Personal System

Self
Perception
Time
Growth and development
Body image

Learning

Personal space

Substantive knowledge about human beings
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King’s Conceptual System Interpersonal Systems
Related to small groups
Interaction
Communication
Role
Transactions
Stress
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King’s Conceptual System Social System

Related to large groups
Decision making
Organization
Power
Status
Authority
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Theory of Goal Attainment

Derived from the goal of nursing:
Help individuals maintain or regain health (King, 1990)
Uses the following concepts:
Self, perception, communication, interaction, transaction, role, growth and development, stress, time, personal space
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Transaction Process Model

Describes a human process that can be observed when two or more people interact.
Information is exchanged, goals are set, and transactions are made during the process.
Nurses should document their conversations and determine if goals were met.
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Documentation System

Implements the nurse-patient transaction process leading to goal attainment
Method used is generally nursing process:
Assess, diagnose, implement, and evaluate
Nurse and patient agree to goals, means, and evaluation :
Entered into patient’s chart
Eliminates need for multiple forms
Documents patient involvement in care decisions
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Instrument Development

Goal Attainment Scale (King, 1989b)
Nurse Performance Goal Attainment (NPGA) (Kameoka, Funashima & Sugimori, 2007)
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Examples of Practice Applications

Development of Middle-Range Theories from:

King’s Interacting Systems Framework

Theory of Perceptual Awareness (Brooks & Thomas, 1997)

Interpersonal System

Family Health Theory (Doornbos, 2007)

Model for collaboration through reciprocation in heath care organizations (Thomason & Lagowski, 2008)

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Examples of Practice Applications (cont)

Development of Middle-Range Theories from:

Interpersonal Systems

Theory of Group Empowerment within Organizations (Sieloff & Bularzik (2011).

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Examples of Practice Applications

Midrange theory used in several categories
Used across the life span
Used in different client systems
Focus on phenomena of concern to clients
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Examples of Practice Applications

Used with different nursing specialties
Used in varied work settings
Multicultural applications
Evidence based practice
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References

Brooks, E. M., & Thomas, S. (1997). The perception and judgment of senior baccalaureate student nurses in

clinical decision making. Advances in Nursing Science, 19(3), 50–69.

Doornbos, M. M. (2007). King’s conceptual system and family health theory in the families of adults with persistent mental illness—An evolving conceptualization. In C. L. Sieloff & M. A. Frey (Eds.), Middle range theory development using King’s conceptual system (pp. 31-49). New York: Springer.

Kameoka, T., Funashima, N., & Sugimori, M. (2007). If goals are attained, satisfaction will occur in nurse- patient interaction: An empirical test. In C. L. Sieloff & M. A. Frey (Eds.), Middle Range Theory Development Using King’s Conceptual System (pp. 261-272). New York: Springer.

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References

King, I. M. (1989b). King’s systems framework for nursing administration. In B. Henry (Ed.), Dimensions of nursing administration: Theory, research, education (p. 35). Cambridge, UK: Blackwell Scientific.

King, I. M. (1990). Health as a goal for nursing. Nursing Science Quarterly, 3, 123–128.

Sieloff, C. L., & Bularzik, A. M. (2011). Group power through the lens of the 21st century and beyond: further validation of the Sieloff-King Assessment of Group Power within Organizations. Journal Of Nursing Management, 19(8), 1020-1027. doi:10.1111/j.1365- 2834.2011.01314.x

Thomason, D., & Lagowski, L. (2008, December). Business and leadership. Sustaining a healthy work force in the 21st century — a model for collaborating through reciprocation. AAOHN Journal, 56(12), 503-513.

The Rise Of Communism And Fascism

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