TNAI JOURNAL

Cancer is one of the most frequent causes of death. It is time to halt the inexorable path to human suffering and to find a logical and pragmatic approach for the control of cancer. The incidence of breast cancer is rising in every country of the world especially in developing countries such as India. This is because more and more women in India are beginning to work outside their home, which exposes them to various risk factors of breast cancer. According to a study by the World Health Organisation, one in 12 urban women develops cancer in her lifetime. Approximately 40 percent of new cases of cancer affect women. Every three minutes a woman is diagnosed with breast cancer. Once in every 13 minutes, a woman dies of breast cancer. In fact the disease accounts for 20 percent of the total cancer related diseases in India. Presently 75,000 new cases occur in Indian women every year. Northouse L, et al., highlighted that women with breast cancer are in need of programme to assist them in coping with the severe effects of disease on their quality of life. Antoni et al., in their study suggested that women with breast cancer reported positive lifestyle changes, emotional well-being and diverse aspects of quality of life after psychological intervention. The authors are : Principal and Lecturer respectively, at Madha College of Nursing, Kunrathur, Chennai (TN)	Akechi et al., in their study revealed that a novel intervention programme for reducing clinically manifested psychological distress has several benefits. At the same time, Schlich- Breast et al., in their prospective study revealed that patients who are young, single with little social support, less optimistic, use an avoiding coping style and experience lower quality of life. Understanding the experience of illness from the perspective of the client assists nurses in validating their nursing practice and provides clinically relevant information to guide intervention. Theory Application In the above background, Johnson’s Behavioural System Model has been found very useful in improving the quality of life of breast cancer clients for the better understanding of application of nursing theory into practice. Dorothy E Johnson proposed her model to foster the efficient and effective behavioural functioning in the client to prevent illness. Mainly based on Florence nightingale’s belief that nursing is designed to help people prevent or recover from illness or injury, she published her behavioural system model in 1980. In her conceptualisation, she had focused mainly on the Person and Nursing. With regard to Person, she explained 7 subsystems that require some regularities and adjustment to maintain a balance (see diagram on next page). Attachment /affiliative sub	system It provides sense of security and survival. Breast cancer clients have the feelings of insecurity, negative self-esteem, loss of hope, helplessness, social isolation, etc. which affect the sense of security and survival. Dependency subsystem It promotes helping behaviour that calls for a nurturing response. In clients with breast cancer sense of hopelessness, negativism, depression, denial, etc., increases the need for dependency Ingestive subsystem It has to do with when, how, what, how much under what conditions we eat. The clients are having many problems like indigestion, loss of appetite, nausea, vomiting, etc. which affect ingestive subsystem. Eliminative subsystem It addresses when, how and under what conditions we eliminate. The breast cancer clients have constipation, burning micturation, oliguria, etc., which disturb the eliminative subsystem. Sexual subsystem It has the functions of procreation and gratification. The clients have loss of sexual feelings, less sexual attractiveness, painful sexual intercourse, etc. that limit the functions of sexual subsystem. Achievement subsystem This subsystem attempts to manipulate the environment. Cli-



ents with breast cancer will have poor self-efficacy, physical impairment, decreased functional subsystem, etc., which decreases the achievement. Aggressive / protective subsystem Its function is protection and preservation. These clients show emotional outbursts like anxiety and anger, distressing thoughts, etc., which will impair the normal protection & preservation function. With regard to Nursing as perceived by Johnson, it is an external force acting to preserve the organisation of the clients’ behaviour by means of imposing regulatory mechanisms or by providing resources while the patients is under stress. The nursing actions including cognitive restructuring, problem-focused coping strategies, cognitive -behavioural stress management	dietary interventions, etc., will be helpful to restore the balance in the behavioural system. Apart from this, environmental influences like recreational therapy, support by spouse & family, self help group, reach & recovery volunteers, etc. plays a vital part in promoting the quality of life of clients with breast cancer. Conclusion This theory enables the nurse to involve the family and community in the care of clients with breast cancer and considers the client as whole system. So nurses can apply different kind of theories in the care of clients with disorders to promote the comprehensive care and quality of life. References 1 Antoni MH, et al, (2006). A comprehensive psycho-pathological rating scale, Acta Psychiatrics,	Scandanavia, pp 6-12 2. Akechi, et al (2006). Screening for depression and anxiety in cancer patients using hospital anxiety and depression scale, General Hospital Psychiatry, pp 69-74 3. Breast cancer in India - Women - India Times http.//women. india times.com/article show/223923 cms /6/22/2006 4. George JB, et al, (1990). Nursing Theories: The Base for Professional Nursing Practice, 3rd edn, Appleton & Lange, Norwalk 5. Marriner-Tomey A, (1998). Nursing Theorist and Their Work, 4th edn, Mosby, St Louis 6. Northouse L, et al, (2007). Quality of life of women with recurred breast cancer and their family members, Journal of Oncology, Oct 1, 20 (19): 4050-64 7. Riehl-Sisca JP, (1989). Conceptual Models for Nursing Practice, 3rd edn, Appleton & Lange, Norwalk 8. Schlich-Breast KJ, et al, (2006). Short term psychological distress in patients actively approached for genetic counseling after diagnosis of breast cancer, European Journal of Cancer, 42 (16), pp 2722-28