Johnny Suzuki

Ecological model and systems theory


You reach Dr. Derauf and learn:

The ecological model rests on an evolutionary, adaptive view of human beings in continuous interaction with their environment.  In biology, accommodation occurs when an individual actively interacts with their environment to ensure a goodness-of-fit (Germaine, 1979).  The result of accommodation is the creation of a "niche."  The niche represents the unique place in which one "fits" in the environment; and once established, attains a level of homeostasis.  If the person or environment is changed, the survival of the whole is dependant upon the niche accommodating change in all other parts (Bower, 1988).


Biopsychosocial Model

The biopsychosocial model expands on the ecological theory, viewing disease as interplay between environment, physical, behavioral, psychological, and social factors.  Bracht (1978) delineated the following premise using the biopsychosocial model to underlie social work's role with health care:


1. Social, cultural, and economic conditions have a significant measurable effect on health status and illness prevention.


2. Illness related behavior, whether perceived or actual, frequently disrupt personal or family equilibrium and coping abilities.


3. Medical treatment alone is often incomplete and occasionally impossible to render without accompanying social support(s) and counseling services.


4. Problems of fragmentation, access, and appropriate utilization of health services are sufficiently endemic to the health care system as to require concerted community planning as well as institutional innovations.


5. Multi-professional health team collaboration on selected individual and community health problems can be an effective approach to solving complex social/medical problems.


Systems theory

General systems theory is used to organize and demonstrate complex interactions between systems using a theoretical base.  Concepts used in this model are boundary definitions and maintenance between systems, interdependence, synergy, environment, and homeostasis. Public Health professionals use concepts of micro (individual), mezzo (family), and macro (community) level interaction to assess how illness affects the individual and other interrelated systems.


Dr. Derauf suggests combining the ecological and system theory model to focus on the individual, his or her situation, and the effect of illness on the system and environment.  He says the crucial assessment occurs at the interface, or transaction between the individual; their systems that are interdependent, and the environment (Gordon, 1969).  Change and adaptation to illness effects all within the system: the individual, their family, the community and surrounding environment.


You thank Dr. Derauf, and begin to use the information to understand what happened to Johnny.


On a sheet of paper, you note several questions:


Is Johnny taking his insulin?


Why is this happening?

You suspect that Johnny is not monitoring his glucose and insulin administration.


What further information do you need?

Using the ecological and systems theory model, you map the affects of diabetes on Johnny and his family.  You ask Johnny about his feelings on diabetes (micro), which family member assists with his diabetes (mezzo) and how the school (macro) helps him in class.


You map out the following:



Further course in the ED
Johnny’s respiratory rate decreased and his vital signs stabilized.  With hydration and insulin therapy, he showed an increased level of consciousness, was able to converse with his mother, and stated he was feeling "a little better."  Johnny tells us that he he ran out of medication several days ago. 


Johnny is stable and transferred to the floor,  you begin the process of discharge planning; however, wonder why he, or the mother did not call, or come to the clinic for a refill of supplies.  In fact, prior to this admission, you referred the mother to the diabetic educator.  The chart note indicates the educational session went well, and the mother and child were able to demonstrate proper technique in glucose monitoring and insulin administration.  Your thoughts again begin to wonder about his social situation…


Using the ecological model and systems theory, you update your notes:


Johnny stopped monitoring his glucose and insulin administration two days ago.


Why is this happening?

Johnny’s day time care giver is not his mother, and the person he turns to for help is not trained to assist in the management of his diabetes.  Both his mother and Aunty are very concerned and want to do their best to help Johnny.  Using systems theory, you begin to wonder about effects of community and culture on Johnny’s diabetes management. 


What further information do you need?

Why is Johnny reluctant to ask others for help?


Does he know how to monitor his glucose and administer insulin?


Does Aunty Clair know how to manage Johnny's diabetes?


Why Aunty Clair did not know about his medication?


Why no one came to the clinic for a refill on supplies?


You decide to ask Dr I about these issues before starting you discharge plan.



Proceed to Community Windshield  Module


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