Dorothy Johnson: Behavioral System Model

Dorothy Johnson built the Behavioral System Model on a clean division of labor: medicine treats the biological system, nursing tends the behavioral system. Her theory defines nursing as "an external regulatory force which acts to preserve the organization and integration of the patient's behaviors at an optimum level under those conditions in which the behavior constitutes a threat to the physical or social health, or in which illness is found." The bedside job is keeping the patient's behavior in balance while illness works on the body.

Biography of Dorothy E. Johnson

Dorothy E. Johnson (August 21, 1919, to February 1999) developed the Behavioral System Model.

Early Life

Johnson was born on August 21, 1919, in Savannah, Georgia, the youngest of seven children. Her father was superintendent of a shrimp and oyster factory; her mother was an avid reader. She finished an associate's degree at Armstrong Junior College in Savannah in 1938. The Great Depression pushed her to take a year off school to work as a governess for two children in Miami, Florida, where she recognized her love for children, nursing, and education.

Education

Johnson's professional nursing career began in 1942 when she graduated from Vanderbilt University School of Nursing in Nashville, Tennessee, as the top student in her class and recipient of the Vanderbilt Founder's Medal. In 1948 she earned a master's in public health from Harvard University in Boston, Massachusetts.

Career and Appointments

Johnson's work was mostly teaching, though she was a staff nurse at the Chatham-Savannah Health Council from 1943 to 1944 and an instructor and assistant professor in pediatric nursing at Vanderbilt. From 1949 until her retirement in 1978 and move to Key Largo, Florida, she served as assistant professor of pediatric nursing, associate professor, and professor of nursing at the University of California, Los Angeles. In 1955 and 1956 she was a pediatric nursing advisor at the Christian Medical College School of Nursing in Vellore, South India. From 1965 to 1967 she chaired the California Nurses Association committee that developed a position statement on specifications for the clinical specialist.

Works

Johnson wrote prolifically on nursing theory and shaped theoretical thinking in nursing through the second half of the twentieth century. Her output includes four books, more than 30 articles, and many papers, reports, proceedings, and monographs. Her 1968 paper One Conceptual Model of Nursing is a classic. Two of her other works are Theory Development: What, Why, How? and Barriers and Hazards in Counseling.

Awards and Honors

Johnson was proudest of the 1975 Faculty Award from graduate students, the 1977 Lulu Hassenplug Distinguished Achievement Award from the California Nurses Association, and the 1981 Vanderbilt University School of Nursing Award for Excellence in Nursing.

Death

Johnson died in February 1999 at the age of 80. She was glad her theory had advanced a theoretical basis for nursing and was being used institution-wide as a practice model, but she said her greatest satisfaction came from following her students' careers.

Johnson's Behavioral System Model

Johnson first proposed the model in 1968, heavily influenced by Florence Nightingale's Notes on Nursing. It promotes efficient, effective behavioral functioning to prevent illness and stresses research-based knowledge about how nursing care affects patients.

The patient is a behavioral system made of seven behavioral subsystems: affiliative, dependency, ingestive, eliminative, sexual, aggressive, and achievement. Each subsystem has three functional requirements: protection from noxious influences, a nurturing environment, and stimulation for growth. An imbalance in any subsystem produces disequilibrium, and nursing's role is to help the client return to equilibrium.

What is the Behavioral System Model?

Johnson held that "each individual has patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual." Nursing is the external regulatory force that preserves the organization and integration of the patient's behavior at an optimal level when that behavior threatens physical or social health or when illness is present.

Goals

Johnson started from the premise that nursing makes a distinctive contribution to society and so has an explicit goal of acting for patient welfare. Under the model, the goals of nursing are fourfold: to assist the patient whose behavior is proportional to social demands; to assist the patient who can modify behavior in ways that support biological imperatives; to assist the patient who can benefit fully during illness from the physician's knowledge and skill; and to assist the patient whose behavior shows no unnecessary trauma as a consequence of illness.

Assumptions of the Behavioral System Model

Johnson's assumptions fall into three categories.

About the system: there is organization, interaction, interdependency, and integration among the parts of behavior that make up the system; the system tends toward balance among the forces operating within and upon it, and a person works continually to hold a behavioral steady state through more or less automatic adjustment to natural forces; a behavioral system that requires and produces regularity and constancy is essential to a person and serves a useful purpose in social life; and system balance reflects adjustments that are successful in some way and to some degree.

About structure and function: from the form a behavior takes and the consequences it achieves, you can infer the drive stimulated or the goal sought; each person has a predisposition to act toward a goal in certain ways, called a "set"; each subsystem has a repertoire of choices called a "scope of action"; and the patient's behavior produces an observable outcome.

The three functional requirements for the subsystems: the system must be protected from toxic influences it cannot cope with, nurtured through appropriate supplies from the environment, and stimulated for use to enhance growth and prevent stagnation.

Major Concepts

Johnson views the human being as two major systems, biological and behavioral. Medicine focuses on the biological system; nursing focuses on the behavioral. The human being is a behavioral system that continually adjusts to achieve, maintain, or regain a steady-state balance.

The environment is not directly defined but is implied to include everything surrounding the human system, including interior stressors. Health is the opposite of illness, defined as "some degree of regularity and constancy in behavior," where the behavioral system reflects adjustments that are successful to some degree and adaptation is functionally efficient and effective. Nursing is the external regulatory force that preserves and integrates the patient's behavior at an optimal level when behavior threatens health or illness is present.

The behavioral system shows the state of the system through behaviors. A system functions as a whole through the organized, interdependent interaction of its parts. A subsystem is a mini system maintained relative to the whole when it and the environment are undisturbed.

Subconcepts

Structure is the parts that make up the whole. Variables are factors outside the system that influence its behavior, which the system cannot change. Boundaries separate the interior of the system from the exterior. Homeostasis is the process of maintaining stability, and stability is a steady-state balance of behavior within an acceptable range. A stressor is an internal or external stimulus that produces stress or instability, and tension is the system's adjustment to demands, change, growth, or actual disruption. Instability is the state in which the system's output of energy depletes the energy needed to maintain stability. A "set" is the predisposition to act: with only a few alternatives, the individual ranks them and chooses the most desirable. Function is the consequence or purpose of an action.

The Seven Subsystems

The attachment or affiliative subsystem covers social inclusion, intimacy, and the formation of a strong social bond. It is probably the most critical because it underlies all social organization and provides survival and security.

The dependency subsystem covers approval, attention or recognition, and physical assistance, promoting helping behavior that calls for a nurturing response. Dependency behavior develops from near-total dependence on others toward greater dependence on self, and a degree of interdependence is essential to social groups.

The ingestive subsystem concerns the meaning and structure of the social events around eating: when, how, what, how much, and under what conditions we eat. It is not the same as the body's input and output mechanisms; each subsystem has its own.

The eliminative subsystem concerns when, how, and under what conditions we eliminate. Cultures define different socially acceptable behaviors for excretion, and social and psychological factors influence the biological aspects and can conflict with them.

The sexual subsystem is both biological and social, with the dual functions of procreation and gratification. It begins with the development of gender role identity and includes courting, mating, and a broad range of sex-role behaviors.

The aggressive subsystem relates to protection and self-preservation, generating a defense response to threats to life or territory. Society demands limits on self-protection and respect for people and property.

The achievement subsystem drives behavior that tries to control or master an aspect of self or environment to some standard of excellence, across intellectual, physical, creative, mechanical, and social skills.

The Behavioral System Model and the Nursing Process

The process begins with assessment and diagnosis. Once a diagnosis is made, the nurse and team build and carry out a care plan, and the process ends with evaluation based on the balance of the subsystems. The model fits the evaluation phase best: the nurse determines whether the patient's subsystems are in balance. Helping a patient hold behavioral equilibrium through an illness in the biological system means the nurse has succeeded.

Strengths

The theory guides practice, education, and research, generates new ideas about nursing, and differentiates nursing from other health professions. It has been used in inpatient, outpatient, and community settings and in administration, and in nursing education around the world. It gives nurses a frame of reference for specific client behaviors, generalizes across the lifespan and cultures, and holds continued utility for achieving nursing goals.

Weaknesses

The theory is potentially complex because of the many possible interrelationships among the behavioral system, its subsystems, and the environment, and more empirical work is needed. It has been used extensively with people who are ill or threatened by illness but only to a limited degree with families, groups, and communities. The seven subsystems are described as open, linked, and interrelated, but the interrelationships lack clear definition, which makes it hard to view the whole behavioral system as one entity and hard to follow the logic of the work.

Conclusion

Johnson's model describes the person as a behavioral system with seven subsystems: achievement, attachment-affiliative, aggressive-protective, dependency, ingestive, eliminative, and sexual. Each is interrelated with the others and the environment and carries structural elements and functions that maintain the system's integrity. The model focuses on the behavior the person presents, which ties it closely to the psychological side of care. When the behavioral system is balanced and stable, behavior is purposeful, organized, and predictable; imbalance occurs when tension and stressors disturb the subsystems' relationships or the internal and external environments.