DOROTHY JOHNSON’S “ THE BEHAVIOURAL SYSTEM MODEL, 1968”

INTRODUCTION : Dorothy Johnson proposed her model in 1968 to foster the “efficient and effective
behavioral functioning in the patient to prevent illness”. She based her model on Florence Nightingale believes
that nursing is a design to help people prevent or recover from illness .
ABOUT AUTHOR-

1. Born on 21st August 1919 in Georgia, USA

2. 1942- BSc Nsg from Nashville Tennessee. Masters in Public health from Harvard University Boston
in1948.Worked at various places in the US and in 1955 at CMC Vallore SON .
3. Creation of her theory began in 1940’s when she began to teach.
4. Associate professor of nursing and a professor of nursing at a university of callifornia in los angeles.
5. 1950s and 1960s , as Johnson developed her model
6. In 1968 first proposed her model of nursing care as the fostering of the efficient and effective behavior
functioning in the patient to prevent illness. DOROTHY JOHNSON(1919-
7. In 1980, Johnson published her conceptualization of behavior system model for nursing. 1999)
8. In 1992, Johnson articulated that much of her thinking was influenced by Florence nightingale.
9. Retired in 1978, and died in 1999.

ABOUT THEORY-In 1961, Johnson proposed that nursing care facilitated the client’s maintenance of a state of equilibrium. Johnson proposed that
clients were “stressed” by a stimulus of either an internal or external nature. These stress stimuli created such disturbance or “tension” in the patient
that a state of disequilibrium occurred. Johnson identified two areas of foci for nursing care that are based on returning the client to a state of
equilibrium. First, nursing care should reduce stimuli that are stressors and second, “nursing care should provide support of the client’s “natural”
defenses and adoptive processes.

DEFINITION OF NURSING
She defined nursing as “an external regulatory force which acts to preserve the organization and integration of the patients behaviors at an optimum
level under those conditions in which the behaviors constitutes a threat to the physical or social health, or in which illness is found”
Four goals of nursing are to assist the patient:

1. Whose behavior commensurate with social demands.

2. Who is able to modify his behavior in ways that it supports biological imperatives
3. Who is able to benefit to the fullest extent during illness from the physicians knowledge and skill.
4. Whose behavior does not give evidence of unnecessary trauma as a consequence of illness

NURSING METAPARADIGM-

 GOAL: Restore or maintain behavior integrity stability and effective behavioral functioning.
 PERSON : A biopsychosocial being with an instability in one of the subsystems due to stress.
 ENVIRONMENT : She refers to a persons external and internal environment but does not explain what they are.
 HEALTH : Is defined as balance and stability of a persons behavioral system; instability or illness, is not addressed directly but can be
inferred as a malfunction of the behavior system.
  NURSING : Is an external regulatory force that acts to preserve optimal organization and integration of a patients behavior when the patient
encounters a threat to physical or social health.

ASSUMPTIONS

There are several layers of assumptions that Johnson makes in the development of conceptualization of the behavioral system model viz.

 Assumptions about system

 Assumptions about structure
 Assumptions about functions

Assumptions about system

There are 4 assumptions of system:

1. First, there is “organization, interaction, interdependency and integration of the parts and elements of behaviors that go to make up the system
”
2. A system “tends to achieve a balance among the various forces operating within and upon it', and that man strive continually to maintain a
behavioral system balance and steady state by more or less automatic adjustments and adaptations to the natural forces impinging upon him.”
3. A behavioral system, which both requires and results in some degree of regularity and constancy in behavior, is essential to man that is to say,
it is functionally significant in that it serves a useful purpose, both in social life and for the individual.
4. Last, “system balance reflects adjustments and adaptations that are successful in some way and to some degree.”.

Assumptions about structure and function of each subsystem

 “From the form the behavior takes and the consequences it achieves can be inferred what “drive” has been stimulated or what “goal” is being
sought”
 Each individual has a “predisposition to act with reference to the goal, in certain ways rather than the other ways”. This predisposition is
called as “set”.
 Each subsystem has a repertoire of choices or “scope of action”
 The fourth assumption is that it produce “observable outcome” that is the individual’s behavior.
Each subsystem has three functional requirements

1. System must be “protected" from noxious influences with which system cannot cope”.
2. Each subsystem must be “nurtured” through the input of appropriate supplies from the environment.
3. Each subsystem must be “stimulated” for use to enhance growth and prevent stagnation.
 These behaviors are “orderly, purposeful and predictable and sufficiently stable and recurrent to be amenable to description and explanation”

FIVE CORE PRINCIPLES

1. Wholeness and Order

2. Stabilization
3. Reorganization
4. Hierarchic Interaction
5. Dialectical Contradiction

1. 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

2. Stabilization
• Dynamic systems respond to contextual changes 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

3. 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 component
 4. Hierarchic Interaction
• Hierarchies, or a pattern of relying on particular subsystems, lead to a degree of stability.

5. 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
• 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

JOHNSONS BEHAVIORAL SYSTEM MODEL

DOROTHY JOHNSON’S “ THE BEHAVIOURAL SYSTEM MODEL, 1968”

BEHAVIORAL SYSTEM MODEL:
Each individual has specific ways of acting that are patterned, purposeful, andrepetitive which embrace a behavioral system.
These individualized behaviors create a ―functional unit‖
which governs the interactions that person has with his surrounding environment and forms relationships between the person and the items,
occurrences, and circumstances within his specific environment.
For each person, their behaviors are ―orderly, purposeful, and predictable.The Behavioral System Model contains seven subsystems:
attachment/affiliation, dependency, ingestive, eliminative, sexual, aggressive, and achievement.

1. Attachment/Affiliation: This is first to develop as a response. For it to function best, social interactions and intimacy must be strong. Caregiver
attachment begins at infancy and is essential, and as the person grows more relationships are formed which give the person a sense of security.

2. Dependency: These are behaviors that cause others to nurture and care for the individual. Responses expected from the other individuals in the
environment include ―approval, attention or recognition, and physical assistance
Most often, the response behaviors come from the caregiver mentioned in the attachment subsystem.
3. Ingestive : These behaviors are centered around food, especially the social aspects that have to do with food and when it is eaten. Behaviors in this
subsystem focus on what is considered acceptable methods of consumption based on the culture and situation, as well as the physiological need for
food.

4. Eliminative: These behaviors relate to defecation. There are socially acceptable manners for the excretion of waste, and are dependent on the
culture.

5. Sexual: These behaviors center around reproduction. These behaviors are also dependent on culture, but also have a strong biological pull. The
gender of the specific individual alters the sexual behaviors.

6. Aggressive: Behaviors in this subsystem are for self-protection. Often, the behaviors are defensive in nature, usually when the person feels
threatened. The actions are not meant to cause harm but rather to guard and defend oneself and their society.

7. Achievement : These behaviors include ―intellectual, physical, creative, mechanical, and social skills. These actions are used to try and regulate
the environment of the individual. Personal achievements are also placed into this subsystem.
NURSING PROCESS
Human being
Johnsons viewed human being as having 2 major system, the biological system and behavior system. It is role of the medicine to focus on biological
system where as nursing’s focus is the behavior system. There is a reciprocal relationship between biological and behavior system when some type of
dysfunction occur in one or the other of system.
Society
It relates to the environment in which the individual exists. According to Johnson, an individuals behavior is influenced by events in the environment.
Health
It is a purposeful adoptive response, physically, mentally, emotionally and socially to internal and external stimuli in order to maintain stability and
comfort.

Nursing
It has a primary goal that is to foster equilibrium with in the individual. Nursing is concerned with organized and integrated whole, but that the major
focus is on maintaining a balance in the behavior system when illness occurs in an individual.
Environment
It consists of all elements that are not a part of individuals behavior system but influence the whole system.

Assessment
Grubb developed an assessment tool based on Johnson’s 7 subsystems.

Affiliation
It must focus on presence of a significant other or on the social system of which individual is a member.
Dependency
It focus on understanding how the individual makes needs, known to significant other and in the environment that can assert the person in meeting
those needs.
Sexuality
Assessment includes information about sexual partners and behavior.
Aggression
Check about how individuals protect themselves from perceived threat to safety.
Elimination
Check for patterns of defecation and urination and social context in which patterns occur.
Ingestion
Examine pattern of food and food intake including social environment in which food and fluid is ingested.
Achievement
It includes assessment of how individual changes environment to facilitate accomplishment of goals.

Nursing diagnosis
Diagnosis tends to be general to the system than specific to the problem. Grubb has proposed four categories of nursing diagnosis derived from
Johnson’s behavioral system model.
Insufficiency
A state which exists when a particular subsystem is not functioning or developed to its fullest capacity due to inadequacy of functional requirement.
Discrepancy
A behavior that does not meet intended goal. The incongruity usually lie between actions and goal of subsystem .
Incompatibility
The goals or behavior of 2 subsystem in the same situation conflict with each other to detriment individual.
Dominance
Behavior in 1 subsystem is used more than other subsystem regardless of situation or detriment of other subsystem.

Planning and implementation

Planning and implementation of the client that are based on Johnsons model focus maintaining or returning and individual subsystem to a state of
equilibrium. Implementation of the nursing care related to the diagnosis may be difficult because of lack of clients input into the plan. The plan will
focus on nurses actions to modify clients behavior, these plan then have a goal, to bring about hemostasis in a subsystem, based on nursing
assessment of the individuals drive, set behavior, repertoire, and observable behavior. The plan may be include protection, nurturance or stimulations
of the identified subsystem.
Evaluation
Evaluation is based on attachment of a goal of balance in the identified subsystems. If the baseline data are available for an individual, the nurse may
have goal for the individual to return to the baseline behavior. If the alterations in the behavior that are planned, do occur the nurse should be able to
observe the return to the previous behavior pattern. Johnsons behavioral model with the nursing process is a nursing centered activity, with the nurse
determining the client needs and state behavior appropriate for that need. There is little or no recognition by either Johnson(1980) or Grubb(1980) of
the patients input into plan for nursing implementation.
History
Definition
In 1980, Johnsons defined nursing “ An external regulatory force which acts to preserve the organization and integration of patients behavior at an
optimum level under those conditions in which the behaviors constitute a threat to physical or social health, or in which illness is found ”.

Concept of theory
Metaparadigm 4 point
Model explanation
Application of theory
Bibliography 3