Introduction
September 9, 2013 in Savannah, Georgia.
B. S. N. from Vanderbilt University in Nashville, Tennessee, in 1942; and her M.P.H. from Harvard University in Boston in 1948.
From 1949 till retirement in 1978 she was an assistant professor of pediatric nursing, an associate professor of nursing, and a professor of nursing at the University of California in Los Angeles.
Johnson stressed the importance of research-based knowledge about the effect of nursing care on clients.
Behavior system model
Dorothy first proposed her model of nursing care in 1968 as fostering of “the efficient and effective behavioral functioning in the patient to prevent illness".
She also stated that nursing was “concerned with man as an integrated whole and this is the specific knowledge of order we require”.
In 1980 Johnson published her conceptualization of “behavioral system of model for nursing”where she explains her definitions of the behavioral system model.
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
Johnson’s Behavioral Subsystem
Attachment or affiliative subsystem
Attachment or affiliative subsystem is the “social inclusion intimacy and the formation and attachment of a strong social bond.” It is probably the most critical because it forms the basis for all social organization. On a general level, it provides survival and security. Its consequences are social inclusion, intimacy, and formation and maintenance of a strong social bond
Dependency subsystem
Dependency subsystem is the “approval, attention or recognition and physical assistance.” In the broadest sense, it promotes helping behavior that calls for a nurturing response. Its consequences are approval, attention or recognition, and physical assistance. Developmentally, dependency behavior evolves from almost total dependence on others to a greater degree of dependence on self. A certain amount of interdependence is essential for the survival of social groups.
Ingestive subsystem
Ingestive subsystem is the “emphasis on the meaning and structures of the social events surrounding the occasion when the food is eaten.” It should not be seen as the input and output mechanisms of the system. All subsystems are distinct subsystems with their own input and output mechanisms. The ingestive subsystem “has to do with when, how, what, how much, and under what conditions we eat.”
Eliminative subsystem
Eliminative subsystem states that “human cultures have defined different socially acceptable behaviors for excretion of waste, but the existence of such a pattern remains different from culture to culture.” It addresses “when, how, and under what conditions we eliminate.” As with the ingestive subsystem, the social and psychological factors are viewed as influencing the biological aspects of this subsystem and may be, at times, in conflict with the eliminative subsystem.
Sexual subsystem
Sexual subsystem is both a biological and social factor that affects behavior. It has the dual functions of procreation and gratification. Including, but not limited to, courting and mating, this response system begins with the development of gender role identity and includes the broad range of sex-role behaviors.
Aggressive subsystem
Aggressive subsystem relates to the behaviors concerning protection and self-preservation, generating a defense response when there is a threat to life or territory. Its function is protection and preservation. Society demands that limits be placed on modes of self-protection and that people and their property be respected and protected.
Achievement subsystem
Achievement subsystem provokes behavior that tries to control the environment. It attempts to manipulate the environment. Its function is control or mastery of an aspect of self or environment to some standard of excellence. Areas of achievement behavior include intellectual, physical, creative, mechanical, and social skills.
.Behavioral System Model and The Nursing Process
The nursing process of the Behavior System Model of Nursing begins with an assessment and diagnosis of the patient. Once a diagnosis is made, the nurse and other healthcare professionals develop a nursing care plan of interventions and setting them in motion. The process ends with an evaluation, which is based on the balance of the subsystems.Johnson’s Behavioral System Model is best applied in the evaluation phase, during which time the nurse can determine whether or not there is balance in the subsystems of the patient. If a nurse helps a patient maintain an equilibrium of the behavioral system through an illness in the biological system, he or she has been successful in the role.
Representation of Johnson's Model
Goal ----- Set --- Choice of Behavior --- Behavior
Affiliation
Dependency
Sexuality
Aggression
Elimination
Ingestion
Achievement
The Four Major Concepts
the biological system and the behavioral system.
It is role of the medicine to focus on biological
system where as Nursling's focus is the behavioral
system.
“Society” relates to the environment on which
the individual exists. According to Johnson an
individual’s behavior is influenced by the events
in the environment
“Health” is a purposeful adaptive response,
physically mentally, emotionally, and socially
to internal and external stimuli in order to maintain
stability and comfort.
“Nursing” has a primary goal that is to foster
equilibrium within the individual. Nursing is
concerned with the organized and integrated
whole, but that the major focus is on maintaining
a balance in the Behavior system when illness
occurs in an individual.
Nursing process
Assessment
Grubbs developed an assessment tool based on
Johnson’s seven subsystems plus a subsystem she labeled as restorative
which focused on activities of daily living. An assessment based on
behavioral model does not easily permit the nurse to gather detailed
information about the biological systems:
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Affiliation
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Dependency
-
Sexuality
-
Aggression
-
Elimination
-
Ingestion
-
Achievement
-
Restorative
Diagnosis tends to be general to the system
than specific to the problem. Grubb has proposed 4 categories of
nursing diagnosis derived from Johnson's behavioral system model:
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Insufficiency
-
Discrepancy
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Incompatibility
-
Dominance
Implementation of the nursing care related to
the diagnosis may be difficult because of lack of clients input in to
the plan. the plan will focus on nurses actions to modify clients
behavior, these plan than have a goal ,to bring about homeostasis in a
subsystem, based on nursing assessment of the individuals drive, set
behavior, repertoire, and observable behavior. The plan may include
protection, nurturance or stimulation of the identified subsystem.
Evaluation is based on the attainment 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 patterns. Johnson's behavioral model
with the nursing process is a nurse centered activity, with the nurse
determining the clients needs and state behavior appropriate for that
need.
Johnson’s and Characteristics of a theory
-
Interrelate concepts to create a different way of viewing a phenomenon - Concepts in Johnson's theory are interrelated.
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Theories must be logical in nature- Johnson's theory is logical in nature.
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Theories must be simple yet generalizable - The theory is simple.
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Theories can be bases of hypothesis that can be tested - Research studies are conducted applying Jonhson's theory.
-
Theories contribute to and assist in increasing the body of
knowledge within the discipline through the research implemented to
validate them.
-
Theories can be utilized by practitioners to guide and improve their practice.
-
Theories must be consistent with other validated theories,
laws and principles but will leave unanswered questions that need to be
investigated.
Limitation
-
Johnson does not clearly interrelate her concepts of subsystems comprising the behavioral system model.
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The definition of concept is so abstract that they are difficult to use.
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It is difficult to test Johnson's model by development of hypothesis.
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The focus on the behavioral system makes it difficult for
nurses to work with physically impaired individual to use this theory.
-
The model is very individual oriented so the nurses working with the group have difficulty in its implementation.
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The model is very individual oriented so the family of the client is only considered as an environment.
-
Johnson does not define the expected outcomes when one of
the system is affected by the nursing implementation an implicit
expectation is made that all human in all cultures will attain same
outcome –homeostasis.
-
Johnson’s behavioral system model is not flexible.
EXPLANATION OF JOHNSON'S THEORY
Dorothy E. Johnson formulated her Behavioral Systems Model, an
analytical theory or approach to the practice of nursing during the 1960s.
Deploying a rigorous scientific analysis towards human behavior (as embodied in
the psychological approach of B.F. Skinner towards human behavior and
psychology) was increasingly popular in Post-World War II American academic
research and medical practice. Julia George writes in her textbook Nursing
Theories (1994) that Dorothy E. Johnson created her Behavioral System Model to
render the patient’s behaviors the nurse’s primary area of analysis. In other
words, what can be observed is what is important when acting as a nurse, rather
than the patient’s presumed internal state. Treat the patient, not the illness,
and see the patient from the perspective of an observer, not an involved
emotional participant.
In Johnson’s view, every human person was a kind of ecosystem, or constellation of behaviors existing in a state of sufficiency or insufficiency in terms of their needs and balance or imbalance in terms of their homeostatic processes. The behavioral system of the human body and mind has seven subsystems in Johnson’s approach. All of these diverse subsystems are interrelated, although they can be analyzed as separate compartments if this facilitates or enhances the nurses’ ability to initially diagnose the patient’s complaint. These components are as follows: the attachment or affiliative system, the system of dependency, the ingestive system, the eliminative system, the sexual system, the aggressive system, and the achievement system. As well as biological needs, these systems are defined by goals or drives, such as the need to eat that drives the impulses and behavior of the ingestive system and the need for the social esteem of others that drives the actions of the achievement system. (George, 1994)
In Johnson’s view, every human person was a kind of ecosystem, or constellation of behaviors existing in a state of sufficiency or insufficiency in terms of their needs and balance or imbalance in terms of their homeostatic processes. The behavioral system of the human body and mind has seven subsystems in Johnson’s approach. All of these diverse subsystems are interrelated, although they can be analyzed as separate compartments if this facilitates or enhances the nurses’ ability to initially diagnose the patient’s complaint. These components are as follows: the attachment or affiliative system, the system of dependency, the ingestive system, the eliminative system, the sexual system, the aggressive system, and the achievement system. As well as biological needs, these systems are defined by goals or drives, such as the need to eat that drives the impulses and behavior of the ingestive system and the need for the social esteem of others that drives the actions of the achievement system. (George, 1994)
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