HOLY CROSS COLLEGE OF NURSING, KOTIYAM

ADVANCED NURSING PRACTICE

SEMINAR

ON

JOHNSON’S THEORY

SUBMITTED BY, SUBMITTED TO,

MR. GIREESH S PILLAI MS. AMRITHA

I YEAR MSC NURSING LECTURER

HOLY CROSS COLLEGE OF HOLY CROSS COLLEGE OF

NURSING NURSING

SUBMITTED ON:08.02.2020
 JOHNSON’S BEHAVIORAL SYSTEM MODEL

INTRODUCTION

The Behaviour system model of nursing was developed by Dorothy e. Johnson. It stresses the
importance of research-based knowledge about the effect of nursing care on patients. When she first
proposed the theory in 1968, she explained that it was to foster “the efficient and effective
behavioural functioning in the patient to prevent illness.” Dorothy e. Johnson is well-known for
her “behavioural system model,” which was first proposed in 1968. Her model was greatly
influenced by Florence nightingale’s book, notes on nursing. It advocates the fostering of efficient
and effective behavioural functioning in the patient to prevent illness and stresses the importance
of research-based knowledge about the effect of nursing care on patients.

Johnson’s behavioural system model is a model of nursing care that advocates the fostering of
efficient and effective behavioral functioning in the patient to prevent illness. The patient is
identified as a behavioral system composed of seven behavioral subsystems: affiliative,
dependency, ingestive, eliminative, sexual, aggressive, and achievement. The three functional
requirements for each subsystem include protection from noxious influences, provision for a
nurturing environment, and stimulation for growth. An imbalance in any of the behavioral
subsystems results in disequilibrium. It is nursing’s role to assist the client to return to a state of
equilibrium.

CREDENTIALS AND BACKGROUND OF THE THEORIST

DOROTHY E. JOHNSON (AUGUST 21, 1919 – FEBRUARY 1999)

Dorothy Johnson was born on august 21, 1919 in savannah, Georgia. She was the youngest of 7
children. Her father was the superintendent of a shrimp and oyster factory and her mother was very
involved and enjoyed reading. She finished her associates of arts degree in 1938 from
Armstrong junior college in savannah, Georgia. Due to the great depression, she took a year
off from school to be a governess, or teacher, for 2 children in Miami, Florida. Thesis when she
began to realize her love for children, nursing and education.in 1942, Dorothy received her
bachelor’s of science in nursing from Vanderbilt university in Nashville, tennessee.in 1948, she
received her master’s in public health from Harvard university in Boston, Massachusetts. After
graduation, she worked for one year in public health nursing and began to teach at Vanderbilt
University.
After 5 years, she moved to california where she was an instructor forpediatrics in the school
of nursing at the university of California, Losangeles. She worked at ULCA until she retired in
1978, except for one year in 1955when Dorothy took sabbatical from ULCA to teach in Vellore,
south India at CMC. she died in february 1999 at the age of 80. She began to use different ways to
build and present knowledge and began to change her practice based on the outcomes. After
more than 15years, she began to think of man and the behavioral systems model and how it best
supported nursing practice.

Johnson stated that her theory is a product of philosophical ideas; soundtheory and research;
her clinical experiences; and many years of thinking, discussing, and writing. Johnson
identified that her work was inspired by:

Florence nightingale –“mother of nursing” - environmental theory

Hans seyle –“father of stress” - general adaptation syndrome theory(aka stress syndrome)

Talcott parsons– structural-functional approach

Rapoport, chin, von bertalanffy, and buckley – system theory (concepts and definitions)she
adapted portions of her theory from the listed theorists in order to perfect her theory on the
behavioral system model. Johnson's theory is also based on a systems paradigm, as perceived from
a sociological perspective.

BEHAVIORAL SYSTEM MODEL

Dorothy johnson’s theory defined 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.”

It also states that “each individual has patterned, purposeful, repetitive ways of acting that comprises
a behavioral system specific to that individual.”

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:

 Whose behavior commensurate with social demands.

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

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:

 First, there is “organization, interaction, interdependency and integration of the parts and
elements of behaviors that go to make up the system ”
 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.”
 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.
 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

o “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”
o 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”.
 o Each subsystem has a repertoire of choices or “scope of action”
o The fourth assumption is that it produce “observable outcome” that is the individual’s
behavior.
o Each subsystem has three functional requirements
o System must be “protected" from noxious influences with which system cannot cope”.
o Each subsystem must be “nurtured” through the input of appropriate supplies from the
environment.
o Each subsystem must be “stimulated” for use to enhance growth and prevent stagnation.
o These behaviors are “orderly, purposeful and predictable and sufficiently stable and
recurrent to be amenable to description and explanation”

MAJOR CONCEPTS

The following are the major concepts and definitions of the johnson’s nursing model including the
definition for its nursing metaparadigm:

Human beings

Johnson views human beings as having two major systems: the biological system and the behavioral
system. It is the role of medicine to focus on the biological system, whereas nursing’s focus is the
behavioral system.

The concept of human being was defined as a behavioral system that strives to make continual
adjustments to achieve, maintain, or regain balance to the steady-state that is adaptation.

Environment: environment is not directly defined, but it is implied to include all elements of the
surroundings of the human system and includes interior stressors.

Health: health is seen as the opposite of illness, and Johnson defines it as “some degree of regularity
and constancy in behavior, the behavioral system reflects adjustments and adaptations that are
successful in some way and to some degree… adaptation is functionally efficient and effective.”

Nursing: nursing is seen as “an external regulatory force which acts to preserve the organization
and integration of the patient’s behavior at an optimal level under those conditions in which the
behavior constitutes a threat to physical or social health, or in which illness is found .
SUBCONCEPTS

 Structure

The parts of the system that make up the whole.

 Variables

Factors outside the system that influence the system’s behavior, but which the system lacks power
to change.

 Boundaries

The point that differentiates the interior of the system from the exterior.

 Homeostasis

Process of maintaining stability.

 Stability

Balance or steady-state in maintaining balance of behavior within an acceptable range.

 Stressor

A stimulus from the internal or external world that results in stress or instability.

 Tension

The system’s adjustment to demands, change or growth, or to actual disruptions.

 Instability

State in which the system output of energy depletes the energy needed to maintain stability.

 Set

The predisposition to act. It implies that despite having only a few alternatives from which to select
a behavioral response, the individual will rank those options and choose the option considered most
desirable.

 Function

Consequences or purposes of action

SUBSYSTEMS OF THE BEHAVIOR SYSTEM MODEL

Johnson identifies seven subsystems in the behavioral system model. They are:

 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 the 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.

EACH OF THE SEVEN SUBSYSTEM CAN BE DESCRIBE ANDANALYZED IN TERMS

OFSTRUCTURAL AND FUNCTIONALREQUIREMENTS.

The Four Structural Elements:

Drive or goal

– the ultimate consequence of behaviourism it.

 Set

– a tendency or predisposition to act in a certain way

Set is subdivided into two types:

O Preparatory – what a person usually attends to

O Perseverative – the habits that one maintains in asituation

Choice

– represents the behavior a patient sees herself asbeing able to use in any given situation

Action

– the behavior of an individual

The Three Functional Requirements:

1.Protection

- from noxious influences with which system cannot cope..

2.Nurturance

- through the input of appropriate supplies from the environment.

3.Stimulation: to enhance growth and prevent stagnation. These functional requirements must
be met through the persons own efforts, or with the outside assistance of the nurse.

For the subsystems to develop and maintain stability, each must have a
constant supply of these functional requirements that usually are supplied
bythe environment. However, during illness or when the potential for illnessposes a threat, the
nurse may become a source of functional requirements.

REPRESENTATION OF JOHNSON'S MODEL

Goal ----- set --- choice of behavior --- behavior

 Affiliation
 Dependency
 Sexuality
  Aggression
 Elimination
 Ingestion
 Achievement

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.

STRENGTHS

o Dorothy Johnson’s theory guides nursing practice, education, and research; generates new
ideas about nursing; and differentiates nursing from other health professions.
o It has been used in inpatient, outpatient, and community settings as well as in nursing
administration. It has always been useful to nursing education and has been used in practice
in educational institutions in different parts of the world.
o Another advantage of the theory is that johnson provided a frame of reference for nurses
concerned with specific client behaviors. It can also be generalized across the lifespan and
across cultures.
o The theory also has potential for continued utility in nursing to achieve valued nursing goals.

WEAKNESSES

 The theory is potentially complex because there are a number of possible interrelationships
among the behavioral system, its subsystems, and the environment. Potential relationships
have been explored, but more empirical work is needed.
 Johnson’s work has been used extensively with people who are ill or face the threat of
illness. However, its use with families, groups, and communities is limited.
  Though the seven subsystems identified by johnson are said to be open, linked, and
interrelated, there is a lack of clear definitions for the interrelationships among them which
makes it difficult to view the entire behavioral system as an entity.
 The problem involving the interrelationships among the concepts also creates difficulty in
following the logic of johnson’s work.

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:

Affiliation
Dependency
Sexuality
Aggression
Elimination
Ingestion
Achievement
Restorative

Diagnosis

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:

Insufficiency
Discrepancy
Incompatibility
Dominance

Planning and implementation

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

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.
Theories must be logical in nature- Johnson's theory is logical in nature.
Theories must be simple yet generalizable - The theory is simple.
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.
 The definition of concept is so abstract that they are difficult to use.
 It is difficult to test Johnson's model by development of hypothesis.
 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.
  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.

IMPLICATIONS

Practice:

The Johnson behavioral systemmodel was used to develop a self-report and

observational instrument to be carried out with the nursing process.

The i m p l e m e n t a t i o n o f t h e instrument provided a more comprehensive and

organized step to assessment and intervention, thereby increasing patient and nurse satisfaction with
care. Moreover, this theory was used as a model to develop as assessment tool when
caring for children. This tool allowed the nurse to objectively describe the child’s behavior and to
guide nursing action (octaviano and balita, 2008).

Education

A c o r e c u r r i c u l u m b a s e d o n a p e r s o n a s a b e h a v i o r a l s ys t e m w o u l d h a v e defi
nite goals and clear course of planning. The study would centre on the patient as a
behavioral system and its dysfunction, which would necessitate the use of the nursing process.
In addition to an understanding of systems theory, the student would need knowledge
from the social and behavioral discipline and the physical and biological sciences.

Research
Nursing research, according to Johnson, is vital to explain and identify the behavioral
system disorders which arise in relation with illness, and develop good reasoning for the means of
management. The theory resulting from the behavioral system model influences to the researcher to choose
between two options.one researcher might examine the functioning of the system and subsystem by
focusing on the basic sciences and another researcher might focus on
investigating methods of gathering diagnostic data or problem-
s o l v i n g activities as these influences the behavioral system (octaviano and balita,2008)
JOURNAL ABSTRACT

Fruehwirth SE ;An application of Johnson's behavioral model: a case study. J Community Health
Nurs. 1989;6(2):61-71 PMID:2723701 :DOI:10.1207/s15327655jchn0602_2

The utilization of Johnson's approach to assess clients' behavioral systems demonstrated that it is
an effective way of determining the many factors that impinge on an individual's ability to cope
with and adapt to change. Small (1980) used the Johnson model as a conceptual framework in
assessing the needs of visually impaired children and found that for nursing practice, the Johnson
model was a practical tool for implementing all phases of the nursing process encompassing the
child's feelings, needs, and desires. Holaday (1980) combined the Johnson model and the Piagetian
theory to assess the cognitive development of a 6-year-old, chronically ill child. She found that use
of this model for assessment allows the nurse to describe objectively the patient's behavior, which
serves to indicate the presence of any disequilibrium. The Johnson model can also be used
successfully in a group situation such as a support group for Alzheimer's caregivers, where problem
solving and making choices to adapt to lifestyle changes are a definite requirement. For professional
nurses in clinical practice, the application of models for assessment of clients will allow them to
categorize the phenomena they observe and to gain insight into the clinical situations with which
they deal.

CONCLUSION

Johnson’s behavioral system model describes the person as a behavioral system with seven
subsystems: the achievement, attachment-affiliative, aggressive protective, dependency, ingestive,
eliminative, and sexual subsystems. Each subsystem is interrelated with the others and the
environment and specific structural elements and functions that help maintain the integrity of the
behavioral system.

Through these, the focus of her model is with what the behavior the person is presenting making
the concept more attuned with the psychological aspect of care in.

When the behavioral system has balance and stability, the individual’s behaviors will be purposeful,
organized, and predictable. Imbalance and instability in the behavioral system occur when tension
and stressors affect the relationship of the subsystems or the internal and external environments.
Johnson’s Behavioral system model is a model of nursing care that advocates the fostering of
efficient and effective behavioral functioning in the patient to prevent illness. The patient is defined
as behavioral system composed of 7 behavioral subsystems. Each subsystem composed of four
structural characteristics i.e. drives, set, choices and observable behavior.

Three functional requirement of each subsystem includes

(1) Protection from noxious influences,

(2) Provision for the nurturing environment, and

(3) stimulation for growth.

Any imbalance in each system results in disequilibrium .it is nursing role to assist the client to return
to the state of equilibrium.

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