Dorothy E.

Johnson, RN, MPH
(1919-1999)
Getting to Know the Theorist
       Dorothy E. Johnson was born August 21, 1919, in Savannah, Georgia. Finished her B. S. N. from Vanderbilt University in Nashville, Tennessee, in 1942. She worked briefly as a public health nurse and in 1944 returned to Vanderbilt as an instructor in Pediatric Nursing. Finished her M.P.H. from Harvard University in Boston in 1948. From 1949 until her 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. She retired at January 1, 1978 and remained active in retirement as a speaker and advocate for nursing education. She died in February 1999.

Influences in Nursing
       Dorothy Johnson has had an influence on nursing through her publications since the 1950s. Her publications included 4 books, more than 30 articles in periodicals, and many papers, reports and proceedings, and monographs. She believed nursing had a body of knowledge reflecting both the science and art 1959 – she proposed that knowledge of the science of nursing necessary for effective nursing can included a synthesis of key concepts drawn from basic and applied sciences 1961 – Johnson proposed that nursing care facilitated the client’s maintenance of a state of equilibrium She proposed that client’s were “stressed” by a stimulus of either an external or internal nature. Johnson recognized two areas of focus for nursing care that are based in giving back to the client to a state of equilibrium, or balance 1. Nursing care should lessen stimuli that are stressors 2. Nursing care should offer support of the client’s normal defenses and adaptive processes 1968 – Johnson first proposed her model of nursing care as the fostering of the “efficient way and effective behavioral functioning in the patient to present illness” She stressed the importance of research-based knowledge about the effect of nursing care on clients. 1980 – Johnson made in print her conceptualization of the Behavioral System Model for Nursing. This is the first work published by Johnson that defines her definitions of the Behavioral System Model.


Metaparadigm in Nursing
Nursing
An external regulatory force acting to preserve the organization of the patient’s behavior by means of imposing regulatory mechanism or by providing resources while the patient is under stress • An art and science that supplies assistance both before and during system balance disturbance and therefore requires knowledge of order, disorder, and control Based on this definition there are 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

Person
• • •

A person has two major systems: the biological system and the behavioral system Nursing’s focus is the behavioral system The person as a behavioral system has patterned, repetitive, and purposeful ways of behaving that link the person to the environment Is an elusive state that is affected by social, psychological, biological and physiological factors The individual is striving to retain some balance or equilibrium

Health
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dysfunctional behavior results. psychological. or the interrelationships among the subsystems are not harmonious.available options a person has to meet goals. Chinn and Buckley • used their concepts and definitions Use of Empirical Evidence Leitch and Escolona • pointed out that tension produces behavioral changes and that the manifestation of tension by an individual depends on both internal and external factor Selye. predisposition to act. some of which can be manipulated by the nurse to achieve the health goal for the patient.through appropriate input of “supplies” from the environment 3.  The patient is a behavioral system with seven interrelated subsystems  Each subsystem can be described and analyzed in terms of structure and functional requirements. experience.motivation for the behaviors 2. Nurturance . 3. The behavioral system attempts to maintain equilibrium in response to environmental factors by adjusting and adapting to the forces that impinge on it. and social factors. 4. behaviors that “enhance growth and prevent stagnation”  The system and subsystems tend to be self-maintaining and self-perpetuating as long as internal and external conditions remain orderly and predictable. Protection – protection from unwanted stimuli 2. psychological.  The responses by the subsystems are developed through motivation. 2 . choice .  The four structural elements that have been identified include: 1. Simmons and Wolf • used their work to support the idea that specific patterns of behavior are reactions to stressors from biological.normal behavior a client prefers to meet goal. drive or goal .  The behavioral system attempts to achieve balance by adapting to internal and environmental stimuli. and sociological sources respectively Caudill • Johnson followed his concept of stress that is . set . Environment • • Theoretical Source Nightingale • The BSM springs from Nightingale's belief that nursing's goal is to help individuals prevent or recover from disease or injury • Nursing should focus on the individual and not the disease itself Talcott Parsons • acknowledged in early developmental writing presenting concepts of then BSM Systems Theory and Rapoport.  If the conditions and resources necessary in their functional requirements are not met.• The individual’s goal is to sustain the entire behavioral system efficiently and effectively but with an adequate amount of flexibility to return to an acceptable balance if a malfunction disrupts the original balance Consists of all the factors that are not part of the individual’s behavior but influence the system. Stimulation . alternatives for action.by experiences.“Stress is a process in which there in interplay between various stimuli and the defenses erected against them” Theoretical Assertions  The theory addresses two major components: (1) the patient and (2) nursing. Grinker. behavior . and learning and are influenced by biological.it will produce an observable outcome which is the individuals behavior  Each of the subsystems has the same three functional requirements: 1.

Health Change Process Active dynamic behavioral system (person. psychological. interaction. Tension 3 .”  A person strives to maintain balance in these parts through adjustments and adaptations to the impinging forces Equilibrium  A key concept in nursing’s specific goal.Drive . It appears to be active and not passive.Choice .Protect . family) Major Concepts and Definitions Behavior  The output of intraorganismic structures and processes as they are coordinated and articulated by and responsive to changes in sensory stimulation.Other changing factors (biological. and integration of the parts and elements.  A state of instability in the system results in need for nursing intervention.Stimulate External Stressors Cue Attachment & affiliation Stress tolerance Flexibility Dependency Sexuality Aggression Elimination Ingestion Achievement Tension Health or Illness Internal stressors (+) or (-) . sociological) Structure .Set . group. interdependency.Behavior Dynamic Equilibrium (Goal) Active dynamic behavioral system (person. The behavioral system manages the environment.Experience . The nurse is external to and interactive with the behavioral system. resting state in which the individual is in harmony with himself and with his environment.Maturation .  It is defined as a stabilized but more or less transitory.Learning . family) Nursing Action .  Identification of the source of the problem in the system leads to appropriate nursing action that results in the maintenance or restoration of behavioral system balance.  Johnson focuses on behavior affected by the actual or implied presence of other social beings that has been shown to have major adaptive significance System  (Rapoport’s) A system is a whole that which functions as a whole by virtue of the interdependence of its parts  (Chinn) “organization. group.Nurture .

 Stimuli may be positive in that they are present. repetitive ways of acting that comprise a behavioral system specific to that individual. or negative in that something desired is absent. attention or recognition. hindering adaptation and causing potential structural damage Stressor  Internal or external stimuli that produce tension and result in a degree of instability. linked. courting and mating. Behavioral System Model  Each individual has patterned. A state of being stretched or strained and can be viewed as an end-product of a disturbance in equilibrium.  These ways of behaving form an organized and integrated functional unit that determines and limits the interaction between the person and his or her environment and establishes the relationship of the person to the objects. and physical assistance • A certain amount of interdependence is essential for the survival of social groups 3. how much. Eliminative Subsystem • addresses when. at times. Attachment/Affiliative Subsystem • probably the most critical because it forms the basis for all social organization • on a general level.  A person as a behavioral system tries to achieve stability and balance by adjustments and adaptations that are successful to some degree for efficient and effective functioning. how. and interrelated where input and output are components  Motivational drives direct the activities of these subsystems. in conflict with the eliminative subsystem • Human cultures have defined different socially acceptable behaviors for excretion of waste 5. how. intimacy and formation and maintenance of a strong social bond 2.  Can be constructive in adaptive change or destructive in inefficient use of energy. and under what conditions we eat • fulfills the need to supply the biologic requirements for food and fluids • It serves the broad function of appetitive satisfaction. it provides survival and security • its consequences are social inclusion. and under what conditions we eliminate • the social and psychological factors are viewed as influencing the biological aspects of this subsystem and may be. Subsystem  A mini system with its own particular goal and function that can be maintained as long as its relationship to the other subsystems or the environment is not disturbed.  The system is usually flexible enough to accommodate the influences affecting it. purposeful. this response system begins with the development of gender role identity and includes the broad range of sex-role behaviors 4 . Sexual Subsystem • serves the biologic requirements for procreation and reproduction • including. Dependency Subsystem • promotes helping behavior that calls for a nurturing response • Its consequences are approval. but not limited to. which are continually changing through maturation.  The seven subsystems are open. experience and learning The Seven Subsystems 1. • The perspective is in the significance and arrangement of the social events surrounding the occasions when food is eaten 4. events and situations within his or her environment. Ingestive Subsystem • has to do with when. what.

which would necessitate the use of the nursing process. • Society demands that limits be placed on modes of self-protection and that people and their property be respected and protected Acceptance by the Nursing Community Practice  The BSM was used to develop a self-report and observational instrument to be carried out with the nursing process 1. aggregates of interactive behavioral systems. Investigating methods of gathering diagnostic data or problem solving activities as these influences the behavioral system Analysis Simplicity • Johnson’s theory is relatively simple in relation to the number of concepts. • However. 1. Generality • Relatively unlimited when applied to sick individuals. Grubbs (1980) – developed an assessment tool and a nursing process sheet based on Johnson’s seven subsystems. • Nursing is an external regulatory force.  The theory resulting form the BSM influences to the researcher to choose between two options. the student would need knowledge from the social and behavioral disciplines and the physical and biological sciences. Education  A core curriculum based on a person as a behavioral system would have definite goals and clear course planning  The study would center on the patient as a behavioral system and its dysfunction. Achievement Subsystem • Attempts to manipulate the environment • Functions to master and control the self or the environment to some standards of excellence • Areas of achievement behavior include intellectual. • A person is described as a behavioral system composed of seven subsystems. and develop good reasoning for the means of management.  Understanding of the systems theory. mechanical and social skills 7. physical.  The implementation of the instrument provided a more comprehensive and organized step to assessment and intervention. Examine the functioning of the system and subsystems by focusing on the Basic Sciences 2. This tool allowed the nurse to objectively describe the child’s behavior and to guide nursing action 3. the theory is potentially complex because there is a number of a possible interrelationship between and among the behavioral system. Holaday (1980) – used the theory to develop an assessment tool when caring for children. • Perceives a person as a behavioral system comprised of seven subsystems. which contends that aggressive behavior is not only learned. but has a primary intent to harm others. but it has not been used as much with well individuals or groups. Research  Nursing research is vital to explain and identify behavioral system disorders which rise in relation with illness. creative.6. 5 . thereby increasing patient and nurse satisfaction with care. 2. its subsystems. Derdiarian (1990) – investigated the effects of using two system assessment instruments on patient and nurse satisfaction. and the forces impinging on them. Aggressive/Protective Subsystem • functions in self and social protection and preservation • This follows the line of thinking of ethologists such as Lorenz and Feshbach rather than the behavioral reinforcement school of thought.

Nursing needs to concentrate on developing preventive nursing to fulfill its social obligations. 2010.• Nursing’s special responsibility for health is derived from its unique social mission. C.Nurturance . • The theory clearly differentiates nursing from medicine. Theoretical basis for nursing. 2009 to January 1.). Pearson Prentice Hall McEwen. Antecedent Variable Independent Variable Dependent Variable Personal Characteristics Age Civil Status Economic Status Gravidity Parity Functional requirements of the Behavioral System Model . civil status. George. (5th ed. (2nd ed. education. A. and research. (5th ed. Ultimate Learning Series  http://www. & Balita. M. (2002).edu/biolib/hc/biopages/djohnson. practice and research. • Practitioners and patients have judged the resulting nursing actions to be satisfactory.Protection .Stimulation Level of stress experienced by postpartum patients High Moderate Low References: Tomey. Mosby Inc. Derivable Consequences • Guides nursing practice. Nursing theories: The base for professional nursing practice. Theoretical foundation of Nursing: The Philippine perspective. to determine the level of stress experienced by postpartum patients 4. gravidity and parity 5. E. W. to determine the significant difference of the nursing care based on the functional requirements of the behavioral system of postpartum patients when grouped according to age. Lippincott Williams & Wilkins. To determine the level of stress experienced by postpartum patient in the OB ward of Iloilo Mission Hospital Specific Objectives: 1. E. to determine the significant difference of the level of stress experienced by postpartum patients when grouped according to age. economic status. J. to determine the nursing care based on the functional requirements of the behavioral system model 3. economic status.mc.html     6 . General Objectives: 1. gravidity and parity 6. • Provides a conceptual framework for nursing education. generates new ideas about nursing. civil status. • The clarity of definitions in the subsystems improves the model’s empirical precision. civil status. • The units and the relationships between the units in Johnson’s theory are consistently defined and used. to determine the significant relationship between the nursing care based on the functional requirements of the BSM and the level of stress experienced by postpartum patients.). Application of this theory Problem: Level of stress experienced by Postpartum Patients in the OB Ward of Iloilo Mission Hospital Target Population: Postpartum patients admitted in the OB ward of IMH from August 1. Empirical Precision • Empirical precision improves when the subconcepts and the relationships between and among the subconcepts become better defined and empirical indicators are introduced to the science. gravidity and parity 2. economic status. Octaviano. although the concepts overlap with the psychosocial professions.). & Alligood.vanderbilt. Nursing theorists and their work. and differentiates nursing from other health professions. & Wills. to determine the personal characteristics as to age.

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