DOROTHY JOHNSON

INTODUCTION
A theory is a group of related concepts that proposed action that guide practice. A nursing
theory is a set of concepts, definitions, relationships, and assumptions or propositions derived
from nursing models or from other disciplines and project a purposive, systematic view of
phenomena by designing specific inter-relationships among concepts for the purposes of
describing, explaining, predicting, and/or prescribing.
CREDENTIALS AND BACKGROUND OF THE THEORIST

 Dorothy E. Johnson was born Aug. 21, 1919, in Savannah, Georgia. She-received her
A.A. from Armstrong Junior College in Savannah, Georgia, in 1938; her B.S.N. from
Vanderbilt University in Nashville, Tennessee, in 1942; and her M.P.H. from Harvard
University in Boston in 1948. Most of Johnson's professional experiences involved
teaching, although she was a staff nurse at the Chatham-Savannah Health Council
from 1943 to 1944. She has been an instructor and an assistant professor in paediatric
nursing at Vanderbilt University School of Nursing. From 1949 until her retirement in
1978 and subsequent move to Florida, Johnson was an assistant professor of
paediatric nursing, an associate professor of nursing, and a professor of nursing at the
University of California in Los Angeles.

 In 1955 and 1956 Johnson was a paediatric nursing advisor assigned to the Christian
Medical College School of Nursing in Vellore, South India. In addition, from 1965 to
1967 she chaired the committee of the California Nurses' Association that developed a
position statement on specifications for the clinical specialist. Johnson's publications
include four books, more than 30 articles in periodicals, and many reports,
proceedings, and monographs.

 Of the many honours she has received, the ones Johnson is proudest of are 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. She is pleased that
her behavioral system model has been found useful in furthering the development of a
theoretical basis for nursing, but says her greatest source of satisfaction, has come
from following the productive careers of her students.

THEORETICAL SOURCES
Johnson's behavioral system theory springs from Nightingale's belief that nursing's goal is to
help individuals prevent or recover from disease or injury." The science and art of nursing
should focus on the patient as an individual and not on the specific disease entity.
Johnson uses the work of behavioural sciences in psychology, sociology, and ethnology to
develop her theory. She relies heavily on the systems theory and uses concepts and
definitions from A. Rapoport, R. Chin, and W. Buckky. The structure of the behavioral
system theory is patterned after a systems conduct, a system is defined as consisting of
interrelated parts mentioning together to form a whole. In her writings, Johnson
conceptualizes man as a behavioral system in which the functioning outcome is observed
behaviour) An analogy to the behavioral system theory is the biological system theory, which
states that man is a biological system consisting of biological parts and that disease is an
outcome of biological system disorder.

Developing the theory from a philosophy perspective, Johnson writes that nursing contributes
by facilitating effective behaviour functioning in the patient before, during, an following
illness. She uses concepts from other disciplines, such as social learning, motivation sensory
stimulation, adaptation, and behavioral modification, to expand her theory.

Johnson notes that although the literature indicates others support the idea that man is
behavioral system, as far as she knows, the idea is original with her. Knowledge of the parts
of the behavioural system is supported in the behavioral sciences, but the empirical literature
supporting the nation that the behavioral system is a whole has yet to be developed. In the
biological system, knowledge of the parts precedes knowledge of the whole.

EMPIRICAL EVIDENCE
Some of the concepts Johnson has identified and defined in her theory are supported in the
literature. Leitch and Escolona point out that? tension produces behavioral changes and that
the manifestation of tension by an individual depends on both internal and external factors.
Johnson uses the work of Selye, Grinker, Simmons, and Wolff to support the idea that
specific patterns of behavior are reactions to stressors from biological, psychological and
sociological sources, respectively.

In Conceptual Models for Nursing Practice, Johnson describes seven subsystem that comprise
her behavioral system. To support the attachment-affiliative subsystem, she uses the work of
Ainsworth and Rolson. Hearthers, Gerwitz, and Rosenthal here described and explained
dependency behavior, another subsystem defined by Johnson. The response systems of
ingestion and elimination, as described by Walike, Mead, and Sears, are also parts of
Johnson's behavioral system. The work of Kagan and Resnit is used to support the sexual
subsystem. The aggressive sub- system which functions to protect and preserve, is supported
by Lorenz and Feshbach. According to Atkinson, Feather, and Crandell, physical, creative,
mechanical, and social skills are manifested by achievement behavior, another subsystem
identified by Johnson.

ASSUMPTIONS OF THE BEHAVIOURAL SYSTEM MODEL

There are several layers of assumptions that Johnson makes in the development of
conceptualization of the behavioural system model (Johnson was influenced by Buckley,
Chin and Rapport) there are 3 assumptions:

ASSUMPTION ABOUT SYSTEM

1. First assumption states that there is "organization, interaction, interdependency and

integration of the parts and elements of behaviours 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 behavioural system balance and steady state
by more or less automatic adjustments and adaptations to the natural forces impinging upon
him.

3. A behavioural system, which both requires and results in some degree of regularity and
constancy in behaviour, 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. The final assumption states "system balance reflects adjustments and adaptations that are
successful in some way and to some degree."

ASSUMPTION ABOUT STRUCTURE

The four assumptions about structure are that: (1) "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." (2) Each person has a "predisposition to act concerning the goal, in certain
ways rather than the other ways." This predisposition is called a "set." (3) Each subsystem
has a repertoire of choices called a "scope of action." And (4) The individual patient's
behavior produces an outcome that can be observed.

ASSUMPTION ABOUT FUNCTION

There are three functional requirements for the subsystems.:

(1) The system must be protected from toxic influences with which the system cannot cope.
(2) Each system has to be nurtured through the input of appropriate supplies from the
environment. And (3) The system must be stimulated for use to enhance growth and
prevent stagnation.

MAJOR CONCEPTS AND DEFINITIONS

BEHAVIOR:

Johnson focuses on behaviour affected by the actual or implied presence of other social
beings that has been shown to have major adaptive significance.

SYSTEM:

Johnson states “A system is a whole that functions as a whole by virtue of the

interdependence of its parts”. She accepts Chins statement that there is “organization,
interaction, interdependency, and integration of the parts and elements.

BEHAVIOURAL SYSTEM:

A behavioural system comprises the pattern , repetitive & purposeful ways of

behaving men as a behavioural system tries to achieve stability & balanced by
adjustment & adaptation that are successful to some degree for efficient &
effective functioning .

FIVE CORE PRINCIPLES

1. Wholeness and order.

2. Stabilization.

3. Reorganization.

4. Hierarchic interaction and

5. Dialectical contradiction.

1. WHOLENESS AND ORDER

The development analogy of wholeness and order is continuity and identity. The issues
should be cast in terms of determining pattern of interaction. Johnson's work infers that
continuity is in the relationship of the parts rather than in their individuality Johnson (1990)
noted that at psychological level, attachment and dependency are the examples of important
specific behaviors that change overtime while representation may remain the same.

2. STABILIZATION

Stabilization or behavioral system balance is another core principle of this system. Systems
have a set point that they try to maintain by altering internal conditions to compensate for
changes in external conditions. Human thermoregulation is an example of a homeostatic
process that is primarily biological but is also behavioral.

3. REORGANIZATION

Adaptive reorganization occurs when behavioral system encounters new experiences in

environment that cannot be balanced by existing system mechanism. Adaptation is defined as
a change that permits behavioral system to maintain its set point best in new situations. To the
extent that the behavioral system cannot assimilate new conditions with existing regulatory
mechanisms, accommodation must occur either as a new relationship between subsystem.

The difference between stabilization and reorganization is that the latter involves change or
evolution. The diagnosis of chronic illness, birth of children, or development of healthy
lifestyle are the examples of accommodation that not only promotes behavioural system but
also involve developmental process.

4. HIERARCHIC INTERACTION

Each behavioral system exists in a context of hierarchic relationship and environment

relationship. Hierarchic or a pattern of relying on particular subsystem, leads to a degree of
stability. A disruption or failure will not destroy the whole system but leads instead to a
decomposition to the next level of stability. For example, one's lifestyle prior to survey is not
a good fit post- operatively. This discontinuity can promote opportunity for reorganization.

5. DIALECTICAL CONTRADICTION

The last core principle is the motivational force for the behavioral change. Johnson in 1980
described these as drives and noted that these responses are developed and modified overtime
through maturation, experience and learning. By acting on the world, each person is
constantly changing it and his or her goal and therefore changing what he or she needs to
know. The number of environmental domains that the person is responding to include the
biological, psychological, cultural, familial, social, and physical setting. The person needs to
resolve a cascade of contraindication between goals related to physical status, social roles and
cognition status when faced with illness or threat of illness. Nurse's intervention during these
periods can make a significant difference in the lives of the persons involved.

METAPARADIGM OF JOHNSONS THEORY

The following are the major concepts and definitions of 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
behavioural system. It is the role of medicine to focus on the biological system, whereas
nursing focuses on the behavioural system.

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

Subsystem- Have a set of behavioural responses that are developed and modified through
motivation, experience and learning.

Environment

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

Subsystem – Carryout the specialized tasks/functions needed to maintain the integrity of the
whole system.

- Manage the system relationship to the environment.

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 somehow, and to some degree… adaptation is functionally efficient and
effective.”

Subsystem – Demonstrated by observed behaviour that is purposeful, orderly and

predictable.

- Behaviour is maintained when it is efficient and effective in managing the persons

relationship to the environment.

Nursing

Nursing is seen as “an external regulatory force that acts to preserve the organization and
integrate 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.

Subsystem – To restore, maintain or attain behavioural system balance and stability at the
highest possible level for the individual.

Nursing and Nursing Therapeutics

• Nursing is "a service that is complementary to that of medicine and other health professions,
but which makes its own distinctive contribution to the health and well-being of people."

• Nursing views patients as behavioral systems, and medicine views patients as biological
systems.

Nursing Therapeutics

 Attempt to repair damaged structural units by altering the individual's set and choice

 Impose regulatory and control measures

  Supply or help the client find his or her own supplies of essential functional
requirements

Johnson’s Behavioral System Model

Dorothy E. Johnson is well-known for her “Behavioral System Model,” which was first
proposed in 1968. Her model was greatly influenced by Florence Nightingale’s book, Notes
on Nursing. It advocates fostering efficient and effective behavioral functioning in the patient
to prevent illness and stresses and the importance of research-based knowledge about the
effect of nursing care on patients.

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.”
 JOHNSON'S BEHAVIOURAL SUBSYSTEM
1. Attachment or affiliative subsystem:
 Behavior associated with the development and maintenance of
interpersonal relationships with parents, peers, authority figures.
 Establish a sense of relatedness and belonging with others including
attachment behavior, interpersonal relationships and communication
skills.
 Goal attainment
2. Dependency subsystem:
• Behaviour associated with obtaining assistance from others in the environment for
completing tasks and/or emotional support.
• Includes seeking of attention, approval, recognition, basic selfcare skills and
emotional security.

3. Ingessive subsystem: Behaviours associated with the intake of needed resources from
the external environments, including food, fluid, information, knowledge and objects for
the propose of establishing an effective relationship with the environment.

4. Eliminative subsystem: "• Behaviour associated with the release of physical waste
products from the body, Express feelings etc.

5. Sexual subsystem: "Behaviour associated with a specific gender based identity for the
purpose of ensuring pleasure/procreation, and knowledge and behaviour being congruent
with biological sex.

6. Aggressive subsystem:

 Behaviour associated with real or potential threat in the environment for the
purpose of ensuring survival.
 Protection of self through direct or indirect acts.
 Identification of potential danger.

7. Achievement subsystem
  Behaviour associated with mastery of oneself and one's environment for the
purpose of producing a desired effect.
 Includes problem solving activity
 Knowledge of personal strengths and weaknesses.

STRUCTURAL COMPONENTS OF SUBSYSTEM

Each subsystem is composed of at least four structural components that interact in a specific
pattern –

 Goal
 Set
 Choice
 Action

Goal:
 This is defined as the desired result on consequences of the behaviour.
 Basis for the goal is a universal drive whose existence can be supported by scientific
research.

Set/Behavioural set:
 Predisposition to act in a certain way in a given situation
 Pattern of responses to particular drives/stimuli
 Represents learn behaviour and its influenced by knowledge, attitudes and beliefs

Components of behavioural set –

Preservation – consistent tendency to react to certain stimuli with the same

pattern of behaviour.
Preparation – functions to establish priorities for attending or not attending to
various stimuli.

Choice:

Refers to individuals’ alternative behaviours in a situation that will best meet the goal
and attain the desired outcome.
The greater the behavioural repertoire of alternative behaviours in a situation, then
more adaptable the individual.
 Action:

Concerns is with the efficiency and effectiveness of the behaviour in goal attainment.
Actions are observable responses to stimuli.

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.

Johnson believes each individual has patterned, purposeful, repetitive ways of acting that
comprise a behavioural system specific to that individual. These actions and behaviours form
an organized and integrated functional unit that determines and limits the interaction between
the person and his environment and establishes the relationship of the person to the objects
event situations in the environment. These behaviours are "orderly, purposeful and
predictable and sufficiently stable and recurrent to be amenable to description and
explanation"

Functional Requirements
 Protection

Nurturance stimulation

STRENGTHS –

 Dorothy Johnson’s theory guides nursing practice, education, and research, generate
new ideas about nursing; and differentiates nursing from other health professions.
 Frame of reference for nurses concerned with specific client behaviours.

 Can be generalized across the lifespan and across cultures.

 The theory serves as a tool or guide to motivate patient or the behavior of man
during distress.
 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 educational
institutions in different parts of the world.

Limitations -

 Very individualistic
 Family of the client is only considered as environment
 Focused on the nursing care of the hospitalized and ill
 Does not focus on health promotion, primary prevention, or disease prevention
ACCEPTANCE BY THE NURSING COMMUNITY

Practice

According to Johnson, 15 the behavioral system theory provides direction for practice, educa
tion, and research. Because the goal of the theory is to maintain and restore balance in the
patient by helping him achieve a more optimal level of functioning, a goal also valued by
nurs ing, the theory is acceptable to nursing. Knowledge of the behavioral system theory
allows the nurse to be aware of the importance of providing a constant supply of protection,
nurturing, and stimulation.

In 1974 Judy Grubbs adapted the theory to the nursing process by developing an assessment
tool and a nursing process sheet based on the seven subsystems. Questions and observations
related to each subsystem provided powerful tools with which to collect important data. By
using these tools, the nurse can discover other choices of behavior that will enable the patient
to accomplish his goal of health.

That same year Bonnie Holaday used the theory as a model to develop an assessment tool
when caring for children. This tool allowed the nurse to objectively describe the child's
behavior and to guide nursing action. Holaday concluded that the user of Johnson's theory
was provided with a guide for planning and giving care based on scientific knowledge.

In 1980 Antionette Rawls presented her attempt to use and evaluate the Johnson behavioral
system theory in clinical practice. She used the theory to systematically assess a patient who
was facing the loss of function in one arm and hand. Rawls concluded that Johnson's theory
provided a tool that predicted the results of nursing intervention. formulation standards for
care, and administered holistic care.

Education

Carol Loveland-Cherry and Sharon Wilkerson analyzed Johnson's theory and concluded that
it has utility in nursing education. A curriculum based on man as a behavioral system would
have definite goals and straight forward course planning. Study would centre on the patient as
a behavioral system and its dysfunction, which would require use of the nursing process. In
addition to an understanding of systems theory, the student would need knowledge in the
biological fields and emphasis on psychology and sociology.

Research

The behavioral system theory leads the re- searcher in one of two directions. One re- searcher
might investigate the functioning of the system and subsystems by focusing on the basic
sciences, while another researcher might concentrate on investigating problemsolving
activities as they influence the behavioral system.

JOHNSON’ BEHAVIOUR SYSTEM THEORY USED IN NURSING

PROSSES

SITUATION

J Smith, 6 weeks brought into the clinic for a routine check-up. He presents with no weight
gain since his last check up at the age of 2 weeks. His mother stated she feeds him but he
does not seem to eat much. He sleeps 4 to 5 hours between the feedings. His mother holds
him in her arms without trunk-to-trunk contact. As the assessment is made the nurse notes
that Mrs. Smith never looks at Johnny and never speaks to him. She stated he was a planned
baby but that she never realized how much worth a baby could be. She says, her mother told
her she was not a good mother because John is not gaining weight like he should. She states
she had not called the nurse when she knew John was not gaining weight because she thought
nurse would think she was a bad mother just like her own mother thought she was a bad
mother.

Assessment

1. Affiliative subsystem between mother and John.

2. Dependency subsystem between mother and John

3. Insufficiency ingestion subsystem.

Diagnosis

1. Risk for Impaired parent/infant/child attachment.

2. Delayed growth and development.

3. Ineffective breast feeding

Planning and implementation

1. . Teach her to bring a bond between her and the baby by touch, pat and cuddles etc

2. Increasing mother's awareness of the baby's clues

3. Assisting her to talk with the baby and teach about feeding technique..

Evaluation

1.. The infant interaction could be assessed, using the nursing child assessment feeding scale

2 . Johnny's weight gain or weight loss will be carefully assessed.

3 .Feeding technique of Mrs.Smith gradually improving .

JOURNAL

The Effect of Behavioral System Model Based Nursing

Intervention on Adolescent Bullying
Derya Evgin and Meral Bayat

Abstract

Method

As a result of the power analysis performed, eighty-three students (43 in study group, 40 in
control group) attending 7th degree were recruited. Education is given in nine sessions with
creative drama method. Data were collected with Individual Information Form, Traditional
Peer Bullying Scale, Problem-Solving Inventory for Children, and the Empathy Index for
Children. Data were analyzed with decrease/increase in percentage, Cronbach α, chi-square,
two way/two factor repeated measures analysis of variance (Post-Hoc: Bonferroni) and
Mann–Whitney U tests.

Results

The decrease in percentage in the mean Traditional Peer Bullying Scale scores of study group
students was higher than those of control group (p<0.05). Mean pre-education 1st
measurement Traditional Peer Bullying Scale scores of study group students were reduced in
the post-education 2nd and 3rd measurements (p<0.05). The increase in percentage in the mean
Problem-Solving Inventory for Children and Empathy Index for Children scores of study
group students was higher than those of control group (p<0.05). The mean pre-education
1st measurement scores of PSIC and Empathy Index for Children was increased in post-
education 2nd and 3rd measurements (p<0.05).

Conclusion

Drama education is effective on prevention of bullying, and that may be used in prevention
programs.

Keywords: Adolescent health, Behavioral System Model, bullying, creative drama,

school nursing

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
behavioral system’s integrity.

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

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 subsystems’ relationship or the internal and
external environments.
 BIBLIOGRAPHY :

1. Basheer Shebeer. P , Khan S . Yaseen . “ A Concise Text book of Advanced Nursing

Practice .” 2nd Edition .Mahalakshmipuram , Bangalore : Emmess medical Publishers ;
2017 . Page No 427-430.
2. Bhaskar E's, "Nursing Theories-A practical view New Delhi, Jaypee brothers medical
publishers(p)Ltd, 2011, P-50-63.
3. Soni S's, "Text book of Advanced Nursing Practice New Delhi, Jaypee Brothers

medical publishers(p)Ltd,2013, P- 352-355.

4. Brar N.K, Rawat HC, “ Text Book Of Advanced Nursing Practice” 1 st edition.,

Ansari Road , New delhi, JAYPEE Brothers;2015. P.624-634.

5. Journal:- Author- “The Effect of Behavioral System Model Based Nursing

Intervention on Adolescent Bullying”, https://www.ncbi.nlm.nih.gov> articles >
PMC7968463