BAHIR DAR UNIVERSITY

COLLAGE OF MEDICINE AND HEALTH SCINCES

DEPARTMENT OF ADULT AND PEDIATRICS

NURSING
NURSING FOUNDATION PRESENTATION
On JBSM
Adviser: Gebre Y.(PhD fellow)
 Group member
• Advisor GEBRE Y. (MSc. Assistant Professor, Phd
fellow)
Prepared by
Name……………………..……………. ID
1. Amanuel Taye……………………BDU1207020PR
2. Eleni Dagnaw………………….....BDU1207023PR
3. Fentahun Meseret……………….BDU1207024PR
4. Mekides Tadesse………………...BDU1207028PR
5. Teshale Mengesha……………….BDU1207031PR
6. Tsegasew Embiale………………..BDU1207032PR
 Outline of the presentation
• Background of the Theorist

• Introduction of the theory

• Major Concepts and Definitions
• Importance
• Principle

• Major Assumptions
• Metaparadigm in Nursing
• Application of the theory

• References
 Objectives
•At the end of the presentation students should be able to:

define JBSM


Identify major concepts of the model


List the major assumptions


State the goals of JBSM


Apply the model
 Background of the
Theorist
Dorothy E. Johnson
(August 21, 1919 –
February 1999) was
one of the greatest
nursing theorists who
developed the BSM.
 Early Life

• she was born on August 21, 1919 in Savannah, Georgia.

• She was the youngest of seven children.
• Her father was the superintendent of a shrimp and
oyster factory
• her mother was very involved and enjoyed reading.
• In 1938, she finished her associates degree in Armstrong
Junior College in Savannah, Georgia.
 Education
• Her professional nursing career began in 1942 when she
graduated from Vanderbilt University School of Nursing in
Nashville, Tennessee.

• She was the top student in her class and received the
prestigious Vanderbilt Founder’s Medal.

• In 1948, she received her Masters in public health from

Harvard University in Boston, Massachusetts.
 career
• She involved in teaching, a staff nurse at the Chatham-
Savannah Health Council from 1943 to 1944.
• an assistant professor in pediatric nursing at
Vanderbilt University School of Nursing.
• an associate professor of nursing, and

• a professor of nursing at the University of California,

Los Angeles.
 Career….
• She is known for her “Behavioral System
Model of Nursing,” which was first proposed
in 1968.
• Her nursing model states that “each individual
has patterned, purposeful, repetitive ways of
acting that comprises a behavioral system
specific to that individual.”
 Death

• Unfortunately, Dorothy Johnson died in February

1999 at the age of 80.
• Before she died, she was pleased that her
theory had been found useful in furthering the
development of a theoretical basis for nursing .
• was being used as a model for nursing practice on
an institution-wide basis.
• but she reported that her greatest source of
satisfaction came from following the productive
careers of her students.
 Introduction of the theory
• Evolved from philosophical ideas, theories,
and research, her clinical background many
years of thought, discussion and writing.
Influences:
– F. nightingale
– System model
– Developmental theories
 Introduction…..
• JBSM is a model of nursing care that advocates
the fostering of efficient and effective
behavioral functioning in the patient to prevent
illness and stress.
• The patient is identified as a behavioral system
composed of seven behavioral subsystems.
 Introduction…..

• Nursing: an external regulatory force w/c act to preserve

the organization and integration of the patient's behaviors
at optimum level.
• Client: bio psychosocial being with an instability in one
of the subsystem due to stress.
• 7 Subsystem: each has structural and functional
components.
CONT……..
 Introduction…..

• 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.
 Major Concepts

• Johnson conceptualized a nursing client as a

behavioral system.
• The behavioral system is:
– orderly,
– repetitive, and
– organized with interrelated and interdependent
biological and behavioral subsystems.
 Major concept……

• The client is seen as a collection of behavioral

subsystems that interrelate to form the

behavioral system.
 Major concept…

• The system may be defined as those complex,

overt actions or responses to a variety of
stimuli present in the surrounding environment
that are purposeful and functional.
 Major concet….

Johnson considered such behavior to be purposeful and

predictable;

it is functionally efficient and effective most of the

time.

is sufficiently stable and recurrent to be amenable to

description and exploration.

 Subsystems
• The parts of the behavioral system are called
subsystems.
• They carry out specialized tasks or functions
needed to maintain the integrity of the whole
behavioral system and manage its relationship to
the environment.
• Each of these subsystems has a set of behavioral
responses that is developed and modified
through motivation, experience, and learning.
 Subsystems……

Individual is made up of seven sub system

Inter related to form a whole

Interact with each other

Environment constantly act up on subsystem
Subsystems
1. Affiliative
2. Dependency
3. Ingestion
4. Elimination
5. Sexual
6. Aggressive
7. Achievement
8. Restorative
 1. Attachment or Affiliative

• is the social inclusion, intimacy and the formation

and attachment of a strong social bond.
• b/r associated with the dev’t and maintenance of
interpersonal r/n ship.
• On a general level, it provides survival and
security.
 2. Dependency subsystem

• b/r associated with obtaining assistance from others

for completing task or emotional support.
• Include seeking of attention, approval or recognition,
and basic self care skill.
• A certain amount of interdependence is essential for
the survival of social groups.
 3. Ingestive subsystem

• b/r associated with the intake of the needed

resource from external env’t such as food,

fluid, knowledge ,information for the purpose

of establishing r/n ship with the env’t.

 3. Ingestive subsystem…..

• The ingestive subsystem has to do with when,

how, what, how much, and under what

conditions we eat.
 4. 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.
• Expressing feeling
 5. Sexual subsystem
• is both a biological and social factor that affects
behavior.
• It has the dual functions of pleasure/procreation and
gratification.
• this response system begins with the development of
gender role identity and includes the broad range of sex-
role behaviors.
 6. Achievement subsystem
• behavior that tries to control the environment and problem
solving activity.

• It attempts to manipulate the environment.

• Its function is control or mastery of one’s self or environment

to some standard of excellence.

• Areas of achievement behavior include intellectual, physical,

creative, mechanical, and social skills.
 7. Aggressive subsystem

• relates to the behaviors concerning

protection and self-preservation,
generating a defense response when there is
a threat to life or territory.
Identification of potential danger.
 Goals
• Restore or maintain behavioral integrity, stability, and
efficient and effective behavioral function.
• To assist the patient whose behavior is proportional to
social demands.
• To assist the patient who is able to modify his behavior
in ways that it supports biological imperatives.
 Goal cont’d….

• To assist the patient who is able to benefit to

the fullest extent during illness from the
physician’s knowledge and skill.
• To assist the patient whose behavior does not
give evidence of unnecessary trauma as a
consequence of illness.
 Importance

• Her theory guides nursing practice, education,

and research; generates new ideas about nursing;
and differentiates nursing from other health
professions.
• It has been used in inpatient, outpatient, and
community settings as well as in nursing
administration.
• It has been used in practice in educational
institutions in different parts of the world.
 Importance cont’d..
• 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.
• The theory also has potential for continued
utility in nursing to achieve valued nursing
goals.
 principle of the Model

There are five core principles:-

• Wholeness and order

• Stabilization

• Reorganization

• Hierarchic interaction

• Dialectical contradiction
 Principle cont’d..

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 the relationship of the part rather than
in their individual.
 principle cont’d..
2. Stabilization:
 nurses act as external regulators.
Monitor patient response,
looking for successful adaptation to occur,

 intervene to help patient restore behavioral

system balance.
 principle cont’d

3. Reorganization:
• nurses acts to provide conditions or resources
essential to help the accommodation process;
– may impose regulatory or control mechanism,
– to stimulate or reinforce certain process,
– may attempt to repair structural components.
 principle cont’d
4. Hierarchic interaction:
• hierarchies or a pattern of replying on
particular subsystem lead to a degree of
stability.
 principle cont’d

5. Dialectical contradiction:
• Motivational force for behavioral change,
drives/responses developed and modified over
time through maturation, experience and
learning.
 Major Assumptions

• The assumptions made by Dorothy Johnson’s

theory are in three categories:

1. assumptions about system,

2. assumptions about structure, and

3. assumptions about functions.

 Assumption about the system
1. 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 occurring on him.
 Assumption about the system

3.A behavioral system, which requires and results in some

degree of regularity and constancy in behavior, is essential to

man.

It is functionally significant because it serves a useful purpose

in social life as well as for the individual.

4. System balance reflects adjustments and adaptations that are

successful in some way and to some degree.

assumptions about structure and function

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 individual person has a predisposition to act
with reference to the goal, in certain ways rather
than the other ways. This predisposition is called a
set.
Assumption about the structure and function

3. Each subsystem has a repertoire of choices

called a scope of action.

4. The individual patient’s behavior produces an

outcome that can be observed.

Functional requirements for subsystems

• The system must be protected from toxic

influences with which the system cannot cope.
• Each system has to be nurtured through the input
of appropriate supplies from the environment.
• The system must be stimulated for use to
enhance growth and prevent stagnation.
 Metaparadigm in Nursing

A. 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.
 Metaparadigm in Nursing

B. 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.
 Metaparadigm in Nursing

C. Health
• Health is seen as the opposite of illness.
• 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.”
 Metaparadigm in Nursing
D. 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.”
 10. Application of the theory

• The nursing process of the BSM 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.
 Application Cont’d..
• JBSM 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.
 Application Cont’d..

• JBSM has served as a means for

– identifying,
– labeling, and
– classifying phenomena important to the nursing
discipline.
• Nurses have used the JBSM model since the early
1970s,.
 Application Cont’d..

• Model has demonstrated its ability to provide:

– a medium for theoretical growth;
– organization for nurses’ thinking, observations,
and interpretations of what was observed;
– a systematic structure and rationale for activities;
 Application Cont’d..

– direction to the search for relevant research

questions;
– solutions for patient care problems; and,
– finally, criteria to determine if a problem has been
solved.
 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.
 Limitation cont’d
• 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.
– so the family of the client is only considered as an environment.
 Case study

•Mrs. Beatriz, a 43-year-old woman was admitted to ER having chief complain of

Decrease Level of Consciousness, Nausea and Vomiting. Her GCS was lethargic

13/15, Blood Pressure 185/80, Pulse Rate 107, Respiratory Rate 20 cpm,

Temperature 37.5 and O2 sat 87%. Blood Sugar 600 mg/dl, blurring of vision,

dysarthria, and severe right-sided weakness.

•According to her daughter, Mrs. Beatriz and her Husband having an argument

and suddenly Mrs. Beatriz fell down on the ground so she was rushed to the

nearby hospital within 15 minutes. She was immediately sent for CT scan and

diagnosed with Acute Ischemic Attack.

• Thrombolytic therapy was immediately started and transferred Mrs.
Beatriz to Neuro ICU. In her bed, I grabbed my neurological examination
kit and started to assess my patient from head to toe. Then I started on my
nursing admission process. The daughter of the patient answered my brief
interview since the patient cannot fully express herself.
• The daughter told me that her mother was rushed to the hospital a week
ago because of acute right-sided weakness and inability to speak. She did
the CT Scan and showed hypodensity on the left middle cerebral artery of
the brain.
• Her past medical history revealed that the
medication for her hypertension was not
religiously complied due to budget constraints.
She is 4 feet and 8 inches tall and weighs 70
kilos (154 lbs.).  She had history of right
nephrectomy five years ago, and rheumatic
heart disease since she’s eighteen years old.
•Ms. Beatriz, a secretarial graduate who worked in an
insurance firm, is married to her childhood friend, Juan.  She
lives with his husband and seven children in their home. Her
husband is unemployed, and an alcoholic.
•Her daughter told me that her father is a good provider but
gradually became depressed after he was terminated from
his work. Her mother became so engrossed with her work in
trying to support her seven children. Her daughter also told
me that their family is slowly breaking into pieces.
• The patient has been compliant with her
medications and dietary regimens until lately
after her husband was out of work that all the
stress came so overwhelmingly to her, that one
morning she just woke up aphasic with severe
weakness on the right limbs.
 Behavioural Model System
AFFILIATION
ASSESSMENT
• Subjective- “I don’t want to see my husband yet”
• Objective- Changing topic when husband was
mentioned
DIAGNOSIS
• Impaired social interaction related to previous
argument with husband as verbalized by patient “I
don’t want to see my husband yet”
PLANNING
• Gradually introduce husband and the importance of their
relationship. Talk to her husband and include him during
nursing care gradually.
IMPLEMENTATION
• Talked to her husband and ask few questions about how
they met and become husband and wife.
• Taught her husband how to her  check blood sugar
EVALUATION
• She tell story about her husband
ELIMINATION
ASSESSMENT
subjective=I have difficulty defecating,
objective=Straining during defecation
DX=Impaired Bowel Elimination related to
decrease bowel movement as manifested by
straining during defecation
PLANNING
• Educate the client on the importance of drinking
water
Implimentation
• Give patient small frequent drinking water.
• EVALUATION
• Bowel become loose
• N.B all subsystem must be assessed like the above
 References

1. Alligood, M., & Tomey, A. Nursing theorists and their work, Maryland Heights:
Mosby-Elsevier, 2010, seventh edition.
2. https://nurseslabs.com/dorothy-e-johnsons-behavioral-system-model/
3. Holaday B. Johnson’s behavioral system model in nursing practice. Nursing
Theory-E-Book: Utilization & Application. 2013:138.
4. Marilyn, E. nursing theories and nursing practice. USA: F.A Davis, 2005. Second
edition..
5. Johnson DE. The behavioral system model for nursing. ME Parker (Ed), Nursing
theories in practice New York: National League for Nursing. 1990.
6. Smith Fruehwirth SE. An application of Johnson's behavioral model: Journal of
community health nursing. 1989; 6(2):61-71.
7. Holiday, B. Dorothy Johnson: Behavioral systems model. In M.Alligood, & A.
Tomey theorists and their work : (2010), (Eds.), , (pp.366-390).
8. Current Nursing Nursing theories: Johnson’s behaviour system model.
(2011). Retrieved from
http://currentnursing.com/nursing_theory/behavioural_system_mo del.html
 Acknowledgement

• First and for most, we would like to express

our deepest gratitude for our instructor
Gebre.Y(Ph.D. Fellow) who provides us this
assignment so we search more and gain
knowledge about it.
Thank you for
your attention