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 the fostering of efficient and effective behavioral 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 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 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.
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 began her work on the model with the premise that nursing was a profession that made a distinctive contribution to the welfare of society. Thus, nursing had an explicit goal of action in patient welfare.
The goals of nursing are fourfold, according to the Behavior System Model: (1) To assist the patient whose behavior is proportional to social demands. (2) To assist the patient who is able to modify his behavior in ways that it supports biological imperatives. (3) To assist the patient who is able to benefit to the fullest extent during illness from the physician’s knowledge and skill. And (4) To assist the patient whose behavior does not give evidence of unnecessary trauma as a consequence of illness.
The assumptions made by Johnson’s theory are in three categories: assumptions about system, assumptions about structure, and assumptions about functions.
Johnson identified several assumptions that are critical to understanding the nature and operation of the person as a behavioral 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.” (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. And (4) “System balance reflects adjustments and adaptations that are successful in some way and to some degree.”
The four assumptions about structure and function 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 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.” (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.
And lastly, 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.
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 is not directly defined, but it is implied to include all elements of the surroundings of the human system and includes interior stressors.
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 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.”
Man is a system that indicates the state of the system through behaviors.
That which functions as a whole by virtue of organized independent interaction of its parts.
A mini system maintained in relationship to the entire system when it or the environment is not disturbed.
The parts of the system that make up the whole.
Factors outside the system that influence the system’s behavior, but which the system lacks power to change.
The point that differentiates the interior of the system from the exterior.
Process of maintaining stability.
Balance or steady-state in maintaining balance of behavior within an acceptable range.
A stimulus from the internal or external world that results in stress or instability.
The system’s adjustment to demands, change or growth, or to actual disruptions.
State in which the system output of energy depletes the energy needed to maintain stability.
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.
Consequences or purposes of action.
7 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 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 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 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 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 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 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.
Johnson’s 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 always been useful to nursing education and has been used in practice in educational institutions in different parts of the world.
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.
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.
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, D. E. (1959a). A philosophy of nursing. Nursing Outlook, 7(4), 198–200.
- Johnson, D.E. (1968). One conceptual model of nursing. Unpublished lecture, Vanderbilt University, Nashville, TN.
- Johnson, D. E. (1980). The behavioral system model for nursing. In McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA: Lippincott Williams & Wilkins.
- Theory Development: What, Why, How?
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- One Conceptual Model of Nursing
- The Nurse Theorists – Dorothy Johnson Promo – YouTube video of an interview with Dorothy Johnson herself.
With contributions by Wayne, G., Ramirez, Q.Last updated on