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Johnson Model Nursing Theory
- 1. C H R I S T I N E D O U G L A S A N D D A N A H O G A N Dorothy Johnson’s Behavioral Systems Model
- 2. Backgound Born August 21st 1919 Associates Degree in 1938 from Armstrong Junior College in Savannah Georgia 1942 BSN Vanderbilt University in Nashville Tennessee 1948 Masters in public health Harvard University Boston Massachusetts
- 3. Influences Florence Nightengale Hans Selye Teaching Empirical approach to nursing
- 4. Nurse Goals Nurses specifically …. “Contribute to patient welfare as that of fostering efficient and effective behavioral functioning in the person both to prevent illness and during and following illness” (Johnson, 1980)
- 5. Definitions Person A behavioral system comprised of subsystems constantly trying to maintain a steady state. Environment Not clearly defined. Health Balance and stability. Nursing External regulatory force that is only indicated when there is instability.
- 6. 7 or 8 Behavioral Subsystems Affiliative Dependency Ingestive Elimination Sexual Aggressive Achievement Restorative
- 7. Four Assumptions Form of behavior can infer what drive or what goal Predisposition to act Different choices/scope of choices Outcomes are produced Goal Set Choice Behavior
- 8. Testing The Theory 1980 Damus tested the validity of Johnson’s model which assisted in sustaining the utilization of model Relationship exists between the patient’s unbalanced physiologic state and behavioral conduct Alterations in behavioral patterns could be recognized/hypothesized Nursing diagnosis and interventions were interrelated concepts
- 9. Tools Developed Based On Theory 1978- Majesky, Brestor, and Nishio Patient Indicators of Nursing Care 1986- Auger and Dee Patient Classification Instrument (PCI) 1983- Lovejoy Johnson Model First-Level Family Assessment Tool (JFFA-J) 1983- Derdiarian Derdiarian Behavioral Systems Model (DBSM) 1991- Derdiarian DBSM Self-Report Instrument for patients DBSM-O Observation
- 10. Research Bruce, G. L., Hinds, P., Hudak, J., Mucha, A., Taylor, M. C., & Thompson, C. R. (1980). Implementation of ANA’s quality assurance program for clients with end-stage renal disease, Advances in Nursing Science, 2(2), 79-95. Coward, D. D., & Wilkie, D. (2000). Metastatic bone pain: Meanings associated with self-report and self-management decision making. Cancer Nursing: An International Journal for Cancer Care, 23(2), 101-108. Dee, V., & Randell, B. (1989). NPH patient classification system theory-based nursing practice model for staffing nursing department. UCLA Neuropsychiatnc Institute and Hospital, Los Angeles. Derdiarian, A. K. (1990). Effects of using systematic assessment instruments on patient and nurse satisfaction with nursing care. Oncology Nursing Forum, 17(1), 95-101. Derdiarian, A.K., & Forsythe, A. B. (1983). An instrument for theory and research development using the behavioral systems model for nursing: The cancer patient. Nursing Research, 32(5), 260-266.
- 11. Research Derdiarian, A. K., & Schobel, D. (1990). Comprehensive assessment of AIDS patients using the behavioural systems model for nursing practice instrument. Journal of Advanced Nursing, 15, 436-446. Fruehwirth, S.E.S. (1989). An application of the Johnson’s behavioral model: A case study. Journal of Community Health Nursing, 6(2), 61-71. Holaday, B. (1981). Maternal response to their chronically ill infants attachment behavior of crying. Nursing Research, 30(6), 343-347. Lovejoy, N. (1983). The leukemic child’s perceptions of family behaviors. Oncology Nursing Forum, 10(4), 20-25. Majesky, S. J., Brester, M. H., & Nishio, K. T. (1978). Development of a research tool: Patient indicators of nursing care. Nursing Research, 27(6), 365-371. Moeller, K., Murvine, S., & Began, C. (2007). Utilizing a scenic curtain to decrease the patient’s anxiety and anger during initial chemotherapy treatment.
- 12. Cons Pros Focused on hospitalized and ill stricken patient Health promotion and patient education Failure to incorporate the nursing process Limited publication Difficult to use in high level research Undefined outcomes Values/Ethics Concepts are interrelated Assumptions are descriptive Simple Very little “new language” Significant impact of nursing Theory Critique
- 13. References Dorothy Johnson Nursing Theory Website. (n.d). http://dorothyjohnson.wetpaint.com/ Johnson, D. E. (1961, November). The significance of nursing care. The American Journal of Nursing Care, 61(11), 63-66. Retrieved from http://www.jstor.org/stable/3418646 Johnson, D. (1980). The behavioral system model for nursing. In J.P. Riehl & C.Roy (eds.), Conceptual models for nursing practice (2nd ed.). New York: Appleton-Century-Crofts. Lobo, M.L. (1995). Johnson’s Behaviour System Model. (n.d.). Retrieved October 07, 2011, from http://currentnursing.com/nursing_theory/behavioural_system_model.html Parker, M. E. (Ed.). (1990). The behavioral system model for nursing. Nursing theories in practice (Illistrated ed., pp. 23-46). [Reader version]. Retrieved from http://books.google.com Vanderbilt University. (n.d). Dorothy E. Johnson BSN, MPH (1919-1999). Retrieved October 12, 2011, from http://www.mc.vanderbilt.edu
Editor's Notes
- Youngest of 7 children, received associates degree. Took a year off from school during great depression and discovered her calling as a nurse. After graduation, she worked for one year in public health nursing and began to teach at Vanderbilt University in their school of nursing. After 5 years, she moved to California where she was an instructor for pediatrics in the school of nursing at the University of California, Los Angeles. She worked at UCLA until she retired in 1978, except for one year in 1955 when Dorothy took sabbatical from UCLA to teach in Vallore, South India at the Christian Medical College School of Nursing (Tomey & Alligood, 2005).
- "mother" of nursing and "father" of stress inspired her work. Hans Selye- General Adaptation Syndrome (G.A.S.), This theory introduced in 1936, sought out to explain the process under which the body confronts "stress" or "noxious agents“. The body passes through three universal stages of coping: an alarm reaction stage, then adaptation where the resistance to the stress is built and finally the body enters a stage of exhaustion, a sort of aging "due to wear and tear." It was through Seyle's work on stress that Johnson was able to expand on stress within her theory. Johnson focused on the person's response to stress of the illness and how they would react to these stresses. Florence Nightengale- Focus on the person not the disease Johnson stressed the importance of the nurse in caring for the patient. Johnson focused on all aspects of the patient and their behavioral systems, attempting to achieve a level of equilibrium. Times had changed by the formation of Johnson's theory and while Nightingale had to focus on the environment and sanitation, Johnson just briefly mentions these. Due to the advances made in nursing and health, Johnson was able to focus more on the individual and not so much on external factors affecting the patients. Teaching- Influenced when as a teacher she was asked to determine what courses content constitutes nursing knowledge. Unable to differentiate between Medical knowledge and science knowledge. She was influenced to answer the differences “what made nursing unique”. Empirical approach to nursing- “Nursing is what nurses do”, big in the late 1940 into early 1950’s, task orientated studies to varied and not good EBP, depressed her because of the many variations however she was grateful that it kept her focused on not people but on ill or prevention of illness in people.
- Goals of Nursing are to assist the Pt: Person behaves appropriate for social situation Person can modify behavior to support biological function Person can benefit from the knowledge and skill given when the person has an illness Person behavior doesn’t reflect trauma from illness
- Person- A behavioral system that strives to make continual adjustments to achieve, maintain, or regain balance to the steady-state that is adaptation. Environment- All elements of the surroundings of the human system and includes interior stressors (not directly defined but implied). Health- 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- 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
- Each subsystem has a specific task, however, the individual is viewed as a whole by virtue of the interdependence of each subsystem When there is an equal distribution among all eight subsystems then balance and equilibrium can be achieved. Affiliative- Behaviors associated with the development and maintenance of interpersonal relationships with parents, peers, authority figures. Established a sense of relatedness and belonging with others including attachment behaviors, interpersonal relationships and communication skills. Dependancy- Behaviors associated with obtaining assistance from others in the environment for completing tasks and/or emotional supports. Includes seeking of attention, approval, recognition, basic self-care skills and emotional security. Ingestive- Behaviors associated with the intake of needed resources from the external environments, including food, fluid, information, objects, for the purpose of establishing an effective relationship with the environment. Elimination- Behaviors associated with the release of physical waste products Sexual – Behaviors associated with a specific gender identity for the purpose of ensuring pleasure/procreation, and knowledge and behavior being congruent with biological sex. Aggressive- Behaviors 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. Achievement-Behaviors associated with mastery of oneself and one’s environment for the purpose of producing a desired effect. Includes problem- solving activities. Knowledge of personal strengths and weaknesses. Added by Grubb later Restorative- Behaviors associated with maintaining or restoring energy equilibrium, e.g. relief from fatigue, recovery from illness, sleep behavior, leisure/recreational interests and sick role behavior, ADL’s.
- 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 has a predisposition to act, with reference to the goal, in certain ways rather than in other ways called “set” 3. Each subsystem has available a repertoire of choices or scope of action alternatives from which choices can be made 4. Observable outcomes are produced Functional requirements for each subsystem: “Protected from noxious influences with which the system cannot cope” (Johnson, 1980). “Nurtured through the input of appropriate supplies from the environment” (Johnson, 1980). “Stimulated for use to enhance growth and prevent stagnation” (Johnson, 1980).
- 1980 Damus tested the validity of Johnson’s model by gathering clinically-acquired observational data associated with the behavioral patterns of hepatitis patients who had received blood transfusions. As a result, she discovered that a relationship did exist between the patient’s unbalanced physiologic state and behavioral conduct, that alterations in behavioral patterns could be recognized and/or hypothesized, and that nursing diagnosis and interventions were interrelated concepts, thus assisting to sustain the utilization of Johnson’s model of behavioral systems in nursing practice
- In 1978, Majesky, Brestor, and Nishio developed an experimental tool, known as the Patient Indicators of Nursing Care, in which to measure the quality of nursing care by assessing the prevalence of complications in hospitalized patients and as a means of testing the validity of the behavioral subsystems. These indicators were based on Johnson’s supposition that complications arise as a result of a person’s inability to handle the tension placed on the behavioral subsystems. The tool consisted of a 24 item list which participants completed 48 hours after admission and again five to seven days following hospitalized admission to screen for the patients’ perceptions of the care they were receiving by the nurses (Majesky, Brestor, & Nishio, 1978). Auger and Dee (1986) formed and validated the Patient Classification Instrument (PCI) for the purpose of measuring behavioral patterns/subsystems in individuals with clinically-diagnosed psychiatric disorders (Meleis, 1991). Lovejoy (1983) developed an assessment tool, known as the Johnson Model First-level Family Assessment Tool (JFFA-J), to examine the functioning and interaction among family members who have a child diagnosed with cancer (leukemia). In 1983, researcher Anayis Derdiarian developed a systems model based on Johnson’s behavioral model, known as the Derdiarian Behavioral Systems Model (DBSM), which consisted of over 190 items that represented behavioral subsystems to be utilized in analyzing alterations in behavioral patterns in oncology patients (Meleis, 1991). DBSM Self-Report Instrument for patients and the DBSM-O, which is an observational tool used specifically by nurses. Each of these models were developed by Derdiarian as a means of evaluating, grouping, and explaining the behavioral subsystems presented within Johnson’s Behavioral Systems Model (Meleis, 1991).
- The theory does not focus on or address the paradigm of health promotion, primary prevention, and disease prevention. Health promotion and patient education is one of the focuses of nursing care. Nurses are responsible for the majority of the patient education that takes place in the hospital setting. Patient education is what helps prevent patients from experiencing disease and illness, which Johnson refers to as "stressors." Johnson's theory only focuses on the nurse's role of restoring equilibrium for the patient while they are in a state of distress. In reality, the nurse's role is more comprehensive than the behavioral model encompasses The nursing process is the basis of many undergraduate nursing curriculums. In contrast, Johnson's theory focuses on human behavior in response to stress or illness. The behavioral model underscores the importance of the nursing process. Johnson's behavioral model could have been used in addition to the nursing process. Additionally, the concepts of nursing in Johnson's theory have been criticized because of their high level of abstraction; however, several researchers have developed operational definitions for Johnson's original definitions Limited publication of Johnson's theory and research has hindered the pervasiveness of the behavioral model. Although, Johnson never published a book on her theory, she did write several chapters and articles explaining her ideas (McEwen & Willis, 2007). Most of Johnson's ideas regarding her theory were implemented only at the institution where she taught at the University of California. Ideas from her theory have been incorporated in the nursing education programs at the University of Colorado, University of Honolulu, and Vanderbilt University. There is little documentation or published works regarding Johnson's original ideas involving the development of a nursing education curriculum. 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 theory emphasizes her concern for ethical standards in nursing theories. Johnson stated that the use of the behavioral model should be in congruence with the values of the nursing profession as well as the values of the individual nurse. Johnson also stressed that patient interventions and treatment should be negotiated between the nurse and patient (Fawcett, 1994). Johnson's theory has provided several contributions to the nursing field. The assumptions of the behavioral model are descriptive, this allows future researchers the ability to retest and clarify assumptions that lack clarity. The behavioral model identifies a clear purpose for nursing which is to restore or maintain behavioral system balance at the highest level for the individual. By establishing a goal, researchers are able to develop standards and measure the effectiveness of nursing interventions. Additionally, the behavioral model provides guidelines for the basis of patient distress by identifying the subsystems that are most likely to motivate human behavior (Fawcett, 1984). Johnson was influential in changing the way nursing was viewed. According to Johnson, nursing care has a significant impact on the health of individuals and the contribution that nursing offers is separate from the field of medicine. Johnson asserted that nursing and the medical field view patients in different ways. Johnson's proposition regarding the goal of nursing is remarkable, it help prompt the recognition of nursing as a discipline of its own (Fawcett, 1984). In conclusion, Johnson's theory has been utilized by various nurses and researchers. Despite the fact, her theory is not well known Dorothy Johnson should be recognized for her inspirational and thought provoking contributions to the field of nursing.