Dorothy e. Johnson behavioral system model JBSM 1 (2)

Addis Ababa University
College of Health Science
Department of Nursing and Midwifery
Graduate Program
Regular Program
Theoretical Foundation of Nursing
Dorothy Johnsons Theory
Presented by : Beresa Lema
Feb, 04,2021 G.C
4/22/2021 1

Content Outline Of The Presentation
• Credentials And Background Of The Theorist
• Theoretical Sources Of The Theorist
• Major Concepts, Definitions and Relationship
• Goals
• Importance
• Principles
• Major Assumptions
• Acceptance By Nursing Community
• Critique
• Summary
• Reference
4/22/2021 2

4/22/2021 3
Martha Raile Alligood : Nursing Theorist and their work. (8th edition).Elsevier.

Credentials and Back Ground of 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.
 Tomey, A. & Alligood, M. (2002). Nursing theorists and their work. (5th ed.). Mosby Inc.
 http://www.mc.vanderbilt.edu/biolib/hc/biopages/djohnson.html
4/22/2021 4

Theory Descriptions and critique
Theory Descriptions
4/22/2021 5

Theoretical sources
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, Chinn and Buckley
 used their concepts and definitions
 Octaviano, E. & Balita, C. Theoretical foundation of Nursing: The Philippine perspective. Ultimate Learning Series
4/22/2021 6

Major Concepts, Definitions and
Relationship
Behavior
 The output of intraorganismic structures and
processes as they are coordinated and
articulated by and responsive to changes in
sensory stimulation.
 Johnson focuses on behavior affected by the
actual or implied presence of other social
beings that has been shown to have major
adaptive significance.
 Martha Raile Alligood: Nursing Theorist and their work. (8th ed.). Elsevier.
4/22/2021 7

Cont…
System
 Using Rapoport’s 1968 definition of system, Johnson
(1980) stated, “A system is a whole that which
functions as a whole by virtue of the interdependence
of its parts”.
 She accepted Chin’s statement that there is
“organization, interaction, interdependency, and
integration of the parts and elements” (Johnson , 1980,
p.208)
 A person strives to maintain balance in these parts
through adjustments and adaptations to the impinging
forces.
4/22/2021 8

Cont…
• Equilibrium
 A key concept in nursing’s specific goal.
 It is defined as a stabilized but more or less transitory,
resting state in which the individual is in harmony with
himself and with his environment.
• Tension
 A state of being stretched or strained and can be
viewed as an end-product of a disturbance in
equilibrium.
 Can be constructive in adaptive change or destructive
in inefficient use of energy, hindering adaptation and
causing potential structural damage
4/22/2021 9

Cont…
• Stressor
 Internal or external stimuli that produce
tension and result in a degree of instability.
 Stimuli may be positive in that they are
present; or negative in that something desired
is absent.
4/22/2021 10

Behavioral System Model
o Each individual has patterned, purposeful, repetitive
ways of acting that comprise a behavioral system
specific to that individual.
o 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, events and situations within his
or her environment.
 https://www.currentnursing.com/nursing_theory/behavioural_system_model.html
4/22/2021 11

Cont…
o 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.
o The system is usually flexible enough to
accommodate the influences affecting it.
4/22/2021 12

Cont…
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 seven subsystems are open, linked, and
interrelated where input and output are components.
 Motivational drives direct the activities of these
subsystems, which are continually changing through
maturation, experience and learning.
The system described appear to exist cross culturally
and are controlled by biological, psychological, and
sociological factors.
4/22/2021 13

Cont…
The seven (7) identified subsystem are :-
1. Attachment/Afflictive Subsystem
2. Dependency Subsystem
3. Ingestion Subsystem
4. Elimination Subsystem
5. Sexual Subsystem
6. Aggressive/protective Subsystem
7. Achievement Subsystem
 Martha Raile Alligood : Nursing Theorist and their work. (8th edition).Elsevier.
 McEwen, W. & Wills, E. Theoretical basis for nursing. (2nd ed.). Lippincott Williams & Wilkins.
4/22/2021 14

Johnson’s Behavioral Subsystem
1. Attachment/Affiliative Subsystem
• 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 formation and
maintenance of a strong social bond.
2. Dependency Subsystem
• promotes helping behavior that calls for a nurturing response.
• Its consequences are approval, attention or recognition, and
physical assistance.
• A certain amount of interdependence is essential for the survival of
social groups.
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Cont…
3. Ingestive Subsystem
 has to do with when, how, what, how much, 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.
 The perspective is in the significance and
arrangement of the social events surrounding the
occasions when food is eaten.
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Cont…
4. Eliminative Subsystem
 addresses when, how, and under what conditions
we eliminate.
 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.
 Human cultures have defined different socially
acceptable behaviors for excretion of waste.
4/22/2021 17

Cont…
5. Sexual Subsystem
o serves the biologic requirements for procreation and
reproduction.
o 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.
6. Aggressive/Protective Subsystem
• functions in self and social protection and preservation
• This follows the line of thinking of ethnologists such as Lorenz
and Feshbach rather than the behavioral reinforcement school of
thought, which contends that aggressive behavior is not only
learned, but has a primary intent to harm others.
• Society demands that limits be placed on modes of self-
protection and that people and their property be respected and
protected.
4/22/2021 18

Cont…
7. 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, physical, creative , mechanical and
social skills.
4/22/2021 19

Summary of seven subsystems
1. Attachment or affiliative subsystem—serves the
need for security through social inclusion or intimacy
2. Dependency subsystem—behaviors designed to get
attention, recognition, and physical assistance
3. Ingestive subsystem—fulfills the need to supply the
biologic requirements for food and fluids
4. Eliminative subsystem—functions to excrete wastes
5. Sexual subsystem—serves the biologic requirements
of procreation and reproduction
6. Aggressive subsystem—functions in self and social
protection and preservation
7. Achievement system—functions to master and
control the self or the environment
4/22/2021 20

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.
4/22/2021 21

Cont…
• 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.
4/22/2021 22

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.
4/22/2021 23

Cont…
• 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.
4/22/2021 24

principle of the Model
There are five core principles:-
• Wholeness and order
• Stabilization
• Reorganization
• Hierarchic interaction
• Dialectical contradiction
4/22/2021 25

Principles Cont…
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.
4/22/2021 26

Principles cont…
2. Stabilization:
 nurses act as external regulators.
Monitor patient response,
looking for successful adaptation to occur,
 intervene to help patient restore behavioral
system balance.
4/22/2021 27

Principles cont…
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.
4/22/2021 28

Principles cont…
4. Hierarchic interaction:
• hierarchies or a pattern of replying on
particular subsystem lead to a degree of
stability.
4/22/2021 29

Principles cont…
5. Dialectical contradiction:
• Motivational force for behavioral change,
drives/responses developed and modified over
time through maturation, experience and
learning.
4/22/2021 30

Metaparadigm in Nursing
Major Assumptions
Nursing
• She defined nursing as “an external regulatory
force which acts to preserve the organization
and integration of the patients behaviors at an
optimum level under those conditions in which
the behaviors constitutes a threat to the
physical or social health, or in which illness is
found”
4/22/2021 31

Cont…
• 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
4/22/2021 32

Cont…
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.
4/22/2021 33

Cont…
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
4/22/2021 34

Cont…
Health
• Is an elusive state that is affected by social,
psychological, biological and physiological
factors
• The individual is striving to retain some balance
or equilibrium
• 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.
4/22/2021 35

Cont…
Environment
• Consists of all the factors that are not part of
the individual’s behavior but influence the
system, some of which can be manipulated by
the nurse to achieve the health goal for the
patient.
• The behavioral system attempts to maintain
equilibrium in response to environmental
factors by adjusting and adapting to the forces
that impinge on it.
4/22/2021 36

4/22/2021 37
 https://nurseslabs.com/dorothy-e-johnsons-behavioral-system-model

Theoretical Assertions
 The theory addresses two major components:
(1) the patient and
(2) nursing.
 The patient is a behavioral system with seven
interrelated subsystems.
o Each subsystem can be described and analyzed in
terms of structure and functional requirements.
4/22/2021 38

Cont…
 The four structural elements that have been
identified include:
1. drive or goal - motivation for the behaviors
2. set - normal behavior a client prefers to meet
goal; predisposition to act;
3. choice - available options a person has to meet
goals; alternatives for action;
4. behavior - it will produce an observable outcome
which is the individuals behavior
4/22/2021 39

Cont…
 Each of the subsystems has the same three
functional requirements:
1. Protection – protection from unwanted stimuli
2. Nurturance - through appropriate input of “supplies”
from the environment
3. Stimulation - by experiences, behaviors that “enhance
growth and prevent stagnation
4/22/2021 40

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. Grubbs (1980) – developed an assessment tool and a nursing
process sheet based on Johnson’s seven subsystems.
2. Holaday (1980) – used the theory 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
3. Derdiarian (1990) – investigated the effects of using two
system assessment instruments on patient and nurse satisfaction.
 The implementation of the instrument provided a more
comprehensive and organized step to assessment and
intervention, thereby increasing patient and nurse
satisfaction with care.
 George, J. Nursing theories: The base for professional nursing practice. (5th ed.). Pearson Prentice Hall
4/22/2021 42

Cont…
Education
o A core curriculum based on a person as a
behavioral system would have definite goals and
clear course planning.
o The study would center on the patient as a
behavioral system and its dysfunction, which
would necessitate the use of the nursing process.
o Understanding of the systems theory, the
student would need knowledge from the social
and behavioral disciplines and the physical and
biological sciences.
4/22/2021 43

Cont…
Research
 Nursing research is vital to explain and identify
behavioral system disorders which rise in relation with
illness, and develop good reasoning for the means of
management.
 The theory resulting form the BSM influences to the
researcher to choose between two options.
1. Examine the functioning of the system and subsystems
by focusing on the Basic Sciences
2. Investigating methods of gathering diagnostic data or
problem solving activities as these influences the
behavioral system.
4/22/2021 44

Critique (Analysis)
Clarity
 Johnson’s theory is comprehensive and broad
enough to include all areas of nursing practice
and provide guidelines for research and
education.
 The theory is relatively simple in relation to the
number of concepts.
 A person is described as behavioral system
composed of seven subsystem.
 Nursing is an external regulatory force.
4/22/2021 45

Cont…
Simplicity
 The theory is potentially complex because
there is a number of a possible
interrelationship among the behavioral system,
its subsystems, and the environment.
 Potential relationship have been explored, but
more empirical work is needed (Brown, 2006)
4/22/2021 46

Cont…
Generality
 Relatively unlimited when applied to sick
individuals, but it has not been used as much
with well individuals, families or groups.
 Perceives a person as a behavioral system
composed of seven subsystems, aggregates of
interactive behavioral systems.
She stated, “Nursing’s special responsibility for
health is derived from its unique social mission.
Nursing needs to concentrate on developing
preventive nursing to fulfill its social
obligations” (Johson,1992,p26.)
4/22/2021 47

Cont…
Accessibility (Empirical precision )
 Is achieved by identifying empirical indicators
for the abstract concept of model.
Empirical precision improves when the sub
concepts and the relationships between and
among the sub concepts become better
defined and empirical indicators are
introduced to the science.
4/22/2021 48

Accessibility cont…
The units and the relationships between the
units in Johnson’s theory are consistently
defined and used.
 The clarity of definitions in the subsystems
improves the model’s empirical precision.
• Is achieved by identifying empirical indicators
for the abstract concept of model.
4/22/2021 49

Accessibility Cont…
Empirical precision improves when the sub
concepts and the relationships between and
among the sub concepts become better
defined and empirical indicators are
introduced to the science.
 The units and the relationships between the
units in Johnson’s theory are consistently
defined and used.
 The clarity of definitions in the subsystems
improves the model’s empirical precision.
4/22/2021 50

Summary
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
defined as behavioral system composed of
seven (7) behavioral subsystems. Each
subsystem composed of four (4) structural
characteristics i.e. drives, set, choices and
observable behavior.
4/22/2021 51

Cont…
Three (3) functional requirement of each
subsystem includes
(1) Protection from noxious influences,
(2) Provision for the nurturing environment, and
(3) stimulation for growth.
Any imbalance in each system results in
disequilibrium .it is nursing role to assist the
client to return to the state of equilibrium.
4/22/2021 52

References:
 George, J. Nursing theories: The base for professional nursing practice. (5th
ed.). Pearson Prentice Hall
 McEwen, W. & Wills, E. Theoretical basis for nursing. (2nd ed.).
Lippincott Williams & Wilkins.
 Martha Raile Alligood : Nursing Theorist and their work. (8th
edition).Elsevier.
 Octaviano, E. & Balita, C. Theoretical foundation of Nursing: The
Philippine perspective. Ultimate Learning Series
 Tomey, A. & Alligood, M. (2002). Nursing theorists and their work. (5th
ed.). Mosby Inc.
 https://www.currentnursing.com/nursing_theory/behavioural_system_mode
l.html
 https://nurseslabs.com/dorothy-e-johnsons-behavioral-system-model.html
4/22/2021 53

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