Background of Dorothy Johnson• Born on 21st Aug 1919 in Georgia USA.• 1942- BSc Nsg from Nashville Tennessee.• Masters in Public health from Harvard University Boston in1948.Worked at various places in the US and in 1955 at CMC Vallore SON .• Creation of her theory began in 1940’s when she began to teach.• .Retired in 1978, and died in 1999.
The Theory• The BSM of Nsg was first proposed in 1968.• It advocates the fostering of efficient and effective behavioral functioning of the patient to prevent illness.• The pt is defined as a behavioral system composed of seven behavioral subsystems.• Each subsystem is comprised of four structural characteristics.• An imbalance in each results in disequilibrium.• The nurses role is to help the patient maintain his or her equilibrium.
Goals of Nsg according to BSM1. 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 physicians knowledge and skill.4. To assist the patient whose behavior does not give evidence of unnecessary trauma as a consequence of illness.
Johnson Behavioral System Model (BSM) OverviewEvolved from philosophical ideas, theory, and research; her clinical background; and many years of thought, discussions, and writingInfluences: Florence Nightingale Systems theory Developmental theory
Dorothy JohnsonGoal: restore or maintain behavioral integrity, stability, and efficient and effective behavioral functioningClient: a biopsychosocial being with an instability in one of the subsystems due to stressNursing: “an external regulatory force which acts to preserve the organization and integration of the patient’s behaviors at an optimum level….”7 Subsystems : Each has structural and functional components.
Affiliative or Attachment Subsystems• 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
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 self care skills and emotional security.
Ingestive Subsystem• Behaviors 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.
Eliminative Subsystem• Behaviour associated with the release of physical waste products from the body.• Express feelings
Sexual Subsystems• Behavior associated with a specific gender based identity for the purpose of ensuring pleasure/procreation, and knowledge and behavior being congruent with biological sex.
Aggressive Protective 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.
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.
Restorative• Behaviour associated with maintaining and restoring energy equilibrium, e.g. relief from fatigue, recovery from illness, sleep behaviour, leisure/recreational interests and sick role behaviour.
Purpose of the Systems TheoryNurse creates a balance between client and environment to achieve an optimal level of functioning
Subsystems• Individual made up of 7 subsystems• Interrelated parts function together to form a whole• Interact with each other• Interrelated and interconnected• Environment constantly acting on subsystems
Five Core PrincipalsWholeness and OrderStabilizationReorganizationHierarchic InteractionDialectical Contradiction
Wholeness and Order• Developmental analogy of wholeness and order is continuity and identity.• Continuity and change can exist across the life span.• Continuity is in the relationship of the parts rather than in their individuality.
Stabilization• Dynamic systems respond to contextual changes Set point maintained by altering internal conditions to compensate for changes in external conditions.• Nurses act as external regulators. – Monitor patient response, looking for successful adaptation to occur.• Nurses intervene to help patient restore behavioral system balance.• Intervention is not needed if behavioral system balance returns.
Reorganization• Occurs when the behavioral system encounters new experiences in the environment that cannot be balanced by existing system mechanisms• Nurse acts to provide conditions or resources essential to help the accommodation process: – May impose regulatory or control mechanisms to stimulate or reinforce certain behaviors – May attempt to repair structural components
Hierarchic Interaction• Hierarchies, or a pattern of relying on particular subsystems, lead to a degree of stability.
Dialectical Contradiction• Motivational force for behavioral change• Drives/responses developed and modified over time through maturation, experience, and learning• Environmental domains that the person is responding to include the biological, psychological, cultural, familial, social, and physical setting
Dialectical Contradiction (continued)• Faced with illness or the threat of illness, the person needs to resolve (maintain behavioral system balance of) a cascade of contradictions between goals related to: – Physical status, social roles, and cognitive status.• Nurses’ interventions: – Focus on restoring behavioral system balance – Leading to a new level of development
System is out of balance when..1. Insufficiency= does not get enough of something2. Discrepancy= not optimally working3. Incompatibility= subsystems conflict4. Dominance= one syctem is always used
Major concepts of the modelPersonSubsystemsHealthNursing and nursing therapeutics
Person• Viewed as an open system with organized, interrelated, and interdependent subsystems.• The whole of the human organism (system) is greater than the sum of its parts (subsystems).• Wholes and parts create a system with dual constraints: Neither has continuity and identity without the other.• Nursing client viewed as a behavioral system• Behavioral systems are orderly, repetitive, and organized
Subsystems• Are parts of the behavioral system• Carry out specialized tasks/functions needed to maintain the integrity of the whole system• Manage system relationship to the environment• Have a set of behavioral responses that are developed and modified through motivation, experience, and learning
Each Subsystem• 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 or consequence of the behavior.• The basis for the goal is a universal drive whose existence can be supported by scientific research.
Behavioral Set• Is a predisposition to act in a certain way in a given situation• Represents a relatively stable and habitual behavioral pattern of responses to particular drives or stimuli• Represents learned behavior and is influenced by knowledge, attitudes, and beliefs
Behavioral Set Components• Perseveration – Consistent tendency to react to certain stimuli with the same pattern of behavior• Preparation – Functions to establish priorities for attending or not attending to various stimuli
Choice• Refers to the individual’s repertoire of alternative behaviors in a situation that will best meet the goal and attain the desired outcome.• The greater the behavioral repertoire of alternative behaviors in a situation, the more adaptable the individual.
Action• Observable action of the individual – Concern is with the efficiency and effectiveness of the behavior in goal attainment. – Actions are observable responses to stimuli.
The Johnson Model Proposes• For behavior to be maintained, it must be protected, nurtured, and stimulated. • Protection from noxious stimuli that threaten the survival of the behavioral system • Nurturance, which provides adequate input to sustain behavior • Stimulation to continue growth of the behavior and counteracts stagnation
The Johnson Model (continued• Deficiency in any or all of these functional requirements – Threatens the behavioral system as a whole or the effective functioning of the particular subsystem with which it is directly involved.
Environment• Consists of all elements that are not a part of the individual’s behavioral system but influence the system and can serve as a source of sustenal imperatives• Manipulated by the nurse to achieve health
External environment• May include people, objects, and phenomena that can potentially permeate the boundary of the behavioral system• External stimulus forms an organized/meaningful pattern that elicits a response from the individual
Internal Environment• Internalized intervening variables: – Physiology, temperament, ego, age and related developmental capacities, attitudes, and self- concept• General regulators – Variables that influence set, choice, and action• Key areas for nursing assessment
Health• Behavioral system balance or stability• Demonstrated by observed behavior that is purposeful, orderly, and predictable.• Behavior maintained when it is efficient and effective in managing the person’s relationship to the environment
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.
Specific Goal of Nursing Action Is“to restore, maintain, or attain behavioral system balance and stability at the highest possible level for the individual” (Johnson, 1980, p 214)
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
The nurse may provide• Nurturance – through the input of appropriate supplies from the environment• Stimulation – for use to enhance growth and prevent stagnation• Protection- from noxious influences with which the system cannot cope”
Assumptions made by the theoryThese are divided into three categories1. Assumptions about system.2. Assumption about structure.3. Assumption about functions.
Assumptions about the systems in the model1. There is organization, interaction, interdependency and integration of the parts and elements of behaviors that go to make up the subsystem.2. A system tends to achieve a balance among the various forces operating within and upon it and continuously strives to maintain an equilibrium.3. A behavioral system which requires and results in some degree of regularity and consistency in behavior, is essential to man as it is functionally significant as an individual and in social life.4. Systems balance reflects adjustments and adaptations that are successful.
Assumptions about the structure1. From the form the behavior takes and the consequence it achieves can be inferred what ‘Drive’ has been stimulated and 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. This Predisposition is called a ‘SET’3. Each subsystem has a repertoire of choice called a ‘Scope of Action’4. The individual patient’s behavior produces an outcome that can be observed.
Assumptions about the Functions1. The system must be protected from toxic influences with witch the system cannot cope.2. Each system has to be nurtured through the input of appropriate supplies from the environment.3. The system must be stimulated for use to enhance growth and prevent stagnation.
BriefThus behaviors are - orderly - Purposeful - Predictive - sufficiently stable& - recurrentTo be amenable to description and explanation.
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
Critique• Past observational studies and general systems theory influenced Dorothy Johnson in the development of her BSM.• There are – 7 behavioral subsystems• - 3 functional requirement• The major phenomenon of concern in Johnson’s work is behavior
Contd.....• Can be generalized across the lifespan and across cultures• It is difficult to test Johnsons model by the development of hypothesis• Decision making for nursing practice using this model would involve critical thinking• Does not clearly define the expected outcome when one of the subsystems is being affected by nursing intervention
Contd.........• Refers to communication rather than directing• There is a limited body of literature on the use of BSM in clinical practice or to provide framework for nursing research
A little backgroundWhat type of theory did Dorothy Johnson Postulate?
GENERAL THEORIES1. Florence Nightingale2. Virginian Henderson3. Martha Rogers4. Sr Cellistea Roy5. Dorothea Orem6. Betty Numen7. Dorothy Johnson
Systems Theory1. Roy’s adaptation theory2. Numen’s Health care systems model3. Johnson’s health care behavioral model4. King’s goal attainment theory
Interpersonal/ Caring Theories1. Peplau’s Psychodynamic Nursing theories2. Leininger’s Tran cultural care theories.3. Watson’s Philosophy and science of caring theory
Client is Clie m biopsychosocial nt i yste s an or al s Person can be broken ada e havi ith down into parts for study/care 2a dap pti ve ab ea ch w a tive sys n t is ms, s and ada subs tem Clie ste bsy onen su mp t • System’s Theory ptiv yst e m ems ra l o • Holistic view of client ode and e avio ural c ction. h ct • Client interacts with the environment s 47 b stru fun 4 al • Client is the center-focus of theoretical v i du ni n di framework and of nursing care n t is a • Nursing facilitates client’s progress toward Clie some balance or homeostasis (adaptation, order, stability, etc.) • Weak definition of nurse-patient relations • Person becomes nursing client when threatened by internal or external forces Acknowledge client as • Psychological, biological, and sociological aspects of individual, family, client recognized group, or community Physiological, psychological, sociological, developmental, and spiritual variables Client represented as central structure, lines of defense, and resistance.
Case studyRam a daily wage laborer in a stone query had a lacerated wound on his forehead. He was referred to the PHC. The wound extended to the skull. As a result he was out of work and spend plenty of time with his friends and seemed depressed. His wife spent hours each day making a variety of snacks .to cheer him up and found it was a good way to release her anxiety about her husband condition.After three weeks the wound showed no improvement, although it was not infected. During the visit to the PHC the wife confided to the nurse stating that her husband was drinking a lot of water and seemed to be urinating frequently, even at night he had a disturbed sleep due o this problem. She was wondering if there was any pill to help him sleep through the night.
At the PHC Uma the nurse used the BHM to solve the problem.• She assessed Ram and his family using the 7 subsystems of behaviour she found deficit in 3 subsystems • Achievement subsystem due to lack of social involvement and depression • Eliminative subsystem due to polyuria, nocturia • Ingestive subsystem due to drinking lots of water, and eating lots of
Based on Johnson’s BSM assumptions Uma concludes that Ram probably has diabetes. After confirming the diagnosis, she helps Ram to correct his system imbalances by modifying his behavior in order to achieve homeostasis
Ram’s wound started healing almost immediately after his diabetes was identified and controlled. He was able to go back to work and to meet with his friends again. His wife learned fun, new diabetic-friendly foods to cook for herself and Ram.
SUMMERY Johnson’s theory defines health as a purposeful adaptive response to internal and external stimuli in order to maintain stability and comfort.The main goal of nursing is to foster equilibrium within the patient.The practice of nursing is concerned with the organized and integrated whole, but maintaining a balance in the behavior system when illness occurs is the major focus of the career.