- Dorothy
E. Johnson was born August 21, 1919, in Savannah, Georgia.
- B.
S. N. from Vanderbilt University in Nashville, Tennessee, in 1942; and her
M.P.H. from Harvard University in Boston in 1948.
- From
1949 till 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.
- Johnson
stressed the importance of research-based knowledge about the effect of
nursing care on clients.
Behavior system
model
- Dorothy
first proposed her model of nursing care in 1968 as fostering of “the
efficient and effective behavioral functioning in the patient to prevent
illness".
- She
also stated that nursing was “concerned with man as an integrated whole
and this is the specific knowledge of order we require”.
- In
1980 Johnson published her conceptualization of “behavioral system of
model for nursing”where she explains her definitions of the behavioral
system model.
Definition of
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”
Four goals of nursing are to assist the patient:
- Whose
behavior commensurate with social demands.
- Who
is able to modify his behavior in ways that it supports biological
imperatives
- Who
is able to benefit to the fullest extent during illness from the
physicians knowledge and skill.
- Whose
behavior does not give evidence of unnecessary trauma as a
consequence of illness
Assumptions
There are several layers of
assumptions that Johnson makes in the development of conceptualization of the
behavioral system model viz.
- Assumptions
about system
- Assumptions
about structure
- Assumptions
about functions
Assumptions about system
There are 4 assumptions of
system:
- First,
there is “organization, interaction, interdependency and integration of
the parts and elements of behaviors that go to make up
the system ”
- 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 impinging upon him.”
- A
behavioral system, which both requires and results in some degree of
regularity and constancy in behavior, is essential to man that is to say,
it is functionally significant in that it serves a useful purpose, both in
social life and for the individual.
- Last,
“system balance reflects adjustments and adaptations that are successful
in some way and to some degree.”.
Assumptions about structure and
function of each subsystem
- “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”
- Each
individual has a “predisposition to act with reference to the goal, in
certain ways rather than the other ways”. This predisposition is called as
“set”.
- Each
subsystem has a repertoire of choices or “scope of action”
- The
fourth assumption is that it produce “observable outcome” that is the
individual’s behavior.
Each subsystem has three functional
requirements
- System
must be “protected" from noxious influences with which system cannot
cope”.
- Each
subsystem must be “nurtured” through the input of appropriate supplies
from the environment.
- Each
subsystem must be “stimulated” for use to enhance growth and prevent
stagnation.
- These
behaviors are “orderly, purposeful and predictable and sufficiently stable
and recurrent to be amenable to description and explanation”
Johnson’s Behavioral
Subsystem
- Attachment
or affiliative subsystem: “social inclusion intimacy and the formation and
attachment of a strong social bond.”
- Dependency
subsystem:
“approval, attention or recognition and physical assistance”
- Ingestive
subsystem: “the
emphasis is on the meaning and structures of the social
events surrounding the occasion when the food is eaten”
- Eliminative
subsystem: “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.”
- Sexual
subsystem:" both
biological and social factor affect the behavior in the sexual
subsystem”
- Aggressive
subsystem: " it relates to the behaviors concerned with
protection and self preservation Johnson views aggressive subsystem
as one that generates defensive response from the individual when life or
territory is being threatened”
- Achievement
subsystem: " provokes behavior that attempt to control the
environment intellectual, physical, creative, mechanical and social skills
achievement are some of the areas that Johnson recognizes".
Representation
of Johnson's Model
Goal ----- Set --- Choice
of Behavior --- Behavior
- Affiliation
- Dependency
- Sexuality
- Aggression
- Elimination
- Ingestion
- Achievement
The four major
concepts
- “Human
being” as having two major systems, the biological system and the
behavioral system. It is role of the medicine to focus on biological
system where as Nursling's focus is the behavioral system.
- “Society”
relates to the environment on which the individual exists. According to
Johnson an individual’s behavior is influenced by the events in the
environment
- “Health”
is a purposeful adaptive response, physically mentally, emotionally, and
socially to internal and external stimuli in order to maintain stability
and comfort.
- “Nursing”
has a primary goal that is to foster equilibrium within the individual.
Nursing is concerned with the organized and integrated whole, but that the
major focus is on maintaining a balance in the Behavior system when
illness occurs in an individual.
Nursing process
Assessment
Grubbs developed an assessment tool
based on Johnson’s seven subsystems plus a subsystem she labeled as restorative
which focused on activities of daily living. An assessment based on behavioral
model does not easily permit the nurse to gather detailed information about the
biological systems:
- Affiliation
- Dependency
- Sexuality
- Aggression
- Elimination
- Ingestion
- Achievement
- Restorative
Diagnosis
Diagnosis tends to be general to the
system than specific to the problem. Grubb has proposed 4 categories of nursing
diagnosis derived from Johnson's behavioral system model:
- Insufficiency
- Discrepancy
- Incompatibility
- Dominance
Planning and implementation
Implementation of the nursing care
related to the diagnosis may be difficult because of lack of clients input in
to the plan. the plan will focus on nurses actions to modify clients behavior,
these plan than have a goal ,to bring about homeostasis in a subsystem, based
on nursing assessment of the individuals drive, set behavior, repertoire, and
observable behavior. The plan may include protection, nurturance or stimulation
of the identified subsystem.
Evaluation
Evaluation is based on the
attainment of a goal of balance in the identified subsystems. If the baseline
data are available for an individual, the nurse may have goal for the
individual to return to the baseline behavior. If the alterations in the
behavior that are planned do occur, the nurse should be able to observe the
return to the previous behavior patterns. Johnson's behavioral model with the
nursing process is a nurse centered activity, with the nurse determining the
clients needs and state behavior appropriate for that need.
Johnson’s and
Characteristics of a theory
- Interrelate
concepts to create a different way of viewing a phenomenon - Concepts in
Johnson's theory are interrelated.
- Theories
must be logical in nature- Johnson's theory is logical in nature.
- Theories
must be simple yet generalizable - The theory is simple.
- Theories
can be bases of hypothesis that can be tested - Research studies are
conducted applying Jonhson's theory.
- Theories
contribute to and assist in increasing the body of knowledge within the
discipline through the research implemented to validate them.
- Theories
can be utilized by practitioners to guide and improve their practice.
- Theories
must be consistent with other validated theories, laws and principles but
will leave unanswered questions that need to be investigated.
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.
- 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.
- The
model is very individual oriented so the family of the client is only
considered as an environment.
- 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
behavioral system model is not flexible.
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 7 behavioral subsystems. Each
subsystem composed of four structural characteristics i.e. drives, set, choices
and observable behavior.
Three 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.
References
- George
B. Julia, Nursing Theories- The base for professional Nursing Practice,
3rd ed. Norwalk, Appleton and Lange.
- Polit
DF, Hungler BP. Nursing Research: Principles and Methods. Philadelphia: JB
Lippincott Company; 1998.
- Burns
N, Grove SK. The practice of Nursing Research. 4th Ed. Philadelphia: WB
Saunders Publications; 2001.
Treece JW, Treece EW. Elements of Research in
Nursing (3rded.). St. Louis: Mosby; 1982.
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