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Contribution to nursing
Theory development and influences
Major concepts
Applications and future directions
Nursing process
Theory critique


All of us, scientists and practicing
must turn our attention to practice and
ask questions of that practice.
We must be inquisitive and inquiring,
seeking the fullest and truest possible
understanding of the theoretical and
practical problems we encounter (Johnson,

BIOGRAPHY (1919-1999)
Born in Savannah, Georgia in August 21, 1919
Youngest in the family of seven
She finished her associates degree in arts 1938 from Armstrong Junior
college in Savannah, Georgia.
Finished a degree in Bachelor of Science in Nursing in 1942 from
Vanderbilt University, Nashville, Tennessee

Obtained a Masters of Public Health in 1948 from Harvard University,

Boston, Massachusetts
Most of her teaching career was in Pediatric Nursing at the University of
California, Los Angeles (UCLA)
The creation of her theory began in in the 1940s when she began to

She was studying nursing and how it was being taught and realized that
there was no evidence that supported what should be taught to nurses
After more than 15 years, she began to think of man and the behavioral
systems model and how it best supported nursing practice. This theory is
a highly abstract concept.

It should be used to build a perspective of the patient and not the

disease. Dorothy's behavioral theory has been used in practice, research,
and education.

Was proudest of the 1975 Faculty Award from graduate students

Received Lulu Hassenplug Distinguished Achievement Award from the
California Nurses Association in 1977.

Retired as Professor Emeritus on January 1, 1978

Received Vanderbilt University School of Nursing Award for Excellence in

Nursing in 1981
Died in February 1999 at the age of 80

Definition of Nursing According to Johnson:
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

She believed nursing had a body of knowledge reflecting both the

science and art

1959 proposed that knowledge of the science of nursing necessary

for effective nursing can included a synthesis of key concepts drawn
from basic and applied sciences
1961 Johnson proposed that nursing care facilitated the
clients maintenance of a state of equilibrium
She proposed that clients were stressed by a stimulus of either an
external or internal nature
1968 Johnson first proposed her model of nursing care as the fostering
of the efficient way and effective behavioral functioning in the patient
to present illness


Johnson stated that her theory is a product of philosophical ideas; sound
theory and research; her clinical experiences; and many years of
thinking, discussing, and writing (Johnson, 1978).
Johnson identified that her work was inspired by Nightingale, Seyle,
Grinker, Buckely, Chin and most importantly, students, faculty, and
colleagues with whom she has worked with.
So , the theory is deductive
and inductive.

Johnson's theory is also based on a systems paradigm, as perceived from

a sociological perspective (Melesis, 2007).
Johnson has also been credited by inspiring students notably Adam,
Neuman, and Roy, who have now developed their own theories
(Johnson and Webber, 2007).
Works written by Dorothy Johnson include:
Theory Development: What, Why, How?
Barriers and Hazards in Counseling

The human being strives to make continual adjustments to achieve,
maintain, or regain balance to the steady-state that is adaptation.
It has two major systems: the biological and behavioral systems.

The role of medicine is to focus on the biological system, while nursing's

focus is on the behavioral system.

Society relates to the environment in which the patient exists; the the
environment and events that occur in it influence a patient's behavior

Health is a purposeful adaptive response to internal and external stimuli

in order to maintain stability and control.

The responses include physical, mental, emotional, and social realms.

The primary goal of nursing is to foster equilibrium in the individual
patient. One focus of nursing concerns the organized and integrated
whole, but the major focus is on maintaining balance in the behavioral
system during an illness in the biological system. And that the nurse is
the External force that acts to impose temporary regulatory/ control
mechanisms / providing resources while patient is experiencing stress.

A system of independent parts with patterned, repetitive, purposeful
ways of behaving behavioral system composed of
7 subsystems

All forces that affect the person and influence the behavioral system

Health is reflected by the organization, interaction, interdependence,
and integration of subsystem of the
behavioral system

Promotion of behavioral system balance and stability; an external
regulatory force that acts to preserve the
organization and integration of the client's behavior at
optimal level under those condition, which the behavior constitutes a
threat to physical or social health, or which
illness is found

Behavioral system
Man is a system that indicates the state of the system through behaviors.

The point that differentiates the interior of the system from the exterior.

All elements of the surroundings of the human system and includes
interior stressors (not directly defined but implied).

Consequences or purpose of actions.

Functional requirements

Input that the system must receive to survive and develop.

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

Process of maintaining stability.

A behavioral system that strives to make continual adjustments to
achieve, maintain, or regain balance to the steady-state that is

State in which the system output of energy depletes the energy needed
to maintain 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

The parts of the system that make up the whole.

That which functions as a whole by virtue of organized independent
interaction of its parts.

A minisystem maintained in relationship to the entire system when it or
the environment is not disturbed.

The system's adjustments to demands, change or growth, or to actual

Factors outside the system that influence the system's behavior, but
which the system lacks power to change.

Assumptions about system
Assumptions about structure
Assumptions about functions


First, that a system is composed of organization, interaction,
interdependency and integration of the parts and elements of
Second, that a system tends to achieve a balance among the diverse
forces operating within and upon it,' and that, man endeavors to keep up
by more or less having automatic adjustments and adaptations to the
natural forces impinging upon him in order to maintain continuously a
steady state and a behavioral system balance.

Third, a behavioral system, which requires and results into a degree of

regularity and of constancy, is essential to man. It is of prior importance
because it serves a purpose tantamount in social life aspect as well as for
the individual.
Last, a system balance reflects adjustments and adaptations that are
successful in some way and to some degree.

Patient Behavioral Systems - adapted from Dee V and Randell B





1. Attachment or

Serves the need for security through social inclusion or


2. Dependency

Behaviors designed to get attention, recognition & physical


3. Ingestive

Fulfills the need to supply the biologic requirements for food

& fluids.

4. Eliminative

Functions to excrete wastes.

5. Sexual

Serves the biologic requirements of procreation &


6. Aggressive

Functions in self, & social protection & preservation.

7. Achievement

Functions to master & control the self or the environment.

Representation of Johnson's Model

Goal ----- Set --- Choice of Behavior --Behavior



Drive has been stimulated or Goal is being sought from the

behaviour an individual takes and from the consequences it achieves.

Set is a predisposition termed to act with reference to the goal, in

certain ways rather than the other ways by each individual.
Scope of Action is a repertoire of choices of each subsystem.
Observable outcome is produced from an individuals behaviour.

Each subsystem has three functional requirements

The system must be protected" from noxious influences with which it
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 behaviours are orderly, purposeful and
predictable and sufficiently stable and recurrent to be amenable to
description and explanation.


NURSING PRACTICE (Clinical Setting)
Dorothy Johnson is one of the nursing theorists who tried to change the
way nursing was viewed and proved that it was different from the field
of medicine.

She proposed the idea that the focus of nursing should be on a persons
behavior rather than on the health state or disease condition (Cromwell,

According to Tabers Online, Johnsons implication to nursing practice is

that it became directed toward restoration, maintenance, or attainment
of behavioral system balance and dynamic stability at the highest
possible level for the individual.
Johnsons model has been incorporated into the nursing practice as it
provided a systematic approach and method to guide patient care.

Nursing Education
Johnsons vision was to create a curriculum focused on nursing and not
derived solely from other disciplines.
She believed that nursing is a discrete science and her beliefs have held
true (McEwen & Willis in Cromwell, 2008).

Education guided by her model was focused on the study of the

behavioural system as a whole and as a composite of subsystems.

Emphasis was given to the physiologic bases of behaviour, psychosocial

mechanisms that regulate behaviour, social learning processes, and
motivational structures (Tabers Online).
Johnsons theory and ideas also helped shift the focus of nursing
graduate programs from teaching and administration to clinical nurse
specialists and nurse practitioner programs (Johnson & Webber in
Cromwell, 2008).

These programs helped identify nursing as a unique discipline and as a

Johnsons ideas were also incorporated in the development of the
nursing education programs at the University of Colorado, University of
California, University of Hawaii, and California State University.

ou Can Be a Nurse!

Nursing Research
According to McEwen &Willis (2007), Johnsons theory was tested in
more than twenty research studies.
These include studies conducted in various patient populations such as
the visually impaired, elementary school children, and cancer patients
(Johnson & Webber in Cromwell, 2008), and in the development of tools
to measure the concepts presented in the model.
The explanation of the concepts in the behavioural model was criticized
for being highly-abstract and the theoretical assumptions were

These can inspire researchers to study the relationship between the

concepts and the behavioural system further, and to retest the
Opportunity for research is also attributed to the limited publication of
Johnsons theory.
Johnson never published a book about it but she wrote several chapters
and articles that contain her ideas according to McEwen & Willis (2007).

This gives researchers the chance to review and examine the aspects of
her theory that may lack in clarity.

Behavioral Systems Model
More than 20 research studies have been identified using Johnsons
model. (Ex: Turner-Henson, 1992, used it as a framework to examine
how mothers of chronically ill children perceived the environment, i.e.,
whether it was supportive, safe, and accessible).
Poster, Dee & Randell (1997) used Johnsons theory as a conceptual
framework in a study of client outcome evaluation; they found that the
nursing theory made it possible to prescribe nursing care and to
distinguish it from medical care.
Derdiarian & Schobel (1990) used the model to develop an assessment
tool for individuals with acquired immunodeficiency syndrome.
Derdiarian (1990) examined the relationship between
aggressive/protective subsystem & the other six model subsystems.

I. Assessment
Grubbs developed an assessment tool based on Johnsons 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:


II. Diagnosis
Diagnosis tends to be general to the system than specific to the

Grubb has proposed 4 categories of nursing diagnosis derived from

Johnson's behavioral system model:


III. 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.

IV. 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

Dorothy Johnson's Behavioral System model contributed much on the
nursing profession.

She identified the major purpose and role of the theory in the nursing
profession and that is to keep the level of behavioral system in
equilibrium up to the highest level.

The theory serves as a tool or guide to motivate patient or the behavior

of man during distress.

Its scope and uses was not limited only to the patient care in
practice of nursing but it was also used by the administrators and
also in researches.

With a very definite goal, it made the researcher to have a set of

standard and are able to calculate how effective a nursing
providing standards and guidelines in research focuses on the
relation of behavior system in Nursing.

Her theory change how the world see nursing profession separate in
medicine because Johnson believes that nursing care has a definite
effect on the health of a person which is not the same on how medicine
perform its duties and responsibilities in alleviating the health of the

This theory contributed very much in shaping the future of our

profession and on how nursing profession was viewed today

The recipient of her nursing care was only limited to the person who are
admitted in the hospital (obviously the sick individuals).

Dorothy did not mention the importance of prevention instead she

focuses on ill hospitalized client with occurring disease which she
mentioned as stressors.

She also fails to include and give importance to the Nursing Process in
her theory and instead focuses on the behavior of the client in response
to illness or disability.

Lack and limited publication of her theory is one of the limitations

(made sense right?).
The relationship between the subsystem and the behavioral system
was not clear.
The concept is abstract that what it makes difficult to understand and
so difficult to test using hypothesis.

Study on behavior is very specific or very particular and differ from

person to person so it is not good to use on a group basis as well as
to the health of the family.

The theory is not as flexible as other theories that can be utilized

not only to the individuals but to families or even the whole

I think that Johnson theory gives
the researchers the base for new
ideas, innovations which driven
from her abstract concepts and
assumptions and in any theory
there is always strengths and
limitations points so with our bright
minds and our limitless potential
we can use limitations to
improvement and development and
strengths to support and guided us
in the search


Parker (2010), Nursing theory and practice 3rd edition