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BEHAVIOURAL SYSTEM MODEL

Dorothy E. Johnson

Biographical sketch of the theorist


Born 21 August 1919, Savannah, Georgia, U.S.A
BSN - 1942 from Harward University Boston
MPH - 1948
Carrier as staff nurse, instructor, Assistant Professor in
Paediatric nursing, Asso. Professor & Professor of Nursing at
the University of California

1955-56

Paediatric nurse advisor assigned to CMC


School of Nursing Velloore, South India

Publication -

Four books, 30 articles, many


reports, monographs

papers,

1975

Faculty Award

1977

Lulu Hassenplug distinguished


Achievement Award from California
Nurses Association

1981

Vanderbilt University School of Nursing


Award for excellence in nursing

Died

1999

THEORETICAL ORIGIN

Johnsons behavioral system theory springs


from nightingales belief that nursings goal is to
help individuals prevent or recover from disease or
injury. The science and art of nursing should
focus on the specific disease entity. Behavioural
system model is based on a preexisting body of
knowledge developed by a number of different
discipline psychology, sociology and ethmology.

The structure of the behavioural system model


is patterned after a system model; a system is
defined as consisting of interrelated parts
functioning together to form a whole. Johnson
conceptualizes a person as a behavioural system
in which the functioning outcome is the
observed behaviour.

Nursing

contributes

by

facilitating

effective

behavioural functioning in the patient before, during and


after illness. She uses concepts from other disciplines such
as

social

covering,

motivation,

sensory

stimulation,

adaptation, behaviour modification, change process, tension


and stress to expand her theory for the practice of nursing.

Johnson uses the work of Selye, Grinker,


Simmons to support the idea that specific
patterns of behaviour are reactions to stressors
from biological, psychological and sociological
sources. Stress is a process in which interplay
between various stimuli and defenses erected
against them. Stimuli may be positive in that
they are present or negative in that something
required or desired is absent.

CONCEPTUAL MODELS FOR NURSING PRACTICE


Johnson described seven subsystems that
comprises her behavioural system. Another subsystem
restorative has been suggested by faculty and clinicians
to include behaviors such as sleep, play and relaxation.
But Johnson does not accept restorative as a subsystem
of the behavioural system model. She believes that sleep
is primarily a biological force, not a motivational
behaviour.

MAJOR CONCEPTS AND DEFINITIONS


Behaviour is the output of intraorganismic
structures and processes as they are
coordinated and articulated by and responsive
to changes in sensory stimulation.

System
A system is a whole that functions as a whole by
virtue of the interdependence of its parts.
Behavioural system
A behavioural system encompasses the patterned,
repetitive, and purposeful ways of behaving.
The
behavioural system is composed of seven subsystems.
Each person strives to achieve balance and stability both
internally and externally and to function effectively by
adjusting & adapting to environment through learned
patterns of behaviour. When the forces are great the
person is unable to adapt and behavioural instability
develops in one or more of the subsystems.

Subsystems
A subsystem is a minisystem with its own particular
goals and function that can be maintained as long as its
relationship to other subsystems or the environment is
not disturbed.
Motivational drives direct the activities of these
subsystems, which are continually changing through
maturation, experience and learning.
Subsystems

Attachment /Affiliative system


Attachment/Affiliative means to relate to or
belong to something or someone. Its purpose is
to achieve social inclusion, intimacy and strong
social bonds for security and ultimately for
survival.

Dependency
Dependency
subsystems
promotes
helping
behaviour that calls for a nurturing response.
Its
consequences are approval, attention & recognition and
physical assistance.

Ingestive subsystem
The ingestive subsystem has to do with
where, how, what, how much and under what
conditions we eat. It serves the broad function
of appetite satisfaction. This behaviour is
associated with social, psychological and
biological considerations.

Eliminative system
The eliminative subsystem address when,
how and under what conditions we eliminate.
Social & psychological factors influence the
biological aspects of the subsystem.

Sexual system
The sexual subsystem has the dual function
of procreation and gratification. This
subsystem begins in the development of gender
role identify and includes the broad range of sex
role behaviours.

Achievement subsystem
The
achievement
subsystem
attempts
to
manipulate the environment. Its function is control or
mastery of an aspect of self or environment to some
standard of excellence. Areas of achievement behaviour
include intellectual, physical, creative, mechanical and
social skills.

Aggressive /Protective subsystem

The aggressive/protective subsystem


function is protection and preservation. Society
demands that limits be placed on modes of self
protection and that people and their property
be respected and protected.

Equilibrium
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. It is not synonymous with as
state of health, since it may be found either in
health or illness.

Tension

It is defined as a state of being stretched or


strained and can be viewed as an end product of
a disturbance in equilibrium. Tension can be
constructive in adaptive change or destructive
in inefficient use of energy hindering adaptation
and causing potential structural damage.
Tension is the cue to disturbance in equilibrium.

Stressor
Internal or external stimuli that produce
tension and result is a degree of instability are
called stressor. Stimuli may be positive in that
they are present or negative in that something
desired or required is lacking.

JOHNSONS BELIEF/ASSUMPTIONS

Nursing as perceived by Johnson is an


external force acting to preserve the
organizations of the patients behaviour by
means of imposing regulatory mechanisms or
by providing resources while the patient is
under stress. Otherwise regulation of external
force to stabilize clients behavioural system
and restore, maintain and attain balance.

Person - Johnson views the person as a


behavioural system with patterned, repetitive
and purposeful ways of behaving that link the
person to the environment. A person is a
system of interdependent part that requires
some regularity and adjustment to maintain a
balance. When strong forces or lower resistance
disturb behavioural system balances, the
individuals integrity is threatened. A client is a
behavioural system (person) threatened or
potentially threatened by illnesses (imbalance)
and /or hospitalization.

Health is reflected by the organization,


interaction, interdependence, and integration of
the subsystems of the behavioural system. A
lack of balance in structural or functional
requirements of the subsystems leads to poor
health. Health is an efficient and effectively
functioning behavioural system (person) who
maintains
balance/stability
by
adapting
/adjusting to onside forces.

Environment
No specific setting identified. Environment consists of
all the factors that are not part of the individuals behavioural
system, but influence the system, some of which can be

manipulated

by the nurse to achieve the health goals for


the patient. When the environment is stable, the individuals is
able to continue with successful behaviours.

Theoretical assertions

Johnsons behavioural system theory


addresses two major components. The patient
system with seven interrelated system. Each
system has structural and functional
requirements. The four structural elements
are: 1) drive or goals 2) self, predisposition to
act 3) choice, alternative for action 4)
Behaviour. Each of the subsystem and some
three functional requirements.1) Protection 2)
nurturance 3) stimulation.

Health Change Process


Dynamic environment
External stressors
(+) or (-)

Nursing action
Nurture
Protect
Stimulate

Behavioral system (Patient)


Attachment/affiliation

Achievement

Dependency

Stress tolerance
Flexibility

Subsystems
Aggressive

Cue

Tension
Health or illness
Sexual

Internal stressors
(=) or (-)
Learning
Ingestive/eliminative
Experience
Maturation
Other changing factors
(biological, psychological,
sociological
Active dynamic behavioral system
(person, group, family)
JOHNSONS BEHAVIORAL SYSTEM MODEL

Structure
Drive
Set, Choice
Behavior
Dynamic
Equilibrium
(Goal)

The system and subsystems tend to be self


maintaining and self perpetuating as long as internal and
external conditions remain orderly and predictable. If the
conditions and resources necessary to their functional
requirements are not met, or the interrelationship among
the subsystems are not harmonious dysfunctional
behaviour results.

The responses by the subsystems are developed


through motivation, experiences and learning
and are influenced by biological, psychological
and social factors. The behavioural system
attempts to achieve balance by adapting to
internal and environmental stimuli.

The functional unit of behaviour determines and


limit the interaction of person and his environment and
establishes the relationship of the person with objects,
events and situations in his environment.
The
behavioural system manages its relationship with its
environment. The behavioural system appears to be
active. A state of instability in the behavioural system
results in a need for nursing intervention. Identification
of the source of problem in the system leads to
appropriate nursing action that results in the
maintenance or restoration of behavioural system
balance. Nursing is seen as an external regulatory force
that acts to restore the balance in the behavioural
system.

Logical form
Johnson used logical forms of deductive & inductive
reasoning to develop her theory. She states that a common
core exists in nursing, a core that practitioners use in many
settings and with varying populations. Johnson used her
observations of behaviour to formulate a general theory of the
person as a behavioural system.

APPLICATION OF THE THEORY


Practice

Theory provides direction for practice, education


and research. The goals of theory is to use protection,
nurturing and stimulation to maintain and restore
balance in the patient and a more optimal level of
functioning which is congruent with the goals if
nursing. Assessment, disorders, treatment and
evaluation are of more importance. Nursing process
becomes applicable in the behavioural system model
when behavioural malfunction occurs.

Initial nursing assessment begins when cue


tensions is observed and signals disequilibrium.
Sources for assessment data can be through history
taking, testing, and structural observations. The only
observed part of the subsystem structure as behaviour.
Six internal and external regulations have been
identified that simultaneously influence and are
influenced by behaviour including biophysical,
psychological, development, sociocultural, family and
physical environmental regulations. The means of
management or interventions consist in the part of
provision of nurturance, protection and stimulation.

The behavioural system model operationalized


through the development of several assessment
instruments.
1974
Grubbs used theory to develop
assessment tool and
nursing process
based on 7 subsystems.
1974
Holday Assessment tool for
children.

Derdiarian used Johnson Behavioural system


model to develop a self report and observational
instrument to be implemented with the nursing process.
The Derdian Behavioural System Model (DBSM)
instrument
included
assessment
of
restorative
subsystem and seven subsystems.
Case studies based on Johnson model in clinical
practice.
Nursing administration For making decisions
concerning the management of impaired nurses.
Neuropsychiatric institute California used Johnsons
model for psychiatric nursing practice.

Dec, van Servellen, and Brecht examined


the effects of managed health care on patient
outcomes using Johnsons Behavioural system
model.
Upon admission nurses develop a
behavioural profile by assessing eight
subsystems determine balance or imbalance of
the subsystems and role the impact of six
regulators.
This is used to determine the
nursing diagnoses, plan of action, and
evaluation of care for each patient.

Education

A curriculum based on a person as a


behavioural system would have definite goals
and straight forward course planning. The
model has been used in practice and
educational institutions in the United States,
Canada & Australia.

Research
Nursing research would need to identify and explain
the behavioural system disorders which arise in
connection with illness, and develop the rationale for the
means of management. Research can investigate the
functioning of the system and subsystems by focusing on
the basic sciences.
Research can also investigate
methods of gathering diagnostic data or problem solving
activities as they influence the behavioural system. Small
used Johnsons theory as a conceptual framework to use
then caring for visually impaired children by evaluating
and compared the perceived body image and spatial
awareness of normally sighted children with visually
impaired children.

Wilkie, Lovejoy, Dodd and Tesler examined


cancer pain control behaviours with the use of
Johnsons Behavioural System Model. The
high pain intensity persons used known
behaviours to protect themselves from the
pain.
This supports the assumption that
aggressive/protective subsystem behaviours
an developed and modified overtime to protect
the individual from pain.

Derdiarian examined the relationships between the


aggressive and protective subsystem and the other
subsystems.
Her findings supported the
proposition that subsystems are interactive,
interdependent and integrated and that changed
in a subsystem resulting from illness can not be
well understood without understanding their
relationship to changes in the other subsystems.

Studies conducted with individuals with long term illness


AIDS, cancer, & psychiatric illness.
Studies have
documented the effectiveness of using the model with
children, adolescents and elderly population.
Behavioural system framework can be applied
to community health. A community can be described
as a behavioural system with interacting subsystems
that
have
structural
elements
and
functional
requirements. For eg. Mothers of chronically ill children
here functional requirements needed to maintain stability
within the achievement subsystem. The interaction of
environmental factors such as economic, educational,
employment influence mothers caretaking skills.

CRITIQUE
Simplicity
Johnsons theory is relatively simple in relation
to number of concepts.
However the theory is
potentially complex because the relationship between
the subsystems and the forces impinging on them are
not much explored.
Generality
Johnsons theory is relatively unlimited when
applied to sick individuals, but it has not been used as
much with well individuals or groups.

Empirical precision

The units and the relationship between the


units in Johnsons theory are consistently
defined. A moderate degree of empirical
precision has been demonstrated in research
using Johnsons model.

Derivable consequences
Johnsons

model

provided

conceptual

framework education and research, generates new


ideas about nursing, and differentiates nursing from
other health professions.

By focusing on behaviour

rather than biology the theory clearly dedifferentiates


nursing

from

medicine.

This

theory

is

found

appropriate as a basis for the development of a


nursing curriculum.

The theory has potential for

continued utility in nursing to achieve valued nursing


goals.