Introduction

1.   Dorothy E. Johnson was born August 21, 1919, in Savannah, Georgia.

2.   B. S. N. from Vanderbilt University in Nashville, Tennessee, in 1942; and her M.P.H. from Harvard University in Boston in 1948.

3.   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.

4.   Dorothy Johnson has had an influence on nursing through her publications since the 1950s. Throughout her career, Johnson has stressed the importance of research-based knowledge about the effect of nursing care on clients.

Johnson’s behavior system model

1.   In 1968 Dorothy first proposed her model of nursing care as fostering of    “the efficient and effective behavioral functioning in the patient to prevent illness".

2.    She also stated that nursing was “concerned with man as an integrated whole and this is the specific knowledge of order we require”.

3.   In 1980 Johnson published her conceptualization of “behavioral system of model for nursing” this is the first work of Dorothy that explicates 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”

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 

Assumptions of behavioral system model

There are several layers of assumptions that Johnson makes in the development of conceptualization of the behavioral system model (Johnson was influenced by Buckley ,Chin and  Rapport) there are  4 assumptions of system:

1.   First assumption states that there is “organization, interaction, interdependency and integration of the parts and elements of  behaviors that go to make up The  system ” 

2.    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.”

3.    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.

4.    The final assumption states “system balance reflects adjustments and adaptations that are successful in some way and to some degree.”

The integration of these assumptions provides the behavioral system with the pattern of action to form “an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relation of the person to the objects, events and situations in his environment.

The integration of these assumptions provides the behavioral system with the pattern of action to form “an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relation of the person to the objects, events and situations in his environment.”

Assumptions about structure and function of each subsystem

1. “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”

2. 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”.

3. Each subsystem has a repertoire of choices or “scope of action”

4. The fourth assumption is that it produce “observable outcome” that is the individual’s behavior.

Each subsystem has three functional requirements

1. System must be “protected" from noxious influences with which system cannot cope”.

2. Each subsystem must be “nurtured” through the input of appropriate supplies from the environment.

3. Each subsystem must be “stimulated” for use to enhance growth and prevent stagnation

Johnson believes each individual has patterned, purposeful, repetitive ways of acting that comprise a behavioral system specific to that individual. These actions and behaviors form an organized and integrated functional unit that determines and limits the interaction between the person and his environment and establishes the relationship of the person to the objects event situations in the environment.These behaviors are “orderly, purposeful and predictable and sufficiently stable and recurrent to be amenable to description and explanation”  

Johnson’s Behavioral Subsystem 

1. Attachment or affiliative subsystem: “social inclusion intimacy and the formation and attachment of a strong social bond.”

2. Dependency subsystem: “approval, attention or recognition and physical assistance”

3. Ingestive subsystem: “the emphasis is on the meaning and structures of the social events  surrounding the occasion when the food is eaten”

4. 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.”

5. Sexual subsystem:" both biological and social factor  affect the behavior in the sexual subsystem”

6. 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”

7. 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

1. Johnson views “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.

2. “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

3. “Health” is a purposeful adaptive response, physically mentally, emotionally, and socially to internal and external stimuli in order to maintain stability and comfort.

4. “Nursing” has a primary goal that is to foster equilibrium within the individual .she stated that 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:

1. Affiliation
2. Dependency
3. Sexuality
4. Aggression
5. Elimination
6. Ingestion
7. Achievement
8. 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:

1. Insufficiency
2. Discrepancy
3. Incompatibility
4. 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.

Situation

John Smith, 6 weeks brought into the clinic for a routine check-up.  He presents with no weight gain since his check up at the age of 2 weeks .His mother stated she feeds him but he does not seem to eat much. He sleeps 4to 5 hour between the feedings. His mother holds him in her arms without trunk to trunk contact. As the assessment is made the nurse notes that Mrs. Smith never looks at Johnny and never speaks to him. She stated he was a planned baby but that she never realized how much work a baby could be. She says, her mother told her she was not a good mother because John is not gaining weight like he should.  She states she had not called the nurse when she knew John was not gaining weight because she thought nurse would think she was a bad mother just like her own mother thought she was a bad mother.

Assessment

1. Affiliative subsystem between mother and John.
2. Dependency subsystem between mother and John
3. Affiliative subsystem between Mrs.Smith and her mother.
4. Insufficiency ingesion subsystem.

Diagnosis

1. Insufficient development of the affiliative subsystem.
2. Insufficient development of the dependency subsystem

Planning and implementation

1. Increasing mother’s awareness of the baby’s clues.
2. Assisting her to talk with the baby.
3. Teach her to bring a bond between her and the baby by touch, pat and cuddles etc.

Evaluation

1. Johnny's weight gain or weight loss will be carefully assessed.
2. The –infant interaction could be reassessed, using the nursing child assessment feeding scale.
3. The interaction of Mrs. Smith with her mother.  

Johnson’s and Characteristics of a theory

1. Interrelate concepts to create a different way of viewing a phenomenon.
2. Theories must be logical in nature.
3. Theories must be simple yet generalizable
4. Theories can be bases of hypothesis that can be tested.
5. Theories contribute to and assist in increasing the body of knowledge within the discipline through the research implemented to validate them
6. Theories can be utilized by practitioners to guide and improve their practice.
7. Theories must be consistent with other validated theories, laws and principles but will leave unanswered questions that need to be investigated.   

Limitation

1. Johnson does not clearly interrelate her concepts of subsystems comprising the behavioral system model.
2. The definition of concept is so abstract that they are difficult to use.
3. It is difficult to test Johnson's model by development of hypothesis.
4. The focus on the behavioral system makes it difficult for nurses to work with physically impaired individual to use this theory.
5. The model is very individual oriented so the nurses working with the group have difficulty in its implementation.
6. The model is very individual oriented so the family of the client is only considered as an environment.
7. 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.
8. 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.

Research Input

1.    The health and well-being of caregivers of children with cerebral palsy. Raina.p.  Et al (pediatrics 2005 June)

The psychological and physical health of caregivers, who in this study were primarily mothers, was strongly influenced by child behavior and care giving demands. Child behavior problems were an important predictor of caregiver psychological well-being, both directly and indirectly, through their effect on self-perception and family function

2.   Creating opportunities for parent empowerment: program effects on the mental health/coping outcomes of critically ill young children and their mothers. Malnvk BM. Et. Al (Pediatric 2004)

COPE mothers reported significantly less parental stress and participated more in their children's physical and emotional care on the pediatric unit, compared with control mothers, as rated by nurses who were blinded with respect to study group. In comparison with control mothers, COPE mothers reported less negative mood state, less depression, and fewer PTSD symptoms at certain follow-up assessments after hospitalization