Dorothy Johnsons Behavioral System

Model
Education and Nursing Specialty of
Theories - Tessa Carson
Education
During the year 1919, Dorothy Johnson was the last of seven siblings to be born in Savannah, Georgia.
When she was of age, she received her Bachelor of Science in Nursing from Vanderbilt University and
later went on to earn her masters in public health from Harvard. It did not take her long after graduating
with her Bachelor of Science in Nursing degree before she started generating ideas focused on the impaired
individual. These ideas were published shortly after leaving Vanderbilt. Her learning did not stop at the
extent of education from schooling. She took past theorists ideas and beliefs and implemented them when
developing the Behavioral Systems Model. Those ideas and beliefs influencing the development of
Johnsons theory primarily belonged to Florence Nightingale. (George, 2011)

Pictured above is Dorothy Johnson's school picture from Vanderbilt University in Nashville, Tennessee in
the year 1942. During her time there she was awarded outstanding student in her class and received the
Founders Medal. She joined the faculty of the nursing school at Vanderbilt after she graduated. (George,
2011)
Specialty
Dorothy Johnson was not only an active learner, but also a teacher. The majority of her career as a teacher
was in pediatric nursing at the University of California, Los Angeles. During this time she formulated the
ideas and concepts that went into developing her theory. She took into account Nightingales focus on the
fundamental needs of the patient rather than the disease process as well as the relationship of the person in
accordance to a clean environment rather than the relationship with the illness or disease. From first
developing a model of nursing care as the fostering of the efficient and effective behavioral functioning in
the patient to prevent illness, she later formulated subsystems that contributed to her Behavioral Systems
Model (George, 2011, p. 147). In the year 1978, Johnsons career as a teacher came to an end and she
retired as "Professor Emeritus" (George, 2011, p. 146). She died in the year 1999. (George, 2011)

References
George, J.B. (2011). Nursing Theories: The base for professional nursing practice (6th ed.). Philadelphia:
Pearson.
http://www.mc.vanderbilt.edu/throughtime/items/show/2107?tags=nursing
(Hyperline is embedded in picture too)
Nursing Theory, Concepts, and Propositions
Maggie Shabel
Nursing Defined: Johnsons developed her definition of nursing from a philosophical perspective. She
stated it as an external regulatory force which acts to preserve the organization and integration of the
patients behavior at an optimal level under those conditions in which the behavior constitutes a threat to
physical or social health, or in which illness is found (George, p. 147). To help the patient become a
person, Johnson listed four goals of nursing:
1. Whose behavior is commensurate with social demands
2. Who is able to modify his behavior in ways that support biological imperatives
3. Who is able to benefit to the fullest extent during illness from the physician knowledge and skill
4. Whose behavior does not give evidence of unnecessary trauma as a consequence of illness
(George, 2011, p. 147)
Behavioral System Model: Each individual has specific ways of acting that are patterned, purposeful, and
repetitive which embrace a behavioral system. These individualized behaviors create a functional unit
which governs the interactions that person has with his surrounding environment and forms relationships
between the person and the items, occurrences, and circumstances within his specific environment (George,
p. 149). For each person, their behaviors are orderly, purposeful, and predictable (George, 2011, p. 149-
150).
The Behavioral System Model contains seven subsystems: attachment/affiliation, dependency, ingestive,
eliminative, sexual, aggressive, and achievement.
1. Attachment/Affiliation: This is first to develop as a response. For it to function best, social
interactions and intimacy must be strong. Caregiver attachment begins at infancy and is essential,
and as the person grows more relationships are formed which give the person a sense of security.
2. Dependency: These are behaviors that cause others to nurture and care for the
individual. Responses expected from the other individuals in the environment include approval,
attention or recognition, and physical assistance (George, 2011, p. 151). Most often, the response
behaviors come from the caregiver mentioned in the attachment subsystem.
3. Ingestive: These behaviors are centered around food, especially the social aspects that have to do
with food and when it is eaten. Behaviors in this subsystem focus on what is considered
acceptable methods of consumption based on the culture and situation, as well as the physiological
need for food.
4. Eliminative: These behaviors relate to defecation. There are socially acceptable manners for the
excretion of waste, and are dependent on the culture.
5. Sexual: These behaviors center around reproduction. These behaviors are also dependent on
culture, but also have a strong biological pull. The gender of the specific individual alters the
sexual behaviors.
6. Aggressive: Behaviors in this subsystem are for self-protection. Often, the behaviors are
defensive in nature, usually when the person feels threatened. The actions are not meant to cause
harm but rather to guard and defend oneself and their society.
7. Achievement: These behaviors include intellectual, physical, creative, mechanical, and social
skills (George, 2011, p. 151). These actions are used to try and regulate the environment of the
individual. Personal achievements are also placed into this subsystem.

http://nursingtheories.weebly.com/dorothy-johnson.html
Concepts: There are several major concepts within the system.
A large concept is the environment in which the individual resides. It includes all aspects of the
surroundings that impact the person, such as interior stressors (Gonzalo, 2011).
Health is also another basic concept of the model. Johnson interprets health to be regular and
constant behavior where the individual can adapt and adjust accordingly to stressors and changes
to their environment (Gonzalo, 2011).
Nursing is also considered to be a concept within the model. It is an external force that helps to
regulate and maintain the persons usual behavior patterns when illness or a threat is presented
(Gonzalo, 2011).
The behavioral system is a concept, which defines man as a system and the behaviors of the man
indicates which state or part of the system he is in.
A subsystem is a smaller portion of the whole system that works together with other subsystems to
maintain the entire system. Examples of these are the seven subsystems mentioned above.
o The model lacks explanation of how each subsystem interrelates, making it difficult to
view the whole model as a single entity. The lack of clearly defined interrelationships
also enables one to define each in their own manner, but this can also cause issues. Due
to the many possible definitions, it is nearly impossible to compare the same subsystem
from multiple studies (George, 2011).
The three functional requirements of the person: to be protected from harmful influences, to be
nurtured, and to be regularly stimulated to further growth (Gonzalo, 2011).
Other minor concepts include:
Variables (things outside the system that the system itself is unable to control or change, but they
still affect the system)
Boundaries (the line that separates the persons environment from the exterior)
Stressor (a type of stimulus that causes instability or stress)
Tension (caused by an imbalance in a subsystem due to change, growth, or disruptions)
Propositions: Johnson makes four system assumptions in her model and four subsystem assumptions.
1. The first assumption about developing a behavioral system is that there is organization,
interaction, interdependency, and integration of the parts and elements (Chin, 1961) of behavior
that go to make up the system (George, 2011, p. 148). Johnson meant by this assumption that
each of the systems parts is related and thus make up the whole.
2. The second assumption explains that a system tends to achieve a balance among the various
forces operating within and upon it (1961), and that man strives continually to maintain a
behavioral system balance and steady states by more or less automatic adjustments and
adaptations to the natural forces impinging upon him (George, 2011, p. 148). Johnson meant
by this that the individual requires the ability to adapt to the daily circumstances they are faced
with, and should be able to do so without much thought or effort (naturally).
3. The third assumption states that, a behavioral system, which both requires and results in some
degree of regularity and constancy in behavior, is essential to manit is functionally significant in
that it serves purpose both in social life and for the individual (George, 2011, p. 148). This
means that the normal behaviors of each person help to sustain homeostasis, and these actions
must be acceptable to the person as well as to society.
4. The fourth and final system assumption is that system balance reflects adjustments and
adaptations that are successful in some way and to some degree (George, 2011, p. 148). Balance
is not exactly alike for each individual and will not always be considered socially acceptable, but
are essential in order for the person to properly adapt.
5. The first assumption regarding the subsystems states: 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 (George, 2011, p. 149). This assumption means that although each person is different and
how they go about getting to the goal varies, the final goal is the same for each and every
subsystem.
6. The second subsystem assumption explains that for each person, they have an individual
predisposition to act, with reference to the goal, in certain ways rather than in other ways
(George, 2011, p. 149). Each individual has their own predisposition on the right way to act, and
will choose the act that results in the most desired outcome.
7. The third assumption regarding the subsystems is defined by Johnson as: each subsystem has
available a repertoire of choices or scope of action alternatives from which choices can be made
(George, 2011, p. 149). As the individual grows and matures, they gain more ways to act or
behave when adapting, increasing their number of choices available to them.
8. The last assumption is that the subsystems produce observable outcomesthat is, the
individuals behavior (George, 2011, p. 149). The behaviors, which are done in an attempt to
reach a goal, can be recorded by an outside source (a nurse) for each subsystem. This enables the
outsider to see how efficient each behavior is at reaching the goal.



References
George, J. B. (2011). Nursing theories: The base for professional nursing practice (6
th
ed.). Philadelphia:
Pearson.
Gonzalo, A. (2011). Dorothy Johnson: The behavioral system model. Theoretical foundations of
nursing. Retrieved from http://nursingtheories.weebly.com/dorothy-johnson.html
Application of Meta-Paradigms in the Nursing Theory
Nicole Stolte
The meta-paradigm of nursing encompasses the global perspective of a discipline (Masters,
2012, p. 48). It acts as a framework for the different nursing theories to describe phenomena. The four
components of the meta-paradigm of nursing are person, environment, health, and nursing. Below, each of
these are described as they relate to the Behavioral System Model.



As nurses, our role is to focus on the behavior system of the human being when encompassing the
Behavioral System Model (George, 2011). The behavior system is how the body responds to illness,
including emotional, physiologic, and psychological responses. This is opposite of what doctors focus on,
which is the biologic system of the human being. When a human being is ill, there are actions and
responses that occur reciprocally in both systems (George, 2011).
When focused on society and the Behavioral System Model, Johnson indicated that an individual's
behavior is influenced by all the events in the environment (George, 2011, p. 151). All of the events
include both the internal and external environment. Cultural influences are the societal influences that are
most profound (Masters, 2012, p. 65). Culture has the greatest impact on how a person will behave when
in the healthcare environment. Even though there are many different cultures that vary in beliefs, the
Behavioral System Model can be applied to all cultures.
In Johnsons theory, health is defines as an elusive state that is determined by psychological,
social, biological, and physiological factors (George, 2011, p. 152). In other words, the individual is trying
to return their body or mind back to equilibrium in an efficient and effective way (George, 2011).
The goal of nursing is to assist the patient in reaching the equilibrium regarding their health status.
When illness is present, it is important for the nurse to focus on maintaining balance in the behavioral
system as it relates to the whole patient (George, 2011, p. 152).
References
George, J.B. (2011). Nursing theories: The base for professional nursing practice (6
th
ed.). Philadelphia:
Pearson.
Masters, K. (2012). Framework for professional nursing practice. (1
st
ed.). Sandbury, MA: Jones & Bartlett
Learning.
Picture
http://www.google.com/search?q=metaparadigm+of+nursing&tbm=isch&ei=QjnMU6q3N4GQyATn_oCo
CQ
Theorys Implication to Nursing Practice, Education,
and Research
-Rachel Stolte
Nursing Practice
Dorothy Johnsons Behavioral System Model follows the nursing process. It is important to begin with
subsystems then progress toward the system as a whole.
Assessment
o Grubbs created an assessment tool for Johnsons model based on the activities of daily
living. This assessment tool included Johnsons seven subsystems plus the addition of the
restorative subsystem. This assessment tool is helpful because a diagnosis can ben more
easily recognized when activities of daily living are affecting an individuals lifestyle.
The nurse should assess the dependency of subsystems, the ingestive subsystem, the
eliminative subsystem, the sexual subsystem, the aggressive subsystem, and the
achievement subsystem. It is important for the nurse to assess information beyond these
subsystems because they do not include many physiologic factors.
Diagnosis
o There are four broad categories for nursing diagnosis for Johnsons model. These
diagnoses are insufficiency, discrepancy, incompatibility, and dominance. Insufficiency
occurs when a subsystem is not working to its fullest ability. Discrepancy is when a
certain goal does not meet its expectation. Incompatibility occurs when two or more goals
from different subsystems disagree with each other. Dominance is when one subsystems
behavior is more pertinent and important than the others and used more often.
Planning
o Planning for implementation has one goal according to Johnsons model, to bring about
homeostasis in a subsystem that is based on the nurses assessment of the individuals
drive, set, behavioral repertoire, and observable pattern (George, 2011, p. 153). Johnson
does not refer to patients becoming involved with the nursing plan, so the nurse is the one
who is identifying the individuals need and planning interventions for the patient.
Implementation
o The nurse is supposed to plan to implement changes to the patients behavior. Johnson
focuses on the biological systems to be apart of the nursing goals because of how she
wants patients to return their bodies back to homeostasis, but sometimes these goals
conflict with her Behavioral Systems Model. This makes implementing nursing actions
difficult because the implementations conflict with the planning.
Evaluation
Evaluation is the last step of the nursing process. In this stage, goals are evaluated to see if the patient has
met them. Implementations are continued, discontinued, or modified based on the patients needs. For
Johnsons model, this stage is difficult to do if there is no baseline data for the patient. It is hard to say if a
patients emotions have returned to normal, so it is important that the nurse to evaluate the data carefully.
(George, 2011)

http://intranet.tdmu.edu.ua/data/kafedra/internal/magistr/classes_stud/English/First%20year/Nursing%20di
agnosis/4%20Nursing%20process%20definition,%20objectives,%20functions,%20steps.htm

Education
It is important for nurses, especially new nurses who are becoming educated, to understand the use of
Johnsons model. Johnson did not clearly define her subsystems, so it is hard to use this model in the
nursing practice. Nurses have found that it is helpful to integrate this model into larger theories to create the
best nursing practice for the patient. (George, 2011)
Research
There is a limited amount of research on Johnsons Behavioral Systems Model because of the broad
definitions presented in the model. Hypotheses are very difficult to create because she does not explain the
relationships between the different subsystems of this model. Hypotheses are not effective because
researchers cannot determine whether there is a relationship between Johnsons work or the interpretation
of her work. Even though her work is difficult to test, tools have been created that are based around
Johnsons work.
N .C. Lovejoy created the Johnson Model First-Level Family Assessment Tool to be
used in outpatient allergy clinics. This tool assessed asthmatic childrens relationship
with their families.
B. Reigel created a connection about negative relationships related to social support
and interpersonal dependency after a myocardial infarction.
A. Turner-Henson identified that Johnsons Behavioral System Model was important
for nurses to help new mothers recognize their needs.
K. A. Talerico indicated that using control-based care in patients with dementia was
ineffective because this care was found to cause more aggressive behavior.
Even though these assumptions have been made, none of the research regarding Johnsons Behavioral
System Model has been tested by using an experimental design. (George, 2011)
References
George, J. B. (2011). Nursing theories: The base for nursing practice (6
th
ed.). Philadelphia: Pearson.
Summary
After Dorothy Johnsons schooling at Vanderbilt University and Harvard, she developed the Behavioral
System Model. Her focus on teaching, fundamental needs, and the environment helped her first create the
model and then later the subsystems of the model. She took into account past theories, including
Nightingales Environmental Theory, when creating her work. The Behavioral System Model states that for
each person, his or her behaviors are orderly, purposeful, and predictable (George, 2011, p. 149-150).
The seven subsystems of the model include attachment/affiliation, dependency, ingestive, eliminative,
sexual, aggressive, and achievement. As the theory relates to the meta-paradigm of nursing, the goal of
nursing is to assist the patient in reaching the equilibrium regarding their health status. When using the
nursing process and the Behavioral System Model, the assessment needs to focus on the seven subsystems.
The diagnosis is based off insufficiency, discrepancy, incompatibility, and dominance. The planning is
focused on the goal to bring about homeostasis (George, 2011, p. 153). The implementation is focused on
the biological systems of behavior to bring the body back to homeostasis. The evaluation is hard to judge
because it is based off the emotions of the patient, but is still measured to see if the goals are met. Dorothy
Johnsons Behavioral System Model paved the way for future theorists and nursing practice.