3. Background of Dorothy Johnson
• Born on 21st Aug 1919 in Georgia USA.
• 1942- BSc Nsg from Nashville Tennessee.
• Masters in Public health from Harvard
University Boston in1948.Worked at various
places in the US and in 1955 at CMC Vallore
SON .
• Creation of her theory began in 1940’s when
she began to teach.
• .Retired in 1978, and died in 1999.
4. The Theory
• The BSM of Nsg was first proposed in 1968.
• It advocates the fostering of efficient and effective
behavioral functioning of the patient to prevent
illness.
• The pt is defined as a behavioral system composed
of seven behavioral subsystems.
• Each subsystem is comprised of four structural
characteristics.
• An imbalance in each results in disequilibrium.
• The nurses role is to help the patient maintain his or
her equilibrium.
5. Goals of Nsg according to BSM
1. To assist the patient whose behavior is
proportional to social demands.
2. To assist the patient who is able to modify his
behavior in ways that it supports biological
imperatives.
3. To assist the patient who is able to benefit to the
fullest extent during illness from the physicians
knowledge and skill.
4. To assist the patient whose behavior does not give
evidence of unnecessary trauma as a consequence
of illness.
6. Johnson Behavioral
System Model (BSM) Overview
Evolved from philosophical ideas, theory, and
research; her clinical background; and
many years of thought, discussions, and
writing
Influences:
Florence Nightingale
Systems theory
Developmental theory
7. Dorothy Johnson
Goal: restore or maintain behavioral integrity,
stability, and efficient and effective behavioral
functioning
Client: a biopsychosocial being with an instability
in one of the subsystems due to stress
Nursing: “an external regulatory force which acts
to preserve the organization and integration of
the patient’s behaviors at an optimum
level….”
7 Subsystems : Each has structural and functional
components.
9. Affiliative or Attachment
Subsystems
• Behavior associated with the development and
maintenance of interpersonal relationships with
parents, peers, authority figures.
• Establish a sense of relatedness and
belonging with others including attachment
behavior, interpersonal relationships and
communication skills.
• Goal attainment
10. Dependency
Subsystem
• Behaviour associated with obtaining
assistance from others in the environment for
completing tasks and/or emotional support.
• Includes seeking of attention, approval,
recognition, basic self care skills and emotional
security.
11. Ingestive Subsystem
• Behaviors associated with the intake of
needed resources from the external
environments, including food, fluid,
information, knowledge and objects for the
propose of establishing an effective
relationship with the environment.
13. Sexual Subsystems
• Behavior associated with a specific gender
based identity for the purpose of ensuring
pleasure/procreation, and knowledge and
behavior being congruent with biological sex.
14. Aggressive Protective
Subsystem
• Behaviour associated with real or potential
threat in the environment for the purpose of
ensuring survival.
• Protection of self through direct or indirect
acts.
• Identification of potential danger.
15. Achievement Subsystem
• Behaviour associated with mastery of oneself
and one’s environment for the purpose of
producing a desired effect.
• Includes problem solving activity
• Knowledge of personal strengths and
weaknesses.
16. Restorative
• Behaviour associated with maintaining and
restoring energy equilibrium, e.g. relief from
fatigue, recovery from illness, sleep behaviour,
leisure/recreational interests and sick role
behaviour.
18. Purpose of the Systems Theory
Nurse creates a balance between client and
environment to achieve an optimal level
of functioning
19. Subsystems
• Individual made up of 7 subsystems
• Interrelated parts function together to form a
whole
• Interact with each other
• Interrelated and interconnected
• Environment constantly acting on subsystems
22. Wholeness and Order
• Developmental analogy of wholeness and
order is continuity and identity.
• Continuity and change can exist across the
life span.
• Continuity is in the relationship of the parts
rather than in their individuality.
23. Stabilization
• Dynamic systems respond to contextual changes
Set point maintained by altering internal conditions
to compensate for changes in external conditions.
• Nurses act as external regulators.
– Monitor patient response, looking for successful
adaptation to occur.
• Nurses intervene to help patient restore behavioral
system balance.
• Intervention is not needed if behavioral system
balance returns.
24.
25. Reorganization
• Occurs when the behavioral system
encounters new experiences in the
environment that cannot be balanced by
existing system mechanisms
• Nurse acts to provide conditions or
resources essential to help the
accommodation process:
– May impose regulatory or control mechanisms to
stimulate or reinforce certain behaviors
– May attempt to repair structural components
28. Dialectical Contradiction
• Motivational force for behavioral change
• Drives/responses developed and modified
over time through maturation, experience,
and learning
• Environmental domains that the person is
responding to include the biological,
psychological, cultural, familial, social, and
physical setting
29. Dialectical Contradiction (continued)
• Faced with illness or the threat of illness, the
person needs to resolve (maintain behavioral
system balance of) a cascade of
contradictions between goals related to:
– Physical status, social roles, and cognitive
status.
• Nurses’ interventions:
– Focus on restoring behavioral system balance
– Leading to a new level of development
30.
31. System is out of balance when..
1. Insufficiency= does not get enough of
something
2. Discrepancy= not optimally working
3. Incompatibility= subsystems conflict
4. Dominance= one syctem is always used
32.
33. Major concepts of the model
Person
Subsystems
Health
Nursing and nursing therapeutics
34.
35. Person
• Viewed as an open system with organized,
interrelated, and interdependent subsystems.
• The whole of the human organism (system)
is greater than the sum of its parts
(subsystems).
• Wholes and parts create a system with dual
constraints: Neither has continuity and
identity without the other.
• Nursing client viewed as a behavioral system
• Behavioral systems are orderly, repetitive,
and organized
36. Subsystems
• Are parts of the behavioral system
• Carry out specialized tasks/functions needed
to maintain the integrity of the whole system
• Manage system relationship to the
environment
• Have a set of behavioral responses that are
developed and modified through motivation,
experience, and learning
37. Each Subsystem
• Composed of at least four structural
components that interact in a specific pattern
– Goal
– Set
– Choice
– Action
38. Goal
• This is defined as the desired result or
consequence of the behavior.
• The basis for the goal is a universal drive
whose existence can be supported by
scientific research.
39. Behavioral Set
• Is a predisposition to act in a certain way in a
given situation
• Represents a relatively stable and habitual
behavioral pattern of responses to particular
drives or stimuli
• Represents learned behavior and is
influenced by knowledge, attitudes, and
beliefs
40. Behavioral Set Components
• Perseveration
– Consistent tendency to react to certain stimuli
with the same pattern of behavior
• Preparation
– Functions to establish priorities for attending or
not attending to various stimuli
41. Choice
• Refers to the individual’s repertoire of
alternative behaviors in a situation that will
best meet the goal and attain the desired
outcome.
• The greater the behavioral repertoire of
alternative behaviors in a situation, the more
adaptable the individual.
42. Action
• Observable action of the individual
– Concern is with the efficiency and effectiveness
of the behavior in goal attainment.
– Actions are observable responses to stimuli.
43. The Johnson Model Proposes
• For behavior to be maintained, it must be
protected, nurtured, and stimulated.
• Protection from noxious stimuli that threaten the
survival of the behavioral system
• Nurturance, which provides adequate input to
sustain behavior
• Stimulation to continue growth of the behavior and
counteracts stagnation
44. The Johnson Model (continued
• Deficiency in any or all of these functional
requirements
– Threatens the behavioral system as a whole or the
effective functioning of the particular subsystem
with which it is directly involved.
45.
46. Environment
• Consists of all elements that are not a part of
the individual’s behavioral system but
influence the system and can serve as a
source of sustenal imperatives
• Manipulated by the nurse to achieve health
47. External environment
• May include people, objects, and phenomena
that can potentially permeate the boundary of
the behavioral system
• External stimulus forms an
organized/meaningful pattern that elicits a
response from the individual
48. Internal Environment
• Internalized intervening variables:
– Physiology, temperament, ego, age and related
developmental capacities, attitudes, and self-
concept
• General regulators
– Variables that influence set, choice, and action
• Key areas for nursing assessment
49.
50. Health
• Behavioral system balance or stability
• Demonstrated by observed behavior that is
purposeful, orderly, and predictable.
• Behavior maintained when it is efficient and
effective in managing the person’s
relationship to the environment
51.
52. Nursing and Nursing Therapeutics
• Nursing is “a service that is complementary
to that of medicine and other health
professions, but which makes its own
distinctive contribution to the health and
well-being of people.”
• Nursing views patients as behavioral
systems, and medicine views patients as
biological systems.
53. Specific Goal of Nursing Action Is
“to restore, maintain, or attain behavioral
system balance and stability at the highest
possible level for the individual” (Johnson,
1980, p 214)
54. Nursing Therapeutics
• Attempt to repair damaged structural units
by altering the individual’s set and choice
• Impose regulatory and control measures
• Supply or help the client find his or her own
supplies of essential functional requirements
55. The nurse may provide
• Nurturance – through the input of
appropriate supplies from the environment
• Stimulation – for use to enhance growth and
prevent stagnation
• Protection- from noxious influences with
which the system cannot cope”
56.
57. Assumptions made by the theory
These are divided into three categories
1. Assumptions about system.
2. Assumption about structure.
3. Assumption about functions.
58. Assumptions about the systems in the model
1. There is organization, interaction, interdependency
and integration of the parts and elements of
behaviors that go to make up the subsystem.
2. A system tends to achieve a balance among the
various forces operating within and upon it and
continuously strives to maintain an equilibrium.
3. A behavioral system which requires and results in
some degree of regularity and consistency in
behavior, is essential to man as it is functionally
significant as an individual and in social life.
4. Systems balance reflects adjustments and
adaptations that are successful.
59. Assumptions about the structure
1. From the form the behavior takes and the
consequence it achieves can be inferred what
‘Drive’ has been stimulated and what ‘Goal’ is
being sought.
2. Each individual person has a predisposition to act
with reference to the goal, in certain ways rather
than the other. This Predisposition is called a ‘SET’
3. Each subsystem has a repertoire of choice called a
‘Scope of Action’
4. The individual patient’s behavior produces an
outcome that can be observed.
60. Assumptions about the Functions
1. The system must be protected from toxic
influences with witch the system cannot cope.
2. Each system has to be nurtured through the input
of appropriate supplies from the environment.
3. The system must be stimulated for use to enhance
growth and prevent stagnation.
61. Brief
Thus behaviors are
- orderly
- Purposeful
- Predictive
- sufficiently stable
& - recurrent
To be amenable to description and explanation.
62. Limitations
• Very individualistic
• Family of the client is only considered as
environment
• Focused on the nursing care of the
hospitalized and ill
• Does not focus on health promotion, primary
prevention, or disease prevention
63. Critique
• Past observational studies and general
systems theory influenced Dorothy Johnson
in the development of her BSM.
• There are – 7 behavioral subsystems
• - 3 functional requirement
• The major phenomenon of concern in
Johnson’s work is behavior
64. Contd.....
• Can be generalized across the lifespan and
across cultures
• It is difficult to test Johnson's model by the
development of hypothesis
• Decision making for nursing practice using this
model would involve critical thinking
• Does not clearly define the expected outcome
when one of the subsystems is being affected
by nursing intervention
65. Contd.........
• Refers to communication rather than directing
• There is a limited body of literature on the use
of BSM in clinical practice or to provide
framework for nursing research
67. GENERAL THEORIES
1. Florence Nightingale
2. Virginian Henderson
3. Martha Rogers
4. Sr Cellistea Roy
5. Dorothea Orem
6. Betty Numen
7. Dorothy Johnson
68. Systems Theory
1. Roy’s adaptation theory
2. Numen’s Health care systems model
3. Johnson’s health care behavioral model
4. King’s goal attainment theory
69. Interpersonal/ Caring Theories
1. Peplau’s Psychodynamic Nursing theories
2. Leininger’s Tran cultural care theories.
3. Watson’s Philosophy and science of caring
theory
70.
71.
72.
73. Client is Clie
m biopsychosocial nt i
yste s an
or al s Person can be broken ada
e havi
ith
down into parts for
study/care 2a
dap
pti ve
ab ea ch w a tive sys
n t is ms, s and ada subs
tem
Clie ste
bsy onen
su mp
t • System’s Theory ptiv yst
e m ems
ra l o • Holistic view of client
ode and
e avio ural c ction.
h ct • Client interacts with the environment s 4
7 b stru fun
4 al • Client is the center-focus of theoretical
v i du
ni n di framework and of nursing care
n t is a • Nursing facilitates client’s progress toward
Clie some balance or homeostasis (adaptation,
order, stability, etc.)
• Weak definition of nurse-patient relations
• Person becomes nursing client when
threatened by internal or external
forces
Acknowledge client as
• Psychological, biological, and
sociological aspects of individual, family,
client recognized group, or community
Physiological, psychological, sociological,
developmental, and spiritual variables
Client represented as central structure,
lines of defense, and resistance.
74. Case study
Ram a daily wage laborer in a stone query had a lacerated
wound on his forehead. He was referred to the PHC. The
wound extended to the skull. As a result he was out of
work and spend plenty of time with his friends and seemed
depressed. His wife spent hours each day making a variety
of snacks .to cheer him up and found it was a good way to
release her anxiety about her husband condition.
After three weeks the wound showed no improvement, although
it was not infected. During the visit to the PHC the wife
confided to the nurse stating that her husband was drinking
a lot of water and seemed to be urinating frequently, even at
night he had a disturbed sleep due o this problem. She was
wondering if there was any pill to help him sleep through
the night.
75. At the PHC Uma the nurse used the BHM to solve the
problem.
• She assessed Ram and his family using the 7
subsystems of behaviour she found deficit in 3
subsystems
• Achievement subsystem due to lack of social
involvement and depression
• Eliminative subsystem due to polyuria, nocturia
• Ingestive subsystem due to drinking lots of water,
and eating lots of
76. Based on Johnson’s BSM assumptions Uma
concludes that Ram probably has diabetes.
After confirming the diagnosis, she helps
Ram to correct his system imbalances by
modifying his behavior in order to achieve
homeostasis
77. Ram’s wound started healing almost
immediately after his diabetes was identified
and controlled. He was able to go back to
work and to meet with his friends again. His
wife learned fun, new diabetic-friendly foods
to cook for herself and Ram.
78. SUMMERY
Johnson’s theory defines health as a purposeful
adaptive response to internal and external stimuli in
order to maintain stability and comfort.
The main goal of nursing is to foster equilibrium within
the patient.
The practice of nursing is concerned with the
organized and integrated whole, but maintaining a
balance in the behavior system when illness occurs
is the major focus of the career.
