Dorothy Johnson's belief that medicine and nursing were two distinct disciplines and
that research-based knowledge was needed to study the effect of nursing care on patients
led her to develop the Behavior System Model of Nursing. The theory was first introduced
in 1961 and presented in its final form in 1980.
Dorothy E. Johnson was a professor at the University of California, Los Angeles (UCLA)
School of Nursing for most of her nursing career. Working at a time of transition in
nursing education, she made an important contribution to the way nursing is viewed
and practiced. Florence Nightingale's concept of placing primary needs of the patient
ahead of the disease process had a great influence on Johnson and her model of nursing.
Johnson's nursing theory states that nursing care should facilitate the maintenance
of a patient's state of equilibrium. She believed that nursing was an independent
profession rather than an adjunct of medicine. As an advocate of higher education
for nurses, she considered nursing a science as well as an art. Her 1968 paper, One
Conceptual Model of Nursing, is an early example of her thoughts.
The Behavior System Model of Nursing has major concepts, assumptions, subsystems and
nursing goals as listed below.
- Medicine focuses on the biological system of the person while nursing focuses on the behavioral system.
- The behavior of a person is directly related to his environment and the events that occur within that environment.
- A person has an adaptive response to internal and external stimuli that affect the stability of health. These responses can be physical, emotional and/or sociological.
- The main goal of nursing is to maintain the equilibrium of the behavioral system during a disruption of the biological system.
Assumptions about the System
- Behaviors that make up the system are organized and interdependent and make up an integrated whole.
- The system is constantly trying to maintain balance by adjustments to natural forces.
- The behavioral system is essential for each individual.
- The balance of the system is the result of successful adaptations and adjustments.
Assumptions about Structure and Function
- The form that the behavior takes depends upon the goal that is being sought.
- Each person has an inborn tendency to act in certain ways.
- There are a variety of choices for action within each subset.
- The patient's behavior provides an observable outcome.
Requirements for Subsystems
- The system must be protected from harmful influences.
- The system must be nurtured with suitable input from the environment.
- Growth does not occur without stimulation.
- Attachment provides a social bond with other people.
- Dependency includes physical assistance, emotional approval and recognition.
- Ingestive incorporates the structure and meaning of social events in which food is eaten.
- Eliminative patterns that are socially acceptable vary from culture to culture and affect behavior.
- Sexual beliefs affect behavior and actions.
- Aggressive behaviors come into play when a real or perceived threat occurs.
- Achievement behavior is one that tries to control the environment.
While Johnson's theory has contributed much to the practice, it is not without its critics
and recommendations for improvement. Critics say that the theory focuses on the ill and
hospitalized patient but does not address the promotion of health and prevention of disease.
They contend that the nurse's role goes further than restoring equilibrium to the patient.
It also has been said that the concepts are too abstract and do not include the nursing
Johnson never wrote a book about her theory but did write papers and articles. Since
there is little documentation concerning her ideas for developing a nursing curriculum,
this may be why her theory is not more widely known. Most of her ideas were incorporated
into the curriculum at UCLA, and some of her ideas have been used at Vanderbilt University,
the University of Colorado and the University of Honolulu.
Johnson's most fundamental contribution to the field of nursing is the concept of viewing
nursing as an autonomous profession that has a significant impact on the health of patients.
Her theory is one that deserves to be studied and applied to modern nursing practice.
- Nurses assist patients in behaviors that are in balance with social demands.
- Nurses help patients modify behaviors to support biological necessities.
- Nurses help patients benefit from the physician's knowledge and skill.
- Nurses assist the patient whose behavior does not show undue trauma as a result of the illness.
Publications related to Behavior System Model
- Conceptual Models of Nursing: Analysis and Application (4th Edition)
- Theoretical Basis for Nursing, Third Edition
- Patterns of Nursing Theories in Practice (NATIONAL LEAGUE FOR NURSING SERIES (ALL NLN TITLES))
- Fruehwirth, S.E.S. An Application of the Johnson's Behavioral Model: A Case Study. Journal of Community Health Nursing, 1989
- Poster, E. C., Dee, V. and Randell, B. P. The Johnson Behavioral Systems Model as a Framework for Patient Outcome Evaluation, Journal of the American Psychiatric Nurses Association, 1997
- Schultz, P.R. Milestones in the Success of Nursing as an Emerging Discipline, American Journal of Pharmaceutical Education, 1990
- Derdiarian, A. K. An Instrument for Research and Theory Development Using the Behavioral System Model for Nursing: The Cancer Patient, Nursing Research, 1983