Meaning
The main concepts of Dorothy Johnson’s Behavioral System Model include human beings as identities consisting of two major systems, the behavioral and the biological systems. At the same time, the patient’s behavioral system is divided into seven behavioral subsystems, such as eliminative, affiliative, dependency, ingestive, aggressive, sexual, and achievement. The five core principles of the theory are wholeness and order, stabilization, reorganization, hierarchic interaction, and dialectical contradiction (Smith & Parker, 2015). It is assumed that each of the concepts is present in the behavioral system of a person via subsystems that interact and are interrelated.
In general, the patient is perceived as a behavioral system within an environment. Whereas the behavioral system (a person) consists of the mentioned subsystems, the environment comprises physical, interpersonal, and sociocultural components (Smith & Parker, 2015). These components supply the sustenance imperatives that are obligatory for the effective functioning of the behavioral system (a patient). The interconnection between the environment and the behavioral system is in the environment’s ability to provide the patient with the substernal imperatives of protection, stimulation, and nurturance. Such imperatives are created by the people close to patients, including friends, doctors, family members, and nurses. These individuals can encourage the patient to perform specific actions or recognize their progress, as well as ensure that patient’s autonomy is increasing.
Health and nursing are other important concepts of the model. Health is defined as regularity and consistency in the behavioral system, and the behavioral system’s adaptation proceeds effectively and efficiently. Nursing is an external force that can regulate the behavioral system so that it preserves its organization and integration at the level possible during this time (e.g., if a patient is recovering or ill).
All of the concepts (the behavioral system, the environment, nursing, and health) mutually influence each other, and the role of a nursing professional is to maintain equilibrium among the subsystems of behavioral systems.
Origins of Theory
Other nursing models, including Nightingale’s work and the General System Theory, influenced Johnson’s development of her model. Furthermore, Auger and Dee’s work on behavioral indices, critical adaptive, and maladaptive models has also contributed to the development of the model (Holaday, 2017). Additionally, the concepts of behaviorism, and behaviorist psychology (response to stress, the impact of the environment, etc.) also provided Johnson with ideas that would be further used in the model.
To support the theory, Johnson provided her observations of patients, indicating that they could be stressed by an external or internal stimulus, which created tensions and led to patients’ disequilibrium. She also heavily relied on behaviorist theories and concepts, emphasizing that “all the patterned, repetitive, purposeful ways of behaving that characterize each person’s life make up an organized and integrated whole, or a system” (Johnson, 1997, p. 26). It was also assumed that behaviors could be predicted and ordered if necessary.
Patient observation and strive for perceiving a patient from an approach of wholeness motivated Johnson to create the theory. She also supported critical thinking in nursing practice and a critical approach toward decision-making, consequences of nursing education, and analysis of the available information (Holaday, 2017).
The approach chosen by the nursing theorist was systematic, e.g., Johnson viewed patients as systems that comprise intertwined parts, which function in such a way that allows them to form a whole (the behavioral system).
Usefulness
The model’s usefulness is difficult to oversee since it was developed to become the basis of the nursing core content (Alligood, 2014). It helps nurses address patients at first and not their disease; the approach to a patient as a whole or a behavioral system can improve nurse-patient interaction and reduce the number of possible misunderstandings.
It is also helpful in the field of nursing because it can be used as a tool for gathering diagnostic data, evaluating patient progress, and providing care that can influence behavioral system balance (Alligood, 2014). The model was used by nursing professionals to improve the quality of life of breast cancer survivors and to decrease teen pregnancies in South Africa. Thus, it can be used in predicting and/or understanding patient outcomes (Alligood, 2014). More importantly, the model also indicates whether the nursing intervention is effective by allowing the nurse to evaluate changes in the patient’s behavior during or after the intervention.
The theory could be used with patients who have an anxiety disorder. The nurse can teach them specific relaxation techniques and observe whether their behavior is transforming with the help of these techniques or they cannot avoid disequilibrium when facing a trigger or any other situation that provokes anxiety. Furthermore, it can also facilitate the assessment of patients’ quality of life by indicating what subsystems are negatively influenced by the environment and whether the environment directly relates to patients’ condition. The value of the model is also in its potential for nursing professionals; it can determine whether nursing interventions are as effective as expected and how patients perceive them.
Testability
As was already mentioned, the theory was tested by different researchers and targeted different populations, e.g., cancer survivors, teenagers, and patients at Neuropsychiatric Institute in Los Angeles, CA (Smith & Parker, 2015). Other research was dedicated to the use of Johnson’s model with elderly patients with dementia that has proven that the biomedical model was inapplicable in this case. Wang and Palmer (2010) observed women’s toileting behavior. Using Johnson’s model, they found that the behavior was “also influenced by the physical and social environments” (p. 1874). The study was a report of analysis of the concept of women’s toileting behavior and focused on helping nurses develop behavioral interventions that can reduce and manage lower urinary tract symptoms.
Even though the theory has not generated much research, it enjoys support across the world. As Holaday (2017) points out, the theory does not have a specific foundation or an official group of supporters, but nurses continue to use it in their clinical practice in different units. The research conducted at Neuropsychiatric Institute in Los Angeles, CA also showed how this model could improve clinical practice: it divided patients into different groups about their behavior, and nursing interventions were based on these characteristics. As Smith and Parker (2015) point out, the clinical practice and nurse-patient communication have significantly improved after the implementation of the model. Moreover, interventions that were used earlier were proven to be ineffective exactly due to the previously lacking behavioral approach toward patients.
As can be seen, the theory was tested in different environments and various patients; it was able to facilitate and enhance clinical practice, as well as make nurses review their interventions and activities. However, one should also remember that the model might not apply to all types of nursing care.
Overall Evaluation
The theory provides a comprehensive understanding of the interconnection between nursing, environment, health, and patient behavior. It directly addresses issues that can lead to disequilibrium and indicates how equilibrium can be restored. The theory can be applied in psychiatric nursing care, treatment of children, infants, adolescents, pregnancy care, obesity, oncology, etc. (Alligood, 2014).
The strengths of the theory are its suitability for different types of care, patient-centered approach, and appropriateness for various cultures. Its weaknesses include unclear interconnections between subsystems and the lack of detailed explanation of their mutual influence. It also remains unclear what concepts have more influence on patients’ behavior and what concepts cannot have that much impact (for example, is the environment more important for mental health patients than interactions with the nursing professional?).
I would use this practice only to assess and evaluate the patient’s quality of life after the intervention. As this model directly targets human behavior, it can be effective in addressing lifestyle interventions in patients with obesity or patients with mental illnesses. I would also use it to evaluate the process of coping with adolescent cancer survivors. I believe that particular emphasis should be made on the patient’s perception of him/herself and the subsystems that are interconnected within him/her. One of the biggest advantages of this model is, in my opinion, in its ability to show how patients respond to a specific health issue or change in their life related to their condition. It also promotes post-discharge supervision, especially in those patients with the high possibility of an exacerbation, and helps both nurses and patients create a plan for quality of life improvement.
References
Alligood, M. (2014). Nursing theory. Utilization and application. St. Louis, MO: Elsevier.
Holaday, B. (2017). Johnson’s behavioral system model in nursing practice. Web.
Johnson, D. (1997). Behavioral systems model. New York, NY: FITNE.
Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice. Philadelphia, PA: FA Davis.
Wang, K., & Palmer, M. H. (2010). Women’s toileting behaviour related to urinary elimination: Concept analysis. Journal of Advanced Nursing, 66(8), 1874-1884.