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Dorothy E.

Johnson, RN, MPH


(1919-1999)
Getting to Know the Theorist
Dorothy E. Johnson was born August 21, 1919, in Savannah, Georgia. Finished her B. S. N. from Vanderbilt University in Nashville, Tennessee, in 1942. She worked briefly as a public health nurse and in 1944 returned to Vanderbilt as an instructor in Pediatric Nursing. Finished her M.P.H. from Harvard University in Boston in 1948. 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. She retired at January 1, 1978 and remained active in retirement as a speaker and advocate for nursing education. She died in February 1999.

Influences in Nursing
Dorothy Johnson has had an influence on nursing through her publications since the 1950s. Her publications included 4 books, more than 30 articles in periodicals, and many papers, reports and proceedings, and monographs. She believed nursing had a body of knowledge reflecting both the science and art 1959 she proposed that knowledge of the science of nursing necessary for effective nursing can included a synthesis of key concepts drawn from basic and applied sciences 1961 Johnson proposed that nursing care facilitated the clients maintenance of a state of equilibrium She proposed that clients were stressed by a stimulus of either an external or internal nature. Johnson recognized two areas of focus for nursing care that are based in giving back to the client to a state of equilibrium, or balance 1. Nursing care should lessen stimuli that are stressors 2. Nursing care should offer support of the clients normal defenses and adaptive processes 1968 Johnson first proposed her model of nursing care as the fostering of the efficient way and effective behavioral functioning in the patient to present illness She stressed the importance of research-based knowledge about the effect of nursing care on clients. 1980 Johnson made in print her conceptualization of the Behavioral System Model for Nursing. This is the first work published by Johnson that defines her definitions of the Behavioral System Model.

Metaparadigm in Nursing
Nursing
An external regulatory force acting to preserve the organization of the patients behavior by means of imposing regulatory mechanism or by providing resources while the patient is under stress An art and science that supplies assistance both before and during system balance disturbance and therefore requires knowledge of order, disorder, and control 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

Person

A person has two major systems: the biological system and the behavioral system Nursings focus is the behavioral system The person as a behavioral system has patterned, repetitive, and purposeful ways of behaving that link the person to the environment Is an elusive state that is affected by social, psychological, biological and physiological factors The individual is striving to retain some balance or equilibrium

Health

The individuals goal is to sustain the entire behavioral system efficiently and effectively but with an adequate amount of flexibility to return to an acceptable balance if a malfunction disrupts the original balance Consists of all the factors that are not part of the individuals behavior but influence the system, some of which can be manipulated by the nurse to achieve the health goal for the patient. The behavioral system attempts to maintain equilibrium in response to environmental factors by adjusting and adapting to the forces that impinge on it.

Environment

Theoretical Source
Nightingale The BSM springs from Nightingale's belief that nursing's goal is to help individuals prevent or recover from disease or injury Nursing should focus on the individual and not the disease itself Talcott Parsons acknowledged in early developmental writing presenting concepts of then BSM Systems Theory and Rapoport, Chinn and Buckley used their concepts and definitions

Use of Empirical Evidence


Leitch and Escolona pointed out that tension produces behavioral changes and that the manifestation of tension by an individual depends on both internal and external factor Selye, Grinker, Simmons and Wolf used their work to support the idea that specific patterns of behavior are reactions to stressors from biological, psychological, and sociological sources respectively Caudill Johnson followed his concept of stress that is - Stress is a process in which there in interplay between various stimuli and the defenses erected against them

Theoretical Assertions
The theory addresses two major components: (1) the patient and (2) nursing. The patient is a behavioral system with seven interrelated subsystems Each subsystem can be described and analyzed in terms of structure and functional requirements. The four structural elements that have been identified include: 1. drive or goal - motivation for the behaviors 2. set - normal behavior a client prefers to meet goal; predisposition to act; 3. choice - available options a person has to meet goals; alternatives for action; 4. behavior - it will produce an observable outcome which is the individuals behavior Each of the subsystems has the same three functional requirements: 1. Protection protection from unwanted stimuli 2. Nurturance - through appropriate input of supplies from the environment 3. Stimulation - by experiences, behaviors that enhance growth and prevent stagnation

The system and subsystems tend to be self-maintaining and self-perpetuating as long as internal and
external conditions remain orderly and predictable. If the conditions and resources necessary in their functional requirements are not met, or the interrelationships among the subsystems are not harmonious, dysfunctional behavior results. The responses by the subsystems are developed through motivation, experience, and learning and are influenced by biological, psychological, and social factors. The behavioral system attempts to achieve balance by adapting to internal and environmental stimuli.

The behavioral system manages the environment. It appears to be active and not passive. The nurse is external to and interactive with the behavioral system. A state of instability in the system results in need for nursing intervention. Identification of the source of the problem in the system leads to appropriate nursing action that results in the maintenance or restoration of behavioral system balance.

Health Change Process


Active dynamic behavioral system (person, group, family) Nursing Action - Nurture - Protect - Stimulate

External Stressors Cue

Attachment & affiliation


Stress tolerance Flexibility

Dependency Sexuality Aggression

Elimination Ingestion Achievement

Tension Health or Illness

Internal stressors (+) or (-) - Learning - Experience - Maturation - Other changing factors (biological, psychological, sociological)

Structure - Drive - Set - Choice - Behavior Dynamic Equilibrium (Goal)

Active dynamic behavioral system (person, group, family)

Major Concepts and Definitions


Behavior The output of intraorganismic structures and processes as they are coordinated and articulated by and responsive to changes in sensory stimulation. Johnson focuses on behavior affected by the actual or implied presence of other social beings that has been shown to have major adaptive significance System (Rapoports) A system is a whole that which functions as a whole by virtue of the interdependence of its parts (Chinn) organization, interaction, interdependency, and integration of the parts and elements. A person strives to maintain balance in these parts through adjustments and adaptations to the impinging forces Equilibrium A key concept in nursings specific goal. It is defined as a stabilized but more or less transitory, resting state in which the individual is in harmony with himself and with his environment. Tension

A state of being stretched or strained and can be viewed as an end-product of a disturbance in equilibrium. Can be constructive in adaptive change or destructive in inefficient use of energy, hindering adaptation and causing potential structural damage Stressor Internal or external stimuli that produce tension and result in a degree of instability. Stimuli may be positive in that they are present; or negative in that something desired is absent.

Behavioral System Model


Each individual has patterned, purposeful, repetitive ways of acting that comprise a behavioral system specific to that individual.
These ways of behaving form an organized and integrated functional unit that determines and limits the interaction between the person and his or her environment and establishes the relationship of the person to the objects, events and situations within his or her environment. A person as a behavioral system tries to achieve stability and balance by adjustments and adaptations that are successful to some degree for efficient and effective functioning. The system is usually flexible enough to accommodate the influences affecting it. Subsystem A mini system with its own particular goal and function that can be maintained as long as its relationship to the other subsystems or the environment is not disturbed. The seven subsystems are open, linked, and interrelated where input and output are components Motivational drives direct the activities of these subsystems, which are continually changing through maturation, experience and learning

The Seven Subsystems


1. Attachment/Affiliative Subsystem probably the most critical because it forms the basis for all social organization on a general level, it provides survival and security its consequences are social inclusion, intimacy and formation and maintenance of a strong social bond 2. Dependency Subsystem promotes helping behavior that calls for a nurturing response Its consequences are approval, attention or recognition, and physical assistance A certain amount of interdependence is essential for the survival of social groups 3. Ingestive Subsystem has to do with when, how, what, how much, and under what conditions we eat fulfills the need to supply the biologic requirements for food and fluids It serves the broad function of appetitive satisfaction. The perspective is in the significance and arrangement of the social events surrounding the occasions when food is eaten 4. Eliminative Subsystem addresses when, how, and under what conditions we eliminate the social and psychological factors are viewed as influencing the biological aspects of this subsystem and may be, at times, in conflict with the eliminative subsystem Human cultures have defined different socially acceptable behaviors for excretion of waste 5. Sexual Subsystem serves the biologic requirements for procreation and reproduction including, but not limited to, courting and mating, this response system begins with the development of gender role identity and includes the broad range of sex-role behaviors

6. Achievement Subsystem Attempts to manipulate the environment Functions to master and control the self or the environment to some standards of excellence Areas of achievement behavior include intellectual, physical, creative, mechanical and social skills 7. Aggressive/Protective Subsystem functions in self and social protection and preservation This follows the line of thinking of ethologists such as Lorenz and Feshbach rather than the behavioral reinforcement school of thought, which contends that aggressive behavior is not only learned, but has a primary intent to harm others. Society demands that limits be placed on modes of self-protection and that people and their property be respected and protected

Acceptance by the Nursing Community


Practice The BSM was used to develop a self-report and observational instrument to be carried out with the nursing process 1. Grubbs (1980) developed an assessment tool and a nursing process sheet based on Johnsons seven subsystems. 2. Holaday (1980) used the theory to develop an assessment tool when caring for children. This tool allowed the nurse to objectively describe the childs behavior and to guide nursing action 3. Derdiarian (1990) investigated the effects of using two system assessment instruments on patient and nurse satisfaction. The implementation of the instrument provided a more comprehensive and organized step to assessment and intervention, thereby increasing patient and nurse satisfaction with care. Education A core curriculum based on a person as a behavioral system would have definite goals and clear course planning The study would center on the patient as a behavioral system and its dysfunction, which would necessitate the use of the nursing process. Understanding of the systems theory, the student would need knowledge from the social and behavioral disciplines and the physical and biological sciences. Research Nursing research is vital to explain and identify behavioral system disorders which rise in relation with illness, and develop good reasoning for the means of management. The theory resulting form the BSM influences to the researcher to choose between two options. 1. Examine the functioning of the system and subsystems by focusing on the Basic Sciences 2. Investigating methods of gathering diagnostic data or problem solving activities as these influences the behavioral system

Analysis
Simplicity Johnsons theory is relatively simple in relation to the number of concepts. A person is described as a behavioral system composed of seven subsystems. Nursing is an external regulatory force. However, the theory is potentially complex because there is a number of a possible interrelationship between and among the behavioral system, its subsystems, and the forces impinging on them. Generality Relatively unlimited when applied to sick individuals, but it has not been used as much with well individuals or groups. Perceives a person as a behavioral system comprised of seven subsystems, aggregates of interactive behavioral systems.

Nursings special responsibility for health is derived from its unique social mission. Nursing needs to concentrate on developing preventive nursing to fulfill its social obligations.

Empirical Precision Empirical precision improves when the subconcepts and the relationships between and among the subconcepts become better defined and empirical indicators are introduced to the science. The units and the relationships between the units in Johnsons theory are consistently defined and used. The clarity of definitions in the subsystems improves the models empirical precision. Derivable Consequences Guides nursing practice, education, and research; generates new ideas about nursing; and differentiates nursing from other health professions. The theory clearly differentiates nursing from medicine, although the concepts overlap with the psychosocial professions. Provides a conceptual framework for nursing education, practice and research. Practitioners and patients have judged the resulting nursing actions to be satisfactory.

Application of this theory


Problem: Level of stress experienced by Postpartum Patients in the OB Ward of Iloilo Mission Hospital Target Population: Postpartum patients admitted in the OB ward of IMH from August 1, 2009 to January 1, 2010. General Objectives: 1. To determine the level of stress experienced by postpartum patient in the OB ward of Iloilo Mission Hospital Specific Objectives: 1. to determine the personal characteristics as to age, civil status, economic status, gravidity and parity 2. to determine the nursing care based on the functional requirements of the behavioral system model 3. to determine the level of stress experienced by postpartum patients 4. to determine the significant difference of the nursing care based on the functional requirements of the behavioral system of postpartum patients when grouped according to age, civil status, economic status, gravidity and parity 5. to determine the significant difference of the level of stress experienced by postpartum patients when grouped according to age, civil status, economic status, gravidity and parity 6. to determine the significant relationship between the nursing care based on the functional requirements of the BSM and the level of stress experienced by postpartum patients. Antecedent Variable Independent Variable Dependent Variable

Personal Characteristics Age Civil Status Economic Status Gravidity Parity

Functional requirements of the Behavioral System Model - Nurturance - Protection - Stimulation

Level of stress experienced by postpartum patients High Moderate Low

References: Tomey, A. & Alligood, M. (2002). Nursing theorists and their work. (5th ed.). Mosby Inc. George, J. Nursing theories: The base for professional nursing practice. (5th ed.). Pearson Prentice Hall McEwen, W. & Wills, E. Theoretical basis for nursing. (2nd ed.). Lippincott Williams & Wilkins. Octaviano, E. & Balita, C. Theoretical foundation of Nursing: The Philippine perspective. Ultimate Learning Series http://www.mc.vanderbilt.edu/biolib/hc/biopages/djohnson.html

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