Dorothy Johnson was born on August 21, 1919 in Savannah, Georgia. She was the youngest of 7 children. Her father was the superintendent of a shrimp and oyster factory and her mother was very involved and enjoyed reading. She finished her associates degree in 1938 from Armstrong Junior college in Savannah, Georgia. Due to the Great Depression, she took a year off from school to be a governess, or teacher, for 2 children in Miami, Florida. This is when she began to realized her love for children, nursing and education. In 1942, Dorothy received her Bachelors of Science in Nursing from Vanderbilt University in Nashville, Tennessee. In 1948, she received her Masters in public health from Harvard University in Boston, Massachusetts. After graduation, she worked for one year in public health nursing and began to teach at Vanderbilt University in their school of nursing. After 5 years, she moved to California where she was
an instructor for pediatrics in the school of nursing at the University of California, Los Angeles. She worked at UCLA until she retired in 1978, except for one year in 1955 when Dorothy took sabbatical from UCLA to teach in Vallore, South India at the Christian Medical College School of Nursing (Tomey & Alligood, 2005).
The creation of her theory began in in the 1940s when she began to teach. She was studying nursing and how it was being taught and realized that there was no evidence that supported what should be taught to nurses. Although medicine had a biological systems model, she realized that nursing was unique. She began to use different ways to build and present knowledge and began to change her practice based on the outcomes. After more than 15 years, she began to think of man and the behavioral systems model and how it best supported nursing practice. This theory is a highly abstract concept. It should be used to build a perspective of the patient and not the disease. Dorothy's behavioral theory has been used in practice, research, and education. After retiring from UCLA, Dorothy moved to Key Largo, FL where she assisted others in the development of her theory until she died in 1999 at the age of 80 (Tomey & Alligood, 2005)
Nursing has changed tremendously since Dorothy Johnson began her nursing career. The following historical influences may have been the reason for the development of her theory. Nursing began to grow in the Victorian Era when Florence Nightingale ascended into a position of power and influence during the Crimean War. It was unusual to see a woman working outside of the home and even more unusual to see a woman from an affluent family in a hospital. Hospitals were made for the lower classes and were dirty and overcrowded (Griffin & Griffin, 1965). Florence Nightingale's persistence, money, and influence creating nursing help evolve nursing into a position in which nurses assist doctors and improve the conditions of the facilities. As far as nursing education, Florence Nightingale insisted that the school of nursing remain separate from the hospitals. She did this to prevent the care of patients from overriding the education portion of nursing because she felt that education was the priority for nurses. Unfortunately, although
separate, most hospitals controlled nursing schools and education became secondary to the care of patients (Griffin &Griffin, 1965). Throughout this era, nursing remained as an apprenticeship model and did not have a theoretical basis for practice. This and the fact that nursing remained a "profession" dominated by women kept nurses as an oppressed and powerless group of individuals that remained at the mercy of physicians and hospitals.
From 1900-1949, which was when Johnson started in nursing, nursing began to develop as an autonomous profession. Student nurses were primarily working in the hospital for free while trained nurses worked in the home. This lasted until the 1930s. The development of graduate education was a way for hospitals to address nursing shortages. Nursing was still cheap labor and many of the classes were similar to undergraduate classes and were based on psycho-motor skills and not theory. This type of education remained until World War II when baccalaureate degrees took a more leading role (Stein, 1998). Even with the 19th Amendment to the Constitution in 1920, nursing did not see any effects from this. World War II brought about the creation of the Cadet Nurse Corps, funded by the federal government. The American Nurses Association (ANA) and NLN convinced the US government to fund the nurse corps by conducting studies that would ensure the supply of nurses during the war (Schultz, 1990)
.
From 1950-1965, the world recovered from World War II, the economy was improving and jobs were available. Because of this historical event, funding was available to assist with improving nursing as a profession. In 1952, the first journal for nursing devoted to research was established. The first modern nursing theory, by Dr. Martha Rogers, was created in the early 1960s; although some say that Florence Nightingale 's work was the first. Historical events in the late 1960s impacted nursing education and nursing. These events were the passage of Title VIII to the US Public Health Service Act in 1964, the passage of the Medicare Act in 1965, and the establishment of the first coronary care unit in 1962. These events prompted the availability of funds and nursing leaders realized that if nursing was going to be considered a profession, it would have to have its own body of knowledge and theoretical base. This could only be done through research and theory development. During this period, Dorothy Johnson was a teacher at UCLA and in 1961, she began to propose that stress was causing equilibrium imbalance in patients. The funding and encouragement that was available to her at this time greatly influenced the development of her theory.
From 1966-1989, nursing and nursing education grew tremendously because there was a need to further educate nurses and there was money to do it. In 1971, the ANA was awarded a grant to help survey schools of nursing to make sure that they are meeting the requirements for nursing education and encouraging development of these facilities for improvement. In 1961, Dorothy Johnson proposed part of her model, but did not publish the behavioral systems model for nursing until 1980. This theory as well as others like Rogers, Levine, Orem, and Roy became the basis for the views of nursing for schools and they were also used to develop theoretical framework to guide further theory development and research (Stein, 1998).
Today nursing has made large improvements in becoming a profession, but has not yet met its goal. The challenges that are faced today are that our health care system is fragmented. Hospitals are receiving less money for services provided, budget cuts are leading to layoffs, and managed care is controlling funding. Money for nursing is decreasing and there is a threat that associate degree programs will be eliminated and other programs will be downsized. There is a need for urgency to continue theory development in nursing to justify and guide practice. As the field of nursing continues to face decreases in funding, nursing will have to continue to justify its existence to governmental and private sources in order to continue to receive support. As nurses, it is important that we continue to understand the importance of theory, research, and evidence based practice; our "profession" depends on it.
an instructor for pediatrics in the school of nursing at the University of California, Los Angeles. She worked at UCLA until she retired in 1978, except for one year in 1955 when Dorothy took sabbatical from UCLA to teach in Vallore, South India at the Christian Medical College School of Nursing (Tomey & Alligood, 2005).The creation of her theory began in in the 1940s when she began to teach. She was studying nursing and how it was being taught and realized that there was no evidence that supported what should be taught to nurses. Although medicine had a biological systems model, she realized that nursing was unique. She began to use different ways to build and present knowledge and began to change her practice based on the outcomes. After more than 15 years, she began to think of man and the behavioral systems model and how it best supported nursing practice. This theory is a highly abstract concept. It should be used to build a perspective of the patient and not the disease. Dorothy's behavioral theory has been used in practice, research, and education. After retiring from UCLA, Dorothy moved to Key Largo, FL where she assisted others in the development of her theory until she died in 1999 at the age of 80 (Tomey & Alligood, 2005)
Nursing has changed tremendously since Dorothy Johnson began her nursing career. The following historical influences may have been the reason for the development of her theory. Nursing began to grow in the Victorian Era when Florence Nightingale ascended into a position of power and influence during the Crimean War. It was unusual to see a woman working outside of the home and even more unusual to see a woman from an affluent family in a hospital. Hospitals were made for the lower classes and were dirty and overcrowded (Griffin & Griffin, 1965). Florence Nightingale's persistence, money, and influence creating nursing help evolve nursing into a position in which nurses assist doctors and improve the conditions of the facilities. As far as nursing education, Florence Nightingale insisted that the school of nursing remain separate from the hospitals. She did this to prevent the care of patients from overriding the education portion of nursing because she felt that education was the priority for nurses. Unfortunately, although
separate, most hospitals controlled nursing schools and education became secondary to the care of patients (Griffin &Griffin, 1965). Throughout this era, nursing remained as an apprenticeship model and did not have a theoretical basis for practice. This and the fact that nursing remained a "profession" dominated by women kept nurses as an oppressed and powerless group of individuals that remained at the mercy of physicians and hospitals.From 1900-1949, which was when Johnson started in nursing, nursing began to develop as an autonomous profession. Student nurses were primarily working in the hospital for free while trained nurses worked in the home. This lasted until the 1930s. The development of graduate education was a way for hospitals to address nursing shortages. Nursing was still cheap labor and many of the classes were similar to undergraduate classes and were based on psycho-motor skills and not theory. This type of education remained until World War II when baccalaureate degrees took a more leading role (Stein, 1998). Even with the 19th Amendment to the Constitution in 1920, nursing did not see any effects from this. World War II brought about the creation of the Cadet Nurse Corps, funded by the federal government. The American Nurses Association (ANA) and NLN convinced the US government to fund the nurse corps by conducting studies that would ensure the supply of nurses during the war (Schultz, 1990)
.From 1950-1965, the world recovered from World War II, the economy was improving and jobs were available. Because of this historical event, funding was available to assist with improving nursing as a profession. In 1952, the first journal for nursing devoted to research was established. The first modern nursing theory, by Dr. Martha Rogers, was created in the early 1960s; although some say that Florence Nightingale 's work was the first. Historical events in the late 1960s impacted nursing education and nursing. These events were the passage of Title VIII to the US Public Health Service Act in 1964, the passage of the Medicare Act in 1965, and the establishment of the first coronary care unit in 1962. These events prompted the availability of funds and nursing leaders realized that if nursing was going to be considered a profession, it would have to have its own body of knowledge and theoretical base. This could only be done through research and theory development. During this period, Dorothy Johnson was a teacher at UCLA and in 1961, she began to propose that stress was causing equilibrium imbalance in patients. The funding and encouragement that was available to her at this time greatly influenced the development of her theory.
From 1966-1989, nursing and nursing education grew tremendously because there was a need to further educate nurses and there was money to do it. In 1971, the ANA was awarded a grant to help survey schools of nursing to make sure that they are meeting the requirements for nursing education and encouraging development of these facilities for improvement. In 1961, Dorothy Johnson proposed part of her model, but did not publish the behavioral systems model for nursing until 1980. This theory as well as others like Rogers, Levine, Orem, and Roy became the basis for the views of nursing for schools and they were also used to develop theoretical framework to guide further theory development and research (Stein, 1998).
Today nursing has made large improvements in becoming a profession, but has not yet met its goal. The challenges that are faced today are that our health care system is fragmented. Hospitals are receiving less money for services provided, budget cuts are leading to layoffs, and managed care is controlling funding. Money for nursing is decreasing and there is a threat that associate degree programs will be eliminated and other programs will be downsized. There is a need for urgency to continue theory development in nursing to justify and guide practice. As the field of nursing continues to face decreases in funding, nursing will have to continue to justify its existence to governmental and private sources in order to continue to receive support. As nurses, it is important that we continue to understand the importance of theory, research, and evidence based practice; our "profession" depends on it.
The Behavioral System Model
Johnson’s Model (Torres, 1986)
Johnson’s Behavioral System Model is a model of nursing care that advocates the fostering of efficient and effective behavioral functioning in the patient to prevent illness. The patient is identified as a behavioral system composed of seven behavioral subsystems: affiliative, dependency, ingestive, eliminative, sexual, aggressive, and achievement. The three functional requirements for each subsystem include protection from noxious influences, provision for a nurturing environment, and stimulation for growth. An imbalance in any of the behavioral subsystems results in disequilibrium. It is nursing’s role to assist the client to return to a state of equilibrium.
Major Concepts
Johnson (1980) views human beings as having two major systems: the biological system and the behavioral system. It is the role of medicine to focus on the biological system, whereas nursing’s focus is the behavioral system.
The concept of human being was defined as a behavioral system that strives to make continual adjustments to achieve, maintain, or regain balance to the steady-state that is adaptation. Environment is not directly defined, but it is implied to include all elements of the surroundings of the human system and includes interior stressors. Health is seen as the opposite of illness, and Johnson defines it as “some degree of regularity and constancy in behavior, the behavioral system reflects adjustments and adaptations that are successful in some way and to some degree… adaptation is functionally efficient and effective.” Nursing is seen as “an external regulatory force which acts to preserve the organization and integration of the patient’s 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.” Behavioral system Man is a system that indicates the state of the system through behaviors. System That which functions as a whole by virtue of organized independent interaction of its parts. Subsystem A minisystem maintained in relationship to the entire system when it or the environment is not disturbed. |
Subconcepts
Structure
The parts of the system that make up the whole. Variables Factors outside the system that influence the system’s behavior, but which the system lacks power to change. Boundaries The point that differentiates the interior of the system from the exterior. Homeostasis Process of maintaining stability. Stability Balance or steady-state in maintaining balance of behavior within an acceptable range. Stressor A stimulus from the internal or external world that results in stress or instability. Tension The system’s adjustment to demands, change or growth, or to actual disruptions. Instability State in which the system output of energy depletes the energy needed to maintain stability. Seven Subsystems (Johnson, 1980) 1. Attachment or affiliative subsystem – serves the need for security through social inclusion or intimacy 2. Dependency subsystem – behaviors designed to get attention, recognition, and physical assistance 3. Ingestive subsystem – fulfills the need to supply the biologic requirements for food and fluids 4. Eliminative subsystem – functions to excrete wastes 5. Sexual subsystem – serves the biologic requirements of procreation and reproduction 6. Aggressive subsystem – functions in self and social protection and preservation 7. Achievement subsystem – functions to master and control the self or the environment Set The predisposition to act. It implies that despite having only a few alternatives from which to select a behavioral response, the individual will rank those options and choose the option considered most desirable. Function Consequences or purposes of action. Functional requirements Input that the system must receive to survive and develop Three functional requirements of humans(Johnson, 1980) 1. To be protected from noxious influences with which the person cannot cope 2. To be nurtured through the input of supplies from the environment 3. To be stimulated to enhance growth and prevent stagnation |
Assumptions
Assumptions on Behavioral Systems
Johnson cites Chin (1961) as the source for her first assumption. There is “organization, interaction, interdependency, and integration of the parts and elements of behavior that go to make up the system.”
A system “tends to achieve a balance among the various forces operating within and upon it (Chin, 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.”
The individual is continually presented with situations in everyday life that require adaptation and adjustment. These adjustments are so natural that they occur without conscious effort by the individual.
The third assumption about a behavioral system is that a behavioral system, which both requires and results in some degree of regularity and constancy in behavior, is essential to man; that is to say, it is functionally significant in that it serves a useful purpose both in social life and for the individual. (Johnson, 1980)
The system balance reflects adjustments and adaptations that are successful in some way and to some degree. (Johnson, 1980)
Johnson acknowledges that the achievement of this balance may and will vary from individual to individual. At times this balance may not be exhibited as behaviors that are acceptable or meet society’s norms. What may be adaptive for the individual in coping with impinging forces may be disruptive as a whole.
Assumptions on the Structure and Function of Subsystems (Johnson, 1980)
“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.”
The ultimate goal for each subsystem is expected to be the same for all individuals. However, the methods of achieving the goal may vary depending on the culture or other individual variations.
Each individual has a “predisposition to act, with reference to the goal, in certain ways rather than in any other ways.
Each subsystem has available repertoire of choices or “scope of action” alternatives from which choices can be made.
Larger behavioral repertoires are available to more adaptable individuals. As life experiences occur, individuals add to the number of alternative action available to them. At some point, however, the acquisition of new alternatives of behavior decreases as the individual becomes comfortable with the available repertoire.
Behavioral subsystems produce observable outcomes – that is, the individual’s behavior.
The observable behaviors allow an outsider – in this case the nurse – to note the actions the individual is taking to reach a goal related to a specified subsystem. The nurse can then evaluate the effectiveness and efficiency of these behaviors in assisting the individual in reaching one of these goals.
Johnson cites Chin (1961) as the source for her first assumption. There is “organization, interaction, interdependency, and integration of the parts and elements of behavior that go to make up the system.”
A system “tends to achieve a balance among the various forces operating within and upon it (Chin, 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.”
The individual is continually presented with situations in everyday life that require adaptation and adjustment. These adjustments are so natural that they occur without conscious effort by the individual.
The third assumption about a behavioral system is that a behavioral system, which both requires and results in some degree of regularity and constancy in behavior, is essential to man; that is to say, it is functionally significant in that it serves a useful purpose both in social life and for the individual. (Johnson, 1980)
The system balance reflects adjustments and adaptations that are successful in some way and to some degree. (Johnson, 1980)
Johnson acknowledges that the achievement of this balance may and will vary from individual to individual. At times this balance may not be exhibited as behaviors that are acceptable or meet society’s norms. What may be adaptive for the individual in coping with impinging forces may be disruptive as a whole.
Assumptions on the Structure and Function of Subsystems (Johnson, 1980)
“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.”
The ultimate goal for each subsystem is expected to be the same for all individuals. However, the methods of achieving the goal may vary depending on the culture or other individual variations.
Each individual has a “predisposition to act, with reference to the goal, in certain ways rather than in any other ways.
Each subsystem has available repertoire of choices or “scope of action” alternatives from which choices can be made.
Larger behavioral repertoires are available to more adaptable individuals. As life experiences occur, individuals add to the number of alternative action available to them. At some point, however, the acquisition of new alternatives of behavior decreases as the individual becomes comfortable with the available repertoire.
Behavioral subsystems produce observable outcomes – that is, the individual’s behavior.
The observable behaviors allow an outsider – in this case the nurse – to note the actions the individual is taking to reach a goal related to a specified subsystem. The nurse can then evaluate the effectiveness and efficiency of these behaviors in assisting the individual in reaching one of these goals.
Strengths/Weaknesses
Strengths:
She provided a frame of reference for nurses concerned with specific client behaviors.
Johnson’s behavioral model can be generalized across the lifespan and across cultures.
Weaknesses:
Johnsons does not clearly interrelate her concepts of subsystems.
Lack of clear definitions for the interrelationships among and between the subsystems makes it difficult to view the entire behavioral system as an entity.
The lack of clear interrelationships among the concepts creates difficulty in following the logic of Johnson’s work.
She provided a frame of reference for nurses concerned with specific client behaviors.
Johnson’s behavioral model can be generalized across the lifespan and across cultures.
Weaknesses:
Johnsons does not clearly interrelate her concepts of subsystems.
Lack of clear definitions for the interrelationships among and between the subsystems makes it difficult to view the entire behavioral system as an entity.
The lack of clear interrelationships among the concepts creates difficulty in following the logic of Johnson’s work.
Analysis
Johnson’s behavioral model is clearly an Individual-oriented framework. Its extent to consider families, groups and communities was not considered.
In her model, the focus is with what the behavior the person is presenting making the concept more attuned with the psychological aspect of care in.
Categorizing different behaviors in seven subsystems divided the focus of nursing interventions. In turn quality of care given by the nurse may be lessened because of fractionalized care which does not support seeing the individual as a whole adaptive system.
A lack of an authenticated schematic diagram by Johnson which is seen necessary was not presented. Johnson has developed multiple concepts thus a diagram showing each and every concepts relationship might be helpful.
In her model, the focus is with what the behavior the person is presenting making the concept more attuned with the psychological aspect of care in.
Categorizing different behaviors in seven subsystems divided the focus of nursing interventions. In turn quality of care given by the nurse may be lessened because of fractionalized care which does not support seeing the individual as a whole adaptive system.
A lack of an authenticated schematic diagram by Johnson which is seen necessary was not presented. Johnson has developed multiple concepts thus a diagram showing each and every concepts relationship might be helpful.
