Dorothy Johnson Behavioral System Model

Dorothy E. Johnson, a renowned nursing theorist, was born on August 21, 1919, in Savannah, Georgia. Her contributions to the field of nursing, particularly through Johnson Behavioral System Model, emphasize the intricate relationship between nursing care and the behavioral functions of individuals, promoting health and balance. Johnson’s innovative approach transformed nursing practice by advocating for the integration of scientific principles with the art of nursing. This model has become a cornerstone in understanding human behavior in healthcare settings, making it a pivotal component in contemporary nursing education and practice. Johnson’s legacy is underscored by her distinguished career, during which she introduced essential concepts such as nursing diagnosis and identified key subsystems integral to her behavioral system model.

Introduction to Dorothy E. Johnson’s Model

Dorothy E. Johnson, a prominent nursing theorist, is known for her influential contributions to the field of nursing, particularly through her development of the Behavioral System Model. Her biography reveals a strong foundation built upon her upbringing, education, and extensive nursing career.

Background on Dorothy E. Johnson Biography

Dorothy Johnson’s life and career exemplify her dedication to nursing. Born on August 21, 1919, in Savannah, Georgia, her early years were marked by an environment that shaped her understanding of health challenges faced by communities with limited healthcare access. This upbringing fueled her passion for enhancing nursing care and advocating for patients.

Early Life

Johnson’s early life experiences were pivotal in her development as a nursing theorist. Growing up amidst societal health disparities, she developed a keen awareness of the necessity for effective nursing practices. These formative years laid the groundwork for her future endeavors in nursing education and theory formulation.

Education

Her academic journey commenced with an Associate’s Degree from Armstrong Junior College, followed by a Bachelor of Science in Nursing from Vanderbilt University. This rigorous academic background was further enriched by her Master of Public Health degree earned at Harvard University in 1948. The comprehensive nursing education she received fostered significant insights that would later influence her theoretical contributions.

Career & Appointments

Dorothy Johnson’s nursing career began as a pediatric nursing instructor at Vanderbilt University, where she served for approximately five years. Subsequently, she accepted a faculty position at UCLA, dedicating nearly 29 years to nursing education, research, and administration. Her teaching appointments allowed her to shape future generations of nurses and empower them with her theoretical knowledge. Notably, Johnson made a lasting impact on global nursing education during her sabbatical in India, where she successfully initiated a baccalaureate nursing program.

Key Concepts of the Johnson Behavioral System Model

Core Concept	Definition	Characteristics	Clinical Application
Behavioral System	A system of patterned, repetitive, and purposeful behaviors that function as an integrated whole	• Dynamic • Organized • Interdependent parts • Goal-directed • Self-maintaining • Adaptive	Foundation for nursing assessment, viewing the person holistically as a complete behavioral system
System Balance & Stability	State of equilibrium among subsystems where all are functioning efficiently	• Flexibility within stability • Efficient energy use • Predictable patterns • Effective adaptation	Goal of nursing interventions is to maintain or restore system balance
System Imbalance	Disruption in function of one or more subsystems	• Inefficient behavior • Unpredictable responses • Maladaptive patterns • Energy misuse	Triggers nursing assessment and intervention

The Seven Behavioral Subsystems

Subsystem	Purpose	Key Behaviors	Functional Requirements	Imbalance Indicators	Nursing Interventions
Attachment/Affiliative	Social inclusion and bond formation	• Forming relationships • Social interaction • Intimacy behaviors • Belonging	• Security in relationships • Opportunities for meaningful connection • Social stimulation	• Social isolation • Difficulty forming attachments • Excessive dependency • Social withdrawal	• Facilitate social connections • Promote therapeutic relationships • Support family involvement
Dependency	Obtaining nurturing and approval	• Help-seeking • Approval-seeking • Care-receiving behavior	• Reliable caregivers • Appropriate assistance • Validation	• Excessive dependency • Inability to seek help • Rejection of assistance	• Provide appropriate assistance • Encourage self-care when possible • Establish boundaries
Ingestive	Food and fluid intake	• Eating • Drinking • Food selection • Appetite regulation	• Nutritional adequacy • Eating satisfaction • Cultural appropriateness	• Poor appetite • Malnutrition • Disordered eating • Inadequate fluid intake	• Nutritional assessment • Meal planning • Feeding assistance • Hydration management
Eliminative	Excretion of waste products	• Bowel elimination • Urination • Sweating • Expelling carbon dioxide	• Regular patterns • Privacy • Comfort • Accessibility	• Constipation • Incontinence • Retention • Irregular patterns	• Bowel/bladder training • Elimination monitoring • Environmental adaptations
Sexual	Procreation and gratification	• Sexual identity expression • Intimacy • Reproductive behaviors • Sexual response	• Gender identity support • Privacy • Sexual health education • Respect for values	• Sexual dysfunction • Identity conflicts • Reproductive disorders	• Sexual health education • Respect privacy • Address concerns sensitively
Aggressive/Protective	Self-protection and preservation	• Self-defense • Boundary setting • Protection of values • Assertion of rights	• Safety • Ability to protect self • Constructive expression	• Excessive aggression • Inability to defend self • Self-harm • Risk-taking	• Safety planning • Boundary education • Anger management • Protective environments
Achievement	Environmental mastery and competence	• Skill development • Intellectual pursuits • Goal-directed activities • Creative expression	• Challenges • Recognition • Opportunities to achieve • Skill development	• Underachievement • Perfectionism • Lack of motivation • Skill deficits	• Realistic goal setting • Skill development • Recognition of achievements • Adaptive equipment

Functional Requirements for All Subsystems

Requirement	Definition	Examples	Nursing Implications
Protection	Shielding from harmful influences	• Safe environment • Health maintenance • Disease prevention	Nurses implement protective measures to prevent system damage
Nurturance	Providing input needed for growth	• Educational support • Emotional nourishment • Resource provision	Nurses support growth of each subsystem through targeted interventions
Stimulation	Promoting appropriate behavioral responses	• Sensory input • Challenges • Activity promotion	Nurses provide appropriate stimulation to activate subsystems

Nursing Process in JBSM

Process Step	Focus	Activities	Goals
Assessment	Identify subsystem status and function	• Observe behavioral patterns • Interview about subsystem function • Evaluate relationships between subsystems	Comprehensive understanding of behavioral system status
Diagnosis	Determine causes of system imbalance	• Identify structural issues (insufficient, excessive, or restrictive environment) • Recognize functional problems (impaired use or development)	Clear identification of behavioral system problems
Intervention	Apply external regulatory mechanisms	• Impose (restrict behaviors) • Teach (new behaviors) • Support (existing adaptive behaviors)	Restoration of behavioral system balance
Evaluation	Measure restoration of balance	• Reassess subsystem functioning • Monitor stability over time • Evaluate integration of subsystems	Document progress toward behavioral system equilibrium

External Regulatory Mechanisms

Mechanism	Purpose	Examples	Clinical Application
Imposition	Establish or reinforce behavioral limits	• Activity restrictions • Dietary limitations • Safety protocols	Used when patient cannot self-regulate behaviors
Teaching	Provide knowledge for new behaviors	• Health education • Skill development • Decision-making guidance	Used to develop new, more adaptive behaviors
Support	Maintain existing adaptive behaviors	• Positive reinforcement • Environmental modifications • Resource provision	Used to strengthen functional behaviors

The Behavioral System Model proposed by Dorothy E. Johnson represents an essential facet of modern nursing theory, focusing on the interplay between various behavioral systems and their impact on patient health. This model places a premium on understanding the organized and dynamic nature of behaviors that each individual exhibits. The following sections will elucidate the concept definition of behavioral systems and outline the critical behavioral system model components essential for nursing practice.

Definition of Behavioral Systems

Behavioral systems refer to structured patterns of behavior that coexist within individuals, influenced by biological, psychological, and social factors. Through the lens of nursing theory, these systems emphasize the interaction and interdependence of behaviors, asserting that health outcomes are significantly influenced by how these behaviors are organized. Johnson’s model articulates that understanding these systems is critical for effective nursing care, as they help healthcare professionals identify areas where patients may be experiencing imbalance and require support.

Components of the Johnson Behavioral System Model

Within the Johnson Behavioral System Model, several components emerge that serve to categorize human behavior into distinct subsystems. Johnson identified seven behavioral system model components:

• Attachment
• Achievement
• Aggressive
• Dependence
• Sexual
• Ingestive
• Eliminative

Each of these subsystems possesses three functional requirements necessary for maintaining balance: protection from harmful influences, nurturing through appropriate environmental input, and stimulation for growth. Johnson’s insights into the behavioral system model components illuminate how these subsystems can interact and influence each other, essential for restoring equilibrium when disruptions occur. This holistic understanding is pivotal in nursing practices, where diverse factors converge to shape patient h

Within the Johnson Behavioral System Model, several components emerge that serve to categorize human behavior into distinct subsystems. Johnson identified seven behavioral system model components:

• Attachment
• Achievement
• Aggressive
• Dependence
• Sexual
• Ingestive
• Eliminative

Each of these subsystems possesses three functional requirements necessary for maintaining balance: protection from harmful influences, nurturing through appropriate environmental input, and stimulation for growth. Johnson’s insights into the behavioral system model components illuminate how these subsystems can interact and influence each other, essential for restoring equilibrium when disruptions occur. This holistic understanding is pivotal in nursing practices, where diverse factors converge to shape patient health and wellbeing.

The Role of the Nurse in the Model

Johnson’s Behavioral System Model positions nursing as a fundamental component of behavioral science, highlighting its critical role in understanding patient behavior and influencing health outcomes. The model suggests that to fulfill their nursing responsibilities effectively, nurses must engage with the various behavioral subsystems that govern patients’ actions. This requires a nuanced approach that balances scientific knowledge with compassionate care, enabling nurses to address both physical and emotional dimensions of health.

Nursing as a Behavioral Science

The integration of nursing with behavioral science enables practitioners to observe and respond to patient needs more effectively. Nurses analyze behaviors that may indicate underlying health issues, applying research-based knowledge to foster a supportive environment conducive to healing. In this context, the nursing role encompasses not only the assessment of patients but also the creation of individualized care plans that promote optimal functioning across the identified subsystems. By focusing on holistic assessments, nurses can pinpoint interconnected problems and facilitate improved health outcomes for their patients.

Responsibilities of the Nurse Practitioner

Nurse practitioners carry substantial responsibilities in executing the principles outlined in Johnson’s model. Primarily, they evaluate the balance within a patient’s behavioral system, identifying any disruptions that could stem from internal stressors such as anxiety or external factors like environmental influences. Continuous assessment is vital as it allows for flexibility in care plans, ensuring they evolve alongside the patient’s needs. Additionally, nurse practitioner roles include the collaboration with interdisciplinary teams, which enhances the effectiveness of interventions aimed at restoring stability and promoting holistic well-being. This commitment to addressing both medical and behavioral challenges underscores the critical nature of nursing practice in achieving healthy patient outcomes.

Johnson Behavioral System Model: Seven Subsystems Explained

Dorothy Johnson viewed each person as a behavioral system made up of seven interconnected subsystems. Think of these subsystems as seven essential parts of a person that work together to maintain balance and health. When one subsystem is affected, it impacts the others—much like how a mobile hanging above a baby’s crib will tilt completely if just one piece is moved.

Before we dive into each subsystem, remember that:

• Each subsystem has a purpose (what it aims to accomplish)
• Each has functional requirements (what it needs to work properly)
• Each displays behaviors (observable actions)
• Each requires nursing care when imbalanced

1. Attachment and Affiliative Subsystem: Building Meaningful Connections

What It Is

This subsystem governs how we form social bonds and maintain relationships with others. It’s about our need to belong and connect.

Real-World Example

Meet Mrs. Chen: An 82-year-old widow hospitalized for pneumonia. She rarely has visitors and appears withdrawn. Nurses notice she brightens significantly when they spend extra time talking with her during medication administration.

Functional Assessment

• Healthy Function: Mrs. Chen maintained close relationships with her church group before hospitalization
• Dysfunction: Isolation in hospital has disrupted her attachment patterns

Nursing Application

1. Personalized Care: The nurse assigns the same staff to Mrs. Chen when possible
2. Environmental Adjustment: Places Mrs. Chen in a semi-private room with a compatible roommate
3. Family Involvement: Coordinates video calls with her church friends
4. Therapeutic Communication: Schedules brief but meaningful daily conversations

Result

Mrs. Chen develops a trusting relationship with her care team, participates more actively in recovery, and experiences reduced anxiety—demonstrating how supporting the attachment subsystem promotes healing.

2. Dependency Subsystem: Balancing Help and Self-Reliance

What It Is

This subsystem controls behaviors related to caretaking, assistance, and the balance between dependence and independence.

Real-World Example

Meet James: A 45-year-old man recovering from a stroke who is frustrated by his new limitations. He refuses help with activities he cannot safely perform alone, saying “I don’t need anyone’s help!”

Functional Assessment

• Healthy Function: Before his stroke, James appropriately sought help for complex tasks while maintaining independence
• Dysfunction: Now alternates between refusing necessary assistance and becoming frustrated when tasks are difficult

Nursing Application

1. Gradual Independence: The nurse creates a schedule where James does more for himself each day
2. Reframing Assistance: Explains how accepting help now leads to greater independence later
3. Partnership Approach: “Let’s work on this together” instead of “Let me do this for you”
4. Celebrating Milestones: Acknowledges each new skill James masters

Result

James begins to accept necessary help while working toward independence, showing how properly supporting the dependency subsystem creates a healthy balance between assistance and autonomy.

3. Ingestive Subsystem: Nourishing the Body and Mind

What It Is

This subsystem manages behaviors related to eating, drinking, and taking in nourishment—both what and how we consume.

Real-World Example

Meet Sophia: A 16-year-old with newly diagnosed diabetes who is struggling with dietary restrictions. She secretly eats forbidden foods and then lies about her blood sugar readings.

Functional Assessment

• Healthy Function: Previously ate a varied diet with regular meal patterns
• Dysfunction: Now exhibits disordered eating patterns and resistance to dietary guidelines

Nursing Application

1. Education Through Exploration: The nurse helps Sophia discover diabetes-friendly versions of favorite foods
2. Psychological Support: Addresses the emotional aspects of dietary changes
3. Practical Skills: Teaches carbohydrate counting instead of rigid “forbidden foods” rules
4. Social Strategies: Role-plays how to handle food-centered social situations

Result

Sophia develops a healthier relationship with food while managing her diabetes appropriately, demonstrating how addressing both physical and psychological aspects of the ingestive subsystem leads to better outcomes.

4. Eliminative Subsystem: Managing Waste Processes with Dignity

What It Is

This subsystem regulates behaviors related to bodily excretion—how we eliminate waste biologically, socially, and psychologically.

Real-World Example

Meet Mr. Rodriguez: A 70-year-old man hospitalized after prostate surgery who is now incontinent. He refuses to leave his room or see visitors due to embarrassment.

Functional Assessment

• Healthy Function: Previously had normal elimination patterns and no social limitations
• Dysfunction: Now experiencing incontinence and social withdrawal due to shame

Nursing Application

1. Preserving Dignity: The nurse ensures privacy during care and uses discreet incontinence products
2. Scheduled Voiding: Implements a timed toileting program
3. Environmental Control: Places his room near the bathroom and creates clear access
4. Normalization: Explains that temporary incontinence is common after his procedure

Result

Mr. Rodriguez regains confidence to participate in physical therapy and accept visitors, showing how addressing both physical and psychological aspects of the eliminative subsystem preserves dignity and promotes recovery.

5. Sexual Subsystem: Acknowledging Identity and Intimacy Needs

What It Is

This subsystem encompasses behaviors related to gender identity, sexual expression, and reproduction.

Real-World Example

Meet Maria: A 35-year-old woman recovering from a mastectomy who expresses concerns about her relationship with her husband and her self-image.

Functional Assessment

• Healthy Function: Previously had positive body image and satisfying intimate relationship
• Dysfunction: Now experiencing altered body image and anxiety about intimacy

Nursing Application

1. Open Communication: The nurse creates opportunities to discuss concerns about intimacy and relationship changes
2. Body Image Support: Teaches Maria how to care for her surgical site while acknowledging emotional responses
3. Resource Connection: Provides information about support groups and reconstruction options
4. Partner Inclusion: With Maria’s permission, includes her husband in discussions about adjustment

Result

Maria begins to adapt to body changes and communicates more openly with her husband, demonstrating how supporting the sexual subsystem addresses both physical adjustments and relational aspects of health.

6. Aggressive/Protective Subsystem: Safeguarding Self and Values

What It Is

This subsystem manages behaviors related to self-protection, setting boundaries, and responding to threats—both real and perceived.

Real-World Example

Meet Devon: A 19-year-old admitted after a car accident who becomes verbally aggressive when healthcare decisions are made without his input.

Functional Assessment

• Healthy Function: Previously used appropriate assertiveness to protect his interests
• Dysfunction: Now displaying excessive aggression due to feeling threatened and powerless

Nursing Application

1. Control Restoration: The nurse involves Devon in care planning: “What time would you prefer to take your medication?”
2. Boundary Education: Teaches the difference between assertiveness and aggression
3. Predictability: Explains procedures before they happen to reduce threat perception
4. Validation: Acknowledges his right to have opinions about his care

Result

Devon’s aggressive outbursts decrease as he gains appropriate control over his care, showing how supporting healthy protective behaviors while redirecting unhelpful aggression balances this subsystem.

7. Achievement Subsystem: Mastering Skills and Environment

What It Is

This subsystem directs behaviors related to accomplishment, intellectual mastery, and skill development.

Real-World Example

Meet Aisha: A 50-year-old teacher who has had a stroke affecting her language abilities. She becomes depressed when unable to read or communicate effectively.

Functional Assessment

• Healthy Function: Previously derived significant satisfaction from intellectual accomplishments and teaching
• Dysfunction: Now experiencing frustration and loss of identity due to communication difficulties

Nursing Application

1. Modified Goals: The nurse helps break rehabilitation into achievable milestones
2. Alternative Achievements: Identifies non-verbal accomplishments Aisha can master
3. Progress Visibility: Creates a visual chart showing improvement over time
4. Strength Focus: Emphasizes abilities retained rather than only what was lost

Result

Aisha engages more actively in speech therapy and finds new ways to experience achievement, demonstrating how supporting this subsystem maintains motivation and identity during recovery.

How These Subsystems Work Together: A Holistic View

Interconnected Nature

Consider how these subsystems overlap and influence each other:

Case Study: Mr. Jackson Mr. Jackson, a 60-year-old with newly diagnosed heart failure, shows how disturbance in one subsystem affects others:

• Ingestive subsystem is affected by sodium restrictions
• This impacts his achievement subsystem as he can no longer cook favorite family recipes
• His attachment subsystem is strained as social gatherings revolved around these meals
• His aggressive/protective subsystem activates as he feels his identity threatened
• His dependency subsystem struggles with new reliance on medications
• His eliminative subsystem is affected by diuretics
• His sexual subsystem faces challenges due to medication side effects and fatigue

Nursing Application to Multiple Subsystems

Effective nursing care addresses these connections:

1. Holistic Assessment: Evaluate all subsystems, not just the most obvious one
2. Prioritization: Address the most critical subsystem first while planning for others
3. Ripple Effect Planning: Anticipate how interventions in one area will affect others
4. Patient Perspective: Ask which subsystem disruption matters most to the patient

Practical Application for Nursing Students

Assessment Questions for Each Subsystem

Attachment:

• “Who are the important people in your life?”
• “How has your illness affected your relationships?”

Dependency:

• “What activities do you need help with now?”
• “How do you feel about asking for assistance?”

Ingestive:

• “Describe your typical eating patterns.”
• “Have you noticed any changes in appetite or enjoyment of food?”

Eliminative:

• “Have you experienced any changes in your bowel or bladder habits?”
• “Are you comfortable using the bathroom facilities here?”

Sexual:

• “Has your condition affected how you see yourself?”
• “Do you have concerns about how this condition might affect intimate relationships?”

Aggressive/Protective:

• “What helps you feel safe and in control?”
• “How do you typically respond when you feel threatened?”

Achievement:

• “What activities give you a sense of accomplishment?”
• “How has your condition affected your ability to do things that matter to you?”

Creating Nursing Care Plans Using Johnson’s Model

• Step 1: Identify which subsystems are imbalanced
• Step 2: Determine what each subsystem needs (protection, nurturance, stimulation)
• Step 3: Plan interventions that specifically address those needs
• Step 4: Evaluate effectiveness by observing behavioral changes

Example: For Mr. Jackson (heart failure patient mentioned earlier):

• Priority Subsystem: Ingestive
• Need: Knowledge about heart-healthy eating while preserving enjoyment
• Intervention: Work with dietitian to modify favorite recipes to be heart-healthy
• Evaluation: Mr. Jackson demonstrates understanding by creating a meal plan that follows restrictions while maintaining satisfaction

Dorothy Johnson’s Behavioral System Model offers a structured way to understand the whole person—not just their medical diagnosis. By recognizing how these seven subsystems interact, nurses can:

1. Provide truly holistic care that addresses all aspects of human functioning
2. Anticipate problems before they develop by noticing early subsystem imbalances
3. Create interventions that promote balance rather than just treating symptoms
4. Recognize that behavior has meaning and serves a purpose in maintaining balance

Remember that each patient’s behavioral system is unique, shaped by their culture, experiences, and values. The art of nursing using Johnson’s model lies in understanding each patient’s individual patterns and supporting their return to their optimal balance.

Furthermore, Johnson Behavioral System Model can be effectively juxtaposed against other nursing theories, including Orem’s Self-Care Deficit Theory. While Orem emphasizes the importance of individual self-care abilities, Johnson’s framework places a greater emphasis on the nurse’s role in achieving behavioral equilibrium for their patients. This Johnson model comparison allows for deeper insights into varying approaches to nursing care, reinforcing the necessity for adaptable strategies that meet diverse patient needs. The exploration of these nursing theories further solidifies the importance of acknowledging both self-care capabilities and the facilitative role of nursing in managing patient behaviors and health outcomes.

FAQ

What is Dorothy E. Johnson’s Behavioral System Model?

The Behavioral System Model developed by Dorothy E. Johnson emphasizes the relationship between nursing care and individuals’ behavioral functions to promote health and equilibrium. It advocates a holistic approach to nursing that integrates both the science and art of care.

How does Johnson’s model categorize human behavior?

Johnson’s model categorizes human behavior into seven distinct subsystems, each addressing a specific function and goal. These subsystems facilitate the understanding of how behaviors interconnect and influence health outcomes.

What role do nurses play in the Behavioral System Model?

Nurses are tasked with assessing behavioral systems, implementing interventions, and evaluating patient outcomes. They are responsible for creating a therapeutic environment that empowers patients to modify their behaviors for better health.

How does the Behavioral System Model relate to patient autonomy?

Johnson’s model underscores the importance of encouraging patient autonomy while recognizing their needs for support. This balance is critical for recovery and self-management, making it essential for nurses to foster independence during care.

What are the practical applications of Johnson’s Behavioral System Model?

The model’s framework aids nurses in systematizing patient assessments and interventions, ensuring that care is patient-centered and responsive to behavioral needs, ultimately facilitating recovery in clinical settings.

How does the Behavioral System Model integrate into nursing education?

By incorporating Johnson’s model into nursing curricula, students are equipped to analyze patient behaviors better and design effective care plans that align with holistic health promotion.

How does Johnson’s model compare to Orem’s Self-Care Deficit Theory?

While Orem’s theory focuses on individuals’ self-care abilities, Johnson emphasizes the role of nurses in facilitating behavioral equilibrium. Both theories contribute to a more comprehensive approach to patient care.