Dorothy Johnson

Posted: January 4th, 2023

Dorothy Johnson

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Dorothy Johnson

Dorothy E. Johnson is a nursing theorist who influenced greatly nursing theoretical thinking in the twentieth century. Her theory, the Behavioral System Model, is a mid-range nursing theory because it addresses specific aspects of nursing practice in relation to their theoretical underpinning (Lee, 2014). A description of this theory, how it influences nursing practice and how it characterizes the metaparadigms of nursing, are discussed. 

Background

The Behavioral System Model of Nursing was proposed by Dorothy E. Johnson in 1968. This theory was inspired by Notes on Nursing, a book authored by Florence Nightingale, which emphasized the pertinent of the environment around a patient and the role of the nurse in modifying the environment to facilitate healing (Alligood, 2014). The theory emphasizes the importance of facilitating the efficient and effective functioning of a patient to prevent illnesses. It also reemphasizes the significance of research-based knowledge on the impact of nursing care on the patients’ wellbeing (Robert, Tilley & Petersen, 2014). The theory distinguishes the behavioral and biological systems that comprise the human being. Johnson observed that while the physicians focused on the biological system using the medicine perspective, the nurse’s attention should be on the behavioral system. As such, the Behavioral System Model distinguishes nursing from medicine.    

Nursing Theory and Practice

As a mid-range nursing theory, the Behavioral System Model describes the nurses role in the care processes and the manner in which nurses can assist patients prevent illness and return to good health upon the onset of illness. By using the behavioral system as the theoretical knowledge base, nurses can use the theories that categorize behavior to predict and modify patients’ behavior to facilitate the maintenance or return to health (Lee, 2014). Therefore, nurses are asked to assess the behavior of their patient based on the seven subsystems. According to Johnson, these included the achievement, aggressive, attachment, dependency, eliminative, ingestive and sexual subsystems. The assessment helps nurses to identify which of these subsystems needed attention to help patients return to or maintain a balanced state. In practice, the state of equilibrium and imbalance differed across different patients. As such, the nurse’s actions needed to be customized to the individual patients to attend to their unique needs (Stetler, Ritchie, Rycroft&Malone & Charns, 2014). Consequently, the Behavioral Systems Model is applicable at the evaluation stage of the nursing process. In this regard, the nurse can determine whether the patient’s subsystems are in a state of balance or not, after which the nurse can decide on a course of action that would help the patient, as a behavioral system, maintain equilibrium, which in this case, is good health.       

Metaparadigm of Nursing Science

Nursing, person, health, and environment are four nursing metaparadigms that guide nursing practice. Johnson viewed nursing as the promotion of the balance and stability of the behavioral system of a patient (Deliktas, Korukcu, Aydin & Kabukcuoglu, 2019). Therefore, according to Johnson, nurses were external agents, whose force could facilitate the ordering and preserving of the organization and integrity of the behavior of patients. This external force aimed maintaining the optimal level of the patients’ behavior. Therefore, nurses were important when the when the physical and social wellness of the patient was threatened by their behavior. Johnson perceived the person as system comprising of interdependent components that were patterned in a repetitive and purposeful manner related to behavior. As such, the behavioral system of a person comprised of seven subsystems. Also, Johnson viewed health as a reflection of the organizational interaction, integration and interdependence of the subsystems in the behavioral system of a person. Moreover, she recognized the environment as the collection of the forces that affected a person and influenced the behavioral system of the person.

Johnson’s perceptions of the nursing metaparadigms conform to their definitions. The nursing metaparadigms delineate various aspects of the nursing profession such as the goals, outcomes, practice and career (Deliktas, et al., 2019). In this aspect, Johnson describes the nursing objectives facilitating the return of a patient to equilibrium, which is the condition prior to illness. The person metaparadigm is related an individual patient in the context of the family, culture and society (Deliktas, et al., 2019). In this regard, Johnson described a person as a behavioral system, whose actions are influenced by the family, culture and society. The health metaparadigm defines the process involved in life and death (Deliktas, et al., 2019). According to Johnson, health, as being opposite to illness, could be maintained and enhanced through regular and consistent behavior. The absence of such behavior invited illness and could end up in death. The environment metaparadigm describes all the conditions that influence human health; namely, the economic, social, political conditions in a nation, a region and worldwide (Deliktas, et al., 2019). Johnson likened the environmental conditions to the surrounding internal and external forces influencing a patient’s behavior.

Summary

Johnson’s Behavioral System Model is a mid-range nursing theory that relates nursing theory to practice by defining the role of nursing and the application of the behavioral systems to nursing practice. The model proposed the viewing of patients as behavioral systems comprising of subsystem, which could be in stable equilibrium when the patient is healthy and imbalanced when the patient is ill. The role of the nurse is clearly distinguished from that of the physician; with the nurse focusing on assisting the patient attain stability and equilibrium. Nonetheless, the theory facilitates nursing practice by asking the nurses to use behavioral and systems theories to evaluate patients and facilitate behavioral change that would enhance health wellbeing.      

References

Alligood, M. R. (2014). Nursing theory-E-book: Utilization & application. Elsevier Health Sciences.

Deliktas, A., Korukcu, O., Aydin, R., & Kabukcuoglu, K. (2019). Nursing students’ perceptions of nursing metaparadigms: A phenomenological study. The Journal of Nursing Research, 27(5), e45. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752693/

Lee, S. W. (2014). Overview of nursing theory. Japanese Journal of Nursing and Health Sciences, 12(2), 58-67.

Robert, R. R., Tilley, D. S., & Petersen, S. (2014). A power in clinical nursing practice: concept analysis on nursing intuition. Medsurg Nursing, 23(5), 343-349.

Stetler, C. B., Ritchie, J. A., Rycroft‐Malone, J., & Charns, M. P. (2014). Leadership for evidence‐based practice: strategic and functional behaviors for institutionalizing EBP. Worldviews on Evidence‐Based Nursing, 11(4), 219-226.