Dorothy Johnson's Behavioral System Model PDF

DOROTHY JOHNSON BEHAVIORAL SYSTEM MODEL OVERVIEW Johnson’s theory defined Nursing as “an external regulatory force which acts to preserve the organization and integration of the patient’s behaviors at an optimum level under those conditions in which the behavior constitutes a threat...

DOROTHY JOHNSON BEHAVIORAL SYSTEM MODEL OVERVIEW Johnson’s theory defined Nursing as “an external regulatory force which acts to preserve the organization and integration of the patient’s behaviors at an optimum level under those conditions in which the behavior constitutes a threat to the physical or social health, or in which illness is found.” It also states that “each individual has patterned, purposeful, repetitive ways of acting that comprises a behavioral system specific to that individual.” Johnson’s model for nursing presents a view of the client as a living open system. The client is seen as a collection of behavioral subsystems that interrelate to form a behavioral system. Therefore, the behavior is the system, not the individual. This behavioral system is characterized by repetitive, regular, predictable, and goal-directed behaviors that always strive toward balance The human being has two major systems: the biological and behavioral systems. The role of medicine is to focus on the biological system, while nursing’s focus is on the behavioral system. Health is a purposeful adaptive response to internal and external stimuli in order to maintain stability and control. The responses include physical, mental, emotional, and social realms. Society relates to the environment in which the patient exists; a patient’s behavior is directly influenced by the environment and events that occur in the environment. The primary goal of nursing is to foster equilibrium in the individual patient. One focus of nursing concerns the organized and integrated whole, but the major focus is on maintaining balance in the behavioral system during an illness in the biological system. MAJOR CONCEPTS & DEFINITIONS BEHAVIOR The output of intra-organismic structures and processes as they are coordinated and articulated by and responsive to changes in sensory stimulation. Johnson focused on behavior affected by the actual or implied presence of other social beings that has been shown to have major adaptive significance. SYSTEM Using Rapoport’s 1968 definition of system, Johnson (1980) stated“ A system is a whole that functions as a whole by virtue of the interdependence of its parts” She accepted Chin’s statement that there is “organization, interaction, interdependency, and integration of the parts and elements” (Johnson, 1980, p. 208). In addition, a person strives to maintain a balance in these parts through adjustments and adaptations to the impinging forces. BEHAVIORAL SYSTEM A behavioral system encompasses the patterned, repetitive, and purposeful ways of behaving. 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. Usually the behavior can be described and explained.  A person as a behavioral system tries to achieve stability and balance through 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 SUBSYSTEMS The behavioral system has many tasks to perform; therefore, parts of the system evolve into subsystems with specialized tasks. “a minisystem 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 identified by Johnson are open, linked, and interrelated. Input and output are components of all seven subsystems Motivational drives direct the activities of these subsystems, which are continually changing through maturation, experience, and learning. EQUILIBRIUM A key concept in nursing’s 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”. “It implies that biological and psychological forces are in balance with each other and with impinging social forces” It is “not synonymous with a state of health, since it may be found either in health or illness” FUNCTIONAL REQUIREMENTS/SUSTENAL IMPERATIVES For the subsystems to develop and maintain stability, each must have a constant supply of function requirements. The environment supplies sustenal imperatives such as protection, nurturance and stimulation. Johnson notes that the biological system and all other living systems have the same requirements. REGULATION/CONTROL The interrelated behavioral subsystems must be regulated in some fashion so that their goals can be realized. Regulation implies that deviations will be detected and corrected. Feedback is, therefore, a requirement of effective control. There is self-regulation by the client. The nurse can act as a temporary external regulatory force to preserve the organization and integration of the client’s behavior at an optimal level in situations where illness, or under conditions where behavior, constitutes a threat to health. TENSION “The concept of tension is defined as a state of being stretched or strained and can be viewed as an end-product of a disturbance in equilibrium”. Tension can be constructive in adaptive change or destructive in inefficient use of energy, hindering adaptation and causing potential structural damage. Tension is the cue to disturbance in equilibrium STRESSOR Internal or external stimuli that produce tension and result in a degree of instability are called stressors. “Stimuli may be positive in that they are present; or negative in that something desired or required is absent. [Stimuli]…may be either endogenous or exogenous in origin [and] may play upon one or more of our linked open systems”. The open-linked systems are in constant interchange. The open-linked systems include the physiological, personality, and meaningful small group (the family) systems and the larger social system MAJOR ASSUMPTIONS NURSING Nursing’s goal is to maintain and restore the person’s behavioral system balance and stability or to help the person achieve a more optimum level of balance and functioning. Thus, nursing, as perceived by Johnson, is an external force that acts to preserve the organization and integration of the patient’s behavior to an optimal level by means of imposing temporary regulatory or control mechanisms or by providing resources while the patient is experiencing stress or behavioral system imbalance. An art and a science, nursing supplies external assistance both before and during system balance disturbance and therefore requires knowledge of order, disorder, and control Nursing activities do not depend on medical authority, but they are complementary to medicine. PERSON Johnson viewed the person as a behavioral system with patterned, repetitive, and purposeful ways of behaving that link the person with the environment. The conception of the person is basically a motivational one. This view leans heavily on Johnson’s acceptance of ethology theories, which suggest that innate, biological factors influence the patterning and motivation of behavior. She also acknowledged that prior experience, learning, and physical and social stimuli also influence behavior. She noted that to look at a person as a behavioral system, as well as to be able to see a collection of behavioral subsystems and be knowledgeable about the physiological, psychological, and sociocultural factors operating outside them, was a prerequisite to using this model Johnson identified several assumptions that are critical to understanding the nature and operation of the person as a behavioral system. We assume that there is organization, interaction and interdependency, and integration of the parts of behavior that make up the system. An individual’s specific response patterns form an organized and integrated whole. The interrelated and interdependent parts are called subsystems. Johnson, further assumed that the behavioral system tends to achieve balance among the various forces operating within and upon it. People strive continually to maintain a behavioral system balance and steady states by more or less automatic adjustments and adaptations to the natural forces impinging upon them. Johnson also recognized that people actively seek new experiences that may temporarily disturb balance. Johnson further assumed that a behavioral system, which both requires and results in some degree of regularity and constancy in behavior, is essential to human beings. Finally, assumed that behavioral system balance reflected adjustments and adaptations by the person that are successful in some way and to some degree. This will be true even though the observed behavior may not always match cultural norms for acceptable or health behavior. Balance is essential for effective and efficient functioning of the person. Balance is developed and maintained within the subsystems(s) or the system as a whole. Changes in the structure or function of a system are related to problems with drive, lack of functional requirements/sustenal imperatives, or a change in the environment. A person’s attempt to reestablish balance may require an extraordinary expenditure of energy that leaves a shortage of energy to assist biological processes and recovery. HEALTH Johnson perceived health as an elusive, dynamic state influenced by biological, psychological, and social factors. Health is reflected by the organization, interaction, interdependence, and integration of the subsystems of the behavioral system An individual attempts to achieve a balance in this system, which will lead to functional behavior. A lack of balance in the structural or functional requirements of the subsystems leads to poor health. Thus, when evaluating “health,” one focuses on the behavioral system and system balance and stability, effective and efficient functioning, and behavioral system imbalance and instability. The outcomes of behavior system balance are as follows: o (1) a minimum expenditure of energy is required (implying that more energy is available to maintain health, or, in the case of illness, that energy is available for the biological processes needed for recovery); o (2) continued biological and social survival are ensured; and o (3) some degree of personal satisfaction accrues ENVIRONMENT In Johnson’s theory, the environment consists of all the factors that are not part of the individual’s behavioral system, but that influence the system. The nurse may manipulate some aspects of the environment so that the goal of health or behavioral system balance can be achieved for the patient The behavioral system “determines and limits the interaction between the person and their environment and establishes the relationship of the person to the objects, events and situations in the environment” Such behavior is orderly and predictable. It is maintained because it has been functionally efficient and effective most of the time in managing the person’s relationship to the environment. It changes when this is no longer the case, or when the person desires a more optimum level of functioning. The behavioral system has many tasks and missions to perform in maintaining its own integrity and in managing the system’s relationship to its environment. The behavioral system attempts to maintain equilibrium in response to environmental factors by adjusting and adapting to the forces that impinge on it. Excessively strong environmental forces disturb the behavioral system balance and threaten the person’s stability. An unusual amount of energy is required for the system to reestablish equilibrium in the face of continuing forces The environment is also the source of the sustenal imperatives of protection, nurturance, and stimulation that are necessary prerequisites to maintaining health (behavioral system balance) When behavioral system imbalance (disequilibrium) occurs, the nurse may need to become the temporary regulator of the environment and provide the person’s supply of functional requirements, so the person can adapt to stressors. The type of functional requirements and the amount needed will vary by such variables as age, gender, culture coping ability, and type and severity of illness. JOHNSON’S BEHAVIORAL SYSTEMS MODEL 4 goals of nursing To assist patient: 1. whose behavior is in proportion with social demands. 2. who is able to modify his behavior in order to support biological imperatives. 3. who is able to benefit to the fullest extent during illness from the physician’s knowledge and skill. 4. whose behavior does not give evidence of unnecessary trauma as a consequence of illness. 7 SUBSYSTEMS The nursing client is a behavioral system with behaviors of interest to nursing and is organized into seven subsystems of behavior: – achievement, – affiliative, – aggressive, – dependence, – eliminative, – ingestive, and – sexual. The restorative subsystem was developed by faculty and clinicians in order to include behaviors such as sleep, play, and relaxation (Grubbs, 1980). ATTACHMENT-AFFILIATIVE SUBSYSTEM The attachment-affiliative subsystem is 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 DEPENDENCY SUBSYSTEM In the broadest sense, the dependency subsystem promotes helping behavior that calls for a nurturing response. Its consequences are approval, attention or recognition, and physical assistance. Developmentally, dependency behavior evolves from almost total dependence on others to a greater degree of dependence on self. A certain amount of interdependence is essential for the survival of social groups INGESTIVE SUBSYSTEM The ingestive and eliminative subsystems should not be seen as the input and output mechanisms of the system. All subsystems are distinct subsystems with their own input and output mechanisms. The ingestive subsystem “has to do with when, how, what, how much, and under what conditions we eat” “It serves the broad function of appetitive satisfaction” This behavior is associated with social, psychological, and biological considerations ELIMINATIVE SUBSYSTEM The eliminative subsystem addresses “when, how, and under what conditions we eliminate” As with the ingestive subsystem, 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 SEXUAL SUBSYSTEM The sexual subsystem has the dual functions of procreation and gratification. 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 ACHIEVEMENT SUBSYSTEM The achievement subsystem attempts to manipulate the environment. Its function is control or mastery of an aspect of self or environment to some standard of excellence. Areas of achievement behavior include intellectual, physical, creative, mechanical, and social skills AGGRESSIVE-PROTECTIVE SUBSYSTEM The aggressive-protective subsystem’s function is protection and preservation. Society demands that limits be placed on modes of self-protection, and that people and their property be respected and protected STRUCTURAL AND FUNCTIONAL REQUIREMENTS Each subsystem comprises a goal based on a universal drive, set, choice, and action. Each of these four factors contributes to the observable activity of a person. The goal of a subsystem is defined as “the ultimate consequence of behaviors” Choice of Behavior Goal Set Behavior (Action) The basis for the goal is a universal drive, the existence of which is supported by existing theory or research. The goal of each subsystem is the same for all people when stated in general terms; however, variations among individuals occur and are based on the value placed on the goal and drive strength. The second structural component is set, which is a tendency to act in a certain way in a given situation. Once they are developed, sets are relatively stable. Set formation is influenced by such societal norms and variables as culture, family, values, perception, and perseverative sets. The preparatory set describes one’s focus in a particular situation. The perseverative set, which implies persistence, refers to the habits one maintains. The flexibility or rigidity of the set varies with each person. Set plays a major role in determining the choices a person makes and actions eventually taken. Choice refers to the alternate behaviors the person considers in any given situation. A person’s range of options may be broad or narrow. Options are influenced by such variables as age, gender, culture, and socioeconomic status. The action is the observable behavior of the person. The actual behavior is restricted by the person’s size and abilities. Here the concern is the efficiency and effectiveness of the behavior in goal attainment. 3 FUNCTIONAL REQUIREMENTS Each of the seven subsystems has the same three functional requirements: (1) protection, (2) nurturance, and (3) stimulation. These functional requirements must be met through the person’s own efforts, or with the outside assistance of the nurse. For the subsystems to develop and maintain stability, each must have a constant supply of these functional requirements that usually are supplied by the environment. However, during illness or when the potential for illness poses a threat, the nurse may become a source of functional requirements. APPLICATION CASE HISTORY OF NELLY Nelly is a 29-year-old woman who was recently admitted to the oncology nursing unit for evaluation after sensing pelvic “fullness” and noticing a watery, foul-smelling vaginal discharge. A Papanicolaou smear revealed class V cervical cancer. She was found to have stage II squamous cell carcinoma of the cervix and underwent a radical hysterectomy with bilateral salpingo-oophorectomy. Her past health history revealed that physical examinations had been infrequent. She also reported that she had not performed breast self-examination. She is 5 feet, 4 inches tall and weighs 89 pounds. Her usual weight is about 110 pounds. She has smoked approximately two packs of cigarettes a day for the past 16 years. She is gravida 2, para 2. Her first pregnancy was at age 16, and her second was at age 18. Since that time, she has taken oral contraceptives on a regular basis. Nelly completed eighth grade. She is married and lives with her husband and two children in her mother’s home, which she describes as less than sanitary. Her husband is unemployed. She describes him as emotionally distant and abusive at times. She has done well following surgery except for being unable to completely empty her urinary bladder. She is having continued postoperative pain and nausea. It will be necessary for her to perform intermittent self-catheterization at home. Her medications are (1) an antibiotic, (2) an analgesic as needed for pain, and (3) an antiemetic as needed for nausea. In addition, she will be receiving radiation therapy on an outpatient basis. Nelly is extremely tearful. She expresses great concern over her future and the future of her two children. She believes that this illness is a punishment for her past life. Nursing Care of Nelly with Johnson’s Model Behavioral Assessment The relative behavioral assessment data are as follows. Achievement Nelly has an eighth-grade education, feels a loss of control of her future and that of her children, and has lost the ability to achieve the developmental outcomes of young adulthood. Affiliative Nelly is married but describes her husband as emotionally distant and abusive at times; there may be a possible impairment of emotional endurance. Aggressive/Protective Her emotional endurance may be impaired. Nelly is not protective of herself (she smoked, sought health care infrequently, did not perform breast selfexamination). With the loss of her health, she is protective of her children, but her husband is unemployed. Who will provide for the family? Dependency Because she lives with her mother, self- sufficiency may decrease. Ingestive Nelly has experienced weight loss and nausea. Eliminative Nelly is unable to empty her bladder. She is tearful, expressing concern about the future. Sexual Because Nelly has had a hysterectomy, her sexual relationship with her husband may change and she may have concerns about her feminine identity. Restorative Nelly is experiencing fatigue, pain, and possible sleep disturbance. Diagnosis and Intervention The JBSM provides a perspective for nursing practice by viewing Nelly as a biopsychosocial being represented in a behavioral system. The objective and subjective data indicate a problem in the achievement subsystem, as follows: Objective data: Nelly has class V cervical cancer—stage II squamous cell carcinoma of the cervix with an uncertain prognosis at this time. Subjective data: Nelly is tearful and expresses concern about her ability to fulfill personal and family needs and responsibilities.