Importance of Dorothy Johnson's Theory for Nursing

Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (other). Dorothy E. Johnson was a nursing theorist, who was born August 21, 1919, in Savanna, Georgia. She has had an influence on her nursing through her publications since the 1950's. Throughout her career, Johnson has stressed the importance of research-based knowledge about the effect of nursing care on clients.

This led to The Johnson Behavioral System Model, in which she came up with in 1980. Nursing theories are used to describe, develop, disseminate, and use present knowledge in nursing. Johnson was an early fan of nursing as a science as well as an art. From the beginning, Johnson proposed that the knowledge of the science of nursing was necessary for effective nursing care. In 1961, Johnson proposed that nursing care facilitated the client's maintenance of a state of equilibrium.

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Furthermore, Johnson proposed that clients were "stressed" by a stimulus of either an internal or external nature. These stressful stimuli created such disturbances, or "tensions," in the patient that a state of disequilibrium occurred. Johnson identified two areas of nursing care that should be based on in order to return the client to a state of equilibrium. First, by reducing stressful stimuli, and second, by supporting natural and adaptive processes. Johnson's behavioral system theory springs from Nightingales belief that nursing's goal is to help individuals prevent or recover from disease or injury.

The "science and art" of nursing should focus on the patient as an individual and not on the specific disease. Johnson used the work of behavioral scientists in psychology, sociology, and ethnology to develop her theory.

Moreover, Johnson states that nurses should use the behavioral system as their knowledge base; comparable to the biological system that physicians use as their base of knowledge (Lobo, 1995). The reason Johnson chose the behavioral system model is the idea that "all the patterned,repetitive, purposeful ways of behaving that characterize each person's life make up an organized and integrated whole, or a system"(other). Johnson states that by categorizing behaviors, they can be predicted and ordered. Johnson categorized all human behavior into seven subsystems(SSs):Attachment,Achievement, Aggressive, Dependence, Sexual, Ingestive, and Eliminative. Each subsystem is composed of a set of behavioral responses or tendencies that share a common goal. These responses are developed through experience and learning and are determined by numerous physical, biological, psychological, and social factors. Four assumptions are made about the structure and function of each SS. These four assumptions are the"structural elements" common to each of the seven SSs.

The first assumption is "from the form of the behavior it takes and the consequences it achieves and can be inferred to what drive that has been stimulated or what goal is being sought" (Johnson, 1980). The ultimate goal for each subsystem is expected to be the same for all individuals. The second assumption is that each individual has a "predisposition to act, with reference to the goal, in certain ways rather than in other ways" (Johnson, 1980). This predisposition to act is labeled "set" by Johnson. The third assumption is that each subsystem has available choices or "scope of action" alternatives from which choices can be made. The fourth assumption about the behavioral subsystem is that they produce observable outcomes-that is, the individuals behavior (Johnson, 1980).The observable behaviors allow an outsider to note the actions the individual is taking to reach a goal related to a specified SS.

In addition, each of the SSs has three functional requirements. First, each subsystem must be "protected from noxious influences with which the system cannot cope" (Johnson, 1980). Second, each subsystem must be "nurtured through the input of appropriate supplies from the environment." Finally each subsystem must be "stimulated for use to enhance growth and prevent stagnation." As long as the SSs are meeting these requirements, the system and the SSs are viewed as self-maintaining and self- perpetuating. The internal and external environments of the system need to remain orderly and predictable for the system to maintain homeostasis. The interrelationships of the structural elements of the subsystem to maintain a balance that is adaptive to that individual's needs.

Johnson's Behavioral Subsystems, The Attachment subsystem is probably the most critical, because it forms the basis for all social organization. It provides survival and security. Its consequences are social inclusion, intimacy, and formation and maintenance of a strong social bond. 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.

The Aggressive subsystem function is protection and preservation. It holds that aggressive behavior is not only learned, but has a primary intent to harm others. However, society has placed limits when dealing with self-protection and that people and their property be respected and protected. The Dependency subsystem promotes helping behavior that calls for a nurturing response. Its consequences are approval, attention or recognition, and physical assistance. Ultimately, dependency behavior develops from the complete reliance on others for certain resources essential for survival. An imbalance in a behavioral subsystem produces tension, which results in disequilibrium.

The Sexual subsystem has the dual functions of procreation and gratification. It begins with the development of gender role identity and includes the broad range of sex role behaviors (Johnson, 1980).When there is an alteration in the "equilibrium" that exists, Johnson's Model tends to diagnose to a subsystem rather than a specific problem. Johnson's Model states that it is at this point when the nurse is needed in order to return the client to homeostasis (Conner et al., 1994). Nursing activities are a balance of medicine, not dependent on it. A person is viewed as a behavioral system with patterned, repetitive, and purposeful ways of behaving that link him to the environment (Johnson,1980). A person is a system of interdependent parts that requires some regularity and adjustment to maintain a balance (Johnson, 1980). Health is perceived as an "elusive, dynamic state influenced by biological, psychological, and social factors. It focuses on the person rather than the illness (Conner et al., 1994). It consists of all the factors that are not part of the individual's behavioral system but that influence the system and the nurse to achieve the health goal for the patient.

In conclusion, Johnson's theory could help direct the future of nursing theories, models, research, and education. By focusing on behavioral rather than biology, the theory clearly separates nursing from medicine. But do we need to separate the behavioral from the biological? It can be a huge help and has been proven by Johnson and some of her followers. In order to focus on the holistic idea of nursing, it is important to think of the behavioral and biological together as a whole. We cannot look at one without looking at the other.