This study delves Dorothy E. Johnson’s nursing theory. It begins by explaining the meaning of her theory. Next, it pays specific reference to the origins, usefulness, testability, and the overall evaluation of the theory. Strengths, weaknesses, assumptions and major concepts of the theorist are also covered.
Meaning of the Theory
Dorothy Johnson first introduced the behavior system nursing model in 1968 (Masters, 2014). This model emphasizes the relevance of research-based knowledge on the impact of nursing care delivered to patients. According to Johnson, this theory means that nurse practitioners must foster effective and efficient behavioral functioning in their patients as this will help to prevent illnesses (Smith & Parker, 2015). Johnson’s theory identifies the patient as a behavioral system, which is made of seven behavioral subsystems. These include achievement, aggressive, sexual, eliminative, dependency, ingestive, and affiliative. These subsystems serve to provide a nurturing environment, stimulate growth, and protect from harmful influences. In the event any of these behavioral subsystems are imbalanced, it results in disequilibrium. The primary role of nursing is to help the patient return to the state of equilibrium.
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Origins
Johnson started developing her theory in the 40s, when she joined the teaching profession (Blais et al. 2015). By then, she was a nursing student, and she discovered that there was no evidence to support what and how nurses should be taught. Realizing the uniqueness of nursing, Johnson started using different methods to build and present nursing knowledge, which made her change her nursing practice as per the outcomes. It took her many years before she thought of the human creature, the behavior system, and how it best supports the practice of nursing. Eventually, she developed her theory as a bi-product of sound theory, philosophical ideas, her clinical experiences, and years of writing, thinking, and research. Mainly, her theory draws largely from Florence Nightingale’s environmental theory, Hans Seyle’s stress syndrome theory, Rapoport Chin, and colleagues’ systems theory (Smith & Parker, 2015). To perfect her behavioral systems model, Johnson adapted some sections of her theory from these theorists.
Usefulness
Johnson’s theory has proven useful and made significant contributions to the field of nursing (Fawcett, 2017). The behavioral model has highly descriptive assumptions, which grant future researchers the ability to clarify and retest assumptions which lack clarity. Further, the theory describes a clear role of nursing, which is to maintain ort restore balance within the behavioral system at the highest level possible for the client. By identifying the purpose of nursing, researchers can create standards and measure the success of nursing interventions (In Cooper & In Quick, 2017).
Testability
Johnson’s model has been successfully tested and used in nursing research, administration, and practice. According to Fawcett (2017), the testability of the behavioral system theory has been adequately documented in over twenty research studies.
Overall Evaluation
Is the Theory Comprehensive and Specific?
For Johnson’s behavioral system theory to be useful in clinical practice there must be an incorporation of the nursing process. Health practitioners must create assessment instruments which incorporate all components of this theory (Fawcett, 2017). This is the only way that practitioners can assess a patient as a behavioral system to detect the presence of a perceived or actual threat of illness. In addition, this is the only way to determine the client’s ability to adjust and adapt to illness or threats to illness without experiencing imbalance in the behavioral system. Essentially, it is all about developing proper observations for each of the patient’s behavioral subsystems.
Whenever a person experiences a state of behavioral, systemic instability, it means the individual needs nursing intervention (Blais et al. 2015). Nursing thus must identify the origin of the problem and initiate appropriate nursing action to restore and maintain behavioral system balance. This renders Johnson’s theory to be seen as a very general theory. The fact that the theory has seven subsystems, which interrelate and interact, makes it very complex. It is can be difficult to determine which system is causing a problematic behavior because all of them constantly interact. Also, there are countless external forces which act on these subsystems (Smith & Parker, 2015). Therefore, the goal of maintaining and restoring a person’s behavioral system stability and balance cannot be achieved.
Strengths
Johnson’s behavioral system model guides nursing education, research, and practice (Renpenning et al. 2016). Besides generating new ideas regarding nursing, the theory has differentiated nursing from other healthcare related professions. It has proven valuable in outpatient, inpatient, and community settings, including nursing administration. For years, it has been used in nursing education and academic institutions across the globe. Indeed, there is hope that Johnson’s nursing theory will continue to be used in nursing practice to achieve valuable nursing objectives.
Weaknesses
Johnson’s theory is extremely general and complex because of the numerous interrelationships among the subsystems, the environment, and the behavioral system (Blais et al. 2015). This complexity means that it is not generalizable.
Generalizability
Johnson’s theory seeks to offer a systemic and behavioral basis for nursing. The scope of the framework encompasses seven behavioral subsystems. In addition, the theory addresses aspects of preventing illness and maintaining balance in the behavioral system during a state of illness in the biological system, thereby limiting its generality. Moreover, the generalizability of this theory is limited by the emphasis it places on behavioral rather than physiological and psychosocial aspects of care (Cowie et al. 2018).
Assumptions of the Theorist
While developing this theory, Johnson made some key assumptions, which can be used to understand the nature and functioning of a human being as a behavioral system (Sitzman & Eichelberger, 2017). They are classified into structural assumptions, functional assumptions, and systemic assumptions (Espelage et al. 2018). Under the systemic umbrella, Johnson assumed that (1) there is interdependency, interaction, organization and integration among the elements and parts of behaviors which combine to create a system. (2) A system strives to attain balance among the diverse forces that operate within it and human beings seek to constantly maintain a balance within the behavioral system through automatic adjustments and adaptations to the environmental forces. (3) A behavioral system resulting in some level of constancy and regularity in behavior is crucial to human beings. The functional significance of this system is that it serves a valuable role for the individual, including his/her social life. (4) Balance in the system is a reflection of adaptations and adjustments which are successful to some degree (Espelage et al. 2018).
Under the structural group, Johnson assumed that (1) a person’s behavior and the associated consequences can help infer the driver behind the behavior and the goal being pursued. (2) Individuals tend to act according to certain goals. (3) Each subsystem has a scope of action which guides an individual’s behavior. Finally, the behavior of a patient yields outcomes which can be observed (Creasia & Friberg, 2015).
The final group lists the main functional requirements for each subsystem. (1) It is important to protect the subsystem from toxic influences that the system cannot handle. (2) It is important to nurture each system by consuming appropriate supplies from the environment. (3) It is mandatory to stimulate the system for use to prevent stagnation and promote growth (Renpenning et al. 2016).
Major Concepts
Three major concepts underlie Johnson’s theory; a human being, health, and primary goal of nursing (Blais et al. 2015). The human being must strive to make continued adjustments to achieve, regain, and maintain balance. The human being is made up of two main systems, namely the behavioral and biological systems. The primary purpose of medicine is to concentrate on the biological systems, whereas nursing focuses on the behavioral system. The second concept (health) refers to the purposefully adapted responses to external and internal stimuli to maintain control and stability (Fawcett, 2017). These responses entail social, emotional, mental, and physical realms. The final concept (the primary goal of nursing) is all about promoting a state of equilibrium in the patient (Masters, 2014). Though the primary focus of nursing is to maintain balance in the behavioral system during a state of illness in the biological system, another focus is on the integrated and organized whole. In this context, the nurse is the external force which serves to impose temporary control and regulatory mechanisms while the client is experiencing illness.
References
Blais, Kathleen, R.n., & Hayes, Janice S. (2015). Professional Nursing Practice . Pearson.
Cowie, D., McKenna, A., Bremner, A. J., &Aspell, J. E. (May 01, 2018). The development of bodily self-consciousness: changing responses to the Full Body Illusion in childhood. Developmental Science, 21, 3.)
Creasia, J. L., &Friberg, E. E. (2015). Conceptual Foundations - E-Book: The Bridge to Professional Nursing Practice .
Espelage, D. L., Merrin, G. J., Hong, J. S., &Resko, S. M. (November 01, 2018). Applying Social Cognitive Theory to Explore Relational Aggression across Early Adolescence: A Within- and Between-Person Analysis. Journal of Youth and Adolescence : a Multidisciplinary Research Publication, 47, 11, 2401-2413.
Fawcett, J. (2017). Applying conceptual models of nursing: Quality improvement, research, and practice .http://public.ebookcentral.proquest.com/choice/publicfullrecord.aspx?p=4744444.
In Cooper, C. L., & In Quick, J. C. (2017). The handbook of stress and health: A guide to research and practice .
Masters, K. (2014). Nursing theories a framework for professional practice . https://ebookcentral.proquest.com/lib/ulaval/detail.action?docID=4441309.
Renpenning, K. M. L., Taylor, S. G., & Pickens, J. M. (2016). Foundations of professional nursing: Care of self and others .
Sitzman, K., &Eichelberger, L. W. (2017). Understanding the work of nurse theorists: A creative beginning .
Smith, M. C., & Parker, M. E. (2015). Nursing theories & nursing practice . http://public.eblib.com/choice/publicfullrecord.aspx?p=1972374.
