Behavioral System Model and Nursing Care Dorothy Johnson’s Behavioral System Model (BSM) is a significant conceptual framework in nursing that emphasizes the understanding of patients as behavioral systems. This model is designed to provide nurses with a comprehensive approach to understanding patient behaviors and developing nursing interventions that support the maintenance or restoration of behavioral equilibrium.
Johnson’s Behavioral System Model
Johnson’s Behavioral System Model consists of two major components: nursing and person. In this model, nursing is described as a function that encompasses specific actions and goals aimed at helping individuals achieve and maintain a state of equilibrium. The person is conceptualized as a behavioral system comprising interrelated subsystems that interact with one another and with the environment (Johnson, 1980).
These subsystems are dynamic and continuously change due to maturation, environmental stimuli, or internal forces, leading to temporary disturbances in equilibrium. When a greater disequilibrium occurs, nursing acts as an external regulatory force that helps the person regain balance and stability.
Subsystems
Johnson identified seven subsystems within the behavioral system, each with specific needs for protection, nurturance, and stimulation from the environment. Without these, the subsystems cannot perform their functions effectively. Each subsystem is also driven by a particular goal, a predisposition or “set” to respond in a specific way, and the choices that the individual makes. The seven subsystems are:
- Attachment/Affiliative Subsystem: Focused on security, this subsystem involves social inclusion, intimacy, and social bonding. It plays a crucial role in maintaining a sense of connection and emotional support.
- Dependency Subsystem: Evolves from total dependency in infancy to independence while still providing nurturance through approval, attention, recognition, or physical assistance.
- Achievement Subsystem: Concerned with mastery or control over some aspect of the self or environment. It relates to developing physical, creative, mechanical, and social skills.
- Ingestive Subsystem: Focuses on behaviors related to appetite satisfaction, including when, where, how, what, how much, and under what conditions individuals eat. It emphasizes social and psychological influences on eating behaviors.
- Eliminative Subsystem: Concerns the behavioral aspects of waste excretion, such as when, where, and how waste elimination occurs, influenced by social and psychological factors.
- Sexual Subsystem: Has dual functions of procreation and gratification, influenced by cultural norms, values, and biological sex. It encompasses gender identity, courting, and mating behaviors.
- Aggressive Subsystem: Focuses on self-protection and preservation. This subsystem is not seen as a negative learned behavior but as a natural and necessary response for survival.
More Concerned with Behavioral Aspects
The model is more concerned with behavioral, rather than purely biological, aspects of the individual. For example, the ingestive and eliminative subsystems focus on how behaviors around eating and waste elimination are shaped by social, cultural, and psychological factors. This focus helps nurses understand not just the physiological needs of patients, but also the behaviors that influence their health and well-being.
Dual Model
The model incorporates a dual perspective: it views behavior from both the perspective of internal biological needs and external environmental demands. For instance, the sexual subsystem’s functions of procreation and gratification are influenced by cultural norms and values, as well as biological factors. Similarly, the aggressive subsystem, which serves the purpose of self-protection, reflects both inherent biological instincts and responses shaped by the environment.
Behavioral Research Model and Research
Johnson’s Behavioral System Model guides nursing research by identifying behavioral system disturbances linked to illness or major environmental stimuli. The model has proven particularly useful in clinical practice, where it helps nurses assess patient outcomes and formulate personalized nursing interventions.
Research using Johnson’s model often involves assessments based on patterns individuals use to meet their needs. It has been applied as a framework for nursing interventions tailored to individual patients (Cox, M., 1994; Derdiarian, 1990; Holiday, 1997). Furthermore, patient classification systems have been developed based on the subsystems identified in this model (Poster, Dee, & Randell, 1997).
Behavioral Model and Effectiveness of Model
The ultimate goal of Johnson’s Behavioral System Model is to maintain or restore balance in an individual’s behavioral system. To achieve this, nurses can develop precise measurements for evaluating the effectiveness of nursing actions. For example, Majesky, Brester, and Nishio (1978) developed patient indicators of nursing care, which are considered measures of quality nursing care.
The model’s effectiveness has been demonstrated in various studies. W. Reynolds and Cormack (1991) evaluated the outcomes of nursing interventions with psychiatric patients, while other research has shown the usefulness of the Behavioral System Model in diverse settings (Raudonis & Acton, 1997; Stuifbergen, Becker, Rogers, Timmerman, & Kulberg, 1999). These studies highlight the model’s capacity to guide nursing practice, promote behavioral system equilibrium, and foster appropriate changes in patient behavior.
Conclusion
Dorothy Johnson’s Behavioral System Model offers a robust framework for understanding patient behavior and developing effective nursing interventions. By focusing on behavioral aspects and recognizing the dynamic interplay between internal and external factors, the model provides nurses with a comprehensive approach to patient care. Its application across various settings demonstrates its flexibility and relevance in contemporary nursing practice, ultimately enhancing patient outcomes by maintaining or restoring behavioral balance.