Dorothy E. Johnson’s Behavioral System Model is a foundational nursing theory that views patients as complex behavioral systems composed of interrelated subsystems. Her model emphasizes maintaining or restoring behavioral balance to promote health and prevent illness.
Life Story of Dorothy E Johnson
Dorothy Elma Johnson (1919–1999) was a pioneering nurse theorist whose Behavioral System Model reshaped nursing into a science of holistic care. Her work emphasized the importance of understanding patients as dynamic behavioral systems, not just biological entities.
Early Life & Education
- Born August 21, 1919, in Savannah, Georgia, the youngest of seven children.
- Earned an Associate of Arts from Armstrong Junior College (1938).
- Received her BS in Nursing from Vanderbilt University (1942), where she was awarded the prestigious Founder’s Medal.
- Completed her Master of Public Health at Harvard University in 1948.
Career & Global Influence
- Began teaching at Vanderbilt University School of Nursing, then spent nearly 30 years at UCLA as a professor of pediatric nursing.
- Served as a pediatric nursing advisor in South India (1955–1956), helping develop a baccalaureate nursing program.
- Introduced the concept of nursing diagnosis in 1959, distinguishing nursing from medicine by focusing on behavioral systems rather than biological ones.
The Behavioral System Model (1968)
- Views patients as behavioral systems composed of seven subsystems:
- Attachment/Affiliative: forming relationships
- Dependency: seeking help and approval
- Ingestive: eating and drinking
- Eliminative: waste removal
- Sexual: identity and reproduction
- Aggressive/Protective: self-defense
- Achievement: mastery and competence
- Each subsystem has three functional needs: protection, nurturance, and stimulation.
- Nurses act as external regulators, helping restore balance when stressors disrupt these systems.
Legacy & Honors
- Authored influential works like One Conceptual Model of Nursing and To Be a Nurse.
- Received the Lulu Hassenplug Distinguished Achievement Award and multiple faculty honors.
- Her model is widely used in nursing education, research, and practice across the globe.
- Passed away in February 1999 in Key Largo, Florida, after a life devoted to advancing nursing science.
Behaviour system model
In 1980 Johnson published her conceptualization of “behavioral system of model for nursing “where she explains her definitions of the behavioral system model.
“Each individual has a predisposition to act, with reference to the goal, in certain ways rather than in other ways.”
Dorothy first proposed her model of nursing care in 1968 as fostering of “the efficient and effective behavioral functioning in the patient to prevent illness”.
She also stated that nursing was “concerned with man as an integrated whole and this is the specific knowledge of order we require”.
Concepts of the Theory
- Patient Independence: Nurses support patients until they can care for themselves.
- Holistic Care: Addresses physiological, psychological, sociological, and spiritual needs.
Four Metaparadigm Elements:
- Individual: A sum of interrelated parts with basic needs.
- Environment: External conditions affecting life and development.
- Health: Ability to function independently.
- Nursing: Assisting in activities that promote health or peaceful death.
Assumptions
There are several layers of assumptions that Johnson makes in the development of conceptualization of the behavioral system model viz.
- Assumptions about system
- Assumptions about structure
- Assumptions about functions
Assumptions about system
There are 4 assumptions of system:
- First, there is “organization, interaction, interdependency and integration of the parts and elements of behaviours that go to make up the system”
- A system “tends to achieve a balance among the various forces operating within and upon it’, and that man strive continually to maintain a behavioral system balance and steady state by more or less automatic adjustments and adaptations to the natural forces impinging upon him.”
- A behavioral system, which both requires and results in some degree of regularity and constancy in behavior, is essential to man who is to say, it is functionally significant in that it serves a useful purpose, both in social life and for the individual.
- Last, “system balance reflects adjustments and adaptations that are successful in some way and to some degree.”.
Assumptions about structure & function of each subsystem
- “From the form the behavior takes and the consequences it achieves can be inferred what “drive” has been stimulated or what “goal” is being sought”
- Each individual has a “predisposition to act with reference to the goal, in certain ways rather than the other ways”. This predisposition is called as “set”.
- Each subsystem has a repertoire of choices or “scope of action”
- The fourth assumption is that it produces “observable outcome” that is the individual’s behavior.
Each subsystem has three functional requirements
- System must be “protected” from noxious influences with which system cannot cope”.
- Each subsystem must be “nurtured” through the input of appropriate supplies from the environment.
- Each subsystem must be “stimulated” for use to enhance growth and prevent stagnation.
Representation of Johnson’s Model
Johnson viewed the individual as a behavioral system composed of seven subsystems, each with:
- Goals/Drive : Internal motivation or need
- Set: Predisposition to act in certain ways
- Choice: Range of behavioral options
- Observable Behavior: The actual actions taken
These subsystems interact to maintain homeostasis—a balanced, stable behavioral state.
The Seven Behavioral Subsystems
| Subsystem | Purpose |
|---|---|
| Attachment/Affiliative | Builds social bonds and ensures survival through relationships |
| Dependency | Seeks approval, attention, and assistance |
| Ingestive | Manages food intake and its social context |
| Eliminative | Regulates waste excretion within cultural norms |
| Sexual | Addresses reproduction and gratification, influenced by biology and society |
| Aggressive/Protective | Ensures self-preservation and defense |
| Achievement | Drives mastery, control, and goal attainment |
Each subsystem must be:
- Protected from harmful influences
- Nurtured with environmental support
- Stimulated to prevent stagnation
14 Fundamental Needs Identified by Henderson
| Category | Need |
|---|---|
| Physiological | Breathe normally, Eat and drink adequately, Eliminate body wastes, Move and maintain posture, Sleep and rest, Dress appropriately, Maintain body temperature, Keep body clean and groomed |
| Safety | Avoid environmental dangers |
| Communication | Express emotions, needs, fears, opinions |
| Spiritual | Worship according to faith |
| Occupational & Recreational | Work with a sense of accomplishment, Play or engage in recreation |
| Learning | Discover or satisfy curiosity for health development |
Application of Dorothy E. Johnson’s Behavioral System Model
1. Assessment
- Assess the seven behavioral subsystems to identify any imbalance or disturbance:
- Attachment–Affiliative
- Dependency
- Ingestive
- Eliminative
- Sexual
- Aggressive–Protective
- Achievement
- Collect subjective and objective data on the patient’s behavioral patterns.
2. Nursing Diagnosis
- Formulate nursing diagnoses related to imbalanced or disrupted behavioral subsystems.
- Focus on behaviors that deviate from normal function or threaten system stability.
3. Planning
- Establish goals to restore behavioral balance and system stability.
- Determine expected outcomes that reflect improved function of the affected subsystem(s).
4. Intervention
- Support, maintain, or restore behavioral subsystem equilibrium through:
- Environmental modification
- Health education and guidance
- Direct care to correct or support behavior
- Promote adaptive and functional behaviors that enhance health.
5. Evaluation
- Evaluate the effectiveness of nursing interventions in restoring behavioral balance.
- Adjust the care plan as needed to maintain or achieve stability and health.
Case Scenario 1: Postoperative Patient with Refusal to Eat
Scenario:
Mr. X, 55 years old, underwent abdominal surgery 2 days ago. He refuses meals, complains of pain, and frequently calls for the nurse’s attention.
Affected Behavioral Subsystems:
- Ingestive – Refuses to eat due to discomfort.
- Dependency – Frequently seeks nurse’s presence and attention.
Possible Nursing Diagnosis:
- Imbalanced nutrition: Less than body requirements related to decreased oral intake.
- Ineffective coping related to increased dependency behavior.
Nursing Interventions:
- Provide pain management to improve comfort and encourage eating.
- Offer small, frequent, and palatable meals.
- Provide emotional support and reassurance to meet dependency needs.
- Encourage gradual independence in self-care and meal intake.
- Evaluate for improved oral intake and reduced dependency calls.
Case Scenario 2: Elderly Patient with Social Isolation in a Nursing Home
Scenario:
Mrs. Y, 75 years old, lives in a long-term care facility. She avoids group activities, skips meals, and stays in her room most of the time.
Affected Behavioral Subsystems:
- Attachment–Affiliative – Limited social interaction and bonding.
- Achievement & Ingestive – Loss of interest in meals and purposeful activities.
Possible Nursing Diagnosis:
- Social isolation related to limited attachment behavior.
- Risk for imbalanced nutrition related to decreased social stimulation.
Nursing Interventions:
- Encourage participation in social and recreational activities.
- Arrange family visits or video calls to enhance attachment behaviors.
- Offer meals in a social dining area to stimulate appetite.
- Involve patient in simple purposeful tasks to increase achievement behavior.
- Monitor improvement in food intake and participation in activities.
REFERENCES
- Conner, S. S., Harbour, L. S., Magers, J. A., and Watt, J. K. (1994). Dorothy E. Johnson: Behavioral System Model. In Ann Marriner-Tomey (3rd ed.), Nursing Theorists and Their Work (pp. 231-240). St. Louis: Mosby-Year Book, Inc.
- Derdiarian, A. K. (1983). An instrument for research and theory development using the Behavioral System Model for Nursing: The cancer patient. Part I. Nursing Research, 32:4, 196-201.
- Derdiarian, A. K. (1993). The Johnson Behavioral System Model. In M. E. Parker (Ed.), Patterns of Nursing Theories in Practice. New York: National League for Nursing Press.
- George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton and Lange.
- Abyu, Gebre & University, Bahirdar. (2020). “Behavioral System Model of Nursing, https://www.researchgate.net/publication/339432791_Behavioral_System_Model_of_Nursing/citation/download
- Polit DF, Hungler BP. Nursing Research: Principles and Methods. Philadelphia: JB Lippincott Company; 1998.
- Burns N, Grove SK. The practice of Nursing Research. 4th Ed. Philadelphia: WB Saunders Publications; 2001.
- Treece JW, Treece EW. Elements of Research in Nursing (3rded.). St. Louis: Mosby; 1982.
- Johnson, D.E. (1980). The behavioral system model for nursing. In J.P. Riehl & C. Roy (Eds.), Conceptual models for nursing practice (2nd ed.). New York: Appleton-Century-Crofts. Lobo, M. L. (1995).
- Dorothy E. Johnson. In J. B. George (Ed.), Nursing Theories: The Base for Professional Nursing Practice (4th ed.). New York: Macmillian Co. Random House College Dictionary, 1988.
- George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton and Lange.
- Polit DF, Hungler BP. Nursing Research: Principles and Methods. Philadelphia: JB Lippincott Company; 1998.
- Burns N, Grove SK. The practice of Nursing Research. 4th Ed. Philadelphia: WB Saunders Publications; 2001.
- Treece JW, Treece EW. Elements of Research in Nursing (3rded.). St. Louis: Mosby; 1982.
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
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