Dorothy Johnson proposed her behavioral system model in 1968 to move away from the concept of human needs and ideas about a person in medical practice. She determined the role of each of a patient’s 7 subsystems in his or her effort to achieve certain goals based on past experience. The result of this effort depends on how the patient perceives their behavior and how they understand their ability to change it. Zaccagnini and Pechacek (2021) explain that “the person is a behavioral system existing within an environment of multiple components, and the human or system interacts with the environment in various ways” (p. 17). Johnson’s model distinguishes between two main types of human behavior: adjustment caused by actions and objects directly around a person, and the attitude created by past habits. An illness or lifestyle changes can unbalance the subsystems of human behavior, therefore, nursing care should be aimed at restoring that balance. According to Johnson, imbalance in one subsystem affects the interrelated subsystems. However, to establish a proper algorithm of nursing intervention, the nurse has to assess the condition of each subsystem of the patient’s behavior.
The nursing assessment should be carried out in two stages. Firstly, the nurse have to define whether the patient’s behavior suggests an imbalance in any subsystem. Secondly, if a disproportion has manifested, the nurse should determine what changes caused it – functional or organic.
A good example of such assessment would be the case of a young man at a hospital, who, despite having his leg broken, does not want to use the crutches to walk. Moreover, he is not willing to allow his wife to interfere and help, as he claims it is her who is guilty of this injury. Here, the nurse should begin the assessment with looking if there are violations in the patient’s aggressive and dependent subsystems. Subsequently, the nurse will have to decide the direction of the medical intervention. In order to do this, she needs to gather valuable data about the young man’s behavior from other people related to the case. In particular, for that case, the sister has to find out whether the young man has experienced an excessive anxiety regarding his safety or any unpleasant interference from his wife in the past. If it did happen, then the patient has organic causes. Otherwise, if displayed behavior is atypical for this young person, it can be concluded that these changes are of a functional nature.
Having established an imbalance in concrete subsystems, the nurse has to team up with the patient to establish the care goals. If the patient’s problem is related to functional violations, the nurse has to intervene with both the patient’s environment and their motivations or beliefs. For example present, a nurse could schedule visits to a psychologist to reduce the young man’s unnecessary fear of walking with the help of crutches. However, if the imbalance lies in organic changes, there would be a need for the nurse to perform appropriate procedures to revert physical dysfunction. According to Zaccagnini and Pechacek (2021), “the nurse might act as a regulatory force, enacting controls to restore stability” (p. 18). In any case, the nurse’s detailed plan should establish short-term, intermediate, and long-term goals for rebalancing the subsystems. Evaluating the effectiveness of the Johnson’s model, a nurse should describe the results of planned interventions, indicating the type of behavioral changes. Moreover, the nurse has to anticipate the patient’s possible behavior in advance, since it influences heavily the success of the intervention. If the care goals are not achieved, the nurse should re-evaluate each of the patient’s behavioral subsystems and correct her assessment accordingly.
Reference
Zaccagnini, M. E., & Pechacek, J. M. (2021). The doctor of nursing practice essentials: a new model for advanced practice nursing. Jones & Bartlett Learning.