Johnson’s model for nursing presents a view of the client as a living open system.
The client is seen as a collection of behavioral subsystems that interrelate to form a behavioral system. Therefore, the behavior is the system, not the individual. This be-havioral system is characterized by repetitive, regular, predictable, and goal-directed behaviors that always strive toward balance (Johnson, 1968).
Johnson (1968) proposed that the nursing client is a behavioral system with behaviors of interest to nursing and is organized into seven subsystems of behavior:
achievement, affiliative, aggressive, dependence, eliminative, ingestive, and sexual.
Nurses using the model believed that an additional area of behavior needed to be addressed (Auger, 1976; Derdiarian, 1990; Grubbs, 1974; Holaday, 1980). They added an eighth subsystem, restorative. Each subsystem has its own structure and function. Each subsystem comprises a goal based on a universal drive, set, choice, and action. Each of these four factors contributes to the observable activity of a person. Boxes 8-1 and 8-2 provide examples of how one might operationalize the function and structure of each subsystem. Grubbs (1980) provides excellent defini-tions of the concepts and terms used in the JBSM.
The goal of a subsystem is defined as “the ultimate consequence of behaviors”
(Grubbs, 1974, p. 226). The basis for the goal is a universal drive, the existence of which is supported by existing theory or research. The goal of each subsys-tem is the same for all people when stated in general terms; however, variations among individuals occur and are based on the value placed on the goal and drive strength.
The second structural component is set, which is a tendency to act in a certain way in a given situation. Once they are developed, sets are relatively stable. Set formation is influenced by such societal norms and variables as culture, family, values, perception, and perseverative sets. The preparatory set describes one’s focus in a particular situation. The perseverative set, which implies persistence, refers to the habits one maintains. The flexibility or rigidity of the set varies with each per-son. Set plays a major role in determining the choices a person makes and actions eventually taken.
Choice refers to the alternate behaviors the person considers in any given situ-ation. A person’s range of options may be broad or narrow. Options are influenced by such variables as age, gender, culture, and socioeconomic status.
The action is the observable behavior of the person. The actual behavior is re-stricted by the person’s size and abilities. Here the concern is the efficiency and effectiveness of the behavior in goal attainment.
Each of the subsystems also functions in a manner analogous to the physiology of biological systems (e.g., the urological system has both structural and functional components). The goal of the subsystem is a part of the structure. It is not entirely separate from its function.
For the eight subsystems to develop and maintain stability, each must have a constant supply of “functional requirements” or sustenal imperatives (Johnson, 1980, p. 212). The environment must supply the functional requirements or sus-tenal imperatives of protection from unwanted, disturbing stimuli; nurturance
through giving input from the environment (e.g., food, caring, conditions that support growth and development); encouragement; and stimulation by experi-ences, events, and behavior that would “enhance growth and prevent stagnation”
(Johnson, 1980, p. 212).
The subsystems maintain behavioral system balance as long as both the inter-nal and the exterinter-nal environments are orderly, organized, and predictable and each of the subsystems’ goals is met. Behavioral system imbalance arises when struc-ture, function, or functional regimen is disturbed. The JBSM differentiates four
BOX 8-1
Affiliative Subsystem
FUNCTION
• To form cooperative and interdependent role relationships within human social systems • To enjoy interpersonal relationships
• To belong to something other than oneself • To share
• To achieve intimacy and inclusion STRUCTURAL COMPONENTS
Goal: To relate or belong to something or someone other than oneself, to achieve intimacy and inclusion.
Perseveratory Set: A consistent approach (or pattern of behavior) to establishing affiliative relationships; a consistent tendency to select a certain individual or group for the purpose of affiliation; inherited generic characteristics that determine the influence of affiliative behaviors; development of self-identity and self-concept to a group; cultural beliefs and customs.
Preparatory Set: Perception of a situation as requiring particular role behaviors required by the interaction setting; selective inattention to social behaviors; mood.
Choice: Selection from among the alternatives available in the situation as perceived through set, the behaviors considered appropriate to meet the goal. Within the context of the situation, the behaviors include affiliation, avoidance,
nonreciprocated relationships, noncontingent social relationships, maintenance of a relationship, and affiliation with animals or other objects.
Acts: Any directly observable behavior that facilitates movement toward others in the environment. Specific acts include smiling, visual contact, talking (social greeting, conversation, extending invitations), facial expression, motor behaviors (touching, holding, hugging), and other actions that establish or maintain a reciprocal relationship between two or more individuals.
Sustenal Imperatives: Conditions that serve to protect, stimulate, and mature behaviors related to affiliation. Included are learned behaviors to initiate and maintain a social exchange: presence of an environment where these skills can be taught and nurtured; development of trust; kinship; awareness of one’s self-identity; self-esteem; ability to communicate verbally and nonverbally; membership in groups;
knowledge of formal and informal guidelines for interpersonal processes; and secure parent-infant attachment.
142 PART 2 Application
diagnostic classifications to delineate these disturbances: insufficiency, discrepancy, incompatibility, and dominance.
Nursing has the goal of maintaining, restoring, or attaining a balance or stabil-ity in the behavioral system or in the system as a whole. Nursing acts as an “external regulatory force” to modify or change the structure or to provide ways in which subsystems fulfill the structure’s functional requirement (Johnson, 1980, p. 214).
Interventions directed toward restoring behavioral system balance are directed toward repairing damaged structural units, with the nurse temporarily imposing regulatory and control measures or helping the client develop or enhance his or her supplies of essential functional requirements.
BOX 8-2
Ingestive Subsystem
FUNCTION
• To sustain life through the intake of food and fluids and oxygen • To obtain knowledge or information useful to the self
• To obtain pleasure or gratification through the intake of nonfunctional materials such as smoking, alcohol, or drugs
• To restore a felt deficiency within the self system • To relieve pain or other psychophysiological systems STRUCTURAL COMPONENTS
Goal: To internalize the external environment.
Perseveratory Set: Status of sensory modalities; digestive system, respiratory system, fluid and electrolyte balance; oral cavity conditions; socialization into food types;
drinking habits; smoking use; oral medications; subcutaneous, intravenous, and intramuscular injections; sensory assistance, such as hearing aids, glasses, and dentures. Beliefs and values about times and places for eating and drinking; types of foods and beverages preferred by the social group; attitudes toward alcohol and smoking; beliefs about efficiency of oral, intravenous, and subcutaneous medication.
Perception of self as fat or thin; abstainer or alcoholic, addict, smoker, asthmatic.
Preparatory Set: Awareness of being hungry or thirsty, in need of a drink; wish to be high; relief of pain; time for eating, availability of food, fluid or medication resources;
barriers to respiration, desire for information; awareness of ignorance.
Choice: Behavioral options available for food and fluid, medication, air supply, tobacco, alcohol, marijuana, narcotics; supplies available in the environment; selections are made on the basis of set and situation. Choice includes deferred gratification and overindulgence. Options are available for taking in information.
Acts: Behaviors may include visual, auditory, olfactory, and gustatory acts or overindulgences (or less than optimal) and preferences for particular substances.
Ingestive acts may be directed toward goals other than ingestion. Sensory acts (seeing, hearing, smelling, tasting, and sensations) are used in all other subsystems to serve other goals. When sensory acts are directed toward obtaining information, the acts are ingestive goal-oriented. The process of hearing also requires ingestive acts. The ingestion may be for achievement goals.