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CHAPTER 18 Dorothy E. Johnson 341

system theory. One monitors outputs from a given and stimulation (Johnson, 1968, 1980). The nurse may
subsystem in order to monitor performance. Signs of provide “temporary imposition of external regulatory
disequilibrium require one to identify the problem, and control mechanisms, such as inhibiting ineffective
further define the problem by gathering data, and behavioral responses, and assisting the patient to acquire
design an intervention to restore equilibrium/balance new responses” (Johnson, 1968, p. 6). Johnson (1980)
(Miller, 1965; Jenkins, 1969). suggested that techniques include “teaching, role model-
Johnson (1959a) implied that the initial nursing as- ing, and counseling” (p. 211). If a problem or disorder is
sessment begins when the cue tension is observed and anticipated, preventive nursing action is appropriate
signals disequilibrium. Sources for assessment data can with adequate methodologies (Johnson, 1980). Nurtur-
be through history taking, testing, and structural ob- ance, protection, and stimulation are as important for
servations (Johnson, 1980). “The behavioral system is preventive nursing care or health promotion as they are
thought to determine and limit the interaction between for managing illness (Brown, 2006).
the person and his environment” (Johnson, 1968, p. 3). If the problem is a structural stressor, the nurse
This suggests that the accuracy and quantity of the data will focus on goal, set, choice, or action of the subsys-
obtained during nursing assessment are not controlled tem. The nurse works to redirect the person’s goals,
by the nurse, but by the patient (system). The only ob- change drive significance, broaden the range of
served part of the subsystem’s structure is behavior. Six choices, alter the set, or change the action. The nurse
internal and external regulators have been identified manipulates the structural units or imposes tempo-
that “simultaneously influence and are influenced by rary controls. Both types of nursing actions regulate
behavior” including biophysical, psychological, devel- the interaction of the subsystems.
opmental, sociocultural, family, and physical environ- The outcome of nursing intervention is behavioral
mental regulators (Randell, 1991, p. 157). system equilibrium. “More specifically, equilibrium
The nurse must be able to access information can be said to have been achieved at that point at
related to goals, sets, and choices that make up the which the individual demonstrates a degree of con-
structural subsystems. “One or more of [these] sub- stancy in his pattern of functioning, both internally
systems is likely to be involved in any episode of ill- and interpersonally” (Johnson, 1961a, p. 9). The eval-
ness, whether in an antecedent or a consequential way uation of the nursing intervention is based on whether
or simply in association, directly or indirectly with it made “a significant difference in the lives of the
the disorder or its treatment” (Johnson, 1968, p. 3). persons involved” (Johnson, 1980, p. 215).
Accessing the data is critical to accurate statement of The Behavioral System Model has been operation-
the disorder. alized through the development of several assessment
Johnson did not define specific disorders, but she instruments. In 1974, Grubbs (1980) used the theory
did state two general categories of disorders on the to develop an assessment tool and a nursing process
basis of the relationship to the biological system sheet based on Johnson’s seven subsystems. Questions
(Johnson, 1968). and observations related to each subsystem provided
tools with which to collect important data, noting
Disorders are those which are related tangentially choices of behavior that will enable the patient to
or peripherally to disorder in the biological sys- accomplish his or her goal of health.
tem; that is, they are precipitated simply by the That same year, Holaday (1980) used the theory as
fact of illness or the situational context of treat- a model to develop an assessment tool when caring
ment; and . . . those [disorders] which are an inte- for hospitalized children. This tool allowed the nurse
gral part of a biological system disorder in that to describe objectively the child’s behavior and to
they are either directly associated with or a direct guide nursing action. In expanding the concept of
consequence of a particular kind of biological “set,” Holaday also identified patterns of maternal
system disorder or its treatment behaviors that would indicate an inadequate or poorly
(Johnson, 1968, p. 7).
functioning set that was eroding to the limited choices
The “means of management” or interventions do of action in responding to the needs of chronically ill
consist in part of the provision of nurturance, protection, infants (Holaday 1981; 1982).