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342 UNIT III Nursing Conceptual Models

Derdiarian (1990) investigated the effects of using among older adults. The Behavioral System Model was
two systematic assessment instruments on patient used to describe the “hazards of fear of crime” that
and nurse satisfaction. The Johnson Behavioral could cause disturbances in the ingestive, dependency,
System Model was used to develop a self-report and achievement, affiliative, and aggressive-protective
observational instrument implemented with the subsystems (Benson, 1997, p. 26). Patient- and com-
nursing process. The Derdiarian Behavioral System munity-focused interventions were presented to im-
Model instrument included assessment of the restor- prove quality of care and quality of life in older adults.
ative subsystem and the seven subsystems advocated Brinkley, Ricker, & Toumey (2007) demonstrated the
by Johnson. The results indicated that the instruments use of the Johnson Behavioral System Theory with
provided a more comprehensive and systematic ap- a morbidly obese patient with complex needs, and
proach to assessment and intervention, thereby increas- Tamilarasi and Kanimozhi (2009) provided theory-
ing patient and nurse satisfaction with care. based interventions to improve the quality of life of
Lanouette and St-Jacques (1994) used Johnson’s breast cancer survivors.
model to compare the coping abilities and percep- Lachicotte and Alexander (1990) examined the
tions of families with premature infants with those of use of Johnson’s Behavioral System Model as a frame-
families with full-term infants. The results indicated work for nursing administrators to use when making
that positive coping skills were relative to bonding decisions concerning the management of impaired
with the infant, using resources, solving problems, nurses. They suggested that, by viewing all levels
and making decisions. Lanouette and St-Jacques sug- of environment, the framework encouraged nurse
gested that improvement in nursing care practices in administrators to assess imbalance in the nursing
nursery, hospital, and community settings might system when nurse impairment exists and evaluate
have contributed to this outcome. This supported the “system’s state of balance in relationship to the
Johnson’s statement that “the effective use of nurtur- method chosen to deal with nurse impairment”
ance, protection, and stimulation during maternal (Lachicotte & Alexander, 1990, p. 103). Results indi-
contact at birth could significantly reduce the behav- cated that nurse administrators preferred an assistive
ioral system problems we see today” (personal com- approach when dealing with nurse impairment. It was
munication, 1996) believed that “when the impaired nurse is confronted
Case studies have documented the use and evalua- and assisted equilibrium begins to be restored and
tion of the Johnson Behavioral System Model in balance brought back to the system” (Lachicotte &
clinical practice. In 1980, Rawls used the theory to Alexander, 1990, p. 103).
systematically assess a patient who was facing the loss At the University of California, Los Angeles, the
of function in one arm and hand. Herbert (1989) re- Neuropsychiatric Institute and Hospital has used
ported the outcomes of a nursing care plan developed Johnson’s Behavioral System Model as the basis of
for an elderly stroke patient. They each concluded their psychiatric nursing practice for many years
that Johnson’s theory provided a theoretical base that (Auger & Dee, 1983; Dee, Tyson, Capparrell, et al.,
predicted the results of nursing interventions, formu- 1999; Poster, Dee, & Randell, 1997). “Patients are
lated standards for care, and administered holistic assessed and behavioral data are classified by subsys-
care. Fruehwirth (1989) found it equally effective tem. Nursing diagnoses are formulated that reflect the
when intervening with a support group for caregivers nature of the ineffective behavior and its relationship
of patients with Alzheimer’s disease. to the regulators in the environment” (Randell, 1991,
Some studies of practice using Johnson’s model p. 154). Johnson’s theory is also incorporated into the
have focused on decision making and evaluation of new graduate orientation program (Puntil, 2005). A
outcomes. Grice (1997) found that the nurse, patient, study comparing the diagnostic labels generated from
and situational characteristics influenced assessment the Johnson Behavioral System Model with those on
and decision making for the administration of anti- the North American Nursing Diagnosis Association
anxiety and antipsychotic medications for psychiatric list indicated that the Johnson Behavioral System
inpatients at certain hours. Benson (1997) conducted Model was better at distinguishing the problems and
a review of research literature on the fear of crime the etiology (Randell, 1991).