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CHAPTER 18 Dorothy E. Johnson 343

It has become increasingly important to docu- man, and (2) contributions to understanding behav-
ment nursing care and demonstrate the effectiveness ioral system problems and treatment rationale and
of the care on patient outcomes. Using Johnson’s methodologies. She identified the important areas for
model, Poster and colleagues (1997) reported a posi- research as: (1) the study of the behavioral system as
tive relationship between nursing interventions and a whole including such issues as stability and change,
the achievement of patient outcomes at discharge. organization and interaction, and effective regulatory
They concluded “a nursing theoretical framework and control mechanisms; and (2) study of the subsys-
made it possible to prescribe nursing care as a dis- tems including the identification of additional subsys-
tinction from medical care” (Poster, Dee, & Randell, tems (Class Notes, 1971).
1997, p. 73). Small (1980) used Johnson’s theory as a conceptual
Dee, van Servellen, and Brecht (1998) examined framework when caring for visually impaired chil-
the effects of managed health care on patient out- dren. By evaluating and comparing the perceived
comes using Johnson’s Behavioral System Model. body image and spatial awareness of normally sighted
Upon admission, nurses develop a behavioral profile children with those of visually impaired children,
by assessing the eight subsystems, determine the bal- Small found that the sensory deprivation of visual
ance or imbalance of the subsystems, and rate the impairment affected the normal development of the
impact of the six regulators. This is used to determine child’s body image and the awareness of his body in
the nursing diagnoses, plan of action, and evaluation space. She concluded that when the human system is
of care for each patient. The results of this study subjected to excessive stress, the goals of the system
indicated significant improvement in the level of cannot be maintained.
functioning upon discharge for patients with shorter Wilkie, Lovejoy, Dodd, and Tesler (1988) examined
hospital stays. cancer pain control behaviors using Johnson’s Behav-
ioral System Model. The results of the study demon-
Education strated that persons used known behaviors to protect
Loveland-Cherry and Wilkerson (1983) analyzed themselves from high-intensity pain. This supported
Johnson’s theory and concluded that it has utility in the assumption that “aggressive/protective subsystem
nursing education. A curriculum based on a person behaviors are developed and modified over time to
as a behavioral system would have definite goals and protect the individual from pain and these behaviors
straightforward course planning. Study would center represent some of the patient’s pain control choices”
on the patient as a behavioral system and its dysfunc- (Wilkie, Lovejoy, Dodd, et al., 1988, p. 729).
tion, which would require use of the nursing process. These findings were supported in a study that ex-
In addition to an understanding of systems theory, amined the “meanings associated with self-report and
the student would need knowledge from the social self-management decision-making” of cancer patients
and behavioral disciplines and the physical and bio- with metastatic bone pain (Coward & Wilkie, 2000,
logical sciences. The model has been used in practice p. 101). Pain provided an incentive to seek treatment
and educational institutions in the United States, from health care providers; therefore, it was a protec-
Canada, and Australia (Derdiarian, 1981; Fleming, tive mechanism. Yet the results indicated that most of
1990; Grice, 1997; Hadley, 1970; Harris, 1986; Orb & the cancer patients did not take pain medication as
Reilly, 1991; Puntil, 2005). often as prescribed and preferred nonpharmacologi-
cal methods, such as positioning or distraction, as
Research their pain-control choices.
Johnson (1968) stated that nursing research would Believing that the model had potential in preven-
need to “identify and explain the behavioral system tive care, Majesky, Brester, and Nishio (1978) used it to
disorders which arise in connection with illness, and construct a tool to measure patient indicators of nurs-
develop the rationale for the means of management” ing care. Holaday (1980), Rawls (1980), and Stamler
(p. 7). Johnson believed the task for nurse scientists (1971) have conducted research using one subsystem.
might follow one of two paths: (1) contributions to Derdiarian (1991) examined the relationships between
the basic understanding of the behavioral system of the aggressive and protective subsystem and the other