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CHAPTER 18 Dorothy E. Johnson 345

to identify precursors of disequilibrium and respond reality (set) that guide their decision making (choice
with preventive interventions. and action)? What potential problems/deficiencies
Assuming that a community is a geographical area, in a client’s set could be identified from a nursing
a subpopulation, or any aggregate of people and as- assessment that incorporated tenets from system
suming that a community can benefit from nursing dynamics? Research could lead to development of
interventions, the behavioral system framework can effective assessment instruments for clinical settings.
be applied to community health. A community can be The research in systems dynamics also provides
described as a behavioral system with interacting some ideas for nursing interventions to test with our
subsystems that have structural elements and func- clients. System dynamicists have found that model
tional requirements. For example, mothers of chroni- building with clients (using flowcharts and diagrams)
cally ill children have functional requirements to are helpful in improving information processing.
maintain stability within the achievement subsystem This is based on the premise that diagramming helps
and environmental factors such as “economic, educa- with information processing (set and choice), espe-
tional, and employment influence mothers’ caretak- cially with complex topics. They have also found that
ing skills” (Turner-Henson, 1992, p. 97). using simulation and training in facilitation (asking
Communities have goals, norms, choices, and questions that foster reflection and learning, good
actions in addition to needing protection, nurturance, process structuring of questions and materials) are
and stimulation. The community reacts to internal also effective (Vennix, Gubbels, Post, et al., 1990;
and external stimuli, which results in functional or Huz, Andersen, Richardson, et al., 1997). If a diagno-
dysfunctional behavior. An example of an external sis of insufficiency or discrepancy in the ingestive
stimulus is health policy, and an example of dysfunc- subsystem were made, would these same types of
tional behavior is high infant mortality rate. The be- interventions be helpful?
havioral system consists of yet undefined subsystems Holden (2005) noted that complexity science builds
that are organized, interacting, interdependent, and on the tradition in nursing that views clients and nurs-
integrated. Physical, biological, and psychosocial ing care from a systems perspective. Complexity science
factors also affect community behavior. seeks to understand complex adaptive systems (Miller
Finally, future development of the Johnson Behav- & Page, 2007; Rickles, Hawe, & Shiell, 2007). Complex
ioral System theory is to incorporate advances in the adaptive systems are a “collection of individual agents
field of system theory. Significant advances in the use of with the freedom to act in ways that are not totally pre-
system theory have occurred since Johnson developed dictable and whose actions are interconnected so that
her theory such as in the area of system dynamics one agent’s actions changes the context for other agents”
(Lance, 1999; Wolstenholme, 1990). System dynamics (Plsek & Greenhaligh, 2001. p. 625). The Johnson be-
researchers have convincingly demonstrated that peo- havioral system theory emphasized the connections
ple’s information processing capacity is limited, and and interactions within a systems paradigm. The use of
that humans employ bias and heuristics (e.g., anchor- complexity science could expand our understanding of
ing and use the available heuristic) to process informa- the environmental context and the lifestyle-related and
tion and to reduce mental effort. Groups display the chronic health problems we face today. Complexity sci-
same bias (Hogarth, 1987; Vennix, Gubbels, Post, et al., ence, like Johnson’s system theory, indicates that a flex-
1990). Research in the area of cognitive maps has il- ible range of interventions are essential to respond to
lustrated the restricted character of human informa- health care issues. Conditions such as obesity, chronic
tion processing. People seem to experience difficulty in pain, and diabetes have multiple interrelating influences
thinking in terms of causal nets. Research has demon- such as lifestyle, social, and cultural contexts, and the
strated that people tend to ignore feedback processes way forward is not easily reduced to one uniform solu-
(Dorner, 1980). tion. Principles form complex adaptive systems theory,
This body of research offers some useful insights and Johnson’s behavioral system theory could be used
for the study of the ingestive subsystem. How do cli- jointly to examine health care issues, allowing new and
ents process information and construct the models of revised insights to emerge.