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CHAPTER 18 Dorothy E. Johnson 347

the relationship of the subsystems or the internal and
external environments. missing his appointment with the orthopedic
Nursing is an external regulatory force that acts to physician who was to evaluate his right arm. The
restore balance and stability by inhibiting, stimulating, patient reports that food doesn’t taste right any-
or reinforcing certain behaviors (control mechanisms), more and he has no appetite. With encouragement
changing the structural components (patient goals, from his family, he eats small portions of each
choices, actions), or fulfilling function requirements. meal and drinks fluids without difficulty.
Health is the result of the behavioral system having The patient is a college graduate who recently
stability, balance, and equilibrium (Johnson, 1980). retired. He has been married for 45 years and has
Johnson’s ultimate goals were directed toward two adult children who live in the same city. He is
nursing practice, a curriculum for schools of nursing, a leader in the church and social community. His
and to develop nursing science. She wanted the Johnson family and friends visit him frequently in the hos-
Behavioral System Model to successfully generate and pital. He is cheerful and attempts to talk with them
disseminate nursing science; systematize nursing in- when they visit. When he doesn’t have visitors, he
terventions that were ethically reflective; account for sits quietly in a dark room or sleeps. He is tearful
multiple perspectives; and be sensitive to society’s each time his family hugs him prior to leaving. He
values. It was her hope that the Johnson Behavioral expresses appreciation for each visit and apolo-
System Model was a framework she could leave to gizes each time he “gets emotional.”
future generations of nurses (D. Johnson, personal Behavioral Assessment
communication, 1991).
Using Johnson’s Behavioral System Model, the fol-
lowing behavioral assessment is identified:
n Achievement: The patient has achieved many de-
CASE STUDY
velopmental goals of adulthood. He is relearning
A 67-year-old man is admitted to the hospital for how to do activities of daily living (ADLs), walk,
diagnostic tests after experiencing severe abdomi- talk, as well as other cognitive-motor skills such
nal pain and streaks of blood in his stool. He is as reading, writing, and speaking.
alert and oriented. He has a history of type 2 dia- n Attachment-affiliative: The patient is married
betes and hypertension. His blood glucose level is with two adult children who are supportive
187 mg/dl and blood pressure is 188/100 mm Hg. and live in the same city. He has many friends
The patient is 5 feet 10 inches tall and weighs and social contacts who visit frequently.
145 pounds. He is currently taking antihypertensive, n Aggressive-protective: The patient worries about
anticoagulant, antiinflammatory, and antidiabetic his wife traveling to the hospital at night, and
medications. he worries that she doesn’t eat well while stay-
His recent history reveals that he had an acute ing with him in the hospital.
cerebral vascular accident (CVA) 6 weeks ago that n Dependency: His recent stroke, resulting in de-
resulted in partial paralysis and numbness of the creased use of his right arm and leg, has affected
right arm and leg, expressive aphasia, and slurred his mobility and independent completion of
speech. He completed 4 weeks of inpatient reha- ADLs. His potential for falling, inability to feel
bilitation and is able to walk short distances with a his arm or leg if injured, and weakness are safety
cane and moderate assistance. The patient is weak concerns. His wife has taken on the financial
and becomes fatigued quickly. Although he can and home maintenance responsibilities.
move his right arm, he guards it due to pain with n Ingestive: Since the stroke, the patient has had
movement. He receives acetaminophen (Extra a decreased appetite. He has lost 20 pounds
Strength Tylenol) for his right arm prior to ther- in 6 weeks. Studies reveal no swallowing dif-
apy and before sleep. He also continues to exhibit ficulties. He is able to feed himself with his
slight expressive aphasia. He is anxious about con- left hand but needs assistance with cutting
tinuing his therapy and indicates concern about foods.