Introduction

September 9, 2013 in Savannah, Georgia.

B. S. N. from Vanderbilt University in Nashville, Tennessee,

in 1942; and her M.P.H. from Harvard University in Boston
in 1948.

From 1949 till retirement in 1978 she was an assistant

professor of pediatric nursing, an associate professor of
nursing, and a professor of nursing at the University of
California in Los Angeles.

Johnson stressed the importance of research-based

knowledge about the effect of nursing care on clients.

Behavior system model

Dorothy first proposed her model of nursing care in 1968 as

fostering of the efficient and effective behavioral functioning
in the patient to prevent illness".

She also stated that nursing was concerned with man as

an integrated whole and this is the specific knowledge of
order we require.

In 1980 Johnson published her conceptualization of

behavioral system of model for nursingwhere she explains
her definitions of the behavioral system model.

Definition of nursing
She defined nursing as an external regulatory force which acts to
preserve the organization and integration of the patients behaviors at
an optimum level under those conditions in which the behaviors
constitutes a threat to the physical or social health, or in which illness
is found
Four goals of nursing are to assist the patient:
1.

Whose behavior commensurate with social demands.

2.

Who is able to modify his behavior in ways that it supports

biological imperatives

3.

Who is able to benefit to the fullest extent during illness

from the physicians knowledge and skill.

4.

Whose behavior does not give evidence of unnecessary

trauma as a consequence of illness

Assumptions

There are several layers of assumptions that Johnson makes in the

development of conceptualization of the behavioral system model viz.

Assumptions about system

Assumptions about structure

Assumptions about functions

Assumptions about system

There are 4 assumptions of system:
1.

First, there is organization, interaction, interdependency

and integration of the parts and elements of behaviors that
go to make up the system

2.

A system tends to achieve a balance among the various

forces operating within and upon it', and that man strive
continually to maintain a behavioral system balance and
steady state by more or less automatic adjustments and
adaptations to the natural forces impinging upon him.

3.

A behavioral system, which both requires and results in

some degree of regularity and constancy in behavior, is
essential to man that is to say, it is functionally significant in
that it serves a useful purpose, both in social life and for the
individual.

4.

Last, system balance reflects adjustments and adaptations

that are successful in some way and to some degree..

Assumptions about structure and function of each subsystem

from the form the behavior takes and the consequences it

achieves can be inferred what drive has been stimulated
or what goal is being sought

Each individual has a predisposition to act with reference to

the goal, in certain ways rather than the other ways. This
predisposition is called as set.

Each subsystem has a repertoire of choices or scope of

action

The fourth assumption is that it produce observable

outcome that is the individuals behavior.

Each subsystem has three functional requirements

1.

System must be protected" from noxious influences with

which system cannot cope.

2.

Each subsystem must be nurtured through the input of

appropriate supplies from the environment.

3.

Each subsystem must be stimulated for use to enhance

growth and prevent stagnation.

These behaviors are orderly, purposeful and predictable

and sufficiently stable and recurrent to be amenable to
description and explanation

Johnsons Behavioral Subsystem

Attachment or affiliative subsystem: social inclusion

intimacy and the formation and attachment of a strong
social bond.

Dependency subsystem: approval, attention or

recognition and physical assistance

Ingestive subsystem: the emphasis is on the meaning

and structures of the social events surrounding the occasion
when the food is eaten

Eliminative subsystem: human cultures have defined

different socially acceptable behaviors for excretion of
waste ,but the existence of such a pattern remains different
from culture to Culture.

Sexual subsystem:" both biological and social factor affect

the behavior in the sexual subsystem

Aggressive subsystem: " it relates to the behaviors

concerned with protection and self preservation Johnson
views aggressive subsystem as one that generates
defensive response from the individual when life or territory
is being threatened

Achievement subsystem: " provokes behavior that

attempt to control the environment intellectual, physical,
creative, mechanical and social skills achievement are
some of the areas that Johnson recognizes".

Representation of Johnson's Model

Goal ----- Set --- Choice of Behavior --- Behavior

Affiliation

Dependency

Sexuality

Aggression

Elimination

Ingestion

Achievement

The four major concepts

Human being as having two major systems, the biological

system and the behavioral system. It is role of the medicine
to focus on biological system where as Nursling's focus is
the behavioral system.

Society relates to the environment on which the individual

exists. According to Johnson an individuals behavior is
influenced by the events in the environment

Health is a purposeful adaptive response, physically

mentally, emotionally, and socially to internal and external
stimuli in order to maintain stability and comfort.

Nursing has a primary goal that is to foster equilibrium

within the individual. Nursing is concerned with the
organized and integrated whole, but that the major focus is
on maintaining a balance in the Behavior system when
illness occurs in an individual.

Nursing process
Assessment
Grubbs developed an assessment tool based on Johnsons seven
subsystems plus a subsystem she labeled as restorative which
focused on activities of daily living. An assessment based on
behavioral model does not easily permit the nurse to gather detailed
information about the biological systems:

Affiliation

Dependency

Sexuality

Aggression

Elimination

Ingestion

Achievement

Restorative

Diagnosis
Diagnosis tends to be general to the system than specific to the
problem. Grubb has proposed 4 categories of nursing diagnosis
derived from Johnson's behavioral system model:

Insufficiency

Discrepancy

Incompatibility

Dominance

Planning and implementation

Implementation of the nursing care related to the diagnosis may be
difficult because of lack of clients input in to the plan. the plan will
focus on nurses actions to modify clients behavior, these plan than
have a goal ,to bring about homeostasis in a subsystem, based on
nursing assessment of the individuals drive, set behavior, repertoire,
and observable behavior. The plan may include protection,
nurturance or stimulation of the identified subsystem.
Evaluation
Evaluation is based on the attainment of a goal of balance in the
identified subsystems. If the baseline data are available for an
individual, the nurse may have goal for the individual to return to the
baseline behavior. If the alterations in the behavior that are planned
do occur, the nurse should be able to observe the return to the
previous behavior patterns. Johnson's behavioral model with the
nursing process is a nurse centered activity, with the nurse
determining the clients needs and state behavior appropriate for that
need.
Johnsons and Characteristics of a
theory

Interrelate concepts to create a different way of viewing a

phenomenon - Concepts in Johnson's theory are
interrelated.

Theories must be logical in nature- Johnson's theory is

logical in nature.

Theories must be simple yet generalizable - The theory is

simple.

Theories can be bases of hypothesis that can be tested Research studies are conducted applying Jonhson's theory.

Theories contribute to and assist in increasing the body of

knowledge within the discipline through the research

implemented to validate them.

Theories can be utilized by practitioners to guide and

improve their practice.

Theories must be consistent with other validated theories,

laws and principles but will leave unanswered questions
that need to be investigated.

Limitation

Johnson does not clearly interrelate her concepts of

subsystems comprising the behavioral system model.

The definition of concept is so abstract that they are difficult

to use.

It is difficult to test Johnson's model by development of

hypothesis.

The focus on the behavioral system makes it difficult for

nurses to work with physically impaired individual to use this
theory.

The model is very individual oriented so the nurses working

with the group have difficulty in its implementation.

The model is very individual oriented so the family of the

client is only considered as an environment.

Johnson does not define the expected outcomes when one

of the system is affected by the nursing implementation an
implicit expectation is made that all human in all cultures will
attain same outcome homeostasis.

Johnsons behavioral system model is not flexible.

Summary
Johnsons Behavioral system model is a model of nursing care that
advocates the fostering of efficient and effective behavioral
functioning in the patient to prevent illness. The patient is defined as
behavioral system composed of 7 behavioral subsystems. Each
subsystem composed of four structural characteristics i.e. drives, set,
choices and observable behavior.
Three functional requirement of each subsystem includes

(1) Protection from noxious influences,

(2) Provision for the nurturing environment, and

(3) stimulation for growth.

Any imbalance in each system results in disequilibrium .it is nursing

role to assist the client to return to the state of equilibrium.
References
1.

George B. Julia , Nursing Theories- The base for

professional Nursing Practice , 3rd ed. Norwalk, Appleton
and Lange.

2.

Polit DF, Hungler BP. Nursing Research: Principles and

Methods. Philadelphia: JB Lippincott Company; 1998.

3.

Burns N, Grove SK. The practice of Nursing Research. 4th

Ed. Philadelphia: WB Saunders Publications; 2001.

4.

Treece JW, Treece EW. Elements of Research in Nursing

(3rded.). St. Louis: Mosby; 1982.

Dorothy E. Johnson is well-known for her Behavioral System Model, which was first
proposed in 1968. Her model was greatly influenced by Florence Nightingales book, Notes
on Nursing. It advocates the fostering of efficient and effective behavioral functioning in the
patient to prevent illness and stresses the importance of research-based knowledge about
the effect of nursing care on patients.

Description
Johnsons theory defined Nursing as an external regulatory force which acts to preserve
the organization and integration of the patients behaviors at an optimum level under those
conditions in which the behavior constitutes a threat to the physical or social health, or in
which illness is found.
It also states that each individual has patterned, purposeful, repetitive ways of acting that
comprises a behavioral system specific to that individual.

Goals

Johnson began her work on the model with the premise that nursing was a profession that
made a distinctive contribution to the welfare of society. Thus, nursing had an explicit goal of
action in patient welfare.
The goals of nursing are fourfold, according to the Behavior System Model: (1) To assist the
patient whose behavior is proportional to social demands. (2) To assist the patient who is
able to modify his behavior in ways that it supports biological imperatives. (3) To assist the
patient who is able to benefit to the fullest extent during illness from the physicians
knowledge and skill. And (4) To assist the patient whose behavior does not give evidence of
unnecessary trauma as a consequence of illness.

Assumptions
The assumptions made by Johnsons theory are in three categories: assumptions about
system,assumptions about structure, and assumptions about functions.
Johnson identified several assumptions that are critical to understanding the nature and
operation of the person as a behavioral system: (1) There is organization, interaction,
interdependency and integration of the parts and elements of behaviors that go to make up
the system. (2) A system tends to achieve a balance among the various forces operating
within and upon it, and that man strive continually to maintain a behavioral system balance
and steady state by more or less automatic adjustments and adaptations to the natural
forces occurring on him. (3) A behavioral system, which requires and results in some
degree of regularity and constancy in behavior, is essential to man. It is functionally
significant because it serves a useful purpose in social life as well as for the individual. And
(4) System balance reflects adjustments and adaptations that are successful in some way
and to some degree.
The four assumptions about structure and function are that: (1) From the form the
behavior takes and the consequences it achieves can be inferred what drive has been
stimulated or what goal is being sought. (2) Each individual person has a predisposition
to act with reference to the goal, in certain ways rather than the other ways. This
predisposition is called a set. (3) Each subsystem has a repertoire of choices called a

scope of action. And (4) The individual patients behavior produces an outcome that can
be observed.
And lastly, there are three functional requirements for the subsystems.: (1) The system
must be protected from toxic influences with which the system cannot cope. (2) Each
system has to be nurtured through the input of appropriate supplies from the environment.
And (3) The system must be stimulated for use to enhance growth and prevent stagnation.

Major Concepts
Human Beings
Johnson views human beings as having two major systems: the biological system and the
behavioral system. It is the role of medicine to focus on the biological system, whereas
nursings focus is the behavioral system.
The concept of human being was defined as a behavioral system that strives to make
continual adjustments to achieve, maintain, or regain balance to the steady-state that is
adaptation.

Environment
Environment is not directly defined, but it is implied to include all elements of the
surroundings of the human system and includes interior stressors.

Health
Health is seen as the opposite of illness, and Johnson defines it as some degree of
regularity and constancy in behavior, the behavioral system reflects adjustments and
adaptations that are successful in some way and to some degree adaptation is
functionally efficient and effective.

Nursing

Nursing is seen as an external regulatory force which acts to preserve the organization and
integration of the patients behavior at an optimal level under those conditions in which the
behavior constitutes a threat to physical or social health, or in which illness is found.

Behavioral system
Man is a system that indicates the state of the system through behaviors.

System
That which functions as a whole by virtue of organized independent interaction of its parts.

Subsystem
A mini system maintained in relationship to the entire system when it or the environment is
not disturbed.

Subconcepts
Structure
The parts of the system that make up the whole.

Variables
Factors outside the system that influence the systems behavior, but which the system lacks
power to change.

Boundaries
The point that differentiates the interior of the system from the exterior.

Homeostasis
Process of maintaining stability.

Stability
Balance or steady-state in maintaining balance of behavior within an acceptable range.

Stressor
A stimulus from the internal or external world that results in stress or instability.

Tension
The systems adjustment to demands, change or growth, or to actual disruptions.

Instability
State in which the system output of energy depletes the energy needed to maintain stability.

Set
The predisposition to act. It implies that despite having only a few alternatives from which to
select a behavioral response, the individual will rank those options and choose the option
considered most desirable.

Function
Consequences or purposes of action.

7 Subsystems

Johnsons Behavioral System Model

Johnson identifies seven subsystems in the Behavioral System Model. They are:

Attachment or affiliative subsystem

Attachment or affiliative subsystem is the social inclusion intimacy and the formation and
attachment of a strong social bond. It is probably the most critical because it forms the
basis for all social organization. On a general level, it provides survival and security. Its
consequences are social inclusion, intimacy, and formation and maintenance of a strong
social bond

Dependency subsystem
Dependency subsystem is the approval, attention or recognition and physical assistance.
In the broadest sense, it promotes helping behavior that calls for a nurturing response. Its
consequences are approval, attention or recognition, and physical assistance.
Developmentally, dependency behavior evolves from almost total dependence on others to
a greater degree of dependence on self. A certain amount of interdependence is essential
for the survival of social groups.

Ingestive subsystem
Ingestive subsystem is the emphasis on the meaning and structures of the social events
surrounding the occasion when the food is eaten. It should not be seen as the input and
output mechanisms of the system. All subsystems are distinct subsystems with their own
input and output mechanisms. The ingestive subsystem has to do with when, how, what,
how much, and under what conditions we eat.

Eliminative subsystem
Eliminative subsystem states that human cultures have defined different socially acceptable
behaviors for excretion of waste, but the existence of such a pattern remains different from
culture to culture. It addresses when, how, and under what conditions we eliminate. As
with the ingestive subsystem, the social and psychological factors are viewed as influencing

the biological aspects of this subsystem and may be, at times, in conflict with the eliminative
subsystem.

Sexual subsystem
Sexual subsystem is both a biological and social factor that affects behavior. It has the dual
functions of procreation and gratification. Including, but not limited to, courting and mating,
this response system begins with the development of gender role identity and includes the
broad range of sex-role behaviors.

Aggressive subsystem
Aggressive subsystem relates to the behaviors concerning protection and self-preservation,
generating a defense response when there is a threat to life or territory. Its function is
protection and preservation. Society demands that limits be placed on modes of selfprotection and that people and their property be respected and protected.

Achievement subsystem
Achievement subsystem provokes behavior that tries to control the environment. It attempts
to manipulate the environment. Its function is control or mastery of an aspect of self or
environment to some standard of excellence. Areas of achievement behavior include
intellectual, physical, creative, mechanical, and social skills.

Behavioral System Model and The Nursing Process

The nursing process of the Behavior System Model of Nursing begins with an assessment
and diagnosis of the patient. Once a diagnosis is made, the nurse and other healthcare
professionals develop a nursing care plan of interventions and setting them in motion. The
process ends with an evaluation, which is based on the balance of the subsystems.
Johnsons Behavioral System Model is best applied in the evaluation phase, during which
time the nurse can determine whether or not there is balance in the subsystems of the

patient. If a nurse helps a patient maintain an equilibrium of the behavioral system through
an illness in the biological system, he or she has been successful in the role.

Strengths
Johnsons theory guides nursing practice, education, and research; generates new ideas
about nursing; and differentiates nursing from other health professions.
It has been used in inpatient, outpatient, and community settings as well as in nursing
administration. It has always been useful to nursing education and has been used in
practice in educational institutions in different parts of the world.
Another advantage of the theory is that Johnson provided a frame of reference for nurses
concerned with specific client behaviors. It can also be generalized across the lifespan and
across cultures.
The theory also has potential for continued utility in nursing to achieve valued nursing goals.

Weaknesses
The theory is potentially complex because there are a number of possible interrelationships
among the behavioral system, its subsystems, and the environment. Potential relationships
have been explored, but more empirical work is needed.
Johnsons work has been used extensively with people who are ill or face the threat of
illness. However, its use with families, groups, and communities is limited.
Though the seven subsystems identified by Johnson are said to be open, linked, and
interrelated, there is a lack of clear definitions for the interrelationships among them which
makes it difficult to view the entire behavioral system as an entity.
The problem involving the interrelationships among the concepts also creates difficulty in
following the logic of Johnsons work.

Conclusion
Johnsons Behavioral System Model describes the person as a behavioral system with
seven subsystems: the achievement, attachment-affiliative, aggressive protective,
dependency, ingestive, eliminative, and sexual subsystems. Each subsystem is interrelated
with the others and the environment and specific structural elements and functions that help
maintain the integrity of the behavioral system.
Through these, the focus of her model is with what the behavior the person is presenting
making the concept more attuned with the psychological aspect of care in.
When the behavioral system has balance and stability, the individuals behaviors will be
purposeful, organized, and
predictable. Imbalance and instability in the behavioral system occur when tension and
stressors affect the relationship of the subsystems or the internal and external
environments.

See Also

Dorothy E. Johnson Biography and Works

References
1. Johnson, D. E. (1959a). A philosophy of nursing. Nursing Outlook, 7(4), 198200.
2. Johnson, D.E. (1968). One conceptual model of nursing. Unpublished lecture,
Vanderbilt University, Nashville, TN.

External Links

Theory Development: What, Why, How?

Barriers and Hazards in Counseling

One Conceptual Model of Nursing

The Nurse Theorists Dorothy Johnson Promo YouTube video of an interview

with Dorothy Johnson herself.

Transcript of behavioral system model by Dorothy Johnson

Born August 21, 1919, in Savannah, Georgia.
Youngest in a family of seven.
Obtain her B. S. N. degree from Vanderbilt University in Nashville, Tennessee, in
1942; and her M.P.H. from Harvard University in Boston in 1948.
She began publishing her ideas about nursing soon after her graduation. She
worked briefly as a public health nurse and in 1944 returned to Vanderbilt as an
instructor in Pediatric Nursing.
In 1949 she joined the faculty of University California, LA where she and Lulu K. Wolf
Hassenplug developed the "first four year generic basic nursing program in the
United States." She held a strong conviction that continuing improvement of care
was the ultimate goal of nursing.
Johnson stressed the importance of research-based knowledge about the effect of
nursing care on clients.
After her retirement from UCLA Dorothy Johnson moved to the Florida coast to
pursue her hobby of the study of sea shells. She remained active in retirement as a
speaker and advocate for nursing education. Behavior system model Definition of
nursing Dorothy first proposed her model of nursing care in 1968 as fostering of
the efficient and effective behavioral functioning in the patient to prevent illness".
She also stated that nursing was concerned with man as an integrated whole and
this is the specific knowledge of order we require. an external regulatory force
which acts to preserve the organization and integration of the patients behaviors at
an optimum level under those conditions in which the behaviors constitutes a threat
to the physical or social health, or in which illness is found
1. Whose behavior commensurate with social demands.
2. Who is able to modify his behavior in ways that it supports biological imperatives
3. Who is able to benefit to the fullest extent during illness from the physicians
knowledge and skill.
4. Whose behavior does not give evidence of unnecessary trauma as a consequence
of illness Four goals of nursing are to assist the patient: Nursings
Metaparadigm Person Health Environment Nursing Human being as having two
major systems, the biological system and the behavioral system. It is role of the
medicine to focus on biological system where as Nursling's focus is the behavioral
system. Health is a purposeful adaptive response, physically mentally,
emotionally, and socially to internal and external stimuli in order to maintain
stability and comfort. Society relates to the environment on which the individual

exists. According to Johnson an individuals behavior is influenced by the events in

the environment Nursing has a primary goal that is to foster equilibrium within
the individual. Nursing is concerned with the organized and integrated whole, but
that the major focus is on maintaining a balance in the Behavior system when
illness occurs in an individual. Assumptions Assumptions about system Assumptions
about structure and
function of each subsystem Each subsystem has
three functional requirements There are 4 assumptions of system:
1.First, there is organization, interaction, interdependency and integration of the
parts and elements of behaviors that go to make up the system
2. A system tends to achieve a balance among the various forces operating within
and upon it', and that man strive continually to maintain a behavioral system
balance and steady state by more or less automatic adjustments and adaptations to
the natural forces impinging upon him.
3.A behavioral system, which both requires and results in some degree of regularity
and constancy in behavior, is essential to man that is to say, it is functionally
significant in that it serves a useful purpose, both in social life and for the
individual.
4.Last, system balance reflects adjustments and adaptations that are successful in
some way and to some degree. from the form the behavior takes and the
consequences it achieves can be inferred what drive has been stimulated or what
goal is being sought
Each individual has a predisposition to act with reference to the goal, in certain
ways rather than the other ways. This predisposition is called as set.
Each subsystem has a repertoire of choices or scope of action
The fourth assumption is that it produce observable outcome that is the
individuals behavior. 1. System must be protected" from noxious influences with
which system cannot cope.
2. Each subsystem must be nurtured through the input of appropriate supplies
from the environment.
3. Each subsystem must be stimulated for use to enhance growth and prevent
stagnation. Ingestive Attachment or affiliative Sexual Dependency Aggressive
Johnsons Behavioral Subsystem social inclusion intimacy and the formation and

attachment of a strong social bond approval, attention or recognition and physical

assistance the emphasis is on the meaning and structures of the social events
surrounding the occasion when the food is eaten Eliminative human cultures have
defined different socially acceptable behaviors for excretion of waste, but the
existence of such a pattern remains different from culture to Culture. " both
biological and social factor affect the behavior in the sexual subsystem " it relates
to the behaviors concerned with protection and self-preservation Johnson views
aggressive subsystem as one that generates defensive response from the individual
when life or territory is being threatened Achievement " provokes behavior that
attempt to control the environment intellectual, physical, creative, mechanical and
social skills achievement are some of the areas that Johnson recognizes" nursing
process Assessment Planning Diagnosis tends to be general to the system than
specific to the problem. Grubb has proposed 4 categories of nursing diagnosis
derived from Johnson's behavioral system model:
Insufficiency
Discrepancy
Incompatibility
Dominance Implementation of the nursing care related to the diagnosis may be
difficult because of lack of clients input in to the plan. the plan will focus on nurses
actions to modify clients behavior, these plan than have a goal ,to bring about
homeostasis in a subsystem, based on nursing assessment of the individuals drive,
set behavior, repertoire, and observable behavior. The plan may include protection,
nurturance or stimulation of the identified subsystem. Diagnosis Evaluation is based
on the attainment of a goal of balance in the identified subsystems. If the baseline
data are available for an individual, the nurse may have goal for the individual to
return to the baseline behavior. If the alterations in the behavior that are planned do
occur, the nurse should be able to observe the return to the previous behavior
patterns. Johnson's behavioral model with the nursing process is a nurse centered
activity, with the nurse determining the clients needs and state behavior
appropriate for that need. Evaluation

Johnson Behavioral System (JBS) Model

Author Unknown retrieved from the internet September 1,
2002 http://www.myfreeessays.com/science_and_technology/041.sht
ml
In this paper, I am going to summarize the Johnson Behavioral System (JBS) Model
(Johnson, 1980, 1990), explain the perspectives for nursing practice, and explore its

applicability in nursing practice. First, I am going to talk a little about Dorothy E.

Johnson the nurse that wrote the Model. Dorothy E. Johnson was born August 21,
1919, in Savannah, Georgia (Lobo, 1995). She received her A. A. from Armstrong
Junior College in Savannah, Georgia, in 1938; her B. S. N. from Vanderbilt University
in Nashville, Tennessee, in 1942; and her M.P.H. from Harvard University in Boston
in 1948 (Conner, Harbour, Magers, and Watt 1994). Johnson was an instructor and an
assistant professor in pediatric nursing at Vanderbilt University School of Nursing
from 1944 to 1949. From 1949 until her retirement in 1978 and subsequent move to
Key Largo, Florida, she was an assistant professor of pediatric nursing, an associate
professor of nursing, and a professor of nursing at the University of California in Los
Angeles (Conner et. al. 1994).
In 1955 and 1956 she was eligible to go on a sabbatical and went to the Christian
Medical College School of Nursing in Vellore, South India, were she was interested in
starting a baccalaureate program which was received well (Lobo, 1995). Dorothy
Johnson has had an influence on nursing through her publications since the 1950s.
Throughout her career, Johnson has stressed the importance of research-based
knowledge about the effect of nursing care on clients.
Johnson was an early proponent of nursing as a science as well as an art. She also
believed nursing had a body of knowledge reflecting both the science and the art.
From the beginning, Johnson (1959) proposed that the knowledge of the science of
nursing necessary for effective nursing care included a synthesis of key concepts
drawn from basic and applied sciences. In 1961, Johnson proposed that nursing care
facilitated the client's maintenance of a state of equilibrium. Johnson proposed that
clients were "stressed" by a stimulus of either an internal or external nature. These
stressful stimuli created such disturbances, or "tensions," in the patient that a state of
disequilibrium occurred. Johnson identified two areas that nursing care should be
based in order to return the client to a state of equilibrium. First, by reducing stressful
stimuli, and second, by supporting natural and adaptive processes. Johnson's
behavioral system theory springs from Nightingales belief that nursing's goal is to
help individuals prevent or recover from disease or injury. The "science and art" of
nursing should focus on the patient as an individual and not on the specific disease
entity. Johnson used the work of behavioral scientists in psychology, sociology, and
ethnology to develop her theory. The model is patterned after a systems model; a
system is defined as consisting of interrelated parts functioning together to form a
whole (Conner et. al. 1994).
Johnson states that a nurses should use the behavioral system as their knowledge base;
comparable to the biological system that physicians use as their base of knowledge
(Lobo, 1995). The reason Johnson chose the behavioral system model is the idea that
"all the patterned, repetitive, purposeful ways of behaving that characterize each
person's life make up an organized and integrated whole, or a system" (other).

Johnson states that by categorizing behaviors, they can be predicted and ordered.
Johnson categorized all human behavior into seven subsystems (SSs): Attachment,
Achievement, Aggressive, Dependence, Sexual, Ingestive, and Eliminative. Each
subsystem is composed of a set of behavioral responses or tendencies that share a
common goal. These responses are developed through experience and learning and are
determined by numerous physical, biological, psychological, and social factors. Four
assumptions are made about the structure and function of each SS. These four
assumptions are the "structural elements" common to each of the seven SSs. The first
assumption is "from the form the behavior takes and the consequences it achieves can
be inferred what drive has been stimulated or what goal is being sought" (Johnson,
1980). The ultimate goal for each subsystem is expected to be the same for all
individuals.
The second assumption is that each individual has a "predisposition to act, with
reference to the goal, in certain ways rather than in other ways" (Johnson, 1980). This
predisposition to act is labeled "set" by Johnson. The third assumption is that each
subsystem has available a repertoire of choices or "scope of action" alternatives from
which choices can be made. As life experiences occur, individuals add to the number
of alternative actions available to them. At some point, however, the acquisition of
new alternatives of behavior decreases as the individual becomes comfortable with the
available repertoire.
The fourth assumption about the behavioral subsystem is that they produce observable
outcomes-that is, the individuals behavior (Johnson, 1980). The observable behaviors
allow an outsider to note the actions the individual is taking to reach a goal related to
a specified SS. In addition, each of the SSs has three functional requirements. First,
each subsystem must be "protected from noxious influences with which the system
cannot cope" (Johnson, 1980). Second, each subsystem must be "nurtured through the
input of appropriate supplies from the environment." Finally each subsystem must be
"stimulated for use to enhance growth and prevent stagnation." As long as the SSs are
meeting these functional requirements, the system and the SSs are viewed as selfmaintaining and self- perpetuating. The internal and external environments of the
system need to remain orderly and predictable for the system to maintain homeostasis.
The interrelationships of the structural elements of the subsystem to maintain a
balance that is adaptive to that individual's needs. Johnson's Behavioral Subsystems
The Attachment subsystem is probably the most critical, because it forms the basis for
all social organization. It provides survival and security. Its consequences are social
inclusion, intimacy, and formation and maintenance of a strong social bond. The
Achievement subsystem attempts to manipulate the environment. Its function is
control or mastery of an aspect of self or environment to some standard of excellence.
Areas of achievement behavior include intellectual, physical, creative, mechanical,
and social skills. The Aggressive subsystem function is protection and preservation. It

holds that aggressive behavior is not only learned, but has a primary intent to harm
others. However, society has placed limits when dealing with self-protection and that
people and their property be respected and protected.
The Dependency subsystem promotes helping behavior that calls for a nurturing
response. Its consequences are approval, attention or recognition, and physical
assistance. Ultimately, dependency behavior develops from the complete reliance on
others for certain resources essential for survival. An imbalance in a behavioral
subsystem produces tension, which results in disequilibrium. The The Ingestive and
Eliminative SSs "have to do with when, how, what, how much and under what
conditions we eat, and when, how, and under what conditions we eliminate". The
Sexual subsystem has the dual functions of procreation and gratification. It begins
with the development of gender role identity and includes the broad range of sex role
behaviors (Johnson, 1980). When there is an alteration in the "equilibrium" that exists,
Johnson's Model tends to diagnose to a subsystem rather than a specific problem.
Johnson's Model states that it is at this point when the nurse is needed in order to
return the client to homeostasis (Conner et al., 1994).
Application in Nursing Practice
The application of any nursing model to practice requires three conditions: the model's
congruence with practice requirements, its comprehensive development in relation to
practice requirements, and its specificity in relation to practice requirements. These
conditions governing a nursing model's applicability should be understood to enable
practitioners to appropriately and effectively use models in practice (Derdiarian,
1993). What is nursing practice and what are requirements of the practice? Nursing
practice derives its definition from that of professional practice, the action or process
of performing something, the habitual or customary performance of something
(Random House College Dictionary, 1988). Professional practice has three main
requirements: perspective, structure and scientific substance. The first requirement is
the perspective, or a mental view, of facts or ideas and their interrelationships
pertinent of the professions' practice. In nursing, the perspective of the practice refers
to nursing's view of the patient and its role in relation to the patient (Derdiarian,
1993). More specifically, the profession's perspective clarifies the nature, goal, focus,
and scope of its realm of its science and practice (Derdiarian, 1993). By so doing, the
profession's perspective distinguishes nursing's realm of science and practice from
those of related fields. At the same time, the perspective identifies appropriate
alignments between nursing's research and practice and those of other professions. In
other words, the professional perspective provides the professional with a knowledge
base and a mind-set about the patient, about her/his role in relation to the patient, and
her/his actions necessary to fulfill that role (Derdiarian, 1993).

The second requirement of professional practice is a structure for practice to organize

and standardize practice and, thus, render practice habitual and customary.
Professional practice is structured to evaluate a client's well-being, identify problems,
and provide solutions. The latter require organized and scientifically rational
processes of assessment, diagnosis, intervention, and evaluation of outcomes. In
nursing, this structure pertains to the Nursing Process (Derdiarian, 1993). Finally, the
third requirement of professional practice is the coherent scientific body of knowledge
that underlies it or the profession's actions and processes. The scientific body of
knowledge includes facts, theories, hypotheses, and precepts, and assumptions
underlying both the perspective and structure of practice. In nursing, this body of
knowledge includes the facts, theories, hypotheses, and precepts about nursing,
nursing practice actions, and nursing practice methods. Stated more specifically,
nursing practice requires a body of scientific knowledge that rationalizes its view of
the client, its role, nature, goal focus, and scope. Furthermore, nursing practice
requires a body of scientific knowledge that rationalizes the nursing methods of
assessment, diagnosis, intervention, and evaluation of outcomes (Derdiarian, 1993).
The JBS model meets the professional perspective requirements because of its
interaction between the SSs. The SSs are interactive and interdependent, restoration in
one subsystem could effect restoration of behavior in another or others. Thus requiring
diagnostic and interventive action directed at all the SSs (Derdiarian, 1993).
The model as it stood before did not meet the practice structure requirements well
(Derdiarian, 1983), but interaction and studies into the model prompted Johnson to
add five types of interventions-nurturance, stimulation, protection, regulation, and
control (Derdiarian, 1993). It still leaves a gap in where to actually look for the
problems that exist. The JBS model does not meet the scientific substance for practice
well because it needs to be tested on its concepts, propositions, and assumptions.
Despite the obvious overall failure of the JBS model to pass the professional
requirements, the model is always being tested by someone, and some! day maybe
conclude its worth and add to its value.
Summary as related to Nursing, Person, Health, and Environment
Nursing is a force acting to preserve to organization of the patient's behavior while
the patient is under stress by means of imposing regulatory mechanisms or by
providing resources (Conner et al., 1994). An art and a science, it supplies external
assistance both before and during system balance disturbance and therefore requires
knowledge of order, disorder, and control (Johnson, 1980). Nursing activities are
complementary of medicine, not dependent on. Person is viewed as a behavioral
system with patterned, repetitive, and purposeful ways of behaving that link him to
the environment (Johnson, 1980). Man's specific response patterns form an organized
and integrated whole (Conner et al., 1994). Person is a system of interdependent parts
that requires some regularity and adjustment to maintain a balance (Johnson, 1980).

Health is perceived as an "elusive, dynamic state influenced by biological,

psychological, and social factors. It focuses on the person rather than the illness
(Conner et al., 1994). Health is reflected by the organization, interaction,
interdependence, and integration of the SSs of the behavioral system (Johnson, 1980).
Man attempts to achieve a balance in this system, which will lead to functional
behavior. A lack of balance in the requirements of the SSs lead to poor health (Conner
et al., 1994). Environment consists of all the factors that are not part of the
individual's behavioral system but that influence the system and the nurse to achieve
the health goal for the client
Conclusion
Johnson's theory could help guide the future of nursing theories, models, research,
and education. By focusing on behavioral rather than biology, the theory clearly
differentiates nursing from medicine. But do we need to separate the behavioral from
the biological. It can be an asset, and it can work, that has been proven by Johnson
and some of her followers. In order to focus on the holistic idea of nursing, it is
important to think of the behavioral and biological together as health. We cannot look
at one without looking at the other. There is not sufficient research to substantiate the
real applicability of this model. This theory does provide a conceptual framework to
work from, but this model will never be the standard for nursing.
Bibliography
Conner, S. S., Harbour, L. S., Magers, J. A., and Watt, J. K. (1994). Dorothy E.
Johnson: Behavioral System Model. In Ann Marriner-Tomey (3rd ed.), Nursing
Theorists and Their Work (pp. 231-240). St. Louis: Mosby-Year Book, Inc.
Derdiarian, A. K. (1983). An instrument for research and theory development using
the Behavioral System Model for Nursing: The cancer patient. Part I. Nursing
Research, 32:4, 196-201.
Derdiarian, A. K. (1993). The Johnson Behavioral System Model. In M. E. Parker
(Ed.), Patterns of Nursing Theories in Practice. New York: National League for
Nursing Press.
Johnson, D.E. (1980). The behavioral system model for nursing. In J.P. Riehl & C.
Roy (Eds.), Conceptual models for nursing practice (2nd ed.). New York: AppletonCentury-Crofts. Lobo, M. L. (1995).
Dorothy E. Johnson. In J. B. George (Ed.), Nursing Theories: The Base for
Professional Nursing Practice (4th ed.). New York: Macmillian Co. Random House
College Dictionary, 1988.

1. 1. Dorothy Johnsons The Behavioural System ModelCompiled By :- Prof (Mrs) Cynthia

Barrett Chakradeo Msc (Psy ) Nsg. RN RM (India) RN (Wisconsin)
2. 2. Dorothy Johnson The Behavioral System Model
3. 3. Background of Dorothy Johnson Born on 21st Aug 1919 in Georgia USA. 1942- BSc Nsg
from Nashville Tennessee. Masters in Public health from Harvard University Boston
in1948.Worked at various places in the US and in 1955 at CMC Vallore SON . Creation of
her theory began in 1940s when she began to teach. .Retired in 1978, and died in 1999.
4. 4. The Theory The BSM of Nsg was first proposed in 1968. It advocates the fostering of
efficient and effective behavioral functioning of the patient to prevent illness. The pt is
defined as a behavioral system composed of seven behavioral subsystems. Each
subsystem is comprised of four structural characteristics. An imbalance in each results in
disequilibrium. The nurses role is to help the patient maintain his or her equilibrium.
5. 5. Goals of Nsg according to BSM1. To assist the patient whose behavior is proportional to
social demands.2. To assist the patient who is able to modify his behavior in ways that it
supports biological imperatives.3. To assist the patient who is able to benefit to the fullest
extent during illness from the physicians knowledge and skill.4. To assist the patient whose
behavior does not give evidence of unnecessary trauma as a consequence of illness.
6. 6. Johnson Behavioral System Model (BSM) OverviewEvolved from philosophical ideas,
theory, and research; her clinical background; and many years of thought, discussions, and
writingInfluences: Florence Nightingale Systems theory Developmental theory
7. 7. Dorothy JohnsonGoal: restore or maintain behavioral integrity, stability, and efficient and
effective behavioral functioningClient: a biopsychosocial being with an instability in one of the
subsystems due to stressNursing: an external regulatory force which acts to preserve the
organization and integration of the patients behaviors at an optimum level.7 Subsystems :
Each has structural and functional components.
8. 8. The Behavior System Model
9. 9. Affiliative or Attachment Subsystems Behavior associated with the development and
maintenance of interpersonal relationships with parents, peers, authority figures. Establish a
sense of relatedness and belonging with others including attachment behavior, interpersonal
relationships and communication skills. Goal attainment
10. 10. Dependency Subsystem Behaviour associated with obtaining assistance from others in
the environment for completing tasks and/or emotional support. Includes seeking of
attention, approval, recognition, basic self care skills and emotional security.
11. 11. Ingestive Subsystem Behaviors associated with the intake of needed resources from the
external environments, including food, fluid, information, knowledge and objects for the
propose of establishing an effective relationship with the environment.
12. 12. Eliminative Subsystem Behaviour associated with the release of physical waste products
from the body. Express feelings
13. 13. Sexual Subsystems Behavior associated with a specific gender based identity for the
purpose of ensuring pleasure/procreation, and knowledge and behavior being congruent with
biological sex.

14. 14. Aggressive Protective Subsystem Behaviour associated with real or potential threat in
the environment for the purpose of ensuring survival. Protection of self through direct or
indirect acts. Identification of potential danger.
15. 15. Achievement Subsystem Behaviour associated with mastery of oneself and ones
environment for the purpose of producing a desired effect. Includes problem solving activity
Knowledge of personal strengths and weaknesses.
16. 16. Restorative Behaviour associated with maintaining and restoring energy equilibrium, e.g.
relief from fatigue, recovery from illness, sleep behaviour, leisure/recreational interests and
sick role behaviour.
17. 17. Johnsons Behavioral Systems Model
18. 18. Purpose of the Systems TheoryNurse creates a balance between client and environment
to achieve an optimal level of functioning
19. 19. Subsystems Individual made up of 7 subsystems Interrelated parts function together to
form a whole Interact with each other Interrelated and interconnected Environment
constantly acting on subsystems
20. 20. Five Core PrincipalsWholeness and OrderStabilizationReorganizationHierarchic
InteractionDialectical Contradiction
21. 21. Wholeness and Order Developmental analogy of wholeness and order is continuity and
identity. Continuity and change can exist across the life span. Continuity is in the
relationship of the parts rather than in their individuality.
22. 22. Stabilization Dynamic systems respond to contextual changes Set point maintained by
altering internal conditions to compensate for changes in external conditions. Nurses act as
external regulators. Monitor patient response, looking for successful adaptation to occur.
Nurses intervene to help patient restore behavioral system balance. Intervention is not
needed if behavioral system balance returns.
23. 23. Reorganization Occurs when the behavioral system encounters new experiences in the
environment that cannot be balanced by existing system mechanisms Nurse acts to provide
conditions or resources essential to help the accommodation process: May impose
regulatory or control mechanisms to stimulate or reinforce certain behaviors May attempt to
repair structural components
24. 24. Hierarchic Interaction Hierarchies, or a pattern of relying on particular subsystems, lead
to a degree of stability.
25. 25. Dialectical Contradiction Motivational force for behavioral change Drives/responses
developed and modified over time through maturation, experience, and learning
Environmental domains that the person is responding to include the biological, psychological,
cultural, familial, social, and physical setting
26. 26. Dialectical Contradiction (continued) Faced with illness or the threat of illness, the
person needs to resolve (maintain behavioral system balance of) a cascade of contradictions
between goals related to: Physical status, social roles, and cognitive status. Nurses
interventions: Focus on restoring behavioral system balance Leading to a new level of
development

27. 27. System is out of balance when..1. Insufficiency= does not get enough of something2.
Discrepancy= not optimally working3. Incompatibility= subsystems conflict4. Dominance=
one syctem is always used
28. 28. Major concepts of the modelPersonSubsystemsHealthNursing and nursing therapeutics
29. 29. Person Viewed as an open system with organized, interrelated, and interdependent
subsystems. The whole of the human organism (system) is greater than the sum of its parts
(subsystems). Wholes and parts create a system with dual constraints: Neither has
continuity and identity without the other. Nursing client viewed as a behavioral system
Behavioral systems are orderly, repetitive, and organized
30. 30. Subsystems Are parts of the behavioral system Carry out specialized tasks/functions
needed to maintain the integrity of the whole system Manage system relationship to the
environment Have a set of behavioral responses that are developed and modified through
motivation, experience, and learning
31. 31. Each Subsystem Composed of at least four structural components that interact in a
specific pattern Goal Set Choice Action
32. 32. Goal This is defined as the desired result or consequence of the behavior. The basis for
the goal is a universal drive whose existence can be supported by scientific research.
33. 33. Behavioral Set Is a predisposition to act in a certain way in a given situation Represents
a relatively stable and habitual behavioral pattern of responses to particular drives or stimuli
Represents learned behavior and is influenced by knowledge, attitudes, and beliefs
34. 34. Behavioral Set Components Perseveration Consistent tendency to react to certain
stimuli with the same pattern of behavior Preparation Functions to establish priorities for
attending or not attending to various stimuli
35. 35. Choice Refers to the individuals repertoire of alternative behaviors in a situation that will
best meet the goal and attain the desired outcome. The greater the behavioral repertoire of
alternative behaviors in a situation, the more adaptable the individual.
36. 36. Action Observable action of the individual Concern is with the efficiency and
effectiveness of the behavior in goal attainment. Actions are observable responses to
stimuli.
37. 37. The Johnson Model Proposes For behavior to be maintained, it must be protected,
nurtured, and stimulated. Protection from noxious stimuli that threaten the survival of the
behavioral system Nurturance, which provides adequate input to sustain behavior
Stimulation to continue growth of the behavior and counteracts stagnation
38. 38. The Johnson Model (continued Deficiency in any or all of these functional requirements
Threatens the behavioral system as a whole or the effective functioning of the particular
subsystem with which it is directly involved.
39. 39. Environment Consists of all elements that are not a part of the individuals behavioral
system but influence the system and can serve as a source of sustenal imperatives
Manipulated by the nurse to achieve health
40. 40. External environment May include people, objects, and phenomena that can potentially
permeate the boundary of the behavioral system External stimulus forms an
organized/meaningful pattern that elicits a response from the individual

41. 41. Internal Environment Internalized intervening variables: Physiology, temperament, ego,
age and related developmental capacities, attitudes, and self- concept General regulators
Variables that influence set, choice, and action Key areas for nursing assessment
42. 42. Health Behavioral system balance or stability Demonstrated by observed behavior that
is purposeful, orderly, and predictable. Behavior maintained when it is efficient and effective
in managing the persons relationship to the environment
43. 43. Nursing and Nursing Therapeutics Nursing is a service that is complementary to that of
medicine and other health professions, but which makes its own distinctive contribution to the
health and well-being of people. Nursing views patients as behavioral systems, and
medicine views patients as biological systems.
44. 44. Specific Goal of Nursing Action Isto restore, maintain, or attain behavioral system
balance and stability at the highest possible level for the individual (Johnson, 1980, p 214)
45. 45. Nursing Therapeutics Attempt to repair damaged structural units by altering the
individuals set and choice Impose regulatory and control measures Supply or help the
client find his or her own supplies of essential functional requirements
46. 46. The nurse may provide Nurturance through the input of appropriate supplies from the
environment Stimulation for use to enhance growth and prevent stagnation Protectionfrom noxious influences with which the system cannot cope
47. 47. Assumptions made by the theoryThese are divided into three categories1. Assumptions
about system.2. Assumption about structure.3. Assumption about functions.
48. 48. Assumptions about the systems in the model1. There is organization, interaction,
interdependency and integration of the parts and elements of behaviors that go to make up
the subsystem.2. A system tends to achieve a balance among the various forces operating
within and upon it and continuously strives to maintain an equilibrium.3. A behavioral system
which requires and results in some degree of regularity and consistency in behavior, is
essential to man as it is functionally significant as an individual and in social life.4. Systems
balance reflects adjustments and adaptations that are successful.
49. 49. Assumptions about the structure1. From the form the behavior takes and the
consequence it achieves can be inferred what Drive has been stimulated and what Goal is
being sought.2. Each individual person has a predisposition to act with reference to the goal,
in certain ways rather than the other. This Predisposition is called a SET3. Each subsystem
has a repertoire of choice called a Scope of Action4. The individual patients behavior
produces an outcome that can be observed.
50. 50. Assumptions about the Functions1. The system must be protected from toxic influences
with witch the system cannot cope.2. Each system has to be nurtured through the input of
appropriate supplies from the environment.3. The system must be stimulated for use to
enhance growth and prevent stagnation.
51. 51. BriefThus behaviors are - orderly - Purposeful - Predictive - sufficiently stable& recurrentTo be amenable to description and explanation.
52. 52. Limitations Very individualistic Family of the client is only considered as environment
Focused on the nursing care of the hospitalized and ill Does not focus on health promotion,
primary prevention, or disease prevention

53. 53. Critique Past observational studies and general systems theory influenced Dorothy
Johnson in the development of her BSM. There are 7 behavioral subsystems - 3
functional requirement The major phenomenon of concern in Johnsons work is behavior
54. 54. Contd..... Can be generalized across the lifespan and across cultures It is difficult to test
Johnsons model by the development of hypothesis Decision making for nursing practice
using this model would involve critical thinking Does not clearly define the expected outcome
when one of the subsystems is being affected by nursing intervention
55. 55. Contd......... Refers to communication rather than directing There is a limited body of
literature on the use of BSM in clinical practice or to provide framework for nursing research
56. 56. A little backgroundWhat type of theory did Dorothy Johnson Postulate?
57. 57. GENERAL THEORIES1. Florence Nightingale2. Virginian Henderson3. Martha Rogers4.
Sr Cellistea Roy5. Dorothea Orem6. Betty Numen7. Dorothy Johnson
58. 58. Systems Theory1. Roys adaptation theory2. Numens Health care systems model3.
Johnsons health care behavioral model4. Kings goal attainment theory
59. 59. Interpersonal/ Caring Theories1. Peplaus Psychodynamic Nursing theories2. Leiningers
Tran cultural care theories.3. Watsons Philosophy and science of caring theory
60. 60. Client is Clie m biopsychosocial nt i yste s an or al s Person can be broken ada e havi ith
down into parts for study/care 2a dap pti ve ab ea ch w a tive sys n t is ms, s and ada subs
tem Clie ste bsy onen su mp t Systems Theory ptiv yst e m ems ra l o Holistic view of
client ode and e avio ural c ction. h ct Client interacts with the environment s 47 b stru fun 4
al Client is the center-focus of theoretical v i du ni n di framework and of nursing care n t is
a Nursing facilitates clients progress toward Clie some balance or homeostasis
(adaptation, order, stability, etc.) Weak definition of nurse-patient relations Person
becomes nursing client when threatened by internal or external forces Acknowledge client as
Psychological, biological, and sociological aspects of individual, family, client recognized
group, or community Physiological, psychological, sociological, developmental, and spiritual
variables Client represented as central structure, lines of defense, and resistance.
61. 61. Case studyRam a daily wage laborer in a stone query had a lacerated wound on his
forehead. He was referred to the PHC. The wound extended to the skull. As a result he was
out of work and spend plenty of time with his friends and seemed depressed. His wife spent
hours each day making a variety of snacks .to cheer him up and found it was a good way to
release her anxiety about her husband condition.After three weeks the wound showed no
improvement, although it was not infected. During the visit to the PHC the wife confided to
the nurse stating that her husband was drinking a lot of water and seemed to be urinating
frequently, even at night he had a disturbed sleep due o this problem. She was wondering if
there was any pill to help him sleep through the night.
62. 62. At the PHC Uma the nurse used the BHM to solve the problem. She assessed Ram and
his family using the 7 subsystems of behaviour she found deficit in 3 subsystems
Achievement subsystem due to lack of social involvement and depression Eliminative
subsystem due to polyuria, nocturia Ingestive subsystem due to drinking lots of water, and
eating lots of

63. 63. Based on Johnsons BSM assumptions Uma concludes that Ram probably has diabetes.
After confirming the diagnosis, she helps Ram to correct his system imbalances by modifying
his behavior in order to achieve homeostasis
64. 64. Rams wound started healing almost immediately after his diabetes was identified and
controlled. He was able to go back to work and to meet with his friends again. His wife
learned fun, new diabetic-friendly foods to cook for herself and Ram.
65. 65. SUMMERY Johnsons theory defines health as a purposeful adaptive response to
internal and external stimuli in order to maintain stability and comfort.The main goal of
nursing is to foster equilibrium within the patient.The practice of nursing is concerned with the
organized and integrated whole, but maintaining a balance in the behavior system when
illness occurs is the major focus of the career.