Nursing Theories: Behavioral System Model and Its Applications

Introduction

Nursing theories are models which help see nursing practice from various sides. While the real world is always more than any model, they are useful to improve the practice, conduct research, and educate new nurses. Various theories are used for those purposes, and it is always better to apply several of them, as they allow seeing the world from various sides. The behavioral system model focuses on the person’s behavior and allow nurses to track and correct them, improving the well-being of the patient.

Theories Overview

Various nursing theories help nurses understand their work and perform them better. Each of them has a different view on the process of patient caring and how to proceed with it. They may be classified in various ways: for example, by functions or range of application (Bender, 2018). By range, there are four gradations: practice- and middle-level theories, grand theories, and the metaparadigm (Wayne, 2019). The former is basically a set of advice on performing nursing practice better, while middle-range ones focus on specific nursing situations. Grand theories try to cover all nursing practices and create a viable model, and the current metaparadigm is a set of current general views on the nursing practice in general. For example, the nursing practice is currently divided into four concepts: patient, health, environment, and nursing; while there are suggestions to reform the metaparadigm, it is still relevant (Bender, 2018). An example of a grand theory is the behavioral system model, developed by Dorothy Johnson, which will be reviewed in the current paper.

All grand theories differ in their perspectives: to create a whole and logical model, they need to focus on some aspect of nursing and often underrate other ones. Some theories are similar: for example, Dorothy Johnson’s behavioral system model and Sister Callista Roy’s adaptation model both consider patients constantly interacting with open living systems (Wayne, 2019). Self-care theory of Dorothea E. Orem is also based on systems but focuses on the ability of patients to help themselves, and the nurse’s task is to create all opportunities for that. Rogers’s theory of unitary human beings sees all humans as unique unitary systems, inalienable from their environments; the task is to restore wholeness through nursing care.

Behavioral System Model of Dorothy Johnson

From those mentioned theories, the behavioral system model, developed by Dorothy Johnson in the second half of the 20th century, is one of the most interesting. The reason for that is that it considers people as open living systems, interacting with each other constantly and having sets of behavioral patterns (Butts & Rich, 2018). The theoretical framework of the model consists of seven behavioral subsystems, each of them having four structural components. Thus, components form subsystems, and they form systems that describe people. All systems are in constant interaction and under the influence of each other and their surroundings.

The theory allows nurses to see how their patients behave and changes in their behavior in real-time. Also, as it considers influences on patients, it allows tracking those influences and searching for ways to change them. For example, negative influences such as bad habits, stresses, and arguments with family members may easily be tracked and explored. Based on these data, the nurse can propose how the patient may get rid of those wrong influences (Wayne, 2019). It is the main goal of the behavioral system model implementation.

Theory’s Attributes

The attributes are principles of how the theory works within the nursing practice. Seven behavioral subsystems are components of each system, assembling the behavioral pattern for each. In addition, the theory consists of four structural components: the drive, set, choice, and action (Butts & Rich, 2018). They correspond to each of mentioned subsystems and define their characteristics. For example, the action of the system is the result of the drive, set, and choice: it corresponds to the visible behavioral pattern of the person.

Those systems are part of the general behavioral pattern and allow the nurse to evaluate their patients and all other people who are connected with them, including the nurse. There are dependence, aggressive, achievement, sexual, eliminative, affiliative, and ingestive subsystems, according to Dorothy Johnson (Butts & Rich, 2018). They correspond to the basic functions of each human being, and each of them may have a wide range of inner motivations and ways of manifestation.

1. The dependency subsystem is connected with the behavior to help others and care for them and ask for help.
2. The aggressive subsystem is responsible for self-defense and contains triggers that cause aggression.
3. The achievement subsystem is aimed at mastering skills and setting goals and standards. It defines other subsystems, self-esteem, and general views of the person to themselves.
4. The sexual subsystem is connected with the person’s gender-role identification, sexual views, and behaviors.
5. The eliminative subsystem determines how, where, and when the person has to eliminate.
6. The affiliative subsystem is responsible for social organization; it forms the basis for one’s social interactions and reactions.
7. The ingestive subsystem is deeply interconnected with the eliminative and connected with the nutritional preferences of the person.

Four structural components define the range of each subsystem, and together, they allow defining the character of each patient, showing the way to help them.

• The drive is the motivation under each subsystem, which explain why it emerges in the person. They are constantly changing, despite usually slowly, leading to changes in the person’s behavior (Butts & Rich, 2018). Thus, it is the most basic component, which is responsible for the formulation of behavioral sets and choices
• The main behavioral course typical for the patient is the behavioral set. It is conditioned by the drive and maintained by acquired habits.
• Along with the behavioral set, there is a range of choices available for the patient at any moment. It is important to understand that not all choices are available at any time (Butts & Rich, 2018). For example, a patient with Alzheimer’s disease cannot perform all cognitive functions available to a healthy person.
• The action is the observable consequence of three other components: the actual person’s behavior. By observing and analyzing it, the nurse may understand the situation with the client and what should be changed to improve their conditions.

Four Nursing Metaparadigm Concepts

Four concepts are used to define the nursing process: each describes a separate dimension that relates to the entire nursing process. These are person, health, environment, nursing, and all interactions between them; the effective care for patients implies that they all are considered and fulfilled (Bender, 2018). To understand how the behavioral system model relates to them, each concept needs to be reviewed: all nursing grand theories have four dimensions corresponding to these four concepts (Wayne, 2019). The person concept is about the people who will receive the care: patients, families, and other nurse clients.

• The person concept represents a client, a central figure in the nursing process. According to the behavioral system model, patients are open living systems with complex behavior.
• The health concept is a level of wellness that a nurse should maintain. A state of health, according to the model, corresponds to the balance, stability, and effective functioning of the behavioral system.
• The environment concept is the situation in the location where the nursing process takes place: all influences on a patient are included in this category. The behavioral system model sees the concept as a set of influences which may change the system’s behavior.
• The nursing concept is about the nurse and the nursing process itself. The model considers this process as an external regulatory force which changes the system’s behavior. The nurse is also a part of the process and may be represented as a behavioral system.

Significance of the Theory and Its Application

The behavioral system model is useful for all types of nursing practice: it sees the nursing process as the interactions between complex systems. The nurse’s goal is to evaluate problems and solve them by maintaining a balance in these interactions. The theory is actual for the current nursing practice and may be considered significant. Each theory’s significance follows from its applications: when it helps nurses solve patient problems successfully, improve the nursing practice, and educate other nurses, it proves its usefulness.

Nursing Practice

The theory is useful in treating various problems, as in all cases, the main task for nurses is maintaining the best well-being possible for the patient. It is a tool for tracking behavior changes, which is extremely useful, for example, in the case of coronary artery disease (Aşkar & Ovayolu, 2022). Such an approach is useful in the case of heart diseases in general, as behavioral patterns are important for their development (Ghanbari Afra & Haji Mohammad Hoseini, 2020). One may easily worsen their condition by wrong behavior, connected with stress, or bad habits; nurses may help the patient prevent such behavior by using the model.

In addition, the behavioral system model helps to understand and resolve all situations where people’s behavior is the central topic. An example is the issue of bullying in school: it is a common problem that is the result of behavioral problems among students (Evgin & Bayat, 2020). By exploring the interactions between students, where each is a system consisting of seven subsystems, specialists may elucidate influences and interactions that lead to bullying. These data may be used then to advise teachers on how they may act to prevent such behavior patterns: for that, those influences and interactions should be changed.

Nursing Research

As the theory models people’s behavior, it enriches behavioral psychology by exploring nursing cases. Nursing research is built on case studies: data are selected, analyzed, and interpreted to obtain the research conclusions (Doyle et al., 2019). Nurses may use the model as the tool for studying the interactions between people in various contexts. In that way, the model also serves as the good tool for nursing research.

Nursing Education

The theory helps to better understand the entire nursing process by showing it in the easily visible and understandable systems and interactions between them. Students will learn how to explore behavior of their patients and how they may correct them during the nursing practice. Therefore, the model is useful for education, as the main point is to help future nurses perceive how they can care for their clients in the best way.

Summary

The model considers nurses’ patients living systems, and the nurse themselves is a system interacting with them. Each system consists of seven subsystems, which, in turn, consist of four structural components (Butts & Rich, 2018). The model’s usefulness is in its descriptiveness, dynamism, and wholeness: thus, the theory describes reality fairly enough, tracking patient changes and being easy to understand. In addition, the model’s two main advantages are the diversity of its applications and good compatibility with other models.

1. Descriptiveness means that the model is easy to understand and may be used constantly during the nursing practice. It has no large and clumsy theoretical frameworks: only an easy-to-remember set of subsystems and their components and the principle of interactions between systems. The nursing theory must be easy: nurses have to perform much work, and it is hard for them to remember large theories. The descriptiveness also helps educate future nurses, as they will easily understand what they need to do by exploring the model.
2. The model is dynamic due to its constantly changing set of interactions between various systems which it uses to represent reality. It allows for tracking changes that are inevitable during the nursing process. The specialist may also track all influences relevant to the nursing care and then advise how the patient should change their behavior to improve their well-being (Ghanbari Afra & Haji Mohammad Hoseini, 2020). The dynamism
3. The wholeness of the behavior system model means that it includes all factors that may be important: person’s behavioral patterns, influences, environment, the nurse’s personality. While no theory describes the world as it is, a good one should be a good approximation of the world, and the behavioral system model is the example, of such a theory.
4. The theory has various applications, some of which lie outside the nursing field. An example is mentioned prevention of bullying in schools: it is not a typical nursing case, but nevertheless, the behavioral system approach helped to reduce bullying in schools (Evgin & Bayat, 2020). Such a universality proves the power of the theory and its accuracy in the description of the world.
5. In addition to mentioned points, the model is good in combining with other ones; as no theory describes the world as it is, using several of them is often the best case. The theory is focused on behavior and interactions between various systems; if the view from another perspective is required, the nurse may apply other grand theories. For example, Sister Callista Roy’s adaptation model may easily be used to explore how the systems adapt in various environments (Bender, 2018). In that way, while helping nurses to perform their job, the model does not create obstacles in working with other theories and approaches.

Conclusion

Nursing models are useful to represent reality: while they always should ignore some of its elements and focus on others, they help nurses improve their practice. Behavioral system theory models patients, their health, environment, and the nursing process as a set of interacting systems, which are under constant environmental influences. Each system consists of seven subsystems, which determine a specific set of behavioral patterns. The model helps correct patients’ behaviors in order to help them: it is easy to understand and implement, and has a wide range of applications.

References

Aşkar, S. E., & Ovayolu, Ö. (2022). Nursing care based on Dorothy Johnson’s behavioral system model in coronary artery disease: A case report. Medical Science and Discovery, 9(2), 138–142.

Bender, M. (2018). Re-conceptualizing the nursing metaparadigm: Articulating the philosophical ontology of the nursing discipline that orients inquiry and practice. Nursing Inquiry, 25(3).

Butts, J. B., & Rich, K. L. (2018). Philosophies and theories for advanced nursing practice (3rd ed.). Jones & Bartlett Learning.

Doyle, L., McCabe, C., Keogh, B., Brady, A., & McCann, M. (2019). An overview of the qualitative descriptive design within nursing research. Journal of Research in Nursing, 25(5), 1–13.

Evgin, D., & Bayat, M. (2020). The effect of behavioral system model based nursing intervention on adolescent bullying. Florence Nightingale Journal of Nursing, 28(1), 71–82.

Ghanbari Afra, L., & Haji Mohammad Hoseini, M. (2020). Implementing Johnson’s behavioral system model in a patient with heart failure: A case study. Journal of Vessels and Circulation, 1(4), 45–52.

Wayne, G. (2019). Nursing theories and theorists: An ultimate guide for nurses. Nurseslabs. Web.