Dorothy Johnson

Dorothy Johnson

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Dorothy Johnson

Dorothy E. Johnson is a nursing theorist who influenced the nursing theoretical thinking in the twentieth century. Her theory, the Behavioral System Model, is a mid-range nursing system of rules because it addresses specific aspects of nursing practice in relation to their theoretical underpinning (Lee, 2014). The paper describes this theory, explains how it influences nursing practice, and discusses how it characterizes the metaparadigms of nursing. 


Dorothy E. Johnson proposed the Behavioral System Model of Nursing in 1968. The theory was inspired by Notes on Nursing, a book authored by Florence Nightingale, which emphasized the pertinent of the environment around a patient and the role of the nurse in modifying the environment to facilitate healing (Alligood, 2014). The theory emphasizes the importance of creating an efficient and effective setting for a patient to prevent illnesses. It also reemphasizes the significance of research-based knowledge to the nursing care and its impact on the patients’ wellbeing (Robert, Tilley, & Petersen, 2014). The theory distinguishes the behavioral and biological systems that comprise the human being. Johnson observed that while the physicians focused on the biological system using the medicine perspective, the nurse’s attention should be on the behavioral system. As such, the Behavioral System Model distinguishes nursing from medicine.   

Nursing Theory and Practice

As a mid-range nursing theory, the Behavioral System Model describes the nurse’s role in the care processes and the manner in which nurses can assist patients in preventing illness and returning to good health after controlling the illness. By using the behavioral system as the theoretical knowledge base, nurses can employ the tools that predict and modify patients’ behavior, thus facilitating the maintenance or assisting in returning to good health (Lee, 2014). Therefore, nurses are asked to assess the behavior of their patient based on the seven subsystems. According to Johnson, these included achievement, aggressiveness, attachment, dependency, eliminative, ingestive and sexual subsystems (Lee, 2014). The assessment helps nurses to identify which of these subsystems can assist patients in returning to or maintaining a balanced state. In practice, the state of equilibrium and imbalance differs across patients. As such, the nurse’s actions need to be customized to the individual patients to attend to their unique needs (Stetler, Ritchie, Rycroft-Malone, & Charns, 2014). Consequently, the Behavioral Systems Model is applicable at the evaluation stage of the nursing process. In this regard, the nurse can determine whether the patient’s subsystems are in a state of balance or not, and only after that the nurse can decide on a course of action that would help the patient.      

Metaparadigm of Nursing Science

Nursing, patient, health, and environment are four nursing metaparadigms that guide nursing practice. Johnson viewed nursing as the promotion of the balance and stability of the behavioral system of a patient (Deliktas, Korukcu, Aydin, & Kabukcuoglu, 2019). According to Johnson, nurses were external agents whose force could facilitate the ordering and preserving of the organization and integrity of patients’ behavior. That external force aimed at maintaining the optimal level of the patients’ behavior. Therefore, nurses were important when the physical and social wellness of the patient was threatened by their behavior. Johnson perceived the person as system comprising of interdependent components that were patterned in a repetitive and purposeful manner related to behavior. As such, the behavioral system of a person is comprised of seven subsystems. Also, Johnson viewed health as a reflection of the organizational interaction, integration and interdependence of the subsystems in the behavioral system of a person. Finally, she recognized the environment as the collection of the forces that affected a patient and influenced his behavioral system.

Johnson’s perceptions of the nursing metaparadigms conform to the existing definitions of nursing. The nursing metaparadigms delineate various aspects of the nursing profession such as goals, outcomes, tasks, and career (Deliktas et al., 2019). Johnson described the nursing objectives by underscoring the return of a patient to equilibrium, which is the condition prior to illness. The person metaparadigm is related an individual patient in the context of the family, culture and society (Deliktas et al., 2019). In this regard, Johnson described a person as a behavioral system whose actions were influenced by social and cultural factors. The health metaparadigm defines the process involved in life and death (Deliktas et al., 2019). According to Johnson, health, as being opposite to illness, could be maintained and enhanced through regular and consistent behavior. The absence of such behavior resulted in illnesses and could end up in death. The environment metaparadigm describes all the conditions that influence human health, namely the economic, social, political conditions in a nation, region and world (Deliktas et al., 2019). Johnson linked the environmental conditions to the surrounding internal and external forces influencing a patient’s behavior.


Johnson’s Behavioral System Model is a nursing theory that relates nursing to practice by defining the role of nurses and the application of the behavioral systems to nursing practice. The model views patients as behavioral systems comprising of subsystems, which could be in stable equilibrium when the patient is healthy and imbalanced when the patient is ill. The role of the nurse is clearly distinguished from that of the physician with the nurse focusing on helping the patient attain stability and equilibrium. Nonetheless, the theory facilitates nursing practice by encouraging the nurses to use behavioral and systems theories to evaluate patients and facilitate behavioral change that would enhance patient’s health.     


Alligood, M. R. (2014). Nursing theory-E-book: Utilization & application. Elsevier Health Sciences.

Deliktas, A., Korukcu, O., Aydin, R., & Kabukcuoglu, K. (2019). Nursing students’ perceptions of nursing metaparadigms: A phenomenological study. The Journal of Nursing Research27(5), e45. Retrieved from

Lee, S. W. (2014). Overview of nursing theory. Japanese Journal of Nursing and Health Sciences12(2), 58-67.

Robert, R. R., Tilley, D. S., & Petersen, S. (2014). A power in clinical nursing practice: concept analysis on nursing intuition. Medsurg Nursing23(5), 343-349.

Stetler, C. B., Ritchie, J. A., Rycroft-Malone, J., & Charns, M. P. (2014). Leadership for evidence‐based practice: Strategic and functional behaviors for institutionalizing EBP. Worldviews on Evidence‐Based Nursing11(4), 219-226.

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