focuses efforts in nursing science on the expansion
of knowledge about clients’ health problems and
nursing therapeutics. Nurse researchers have
demonstrated the usefulness of Johnson’s model in
a clinical practice in a variety of ways. The majority
of the research focuses on clients’ functioning in
terms of maintaining or restoring behavioral sys-
tem balance, understanding the system and/or sub-
systems by focusing on the basic sciences, or
focusing on the nurse as an agent of action who
uses the JBSM to gather diagnostic data or to pro-
vide care that influences behavioral system balance.
Dr. Anayis Derdiarian’s research program in-
volves both the client and the nurse as agents of
action. Derdiarian’s early research tested an instru-
ment designed to measure and describe, using the
JBSM perspective, the perceived behavioral changes
of cancer patients (Derdiarian, 1983; Derdiarian &
Forsythe, 1983). The research was based on
Johnson’s premise that illness is a noxious stimulus
that affects the behavioral system balance. The re-
sults demonstrated by the instrument possessed
content validity, strong internal consistency, and
thus strong reliability. A later study (Derdiarian,
1988) explained the effects of the variables of
age, site, and stage of cancer on “set” behaviors of
the Johnson model’s eight behavioral subsys-
tems. The study also served to further validate her
instrument.
These studies were important for two reasons.
First, Derdiarian examined the impact of three
moderator variables on set behavior. The measure
can be taken as an indicator of the construct of “be-
havioral set.” The construct was defined by a net-
work of relations that were tied to observables and
were therefore empirically testable. This validation
study linked a particular measure, the Derdiarian
Behavioral System Model (DBSM), to the more
general theoretical construct, “behavioral set,” that
was embedded in the JBSM’s more comprehensive
theoretical network.
The results indicated significant differences in
some mean factor scores in the subsystems among
the groups stratified by age, site of cancer, and stage
of cancer. Therefore, this study extended the devel-
opment of the “nomological network” (Cronbach
& Meehl, 1955) of the Johnson model. It provided
evidence that the measure exhibited, at least in part,
the network of relations derived from the theory of
the construct. It also elaborated the nomological
network by increasing the definiteness of the com-
ponents of the model (e.g., connections between
the moderator variables, behavioral set, and subsys-
tem behaviors). The linking of instrument behav-
iors to a more general attribute provided not only
an evidential basis for interpreting the process un-
derlying the instrument scores, but also a basis for
inferring researchable implications of the scores
from the broader network of the construct’s mean-
ing. A further test of the instrument (Derdiarian &
Schobel, 1990) indicated a rank order among the
subsystems’ response frequency counts as well as
among their importance values. Derdiarian also
found that changes in the aggressive/protective
subsystem made both direct and indirect effects on
changes in other subsystems (Derdiarian, 1990).
Derdiarian also examined the nurse as an action
agent within the practice domain. She focused on
the nurses’ assessment of the patient using the
DBSM and the effect of using this instrument on
the quality of care (Derdiarian, 1990, 1991). This
approach expanded the view of nursing knowledge
from exclusively client based to knowledge about
the context and practice of nursing that is model
based. The results of these studies found a signifi-
cant increase in patient and nurse satisfaction when
the DBSM was used. Derdiarian also found that a
model-based, valid, and reliable instrument could
improve the comprehensiveness and the quality of
assessment data, the method of assessment, and the
quality of nursing diagnosis, interventions, and
outcomes.
Derdiarian’s body of work reflects the complex-
ity of nursing’s knowledge as well as the strategic
problem-solving capabilities of the JBSM. Her arti-
cle (Derdiarian, 1991) demonstrated the clear rela-
tionship between Johnson’s theory and nursing
practice.
Other nurse researchers have demonstrated the
utility of Johnson’s model for clinical practice.
Coward and Wilke (2000) used the JBSM to exam-
ine cancer pain control behaviors. D’Huyvetter
(2000) found that defining trauma as a disease, and
approaching it within the context of the JBSM,
helps the practitioner develop effective interven-
tions.
Lewis and Randell (1990) used the JBSM to
identify the most common nursing diagnoses of
hospitalized geopsychiatric patients. They found
that 30 percent of the diagnoses were related to the
achievement subsystem. They also found that the
JBSM was more specific than NANDA (North88 SECTION II Evolution of Nursing Theory: Essential Influences