model could be used to develop a curriculum. The
primary focus of the program would be the study
of the person as a behavioral system. The student
would need a background in systems theory and
in the biological, psychological, and sociological
sciences.
NURSING PRACTICE AND
ADMINISTRATION
Johnson has influenced nursing practice because
she enabled nurses to make statements about the
links between nursing input and health outcomes
for clients. The model has been useful in practice
because it identifies an end product (behavioral
system balance), which is nursing’s goal. Nursing’s
Nursing’s specific objective is to maintain
or restore the person’s behavioral system
balance and stability, or to help the per-
son achieve a more optimum level of
functioning.specific objective is to maintain or restore the per-
son’s behavioral system balance and stability, or to
help the person achieve a more optimum level of
functioning. The model provides a means for iden-
tifying the source of the problem in the system.
Nursing is seen as the external regulatory force that
acts to restore balance (Johnson, 1980).
One of the best examples of the model’s use in
practice has been at the University of California,
Los Angeles, Neuropsychiatric Institute (UCLA—
NPI). Auger and Dee (1983) designed a patient
classification system using the JBSM. Each subsys-
tem of behavior was operationalized in terms of
critical adaptive and maladaptive behaviors. The
behavioral statements were designed to be measur-
able, relevant to the clinical setting, observable, and
specific to the subsystem. The use of the model
has had a major impact on all phases of the nurs-
ing process, including a more systematic assess-
ment process, identification of patient strengths
and problem areas, and an objective means for
evaluating the quality of nursing care (Dee &
Auger, 1983).
The early works of Dee and Auger lead to fur-
ther refinement in the patient classification system.
Behavioral indices for each subsystem have been
further operationalized in terms of critical adaptive
and maladaptive behaviors. Behavioral data is gath-
ered to determine the effectiveness of each subsys-
tem (Dee & Randell, 1989; Dee, 1990).
The scores serve as an acuity rating system and
provide a basis for allocating resources. These re-
sources are allocated based on the assigned levels of
nursing intervention, and resource needs are calcu-
lated based on the total number of patients as-
signed according to levels of nursing interventions
and the hours of nursing care associated with each
of the levels (Dee & Randell, 1989) (see Table 8–2).
The development of this system has provided nurs-
ing administration with the ability to identify the
levels of staff needed to provide care (licensed vo-
cational nurse versus registered nurse), bill patients
for actual nursing care services, and identify nurs-
ing services that are absolutely necessary in times of
budgetary restraint. Recent research has demon-
strated the importance of a model-based nursing
database in medical records (Poster, Dee, &
Randell, 1997) and the effectiveness of using a
model to identify the characteristics of a large hos-
pital’s managed behavioral health population in re-
lation to observed nursing care needs, level of
patient functioning on admission and discharge,
and length of stay (Dee, Van Servellen, & Brecht,
1998).
The work of Vivien Dee and her colleagues has
demonstrated the validity and usefulness of the
JBSM as a basis for clinical practice within a health-
care setting. From the findings of their work, it is
clear that the JBSM established a systematic frame-
work for patient assessment and nursing interven-
tions, provided a common frame of reference for all
practitioners in the clinical setting, provided a
framework for the integration of staff knowledge
about the clients, and promoted continuity in the
delivery of care. These findings should be general-
izable to a variety of clinical settings.90 SECTION II Evolution of Nursing Theory: Essential Influences