ego, age and related developmental capacities, atti-
tudes, and self-concept are general regulators that
may be viewed as a class of internalized intervening
variables that influence set, choice, and action.
They are key areas for nursing assessment. For ex-
ample, a nurse attempting to respond to the needs
of an acutely ill hospitalized six-year-old would
need to know something about the developmental
capacities of a six-year-old, and about self-concept
and ego development, to understand the child’s be-
havior.
Health
Johnson viewed health as efficient and effective
functioning of the system and as behavioral system
balance and stability. Behavioral system balance
and stability are demonstrated by observed behav-
ior that is purposeful, orderly, and predictable.
Such behavior is maintained when it is efficient and
effective in managing the person’s relationship to
the environment.
Behavior changes when efficiency and effective-
ness are no longer evident or when a more optimal
level of functioning is perceived. Individuals are
said to achieve efficient and effective behavioral
functioning when their behavior is commensurate
with social demands, when they are able to modify
their behavior in ways that support biologic imper-
atives, when they are able to benefit to the fullest
extent during illness from the physician’s knowl-
edge and skill, and when their behavior does not re-
veal unnecessary trauma as a consequence of illness
(Johnson 1980, p. 207).
Behavior system imbalance and instability are
not described explicitly but can be inferred from
the following statement to be a malfunction of the
behavioral system:
The subsystems and the system as a whole tend to be
self-maintaining and self-perpetuating so long as con-
ditions in the internal and external environment of
the system remain orderly and predictable, the condi-
tions and resources necessary to their func-tional re-
quirements are met, and the interrelationships among
the subsystems are harmonious. If these conditions
are not met, malfunction becomes apparent in behav-
ior that is in part disorganized, erratic, and dysfunc-
tional. Illness or other sudden internal or external
environmental change is most frequently responsible
for such malfunctions. (Johnson 1980, p. 212)
Thus, Johnson equates behavioral system imbal-
ance and instability with illness. However, as Meleis
(1991) has pointed out, we must consider that ill-
ness may be separate from behavioral system func-
tioning. Johnson also referred to physical and social
health, but did not specifically define wellness. Just
as the inference about illness may be made, it may
be inferred that wellness is behavioral system bal-
ance and stability, as well as efficient and effective
behavioral functioning.
Nursing and Nursing Therapeutics
Nursing is viewed as “a service that is complemen-
tary to that of medicine and other health profes-
sions, but which makes its own distinctive
contribution to the health and well-being ofNursing is viewed as “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.”people.” Johnson (1980, p. 207) distinguished nurs-
ing from medicine by noting that nursing views the
patient as a behavioral system, and medicine views
the patient as a biological system. In her view, the
specific goal of nursing action is “to restore, main-
tain, or attain behavioral system balance and stabil-
ity at the highest possible level for the individual”
(Johnson, 1980, p. 214). This goal may be expanded
to include helping the person achieve an optimal
level of balance and functioning when this is possi-
ble and desired.
The goal of the system’s action is behavioral sys-
tem balance. For the nurse, the area of concern is a
behavioral system threatened by the loss of order
and predictability through illness or the threat of
illness. The goal of nurses’ action is to maintain or
restore the individual’s behavioral system balance
and stability or to help the individual achieve a
more optimal level of balance and functioning.
Johnson did not specify the steps of the nursing
process but clearly identified the role of the nurse as
an external regulatory force. She also identified
questions to be asked when analyzing system func-
tioning, and she provided diagnostic classifications
to delineate disturbances and guidelines for inter-
ventions.
Johnson (1980) expected the nurse to base judg-
ments about behavioral system balance and stability
on knowledge and an explicit value system. One86 SECTION II Evolution of Nursing Theory: Essential Influences