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Nurse-Led Care Program With Patients With Heart Failure Using Johnson’s Behavioral System Model: A Randomized Controlled Trial

Research questions, purpose, aim, and objectives of the proposed program.

The main objective of the study conducted by Rahmani et al. (2020) is to evaluate how a nurse-based care program based on Johnson’s behavioral system model helps sustain balance in patients with heart failure. This research objective is based on the problem identified and highlights how significantly people with heart failure suffer physical and psychological symptoms. Acknowledging the necessity for an integrated approach, the writers suggest implementing Johnson’s model to deal with various characteristics associated with heart failure care, thus developing the research aim and objective.

Logical Flow

The research questions, purpose, goal and objective stem from the identified problem. The introduction to the following article neatly reveals an important impact that heart failure would bring upon individuals, demonstrating the physiological and psychological manifestations patients get. The problem statement establishes the need to address various dimensions regarding care for heart failure. Then, the author presents Johnson’s Behavioral System Model, which can be used as a theoretical framework to systematically cover the physical, social, and emotional dimensions of patients with heart failure. The aim and objective then logically follow this context by suggesting a program for nurse-led care to promote Johnson’s model as the better balance of the behavioural system.


The author did not state the hypothesis. Nevertheless, an appropriate hypothesis can be created that would suit the topic of this study. A possible alternative hypothesis could be non-directional, stating that the nurse-led care program based on Johnson’s Behavioral System Model would cause substantial changes in the balancing of the behaviour system among patients with heart failure. This hypothesis reflects the generic expectation of a positive change without defining the direction for that change.

Independent Variable (IV)

The IV in this study is the “nurse-led care program based on Johnson’s Behavioral System Model”; it targets different needs of patients with heart failure: physical, social, and emotional. The nurse-led care program takes the role of a manipulated factor, which researchers control to observe its effects on dependent variables.

Dependent Variable(s) (DV)

The DVs are the different components of the behaviour system affected by nurse-led care programs. They include the restorative system, Ingestive Subsystem, Eliminative SubSystem, Aggressive/Protective system, Dependency subsystem, Sexual subsystem, affiliate subsystem, and Achievement Subsystem.

Restorative Subsystem: It means the capacity of patients to recover their physical and psychological integrity.

Ingestive Subsystem: Concerns the ability of patients to consume food and fluids in moderation.

Eliminative Subsystem: Includes the patient’s capacity to discharge waste and communicate verbally and nonverbally.

Aggressive/Protective Subsystem: Addresses the protective capacities of patients about potential threats and emotional excitement.

Dependency Subsystem: Involves patients dependent on others for help and support in everyday activities.

Sexual Subsystem: Respect for the patients’ sexual behaviours and satisfaction.

Affiliative Subsystem: Deals with the patient’s interpersonal relationships.

Achievement Subsystem: Involves adherence to prescribed treatment regarding the use of drugs, diet and physical activity.

The research questions and objectives logically follow from the identified problem, but although a hypothesis is not linked within the article, proper delineation of non-directional inference applies to its purview. The IV is a nurse-led care program that aims to influence the various DVs that represent aspects of the behavioral system in heart failure patients.

Concepts Included in the Literature Review

Rahmani et al.’s study literature review considers related heart failure concepts focusing on the patient’s physical, social and emotional impacts. It presents the complications associated with heart failure, which involve symptoms of HF and factors contributing to hospitalization, as well as the economic impact on healthcare. The ideas are easily related to the study’s purpose, setting up a foundation for understanding heart failure as a complex disorder and an all-encompassing nursing intervention.

Use of Primary Sources

The literature review employs primary sources. For example, while summarizing the causes of multiple hospitalizations in patients with heart failure, this work refers to Agarwal (2013) as noncompliance to medications and dietary regimens and a lack of knowledge about the symptoms of the disease for proper discharge from a hospital.

Use of Secondary Sources

Secondary sources are also incorporated. It is known as the behavioural system model by Johnson, which comes from Nightingale’s idea and gives a theoretical foundation to nursing care. Hence, the application of Johnson’s model is described based on studies that included Bakan & Akyol (2008), which discusses cognitive therapy and Taghadosi et al. (2014)

Organization and Logical Flow

The literature review is structured well with a logical flow. It starts by emphasizing the importance of heart failure as a cardiovascular disease, then exploring physical and psychological manifestations for patients. The discussion flows seamlessly into the reasons behind frequent hospitalizations, facilitating an introduction to nursing theories and the need for a holistic perspective in patient care.

Inclusion of Recent Literature

The review is up-to-date as it refers to statistical data from 2013 and cites studies published in 2015 and 2018. Though the knowledge cutoff date for the study has yet to be mentioned, probably in light of some more recent sources included.

Conclusion and Implications

The literature review ends by defining the challenges heart failure patients encounter and the limitations of prior studies to deal with physical, social, and emotional factors concurrently. It prepares the ground for the research’s objective, focusing on a comprehensive nursing approach. Although the literature review does not say so directly, among selected nursing theories, Johnson’s behavioral system model presents an all-inclusive approach to meeting the mixed needs of heart failure patients.


Agarwal, J. (2013). Predicting risk of re-hospitalization for congestive heart failure patients [unpublished master’s thesis]. University of Washington.

Bakan, G., & Akyol, A. D. (2008). Theory-guided interventions for adaptation to heart failure. Journal of Advanced Nursing, 61(6), 596-608.

Rahmani, B., Aghebati, N., Esmaily, H., & Florczak, K. L. (2020). Nurse-led care program with patients with heart failure using Johnson’s behavioral system model: A randomized controlled trial. Nursing Science Quarterly33(3), 204-214.

Taghadosi, M., Rohollah, F., Aghajani, M., & Raygan, F. (2014). Effect of cognitive therapy on mental health in patients with heart failure. Feyz, Journal of Kashan University of Medical Sciences, 18(1), 52-59.


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