1. Imogene Kings Theory of Goal Attainment NSG 6604 Eddrea Cade
Lindsay Fort Carlie Peacock Leah Williamson
2. Background 1945, Imogene King received nursing diploma from
St. Johns Hospital School of Nursing in St. Louis, Missouri 1948,
received BSN from St. Louis University 1957, received MSN from St.
Louis University 1961, received doctoral degree from Teachers
College, Columbia University 1961 through 1966, was Associate
Professor at Loyola University in Chicago 1966 and 1968, was
Assistant Chief of the Research Grants Branch of the Division of
Nursing in Washington, DC 1968 through 1972, was director of the
Ohio State University School of Nursing 1971 through 1980, was
Professor at Loyola University in Chicago 1980 through 1990, was
Professor at the University of South Floridas College of Nursing in
Tampa, Florida Retired afterwards with the title Professor Emeritus
Active member District IV Florida Nurses Association, the American
Nurses Association, and Sigma Theta Tau International, also a
Fellow in the American Academy of Nursing Works included: Theory
for Nursing: Systems, Concepts, and Process The Language of Nursing
theory and Metatheory Toward a Theory for Nursing: General Concepts
of Human Behavior Curriculum and Instruction in Nursing: Concepts
and Process 1960s, Theory of Goal Attainment was first introduced
(Nursing Theory.org, 2013)
3. Background cont. King produced a conceptual system and a
middle-range theory for nursing 1971, issued the conceptual
framework 1981, expanded to the Theory of Goal Attainment, a
middle-range theory Human beings was the focus of nursing and they
interact with their environment Focused on existing knowledge in
nursing and expanded for nursing practice Concepts analyzed: Social
systems, health, interpersonal relationships, and perceptions for
nursing discipline 1971, a conceptual framework was formulated
around personal, interpersonal and social systems, and was extended
to include communication, interpersonal relationships, information,
energy, social organizations, role and status 1978, believed
science should form scientific knowledge based off nursing and
research Concepts of theory include: perception, communication,
interaction, transaction, self, role, growth and development,
stressors/stress, time and space Changes made to the conceptual
system included: personal system concept; spirituality; and calling
this the conceptual system Linked to nursing process (assessment,
plan, implement, and evaluate) Improve or maintain health, control
illness, or lead to a peaceful death (Khowaja, 2007)
5. Nursing Metaparadigm Person: Nursing practice must be viewed
by patients as central to the experiences of embodiment and illness
while including family members and other important people to the
patient Health: Multifaceted dimension that patient has on well
being and quality of life including functional status, role
performance, psychological wellness, and overall satisfaction
throughout the lifespan Nursing plays a distinct role in the
support of the patient to maximize patient health (Thorne et al.,
1998)
6. Nursing Metaparadigm Environment: Includes both internal and
external factors influencing patient Nursing meets patient
environmental need by having a multilayered view to tailor to
individuals everyday reality, culture, economic structure, and
social interactions Nursing: Nurses are to apply principles of
knowledge, skills, collaboration, communication, and professional
judgment A key focus to nursing is carrying the role of caring to
all individuals (Thorne et al., 1998)
7. Terms Used to Describe Nursing Metaparadigm Person:
embodiment, dependency to independence Health: multifaceted
dimension of individual patient, internal and external Environment:
external and internal adjustment Nursing: knowledge and caring
(Thorne et al., 1998)
8. Kings Definition of Nursing Metaparadigm Person: A system
that uses interpersonal and social environment to grow from a state
of dependency to independence Health: Individuals life experiences,
individuals personal view of what their health is and adjustments
to internal and external environment to achieve the most each day
(King, I.M., 1999)
9. Kings Definition of Nursing Metaparadigm Environment:
External (adjustments to multiple environments each day throughout
life to grow and develop as human beings) Internal (adjustments
made within each day to assist with adjusting to each transition in
the external environment) Nursing: Nurses have a specific role in
obtaining knowledge and providing care to person and persons
important to patient, while maintaining the best environment for
patients to grow each day into patient perceived best health and
improve as person (King, I.M., 1999)
10. Goal of Attainment Model Image Source:
http://nurseslabs.com/imogene-m-kings-theory-goal-attainment/
11. Structure Presented in 3 Open Systems Personal Systems
Individuals Interpersonal Systems Groups Social Systems Society
(Killeen, M., King, I., 2007)
12. Purpose Assists nurses to organize nurse-patient
interactions to reach a goal such as an achieved outcome (Killeen,
M., King, I., 2007) Major Concepts 1.Personal System 2.
Interpersonal System 3. Social System (Alligood, M.R., 2010)
13. Concepts of the Personal, Interpersonal and Social Systems
Personal System Interpersonal System Social System Perception
Communication Authority Self Interaction Decision making Body image
Role Organization Growth & Development Stress Power Learning
Stressors Status Personal space Transaction Time Coping (Alligood,
M.R., 2010)
14. Definitions Nursing: a process of human interactions
between nurse and client whereby each perceived the other and the
situation; and through communication, they set goals, explore
means, and agree on means to achieve goals (Alligood, 2010, p. 100)
Health: dynamic life experiences of a human being, which implies
continuous adjustment to stressors in the internal and external
environment through optimum use of ones resources to achieve
maximum potential for daily living (King, 2007, p.7) System: a set
of components connected by communication links that exhibit
goal-directed purposeful behavior (King, 2007, p.3) Personal
system: a unified, complex whole, self who perceives, thinks,
desires, imagines, decides, identifies goals and selects means to
achieve them (King, 2007, p.54) Social System: Groups with common
interests and goals that make up a community or a society (King,
2007, p.6) Communication: is the vehicle that establishes
relationships, can be verbal or non-verbal and includes all
activities that tie human beings together (Caceres, 2015, p.153)
Action: a sequence of behaviors of interacting persons which
includes (1) recognition of presenting conditions; (2) operations
or activities related to the condition or situation; and (3)
motivation to exert some control over the events to achieve goals
(King, 2007, p.13) Interaction: Is the process of individuals
communicating with one another and developing perceptions of these
encounters (Caceres, 2015, p 153) Transaction: refers to meaningful
interactions that take place between individuals and the
environment with the purpose of achieving goals (Caceres, 2015,
p.153) Perception: the exchange that occurs between individuals and
the environment (Caceres, 2015, p.153)
15. Propositions & Relationships Nurses and patients form
relationships through interactions Transactions will occur if
nurse-patient interactions are present and the patient perceives
the expectations and performance the same as the nurse Goals will
be set and attained mutually if the patient is given information
that is appropriate through communication from the nurse Goals will
be achieved if transactions are made between a nurse and patient
and effective care has been given If goals are achieved,
satisfaction will occur (Alligood, M.R., 2010)
16. Assumptions Focus care of human being Goal is to cure
individuals and groups Open systems interacting with the
environment Communicate to form a goal that is mutual and acts to
attain the set goal (Killeen, M., King, I., 2007)
17. Nursing Goal Assist nurses to mutually establish goals and
agree on how to achieve those goal with patients Maintain health
(King, 2007)
18. Nursing Practice Major milestones: Development and use of
conceptual systems and theories during the scientific evolution in
the 1970s Classification systems beginning in the 1980s Nursing
informatics applications in the 1990s These three milestone
linkages are like the linkages between structure, process, and
outcomes Define the physical and social environments within which
human beings function Personal, interpersonal, and social systems
make up the conceptual structure The ten concepts are important in
todays global issues of cultural diversity and transcultural
nursing Transaction Process Model helps ordered function so human
groups can interact as systems in societies and nations Describes
the nurse-patient interactions leading to transactions and
achievement of goals Theory of Goal Attainment and Transaction
Process were established as part of the scientific movement in
nursing A general systems theory The delivery of healthcare
services have need for both individual and interdisciplinary team
approach Open communication and respect for ones contribution to
the total plan of care is necessary to achieve goal attainment and
outcomes Transaction Process aid in mutual goal setting with
patients Concepts in the Transaction Process provide theoretical
knowledge Nursing process is an international method to use in the
structure of theory (Killeen & King, 2007)
19. Nursing Practice cont. Represent human beings as personal
systems (individuals) Interpersonal systems presented by dyads (two
individuals), triads (three individuals, such as nurse-patient-
physician), and small groups (such as nurse, physician, pharmacist,
and therapists) Social systems are large groups such as healthcare
systems, educational systems, and government systems Three
interacting systems show the interrelationship of human beings as
they function in a variety of systems Knowledge of the 15 concepts
are used by human beings in all three systems Perception, self,
body image, growth and development, time, personal space, and
coping are related to individuals Role, communication, interaction,
stress, and transaction represent interpersonal systems
Organization, status, power, authority, and decision making
represent social systems Age is critical in all three systems Three
systems represent social and physical environments to help achieve
the set goals Relevant in most cultures, differences may exist
relative to perception and communication Ten concepts selected the
conceptual system used to develop a theory of Goal Attainment which
a transaction process was derived Goal Attainment represents
outcome and provides evidence-based practice Transaction process is
mutual goal setting Describes the nature of the nurse-client
encounters and provide a theoretical basis for the nursing process
Concepts can be used by individuals and healthcare professionals in
any healthcare system Transaction process is useful in
multidisciplinary and interdisciplinary involvement (King,
2006)
20. Nursing Research Ultimate use to improve patient/client
care Other theories builds other disciplines; borrowed theories can
develop into nursing theories Requires nursing scientists to
re-evaluate the present state of theory, research, and practice in
the discipline Nursing scholars and educators visualized a
scientific discipline complete with theory-driven research and
practice National League for Nursings accreditation for nursing
education provided a stimulus for nursing researchers to increase
their efforts to develop appropriate theories to guide nursing
research and practice Each single nursing theory or conceptual
model represents an individual system Integration of nursing theory
or conceptual model into scientific research represents the group
system The interaction on the level of the nursing community and
nursing discipline as a whole represents the societal system The
mutual goal for the three systems is to build scientific knowledge
that can be used to improve patient care and nursing practice An
organizing framework help to build nursings scientific knowledge
For over 50 years, nursing scientists have developed the Scientific
Discipline of Nursing through the use of theory to guide research
to improve practice, thereby improving patient outcomes (Bond et
al., 2011)
21. Nursing Research cont. 70% reported adverse events could be
from lack of communication and collaboration Supports the
phenomenon of interdisciplinary collaboration Nurse-physician
collaboration and communication can improve both patient outcomes
and provider satisfaction Gender, age, culture, and level of
education of the nurse or physician may directly impact the
perceived level of collaboration Not only used by nurses with their
patients, but can be used by any individual in any interactions
with other professionals Used to guide nursing practice and
research for approximately 30 years Has depth and scope beyond
bedside nursing Used by nurses, administrators, and other
healthcare providers, also used with nursing administration and to
guide nursing curricula Tested in research and used in every
patient population from infants to the elderly Wicks family health
model and the Advanced directive decision making model was derived
from Kings theory to guide nursing practice Developed research
instruments and facilitated other middle-range theories such as the
Theory of Group Power Promote interdisciplinary collaboration with
the intended outcome of improved patient and nursing outcomes
Application may help to move forward in improving outcomes and
reducing adverse events (Fewster-Thuente & Velsor-Friedrich,
2008)
22. How clear is this theory ? Addresses the nurse-patient
interactions States its main components Provides & maintains
the same definitions for all key concepts Ease of understanding
Concepts clearly defined & models provided (Alligood,
2014)
23. How simple is this theory ? 10 major concepts - Making it a
complex theory Clear concepts are easily understood Derived from
identified characteristics Easily used within the nursing field
& influences positive patient outcomes Provides a systemic
means of viewing & clarifying the nursing profession (Alligood,
2014)
24. How general is this theory ? King believed critics were
assuming that a theory would address every patient & situation
which is impossible Criticized for having limited application in
nursing areas King used the theory in board terms in nurse- patient
relationships Documented examples of the Theory of Goal Attainment
(Alligood, 2014)
25. How accessible is this theory ? Widely accepted in nursing
Used with research studies & in nursing schools Several studies
used this theory to measure patient outcomes Useful in practice -
individualized plan of care with patient actively being involved in
the decision making process (Alligood, 2014)
26. How important is this theory ? Has been proven that the
nurse-patient interaction is a vital component Kings theory
explores this relationship Explains how nurses can interact with
patients to achieve goals Emphasizes all aspects of the nursing
process - Assessment, planning, implementation, & evaluation
(Alligood, 2014)
27. Kings Goal Attainment Theory: Case Study 57 year old male,
newly diagnosed diabetes Goal attainment: decrease anxiety due to
new diagnosis and care for disease RN must 1st interact on a
personal level to achieve proper communication to determine patient
goal and move forward 2nd involve patient on an interpersonal level
(wife & other family) to achieve understanding and goal
attainment 3rd using a social system of others with the disease and
education materials to decrease anxiety and increase knowledge
Lastly, by combining these concepts of personal, interpersonal, and
social systems nurses can obtain proper goal establishment and
success for patients
28. Refrences Alligood, M. R. (2010). Family healthcare with
Kings theory of goal attainment. Nursing Science Quarterly, 23(2),
99-104. http://dx.doi.org/10.1177/0894318410362553 Alligood, M.
(2014). Imogene M. King: Conceptual system and middle-range theory
of goal attainment. Nursing Theorists and Their Work (8th ed., pp.
258-268). St. Louis, Missouri: Elsesvier Mosby. Bond, A. E., Esha,
N. F., Bani-Khaled, M., Hamad, A. O., Habashreh, S., Kataua,
H.,& Maabreh, R. (2011).Who uses nursing theory? A univariate
descriptive analysis of five years research articles. Scandinavian
Journal of Caring Sciences, 25(2), 404-409.
doi:10.1111/j.1471-6712.2010.00835.x Caceres, B. A. (2015). Kings
theory of goal attainment: Exploring functional status. Nursing
Science Quarterly, 28(2), 151-155.
http://dx.doi.org/10.1177/0894318415571601 Christina, S. L.,
Maureen, F. A., & Imogene, K. M. (2007). Kings structure,
process, and outcome in the 21st century. In S. L. Christina, &
F. A. Maureen (Eds.), Middle range theory development using Kings
conceptual system. [eBook Academic Collection]. Retrieved from
http://eds.a.ebscohost.com.ezproxy.una.edu/eds/detail?sid=ccbb3cc3-
dde4-4322-9ab3-b8c5f9d7fabe@sessionmgr4001&vid=1#db=e000xna&AN=194785
29. References Fewster-Thuente, L. & Velsor-Friedrich, B.
(2008). Interdisciplinary collaboration for healthcare
professionals. Nursing Administration Quarterly, 32(1), 40-48.
doi:10.1097/01.NAQ.0000305946.31193.61 Imogene King- Nursing
theorist (2013). Nursing Theory. Retrieved from
http://nursing-theory.org/nursing-theorists/Imogene-King.php
Khowaja, K. (2007). Utilization of Kings interacting systems
framework and theory of goal attainment with new multidisciplinary
model: Clinical pathway. Australian Journal of Advanced Nursing,
24(2), 44-50. Retrieved from
http://search.proquest.com/docview/236088445?accountid=38769
Killeen, M. B., & King, I. M. (2007). Viewpoint: Use of Kings
conceptual system, nursing informatics, and nursing classification
systems for global communication. International Journal of Nursing
Terminologies and Classifications, 18(2), 51-57. Retrieved from
http://web.a.ebscohost.com.libproxy.troy.edu/ehost/pdfviewer/pdfviewer?
sid=830f949b-fd53-4de7-a2c8-
6be49f3eb410%40sessionmgr4002&vid=3&hid=4106 King, I. M.
(1999). A theory of goal attainment: Philosophical and ethical
implications. Nursing Science Quarterly, 12(4), 292-296.
doi:10.1177/08943189922107205
30. References King, I. (2006). A systems approach in nursing
administration: Structure process and outcome. Nursing
Administration Quarterly, 30(2), 100-104. Thorne, S., Canam, C.,
Dahinten, S., Hall, W., Henderson, A., & Kirkham, S. R. (1998).
Nursing's metaparadigm concepts: Disimpacting the debates. J Adv
Nurs Journal of Advanced Nursing, 27(6), 1257-1268. doi:10.1046/j.
1365- 2648.1998.00623.x