Imogene King’sGoal Attainment

Theory

Josephine Ann J. Necor, RN

Imogene King• born in 1923.• Earned a diploma in nursing from St.

John’s Hospital of Nursing in St Louis in 1945.

• Worked as office nurse, staff nurse, school nurse, and private duty nurse to support herself while studying for a baccalaureate degree.

• Bachelor of Science in Nursing from St. Louis University in 1948

• Masters of Science in Nursing from St. Louis University in 1957

• Doctorate from Teacher’s college, Columbia University, New York in 1961.

Goal Attainment Theory

- Grand Theory

THEORETICAL SOURCES

• King: “A search for literature in nursing and other behavioral science fields, discussion with colleagues, attendance at numerous conference, inductive and deductive reasoning, and some critical thinking about the information gathered, lead me to formulate my own theoretical framework.”

THEORETICAL SOURCES• The general systems theory from the behavioral

sciences led to the development of her dynamic interacting systems.

• King: “If the goal of nursing is concern for the health of individuals and the health care of groups, and if one accepts the premise that human beings are open systems interacting with the environment, then a conceptual framework for nursing must be organized to incorporate these ideas.

MAJOR CONCEPTS

ANDDEFINITIONS

• King developed a general systems framework and a theory of goal attainment where the framework refers to the three interacting systems - individual or personal, group or interpersonal, and society or social, while the theory of goal attainment pertains to the importance of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and personal space.

Personal System

• The concepts for the personal system are: perception, self, growth and development, body image, space, and time. These are fundamentals in understanding human being because this refers to how the nurse views and integrates self based from personal goals and beliefs. Among all these concepts, the most important is perception, because it influences behavior.

Personal System• Personal systems are individuals, who are regarded as

rational, sentient, social beings. Concepts related to the personal system are:

• Perception— a process of organizing, interpreting, and transforming information from sense data and memory that gives meaning to one's experience, represents one's image of reality, and influences one's behavior.

• Self— a composite of thoughts and feelings that constitute a person's awareness of individual existence, of who and what he or she is.

Personal System• Growth and development— cellular, molecular, and

behavioral changes in human beings that are a function of genetic endowment, meaningful and satisfying experiences, and an environment conducive to helping individuals move toward maturity.

• Body image—a person's perceptions of his or her body.

• Time—the duration between the occurrence of one event and the occurrence of another event.

• Space—the physical area called territory that exists in all directions.

• Learning—gaining knowledge.

Interpersonal System

• The concepts associated for the interpersonal system are: interaction, communication, transaction, role, and stress. King refers to two individuals as dyads, three as triads and four or more individuals as small group or large group (King, 1981). This shows how the nurse interrelates with a co-worker or patient, particularly in a nurse-patient relationship. Communication between the nurse and the client can be verbal or nonverbal. Collaboration between the Dyads (nurse-patient) is very important for the attainment of the goal.

Interpersonal System• Interactions—the acts of two or more persons in mutual

presence; a sequence of verbal and nonverbal behaviors that are goal directed.

• Communication—the vehicle by which human relations are developed and maintained; encompasses intrapersonal, interpersonal, verbal, and nonverbal communication.

• Transaction—a process of interaction in which human beings communicate with the environment to achieve goals that are valued; goal-directed human behaviors.

Interpersonal System• Role—a set of behaviors expected of a person

occupying a position in a social system.

• Stress—a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance, involving an exchange of energy and information between the person and the environment for regulation and control of stressors.

• Coping—a way of dealing with stress.

Social System

• The final interacting system is the social system. This shows how the nurse interacts with co workers, superiors, subordinates and the client environment in general. These are groups of people within the community or society that share a common goals, values and interests. It provides a framework for social interaction and relationships and establishes rules of behavior and courses of action (King, 1971). Social systems are organized boundary systems of social roles, behaviors, and practices developed to maintain values and the mechanisms to regulate the practices and roles.

Social System• Authority—a transactional process characterized by

active, reciprocal relations in which members' values, backgrounds, and perceptions play a role in defining, validating, and accepting the authority of individuals within an organization.

• Power—the process whereby one or more persons influence other persons in a situation.

• Status—the position of an individual in a group or a group in relation to other groups in an organization.

Social System

• Decision making—a dynamic and systematic process by which goal-directed choice of perceived alternatives is made and acted upon by individuals or groups to answer a question and attain a goal.

• Control—being in charge.

• Among the three systems, the conceptual framework of Interpersonal system had the

greatest influence on the development of her theory. She stated that “Although personal systems

and social systems influence quality of care, the major elements in a theory of goal attainment are discovered in the interpersonal systems in which

two people, who are usually strangers, come together in a health care organization to help and

to be helped to maintain a state of health that permits functioning in roles” ( King, 1981 p. 142).

• King believed that the goal of nursing “is to help individuals maintain their health so they can function in their roles” (King, 1981), transactions occur to set goals

related to the health of the patient.

• Nursing's focus is on the care of the patient, and its goal is the health care of

patients and groups of patients.

MAJOR ASSUMPTIONS

• King’s conceptual framework and theory of goal attainment “are based on an overall assumption that the focus of nursing is

human beings interacting with their environment leading to a state of health for individuals, which is an ability to function in

social roles”

Assumptions

• Nursing focus is the care of human being

• Nursing goal is the health care of individuals & groups

• Human beings: are open systems interacting constantly with their environment.

• Basic assumption of goal attainment theory is that nurse and client communicate information, set goal mutually and then act to attain those goals, is also the basic assumption of nursing process

Assumptions

• “Each human being perceives the world as a total person in making transactions with individuals and things in environment”

• “Transaction represents a life situation in which perceiver & thing perceived are encountered and in which person enters the situation as an active participant and each is changed in the process of these experiences”

Nursing

• “A process of action, reaction and interaction by which nurse and client share information about their perception in nursing situation.” and “a process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication, they set goals, explore means, and agree on means to achieve goals.”

• Action: is defined as a sequence of behaviors involving mental and physical action.

• Reaction: which is considered as included in the sequence of behaviors described in action.

• In addition, king discussed:– (a) goal– (b) domain and– (c) functions of professional nurse

• Goal of nurse: “To help individuals to maintain their health so they can function in their roles.”

• Domain of nurse: “includes promoting, maintaining, and restoring health, and caring for the sick, injured and dying.

• Function of professional nurse: “To interpret information in nursing process to plan, implement and evaluate nursing care.

Person

• Human being or person refers to social being who are rational and sentient.

• Person has ability to :– perceive– think– feel– choose– set goals– select means to achieve goals

and– to make decision

Person• Human being has three

fundamental needs:

1. The need for the health information that is unable at the time when it is needed and can be used

2. The need for care that seek to prevent illness, and

3. The need for care when human beings are unable to help themselves.

Health

• Health involves dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of one’s resources to achieve maximum potential for daily living.

Environment• Environment is the background

for human interactions.

• It involves:1. Internal environment: transforms

energy to enable person to adjust to continuous external environmental changes.

2. External environment: involves formal and informal organizations. Nurse is a part of the patient’s environment.

THEORETICAL ASSERTIONS /

PROPOSITIONS

Propositions of King’s Theory

• If perceptual interaction accuracy is present in nurse-client interactions, transaction will occur

• If nurse and client make transaction, goal will be attained

• If goal are attained, satisfaction will occur

• If transactions are made in nurse-client interactions, growth & development will be enhanced

• If role expectations and role performance as perceived by nurse & client are congruent, transaction will occur

• If role conflict is experienced by nurse or client or both, stress in nurse-client interaction will occur 

• If nurse with special knowledge skill communicate appropriate information to client, mutual goal setting and goal attainment will occur.

LOGICAL FORM• Inductive and deductive reasoning

ACCEPTANCE BY THE NURSING COMMUNITY

PRACTICE

• The theory’s relationship to practice is obvious because the profession of nursing functions through individuals and groups within the environment.

• Useful in practice – individualized plans of care while encouraging active participation from clients in decision making.

EDUCATION

• Has been used for curriculum design in nursing programs and framework for books

• It provides a systematic means of viewing the nursing profession, organizing a body of knowledge for nursing, and clarifying nursing as a discipline.

RESEARCH

• Research can be designed and conducted to implement this system in a hospital unit, in ambulatory care, in community nursing, and home care.

CRITIQUE

• Simplicity – has nine major concepts, making it complex; easily understood because they are defined to show interrelations in nursing practice.; clear concepts conceptually derived from identified characteristics

• Generality – has limited applications in areas of nursing; King believes critics are assuming that a theory will address every person, event, and situation, which is impossible.

CRITIQUE

• Empirical Precision – goal attainment could be measured along the effectiveness of nursing care

• Derivable Consequences – theory deals with choices, alternatives, participation of all individuals in decision-making and specifically deals with outcomes of nursing care.

References

• www.currentnursing.com

• http://imogenekingtheory.blogspot.com/p/key-concepts.html

• Tomey, A.M., (1994). Nursing Theorists and Their Work. 3rd ed. Missouri: Mosby

THANK YOU!