Imogene King:

Goal Attainment Theory

“A professional nurse, with special knowledge and skills, and a client in need of nursing, with knowledge of self and perception of personal problems, meet as strangers in natural environment. They interact mutually, identify problems, establish and achieve goals.”

A. Getting to know the TheoristImogene King was born in West Point, Iowa on

January 30, 1923, youngest of three children.She completed her diploma in nursing education

in 1945, at St. John's Hospital in St. Louis, Missouri.

She received her BS and MS in nursing from St. Louis University in 1957,

She obtained her Doctorate in Education from Columbia University, N.Y.

She has practiced as a staff nurse, nurse educator, and nurse administrator.

She formulated her theory while she was an associate professor of nursing at Loyola University in Chicago.

This was at the time nursing was emerging as a profession and some nurses sought to challenge the existing role of nurses.

King began her work in nursing theory with a conceptual framework.

King considers her theory as a deviation from systems theory, with emphasis on interaction theory.

In 1981 she refined her concepts into a nursing theory that consisted of the following basis:

1. An open system framework as the basis of goal attainment.

2. Nursing as a major system within the health care system.

3. Nursing process emphasis on interpersonal processes.

She Died on December 24, 1997, 2 days after suffering from stroke.

B. Theoretical Sources1971, 1981: students, academic colleagues, nurse

researchers, and clinicians thinking

1981: General System Theory (Von Bertalanffy) conceptual framework

1988:Kaufman, Orlando and Peplau thinking

Kaufman’s 1958 doctoral dissertation explore concepts of perception, time and stress

Research conducted at Yale University School of Nursing to test Orlando’s (1961) theory of the deliberative nursing process thinking

King and Peplau (as cited in Takahashi, 1992) pointed out the connections between their works with regard to patient outcome.

A review of her 1971 book by Rosemary Ellis encouraged her to continue her work by deriving a theory from the General Systems Framework.

The result…

The Theory of Goal Attainment.

C. Use of Empirical Evidence King used a “systems” approach in the development of her Dynamic Interacting Systems Framework and in her subsequent Goal-Attainment Theory. INTERACTING SYSTEMS FRAMEWORK

Three systems in the conceptual framework: Personal System (the individual)

Interpersonal System (individuals interacting with one another)

Social System (groups of people in a community/society sharing common goals, interests, and values) Study systems as a whole rather than as isolated parts of a system.

THEORY OF GOAL ATTAINMENTElements are seen in the interpersonal systems in which two people, who are usually strangers, come together in a health care organization to help and be helped to maintain a state of health that permits functioning of roles.

Reflects King’s belief that the practice of nursing is differentiated from other healthcare professions by what nurses do with and for individuals

Nurse and client communicate information, set goal mutually and then act to attain those goals

D. Metaparadigm in Nursing:

1.Person: Imogene King described a person existing in an open system as a spiritual being and rational thinker who makes choices, selects alternative courses of action, and has the ability to record their history through their own language and symbols, unique, holistic and have different needs, wants and goals.

According to Imogene King, human being has three fundamental needs:

Information on health that can be accessed and utilized when needed

Care that aims to prevent illness

Care in times of illness/helplessness

2.Health : According to Imogene King, 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.

3.Environment : It is the background for human interactions.

It involves:

a. Internal environment – transforms energy to enable person to adjust to continuous external environmental changes.

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

4. Nursing: Nursing for Imogene King is an act wherein the nurse interacts and communicates with the client. The nurse helps the client identify the existing health condition, exploring and agreeing on activities to promote health. The goal of the nurse in Imogene King’s theory is to help the client maintain health through health promotion and maintenance, restoration, and caring for the sick and dying.

E. Theoretical AssertionFrom the theory of goal attainment Imogene King developed predictive propositions, which includes:

If perceptual interaction accuracy is present in nurse-patient interactions, a transaction will happen.

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

If goal are attained, satisfaction will occur.

If goals are met, efficient nursing care will happen.

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

If role expectations and role performance as perceived by nurse and 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 and skill communicate appropriate information to client, mutual goal setting and goal attainment will occur.

The interaction of the person and the nurse is goal-directed and through this, both parties reach a common and accurate perception of the problem and means are explored on how to resolve it.

After the means exploration, goal-setting is made which is subject for agreement.

Finally, transaction happens when the agreed goals are acted upon and necessary actions are taken to achieve them. Finally, if the goals are attained, satisfaction will occur and the health need fulfilled.

F. Acceptance by the Nursing CommunityResearch:Basis for development of middle-range nursing theories:

Model for Multicultural Nursing Practice (Rooda, 1992)

Theory of Personal System Empathy (Alligood & May, 2000)

Theory of Family Health (Doornbos, 2000)

Education:Framework for the baccalaureate program (Ohio State

University School of Nursing)Educational reform resulting in nursing education (Sweden)

Practice:

A model for bedside nursing practice in the hospital setting (Coker & Schreiber, 1990)

Managed care program in hospital settings (Hampton, 1994)

Goal-Oriented Nursing Record system for documentationStructure of Quality Assurance Program

G. AnalysisClarity:Clear and conceptually derived from research

literature at the time the theory was developed.

Generality:It has been criticized for having limited

applications in areas of nursing in which patients are unable to competently interact with the nurse.

King has responded that 70% of communication is nonverbal.

Empirical Precision:From a study of 17 patients, goals were attained in 12 cases

(70%).

King believes that if nursing students are taught the theory of goal attainment and it is used in nursing practice, goal attainment can be measured and the effectiveness of nursing care can be demonstrated.

Derivable Consequences:It focuses on all aspects of the nursing process: assessment,

planning, implementation and evaluation.

King believes that nurses must assess to set mutual goals, plan to provide alternative means to achieve goals, and evaluate to determine if the goal was attained.