Theory is set of interrelated concepts,definitions,and prepositions that explains or predicts events or situations by specifying relations among variables.Theory can be used to guide the research process by generating or testing the area of interest.The primary purpose of theories in nursing profession to improve the practice by positively influence the health and quality of life of individul, family or community.

2. THE INTERACTING SYSTEMS
FRAMEWORKAND THEORYOFGOAL
ATTAINMENT-IMOGENE.M.KING
Prepared By,
Ms.Chithra.A.Valsan
I Year Msc Nursing

3. INTRODUCTION
• ImogeneM Kingwas born in 1923 in
Iowa.
• Diplomain nursing in 1945.
• Bachelorof sciencein Nursing education
in 1948.
• King workedas a medical-surgical
nursing instructorand assistantdirectorof
St.Johns hospital,schoolof nursingfrom
1947 to 1958.

4. INTRODUCTION (Cont’d…)
• M.Sc nursing degree in 1957.
• Doctor of education degree fromTeacher’s college, Columbia University in
1961.
• In 1971,while she was Director at the school of nursing at Ohio State
University, King’s first book was published.
• During the years that followed, King served in various administrative, research
and advisory positions.
• King published a second book in 1981, with a third book to follow in
subsequent years.
• Imogene King retired in 1990, but remained active as a guest lecturer and in
community service until her death in 2007

5. OVERVIEW OF KING’SATTAINMENT
THEORY
• Imogene King proposed the King’s goal attainment theory.
• Imogene King’s theory of goal attainment (1981) was derived from
her conceptual or interacting systems framework, and addresses
nursing as a process of human interaction.
• The theory focuses on the inter personal system interactions in the
nurse-client relationship.

6. OVERVIEW (Cont’d…)
• Within this theory, a transaction process model was designed which
describes the nature and standard for nurse-client interactions that
lead to goal attainment that nurses purposefully interact and mutually
set, explore and agree to means to achieve goals.
• Goal attainment represent outcomes.
• King’s theory offers insight into nurses interactions within
individuals and groups within the environment.

8. OVERVIEW (Cont’d…)
• It highlights the importance of the clients participation in the
decisions that influence care and focuses on both the process of
nurse-client interaction and the outcomes of care.
• When this information recorded in the client record, nurses have data
that represent evidence based nursing practice
• King believes that her theory, used in the evidence theory based
practice, blends the art and science of nursing.

9. OVERVIEW (Cont’d…)
• Imogene King selected 15 concepts from the nursing literature.
• (self, role, perception, communication, interaction, transaction,
growth and development, stress, time, personal space, organization,
status, power, authority and decision making), as essential
knowledge for use by nurses.

10. OVERVIEW (Cont’d…)
10 of the concepts in the framework were selected are the essential
knowledge for use by nurses in concrete nursing situations.
 Self Transaction
 Role  Growth and development
 Perception  Stress
 Communication Time
 Interaction  Personal Space

11. OVERVIEW (Cont’d…)
• King selected 4 universal ideas  social systems, health,
perception and interpersonal relations and to explore the relevance
of these ideas to nursing.
• These ideas provided the general frame of reference for identifying
concepts that then suggested more specific directives for nursing
practice

12. OVERVIEW (Cont’d…)
• King attempted to provide a structure for nursing as a discipline and
profession by using a systems framework as a basis for the
development of her conceptual framework
• In the conceptual framework, the structure of a system is viewed as an
open system with semi permeable boundaries between individuals,
groups and society, all of which interact with the environment.

13. OVERVIEW (Cont’d…)
• King conceptualized three levels of dynamic interacting systems:
Personal systems (individual)
Inter-personal systems(groups)
Social systems (society)
• These three “systems with identified concepts provide a way of
organising one’s knowledge, skills and values.”

15. OVERVIEW (Cont’d…)
• Individuals exist within personal systems.
The concepts relevant to this system include body image, growth
and development, perception, self, space and time.
• Interpersonal systems are formed when 2 or more individuals interact.
The concepts communication, interaction, role, stress & transaction.
• Examples of social systems  religious sytems, educational systems,
and healthcare systems. Concepts in the social system  authority,
decision making, organization, power and status.

17. OVERVIEW (Cont’d…)
• During the nursing process, the nurse and the client each perceive
each other, make judgements and take actions that results in reaction.
• Interaction results, and if perceptual congruence exists, transactions
occur.
• Outcomes are defined over goals attained.
• If the goals are related to patient behavior, then they become criteria
by which the effectiveness of nursing care can be measured.

20. METAPARADIGM CONCEPTSAS DEFINED IN
KING’S MODEL
• Person (Human Being) :Apersonal system that interacts with
interpersonal and social systems.
• Environment : Can be both external and internal.The external
environment is the context “within which the human beings grow,
develop, and perform daily activities.”. The internal environment of
human beings enable them to adjust to continuous external
environmental changes.

21. METAPARADIGM CONCEPTS (Cont’d…)
• Health : Dynamic life experiences of a human being, which implies
continuous adjustment to stressors in the internal and the external
environment through optimum use of one’s resources to achieve
maximum potential for daily living.
• Nursing :Aprocess of human interaction with the goal of helping
patients to achieve their goals.

22. ANALYSIS OFKING’S
THEORYOFGOAL
ATTAINMENT

23. ASSUMPTIONS OF THE THEORYOF GOAL
ATTAINMENT
• The theory of goal attainment is based on the following
specific assumptions about the human beings :
Individuals are
Social beings Sentient beings
Time-oriented beings Controlling beings
Rational beings Purposeful beings.
Reacting beings Action- oriented beings
Perceiving beings

24. SPECIFICASSUMPTIONSABOUTTHE NURSE-
CLIENT INTERACTIONS
• Perceptions of nurse & client influence the interaction process.
• Goals, needs and values of nurse & client influence the interaction
process.
• Individuals have a right to knowledge about themselves.
• Individuals have a right to participate in decisions that influence their
life, their health, and community services

25. SPECIFICASSUMPTIONSABOUTTHE NURSE- CLIENT
INTERACTIONS (Cont’d…)
• Health professionals have a responsibility to share information
that helps individuals make informed decisions about their health
care.
• Individuals have a right to accept or reject health care
• The goals of health professionals and the goals of recipients of
health care may be incongruent.

26. PROPOSITIONS OFTHE THEORYOF GOAL
ATTAINMENT
• If perceptual accuracy is present in nurse-client interactions,
transactions will occur.
• If the nurse and the client make transactions, goals will be
attained.
• If goals are attained, satisfaction will occur.
• If goals are attained, effective nursing care will occur.
• If transactions are made in the nurse-client interactions,
growth and development will be enhanced.

27. PROPOSITIONS (Cont’d…)
• If role expectations and role performance as perceived by the nurse
and the client are congruent, transactions will occur.
• If role conflict is experienced by the nurse, the client or both, stress in
nurse-client interactions will occur.
• If nurses with special knowledge and skills communicate the
appropriate information to client, mutual goal setting and goal
attainment will occur.

28. BRIEF CRITIQUE OFTHE THEORYOF GOAL
ATTAINMENT
• The definitions in the King’s theory are clear and conceptually
derived from the research literature in existence at the time of
their publication.
• The theory of goal attainments have 10 major concepts, making
the theory fairly complex although easily understandable.

29. BRIEF CRITIQUE (Cont’d…)
• Empirical data were used in the development and refinement of
King’s theory and research continues as part of the testing of
conceptual relationships within the theory
• In the past, some criticism was leveled at this theory based on the
claim that the theory of goal attainment has limited application in
areas of nursing in which patients are unable to interact completely
with the nurse.

30. BRIEF CRITIQUE (Cont’d…)
• King has responded to this criticism by pointing out that 70% of
communication is non-verbal.
• This have satisfied at least some of the critics, give the King’s
conceptual model and theory of goal attainment continue to be used
to provide quality, theory based patient care in practice settings in
numerous countries around the world.

31. KING’S INTERACTING SYSTEMS FRAMEWROK
AND THEORYOF GOALATTAINMENTASA
FRAMEWORK FOR NURSING PRACTICE.

32. KING’S INTERACTING SYSTEMS FRAMEWROKAND
THEORYOF GOALATTAINMENTASAFRAMEWORK
FOR NURSING PRACTICE
• King points that nursing is a process of interactions that lead to
transactions.
• Transactions lead to goal attainment , and goal attainment is a
measure of effective nursing care.

33. FRAMEWORK FOR NURSING PRACTICE (Cont’d…)
Nurse - patient interactions can be classified into 8 categories.
• Action
• Reaction
• Disturbance
• Mutual goal setting
• Exploration means to achieve the goal
• Agreement on means to achieve the goal
• Transaction
• Attainment of goal

34. FRAMEWORK FOR NURSING PRACTICE (Cont’d…)
• To implement the theory of goal attainment in practice,
the goal-oriented nursing record was proposed.
• It consists of a nursing database that assesses the patient abilities to
performADL, perceptions of health concerns, and knowledge
related to the patients learning needs.
• From these data, nursing diagnoses are constructed and goals are
mutually set with patients.

35. FRAMEWORK FOR NURSING PRACTICE (Cont’d…)
• During these interactions, nurses provide information to assist
patients in making informed decisions.
• When goals have been identified, nursing orders have been written
based on the goals, and the progress notes indicate that the goals
have been attained, effective nursing care has been documented.

37. THE NURSING PROCESSAND KING’S INTERACTING SYSTEMS
FRAMEWORKANDTHEORYOF GOALATTAINMENT:
THE INTERACTION -TRANSACTION PROCESS
• The model of transaction, also known as the interaction-transaction
process, provides a theoretical basis for the nursing process as a
method.
• Application of the model may be approached using the nursing process,
where assessment focuses on the perceptions of the nurse and client,
communication of the nurse and the client and interaction of the nurse
and the client.

38. ASSESSMENT (PERCEPTION,COMMUNICATION,
INTERACTION)
• Interaction is an ongoing process characterized by communication.
• Communication during this phase of the process includes the nurse
gathering additional information, validating perceptions, delineating
and validating patient concerns and establishing mutual trust.
• Nursing functions during this phase include, viewing, recognizing,
observing andmeasuring.

39. PLANNING (DECISION MAKING, EXPLORATION,
AGREEMENT)
• Nursing functions in this phase are synthesis, interpretation, and analysis
of data within the context of the nursing process, followed by making
decisions about mutually set goals.
• Decisions are made related to actions to meet the agreed upon goals.
• These decisions are made by the asking questions such as the following:
• What are the patient goals?
• What are the priority goals?
• Which goals will serve patients best interest?
• What does the patient perceive is the best way to attain goals?

40. IMPLEMENTATION (TRANSACTION)
• Transactions takes place as a result of perceiving the person or
situation, making judgements about perceptions, and taking action.
• Reactions to actions lead to interaction between the nurse and the
patient.
• During this phase, the nurse will ask questions such as:
Am I doing what we have agreed upon?
Why am I carrying out the action?
How andWhen do I carry out the actions will allow the attainment
of the goals?

41. EVALUATION
• The primary aim to assess the attainment of goals and if goals are
not attained, to determine why they are not attained.
• Unmet goals can result from the identification of incorrect or
incomplete data, incorrect interpretation of data such as a result of
perceptual error, lack of knowledge or goal conflict, or barriers
related to the nurse, patient or system.

43. Perception,
Communication
And Interaction
(Assessment)
Assess
Attainment Of
Goals And If
Goals Are Not
Attained,
Determined
Why.
Goal Attainment
( Evaluation)
Reactions To
Actions Leads
To Interactions
Between
Nurse And
Patient, Which
Then Lead To
Transactions.
Transactions
Reflect Shared
Commitment.
Transaction
(Implementation)
Synthesis
Interpretation,
And Analysis
Of Data.
Mutual Goal
Setting With
Decisions
Related To
Actions To
Meet Goals.
Decision Making
,Exploration,
Agreement
(Planning)
Communication
Including
Gathering
Information,
Validating
Perceptions And
Concerns, And
Establishing
Trust.

44.  Mr. B, is a 78-year-old African American, married male who was
referred to the home health nurse after his discharge from the local
hospital.
 He has been prescribed a low-sodium diet as a result of fluid volume
overload secondary to congestive heart failure.
 During the initial visit, the nursing assessment focuses on the
perceptions of the nurse and the client, communication of the nurse
and the client, and interaction of the nurse and the client.
SCENARIO ILLUSTRATES NURSING CARE BASED
ON KING'S THEORYOF GOALATTAINMENT.

45. Cont’d…
 The nurse begins by asking Mr. B. questions about his perception of
the situation and his conclusions related to the situation.
 The nurse also asks the same questions of herself.
 Communication includes the nurse gathering additional information,
validating her perceptions of Mr. B., validating the concerns of
Mr.B., and establishing mutual trust.
 Nursing functions during assessment include viewing, recognizing,
observing, and measuring they reveal that Mr. consumes a diet high
in sodium.

46. Cont’d…
 Planning for the care of Mr. B. will involve decisions about goals and
agreement as to how to attain goals.
 These decisions are made by the nurse asking questions such as the
following
 (1) Which goals will serve Mr. B's best interest? (2) What are Mr. B’s
goals?(3) Are Mr. B’s goals and the nurse's goals for Mr. B.
congruent? (4) If the goals are not congruent, further communication
and interaction are needed to achieve congruence? (5) What are the
priority goals?(6) What does Mr. B. perceive to be the best way to
attain goals? (7) Is Mr. B. willing work toward attainment of goals?
(8) What does the nurse perceive as the best way to attain the goals?

47. Cont’d…
 There is agreement that Mr. B. needs to adhere to the prescribed
low-sodium diet. To achieve that goal as well as his ultimate goal
of not being hospitalized again for fluid retention, Mr. B. will
require some additional information related to his dietary
restrictions.
 The next step of the process results in the occurrence of
transactions. During this phase of the process, the nurse and Mr.
B. participate in teaching sessions related to his low-sodium diet.
 The nurse will need to ask questions to evaluate whether she is
doing what she and Mr. B. agreed upon as well as questions
related to the feasibility of meeting the goals based on the
transaction.

48. Cont’d…
 The primary aim of the evaluation phase is to assess if the
goals set by the nurse and Mr.B have been attained and, if
goals were not attained, then to determine why they were
not attained.
 Throughout this model of transactions process, the nurse
continues to assess and intervene to apply the model
simultaneously to issues other than the need for education
related to the low-sodium diet as indicated by the condition
of Mr. B. and current best clinical practices