King used a “systems” approach in the development of her dynamic interacting systems framework and in her subsequent Goal-Attainment Theory.
King emphasizes that both the nurse and the client bring important knowledge and information to the relationship and that they work together to achieve goals.
The relationship of three interacting systems led to King’s Theory of Goal Attainment are the personal system (individual), the interpersonal system (nurse-patient dialogue), and the social system (the family, the school, and the church). Each system is given different concepts.
A process of human interactions
King summarized the connections among these concepts as “An individual Perception of self, of body image, of time, of space influences the way he or she responds to object and events in his/her life. As individual grow and develop trough the lifespan,experiences with changes in structure and function of their bodies over time influence their perceptions of self” (King, 1981, p. 19).
Elements found in King’s Goal Attainment Theory originated from the elements or concepts in her Interacting Systems Framework. But it focuses on the Interpersonal System and the interactions, communications and transactions between two individuals, the nurse and the patient. The essence of her theory is that the nurse and the patient come together, communicate, and make transactions – they set goals and work to achieve the goals they set. They each have a purpose, they perceive, judge, act and react upon each other. At the end of their communication, a goal will be set and with this transactions are made.
Furthermore, King proposed that through mutual goal setting and goal attainment, transactions result in enhanced growth and development for the client (Woods, 1994). King used ten major concepts from the personal and interpersonal systems to support the Theory of Goal Attainment. Those concepts include human interactions, perception, communication, role, stress, time, space, growth and development, and transactions. To capture the essence of these interrelated concepts, King stated that “nurse and client interactions are characterized by verbal and nonverbal communication, in which information is exchanged and interpreted; by transactions, in which values, needs, and wants of each member of the dyad are shared; by perceptions of nurse and client and the situation; by self in role of client and self in role of nurse; and by stressors influencing each person and the situation in time and space” (King, 1981, p. 144).
Inductive – personal approach to synthesizing knowledge was to use data and information available from research in nursing and related fields and from her 25 years in active practice, teaching, and research Deductive – breakdown of ideas from different concepts
Ohio State University Shirley Steel’s Child, Health, and the Family
Goal Oriented Nursing Record
Imogene King’s Goal Attainment Theory
Josephine Ann J. Necor, RN
• born in 1923.
• Earned a diploma in nursing from St.
John’s Hospital of Nursing in St Louis
• Worked as office nurse, staff nurse,
school nurse, and private duty nurse
to support herself while studying for a
• 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
• 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
• The general systems theory from the behavioral
sciences led to the development of her dynamic
• 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.
• 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
• 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 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.
• 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
• 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
• Learning—gaining knowledge.
• 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.
• 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.
• 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
• Coping—a way of dealing with stress.
• 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.
• 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
• 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.
• 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.
• 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
• Nursing focus is the care of human being
• Nursing goal is the health care of individuals &
• 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
• “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”
• “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
• Action: is defined as a sequence of behaviors involving mental and
• 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.
• Human being or person
refers to social being who
are rational and sentient.
• Person has ability to :
– set goals
– select means to achieve
– to make decision
• Human being has three
1. The need for the
that is unable at the
time when it is needed
and can be used
2. The need for care that
seek to prevent illness,
3. The need for care when
human beings are
unable to help
• Health involves dynamic
life experiences of a
human being, which
adjustment to stressors
in the internal and
through optimum use
of one’s resources to
potential for daily living.
• Environment is the
background for human
• It involves:
1. Internal environment:
transforms energy to enable
person to adjust to continuous
2. External environment: involves
formal and informal
organizations. Nurse is a part of
the patient’s environment.
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
• If transactions are made in nurse-client
interactions, growth & development will be
• 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.
• Inductive and deductive reasoning
• 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.
• Has been used for curriculum design in
nursing programs and framework for
• It provides a systematic means of viewing
the nursing profession, organizing a body
of knowledge for nursing, and clarifying
nursing as a discipline.
• Research can be designed and conducted
to implement this system in a hospital unit,
in ambulatory care, in community nursing,
and home care.
• 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
• Empirical Precision – goal attainment could be
measured along the effectiveness of nursing
• Derivable Consequences – theory deals with
choices, alternatives, participation of all
individuals in decision-making and specifically
deals with outcomes of nursing care.
• Tomey, A.M., (1994). Nursing Theorists
and Their Work. 3rd ed. Missouri: Mosby