“A professional nurse, withspecial knowledge and skills, anda client in need of nursing, withknowledge of self and perceptionof personal problems, meet asstrangers in naturalenvironment. They interactmutually, identify problems,establish and achieve goals.”
A. Getting to know the Theorist Imogene King was born in West Point, Iowa onJanuary 30, 1923, youngest of three children. She completed her diploma in nursing educationin 1945, at St. Johns 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 fromColumbia University, N.Y.
She has practiced as a staff nurse, nurseeducator, and nurse administrator. She formulated her theory while she was anassociate professor of nursing at LoyolaUniversity in Chicago. This was at the time nursing was emerging as aprofession and some nurses sought to challengethe existing role of nurses. King began her work in nursing theory with aconceptual framework. King considers her theory as a deviation fromsystems theory, with emphasis on interactiontheory.
In 1981 she refined her concepts into a nursingtheory that consisted of the following basis:1. An open system framework as the basisof goal attainment.2. Nursing as a major system within thehealth care system.3. Nursing process emphasis oninterpersonal processes. She Died on December 24, 1997, 2 days aftersuffering from stroke.
B. Theoretical Sources 1971, 1981: students, academic colleagues, nurseresearchers, and clinicians thinking 1981: General System Theory (Von Bertalanffy) conceptual framework 1988:Kaufman, Orlando and Peplau thinking
Kaufman’s 1958 doctoral dissertation exploreconcepts of perception, time and stressResearch conducted at Yale University School ofNursing to test Orlando’s (1961) theory of thedeliberative nursing process thinkingKing and Peplau (as cited in Takahashi, 1992)pointed out the connections between their works withregard to patient outcome.A review of her 1971 book by Rosemary Ellisencouraged her to continue her work by deriving a theoryfrom the General Systems Framework.The result…The Theory of Goal Attainment.
C. Use of Empirical EvidenceKing used a “systems” approach in the development of her Dynamic Interacting SystemsFramework and in her subsequent Goal-Attainment Theory.INTERACTING SYSTEMS FRAMEWORKThree systems in the conceptualframework:Personal System (the individual)Interpersonal System (individualsinteracting with one another)Social System (groups of people ina community/society sharingcommon goals, interests, andvalues)Study systems as a whole ratherthan as isolated parts of a system.
THEORY OF GOAL ATTAINMENT Elements are seen in the interpersonal systems inwhich two people, who are usually strangers,come together in a health care organization tohelp and be helped to maintain a state of healththat permits functioning of roles. Reflects King’s belief that the practice of nursing isdifferentiated from other healthcare professionsby what nurses do with and for individuals Nurse and client communicate information, setgoal mutually and then act to attain those goals
D. Metaparadigm in Nursing:1.Person:Imogene King described a person existing inan open system as a spiritual being andrational thinker who makes choices,selects alternative courses of action, and hasthe ability to record their history throughtheir own language and symbols, unique,holistic and have different needs, wants andgoals.
According to Imogene King, human beinghas three fundamental needs:Information on health that can beaccessed and utilized when neededCare that aims to prevent illnessCare in times of illness/helplessness
2.Health :According to Imogene King, health involvesdynamic life experiences of a human being,which implies continuous adjustment tostressors in the internal and externalenvironment through optimum use of one’sresources to achieve maximum potentialfor daily living.
3.Environment : It is the background forhuman interactions.It involves:a. Internal environment – transformsenergy to enable person to adjust tocontinuous external environmentalchanges.b. External environment – involves formaland informal organizations. Nurse is a partof the patient’s environment.
4. Nursing:Nursing for Imogene King is an act wherein thenurse interacts and communicates with the client.The nurse helps the client identify the existinghealth condition, exploring and agreeing onactivities to promote health. The goal of the nursein Imogene King’s theory is to help the clientmaintain health through health promotion andmaintenance, restoration, and caring for the sickand dying.
E. Theoretical AssertionFrom the theory of goal attainment ImogeneKing developed predictive propositions, whichincludes: If perceptual interaction accuracyis present in nurse-patient interactions, atransaction will happen. If nurse and client make transaction, goal willbe attained. If goal are attained, satisfaction will occur.
If goals are met, efficient nursing care willhappen. If transactions are made in nurse-clientinteractions, growth and development willbe enhanced If role expectations androle performance as perceived by nurseand client are congruent, transaction willoccur
If role conflict is experienced by nurse orclient or both, stress in nurse-clientinteraction will occur If nurse with special knowledge and skillcommunicate appropriate information toclient, mutual goal setting and goalattainment will occur.
The interaction of the person and thenurse is goal-directed and through this,both parties reach a common and accurateperception of the problem and means areexplored on how to resolve it.After the means exploration, goal-setting is made which is subject foragreement.Finally, transaction happens when theagreed goals are acted upon and necessaryactions are taken to achieve them. Finally,if the goals are attained, satisfaction willoccur and the health need fulfilled.
F. Acceptance by the Nursing CommunityResearch:Basis for development of middle-range nursingtheories: 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 StateUniversity School of Nursing) Educational reform resulting in nursing education(Sweden)Practice: A model for bedside nursing practice in the hospitalsetting (Coker & Schreiber, 1990) Managed care program in hospital settings (Hampton,1994) Goal-Oriented Nursing Record system for documentation Structure of Quality Assurance Program
G. AnalysisClarity: Clear and conceptually derived from researchliterature at the time the theory was developed.Generality: It has been criticized for having limitedapplications in areas of nursing in which patientsare unable to competently interact with the nurse. King has responded that 70% of communication isnonverbal.
Empirical Precision: From a study of 17 patients, goals were attained in 12cases (70%). King believes that if nursing students are taught thetheory of goal attainment and it is used in nursingpractice, goal attainment can be measured and theeffectiveness 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 mutualgoals, plan to provide alternative means to achievegoals, and evaluate to determine if the goal wasattained.