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Imogene king


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Imogene King: Theory of Goal Attainment and Interacting Systems Framework

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Imogene king

  1. 1. BRIEF BIOGRAPHY: Who is Imogene King?  January 30, 1923: Born in West Point, Iowa. Youngest of the 3 children  1945: Nursing Diploma from St. John’s Hospital School, St. Louis, Missouri  1948: BSN from St. Louis University  1957: MSN from St. Loius University  1961: EdD from Teacher’s College, Columbia University, New York
  2. 2.  1947-1958: Med-Surg Nursing Instructor and Asst. Director of St. John’s Hospital School of Nursing  1966-1968: Asst. Chief, Research Grants Branch, Division of Nursing, Washington D.C.  1968-1972: Director, School of Nursing at Ohio State University  1961-1966: Associate Professor at Loyola University, Chicago  1971-1980: Professor at Loyola University, Chicago
  3. 3.  1990: Retired with the title Professor Emeritus after serving as Professor at University of South Florida, College of Nursing  Continued to speak at conferences around the world and consulted with students who were using and studying her theory  December 24, 1997: She died, 2 days after suffering from stroke
  4. 4. CONCEPTUAL FRAMEWORK  Imogene King’s Interacting Systems Framework emphasizes the importance of the interaction between nurses and patients.  It views this interaction as an open system which is in constant interaction with a variety of environmental factors.  3 Systems: Personal, Interpersonal and Social Systems
  5. 5. PERSONAL SYSTEM: perception, self, growth and development, body image, space, and time  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.
  6. 6.  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.
  7. 7. INTERPERSONAL SYSTEM: interaction, communication, transaction, role, and stress  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.
  8. 8.  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.
  9. 9. SOCIAL SYSTEM: organization, authority, power, status, decision-making and control  Organization—composed of human beings with prescribed roles and positions who use resources to accomplish personal and organizational goals.  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.
  10. 10.  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
  11. 11. THEORY ASSERTIONS  King’s Theory of Goal Attainment focuses on the interpersonal system and the interactions that take place between individuals, specifically in the nurse-patient relationship.  King developed eight propositions in her Theory of Goal Attainment. These propositions are the following:
  12. 12. 1. If perceptual congruence is present in nurse-client interactions, transactions will occur. 2. If nurse and client make transactions, goals will be attained. 3. If goals are attained, satisfactions will occur. 4. If goals are attained, effective nursing care will occur. 5. If transactions are made in nurse-client interactions, growth and development will be enhanced.
  13. 13. 6. If role expectations and role performance as perceived by nurse and client are congruent, transactions will occur. 7. If role conflict is experienced by nurse and client or both, stress in nurse-client interactions will occur. 8. If nurses with special knowledge and skills communicate appropriate information to clients, mutual goal setting (transactions) and goal attainment will occur.
  14. 14.  Action is defined as a sequence of behaviors involving mental and physical action.  The sequence is first mental action to recognize the presenting conditions; then physical action to begin activities related to those conditions; and finally, mental action in an effort to exert control over the situation, combined with physical action seeking to achieve goals.  Reaction is not specifically defined but might be considered to be included in the sequence of behaviors described in action.
  15. 15.  Interaction is a process of perception and communication between person and environment and between person and person represented by verbal and nonverbal behaviors that are goal-directed.  Transaction is a process of interactions in which human beings communicate with the environment to achieve goals that are valued; transactions are goal-directed human behaviors.
  16. 16. METAPARADIGM: PERSON  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.
  17. 17.  King’s theory of goal attainment identified three basic health needs of man/person: 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. 3. The need for care when human beings are unable to help themselves.
  18. 18. METAPARADIGM: HEALTH  It is a dynamic state in the life cycle; illness interferences with that process.  Health implies continuous adjustment to stress in the internal and external environment through optimum use of one’s resources to achieve maximum potential for daily living.
  19. 19. METAPARADIGM: ENVIRONMENT  King defined Environment as the process of balance involving internal and external interactions inside the social system.  Reactions from the interaction between the internal and external environment can be biological, psychological, physical, social or spiritual.  It has a direct exchange of information between the internal and external.
  20. 20. METAPARADIGM: NURSING  Nursing is a process of action, reaction, and interaction whereby nurse and client share information about their perceptions in the nursing situation.  The nurse and client share specific goals, problems, and concerns and explore means to achieve a goal.
  21. 21.  In addition, King also discusses the following:  GOAL of a NURSE: To help individuals to maintain their health so they can function in their roles.  DOMAIN of a NURSE: Includes promoting, maintaining, and restoring health, and caring for the sick, injured and dying.  FUNCTIONS of a NURSE: To interpret information in nursing process to plan, implement and evaluate nursing care.
  22. 22. APPLICATIONS OF THE THEORY PRACTICE:  Professionals have used King’s theory in different specialized area with the use of dynamic interactive communication between the nurse and the client as proof.  Professionals need communication to successfully and correctly make decisions for their plan of care.
  23. 23.  King also developed the Goal Oriented Nursing Record (GONR) from her theory. GONR have been useful in documenting the outcomes of care that was performed by nurses.  It helps nurses to easily facilitate the present problem from careful assessment of the client gathered through the interactive communication process between the nurse and the client.  Her record management facilitates proper and correct range for the use of evaluation system.
  24. 24.  The significance of King’s Goal Attainment Theory have been applied to different professional practice setting such as in nursing administration, theory- based practice in the emergency department , in tertiary hospitals and in the community.
  25. 25. EDUCATION:  King’s interacting system has been used to design the nursing curriculum in different schools and universities and framework for nursing education.  It provides a systematic means of viewing the nursing profession, organizing nursing knowledge and clarifying the nursing discipline.
  26. 26.  Based on King’s guidelines, the focus of a Nursing curriculum must be the dynamic nurse-client interaction.  Nursing education programs must prepare nursing students to become useful, productive, and relatively happy citizens as well as professional practitioners as they acquire knowledge, values and skills in the practice of nursing.
  27. 27. RESEARCH  King’s theory has been one of the theoretical basis of some researches that helped in formulating a system view of application of the nursing practice.  Some researchers have formulated a middle range theory out of King’s theory such as patient’s satisfaction from nursing care, clients with chronic illness and family health.
  28. 28.  Here are two of out of the many researches which based upon King’s Goal Attainment Theory and Interacting System:  Application of King's Theory of Dynamic Interacting Systems to the Study of Child Abuse and the Development of Alcohol Use/Dependence in Adult Females by Mckinney and Dean  Imogene King's Interacting Systems Theory: Application to emergency and rural nursing by Williams
  29. 29. CRITIQUE OF THE THEORY SIMPLICITY  King’s definitions are clear and are conceptually derived from research literature that existed at the time the definitions were published.  Her theory presents ten major concepts, making the theory complex.  However, these concepts are easily understood and, with the exception of the concept of self, they have been derived from the research literature.
  30. 30. GENERALITY  King’s theory has been said to have limited application for the nursing practice.  It was stated that the interaction between the nurse and the client also comprises non-verbal communication that cannot be clearly defined and evaluated.  This has been the issue of the communication barriers that exist between the nurse-patient relationships.
  31. 31.  King believed that critics assume that a theory will address every person, event, and situation, which is clearly impossible. King addresses this critique through concepts of other theorist that cannot also be tested.
  32. 32. EMPIRICAL PRECISION  King gathered empirical data on the nurse- patient interaction process that leads to goal attainment.  King believe that, if nursing students were taught the transactual process in 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.
  33. 33.  Multiple research studies provide additional and ongoing research evidence of the empirical precision of the Theory of Goal Attainment.  As her theory has been used by different nursing students and other allied nursing practitioner, it is noted that her theory can be used to measure the effectiveness of nursing care provided to clients.
  34. 34. DERIVABLE CONSEQUENCES  King’s Theory of Goal Attainment focuses on all aspects of the nursing process: assessment, planning, implementation and evaluation.  She believed that nurses must assess to set mutual goals, plan to provide alternative means to achieve goals, and evaluate to determine whether goals are attained.
  35. 35.  Healthcare professionals have used, and continue to use, King’s conceptual system and middle range: Theory of Goal Attainment to implement theory-based practice in various nursing practice in worldwide settings.  King’s work has demonstrated over time to be a structured framework for curriculum development at various educational levels.
  37. 37. SAFE & QUALITY NURSING CARE  Through constant interactions and transactions between the patient and the nurse, the nurse could identify health needs and problems of the patient so that mutual goals are attained.  Both the utilization of the King’s theory and the GONR, nurses could provide individualized plans of care.  Thorough assessment of the patient’s need, nurses could prevent unnecessary actions and mistakes in giving safe and quality nursing care to the patients.
  38. 38. MANAGEMENT OF RESOURCES AND ENVIRONMENT  King’s theory somehow may not be relevant or applicable in matters of resource management. HEALTH EDUCATION  In the Goal Attainment Model, interaction between nurse and patient occurs, transaction is achieved or goal is attained furthermore the theory encourages feedback especially from the patient in order for the nurse to determine if methods are effective or not.  Learning is a two-way process and one of the ways that the nurse could educate his/her patient is through mutual interaction which could possibly lead to goal attainment.
  39. 39. LEGAL RESPONSIBILITY  King’s theory somehow may not be relevant or applicable in matters of legal responsibilities. ETHICO-MORAL RESPONSIBILITY  In respecting patient’s rights, King’s theory encourages the importance of interaction between nurses and patients so that there is an active participation of patients in the decision-making phase of the nursing care plan.
  40. 40. PERSONAL AND PROFESSIONAL DEVELOPMENT  King’s theory provides enough direction to how nurses should be able to behave or act in the presence of patients.  Since majority of nursing activities involve direct interaction with patients, nurses should understand the basic implications of the action-reaction- interaction-transaction model of nurse- client relationships.
  41. 41. QUALITY IMPROVEMENT  The theory emphasizes interaction between the nurse and client with that the nurse encourages the patients to verbalize relevant changes and concerns regarding his/her care.  The nurse could gather and analyze data, implement proper actions and evaluate care through the use of King’s theory and possibly through GONR.  If goals are attained, patient satisfaction occurs and quality improves.
  42. 42. RESEARCH  The theory can help set a framework for nursing studies which can further prove the use and advantages of the nursing practice.  The nurse can also utilized King’s GONR which is a method of collecting data, identifying problems, implementing and evaluating care that has been used effectively in patient settings.
  43. 43. RECORDS MANAGEMENT  King developed a documentation system, Goal-Oriented Nursing Record (GONR) which documents the effectiveness of nursing care.  The major elements in this record system are: database, nursing diagnosis, goal list, nursing orders, flow sheets, progress notes and discharge summary.
  44. 44. COMMUNICATION  Communication is a vital concept in the Theory of Goal Attainment because it emphasizes the importance of the interaction between nurses and patients.  Through this, the nurse could establish rapport with the patients, folks and also colleagues in order for them to achieve their goals in a mutual setting.  If there is no communication, there is no interaction and it follows that transactions can’t occur, therefore, no goals are attained.
  45. 45. COLLABORATION AND TEAMWORK  King’s theory and the GONR are useful in practice because nurses have the ability to provide individualized care plans while encouraging active participation from the patients and colleagues in the decision-making phase.  Through this theory, we could achieve good interpersonal relationship with clients, folks and colleagues as well.
  46. 46. REFERENCES  Tomey, AM & Alligood, MR (2008) Nursing Theorists and their Work, 6th Edition, Mosby and Philadelphia  Octaviano, E. & Balita, C. (2008) Theoretical Foundations of Nursing: The Philippine Perspective, Ultimate Learning Series  Bautista, J. (2009) Theoretical Foundations of Nursing: A Beginner’s Journey into Professional Nursing, Revised Edition   king.html  ment_theory.html