kings Goal Attainment Theory

1. Imogene King’s Goal
Attainment Theory
PRESENTED BY: ANJALI ARORA
M.SC. NURSING -1ST YEAR
COLLEGE OF NURSING
INSTITUTE OF LIVER AND BILIARY SCIENCES

2. Name Of Evaluator: Ms. Tarika Sharma
(Assistant Professor)

3. Nursing Theories are
organized bodies of
knowledge to define
what nursing is, what
nurses do, and why do
they do it.

5. Imogene king‘s Goal Attainment theory states that the nurse is considered
part of the patient’s environment and the Nurse-Patient Relationship is for
meeting goals towards good health.

6. Introduction
 Born in Jan,1923 in west point, Lowa
 Earned a diploma in nursing from St.
John’s Hospital of Nursing in St Louis in
1945.
 Worked as staff nurse, school nurse, and
private duty nurse to support herself while
studying for a degree.
 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
1961.

7. Introduction
 She served as faculty member at St
John's Hospital School of Nursing.
 She was also the Director of the
School of Nursing at Ohio State
University.
 She was an Assistant chief of the
Research Grants Branch, Department
of Health, Education and Welfare, in
the mid-1960s.
 She had been active in sports as an
observer of basketball and football
games and active participant in Tennis
and Golf.
 She had enjoyed art by Painting
Pretty Pictures

8. Impetus to write about
Nursing
In the 1960s, as
emerging
professionals, nurses
were identifying the
knowledge base
specific to nursing
practice and to an
expanding role for
nurses.
In 1964, Imogene M
King published a paper
discussing problems
and prospects to the
development of
nursing knowledge.
In 1968, she first
identified several
concepts, she later
used in her conceptual
system and continued
to discuss the need for
a nursing knowledge
base.
Even though these concepts still provide food for thought

9. King towards a theory for
Nursing
King identified her work as a
conceptual system. The function of
a conceptual system is to give
support for arranging ideas or
concepts into group that provides
meaning.
As the theory of goal attainment
is derived from the conceptual
system, the conceptual system and
its assumptions and concepts are
presented first and then the goal
attainment theory

10. King's conceptual system
1
• Concepts are necessary to Nursing as a discipline
2
Provide the derivation of theories
3
Provide an organizing structure for Nursing Curriculum
4
• Supports quality care in all settings in which Nursing occurs

11. The conceptual system
Goal Structure Functions Resources
Decision
Making
ESSENTIAL ELEMENTS

12. The conceptual system
Personal system
Interpersonal
system
Social system

14. THEORY OF GOAL
ATTAINMENT
 Theories may be derived from conceptual frameworks
 King has derived a theory of goal attainment from the concepts and
systems of her conceptual system.

15. Many people decide to pursue a career in nursing because they want
to be instrumental in helping patients get healthy.
In order to do that it is necessary to set health goals with the patient
and then take steps to achieve those goals.
 This theory focuses on this process to aid nurses in the Nurse Patient
Relationship, helping the patients to meet the goals they have set for their
health.
 The theory focus on interpersonal systems reflects that the practice of
nursing and is differentiated from that of other health professions by what
nurses do with and for individuals.

16.  The interpersonal system 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 in roles.

18. The concepts used
Interaction Perception Communication Transaction Role
Decision
Making
concepts are interrelated in every nursing situation.

19. Concepts
Interaction
• observable verbal and nonverbal goal directed behavior and judgment
or decision to act and then each reacts to the other
Perception
• Reality as seen by each individual and exporting information in the
form of observable behaviors.
Communicatio
n
• Exchange of information may occur within a person as well as between
people.

20. Concepts
Transaction
• Series of exchange and represent the aspect of human interactions
in which values are apparent
Role
• Role is defined as a set of expected behaviors and position held by the
person.
Decision
Making
• The process of making choices and then evaluating the results in relation to
goals achieved.

21. Interaction vs Transaction
Interaction Transaction
 The patient and nurse share different ideas
and perceptions with each other.
 Observation occurs both verbally and
nonverbally.
 Both the nurse and the patient make
perceptions and decide to act on the shared
information.
• From the ideas and perceptions shared
between the nurse and the patient, goals are
set.
• Setting goals requires compromising and
social exchange.
• When transactions occur, goals are attained.
• Bargaining and negotiation of priorities occurs
in transaction.

22. Case Study
His perception (Personal system) of his own health is not what his daughter (Interpersonal system) sees.
The situation is that the patient thinks he can go back home once his exacerbation subsides.
Mr. Jones hears his daughter's conversation with the nurse and is quick to state that he wants to return to his
home. The nurse, patient and daughter share their individual discharge goals.
Mr. Jones comes in from home with a COPD exacerbation. He arrives with his daughter. The nurse
notes that the patient's hygiene and nutrition status appear neglected. The daughter states that she is
concerned about her father's forgetfulness.

23. Case Study
The Plan of Care will also involve the daughter for assistance with goal setting and decision
making
The goal is health restoration and maintenance for the patient and Plan of Care is mutually set
by the nurse and the patient.
The patient initially set a goal to return home without assistance. The nurse and the daughter
agreed that the patient needed assistance in order for the patient to return home.
The daughter is obviously stressed about the state of her dad and her own ability to continue
taking care of him.

24. Case Study
Evaluation of goals indicate that both Mr. Jones and his daughter, as well as the nurse, are in
agreement with the discharge plan.
Adult Day Care is arranged twice a week to provide social interaction for the patient and respite
care for his daughter.
With the involvement of Social Work, visiting nurses are set up three times a week for bathing
assistance.

25. Transaction Process Model

26. Law of Nurse-Patient Interaction
“Nurses and patients in presence,
interacting purposefully, make
transactions in nursing situations based on
each individual's perceptions, purposeful
communication and valued goals”.

30. Transaction Process Model

33. Assumptions
 Nursing focus is the care of human being.
 Nursing goal is the health care of individuals & groups
 Human beings: are open systems interacting constantly with their environment.
 Nurse and Client communicate information, set goal mutually and then act to attain
those goals.
 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”

34. Propositions
 If perceptual interaction accuracy is present in nurse client interaction, Transaction will
occur.
 If nurse and client make transaction, goal will be attained
 If goals are attained, satisfaction will occur
 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 ate
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.

35. Nursing
Metaparadigm
Human Beings
Health
Environment/ Society
Nursing

36. Person
• Human being or person refers to
social being who are rational and
sentient.
• Person has ability to :
– perceive
– think
– feel
– choose
– set goals
– select means to achieve goals and
– to make decision

37. Health
• 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.

38. Environment
• Environment is the
background for human
interactions.
• It involves:
1. Internal environment: transforms
energy to enable person to adjust
to continuous external
environmental changes.
2. External environment: involves
formal and informal organizations.
Nurse is a part of the patient’s
environment.

39. Nursing
A process of action, reaction and interaction
by which nurse and client share information
about their perception in nursing situation,
they set goals, explore means, and agree on
means to achieve goals.”
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.

41. Theory of Goal Attainment
and the Nursing Process
Nurses and clients communicate information, set Goals mutually and
then act to attain those goal is also the basic assumption of the
Nursing Process.
King described the steps of the Nursing Process as a system of interrelated
actions and identified concepts that provide the theoretical basis for the Nursing
Process as method.
1
2

43. NURSING CARE PLAN

44. Utilization of the Theory
 Provides a theoretical base for Nursing Process.
 Demonstrates a way for Nurses to interact purposefully with Patients.

45. APPLICATIONS
OF
THEORY

46. Practice
 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.
 King's systems framework and theory have been implemented in a variety of
National and International practice Settings.
 King Developed a documentation system, a Goal Oriented Nursing Record
(GONR) to accompany the theory.

47. GONR
 It is a method of collecting data, identifying problems, and implementing and
evaluating care that has been used effectively in patient setting
 The major elements of GNOR system are:
 Database
 Goal list
 Flow sheets
 Discharge summary
 Nursing Diagnose
 Nursing orders
 Progress Notes

48. Education
 Has been used for curriculum design in Nursing programs and
framework for books.
 It provides a systematic means of viewing the nursing profession,
organizing a body of knowledge for nursing, and clarifying nursing as a
discipline.

49. Research
 Research can be designed and conducted to implement this system in a
hospital unit, in ambulatory care, in community nursing, and home care.

53. Strengths
 Easily understood.
 Clear and conceptually defined from research literature at the time when the
theory was developed.

54. Limitations
 Social System is not clearly connected to the theory, which leads to limitations
of utilizing the theory in nursing care with groups, families and communities.
 King's theory presents nine major concepts, thus making theory complex.
 King's theory has been criticized for having limited application in areas of
nursing where patients are unable to interact with the nurse in case of
unconscious and psychiatric patients.
 King took learning and control as a sub-concept but does not define it.

55. Summary

56. Conclusion

57. References
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Quarterly, 23(2) Thousand Oaks, CA: Sage Chitty, K. K.,& Black, B. P. (2011).
Professional nursing: Concepts and Challenges (6th ed.). Maryland Heights, MO: Saunders Clarke,
P. N., Killeen, M. B., Messmer, P. R., & Sieloff, C. L. (2009).
Imogene M. King's scholars reflect on her wisdom and influence on nursing science. Nursing
Science Quarterly, 22(2) doi: /Fitzpatrick, J. J., & Whall, A. L. (2005).
Conceptual Models of Nursing: Analysis and Application (4th ed.). Upper Saddle River, NJ:
Pearson. Frey, M., Norris, D., & Sieloff, C. (2002).
King’s Conceptual System and Theory of Goal Attainment: Past, Present, and Future. Nursing
Science Quarterly, April 2002; vol. 15, 2: pp