Imogene King developed her Theory of Goal Attainment in the 1970s and 1980s based on von Bertalanffy's General Systems Theory. King received her nursing education and degrees between 1945-1961. Her theory views individuals and nursing as purposeful interacting systems, and proposes that if nurse and client perceptions and goals are congruent through transaction processes, goals will be attained. King's theory has been widely used in nursing education and research internationally. Martha Rogers first described her Science of Unitary Human Beings in 1961, viewing individuals as unitary energy fields in continuous interaction with the environment. Her theory was influenced by quantum physics and systems theories. Rogers earned her nursing diploma and degrees between 1936-1954,

1. Imogene King: King’s Conceptual System and Theory of Goal
Attainment and Transactional Process
King’s theory evolved from early writings about theory
development. In her first book in 1971, she
synthesized scholarship from nursing and related disciplines
into a theory for nursing (King, 1971). She wrote
the Theory of Goal Attainment in 1980. The most recent edition
(King, 1995a) contains further refinements
and more detailed explanation of the general nursing framework
and the theory.
Background of the Theorist
Imogene King graduated from St. John’s Hospital School of
Nursing in St. Louis, Missouri, with a diploma in
nursing in 1945. She received a bachelor of science in nursing
education from St. Louis University in 1948
and a master’s of science in nursing from the same school in
1957. In 1961, she received the doctor of
education degree from Teacher’s College, Columbia University,
in New York (Sieloff & Messmer, 2014).
She held a variety of staff nursing, educational, research, and
administrative roles throughout her professional
life. She worked as a research consultant for the Division of
Nursing in the Department of Health, Education,
and Welfare for several years before moving to Tampa, Florida,
in 1980, assuming the position of professor at
the University of South Florida College of Nursing (Sieloff &
Messmer, 2014). She remained active in
professional organizations for many years. When she died in
2008, her work was widely celebrated by her
colleagues (Mensik, 2008; Mitchell, 2008; Smith, Wright, &
Fawcet, 2008; Stevens & Messmer, 2008).
Philosophical Underpinnings of the Theory
The von Bertalanffy General Systems Model is acknowledged to
be the basis for King’s work. She stated that

2. the science of wholeness elucidated in that model gave her hope
that the complexity of nursing could be
studied “as an organized whole” (King, 1995b, p. 23).
Major Assumptions, Concepts, and Relationships
King’s conceptual system and theory contain many concepts and
multiple assumptions and relationships. A
few of the assumptions, concepts, and relationships are
presented in the following sections. The scholar
wishing to use King’s model or theory is referred to the original
writings as both the model and theory are
complex (Figure 8-2).
Figure 8-2 A model of nurse–patient interactions.
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(Source: King, I. M. [1981]. A theory for nursing: Systems,
concepts, process [p. 61]. Reprinted with permission of Sage
Publications.)
Assumptions
The Theory of Goal Attainment lists several assumptions
relating to individuals, nurse–client interactions, and
nursing. When describing individuals, the model shows that
individuals (1) are social, sentient, rational,
reacting beings and (2) are controlling, purposeful, action
oriented, and time oriented in their behavior (King,
1995b).
Regarding nurse–client interactions, King (1981) believed that
(1) perceptions of the nurse and client
influence the interaction process; (2) goals, needs, and values of
the nurse and client influence the interaction
process; (3) individuals have a right to knowledge about
themselves; (4) individuals have a right to participate
in decisions that influence their lives, health, and community
services; (5) individuals have a right to accept or
reject care; and (6) goals of health professionals and goals o f
recipients of health care may not be congruent.
With regard to nursing, King (1995b) wrote that (1) nursing is
the care of human beings; (2) nursing is

3. perceiving, thinking, relating, judging, and acting vis-à-vis the
behavior of individuals who come to a health
care system; (3) a nursing situation is the immediate
environment in which two individuals establish a
relationship to cope with situational events; and (4) the goal of
nursing is to help individuals and groups
attain, maintain, and restore health. If this is not possible,
nurses help individuals die with dignity.
Concepts
King’s Theory of Goal Attainment defines the metaparadigm
concepts of nursing as well as a number of
additional concepts. Table 8-4 lists some of the major concepts.
Table 8-4 Major Concepts of the Theory of Goal Attainment
Concept Definition
Nursing 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.
Health A dynamic life experience 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.
Individuals Social beings who are rational and sentient. Humans
communicate their thoughts,
actions, customs, and beliefs through language. Persons exhibit
common
characteristics such as the ability to perceive, to think, to feel,
to choose between
alternative courses of action, to set goals, to select the means to
achieve goals, and
to make decisions.
Environment The background for human interactions. It is both
external to and internal to the

4. individual.
Perception The process of human transactions with
environment. It involves organizing,
interpreting, and transforming information from sensory data
and memory.
Communication A process by which information is given from
one person to another, either directly
in face-to-face meetings or indirectly. It involves intrapersonal
and interpersonal
exchanges.
Interaction 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 A process of interactions in which human beings
communicate with the
environment to achieve goals that are valued; transactions are
goal-directed human
behaviors.
Stress A dynamic state in which a human interacts with the
environment to maintain
balance for growth, development, and performance; it is the
exchange of
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information between human and environment for regulation and
control of
stressors.
Source: King (1981).
Relationships
The Theory of Goal Attainment encompasses a great many
relationships, many of them complex. King
organized them into useful propositions that enhance the
understanding of the relationships of the theory. A
review of some relationships among the theory’s concepts
follows:

5. Nurse and client are purposeful interacting systems.
Nurse and client perceptions, judgments, and actions, if
congruent, lead to goal-directed transactions.
If perceptual accuracy is present in nurse–client interactions,
transactions will occur.
If nurse and 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 nurse–client interactions, growth and
development will be enhanced.
If role expectations and role performance as perceived by nurse
and client are congruent, transactions
will occur.
If role conflict is experienced by nurse or client or both, stress
in nurse–client interactions will occur.
If nurses with special knowledge and skills communicate
appropriate information to clients, mutual
goal setting and goal attainment will occur (King, 1981, pp. 61,
149).
Usefulness
King’s Theory of Goal Attainment has enhanced nursing
education. For example, it served as a framework for
the baccalaureate program at the Ohio State University School
of Nursing, where it determined the content
and processes taught at each level of the program (Daubenmire,
1989). Similarly, in Sweden, King’s model
was used to organize nursing education (Frey, Rooke, Sieloff,
Messmer, & Kameoka, 1995). In more recent
years, King’s model has been useful in nursing education
programs in Sweden, Portugal, Canada, and Japan
(Sieloff & Messmer, 2014).
King’s conceptual system is an organizing guide for nursing
practice. In one example, Caceres (2015)
used King’s Theory of Goal Attainment to explore and expand
upon the concept of functional status,
concluding that evaluation of functional status is vital and

6. should be incorporated within mutual decisionmaking
processes from the client family’s perspective. M. L. Joseph,
Laughon, and Bogue (2011) examined
the “sustainable adoption of whole-person care” (p. 989) in a
Florida hospital guided by King’s Theory of
Goal Attainment. Finally, Gemmill and colleagues (2011)
assessed nurses’ knowledge about and attitudes
toward ostomy care using King’s Theory of Goal Attainment to
guide the research. Their findings explained
that it is difficult for staff nurses to maintain their clinical
abilities when there are few opportunities.
Maintaining currency may require creative teaching
interventions, such as simulations.
Testability
Parts of the Theory of Goal Attainment have been tested, and a
number of research studies reported in the
literature used the model as a conceptual framework. For
example, recent research includes a study by L.
Joseph (2013) who used King’s Theory of Goal Attainment to
evaluate the effectiveness of a teaching
program to improve accuracy on pediatric growth
measurements. In other works, Chacko, Kharde, and
Swamy (2013) used King’s theory as the framework to assess
the efficacy of use of infrared lamps on
reducing pain and inflammation due to episiotomy, and Isac,
Venkatesaperumal, and D’Sousa (2013) used
King’s theory to develop and evaluate the efficacy of a nurse-
led information desk on assisting patients to
manage their sickle cell disease.
Parsimony
The conceptual system and theory were presented together in
several versions of King’s writings and remain
largely as written in 1981. The theory is not parsimonious,
having numerous concepts, multiple assumptions,
174
many statements, and many relationships on a number of levels.

7. This complexity, however, mirrors the
complexity of human transactions for goal attainment. The
model is general and universal and can be the
umbrella for many midrange and practice theories.
Value in Extending Nursing Science
In addition to application in practice and research described
previously, King’s work has been the basis for
development of several middle range nursing theories. For
example, the Theory of Goal Attainment was used
by Rooda (1992) to develop a model for multicultural nursing
practice. King’s Systems Framework was
reportedly used by Alligood and May (2000) to develop a theory
of personal system empathy and by
Doornbos (2000) to derive a middle range theory of family
health.
King’s conceptual system and theory have been used
internationally in Australia, Brazil, Canada,
Pakistan, and Sweden, as well as in numerous university nursing
programs in the United States, and have
provided a foundation for many research studies. Her work has
extended nursing science by its usefulness in
education, practice, and research across international
boundaries (King, 2001; Sieloff & Messmer, 2014).

8. Martha Rogers: The Science of Unitary and Irreducible Human
Beings
Martha Rogers first described her Theory of Unitary Man in
1961, and almost from the first, there has been
187
widespread controversy and debate among nursing theorists and
scholars regarding her work (Phillips, 2010,
2016). Prior to Rogers, it was rare that anyone in nursing
viewed human beings as anything other than the
receivers of care by nurses and physicians. Furthermore, the
health care system was organized by
specialization, in which nurses and other health providers
focused on discrete areas or functions (e.g., a
dressing change, medication administration, or health teaching)
rather than on the whole person. As a result, it
took many professionals working in isolation, none of whom
knew the whole person, to care for patients.
Rogers’s (1970) insistence that the person was a “unitary energy
system” in “continuous mutual interaction
with the universal energy system” (p. 90) dramatically
influenced nursing by encouraging nurses to consider
each person as a whole (a unity) when planning and delivering
care. Phillips (2013) states that Rogers’s
“vision was concerned with unitary wholes, a vision she used in
creating the science of unitary human beings
(SUBH) . . . ” (p. 241). A new and dramatically different ideal
in health care.
Background of the Theorist
Martha Rogers was born on May 12, 1914 (the anniversary of
Florence Nightingale’s birth) (Dossey, 2010),
in Dallas, Texas. She earned a diploma in nursing from
Knoxville General Hospital in 1936 and a bachelor’s
degree from George Peabody College in Nashville, Tennessee,
in 1937. She later received a master’s degree
in public health nursing from Teachers College, Columbia
University in New York, and a master’s degree in

9. public health and a doctor of science from The Johns Hopkins
University in Baltimore, Maryland (Gunther,
2014).
Rogers became the head of the Division of Nursing of New
York University (NYU) in 1954, where she
focused on teaching and formulating and elaborating her theory
(Hektor, 1989). She was teacher and mentor
to an impressive list of nursing scholars and theorists, including
Newman and Parse, whose works are
described later in the chapter. Rogers continued her work and
writing until her death in March 1994.
Philosophical Underpinnings of the Theory
The Science of Unitary and Irreducible Human Beings started as
an abstract theory that was synthesized from
theories of numerous sciences; therefore, it was deductively
derived. She drew from Einstein’s Theory of
Relativity as well as Heisenberg’s Uncertainty Principle to
demonstrate the unpredictability of this universe
(Caratao-Mojica, 2015). Of particular importance was von
Bertalanffy’s theory on general systems, which
contributed the concepts of entropy and negentropy and posited
that open systems are characterized by
constant interaction with the environment. The work of
Rapoport provided a background on open systems,
and the work of Herrick contributed to the premise of evolution
of human nature (Rogers, 1994).
Rogers’s synthesis of the works of these scientists formed the
basis of her proposition that human systems
are open systems embedded in larger, open environmental
systems. She also brought in other concepts,
including the idea that time is unidirectional, that living
systems have pattern and organization, and that man
is a sentient, thinking being capable of awareness, feeling, and
choosing. From all these theories, and from her
personal study of nature, Rogers (1970) developed her original
Theory of Unitary Man. She continuously

10. refined and elaborated her theory, which she retitled Science of
Unitary Humans (Rogers, 1986) and, finally,
shortly before her death, the Science of Unitary and Irreducible
Human Beings (Rogers, 1994).
Major Assumptions, Concepts, and Relationships
Assumptions
Rogers (1970) presented several assumptions about man. These
are as follows:
Man is a unified whole possessing integrity and manifesting
characteristics that are more than and
different from the sum of his parts (p. 47).
Man and environment are continuously exchanging matter and
energy with one another (p. 54).
The life process evolves irreversibly and unidirectionally along
the space–time continuum (p. 59).
Pattern and organization identify man and reflect his innovative
wholeness (p. 65).
Man is characterized by the capacity for abstraction and
imagery, language and thought, sensation, and
emotion (p. 73).
Rogers (1990) later revised the term man to human being to
coincide with the request for gender-neutral
188
language in the social sciences and nursing science.
Concepts
In Rogers’s work, the unitary human being and the environment
are the focus of nursing practice. Other
central components are energy fields, openness,
pandimensionality, and pattern; these she identified as the
“building blocks” (Rogers, 1970, p. 226) of her system. Rogers
also derived three other components for the
model, which served as a basis of her work. These were based
on principles of homeodynamics and were
termed resonancy, helicy, and integrality (Rogers, 1990) (Box
9-1). Definitions of the nursing metaparadigm
concepts and other important concepts in Rogers’s work are

11. listed in Table 9-1.
Box 9-1 Principles of Homeodynamics Applied in Rogers’s
Theory
1. Resonancy is continuous change from lower to higher
frequency wave patterns in human and
environmental fields.
2. Helicy is continuous innovative, unpredictable, increasing
diversity of human and environmental field
patterns.
3. Integrality is continuous mutual human and environmental
field processes.
Source: Rogers (1990, p. 8).
Table 9-1 Central Concepts of Rogers’s Science of Unitary
Human Beings
Concept Definition
Human–unitary human beings “Irreducible, indivisible,
multidimensional energy fields identified by
pattern and manifesting characteristics that are specific to the
whole
and which cannot be predicted from the knowledge of the parts”
(p. 7).
Health “Unitary human health signifies an irreducible human
field
manifestation. It cannot be measured by the parameters of
biology or
physics or of the social sciences” (p. 10).
Nursing “The study of unitary, irreducible, indivisible human
and
environmental fields: people and their world” (p. 6). Nursing is
a
learned profession that is both a science and an art.
Environmental field “An irreducible, indivisible,
pandimensional energy field identified by
pattern and integral with the human field” (p. 7).
Energy field “The fundamental unit of the living and the non-
living. Field is a

12. unifying concept. Energy signifies the dynamic nature of the
field; a
field is in continuous motion and is infinite” (p. 7).
Openness Refers to qualities exhibited by open systems; human
beings and their
environment are open systems.
Pandimensional “A nonlinear domain without spatial or
temporal attributes” (p. 28).
Pattern “The distinguishing characteristic of an energy field
perceived as a
single wave” (p. 7).
Source: Rogers (1990).
Relationships
The Science of Unitary and Irreducible Human Beings is
fundamentally abstract; therefore, specifically
defined relationships differ from those in more linear theories.
The major components of Rogers’s model
revolve around the building blocks (energy fields, openness,
pattern, and pandimensionality) and the
principles of homeodynamics (resonancy, helicy, and
integrality). These explain the nature of, and direction
of, the interactions between unitary human beings and the
environment.
189
Among the relationships that Rogers posited are that all things
are integral in that their energy fields are in
continuous mutual process and that pattern is the manifestation
of the integrality of each entity and of the
environmental energy field (Rogers, 1986). Other major
relationships within Rogers’s (1990) work are
contained in the following statements:
Humans and environment are interrelated in that neither “has an
energy field,” both are integral energy
fields (pp. 6–7).
Manifestations of pattern emerge out of the
human/environmental field mutual process and are

13. continuously innovative (p. 8).
The group field is irreducible and indivisible to itself and
integral with its own environmental field (p. 8).
Nursing is concerned with maintaining and promoting health,
preventing illness, and caring for those who are
sick or disabled. The purpose of nursing for Rogers (1986) is to
help human beings achieve well-being within
the potential of each individual, family, or group. Because
human energy fields are complex, individualizing
nursing services supports simultaneous human and
environmental exchange, encouraging health (Rogers,
1990).
Usefulness
Rogers’s theory is a synthesis of phenomena that are important
to nursing. It is an abstract, unified, and highly
derived framework and does not define particular hypotheses or
theories. Rather, it provides a worldview
from which nurses may derive theories and hypotheses and
propose relationships specific to different
situations. In essence, the theory allows many options for
studying humans as individuals and groups and for
studying various situations in health as manifestations of
pattern and innovation. Rogers’s model stresses the
unitary experience and provides an abstract philosophical
framework that can guide nursing practice.
Rogers’s theory has been evident in nursing education,
scholarship, and practice for more than four
decades. In education, among other programs, it has guided the
nursing curriculum at NYU, where Rogers
was head of the Division of Nursing in the 1970s. This resulted
in the education of numerous nurses who use
her theory in practice internationally (Hektor, 1989). In the area
of nursing scholarship, several noted nursing
theorists (e.g., Fitzpatrick, 1989; Newman, 1994; Parse, 1998)
derived theories from Rogers’s work. A
number of middle range nursing theories are based on Rogers’s

14. work as reported by Fawcett (2015). Among
these middle range theories are Health Empowerment Theory
(Shearer, 2009), Theory of the Art of Nursing
(Alligood, 2002), Theory of Self-Transcendence (Reed, 2014),
Theory of Diversity of Human Field Pattern
(Hastings-Tolsma, 2006), and Theory of Intentionality
(Zahourek, 2005).
In other scholarly works, Barrett (1986, 1989) derived a theory,
Power as Knowing Participation in
Change, for nursing practice from Rogers’s theory. She used
several of Rogers’s concepts (e.g., energy fields,
openness, pattern, and four-dimensionality [now
pandimensionality]) and the principles of resonancy, helicy,
and integrality to form her theory. The Theory of Power as
Knowing Participation in Change consists of
awareness, choices, freedom to act intentionally, and
involvement in creating changes and was tested in
research using Barrett’s Power as Knowing Participation in
Change (PKPIC) tool. Barrett’s (1989) theory
consequently has been used in research on patterning of pain
and power with guided imagery by Fuller, Davis,
Servonsky, and Butcher (2012), who examined field patterns in
adult substance users in rehab, and Kirton and
Morris (2012), who used Barrett’s theory to examine adherence
to antiretroviral therapy in adults who are
infected with HIV. Farren (2010) found in a secondary analysis
of data collected using Barrett’s PKPIC tool
with breast cancer survivors that the dimensions of power
(awareness, choices, freedom to act with intention,
and involvement in creating change) were responsible for all the
variance. Moreover, the breast cancer
survivors showed differing intensities of these dimensions.
In clinical settings, Rogerian practitioners employ the visible
manifestations of Rogers’s science. Madrid,
Barrett, and Winstead-Fry (2010), for example, studied the
feasibility of using therapeutic touch with patients

15. who were undergoing cerebral angiography. The design was a
randomized, single blind clinical pilot study
with outcome assessments of blood pressure, pulse, and
respirations. The findings of this study were
inconclusive, but the researchers followed up with exploration
of the reasons and studied the implications.
Reed (2008) wrote about nursing time as a dimension of
practice, research, and theory. In a nursing
educational setting, Malinski and Todaro-Franceschi (2011)
studied comeditation to reduce anxiety and
190
facilitate relaxation. Their data from the qualitative study
suggested that the participants reported feeling
calmer, more relaxed, and balanced and centered after 1 month
of practice. Their findings suggest that
comeditation may help transform education in nursing
programs, most of which have reputations as being
stressful to students.
Testability
Because of the model’s abstractness, Rogers’s (1990) work is
not directly testable, but it is testable in
principle (Bramlett, 2010). Numerous research studies using
Rogers’s model have been completed and
reported in the nursing literature. A plethora of these studies
can be found in Visions: The Journal of Rogerian
Nursing Science. Madrid and Winstead-Fry (2001) also found in
a focused review of literature that from 1990
through 2000, 28 research studies on therapeutic touch were
published in peer-reviewed journals, and 18 of
them were based on the Science of Unitary Human Beings,
typically using Rogers’s model as explanation for
the underlying processes of therapeutic touch and its relation to
energy fields and energy transfer. Examples
of some recent nursing studies using Rogers’s theory are listed
in Box 9-2.