Imogene M. King’s Theory of Goal Attainment

Some people consider their “success” after being hired in a great and well-known institution. But when someone decide to pursue a career in nursing, one should set his or her mind that he or she should be an instrument in helping patients get healthy. And to achieve that, it’s important to set health goals with the patient, then take steps to achieve those goals.

Imogene M. King’s Theory of Goal Attainment focuses on this process to guide and direct nurses in the nurse-patient relationship, going hand-in-hand with their patients to meet the goals towards good health.

King’s Theory of Goal Attainment was first introduced in the 1960s. From the title itself, the model focuses on the attainment of certain life goals. It explains that the nurse and patient go hand-in-hand in communicating information, set goals together, and then take actions to achieve those goals.

Description


The Theory of Goal Attainment states that “Nursing is a process of action, reaction and interaction by which nurse and client share information about their perception in a 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 goals.”

In this definition, action is a sequence of behaviors involving mental and physical action, and reaction is included in the sequence of behaviors described in action. King states that the goal of a nurse is to help individuals to maintain their health so they can function in their roles. The domain of the nurse “includes promoting, maintaining, and restoring health, and caring for the sick, injured and dying.” The function of a professional nurse is “to interpret information in the nursing process to plan, implement, and evaluate nursing care.”

Propositions


The following propositions are made in the Theory of Goal Attainment: (1) If perceptual interaction accuracy is present in nurse-patient interactions, transaction will occur. (2) If the nurse and patient make transaction, the goal or goals will be achieved. (3) If the goal or goals are achieved, satisfaction will occur. (4) If the goal or goals are achieved, effective nursing care will occur. (5) If transactions are made in nurse-patient interactions, growth and development will be enhanced. (6) If role expectations and role performance as perceived by the nurse and patient are congruent, transaction will occur. (7) If role conflict is experienced by either the nurse or the patient (or both), stress in the nurse-patient interaction will occur. (8) If a nurse with special knowledge communicates appropriate information to the patient, mutual goal-setting and goal achievement will occur.

Assumptions


King’s personal philosophy about human beings and life influenced her assumptions related to environment, health, nursing, individuals, and nurse-patient interactions. King’s conceptual system and Theory of Goal Attainment were “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 social roles.”

The assumptions are: (1) The focus of nursing is the care of the human being (patient). (2) The goal of nursing is the health care of both individuals and groups. (3) Human beings are open systems interacting with their environments constantly. (4) The nurse and patient communicate information, set goals mutually, and then act to achieve those goals. This is also the basic assumption of the nursing process. (5) Patients perceive the world as a complete person making transactions with individuals and things in the environment. (6) Transaction represents a life situation in which the perceiver and the thing being perceived are encountered. It also represents a life situation in which a person enters the situation as an active participant. Each is changed in the process of these experiences.

Major Concepts and Subconcepts


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.

Health

Health is 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.

Individual

Individuals are 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

Environment is the background for human interactions. It is both external to, and internal to, the individual.

Action

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

Reaction is not specifically defined but might be considered to be included in the sequence of behaviors described in action.

3 Interacting Systems


According to King, there are three interacting systems in the Theory of Goal Attainment. These are the personal system, the interpersonal system, and the social system. Each system is given different concepts. The concepts for the personal system are: perception, self, growth and development, body image, space, and time. The concepts for the interpersonal system are: interaction, communication, transaction, role, and stress. The concepts for the social system are: organization, authority, power, status, and decision making.

1. Personal Systems

Each individual is a personal system. King designated an example of a personal system as a patient or a nurse. King specified the concepts of body image, growth and development, perception, self, space, and time in order to comprehend human beings as persons.

“The self is a composite of thoughts and feelings which constitute a person’s awareness of his individual existence, his conception of who and what he is. A person’s self is the sum total of all he can call his. The self includes, among other things, a system of ideas, attitudes, values, and commitments. The self is a person’s total subjective environment. It is a distinctive center of experience and significance. The self constitutes a person’s inner world as distinguished from the outer world consisting of all other people and things. The self is the individual as known to the individual. It is that to which we refer when we say “I.”

Growth and development can be defined as the processes in people’s lives through which they move from a potential for achievement to actualization of self.

King defines body image as the way one perceives both one’s body and others’ reactions to one’s appearance.

Space includes that space exists in all directions, is the same everywhere, and is defined by the physical area known as “territory” and by the behaviors of those occupy it.

Time is defined as “a duration between one event and another as uniquely experienced by each human being; it is the relation of one event to another event.”

King (1986) added learning as a subconcept in the personal system but did not further define it.

2. Interpersonal Systems

These are formed by human beings interacting. Two interacting individuals form a dyad; three form a triad, and four or more form small or large groups. As the number of interacting individuals increases, so does the complexity of the interactions. Understanding the interpersonal system requires the concepts of communication, interaction, role, stress, and transaction.

Interactions are defined as the observable behaviors of two or more individuals in mutual presence.

King (1990) defines communication as “a process whereby information is given from one person to another either directly in face-to-face meeting or indirectly through telephone, television, or the written word.”

King defines transactions as “a process of interactions in which human beings communicate with the environment to achieve goals that are valued… goal-directed human behaviors.

The characteristics of role include reciprocity in that a person may be a giver at one time and a taker at another time, with a relationship between two or more individuals who are functioning in two or more roles that learned, social, complex, and situational.

Stress is “a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance, which involves an exchange of energy and information between the person and the environment for regulation and control of stressors.”

3. Social Systems

A more comprehensive interacting system consists of groups that make up society, referred to as the social system. Religious, educational, and health care systems are examples of social systems. The influential behavior of an extended family on an individual’s growth and development is another social system example. Within a social system, the concepts of authority, decision making, organization, power, and status guide system understanding.

Power is the capacity to use resources in organizations to achieve goals… is the process whereby one or more persons influence other persons in a situation… is the capacity or ability of a person or a group to achieve goals… occurs in all aspects of life and each person has potential power determined by individual resources and the environmental forces encountered. Power is social force that organizes and maintains society. Power is the ability to use and to mobilize resources to achieve goals.

Status is “the position of an individual in a group or a group in relation to other groups in an organization” and is identified that status is accompanied by “privileges, duties and obligation.”

Decision making is “a dynamic and systematic process b y which goal-directed choice of perceived alternatives is made and acted upon by individuals or groups to answer a question and attain a goal” (King, 1990).

King (1986) added control as a subconcept in the social system but did not further define the concept.

Dynamic Conceptual Systems


Dynamic-Conceptual-System

The figure above demonstrates the conceptual system that provided “one approach to studying systems as a whole rather than as isolated parts of a system” and was “designed to explain the organized wholes within which nurses are expected to function.”

King has interrelated the concepts of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and space into a theory of goal attainment. Her theory deals with a nurse-client dyad, a relationship to which each person brings personal perceptions of self, role, and personal levels of growth and development. The nurse and client communicate, first in interaction and then in transaction, to attain mutually set goals. The relationship takes place in space identified by their behaviors and occurs in forward-moving time.

She believed that her “framework differs from other conceptual schema in that it is concerned not with fragmenting human beings and the environment but with human transactions in different kinds of environments.”

Process of Interaction


Process of Interaction
Process of Interaction

The figure above represents a process of human interactions that lead to transactions: A model of transaction. According to King, “The human process of interactions formed the basis for designing a model of transactions that depicted theoretical knowledge used by nurses to help individuals and groups attain goals.”

Interaction

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

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.
Perception is “each person’s representation of reality.”

Communication

Communication is defined as “a process whereby information is given from one person to another either directly in face-to-face meetings or indirectly through telephone, television, or the written word.”

Role

Role is defined as “a set of behaviors expected of persons occupying a position in a social system; rules that define rights and obligations in a position; a relationship with one or more individuals interacting in specific situations for a purpose.”

Stress

Stress is “a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance… an energy response of an individual to persons, objects, and events called stressors.”

Growth and Development

Growth and development can be defined as the “continuous changes in individuals at the cellular, molecular, and behavioral levels of activities… the processes that take place in the life of individuals that help them move from potential capacity for achievement to self-actualization.”

Time

Time is “a sequence of events moving onward to the future… a continuous flow of events in successive order that implies a change, a past and a future… a duration between one event and another as uniquely experienced by each human being… the relation of one event to another.”

Space

Space exists in every direction and is the same in all directions. Space includes that physical area called territory. Space is defined by the behaviors of those individuals who occupy it

Theory of Goal Attainment and The Nursing Process


King gives emphasis about the nursing process in her model of nursing. The steps of the nursing process are: assessment, nursing diagnosis, planning, implementations, and evaluation.

The theory explains that assessment takes place during interaction. The nurse uses his or her special knowledge and skills while the patient delivers knowledge of him or her self, as well as the perception of problems of concern to the interaction. During this phase, the nurse gathers data about the patient including his or her growth and development, the perception of self, and current health status. Perception is the base for the collection and interpretation of data. Communication is required to verify the accuracy of the perception, as well as for interaction and translation.

The next phase is the nursing diagnosis. This phase is developed using the data collected in the assessment. In the process of attaining goals, the nurse identifies problems, concerns, and disturbances about which the patient is seeking help.

The planning phase arises after the diagnosis. The nurse and other health care team members create a care plan of interventions to solve the problems identified. This phase is represented by setting goals and making decisions about the means to achieve those goals. This part of transaction and the patient’s participation is encouraged in making decisions on the means to achieve the goals.

The actual activities done to achieve the goals make up the implementation phase of the nursing process. Whereas in this model of nursing, it is the continuation of transaction.

Finally, in the evaluation phase, the nurse evaluates the patient to determine whether or not the goals were achieved. Evaluation involves determining whether or not goals were achieved. The explanation of evaluation in King’s theory addresses meeting goals and the effectiveness of nursing care.

In the healthcare field, the final goal in the nurse-patient relationship is to help the patient achieve his or her goals for getting healthy. By using the nursing process described in King’s Theory of Goal Attainment, a nurse can be more effective in working with a patient to achieve those goals, and can truly help patients.

Strengths


A major strong point of King’s conceptual system and Theory of Goal Attainment is the ease with which it can be understood by nurses.

The theory of goal attainment also does describe a logical sequence of events.

For most parts, concepts are concretely defined and illustrated.

King’s definitions are clear and are conceptually derived from research literature. Her Theory of Goal Attainment presents ten major concepts, and the concepts are easily understood and derived from research literature, which clearly establishes King’s work as important for knowledge building in the discipline of nursing.

Weaknesses


Theory of Goal Attainment has been criticized for having limited application in areas of nursing in which patients are unable to interact competently with the nurse. King maintained the broad use of the theory in most nursing situations.

Another limitation relates to the lack of development of application of the theory in providing nursing care to groups, families, or communities.

King’s theory also contains some inconsistencies: (1) She indicates that nurses are concerned about the health care of groups but concentrates her discussion on nursing as occurring in a dyadic relationship. (2) King says that the nurse and client are strangers, yet she speaks of their working together for goal attainment and of the importance of health maintenance.

Conclusion


King contributed to the advancement of nursing knowledge through the development of her conceptual system and middle-range Theory of Goal Attainment. By focusing on the attainment of goals, or outcomes, by nurse-patient partnerships, King provided a conceptual system and middle-range theory that has demonstrated its usefulness to nurses. Nurses working in a variety of settings with patients from around the world continue to use King’s work to improve the quality of patient care.

References


  • Alligood, M., & Tomey, A. (2010). Nursing theorists and their work, seventh edition. Maryland Heights: Mosby-Elsevier.
  • Safier, G. (1977). Contemporary American leaders in nursing: An oral history. New York: McGraw Hill.
  • Imogene King Biography. (n.d.). Retrieved July 7, 2014, from http://king.clubexpress.com/content.aspx?page_id=22&club_id=459369&module_id=59920
  • http://www.reflectionsonnursingleadership.org/

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