INTRODUCTION s

o Imogene King was born in 1923.

o She earned a diploma in nursing from St. John's Hospital of nursing of St. Louis,
Missouri in 1945.
o She received her bachelor degree from St. Louis university in 1948.
o She completed her master degree in 1957.

o Kings Theory of Goal Attainment was first introduced in the 1960s. From the title itself, the
model focuses on the attainment of certain life goals.
o 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

THEORY OF GOAL ATTAINMENT

o 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
o 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.
o King states that the goal of a nurse is to help individuals to maintain their health so they can
function in their roles.
o The domain of the nurse Includes promoting, maintaining, and restoring health, and caring
for the sick, injured and dying.
o 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
o Kings personal philosophy about human beings and life influenced her assumptions
related to environment, health, nursing, individuals, and nurse-patient interactions.
o 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 ones 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.
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 persons awareness of his
individual existence, his conception of who and what he is. A persons 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 persons total subjective environment. It is a distinctive center
of experience and significance. The self constitutes a persons 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 peoples lives through which
they move from a potential for achievement to actualization of self.

King defines body image as the way one perceives both ones body and others reactions to
ones 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 individuals 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.
o 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.

o 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.

o 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.
o 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

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 persons 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

o King gives emphasis about the nursing process in her model of nursing.
o The steps of the nursing process are: assessment, nursing diagnosis, planning,
implementations, and evaluation.
o 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.
o 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.
o 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.
o The next phase is the nursing diagnosis. This phase is developed using the data
collected in the assessment.
o In the process of attaining goals, the nurse identifies problems, concerns, and
disturbances about which the patient is seeking help.
o 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.
o This phase is represented by setting goals and making decisions about the means to
achieve those goals.
o This part of transaction and the patients participation is encouraged in making
decisions on the means to achieve the goals.
o 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.
o Finally, in the evaluation phase, the nurse evaluates the patient to determine whether
or not the goals were achieved.
 o Evaluation involves determining whether or not goals were achieved. The explanation
of evaluation in Kings 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 Kings
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

o A major strong point of Kings conceptual system and Theory of Goal Attainment is

the ease with which it can be understood by nurses.

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

o For most parts, concepts are concretely defined and illustrated.

o Kings 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 Kings

work as important for knowledge building in the discipline of nursing.

Weaknesses

o 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.
o Another limitation relates to the lack of development of application of the theory in
providing nursing care to groups, families, or communities.
o Kings 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 Kings
work to improve the quality of patient care.

Theory of Goal Attainment and Nursing Process

Assessment

Assessment occur during interaction.

The nurse brings special knowledge and skills whereas client brings knowledge of self
and perception of problems of concern, to this interaction.
During assessment nurse collects data regarding client (his/her growth &
development, perception of self and current health status, roles etc.)
Perception is the base for collection and interpretation of data.
Communication is required to verify accuracy of perception, for interaction and
transaction.

Nursing diagnosis

The data collected by assessment are used to make nursing diagnosis in nursing
process.
In process of attaining goal the nurse identifies the problems, concerns and
disturbances about which person seek help.

Planning

After diagnosis, planning for interventions to solve those problems is done.

In goal attainment planning is represented by setting goals and making decisions
about and being agreed on the means to achieve goals.
This part of transaction and clients participation is encouraged in making decision on
the means to achieve the goals.

Implementations

In nursing process implementation involves the actual activities to achieve the goals.
In goal attainment it is the continuation of transaction.

Evaluation

It involves to finding out whether goals are achieved or not.

In king description evaluation speaks about attainment of goal and effectiveness of
nursing care.
 Nursing Process and Theory of Goal Attainment

Nursing process method Nursing process theory

A system of oriented actions A system of oriented concepts
Perception, communication and interaction of
Assessment
nurse and client
Planning Decision making about the goals
Be agree on the means to attain the goals
Implementation Transaction made
Evaluation Goal attained

References

1. Alligood, M., & Tomey, A. (2010). Nursing theorists and their work, seventh edition.
Maryland Heights: Mosby-Elsevier.
2. Safier, G. (1977). Contemporary American leaders in nursing: An oral history. New York:
McGraw Hill.
3. 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
4. http://www.reflectionsonnursingleadership.org/