IMOGENE KING

Interacting and Open Systems Model,

and Goal Attainment Theory
Unito L. Bondad, MSN, RN
College of Nursing
Foundation University
unito.bondad@foundationu.com
Imogene M. King
 Born on January 30, 1923 in West Point, Iowa
 1945 Received nursing diploma from St. John's
Hospital School of Nursing in St. Louis Missouri
 1948 Received her BSN in nursing education
from St. Louis University
 1957 Acquired Master's of Science in Nursing
also from St. Louis University
 1961 Earned Doctoral of education degree from
Teacher's College, Columbia University in New
York City.
 1966-1968 Spent in the academic settings of
Ohio State, University, Loyola University, and
the University of South Florida.
 Died on December 24, 2007
King’s Goal Attainment Theory
•Assumption is that the
patient and nurse
communicate,
participate in mutual
goal setting, and take
actions to achieve
those goals together.
(http://currentnursing.com/nursing_theory/goal_at
tainment_theory.html) (Williams, L. A., 2001)

•(http://www.palmbeachstate.edu/x3194.xml)
Concept of Goal Attainment
Theory
• The nurse and patient communicate
information, set goals together, and then take
action to achieve those goals.
• An interpersonal relationship that allows a
person to grow and develop in order to attain
certain life goals.
• Factors that affect the attainment of goals
 Roles
 Stress
 Space
 Time
King’s Interacting and Open Systems
Model

Assumption is that the

focus is on the person
and the three interacting
systems: personal,
interpersonal, and
social, within their
interpersonal
relationships and social
contexts. (http://nursingtheories.blogspot.com/2009/07/queen-who-is-king.html)

(http://currentnursing.com/nursing_theory/goal_attainm
ent_theory.html) (Williams, L. A., 2001)
King’s Conceptual System
•Personal system
o perception, self growth and development,
body image, space, and time.
•Interpersonal system
o interaction, communication, transaction, role,
and stress.
•Social system
o organization, authority, power, status, and
decision making.
Essential Elements
• Goal - health as a the goal of nursing
• Structure – represented by 3 open systems
• Functions – demonstrated in reciprocal relations of
individuals in interaction and transactions
• Resource – both people (HCW and their clients) and
money, goods, and services needed to carry out specific
activities
• Decision making – occurs when choices are made in
resource allocation to support attaining system goals.
Concepts
• Personal - If perceptual interaction accuracy is present
in nurse-patient interactions, transaction will occur.
• If the nurse and patient make transaction, the goal or goals will be
achieved.
• If the goal or goals are achieved, satisfaction will occur.
• Personal - If role expectations and role performance
as perceived by the nurse and patient, growth and
development will be enhanced.
• Interpersonal - If role conflict is experienced by ether
the nurse or the patient (or both), stress in the nurse-
patient interaction will occur.
• If a nurse with special knowledge
communicates appropriate information to the patient, mutual goal-
setting and goal achievement will occur.
Concepts
•The patient is a social being who has three
fundamental needs:
o the need for health information
o the need for care that seeks to prevent illness
o the need for care when the patient is unable to help
him or herself

•Also health is involving life experiences of the patient,

which includes adjusting to stressors in the internal
and external environment by using resources
available.
• Personal
system
• Perception
• Self
• Growth and
development
• Body image
• Interpersonal
System
• Interaction
• Communication
• Transaction
• Role
• Social System
• Organization
• Authority
• Power
• Decision
making
A Human Being…
• Refers to social beings that are rational and sentient
• The focus of nursing care
• Are open systems constantly interacting with their environment
• Consists of three systems which include
 Individual~Personal System
 Groups~Interpersonal System
 Society~Social System
• Have the ability to perceive, think, feel, choose, set goals, select
ways to achieve goals, and make decisions
• Requires three basic needs
 The need for health information that can be used when
needed
 The need for care to prevent illness
 The need for care when a person is unable to help
themselves
Environment
• Is consistently changing
• Is the background for human interaction
• Involves two types of environment
 Internal Environment: Transforms energy to allow the
person to adjust to the continuous external environment
changes
 External Environment: Includes formal and informal
organizations with the nurse being part of the patient's
environment
Health
• Health involves
• “A 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 resource to achieve maximum potential for
daily living.”
• “A dynamic state of an individual in which change is
constant and ongoing and may be viewed as the
individual’s ability to function in his or her usual roles.”
Nursing
•"Nursing is an act wherein the nurse interacts and
communicates with the patient. The nurse helps
the patient identify the existing health condition,
exploring and agreeing on activities to promote
health.
• The goal of the nurse in Imogene King's theory is
to help the patient maintain health through health
promotion and maintenance, restoration, and caring
for the sick and dying."
 Nursing
• "A process of action, reaction, and interaction by which
nurse and patient share information about their perception in
the nursing situation." and
• “A process of human interaction between nurse and patient
whereby each perceives the other and the situation, and
through communication, they set goals, explore means, and
agree on means to achieve goals."
• Action: defined as a sequence of behaviors involving mental
and physical action
• Reaction: considered as included in the sequence of
behaviors described in action. In addition, King discussed:
o (a) goal
o (b) domain and
o (c) functions of professional nurse
Can The Theory of Goal Attainment be
implemented in the Emergency Department?
• A busy emergency department often creates
an intimidating environment for patients and they may
feel threatened, or feel that they have no control over
decisions that affect their care.
• The primary complaint of emergency room patients is the
length of waiting time. Waiting two hours may seem like
an eternity for the patient, but for the nurse, time passes
swiftly.
• In an environment that requires one to be reactive and
responsive, clients often perceive the nurses as being
too busy or too hurried (Williams, 2001).
 •Remember that: "An individual's
perceptions of self, of body image, of time
and space influence the way he or she
responds to persons, objects, and events
in his or her life span, experiences with
changes in structure and function of their
bodies over time influence their
What can the nurse in the perceptions of self" (King, 1981),(Williams,
emergency department
do for the patient using 2001).
King's Theory of
Goal Attainment.
•King used major concepts from the
personal and interpersonal system to
support the Theory of Goal Attainment:
o Human interactions and perception
o Communication
o Role
o Stress
o Time
o Space
o Growth and development
Clarification of Origins...
•"King's philosophy is
unique because it
provides a view of •"The theory of goal
persons from the attainment was
perspective of their derived from King's
interactions (or conceptual system."
communications, both
verbal and nonverbal)
with other people at
three levels of
interacting systems."
 Goal Attainment theory can be
used in any setting. Nurses Narrow
should always be in View
communication with the patient
to reach the goal of health.
"Several individuals have developed
theories from King's conceptual system
along with instruments to measure the
concepts. Nurses have published
multiple examples of the usefulness of
the conceptual systems and theory of goal
attainment in practice."
"The concepts of Goal Attainment are
very specific. The nurse and patient
must communicate, set goals together,
and take action to achieve the goals."
(Messmer, 2006)
What practice situations can/has this model been
used in? Here are two examples...
• Theory of Goal Attainment has been used in numerous practice
situations. According to Messmer, "the neonatal intensive care
unit (NICU) used this theory to transform their practice.
• The nurses in the NICU feel that parents believe the NICU
prevents them from assuming a parental role. When the nurses
and parents work together to set goals it helps the parents
function in the parental role."
• "Knowledge of concepts of health, self, role, perception,
transaction, stress, and power in transforming practice with five
elderly women in a nursing home. The nurse made a diagnosis
and mutually set goals with the women then described her
actions in helping them achieve their goals. The application of
knowledge of the concepts in King's theory attests to its value in
caring for the residents in a nursing home."
•(Messmer, 2006)
So what can we conclude??
• Nurse-client interactions increase mutual goal setting
• Open communication increases the likelihood of nurse-
client goal setting and satisfaction
• Nurse-client satisfaction increases goal attainment
• Reaching goal attainment decreases stress and anxiety
and increases client learning and the ability to cope in
nursing situations
• Nurse-client role and conflict results in decreased
interactions
• Nurse-client agreement in role expectations and
performance increases meaningful nurse-client
interactions
Case Study
A 23 year old pregnant female, 39 weeks, gravida1 para0
arrives on the Obstetrics Unit with her significant other complaining
of "frequent contractions".
Upon examination the nurse determines the patient is in
labor. Vital signs are stable and orders have been obtained from
the physician. After having the patient change into a gown, the
nurse then begins to hook the patient to the monitor. As she is
attaching the monitor, she explains the purpose of the monitor and
what the patient should expect such as frequent blood pressures.
The nurse than begins her admission assessment. During
the assessment the nurse explains the different stages of labor and
what to expect during those stages. They discuss the patient’s and
her significant others birthing plan. Expectations between the
nurse, the patient and her significant other are discussed. They all
agree on a plan of care.
References

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