THEORY OF GOAL ATTAINMENT

( IMOGENE M. KING)

“A professional nurse with , with special knowledge and

skills, and a client in need of nursing with knowledge of self
and perception problems, meet as strangers in natural
environment . They interact mutually , identify problems,
establish and achieve goals.”

 INTRODUCTION:

Imogene King is a nursing theorist who has made significant contributions to

the development of nursing knowledge.. Specific clinical examples are
presented to support King's work in practice. The concepts of self, body
image, growth and development, time, communication, and interaction are the concepts from King's
theory that the author identifies as being most useful when working with clients in the emergency
room and in the rural environment. Imogene King's "General Systems Framework" theory.
Developed during the mid 1960s and first published in 1971, this theory emphasizes the importance
of the interaction between nurses and patients. Views this interaction as an open system which is in
constant interaction with a variety of environmental factors.

King's conceptual framework includes three interacting systems

with each system having its own distinct group of concepts and characteristics. These systems
include personal systems, interpersonal systems, and social systems. King's basic assumption
maintained that nursing is a process that involves caring for human beings with health being the
ultimate goal (Torres, 1986). The three systems that constitute King's conceptual framework
provided the basis for the development of her Theory of Goal Attainment.

 KING THEORY OF NURSING:

 DEFINITION:

The King theory of nursing was developed by Imogene King and encompasses a conceptual
framework of interacting systems (personal, interpersonal, and social systems), and a theory of goal
attainment based on King's transaction process model.

King (1981) defines Health as:

“Health is a dynamic, ever changing process that is a state of being. It is not a point to be achieved;
it is an ongoing fluid existence, rather than a static state”.

 EDUCATIONAL BACKGROUND:

 Imogene King was born in January 30, 1923.

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  Diploma, St. John's Hospital School of Nursing St. Louis, MO – 1945
 Completed her Bachelor in science of nursing from St. Louis University in 1948
 Completed her Master of science in nursing from St. Louis University in 1957
 Completed her Doctorate of education, from Teacher’s college, Columbia University in
1961.
 Honorary PhD, Southern Illinois University - 1980
 She has practiced as a staff nurse, nurse educator, and nurse administrator.
 She formulated her theory while she was an associate professor of nursing at Loyola U. in
Chicago.
 King began her work in nursing theory with a conceptual framework.
 In 1971, she published “Toward a Theory for Nursing: General Concepts of Human
Behaviour” , in which she proposed a conceptual framework for nursing rather than a
theory.
 In 1981 she refined her concepts into a nursing theory that consisted of the following basis:
1. An open system framework as the basis of goal attainment.

2. Nursing as a major system within the health care system.

3. Nursing process emphasis on interpersonal processes.

 Died – December 24, 2007.

MEANING - king has been derived this theory from her open system framework .this
theory derived from the conceptual frame work organizes elements in the process of nurse-
patient interactions that results in outcomes , that is goal achievement . Among the three
systems, the conceptual frame work of the inter personal system has the greatest influence
on the development of king’s theory. she stated that “although personal system and social
system influence quality of care , the measure elements theory of goal attainment of
discover in the personal systems in which two people , who are usually strangers ,come
together in a health organization to help and to be helped to maintain as state of health that
permit functioning in role .

 EVOLUTION OF THEORY:

King’s states in the preface of “Toward a Theory for Nursing” that the book’s purpose is to
propose a conceptual frame of reference for nursing to be utilized by students and teachers, and also
by researchers and practitioners to identify and analyse events in specific nursing situations. The
framework suggests that the essential characteristics of nursing are those properties that have
persisted in spite of environmental changes. King proposed that her first book was “a way of
thinking about the real world of nursing” that it suggested “an approach for selecting concepts
perceived to be fundamental for the practice of professional nursing”, and that it showed a process
for developing concepts that symbolize experiences within the physical, psychological, and social
environment in nursing.

King’s derived the following seven hypotheses from Goal Attainment Theory:

1. Perceptual congruence in nurse-patient interactions increases mutual goal setting.

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 2. Communication increases mutual goal setting between nurses and patients and leads to
satisfaction.
3. Satisfactions in nurse and patients increase goal attainment.
4. Goal attainment decreases stress and anxiety in nursing situations.
5. Goal attainment increases patient learning and coping ability in nursing situations.
6. Role conflict experienced by patients, nurses, or both decreases transactions in nurse patient
interactions.
7. Congruence in role expectations and role performance increases transactions in nurse-
patient interactions.

 KING’S OPEN SYSTEM FRAMEWORK:

The framework represents knowledge essential for nursing and has an additional
purpose of allowing the construction and testing of theories from the perspective of nursing. The
conceptual framework includes goal, structure, function, resources and decision making, which are
essential elements. “Nursing phenomena are organised within three dynamic interacting systems”:

i. Personal systems (individuals)

ii. Interpersonal systems (friends, small and large groups)
iii. Social system (family, school, industry, social organizations and health care delivery
system)
She identifies several concepts as relevant for each of these systems and also
states that the placement of concepts with each system is arbitrary because all the concepts
are interrelated in the human environment interaction.

DYNAMIC INTERACTING SYSTEMS

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 1. PERSONAL SYSTEMS:

She conceives each individual is a personal system. For a personal system, the relevant
concepts are perception, self, growth and development, body image, space, learning and time.

Individual
and personal
system

 Perceptions: Refer to each person’s representation of reality. Perceptions are related to past
experiences, concept of self, socio-economic group, biological inheritance, and educational
background. The characteristics of perceptions are selective for each person, meaning that
any given situation will be experienced in a unique manner by each individual involved.
 Self: The self is a composite of thoughts and feelings which constitutes a person’s
awareness of his individual existence, his conception of who and what he is. The self
constitutes a person’s inner world as distinguished from the outer world consisting of all
other people and things.
 Growth and Development: It is defined as continual changes in individuals at the cellular,
molecular and behavioural levels of activities, conducive to helping individuals move
toward maturity. The growth and development is the process in people, lives through which
they move from a potential for achievement to actualization of self.
 Body image: It is characterized as very personal and subjective, acquired or learned,
dynamic and changing as the person redefines self. Body image is part of each stage of
growth and development.
 Space: It is defined operationally “as existing in all directions and is the same everywhere
and it is this immediate environment in which the nurse and client interact.
 Time: It is defined as a sequence of events moving onwards to the future. It is duration
between one event and another as uniquely experienced by each human being; it is the
relation of one event to another event.
 Learning: It is a subject concept in the personal system. King did not define it
operationally.

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2. INTERPERSONAL SYSTEM:

Interpersonal systems 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.

interaction

communicatio
n stress

transection role

 Interaction: Interaction refers to verbal and non verbal behaviour between an individual and
the environment or between two or more individuals, it involves goal directed perception
and communication.
 Communication: Communication refers to the transmission of information from one person
to another, either directly (face to face meeting) or indirectly (through a telephone call or
written message), it is the information component of interaction.
 Transaction: Refers to the interaction between a person and the environment for the
purpose of goal attainment.
 Role: Role refers to the expected behaviours of a person in a specific position and to the
rules that govern the position and affect interaction between two or more persons.
 Stress: Stress refers to an exchange of energy, either positive or negative, between a person
and the environment, objects, persons and events can serve as stressors.

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 A HUMAN INTERACTIONS PROCESS

3. SOCIAL SYSTEM:
A Social system is defined as an organized boundary system of social roles, behaviours,
and practices developed to maintain values and the mechanisms to regulate the practice and
rules.

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 Organization

Authority Power

Decision
Status Control
making

 Organization: Organization refers to a group of people with similar interests who have
prescribed roles and positions and who use resources to achieve personal and organizational
goals.
 Authority: Authority refers to the observable behaviour of providing guidance and order and
being responsible for actions.
 Power: Power is situational, dynamic, and goal-directed is characterized by the ability to
use resources for goal achievement. Power is also a means by which one or more persons
can influence others.
 Status: Status refers to the position of an individual in a group or groups in relation to other
groups in an organization and identifies that status is accompanied by privileges, duties and
obligations.
 Decision-making: Decision making results from developing and acting on perceived
choices for goal attainment.

 KING’S THEORY OF GOAL ATTAINMENT:

1. Interaction:
 According to King, each individual brings to an interaction a different set of values,
ideas, attitudes, and perceptions to exchange.
 Individuals come together for a purpose; each person makes a judgment, takes
mental or physical action, and reacts to the other individual and the situation.
2. Perception:
 A person imports energy from the environment and transforms, processes, and stores
it.
 The individual then exports this energy, as demonstrated by observable behaviors.
3. Communication:
 A person provides information directly or indirectly to another person.
 The other person receives this information and processes it.
4. Transaction:

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  Two individuals mutually identify goals and the means to achieve them.
 They reach an agreement about how to attain these goals and then set about to
realize them.
5. Role:
 Each person occupies a position in a social system that has specific rules and
obligations.
6. Stress:
 When an individual interacts with the environment, an energy response occurs to
objects, events and persons.
 The individual uses this energy response to maintain balance for growth,
development and performance.
7. Growth and Development:
 Individuals are in a constant state of molecular, cellular and behavioural change.
 It moves the individual toward a level of maturity and self- actualization.
8. Time:
 A person experiences a sequence of events that move toward the future.
 As the individual moves forward, changes occur.
9. Space:
 Each person has a designated physical area or territory that extends from the
individual equally in all directions.
 Specific behaviors exist for the person occupying that space.

King’s descriptive study relating to the theory of goal attainment resulted in a

means for analyzing interactions, as presented in the figure below

 PARADIGM OF KING’S THEORY :

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 A. HUMAN BEING /PERSON: is 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

According to King, human being has three fundamental needs:

 (a) The need for the health information that is unable at the time when it is needed and can
be used
 (b) The need for care that seek to prevent illness, and
 (c) The need for care when human beings are unable to help themselves.

B. HEALTH:

According to King, 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.

C. ENVIRONMENT:

Environment is the background for human interactions. It involves:

 (a) Internal environment: transforms energy to enable person to adjust to continuous

external environmental changes.
 (b) External environment: involves formal and informal organizations. Nurse is a part of
the patient’s environment.

D. NURSING:

Definition: “A process of action, reaction and interaction by which nurse and client share
information about their perception in 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.”

 Action: is defined as a sequence of behaviours involving mental and physical action.

 Reaction: not specified, but might be considered as included in the sequence of behaviours
described in action.

In addition, king discussed:

(a) goal
(b) domain and
(c) functions of professional nurse

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  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.

 CHARACTERISTICS OF A THEORY:
1. Theories can interrelate concepts in such a way as to create a different way of looking at a
particular phenomenon.
2. Theories must be logical in nature. King’s theory of goal attainment does describe a logical
sequence of events. The concepts are clearly defined.
3. Theories should be relatively simple yet generalised .
4. Theories can be the bases for hypotheses that can be tested.
5. Theories contribute to and assist in increasing the general body of knowledge within the
discipline through the research implemented to validate them.
6. Theories can be utilized by the practitioners to guide and improve their practice.
7. Theories must be consistent with other validated theories, laws and principles but will leave
open unanswered questions that need to be investigated.

CRITIQUES

Simplicity

King maintain that her definitions are clear and conceptually derived from research literature that existed at
the definitions were published.

King’s Theory of Goal Attainment presented 10 major concepts, thus making the theory complex.
However, these concepts are easily understood, and, with the exception of the concept of self, they
have been derived from the research literature.

Generality

In the past, King’s theory of Goal Attainment has been criticized for having limited application in
areas of nursing where patients are unable to competently interact with the nurse.

Examples of the application of the Theory of Goal Attainment have been documented with the
psychiatric patients, patients with acute orthopaedic problems, and developmentally disabled clients.

King believes critics are assuming that a theory will address every person, event, and situation,
which is impossible. She reminded critics that even Einstein’s Theory of Relativity could not be
tested completely until space travel made testing possible.

Empirical

King gathered empirical data on the nurse-patient interaction process that leads to goal attainment. A
descriptive study was conducted to identify the characteristics of transaction and whether nurses
made transaction s with patients. From a sample of 17 patients, goals were attained in 12 cases(70%
of the sample). King believes that if nursing students are taught the Theory of Goal Attainment and
it is used in nursing practice, goal attainment can be measured and the effectiveness of nursing care
can be demonstrated.

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King continues to serve as a consultant to researches testing hypotheses derived from her theory.
Since publication of theory in 1981, multiple research studies provide additional, and ongoing,
evidence of the empirical precision of the Theory of Goal Attainment.

Forman tested perceptual congruency between nurses and clients who were experiencing medical-
surgical problems. Hanna tested the Theory of Goal Attainment in promoting health behaviours of
adolescents. Kameoka analyzed interactions between nurses and patients, utilizing the Theory of
Goal Attainment.

Derivable Consequences

King’s Theory of Goal Attainment focuses on all aspects of the nursing process (assessing, planning,
implementing, evaluating). King believes one must assess to set mutual goals,, plan to provide
alternative means to achieve goals, and evaluate to determine if the goal was attained. King stated
she is “the only (nurse theorist) who has provided a theory that deals with choice, alternatives,
participation of all individuals in decision making and specifically deals with outcomes of nursing
care.

King’s system framework and Theory of Goal Attainment have been and continue to be used to
implement theory-based practice in a variety of nursing practice settings in Canada, Japan, Sweden,
and the United States. In addition, King’s work has been demonstrated at various education levels.
Finally, the framework has led to theory development at the grand and middle-range levels by King
herself and other nurse researchers who have used her work.

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
Nursing Diagnosis Information shared during assessment.
Planning Decision making about the goals
Be agree on the means to attain the goals
Implementation Transaction made
Evaluation Goal attained, evaluation of effectiveness of
nursing care.

Assessment

According to King, Assessment occurs during the interaction of the nurse and client, who are likely
to meet as strangers. Assessment may be viewed as paralleling action and reaction. The concepts
King identifies are the perception, communication, and interaction of nurse and client. The nurse
brings knowledge of self and perceptions of the problems that are concern. Assessment,
interviewing and communication skills are needed by the nurse as is the ability to integrate
knowledge of natural and behavioural sciences for application to a concrete situation. All concept

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of the theory apply to assessment, growth and development, knowledge of self and role, and the
amount of stress influence perception and in turn influence communication, interaction, and
transaction. In assessment, the nurse needs to collect data about the client’s level of growth and
development, view of self, perception of current health status, communication patterns, androgen
socialization, among other things.

Nursing Diagnosis

The information shared during assessment is used to derive a Nursing Diagnosis, defined by

King as a statement that “identifies the disturbances, problems, or concerns about which patients
seek help”. The implication is that the nurse makes the nursing diagnosis as a result of the mutual
sharing with the client during assessment. Stress may be a particularly important concept in
relation to nursing diagnosis because stress, disturbance, and problem or concern may be closely
connected.

Planning

After the nursing diagnosis is made, Planning occurs. King says that the concepts involved are
decision making about goals and exploring means and identifying means to attain goals. King
describe planning as setting goals and making decisions about how to achieve these goals. This is
part of transaction and again involves mutual exchange with the client. She specifies that the client
are requested to participate in decision-making about how the goals are to be met. Although King
assumes that in nurse-client interactions client have the right to participate in decisions about their
care, she does not say they have the responsibility. Thus, clients are requested to participate, not
expected to do so.

Implementation

It occurs in the activities that seek to meet the goals. Implementation is a continuation of
transaction in King’s theory. She states that the concept involved is the making of transactions .

Evaluation

It involves descriptions of how the outcomes identified as goals are attained. In King’s (1981/1990)
description, evaluation not only speaks to the attainment of the client’s goals but also to the
effectiveness of nursing care. She also indicates that the involved concept is goal attainment or, if
not, why not.

Although all the theory concepts apply throughout the nursing process communication with
perception, interaction, and transaction are vita for goal attainment and need to be apparent in each
phase.

In a Theory of Nursing, King presents an application of theory of her goal attainment that she
identifies as the use of a goal-oriented nursing record. Her description of this goal-oriented nursing
records closely parallels the step of the nursing process.

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 ASSESSMENT NURSING GOAL/PLANNING IMPLIMENTATION EVALUATION
DIAGNOSIS
PERCEPTION Pain related to Assess the level Assessed the level of Expressed that
(NURSE ) infection as of pain and pain and provided she got slight
During evidence by provide medication.(transaction relief from pain
physical pain medication. made ) due to Infection is
examination at assessment cured and goal is
the site of scale. attained.
incision
redness, warm,
and pain is
seen.

PERCEPTION Anxiety Be agree and Interacted with the

(CLIENT) related to communicate client and given
Client anxious, previous with the client psychological support.
stressed and experiences of and give
scared hospitalization psychological Provide calm, and
regarding as manifested support. mutually accepted
previous by facial action given to achieve
experiences of expressions. Provide calm, goal by reaction.
hospitalization. efficient manner
that reassures
the client and
minimize
anxiety.

 SUMMARY:

Imogene King's model is a model of three interacting systems: personal, interpersonal, and
social. In her theory of goal attainment, she states that client goals are met through the transaction
between nurse and client. The model can be applied to all settings. Her ideas were influenced by
systems theory (von Bertalanffy) and interaction theory. Her model is based on systems theory but
has also been classified as an interaction model. King describes her model as a conceptual system and
the goal of nursing as bringing a person closer to a healthy state (King, 1997, 2001). The nurse and
the person interact toward a goal. The end-point of this interaction, which occurs over time, is
transaction, at which the person's goal is met. The personal system that King speaks of refers to the
individual. The concepts within the personal system and fundamental in understanding human
beings are perception, self, body image, growth and development, time, and space (King, 1981).
King (1981) viewed perception as the most important variable because perception influences
behavior. King summarized the connections among the concepts in the following statement: "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. As individuals grow and develop through
the life span, experiences.

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 BIBLIOGRAPHY –

 Basheer Shebeer P. A concise text book of Advance Nursing Practice. First edition.
EMMESS Medical Publisher; Bangalore: 2013. page no. 391-402.
 Basanvanthappa BT.Nursing theories .first edition .Jaypee brothers ;New
Delhi :2007.page no. 147-168
 Soni .samta.text book of advance nursing practice. 1st edition.jaypee brothers.New delhi
2013 .page no.324-330
 kT.Ajesh kumar and somya chandran.application of nurding theories.1st edition .jaypee
brothers.New Delhi 2017. Page no.-57-72.
 George .J.Nursing theories .the base for professional nursing practice .appleton and
lange 2001 .
 Polit .DF , Beck CT.nursing research principles and methods .7th edition. Philadelphia.
Lippincord Williams and Wilkins. 2007 .

WEBSITE –

 https://curentnursing.com/nursing...theory/
 http://www.nurses.info/
 http://blgespot.in/

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GOVT COLEGE OF NURSING
JAGDALPUR

SUBJECT- ADVANCE NURSING PRACTICE

THEORY PRESENTATION
ON
KING’S GOAL ATTAINMENT THEORY

SUBMITTED TO SUBMITTED BY

MS. S. ASHAWAN MRS. SHREERAMA NAIR

HOD OF C.H.N. MS. PREETI SAHU

ASSISTANT PROFESSOR M.Sc. NURSING PREVIOUS YEAR

GCON JAGDALPUR GCON JAGDALPUR

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