IMOGENE M.

KING’S
GOAL ATTAINMENT
THEORY

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 BACKGROUND

• Imogene M. King was born in 1923,

• Youngest of three children.
• Received her basic nursing education from
St. John’s Hospital School of Nursing in St.
Louis, Missouri, graduating in 1946.
• BS in Nursing education (1948) and MS in
nursing (1957) are from St. Louis University
and her EdD (1961) is from Teachers
College, Columbia University, New York.
• postdoctoral study in research design,
statistic, and computers.
FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING
•Experience in nursing as an
administrator, an educator, and a
practitioner.
•Area of clinical practice is adult
medical-surgical.
•Faculty member at St. John’s Hospital
School of Nursing, St. Louis; Loyola
University, Chicago, and the University
of South Florida.
•Director of the School of Nursing at the
Ohio State University, Columbus.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

•Assistant Chief of the Research Grants
Branch, Division of Nursing, Department of
Health, Education and welfare in the mid-
1960s and on the Defense Advisory
Committee on Women Services for the
Department of Defense in the early 1970s.
•Retired from the University of South Florida
and continues to consult and work on the
further application of her theory.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 KING'S THEORY
• The CENTRAL FOCUS of King’s framework
is MAN AS A DYNAMIC HUMAN BEING
whose perceptions of objects, persons,
and events influence his behavior,
social interaction, and health (King,
1971).
• 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.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

• 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.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

1. 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.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING
 • 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 with changes in structure
and function of their bodies over time influence
their perceptions of self”
(King, 1981, p. 19).

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

2. Interpersonal systems involve individuals
interacting with one another. King refers to two
individuals interacting as dyads, three individuals
as triads, and four or more individuals as small or
large groups (King, 1981).
• The concepts associated with interpersonal
systems are interaction, transaction,
communication, role and stress.
• The interactions and transactions that occur
between the nurse and the client, or the dyad,
represent an example of an interpersonal
system..

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

• Communication between the nurse and the client
can be classified as verbal or nonverbal. Verbal
exchanges include both spoken and written
communication, while nonverbal communication
includes such things as appearance, distance,
facial expressions, posture and touch (Seiloff, 1991)

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

3. The third and final interacting system in King’s
model is the social system. Social systems are
groups of people within a community or society
that share common goals, interests, and values.
Social systems provide a framework for social
interaction and relationships, and establish rules
of behavior and courses of action (King, 1971).

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

Examples of social systems include the
family, the school, and the church. It is within these
organizations that individual's beliefs, attitudes,
values and customs are formed. The concepts that
King identified as relating to social systems are
organization, authority, power, status, and decision-
making.

• The relationships between these three systems led

to King’s Theory of Goal Attainment.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

• The conceptual framework of the interpersonal
system had the greatest influence on the
development of this theory.
• King (1981) stated, “Although personal systems
and social systems influence quality of care, the
major elements in a theory of goal attainment are
discovered in the interpersonal systems in which
two people, who are usually strangers, come
together in a health care organization to help and
to be helped to maintain a state of health that
permits functioning in roles” (p. 142).

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 • King used ten major concepts from the
personal and interpersonal systems to
support the Theory of Goal Attainment.
Those concepts include human
interactions, perception, communication,
role, stress, time, space, growth and
development, and transactions.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

• To capture the essence of these interrelated
concepts, King stated that “nurse and client
interactions are characterized by verbal and
nonverbal communication, in which information is
exchanged and interpreted; by transactions, in
which values, needs, and wants of each member
of the dyad are shared; by perceptions of nurse
and client and the situation; by self in role of client
and self in role of nurse; and by stressors
influencing each person and the situation in time
and space” (King, 1981, p. 144).

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING
 MAJOR ASSUMPTIONS

• Nursing – defined as a process of

action, reaction, and interaction whereby
nurse and client share information about
their perception in the nursing situation.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

Person
1. Individuals are spiritual beings.
2. Individuals have the capacity to think, know,
make choices, and select alternative courses of
action.
3. Individuals have the ability through their
language and other symbols to record their
history and preserve their culture.
4. Individuals are open systems in transaction with
the environment.
5. Individuals are unique and holistic, are of intrinsic
worth, and are capable of rational thinking and
decision making in most situations.
6. Individuals differ in their needs, wants, and goals.
FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING
• Environment
• – an understanding of the ways that human
beings interact with their environment to
maintain health is essential for nurses.
Adjustments to life and health are
influenced by an individual’s interaction
with environment.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

• Health
• – defined as 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.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING
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.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

A review of some relationships among the theory’s
concepts follows:

■ 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.
FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING
■ 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).

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 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).

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 Findings show 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.
Hughes, Lloyd, and Clarke (2008) found
King’s model “a radical approach to process of
nursing . . . in the United Kingdom” (p. 48). They
found King’s transaction process especially
suited to nursing information systems.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 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 that of Lockhart and Goodfellow
(2009), who studied the effect of a 5-week head
and neck surgical oncology practicum on nursing
students’ perceptions of facial disfigurement.
With King’s theory of goal attainment to guide
their research, they presented the students with
photographs of the surgical results, which they were
to rank order as to amount of disfigurement.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 The researchers found that the students rated
the female patients more disfigured than the males
who had had the identical procedures. They also
noted that central disfigurement was rated as
greater than peripheral disfigurement.
An investigation in Brazil by Bezerra, da Silva,
Guedes, and de Freitas (2010) analyzed perceptions
of people about hypertension using King’s model to
structure their research.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 Their descriptive exploratory study found that
the subjects feared complications yet were resigned
to the changes in their lives necessitated by their
disease. They also found that patients viewed nurses
as helpful. The authors, however, noted that nurses
need to take time to reflect on how they provide
patient care.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 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, many statements,
and many relationships on a number of levels.
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.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 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.
Theory of Goal Attainment was used by Rood
(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. Several
Magnet status hospitals in the United States are using
King’s conceptual system in practice (I. M. King, personal
communication, October 2005).

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 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, 2006).

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 THEORETICAL ASSERTIONS

• The system is open to permit

feedback because each phase of
the activity potentially influences
perception.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 LOGICAL FORMS
• Nurses are to assume the roles and responsibility
expected of them. The discovery of knowledge
must be disseminated in such away that they are
able to use it in systematically provide cues for
generating hypotheses for research in human
behavior in nursing situation.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 CRITIQUE
• have limited application in areas of nursing
in which patients are unable to
competently interact with the nurse.
• King stated that she is the only one (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.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 CONCLUSION
• 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.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

• 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.

FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING

 REFERENCE:
1. Alligood, M.R., (2018).Nursing Theorists & Their Work (9th Ed.).
St. Louis: Mosby-Elsevier.
2. George, J.B., (2014). Nursing Theories: The Base for
Professional Nursing Practice (6th Ed.).London,
England. Pearson Educational Ltd.
3. McEwen, M., & Wills, E. M. (2014). Theoretical basis for
nursing. Philadelphia: Wolters Kluwer/Lippincott
Williams & Wilkins.
4. McKenna, M. P., Pajnkihar,M., Murphy, F.A. (Eds.) (2014).
Fundamentals of Nursing Models, Theories and
Practice (2nd Ed). Wiley Blackwell
5. Morse, J.M. (2017). Analyzing and Conceptualizing the
Theoretical Foundations of Nursing. New York. Springer
Publishing Company

FREDELYN G. BICLAR RN, MN THEORETICAL FOUNDATION IN NURSING

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FREDELYN G. BICLAR RN,MN THEORETICAL FOUNDATION IN NURSING