Theory of Goal

Attainment
Emogene M. King
Background
✓She was born on January 30, 1923
in West Point, Iowa
✓She earned a BSN in 1948 and MSN
in 1957 from St Louis University and a
Doctor of Education from Teachers
College, Columbia University, N.Y.
(1961) (Teachers College, Columbia
University Hall of Fame inductee).
✓King served as Assistant Chief,
Research Grants Branch, Division of
Nursing, Washington, D.C. (1966-
1968 under Dr. Jessie Scott.).
✓ King was an Associate Professor (1961-66) and Professor
(1971-1980) at Loyola University. Chicago.
✓ King retired in 1990 after serving as Professor, College of
Nursing, University of South Florida. Tampa, Florida, with the
title Professor Emeritus. Until her death, she continued to
speak at local, regional, national and international conferences
and consulted with undergraduate and graduate students who
were using her theory and developing theories from her
Systems Framework.
 Assumptions
✓ Imogene 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.”
(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.
Three Interacting Systems
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.
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.
3. Social Systems
A more comprehensive interacting system consists of
groups that make up society, referred to as the social
system.
Steps of Nursing Process
1. assessment
✓takes place during interaction.
2. nursing diagnosis
✓This phase is developed using the data collected in
the assessment
3. planning
✓arises after the diagnosis.
4. Implementation
✓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.
5. Evaluation

✓the nurse evaluates the patient to determine

whether or not the goals were achieved.
 Major Concept's
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
✓ 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.
Person
✓ 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
✓is the background for human interactions. It is both
external to, and internal to, the individual.
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.
✓ 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.
A nursing case study of a psychotic client with human immunodeficiency virus infection

- The nurses that worked on the psychiatricinpatient unit recognized Harry when he
wasadmitted. The 29-year-old male patient had beenhospitalized there many times in
the past and thestaff members were familiar with Harry’s homo-sexual life-style and his
delusional psychotic behavior. However, when he was readmitted with theadded
medical diagnosis of human immunodefi-ciency virus (HIV) infection, the
situationchanged. A relationship with a familiar patient be-came fearful and
uncomfortable. The members ofthe psychiatric nursing staff on the inpatient unitfound
themselves confronting all of the intensepsychological issues surrounding acquired
immu-nodeficiency syndrome (AIDS) and HIV infectionas well as the additional
dimension of a preexistingpsychosis. The nursing theory of Imogene King(1981)
provided the psychiatric clinical nurse spe-cialist with a framework for viewing the
complexinteractions that began to occur between Harry andthe members of the
psychiatric nursing staff and adirection for action.
The clinical nurse specialist viewed both Harry andeach individual nurse as a personal
system andconsidered the interrelated concepts of perception,self, growth and
development, body image, space,and time.According to the theory, perception is a
majorconcept of the personal system; it is essential to anunderstanding of persons as
systems since it influ-ences the behavior of individuals. In this situation,the clinical
specialist noted that perceptions werealtered in the personal systems of both the
clientand the nurses. Harry’s perceptions were alteredby severe anxiety over a diagnosis
that representedan eventual death sentence to him. As a result,Harry’s behavior was
severely affected.
When hefirst learned about his diagnosis, Harry suffered aperiod of severe withdrawal
and hid in his apart-ment, away from family and friends. Although hewas preoccupied
by the horror of his predicament,a true comprehension was limited by the con-straints
of a major psychosis. As Harry’s inabilityto comprehend his illness and to predict the
futureincreased, his psychotic symptoms reemerged.The nurses’ perceptions were
affected not onlyby sensational media coverage surrounding theAIDS epidemic but by
the known contagious andterminal nature of the disease. The nurses per-ceived that a
continuation of their relationship with Harry would be harmful and that his presence
onthe ward meant that they were now at high risk ofcontagion. Harry’s seductively
draped clothing,thickly applied facial makeup, and sexually pro-vocative behaviors
challenged their personal val-ues and ideals.The concept of perception is related to the
con-cept of self. Each personal system has a concept ofself. King relates the concepts by
stating that “aconcept of self influences one’s perceptions, andone’s perceptions help
develop a concept of self.”(King, 1981, p. 142). The diagnosis of HIV infec-tion
dramatically altered the perceptions in the per-sonal system of the client, and it also
affected hisself-image and self-esteem. The loss of sexualfreedom especially affected
Harry since his freesexual lifestyle was an important part of his iden-tity. Harry’s guilt
about his gay life-style generateda sense of embarrassment and shame. Harry’s self-
concept was decreased further by the initial nega-tive responses that occurred in the
personal systemof each nurse.
Body image, the picture that one has of one’sown body, is closely related to the
concept of self.Harry talked about his body. He worried about thepossibility of
disfigurement and often stated that hefelt ashamed of his body. He asked, “Why
don’tthey just neuter me? You realize that you can nolonger allow people to touch
you, that you havesomething awful wrong with your body and thatyou could kill
your friends. ”The interrelated concepts of perception, self,body image, and growth
and development are in-fluenced by the dimensions of time and space. It isalso
noted that the concept of space is an essentialcomponent in an open systems
framework and thatan individual’s identity is reflected in relation topersonal space
(King, 1981). The concept of spaceprovided the clinical specialist with further assis-
tance in the evaluation of the nurse-client interac-tion.Harry was suspicious of the
attitudes of othersand feared closeness because of his psychosis, butthe added
diagnosis of HIV infection increased theneed for personal space. Harry began to
remainalone in his room and to avoid ward activities. Thephysical distance between
the personal system ofthe client, Harry, and each individual nurse systemincreased
once the isolation sign was posted at theentrance to Harry’s room. Some members
of thestaff increased their own personal space by avoid-ing Harry while others
insisted on excessively pro-tecting themselves with gowns and masks. Othersfelt it
would be best to handle his lunch tray withrubber gloves. Harry said he noticed that
everyonewas avoiding him and that the feeling of isolationwas difficult during a time
that he needed reassur-ance from the staff.