BIOGRAPHY OF IMOGENE KING - The environment, defined as the

- Imogene Martina King (January 30, 1923 background for human interaction. It
– December 24, 2007). involves the internal environment, which
- One of the pioneers and most sought nursing transforms energy to enable people to adjust
theorists (Theory of Goal Attainment – to external environmental changes, and it
1960s). involves the external environment, which is
- As a recognized global leader, King truly
formal and informal organizations. A nurse
made a positive difference for the nursing
profession with her significant impact on is considered part of the patient’s
nursing’s scientific base. environment
- She made an enduring impact on nursing - There are three interacting systems in the
education, practice, and research while Theory of Goal Attainment, according to
serving as a consummate, active leader in King.
professional nursing. 1. Personal System
2. Interpersonal System
THEORY OF GOAL ATTAINMENT (1960s) 3. Social System
- The model focuses on the attainment of - Each system is given different concepts.
certain life goals. Also, to guide and direct
nurses in the nurse – patient relationship. CONCEPTS OF THREE INTERACTING SYSTEMS
- It explains that nurse and patient go hand – Personal System
in – hand in communicating information, set - Perception
goals together, and then take actions to - Self
achieve those goals are roles, stress, space, - Growth and development
and time. - Body Image
- The nurse’s goal is to help patients maintain - Space and Time
health so they can function in their
individual roles. Interpersonal System
- The nurse’s function is to interpret - Interaction
information in the nursing process, plan, - Communication
implement, and evaluate nursing care. - Transaction
- To help nurses understand her work, she - Role
defined several terms which include - Stress
the patient, defined as a social being who
has three fundamental needs: Social System
1. The need for health information - Organization
2. The need for care that seeks to - Authority
prevent illness - Power
3. The need for care when the - Status
patient is unable to help him or - Decision – making
herself.
- She also explained health as involving the • King has interrelated the concepts of
patient’s life experiences, including interaction, perception, communication,
adjusting to stressors in the internal and transaction, self, role, stress, growth and
external environment by using resources development, time, and space into a goal
available. attainment theory.
 • Her theory deals with a nurse-client dyad, a
relationship to which each person brings
personal perceptions of self, role, and
personal growth and development levels.
WHAT IS THEORY OF GOAL ATTAINMENT?
- “Nursing is a process of action, reaction,
and interaction whereby nurse and client
share information about their perception in
the nursing situation.”
- “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.”
- In this definition, the action is a sequence of
behaviors involving mental and physical
activity, and the reaction is included in the
sequence of behaviors described in action.
- King states that a nurse’s goal is to help
individuals maintain their health so they can
function in their roles.
- The domain of the nurse “includes
promoting, maintaining, and restoring
health, and caring for the sick, injured and
dying.”
- 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
Imogene King’s Theory of Goal
Attainment:
1. If perceptual interaction accuracy
is present in nurse – patient
interactions, the transaction will
occur.
2. If the nurse and patient make the
transactions, 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 perceived by the
nurse and patient are congruent,
the 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
- Imogene King’s personal philosophy about
human beings and life influenced her
assumptions about the 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 complete
person making transactions with individuals
and things in the environment.
 6. The transaction represents a life situation in
which the perceiver and the thing being
perceived are encountered. 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
- 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 how to
achieve a goal.
Health
- 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 daily living
potential.
Individual
- 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, think, feel, choose
between alternative courses of action, set
goals, select the means to achieve goals, and
make decisions.
Environment
- The background for human interactions. It is
both external to, and internal to, the
individual.
Action
- Defined as a sequence of behaviors
involving mental and physical activity.
- 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
to exert control over the situation, combined
with physical action seeking to achieve
goals.
Reaction
- Not specifically defined but might be
considered in the sequence of behaviors
described in action.
INTERACTING SYSTEMS OF THEORY OF GOAL
ATTAINMENT
- 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 personal system concepts 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 social system concepts 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 to comprehend human
beings as persons.
- “The self is a composite of thoughts and
feelings which constitute a person’s
awareness of his individual existence, his
conception of who and what he is. A
 person’s self is the total of all he can call his.
The self includes, among other things, a
system of ideas, attitudes, values, and
commitments.
- Growth and development can be defined
as the processes in people’s lives through
which they move from a potential for
achievement to the actualization of self.
- King defines body image as to how one
perceives both one’s body and others’
reactions to one’s 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
occupying 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 sub
concept 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.
- Communication as “a process whereby
information is given from one person to
another either directly in a face-to-face
meeting or indirectly through telephone,
television, or the written word.”
- 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 the role include
reciprocity. A person may be a giver at one
time and a taker at another time, with a
relationship between two or more
individuals functioning in two or more,
learned, social, complex, and situational
roles.
- 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.
- An extended family’s influential behavior on
an individual’s 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. Each person has potential power
determined by individual resources and the
environmental forces encountered. Power is
a social force that organizes and maintains
society. Power is the ability to use and
mobilize resources to achieve goals.
- Status is “the position of an individual in a
group or a group concerning other groups in
an organization,” It is identified that status is
 accompanied by “privileges, duties, and
obligation.”
- Decision making is “a dynamic and
systematic process by 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 sub concept
in the social system but did not further
PROCESS OF INTERACTION
define the concept.
DYNAMIC CONCEPTUAL SYSTEMS
- Demonstrates the conceptual system that
provided “one approach to studying systems
Interaction
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.”
- Her theory deals with a nurse-client dyad, a
relationship to which each person brings
Transaction
personal perceptions of self, role, and
personal growth and development levels.
- The nurse and client communicate, first in
interaction and then in the transaction, to
attain mutually set goals. The relationship
takes place in space identified by their
behaviors and occurs in forward-moving
time.
- She believed that her “framework differs
from other conceptual schemas in that it is
concerned not with fragmenting human
beings and the environment but with human
transactions in different kinds of
environments.”
- Represents a process of human interactions
that lead to transactions: A model of
transaction
- “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.”
- A process of perception and communication
between a person and environment and
between person and person represented by
verbal and nonverbal behaviors that are goal
– directed.
- A process of interactions in which human
beings communicate with environment to
achieve valued goals
- Transactions are goal – directed human
behaviors.
- Perception is “each person’s representation
of reality.”
Communication
- 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
- 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
- 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
- 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
- A sequence of events moving onward to the
future.
- 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
- Imogene King emphasizes the nursing
process in her model of nursing.
- The steps of the nursing process
are assessment, nursing diagnosis, planning,
implementations, and evaluation.
Assessment
- It takes place during the interaction.
- The nurse gathers data about the patient,
including their growth and development, the
perception of self, and current health status
during this phase.
- Perception: the basis for the collection and
interpretation of data.
- Communication: required to verify the
accuracy of the perception, as well as for
interaction and translation.
Nursing Diagnosis
- Developed using the data collected in the
assessment.
- In attaining goals, the nurse identifies
problems, concerns, and disturbances about
which the patient is seeking help.
Planning
- Represented by setting goals and making
decisions about the means to achieve those
goals.
- This part of the transaction and the patient’s
participation are encouraged in making
decisions on the means to achieve the goals.
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.
Evaluation
- The nurse evaluates the patient to determine
whether the goals were achieved.
- Evaluation involves determining whether or
not goals were achieved.
- The explanation of evaluation in King’s
theory addresses meeting goals and the
effectiveness of nursing care.
• The nurse-patient relationship‘s final goal is
to help the patient achieve his or her goals
for getting healthy.
• Using the nursing process described in
King’s Theory of Goal Attainment: A nurse
can be more effective in working with a
patient to achieve those goals and truly help
patients.
ANALYSIS
- The social systems portion of the open
systems framework is less clearly connected
to goal attainment than personal and
interpersonal systems.
- The citation of the individual being in a
social system was not clearly explained,
considering that the social system
encompasses other concepts and sub
concepts in her theory.
- The model presents dyadic interaction in
nature which implies that its applicability
cannot be adapted to unconscious
individuals.
- A multitude of views and definitions is
confusing for the reader. Because of
multiple views on one concept, such as what
has been discussed in her concept of power,
it blurs the point that the theorist is trying to
relate to the readers.
STRENGTHS
- A major strong point of King’s conceptual
system and Theory of Goal Attainment is
how nurses can understand goal attainment
theory and 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 the research
literature.
- Her Theory of Goal Attainment presents ten
major concepts.
- The concepts are easily understood and
derived from the research literature, which
clearly establishes King’s work as important
for knowledge building in nursing.
WEAKNESSES
- Theory of Goal Attainment has been
criticized for having limited application in
nursing areas 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 applying the theory in
providing nursing care to groups, families,
or communities.
- King’s theory also contains some
inconsistencies:
1. She indicates that nurses are
concerned about groups’ health care
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 the importance of health
maintenance.