Development of Theories and Applications in

Nursing King’s Theory

Mediating effects of social support between Type D personality
and self-care behaviors among heart failure patients

Presenter Names:
abdullah Aedh Alwadai
Ali Aali Alharbi Supervised By: Prof. Neffisa Abdulqadir
Suliman Salem Alatawi Professor of Psychiatric Mental Health Nursing

Saad Saud Alharbi

Hussein karkour Program Doctorate 2nd semester / 2022- 2023

Objective

 Developing a model on the presented study using

Gibbs paradigm and king's goal attainment theory.
Outline
 Introduction.
 Aim of the study.
 Sample.
 Derivation of the model.
 Allocation of concepts in the model.
 Rational for King's model.
 King’s assumptions.
 Extrinsic part of the model.
 Intrinsic statements related to the proposed model.
Title of Article

Mediating effects of social support

between Type D personality and
self-care behaviors among heart
failure patients
Introduction
 Burden of pumping blood from the heart usually leads to congestive heart
failure. Heart failure is a disease that characterized by inappropriate and
insufficient pumping of the blood to all parts of the body because of limited
heart activity.

 The most important parameter related to heart failure is associated with the
negative production of stress on the heart especially related to the arterial
chamber.
 Modernization in the medical field has revealed the greater revolution through
identifying the different equipment for the treatment and development
 Conti ...
 Heart failure usually accompanied by different health complications that are
associated with the potential of the personality types indicating the negative
emotional and cognitive experience.
 Type D personality identifies the personality type that is associated with
continuous distress.
 Healthcare behaviors are the particular action that leads to the greater extent of
higher knowledge and competencies for the development of the patient positive
cognitive outlook toward life with respect to the optimism toward the treatment
regarding heart failure.
 Conti...

 The study was an explorative identification based on examination support on the

relationship of type D personality and self-care behavior to understand the negative
consequences of health that lead to fatal consequences among the heart failure
patient.
 Study was an important addition to the medical field along with the research base
paradise to identify and indicate the respective related to the has mediational effect
to the type the personality and healthcare behavior adjustment among the heart
failure patient.
 Aim of The Study

 This study aimed to identify the mediating

effects of social support in the relationship
between Type D personality and self-care
behaviors in patients with heart failure.
Hypothesis
Null Hypothesis

 There is no mediating effects of social support between Type D personality

and self-care behaviors among heart failure patients

Alternative Hypothesis

 Social support act as a strong mediating between Type D personality and

self-care behaviors among heart failure patients.
Sample
The sample in this present study initially
administered to 175 after applying the
exclusion criteria total sample size
remained at 170 indicating the
particular inclusion and explosion
criteria for the patient who were
suffering from heart failure.
 Sample
Inclusion criteria indicate:
 From the age, range 19 years to older.
 The cardiologist governed diagnosis of heart failure.
 Suffering from heart failure problem for the past 1 year.
 Easy to articulate the native Korean language.
Exclusion criteria indicate:
 The classification based on class four functional requirements regarding palliative
care.
 The patient diagnoses with a comorbid with other security complications.
 Difficulty in participating.
Model of the Deriviation

The derivation of the model concept based on king's theory of goal attainment.
The idolization of the research qualitative understanding about the mediating role of
social support on the relationship between self-care behavior and type D personality
among patients suffering from the heart failure.
King’s Theory of Goal Attainment Focus
 The ultimate and fundamental aim of king's theory based on the identification of
nurses' practices
 Indicating the process for the interaction process through the commutative
understanding of reaction and action in the clinical paradigm
 Introducing the nursing care for matrix about the perception of the situation by
the nursing care services.
King’s Theory of Goal Attainment Focus
 King's theory of goal attainment conceptualized on the paradigm
indicating the interaction of the social system with the
interpersonal and personal system to navigate the appropriate
execution of the healthcare mechanism.
 Theoretical paradigm indicated that the conceptual framework of
the king's goal attainment focus on the concentration gradient
understanding of the system.
King’s Theory of Goal Attainment Focus
Overall interaction system of the conceptualized system model
performed by the king's adaptation model in the three levels of
adaptation with respect to the
 Individual generalized system
 Interpersonal system
 Social system.

king's goal attainment theory focuses on the process of interaction

through admiration of the different procedural facts indicating the two
broader visions and scope among the nurses and a patient.
King’s Theory of Goal Attainment Focus
 Rational for King's model

• According to the model, this is convenient with the article aim which is:

• From king theory we select the first construct which is (Body Image) which
convenient with the first concept of the article which is (Type D personality) among
Heart failure patients , the second construct is (Transaction) which consistent with
the second concept which is (social support), the last construct is (goal attainment)
which is convenient with (Self-care behavior ) as the last concept in study.
 King's assumptions

(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 basic assumption of goal attainment is that nurse and patient
communicate information, set goals mutually, and then act to achieve
those goals.
 King's assumptions

(5) Goal attainment decrease stress and anxiety in nursing situation.

(6) Patients perceive the world as a complete person making transactions

with individuals and things in the environment.

(7) The 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.
Proposition
Proposition
 If perceptual interaction accuracy is present in patient care behavior, the
transaction will occur.
 If the nurse make the transaction, the goal or goals will be achieved.
 If the goal or goals are achieved, satisfaction will occur.
 If the goal or goals are achieved, social support will occur.
 If transactions are made in Self-care behavior, Stress will be enhanced.
Proposition

• If social support and health care behavior perceived by the patient

are congruent, the transaction will occur.

• If the negative consequences of the patient Type D personality

occur, social support will be required in greater amount.
Concept Allocation in Model
Kings Model Interpretation

 Input of king’s model represented as (Body Image).

 Interaction capsule of king’s model represented as (Transaction).

 Output of king's model represented as (Goal attainment).

Model Construct
 Construct of Model
Input: Body Image : moving to maturity for the benefits of mutual
understanding about the Type D personality and goal attainment.
Interaction capsule: Transactions: interaction process of human
beings through which communicate achieve goals to environment
based on social support.
Output: Goal attainment: perception of goal directed through the
systematic and standardized choice for perceived alternatives for
attainment of selfcare behavior.
Extrinsic Part of the Model
 Extrinsic Part of the
Model
Interaction
Input
Capsule Output

Body Image
Transaction Goal attainment

Type D
Mediating role of selfcare behavior
personality
social support
Unit Term
Heart Failure Patient
 Time Unit

T1: The point in time that (Body image) had been occurred as (Type D
personality)

T2: The point in time that (Transaction) (Mediating role of social support ) takes
place.

T3: The point in time that (goal attainment) (selfcare behaviors) are attained.
 Model Concept
 Type D personality: constant distress in the personality that causes
hindrance to social life, interactions, and conjugated
relationships. Personalities usually are the enduring characteristics that
based on the identification of potential embedded characteristics that
fundamentally affect health in a negative direction.

• Social support: perceived and actual assistants for others for the
sake of their well-being, help, and reform. Social support focus on the
parameter of understanding and underlining the variable construct that
provides strength to others based on helping provided by others.
 Model Concept
• Self-care behavior: Self care behaviors in heart failure patients refer to the
activities and lifestyle changes that patients with heart failure engage in to manage
their condition, prevent hospitalization or worsening of symptoms, and promote
overall well-being.
Referential and Referent
 Referential

DS-14 It is an acronym referring to type D personality questionnaire. It is composed of

14 items that specifically assess the specific characteristics associated to
Type D personality
personality. Five-point likert scale indicating
questionnaire
0 = false, and 4 = true.

ESSI It is an acronym referring to Enhancing Social Support Instrument (ESSI)

evaluates the attributes of social support, including instrumental, informational
Social Support
and emotional aspects and the in clinical settings social appraisal. The instrument
Instrument
comprises seven questions, where questions 1 to 6 are rated on a 5-point Likert
scale. Question 7 is assessed by score in two points for living alone and four
points for not living alone.
 Referential

EHFScBS-9 It is an acronym referring to European Heart Failure Self-care

European Heart Failure Behavior's Scale (EHFScBS-9) comprise of 9 item and the
Self-care Behaviors scores range from 9 – 45 based on five point Likert scale.
Scale
 Referent
DS-14 is a 14-item self-report
DS-14
scale that employs a five-point rating scale (0 = false, 4 = true).
Type D personality
questionnaire ( 0-56)
The instrument comprises seven questions, where questions 1 to
ESSI
6 are rated on a 5-point Likert scale. Question 7 is assessed by
Social Support scoring two points for living alone and four points for not living
alone.
Instrument
 Referent

EHFScBS-9 It is an acronym referring to The Tool comprises nine

European Heart Failure questions, with a total score ranging from (9–45) points.
Self-care Behaviors
Scale (9-45)
Interinsic Part of the Model
 Axiom
A3 +

T1 T2 T3
A1 + A2 +
Body Image Transaction Goal Attainment
 Axiom
Axiom 1 Among heart failure patient, the greater Body image at T1, the higher
need for transaction at T2

Axiom 2 Among heart failure patient, the greater need for transaction at
T2, the greater goal attainment at T3
Axiom 3 Among heart failure patient, the less Body image at T1, the lower goal
attainment at T3
 Postulate
A3 +
T1 T2 T3
A1 + A2 +
Body image Transaction Goal Attainment

P1 + P2 + P3 +

Type D personality Social selfcare behavior

Support
 Postulate

Postulate 1 Among heart failure patient, the greater Body image at T1

the greater Type D personality at T1.
Postulate 2 Among heart failure patient, the greater transactional T2 the
Greater Social support T2.

Postulate 3 Among heart failure patient, the higher goal attainment at T3,
the higher self care behavior at T3
 Proposition
A3 +

T1 T2 T3
A1 + A2 +
Body image Transaction Goal Attainment

P1 + P2 + P3 +

Social Pro 2 +
Type D Pro1- Selfcare behavior
support
personality
 Proposition

Pro .1 Among heart failure patient, the greater Type D personality at T1, the lower
perceived social support at T2.

Pro .2 Among heart failure patient, the greater social support at T2, the Higher self
care behavior at T3.
Pro .3 Among heart failure patient, the greater Type D personality at T1, the lower self
care behavior at T3.
Transformational Statemente
 Transformational Statemente
A3 +

T1 T2 T3
A1 + A2 +
Body image Transaction Goal Attainment

P1 + P2 + P3 +

Type D Social Pro 2 +

Pro1- Selfcare behavior
personality support

Tr1+
Tr2+ Tr3+

DS-14 ESSI EHFScBS-9

 Transformational Statement

Transformation .1 Among heart failure patient, The higher Type D personality at T1, the
high Score (DS-14) at T1.
Transformation .2 Among heart failure patient, The higher Social Support at T2, the higher
ESSI at T2.
Transformation .3 Among heart failure patient, The higher self care behavior at T3, the
higher EHFScBS-9 at T3.
 Theorm
A3 +

T1 T2 T3
A1 + A2 +
Body image Transaction Goal Attainment

P1 + P2 + P3 +

Type D Social Pro 2 +

Pro1- Selfcare behavior
personality support

Tr1+
Tr2+ Tr3+
DS-14
ESSI EHFScBS-9

0-56 8-34 9-45

 Theorm

Theorem .1 Among heart failure patient, the higher the (DS-14) at T1, the lower ESSI at
T2.
Theorem .2 Amongheart failure patient, the higher the ESSI at T2, the higher
EHFScBS-9 at T3.
Theorem .3 Among heart failure patient, the higher ( D S - 1 4 ) at T1, the Lower
EHFScBS-9 at T3.
 Epistemic statement
A3 +

T1 T2 T3
A1 + A2 +
Body image Transaction Goal Attainment

P1 + P2 + P3 +

Type D Social Pro 2 +

Pro1- Selfcare behavior
personality support

Tr1+
Tr2+ Tr3+
Th1+ Th2+
DS-14 ESSI EHFScBS-9

Th3+
EP2+ EP3+
EP1+

8-34 9-45
0-56
 Epistemic statement

EP 1 Among heart failure patient, the higher the DS-14 at T1, the higher score of
(0-56) at T1.

EP 2 Amongheart failure patient, the higher ESSI at T2, the higher score of
(8-34) at T2.

EP 3 Among heart failure patient, the higher EHFScBS-9 at T3, the higher score
of (9-45) at T3.
 Hypothesis
A3 +

T1 T2 T3
A1 + A2 +
Body image Transaction Goal Attainment

P1 + P2 + P3 +

Type D Social Pro 2 +

Pro1- Selfcare behavior
personality support

Tr1+
Tr2+ Tr3+
Th1+ Th2+
DS-14 ESSI EHFScBS-9

Th3+
EP2+ EP3+
EP1+
Hypo1- Hypo2+ 9-45
0-56 8-34
Hypo3+
Hypothesis

Hypothesis. 1 Among heart failure patient, the higher Score (0-56) at T1, the lower
score of (8-34) at T2.

Hypothesis. 2 Among heart failure patient, the higher score of (8-34) at T2, the
higher score of (9-45) at T3.

Hypothesis. 3 Among heart failure patient, the higher Score (0-56) at T1, the
higher score of (9-45) at T3.
 Hypothesis

Accepted

 Social support act as a strong mediating between Type D personality

and self-care behaviors among heart failure patients
References

Poorrezagholi, M., & Naveh, A. S. (2022). Investigating the Relationship between Religiosity
and Spiritual Intelligence with Attachment among High School Students in
Rafsanjan. Journal of Positive School Psychology, 6(7), 1-16.
Roszak, P. (2022). Not only coping: resilience and its sources from a thomistic
perspective. Journal of Religion and Health, 1-12.
TEMBO, K. (2022). THE ASSESSMENT OF STYLES OF LEADERSHIP AND THEIR
EFFECTS ON PERFORMANCE OF WORKERS IN A MANUFACTURING FIRM:(A CASE
OF TRADE KINGS) (Doctoral dissertation, Cavendish University).
Thank you