Imogene King's Theory of Goal Attainment

Introduction

• Imogene King - born in 1923.
• Bachelor in science of nursing from St. Louis University in 1948
• Master of science in nursing from St. Louis University in 1957
• Doctorate from Teacher’s college, Columbia University.
• Theory of goal attainment was first introduced by Imogene King in the early 1960’s.
• Theory describes a dynamic, interpersonal relationship in which a person grows and develops to attain certain life goals.
• Factors which affects the attainment of goal are: roles, stress, space & time

Basic assumptions

• Nursing focus is the care of human being
• Nursing goal is the health care of individuals & groups
• Human beings: are open systems interacting constantly with their environment.
• Basic assumption of goal attainment theory is that nurse and client communicate information, set goal mutually and then act to attain those goals, is also the basic assumption of nursing process
• “Each human being perceives the world as a total person in making transactions with individuals and things in environment”
• “Transaction represents a life situation in which perceiver & thing perceived are encountered and in which person enters the situation as an active participant and each is changed in the process of these experiences”

Major Concepts

• Interacting systems:
• personal system
  
• Interpersonal system
  
• Social system
• Concepts are given for each system

Concepts for Personal System

• Perception
• Self
• Growth & development
• Body image
• Space
• Time

Concepts for Interpersonal System

• Interaction
• Communication
• Transaction
• Role
• Stress

Concepts for Social System

• Organization
• Authority
• Power
• Status
• Decision making

Propositions of King’s Theory

• If perceptual interaction accuracy is present in nurse-client interactions, transaction will occur
• If nurse and client make transaction, goal will be attained
• If goal are attained, satisfaction will occur
• If transactions are made in nurse-client interactions, growth & development will be enhanced
• If role expectations and role performance as perceived by nurse & client are congruent, transaction will occur
• If role conflict is experienced by nurse or client or both, stress in nurse-client interaction will occur 
• If nurse with special knowledge skill communicate appropriate information to client, mutual goal setting and goal attainment will occur.

Nursing Paradigms

1. Human being /person

• Human being or person refers to 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
• Human being has three fundamental needs:
  1.  The need for the health information that  is unable at the time when it is needed and can be used
     
  2. The need for care that seek to prevent illness, and
     
  3. The need for care when human beings are unable to help themselves.

2. Health

• 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.

3. Environment

• Environment is the background for human interactions.
• It involves:
  1. Internal environment: transforms energy to enable person to adjust to continuous external environmental changes.
     
  2. External environment: involves formal and informal organizations. Nurse is a part of the patient’s environment.
     

4.     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 behaviors involving mental and physical action.
• Reaction: which is considered as included in the sequence of behaviors described in action.
• In addition, king discussed:
• (a)    goal
  
• (b)   domain and
  
• (c)    functions of professional nurse
• 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..

Theory of Goal Attainment and Nursing Process

Assessment

• King indicates that assessment occur during interaction.
• The nurse brings special knowledge and skills whereas client brings knowledge of self and perception of problems of concern, to this interaction.
• During assessment nurse collects data regarding client (his/her growth & development, perception of self and current health status, roles etc.)
• Perception is the base for collection and interpretation of data.
• Communication is required to verify accuracy of perception, for interaction and transaction.

Nursing diagnosis

• The data collected by assessment are used to make nursing diagnosis in nursing process.
• Acc. to king in process of attaining goaI the nurse identifies the problems, concerns and disturbances about which person seek help.

Planning

• After diagnosis, planning for interventions to solve those problems is done.
• In goal attainment planning is represented by setting goals and making decisions about and being agreed on the means to achieve goals.
• This part of transaction and client’s participation is encouraged in making decision on the means to achieve the goals.

Implementations

• In nursing process implementation involves the actual activities to achieve the goals.
• In goal attainment it is the continuation of transaction.

Evaluation

• It involves to finding out weather goals are achieved or not.
• In king description evaluation speaks about attainment of goal and effectiveness of nursing care.

Nursing Process and Theory of Goal Attainment

Nursing process method	Nursing process theory
A system of oriented actions	A system of oriented concepts
Assessment	Perception, communication and interaction of nurse and client
Planning	Decision making about the goals Be agree on the means to attain the goals
Implementation	Transaction made
Evaluation	Goal attained

References

1. Alligood M.R, Tomey. A.M. Nursing theory utilization and application. 2nd Ed. Mosby,  Philadelphia, 2002.
2. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
3. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development & Progress 3rd ed. Philadelphia,  Lippincott.
5. Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed. Philadelphia,  Lippincott.
6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –Concepts Process & Practice 3rd ed. London Mosby Year Book.
7.  Tomey AM, Alligood. MR. Nursing theorists and their work. (5th ed.).  Mosby,  Philadelphia, 2002.