Imogene King developed the nursing goal attainment theory in the 1960s. She created this theory to aid nurses in facilitating patients’ recovery. She stated that good patient care is good nursing care, and both are the obligation of every nurse.
The basis for goal attainment theory is that all behaviors are directed towards goals or ends. Goals are desired end states that individuals work towards to satisfy their needs and desires. Every behavior has a specific purpose, even if that purpose is unknown to the nurse or person doing the behavior. The goal may not be conscious, but the conduct still can get us closer to satisfying a need.
Propositions Made in King’s Goal Attainment Theory
King defined propositions that establish a basis for goal-directed nursing care. They are:
- If perceptual interaction accuracy is present in nurse-patient interactions, the transaction will occur.
- If the nurse and patient make a transaction, the goal or goals will be achieved.
- If the goal or goals are achieved, satisfaction will occur.
- If transactions are made in nurse-patient interactions, growth and development will be enhanced.
- If role expectations and role performance as perceived by the nurse and patient are congruent, the transaction will occur.
- If role conflict is experienced by either the nurse or the patient (or both), stress in the nurse-patient interaction will occur.
- If a nurse with special knowledge communicates appropriate information to the patient, mutual goal-setting and goal achievement will occur.
The goal attainment theory assumes:
- The focus of nursing is the care of the human being (patient).
- The goal of nursing is the health care of both individuals and groups.
- Human beings are open systems interacting with their environments constantly.
- 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.
- Patients perceive the world as a complete person making transactions with individuals and things in the environment.
- 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.
Concepts Defined in King’s Goal Attainment Theory
The following are the major concepts and sub-concepts of Imogene King’s Theory of Goal Attainment:
Nursing is an action-reaction-interaction process in which the nurse and the patient exchange information about their perspectives of the nursing situation. The nurse and patient discuss specific goals, challenges, and concerns, as well as potential solutions.
Health is a complex human life experience that entails improvements to stimuli in the internal and external environment by making the best use of one’s resources in order to obtain maximum daily living potential.
Individuals are cognitive and sentient social entities. Humans use language to express their thoughts, activities, habits, and beliefs. People share traits such as the ability to perceive, think, and feel, as well as the ability to choose between various courses of action, set objectives, choose the methods to reach those goals, and make decisions.
Human beings relationship take place in the context of the environment. The environment affects the individual from both the outside and the inside. Human interactions are therefore affected by behaviors involving mental.
A series of behaviors comprising both mental and physical activity is referred to as action. The sequence follows: mental action to recognize the presenting situations, followed by physical action to undertake actions connected to those conditions, and ultimately, mental action to exert control over the situation, paired with physical activity to attain goals.
The reaction isn’t clearly stated, although it could be included in the action’s sequence of behaviors.
Theory of Goal Attainment Interacting Systems
The Theory of Goal Attainment, according to King, has three interacting systems. The systems are as follows:
- Personal system
- Interpersonal system
- Social system.
Different concepts are assigned to each system.
The personal system concepts include:
- growth and development
- body image
Concepts for the interpersonal system include
The social system concepts include
Personal Systems Model
Every person is a unique system. According to King, a patient or a nurse is an example of a personal system. To understand human beings as individuals, King defined body image, growth, development, perception, self, space, and time.
Body image is an individual’s concept of their own physical body and how others react to his or her body features.
Growth and development is the process that encourages an individual to become increasingly more mature. Development begins with growth and leads to adaptation, according to King’s model.
Perception refers to what humans know about their environment, including people, things, ideas, and events.
Self- includes one’s thoughts and feelings that make a person be aware of his or her existence.
Space and time refer to the environment surrounding an individual.
Interactions between humans create the interpersonal system
A dyad is made up of two interacting persons; a triad is made up of three, and a small or large group is made up of four or more.
The complexity of interactions grows as the number of interacting persons grows.
Communication, interaction, role, stress, and transaction are all ideas that must be understood in order to comprehend the interpersonal system.
Interactions are defined as noticeable transactions of ideas, information, or goods. For example, if a nurse asks for the patient’s name and age, that’s an interaction that can help the patient to evaluate the nursing care being provided.
Transactions are “interactions between two persons with an exchange of some kind taking place; exchanges can be anything from money to time or physical help.”
Communication is the exchange of meaning between two or more people with an understanding of what is being said or written.
The role is the individual’s position in a social structure and how that affects his or her actions within that society.
Stress is defined as “the pressures imposed on the person by the relationship between what he wants, the environment, and what he has.”
Social Systems The social system is a complete interacting system made up of groups that make up society.
Social systems include educational, religious, and healthcare systems.
Another example of a social system is the influence of extended family members on an individual’s growth and development.
The ideas of power, decision-making, structure, authority, and status govern system knowledge within a social system.
Power is the ability to do something that you would normally not be able to accomplish. For example, a nurse could have power over a patient because he or she needs medical attention, and the nurse could provide nursing care.
Authority is defined as “the right to command and control.”
Status is “the position of an individual in society as determined by his or her acknowledged and usually institutionalized worth.” Status can be achieved or ascribed. For example, a doctor would have authority over a nurse because his or her job role is defined as conceptual system. Status can also be ascribed, which means it’s based on birth and not necessarily earned. A person such as a king is born into an ascribed authority status, whereas someone like a nurse is born without authority.
Decision making is “the process by which clear goals are identified, and actions to achieve those goals are selected.”
Organization is defined as the structure in which roles are distributed to individuals.
Theory of Goal Attainment and The Nursing Process
Imogene King’s nursing paradigm stresses the nursing process. Assessment, nursing diagnosis, planning, implementation, and evaluation are all phases in the nursing process.
According to the theory, assessment occurs during an interaction.
The nurse applies his or her specialized knowledge and abilities, while the patient contributes information about himself or herself’s perceptions of potential difficulties to the interaction.
The nurse collects information about the patient throughout this period, such as their growth and development, self-perception, and current health state. Data gathering and interpretation are both based on perception.
Communication is necessary for verification of perception accuracy, as well as interaction and interpretation.
Nursing diagnosis is the next step. This phase is based on the information gathered during the assessment stage. To achieve goals, the nurse must first identify the issues, worries, and disruptions for which the patient is seeking assistance.
After the diagnosis, the planning phase begins. The nurse and other medical team members devise an intervention strategy to address the issues that have been found.
Setting objectives and making decisions about how to attain them are also part of this phase.
This aspect of the transaction and the patient’s participation in deciding how to attain the goals are encouraged.
The implementation phase of the nursing process consists of the actual activities performed to attain the goals. This nursing paradigm, on the other hand, is based on the continuance of transactions.
This is the final phase in the nursing process, which gathers data about how successful this intervention has been. A new plan may be formed based on this new information.
In the healthcare field, a patient-centered care model has been integrated into nursing practice.
In the King’s Goal Attainment theory, nurse and patient have a transaction or interactions between them (“Interaction Process Analysis”, n.d.). In each interaction, there is a nonverbal cue from the patient that leads to a response from the nurse, which leads to an action by the nurse (“Interaction Process Analysis”, n.d.). The response is either nonverbal or verbal, but it leads to the nurse’s behavior, which leads to an outcome for the patient.
King’s transactional model states that people are not influenced directly by what others say, rather they are influenced indirectly based on their own thoughts, beliefs, assumptions, and knowledge.
The ability of nurses to comprehend goal attainment theory and articulate a logical sequence of events is a significant strength of King’s conceptual system and Theory of Goal Attainment.
The majority of the time, topics are explained and illustrated in detail.
The definitions used by King are clear and based on research material.
Ten key principles are presented in her Theory of Goal Attainment.
King’s work is significant for knowledge development in nursing since the principles are simply comprehensible and drawn from the research literature.
The Theory of Goal Attainment has been challenged for its limited applicability in nursing settings when patients cannot communicate effectively with the nurse. King defended the theory’s widespread application in most nursing circumstances.
Another drawback is the lack of progress in applying the theory to the delivery of nursing care to groupings, families, or communities.
There are some contradictions in King’s theory:
- She mentions that nurses are also concerned about the health of groups, but she focuses on nursing as a dyadic interaction.
- Despite the fact that the nurse and client are strangers, King speaks of their collaboration in achieving goals and emphasizing the significance of health maintenance.
King’s conceptual structure and middle-range Theory of Goal Attainment contributed to the progress of nursing knowledge.
King established a conceptual structure and middle-range theory that has shown its value to nurses by concentrating on achieving objectives or outcomes through nurse-patient interactions.
Nurses working in diverse settings with patients worldwide continue to draw on King’s work to enhance patient care quality.