Mrs.

Keerthana
KING’S THEORY OF Assistant Professor
GOAL ATTAINMENT Medical Surgical
Nursing
BIOGRAPHY OF IMOGENE KING
Imogene Martina King (January 30, 1923 – December 24, 2007) was one of the
pioneers and most sought nursing theorists for her Theory of Goal
Attainment, which she developed in the early 1960s. Her work is being taught to
thousands of nursing students worldwide and is implemented in various service
settings.
As a recognized global leader, King truly made a positive difference for the nursing
profession with her significant impact on nursing’s scientific base. She made an
enduring impact on nursing education, practice, and research while serving as a
consummate, active leader in professional nursing.
Imogene King was born on Jan. 30, 1923, in West Point, Iowa. During her early high
school years, she decided to pursue a career in teaching. However, her uncle, the
town surgeon, offered to pay her tuition to nursing school. She eventually accepted
the offer, seeing nursing school as a way to escape life in a small town. Thus began
her remarkable career in nursing.
❖ Imogene King excelled in her nursing studies even though it was not her first
choice to consider. In 1945, she received a nursing diploma from St. John’s
Hospital School of Nursing in St. Louis, Missouri.
❖ While working in various staff nurse roles, King started coursework toward a
Bachelor of Science in Nursing Education, which she received from St. Louis
University in 1948. In 1957, she received a Master of Science in Nursing from St.
Louis University.
❖ She went on to study with Mildred Montag as her dissertation chair at Teacher’s
College, Columbia University, New York and received her EdD in 1961.
 WORK EXPERIENCES

• Administrator (Ohio State University)

• Educator (St. John’s Hospital School of
Nursing; Loyola University; University of South
Florida)
• Practitioner (Adult Medical-Surgical Nursing)
• Assistant chief of the Research Grants
Branch, Division of Nursing, Department of
Health, Education and Welfare
• Professor emeritus at University of South
Florida
King’s Theory of Goal Attainment was first introduced in the 1960s. From the title itself,
the model focuses on the attainment of certain life goals. It explains that the nurse and
patient go hand-in-hand in communicating information, set goals together, and then take
actions to achieve those goals.

King has interrelated the concepts of interaction, perception, communication, transaction,

self, role, stress, growth and development, time, and space into a goal 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. 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.
PROPOSITIONS
(1) If perceptual interaction accuracy is present in nurse-patient interactions, the transaction will occur.

(2) If the nurse and patient make the transaction, 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
(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) 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.
King’s Theory and Nursing’s Metaparadigm -

Person
• Social beings who are rational and
sentient communicate their thoughts,
actions, customs, and beliefs through
language exhibit common
characteristics like ability to perceive,
to think, to feel, to choose between
alternative courses of action, to set
goals, to select means to achieve goals,
and to make decisions
HUMAN
NEEDS

• According to King, humans in receiving

health
care have three fundamental needs:
(a) The need for health information that i
s
understandable at the time when it is needed
and can be used
(b) The need for care that seek to
prevent
illness and promote health, and
(c) The need for care that humans
are
unable to provide themselves.
 King’s Theory and
Nursing’s
Metaparadigm -
NURSING
• Nursing is a process of action, reaction,
and
interaction whereby nurse and client
share
information about their perceptions in the
nursing
situation
• Nurse and patient share goals,
problems,
and concerns and explore means
to
achieve a
goal.
 NURSING
• 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.
 King’s Theory and
Nursing’s
Metaparadigm -
HEALTH
• …dynamic life experience of a
human
being
• …implies continuous adjustment
tostressors in the external and
internal
environment through optimum use
of
one’s resources to achieve
maximum
potential for daily living
 King’s Theory and
Nursing’s -
Metaparadigm
ENVIRONMENT
• Environment is the background
for
• Internal environment:
human actions
transforms energy to enable
person to adjust to
continuous external
environmental changes
• External environment:
involves formal and informal
organizations. Nurse is a
part of the patient’s
environment.
DYNAMIC INTERACTING
SYSTEMS
• Three systems in the conceptual
framework:
– Personal System (the
individual)
– Interpersonal Systems
(individuals interacting with one
another)
– Social System (groups of
people in a community/society
sharing common goals,
interests, and values)
• Study systems as a whole rather
than as isolated parts of a system
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,
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. The self is a person’s total subjective
environment. It is a distinctive center of experience and significance. The self
constitutes a person’s inner world as distinguished from the outer world consisting of
all other people and things.
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.”
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.

King (1990) defines 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.”

King defines 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.”
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).
PROCESS OF INTERACTION

According to King, “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.”
Interaction

Interaction is 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.

Transaction

The transaction is a process of interactions in which human beings communicate with the

environment to achieve valued goals; transactions are goal-directed human behaviors.

Perception is “each person’s representation of reality.”

Communication

Communication is defined as “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

The role is defined as “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

Stress is “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

Growth and development can be defined as the “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

Time is “a sequence of events moving onward to the future… a 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.
❑The theory explains that assessment takes place during the interaction.

❑The nurse uses his or her special knowledge and skills while the patient delivers
knowledge of him or herself and the perception of problems of concern to the
interaction.

❑ During this phase, the nurse gathers data about the patient, including their growth
and development, the perception of self, and current health status. Perception is the
basis for the collection and interpretation of data.

❑Communication is required to verify the accuracy of the perception, as well as for

interaction and translation.
The next phase is the nursing diagnosis. This phase is 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.

The planning phase arises after the diagnosis. The nurse and other health care team
members create a care plan of interventions to solve the problems identified. This
phase is 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.
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.

Finally, in the evaluation phase, 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.
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.
Thank you