KING'S GENERAL SYSTEM  Established to facilitate the

FRAMEWORK NURSING dissemination and utilization of her

CONCEPTUAL MODEL interacting systems framework,
Theory of Goal Attainment
Imogene Martina King
 King died as the result of a stroke on
(January 30, 1923 – December 24, 2007) December 24, 2007 at the age of 84
OVERVIEW OF THE THEORY

I. ABOUT THE THEORIST THEORETICAL SOURCES

 Imogene Martina King was born in King describes the purpose of her first book
West Point, lowa on January 30, 1923 as: proposing a conceptual frame of reference
 She completed her diploma in nursing for nursing. It is intended to be utilized
education in 1945, at St. John's specifically by students and teachers, and also
Hospital in St. Louis, Missouri.  by researchers and practitioners to identify and
 1947-1958, King work as an instructor analyze events in specific nursing situations.
in medical-surgical nursing and as an
 The framework suggests that the
assistant director at St. John’s Hospital
essential characteristics of nursing are
School of Nursing
those properties that have persisted in
 1957- She earned an M.S.N. from St.
spite of environmental changes.
Louis University and a Doctor of
Education (1961) from Teachers  It is a way of thinking about the real
College, Columbia University, New world of nursing
York.
 1961-1966, King was an associate  An approach for selecting concepts
professor of nursing at Loyola perceived to be fundamental for the
University in Chicago practice of professional nursing and
 King served as Assistant Chief of shows a process for developing
Research Grants Branch, Division of concepts that symbolize experiences
Nursing, in the United States within the physical, psychological, and
Department of Health, Education, and social environment in nursing
Welfare. MAJOR CONCEPTS AND DEFINITIONS
 King was the director of the School of
Nursing at The Ohio State University  HEALTH
in Columbus. While at Ohio State, her
"Health is defined as dynamic life experiences
book Toward a Theory for Nursing
of a human being, which implies continuous
was published
adjustment to stressors in the internal and
 She provides community service and
external environment through optimum use of
help plan care through her framework
one's resources to achieve maximum potential
and theory at various healthcare
for daily living"
organizations.
 She keynoted two Sigma Theta Tau ● NURSING
theory conferences in 1992
 King has been an active member of "Nursing is defined as a process of action,
the American Nurses Association, the reaction, and interaction whereby nurse and
Florida Nurses' Association, and client share information about their
Sigma Theta Tau International. perceptions in the nursing situation.
 She is one of the founding members of ● SELF
a nursing organization, the King
International Nursing Group (KING), "The self is a composite of thoughts and
feelings which constitute a person's awareness
of his individual existence, his conception of individual or personal, group or
who and what he is. interpersonal, and society or social
● The theory of goal attainment pertains
to the importance of interaction,
perception, communication,
transaction, self, role, stress, growth
and development, time, and personal
space.
USE OF EMPIRICAL EVIDENCE
● King speaks of concepts as abstract
ideas that gives meaning to our sense
perceptions, permit generalizations
and tend to be stored in our memory
for recall and use at a later time in new
and different situations.
● King defines theory as a set of
concepts, which, when defined, are
interrelated and observable in the
world of nursing practice. Theory
serves to build scientific knowledge
for nursing.
● King identifies at least two methods
for developing theory:
1) a theory can be developed and then Personal system
tested in research
Personal system are individuals, who are
2) research can provide data from which regarded as rational, sentients and social
a theory may be developed. beings. Concepts related to the personal
system are:
● Regarding patient care, King notes
that, "most studies have centered on ● Perception - a process of organizing,
technical aspects of patient care and of interpreting, and transforming
the health care systems rather than on information from sense data and
patient aspects directly. Few problems memory that gives meaning to one’s
have been stated that begin with what experience, represents one’s image of
the patient's condition demands or reality, and influences one’s behavior.
what the patient wants."
● Self - a composite of thoughts and
In her 1981 book, King further discusses that, feelings that constitute a person’s
awareness of individual existence, of
"several theoretical formulations about
who and what he is or she is
interpersonal relations and nursing process
have been described in nursing situations." • Growth and development - cellular,
molecular, and behavioral changes in
• King developed a general systems
human beings that are a function of
framework and a theory of goal
genetic
attainment where the framework refers
to the three interacting systems -
 endowment, meaningful and satisfying Social system
experiences, and an environment conducive to
Shows how the nurse interacts with co
helping individuals
workers superiors, subordinates and the client
move toward maturity. environment in general.
• Body image - a person's perceptions • Authority - a transactional process
of his or her body. characterized by active, reciprocal
relations in which members' values,
• Time - the duration between the
backgrounds, and perceptions play a
occurrence of one event and the
role in defining, validating, and
occurrence of another event.
accepting the authority of individuals.
• Space - the physical area called
• Power-the process whereby one or
territory that exists in all directions.
more persons influence other persons
• Learning - gaining knowledge. in a situation.
• Status - the position of an individual
in a group or a group in relation to
Interpersonal system other groups in an organization.
-Individuals interacting with one another • Decision making - a dynamic and
• Interactions - the acts of two or more systematic process by which goal-
persons in mutual presence; a directed choice of perceived
sequence of verbal and nonverbal alternatives is made and acted upon by
behaviors that are goal directed. individuals or groups to answer a
question and attain a goal.
• Communication - the vehicle by
which human relations are developed • Control - being in charge.
and maintained; encompasses THEORY OF GOAL ATTAINMENT
intrapersonal, interpersonal, verbal,
and nonverbal communication. •Elements are seen in the interpersonal
systems in which two people, who are usually
• Transaction - a process of interaction strangers, come together in a healthcare
in which human beings communicate organization to help and be helped to maintain
with the environment to achieve goals a state of health that permits functioning of
that are valued; goal-directed human roles.
behaviors.
• Reflects King's belief that the practice
• Role - a set of behaviors expected of a of nursing is differentiated from other
person occupying a position in a social healthcare professions by what nurses
system. do with and for individuals
• Stress - a dynamic state whereby a • Nurse and client communicate
human being interacts with the information, set goal mutually and
environment to maintain balance for then act to attain those goals.
growth, development, and
performance, involving an exchange MAJOR ASSUMPTIONS
of energy and information between the
• King's conceptual framework and
person and the environment for
theory of goal attainment are based on
regulation and control of stressors.
an overall assumption that the focus of
• Coping - a way of dealing with stress. nursing is human beings interacting
with their environment leading to a
 state of health for individuals, which is spiritual being and rational thinker
an ability to function in social roles who makes choices, selects alternative
courses of action, and has the ability to
• Nursing focus is the care of human
record their history through their own
being.
language and symbols, unique, holistic
• Nursing goal is the health care of and have different needs, wants and
individuals & groups. goals.

• Human beings: are open systems According to Imogene King, human being has
interacting constantly with their three fundamental needs:
environment.
● Information on health that can be
• Basic assumption of goal attainment accessed and utilized when needed
theory is that nurse and client ● Care that aims to prevent illness
communicate information, set goal
mutually and then act to attain those ● Care in times of illness/helplessness
goals, is also the basic assumption of
C. Health:
nursing process
● According to Imogene King, health
• •“Each human being perceives the
involves dynamic life experiences of a
world as a total person in making
human being, which implies
transactions with individuals and
continuous adjustment to stressors in
things in environment”
the internal and external environment
through optimum use of one's
•“Transaction represents a life
resources to achieve maximum
situation in which perceiver & thing
potential for daily living.
perceived are encountered and in
which person enters the situation as an D. Environment:
active participant and each is changed
in the process of these experiences” ➢ It is the background for human
interactions. It involves:
III. METAPARADIGM OF THE THEORY
A. Internal environment - transforms
A. Nursing: energy to enable person to adjust to
● Nursing for Imogene King is an act continuous external environmental
wherein the nurse interacts and changes.
communicates with the client. B. External environment - involves
● The nurse helps the client identify the formal and informal organizations.
existing health condition, exploring Nurse is a part of the patient's
and agreeing on activities to promote environment
health.
● The goal of the nurse in Imogene
King's theory is to help the client
maintain health through health
promotion and maintenance,
restoration, and caring for the sick and
dying.
B. Person:
● Imogene King described a person
existing in an open system as a
 A. PRACTICE
● King's early publication led to nursing
curriculum development and practice
application at Ohio State and other
universities.
● In her 1981 book, King identifies that
theory,
because it is abstract, cannot be immediately
applied to nursing practice or to concrete
nursing education programs. When empirical
referents are identified, defined and described,
theory is useful and can be applied in concrete
E. Model situations.
Theoretical Assertion ● Professionals in most specialty areas
have used the concepts of King's
From the theory of goal attainment Imogene
Theory of Goal Attainment in nursing
King developed predictive propositions, which
practice. Its relationship to practice is
includes:
obvious because the profession of
● If perceptual interaction accuracy is nursing functions primarily through
present in nurse-patient interactions, a interactions with individuals and
transaction will happen. groups within the environment.

● If nurse and client make transaction, ● Healthcare professionals have

goal will be attained. implemented King's interacting
systems framework and Theory of
● If goal are attained, satisfaction will Goal Attainment in various national
occur. and international practice settings.
● If goals are met, efficient nursing care B. EDUCATION
will happen.
● Nursing faculty at several universities
● If transactions are made in nurse- (Ohio State Loyola in Chicago, and
client interactions, growth and University of Texas in Houston) have
development will be enhanced used King's interacting systems
● If role expectations and role framework to design curricula in
performance as perceived by nurse nursing programs
and client are congruent, transaction ● King's framework and theory also
will occur have application for nursing education
● If role conflict is experienced by nurse internationally as described by Rooke
or client or both, stress in nurse-client for a Swedish educational setting
interaction will occur ● Provide a systematic means of
● If nurse with special knowledge and viewing the nursing profession,
skill communicate appropriate organizing a body of knowledge for
information to client, mutual goal nursing. and clarifying nursing as a
setting and goal attainment will occur. discipline.

IV. ACCEPTANCE BY NURSING ● In 1980, Brown and Lee reported that

COMMUNITY King's concepts were useful in
developing a framework for use in
 nursing education, nursing practice, • 2. Risk for infection related to surgical
and for generating hypotheses for incision.
research.
• 3. Risk for constipation related to bed
C. RESEARCH rest, pain medication and NPO or soft
diet.
● Many researchers have used concepts
from King's interacting systems • 4. Deficient knowledge regarding the
framework. treatment and home care.
● Other researchers have used King's • 5. Ineffective health maintenance.
framework" as a theoretical base. This
Planning
group of research includes the
following studies: Goal 1:
1. Kemppainen analyzed a case study of a • Assess the characteristics of pain.
patient who had HIV and was also
experiencing psychotic symptoms • Administration of prescribed
medicine.
2. Alligood, Evans, and Wilt developed the
concept of empathy within King's framework. • Monitor the responses to drug therapy.

3. Hobdell used King's framework" to work • Provide calm, efficient manner that
with parents of children with neural tube reassures the client and minimizes
defects. anxiety.

4. Sharts-Hopko explored the perceived health • Provide a comfortable position as per

status of women during the transition to client’s requests.
menopause. Goal 2:
5. Doornbos used King's framework to explore ● Monitor vital signs
the health of families with young people who
are chronically mentally ill ● Use aseptic techniques while
changing dressing
V. APPLICATION OF THE THEORY
● Kept the surgical wound site clean
Mr.Sy (74 years) was admitted in L3 ward of
Hospital, for a herniorrhaphy on his left Goal 3:
indirect inguinal hernia and was expecting
• Ensure that the client has adequate
discharge from hospital.
bulk in diet and adequate fluid intake
• The theory of goal attainment was
• Instruct the client on prevention of
used in his nursing process.
straining and avoiding valsalva
Assessment maneuvers

• The first process in nursing process is • Consult treating physician regarding

nurse meets the patient and medications
communicates and interacts with him.
Implementation
Assessment is conducted by gathering
data about the patient based on In nursing process implementation involves
relevant concepts. the actual activities to achieve the goals.
Nursing diagnosis • Am I doing what the patient and I
have agreed upon? Yes
• 1. Acute pain related to surgical
incision.
 • How am I carrying out the actions?
On a mutually acceptable manner in
accordance with the goals set.
• When do I carry out the action?
According to priority, a few
interventions require immediate
attention. Other interventions are
carried out during the period of
hospitalization
• Is it reasonable to think that the
identified goals will be reached by
carrying out the action? Yes
Evaluation
In King’s description evaluation speaks about
attainment of goal and effectiveness of nursing
care.
• Are my actions helping the patient
achieve mutually defined goals? Yes
• What is patient’s response to my
actions? Patient is satisfied with
your actions
• How should the plan be changed to
achieve goals?Health teaching can be
modified according to
developmental stage.Involvement of
family member in care of the
patient.