The Theory of Goal Attainment Imogene M. King

1
The Theory of Goal AttainmentImogene M. King

• Prepared By
• Prof.Dr Nefissa A. kader
• Vice Dean of Education and Student Affairs
• Faculty of Nursing Cairo university

2
Outlines

• Historical background.
• Origin of the Conceptual Model
• Model of transaction
• King's theory Assumptions.
• Strategies for Knowledge Development of the
  system framework.
• Influences from other scholars.
• World View
• Unique focus of the model
• Concepts and Components of the framework.
• Basic paradigm concepts.
• The three dimensional Nursing Process based on
  King's Theory.
• Relationship Among the four Process of nursing .
• Propositions of the model.

3
Historical background

• Imogene King completed her diploma in nursing
  education in 1945,from st. Johns hospital in
  st.louis.
• A bachelors of science in nursing
  education(1948).
• In 1957, She received her MS in nursing.
• In 1961, She obtained her Doctorate in Education
  from Columbia U. N.Y.

4
Historical background

• She has practiced as a staff nurse, nurse
  educator, and nurse administrator.
• From 1961 to 1966, king was an associate
  professor of nursing.
• Her first theory article appeared in 1964 in a
  journal edited by Dr. Martha Rogers titled
  Nursing Science.
• From 1968 to 1972, King was the director of the
  school of Nursing at The Ohio State University in
  Columbus. While at Ohio State, her book Toward a
  Theory for Nursing was published.

5
Historical background

• In 1980, she was appointed as a professor at the
  university of South Florida College of Nursing.
  The manuscript for her second book, A Theory for
  Nursing Systems, Concepts, Process, was
  published.
• In 1981 , addition to her first two books, she
  has authored multiple book chapters and articles
  in professional journals.
• In 1986 , published a third book, Curriculum and
  Instruction in Nursing,. - King retired in 1990,
  is currently a professor at the University of
  South Florida.

6
Historical background

• In 1994, she was a member in the American Academy
  of Nursing.
• In 1997, she is one of the founding members of a
  nursing organization (King International Nursing
  Group) established to facilitate utilization of
  her systems framework and Theory of Goal
  Attainment.
• In 1996, she received the Jessie Scott Award at
  the American Nurses Association convention.

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The Origin of the Conceptual Model

• kings philosophical perspective, as both
  personal and derived from general system theory,
  and the theory of goal attainment with emphasis
  on interaction theory.
• king selected systems theory because it
  reflected perspectives of wholeness, rather than
  reductionism.
• Kings conceptual system can be inferred based on
  Morgan and Smircichs(1980) discussion of
  subjectivity and objectivity within the social
  sciences. King posed several questions
• What is the goal of nursing?
• What are the functions of nurses?
• How can nurses provide quality care?

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King's theory Assumptions

• Explicit Assumptions
• The central focus of nursing is the interaction
  of human beings and environment, with the goal
  being healthy for human being. (King, 1982)
• Individuals are social, sentient, rational,
  reacting, perceiving, controlling, purposeful,
  action-oriented, and time oriented being. (King,
  1981)
• The interaction process is influenced by
  perceptions, goals, needs, and values of both the
  client and the nurse. (1981, 92)

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King's theory Assumptions

• Human being as patients have rights to obtain
  information, to participate in decisions that may
  influence their life, health, and community
  services, and to accept or reject care. (1981).
• It is the responsibility of health care members
  to inform individuals of all aspects of health
  care to help them in making ''informed
  decision''. (19981)
• Incongruities may exist between the goals of
  health for caregivers and recipients. Persons
  have the right to either accept or reject any
  aspect of health care. (1981).

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King's theory Assumptions

• Implicit Assumptions
• Patients want to participate actively in the care
  process.
• Patients are conscious, active, and cognitively
  capable to participate in decision making (Austin
  and Champion, 1983, p. 56)

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Strategies for knowledge Development of the
Systems Framework

• An awareness of the complex dynamics of human
  behavior in nursing situations prompted Kings
  formulation of conceptual framework that
  represents (personal, interpersonal, and social
  systems) as a domain of nursing.
• Kings process of concept development is one of
  synthesis and reformulation using inductive and
  deductive processes, critical thinking, empirical
  observations, extensive reviews of the nursing
  and other literature.

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Influences from Other Scholars

• King (1971,1975. 1981 1989 and 1992) has
  repeatedly mentioned the influence of the
  literature of nursing and adjunctive disciplines
  on the development of the general systems
  framework and theory of goal attainment
• Influence of general system theory (Bertalanffy,
  1968 ) focused on wholism.
• Among the numerous authors from many disciplines
  (Erikson,1950), (Freud,1966), (Orem,1969),
  (Parson,1951), (Selye, 1956)(Piaget,1969)(Peplau,
  1952)

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Influences from Other Scholars

• The term transaction came from a study of Deweys
  theory of knowledge.
• Influence of students , academic colleagues,
  nurse researchers, and clinicians.
• Kaufmans( 1958) doctoral dissertation to explore
  the concepts of perception, time and stress.

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World View

• The general systems framework reflects reciprocal
  interaction world view.
• The holistic element indicated by the focus of
  the framework on three systems- the personal,
  interpersonal, and social as wholes.
• Reciprocal interaction world view reflected by
  Kings view of human beings as active
  participants in interaction with one another and
  her philosophical claim a science of wholeness
• Change is view as continuous, natural desirable
  as Kings (1981) comment that normal changes in
  growth and development take place continuously.

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Unique Focus of the model

• King identified the unique focus of the general
  systems framework as human beings interacting
  with their environment.
• Particular attention is given to the continuing
  ability of the individuals to meet their basic
  needs to function in their socially defined
  roles.
• Kings framework addresses most of the
  characteristics of systems models.
• System is addressed through the personal,
  interpersonal, and social systems, which
  King(1981) viewed as open, dynamic, and
  interacting.

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Unique Focus of the model

• Kings framework addresses environment in terms
  of internal and external components. She referred
  to the interaction between open systems and
  environment and indicated that matter, energy and
  information are exchanged.
• Kings (1981) framework characteristics of
  tension, stress, strain and conflict is addressed
  in her discussion of stress and transaction as
  they relate to the interpersonal system.
• She commented when transactions are made,
  tension or stress is reduced in a situation
• The characteristic of feedback is dealt within a
  dynamic manner in Kings(1971) discussion of
  nurse-patient interaction. This is a continuous
  dynamic process rather than separate incidents in
  which the action of one person influences the
  perceptions of the other.

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Unique Focus of the model

• The framework also addresses each of the
  characteristics of interaction model. A major
  feature is the social act of human interaction
  that occurs in the relationship between nurse and
  patient.
• The characteristic of perception is considered in
  detail as a major concept of personal system, it
  is a central aspect of the process of human
  interaction.
• Communication is a concept associated with the
  interpersonal system. Communication is used to
  establish and maintain relationship between human
  beings(King,1981). Nurses and patients
  communicate to establish mutual goals and decide
  on the means to achieve these goals.

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Unique Focus of the model

• Role is another concept related to the
  interpersonal system. Kings definition of health
  as an ability to function in social roles.
• The interaction model characteristic of self
  concept is addressed in Kings framework through
  the concept of self which associated with the
  personal system.
• Kings defined self as a composite of thoughts
  and feelings which constitute a persons
  awareness of his individual existence, his
  conception of who and what he is.

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Concepts and Components of the Framework

• I - Personal systems( individuals)
• The basic elements in the system, are best
  understood by the concepts of perception, self,
  growth and development, body image, learning
  time, personal space, and coping.
• a. Perception the person's representation of
  reality and it is unique to each individual
  process of organizing interpreting
  transforming information from sense data and
  memory ( King, 1981).
• b. Self The person's subjective environment,
  values, ideas, attitudes, and commitment(
  composite of thoughts feedings).
• C. Growth and Development the processes that
  take place in an individuals life that help the
  individual move from potential capacity for
  achievement to self actualization (King, 1981).

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Concepts and Components of the Framework

• D. Body Image The way a person perceive his/ her
  body and the reaction of others to his/ her
  appearance. Body image is subjective and changes
  as the person changes physically or emotionally.
• E. Personal space existing in all directions and
  is the same every where.
• F. Time duration between the occurrence of one
  event and occurrence of another event.
• G. Learning a process of sensory perception,
  conceptualization, and critical thinking
  involving multiple experiences in which changes
  in concepts, skills, symbols, habit and values
  can be evaluated in observable behaviors.
• H. Coping the constantly changing cognitive and
  behavioral efforts to manage specific external
  and internal demands that are appraised as taxing
  the resourses (Lazarus Folkman's def.1993).

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Concepts and Components of the Framework

• II- interpersonal systems (dyadic or triadic or
  small group)
• Requires an understanding of the concepts of
  communication, interaction, role.
  Stress/Stressors and transaction.
• A. Interaction acts of two or more persons in
  mutual presence.
• B. Communication information processing, a
  change of information from one state to another.
• C. Transaction a process of interaction between
  a person and another person or a person and the
  environment to achieve goals that are valued.

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Concepts and Components of the Framework

• D. Role Set of behaviors expected when occupying
  a position in social system.
• E. Stress dynamic state whereby a human being
  interacts with the environment to maintain
  balance for growth , development and performance
  which involves an exchange of energy
  information between the person and the
  environment for regulation control stressors.

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Concepts and Components of the Framework

III Social Systems Social systems occur when
interpersonal systems come together to form
larger systems such as families, religious
groups, school, work, and peer groups. The
social systems are comprised of Social roles,
behaviors, and practices that are developed to
maintain values and include organizations,
authority, power, status, and decision making.
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Concepts and Components of the Framework

• Organization a system whose continuous
  activities are conducted to achieve goals.
• Authority is the power or the individual who
  make decisions that guide other's actions.
• Power capacity to use resources in organizations
  to achieve goal.
• Status the position of an individual in a group
  or a group in relation to other groups in an
  organization.
• Decision Making Dynamic and systematic process
  by which a goal directed choice of perceived
  alternatives is made and acted upon by
  individuals or groups to attain a goal.

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Basic Paradigm Concepts

• 1- King's concept of Man
• Man is an important focus of King's framework.
• Man is defined as personal system.
• I- The major concept associated with personal
  system is perception and the sub concepts are
  self growth development , body image, time,
  space and learning.

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Basic Paradigm Concepts
King's concept of Man

• King (1989) maintained that perception is a
  comprehensive concept in personal system.
• Knowledge of perception is essential for nurses
  to understand self to understand other
  individuals.
• She defined perception as a process of
  organizing, interpreting transforming
  information from sense data memory.
• It is a process of human transactions with the
  environment.

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Basic Paradigm Concepts
King's concept of Man

• The self is a composite of thoughts feelings
  which constitute a persona's awareness of his
  individual existence, his conception of who
  what he is
• The self is the individual as known to the
  individual.
• Kings (1981) description of growth development
  drew from the works of Erikson (1950), Freud
  (1966) Piaget (1969). She identified two
  characteristics of growth development
• Growth development include cellular, molecular,
  behavioral changes in human beings.
• Growth development are a function of genetic
  endowment , meaningful satisfying experiences
  an environment conducive to help individuals move
  toward maturity.

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Basic Paradigm Concepts
King's concept of Man

• King defined the concept of body image as a
  persons perception of his own body , others
  reaction to his appearance is a result of other
  reactions to self.
• King defined time (1981) as the duration
  between the occurrence of one event the
  occurrence of another event.
• She defined space as existing in all directions
  is the same everywhere .. As the physical
  called territory.

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King's concept of Man

• King(1986)added learning to the list of concepts
  related to the personal system in her discussion
  of use of the general systems framework as a
  guide for curriculum development. She did not
  define or describe that concept.
• King linked all concepts except learning related
  to the personal system in the following
  statement.
• An individuals perceptions of self, of body
  image, of time and space influence the way he or
  she responds to persons, objects and events in
  his or her life.
• As individuals grow and develop through the life
  span, experiences with changes in structure and
  function of their bodies over time influence
  their perceptions of self .

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King's concept of Man

• II-The interpersonal system
• Composed of two , three, or more individuals
  interacting in a given situation.
• King(1990) explained that at the interpersonal
  systems level, individuals increase consciousness
  and are open to interpersonal perceptions in the
  communications and interactions with persons and
  things in the environment.
• The interpersonal system moves the focus from the
  individual alone to individuals interacting in
  dyads, triads, small groups and large groups
  (King,1989).
• The major concept of the interpersonal system is
  interaction the subconcepts are communication,
  transaction, role, stress, and coping
  (King,1986).

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• She defined interaction as the act of two or
  more persons in mutual presence . Interactions
  can reveal how one person thinks and feels about
  another person, how each perceives the other
  what the other does to him.
• According to king(1981)the process of
  interactions between two or more individuals
  represents a sequence of verbal nonverbal
  behaviors that are goal directed.

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• King(1981) viewed communication as the vehicle
  by which human relations are developed and
  maintained, she added that all behavior is
  communication.
• Communication is involved in transactions, which
  is defined as a process of interaction in which
  human beings communicate with environment to
  achieve goals that are valued. Transactions are
  goal directed human behaviors (1981).
• She viewed role in 3 dimensions
• Role is a set of behaviors expected when
  occupying a position in asocial system.
• Rules or procedures define rights and obligation
  in a position in an organization.
• Role is a relationship with one or more
  individuals interacting in specific situations
  for a purpose.

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• King (1981) viewed stress as negative and
  positive as well as constructive and destructive.
  
• King (1981) explained that stress is reduced when
  transactions are made
• King (1987) maintained that coping is an
  essential area of knowledge related to the
  interpersonal system .
• III-Social system
• King the defined a social system as an organized
  boundary system of social roles, behaviors and
  practice developed to maintain values and the
  mechanisms to regulate the practice and rules.

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• King (1989) pointed out that organization is a
  comprehensive concept in social system .
• An organization is composed of human beings with
  prescribed roles and positions who use resources
  to accomplish personal and organizational goals.
• The concept of power was defined as the process
  whereby one or more persons influence other
  persons in a situation
• King(1981) defined status as the position of
  individual in group or a group in relation to
  other groups in an organization
• Decision making in organizations 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 (1986) added control to be the list of
  concepts related to the social system as a guide
  for curriculum development.
• She did not however, provide a definition or
  description of that concept.

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King's concept of Man

• She proposes three basic premises man is
• 1. Man is a reactive being
• is aware of other things persons and events in
  the environment.
• At various times this awareness makes the being
  respond to the environment based upon his
  perceptions, expectations and needs.

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• Man as
• Is influenced by time orientation.
• Each person presents with by his past experience
  that influences his actions.
• His awareness of the present helps shape the
  future.
• Has a continuous exchange with persons in the
  environment.
• Language is a social link and facilitates
  interpersonal communication.

a time-oriented being
a social being
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• King identifies seven (7) other characteristics
  of man  
• 1. The ability to perceive these perceptions
  will influence behavior and thus life and health.
  
• 2. The ability to think thinking is based upon
  the inquiring mind of man. When man thinks he has
  the ability to discriminate and identify
  relationships.
• 3. The ability to feel--or to have emotions about
  the environment.

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King identifies seven (7) other characteristics
of man  

• 4. The ability to choose between alternative
  course of action.
• 5. The ability to set goals.
• 6. The ability to select means to achieve the
  goals.
• 7. The ability to make decisions dependent on
  other characteristics.

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• Kings' concept of environment
• King used the terms environment, health care
  environment, internal environment, external
  environment.
• Internal environment of human beings transforms
  energy to enable them to adjust to continues
  external environmental changes.
• The person continuously adjusts to stressors in
  the internal and external environment.
• King (1990a) stated that environment is a
  function of balance between internal and external
  actions.

40
Kings' concept of environment

• King makes the assumption that humans are open
  systems which are in constant interactions with
  their environment through three interacting
  systems (ecological perspective)
• 1)Personal system
• 2)Interpersonal system
• 3) Social system
• Systems have both internal and external
  environments the internal environment of human
  beings exchange energy, matter, and information
  to enable them to adjust to continuous external
  environmental changes.

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• Kings' concept of Health
• Health is a dynamic life experiences of human
  being, which implies continuous adjustment to
  stressors in the internal and external
  environment through optimum use of ones
  resources to achieve maximum potential for daily
  living (King,1981) .
• She also defined health as (an ability to
  function in social roles).

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Kings' concept of Health

• King did not use the term wellness, and although
  she did mention illness, she rejects a linear
  continuum of wellness-illness ( King 1989a).
• King(1989a) regards health as (a dynamic state of
  an individual in which change is a constant and
  ongoing process).
• Disturbances in the dynamic state are regarded as
  illness or disability.
• King(1981) explicitly defined illness as a
  deviation from normal, that, an imbalance in a
  persons biological structure or in his
  psychological make-up, or a conflict in a
  person's social relationships .

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Kings' concept of Health

• The dynamic state of health occurs in the life
  cycle from conception to death (King,1989).
• Illness is an interference in the continuation
  of the life cycle.
• There is no consideration of age group or point
  of time in King's definition of health.

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• Kings' concept of Nursing
• Nursing
• "is a process of actions, reaction, interaction,
  and transaction whereby nurses assist individuals
  of any age and socioeconomic group to meet their
  basic needs in performing activities of daily
  living and to cope with health and illness at
  some particular point in the life cycle." (1991)
• The domain of nursing includes promotion of
  health, maintenance and restoration of health,
  care of the sick and injured and care of the
  dying (King, 1981). Furthermore King viewed
  nursing as a helping profession that provides a
  service to meet a social need.
• According to King(1976), nurses are key figures
  in health care delivery as partners with
  physicians, social workers, and allied health
  professionals in promoting health, in preventing
  disease, and in managing patient care. They
  cooperate with physicians, families, and others
  to coordinate plans of health care.

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Kings' concept of Nursing

• As a goal of nursing is to help individuals and
  groups attain, maintain, and restore health.
• King(1973) defined the nursing process as a
  dynamic, ongoing interpersonal process in which
  the nurse and the patient are viewed as a system
  with each affecting the behavior of the other and
  both being affected by factors within the
  situation.
• Emphasis on client participation in goal setting
  and goal achievement is a major strength of this
  model.
• King's Goal Attainment Theory the focus of
  nursing is human beings interacting with their
  environment leading to a state of health for
  individuals, which is an ability to function in
  social roles.

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The three dimensional Nursing Processbased on
King's Theory The nursing process is elaborated
through the theory of Goal Attainment.
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Kings' concept of Nursing

• Recently, King(1989a) began to refer to the
  nursing process described by the theory as an
  interaction-transaction process model.
• The components of the nursing process, or
  transactional model, where identified as
  perception, judgment, action, reaction,
  disturbance, mutual goal setting, exploration of
  means to achieve the goal, agreement on means to
  achieved goal, transaction, and attainment of the
  goal.

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Kings' concept of Nursing

• The process, which is depicted in the figure(4.2)
  follows a sequence that encompasses two
  people-the nurse and the client.
• In the assessment phase the nurse and the client
  perceive each other, make mental judgments about
  the other, take some mental action, react to each
  ones perception of the other, communicate, and
  begin to interact (King, 1992).
• In the planning phase, interaction can be
  observed directly, and the data about those
  interactions can be recorded.

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Kings' concept of Nursing

• King (1992a) explained that goal setting is
  based on the nurses assessments of the clients
  'concerns, their problems, and disturbances in
  health, perception of problems, and their sharing
  of information with clients and families to move
  toward quality improvement in their health.
• In the implementation phase of the process is
  when transactions are made. Transactions, which
  are the valuational components of the interaction
  can be observed in the form of goal attainment
  measures .
• The evaluation phase of the process requires a
  decision to be made with regard to whether the
  goal was attained and, if necessary, the
  determination of why the goal was not attained
  (King,1992).

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• King's Model of the Nursing Process

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Nursing Process based on King's Theory.

• Attainment (King, 1992) Provides the theoretical
  basis for nursing practice. King (1995)
  underscored the importance of nursing process as
  both method and theory when she stated
• "Nurses are first, and foremost, human beings
  who perform their function in professional role.
  It is the way in which nurses, in their role, do
  with and for individuals that differentiates
  nursing from other health professionals."

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• In summary, the traditional nursing process is a
  system of interrelated actions, the methods by
  which nursing is practiced. The critical thinking
  process reflects highly developed thinking skills
  essential for nursing practice in the
  twenty-first century.
• The theory of Goal Attainment. King (1999)
  recently drew comparisons between the process of
  ethical decision making, the nursing process, and
  the transaction process to illustrate the use of
  her theory for dealing with ethical issues in
  present-day nursing practice.

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Nursing process as Theory Nursing as Method
- A system of interrelated concepts. - Perception of nurse and Patient. -Communication of nurse and patient. - Interaction of nurse and patient. - Decision making about goals -Agree to means to attain goals. - Transaction made. - Goal attained. - A system of interrelated action. -Assess. - Plan. - Implement - Evaluate.
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Content of the Model Propositions

• The propositions of the General Systems framework
  encompass all four metapardigm concepts. Person
  and environment are linked in the following
  statement.
• In open systems, such as human beings,
  interacting with their environments, there is
  continuous and dynamic communication occurring(
  King. 1981, p. 66)
• The concepts of person, environment, and nursing
  are linked in the following quotation
• The artificial boundaries of nursing are
  individuals and groups interacting with the
  environment. Nurses function in their roles in a
  variety of health care environments. (King, 1981,
  p.1)

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Content of the Model Propositions (contd)

• Person , health and nursing are linked in this
  statement
• As professionals, nurses deal with the behavior
  of individuals and groups in potentially
  stressful situations relative to health and
  illness and help people meet needs that are basic
  in performing activities of daily living ( King
  1976).
• Finally, all four metapardigm concepts are linked
  in the following quotation
• The focus of nursing is human beings interacting
  with their environment leading to a state of
  health for individuals, which is an ability to
  function in social roles (King, 1981).

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Hypotheses

• King (1986b,1990b) derived the following
  hypotheses from the theory propositions
• 1-Functional abilities will be greater in
  patients who participate in mutual goal setting
  than in those who do not participate.
• 2-Mutual goal setting will increase functional
  abilities in performance of activities of daily
  living.
• 3-Goal attainment will be greater in patients who
  participate in mutual goal setting than in
  patients who do not participate.
• 4- There is a positive relationship between
  functional abilities and goal attainment.
• 5- Perceptual congruence in nurse-patient
  interactions increases mutual goal setting.
• 6- Mutual goal setting will increase the morale
  of elderly patients.
• 7- Mutual goal setting decreases stress in
  planning and implementing decisions about goals
  to be attained.

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Hypotheses

• 8- Mutual goal setting increases transactions,
  which increases goal attainment, which leads to
  effective nursing care.
• 9-Goal attainment in nursing situations leads to
  growth and development in nurse and patient.
• 10-Transactions increase nurses and patients
  self-awareness in goal attainment.
• 11- congruence in role expectations and role
  performance increases transactions in
  nurse-patient interactions.
• 12- Accurate perceptions of time-space relations
  in nurse-client interactions increase transaction
  and goal attainment.
• 13-Goal attainment decreases stress and anxiety
  in nursing situation.
• 14- Goal attainment increases patients' learning
  and coping abilities in nursing situations.

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• The General System framework reflects the
  characteristics of both the systems and
  interaction categories of nursing knowledge.
• King (1989b) has also derived a middle-range
  theory of nursing administration from the General
  System Framework.

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