GOAL ATTAINMENT THEORY IMOGENE KING

ST. LUKES COLLEGE OF NURSING TRINITY UNIVERSITY OF ASIA

IMOGENE KING

Born in 1923. Received her basic Nursing Education from St. Johns Hospital School of Nursing in 1945. Received her Bachelor of Science in Nursing and Education with minors in Philosophy and Chemistry from St. Louis University in 1948. Received her Master of Science in Nursing from St. Louis University in 1957. Received her Doctor of Education from Teachers College, Columbia University.

IMOGENE KING

King has had experience in Nursing as an administrator, an educator, and a practitioner. Her area of clinical practice in adult Medical-Surgical Nursing She served as Director of the School of Nursing at The Ohio State University in Columbus She has been a faculty member at: St. Johns Hospital School of Nursing, St. Louis Loyola University, Chicago University of South Florida

IMOGENE KING

The goal of the nurse is to help individuals maintain or regain health. Nursings domain includes promoting, maintaining, restoring health and caring for the sick, injured or dying. The function of the professional nurse is to interpret information in, what is known as the nursing process, to plan, implement, and evaluate nursing care for individuals, families, groups and communities.

NURSING PARADIGMS

HUMAN BEINGS
King describes human beings as social, sentient, rational, reacting, perceiving, controlling, purposeful, action-oriented and time-oriented. King states that a concern for Nursing is helping people interact with their environment in a manner that will support health maintenance and growth toward self fulfillment.

HUMAN BEINGS
King has derived the following assumptions that are specific to nurse-client interaction:
Perceptions of nurse and of client influence the interaction process. Goals, needs, and values of nurse and client influence the interaction process. Individuals have a right to knowledge about themselves. Individuals have a right to participate in decisions that influence their life, their health, and community services. Individuals have a right to accept or to reject health care. Goals of health professionals and goals of recipients of health care may be incongruent.

HUMAN BEINGS
King stated that human beings have three fundamental health needs: The need for health information that is usable at the time when it is needed and can be used. The need for care that seeks to prevent illness. The need for care when human beings are unable to help themselves. King indicated that nurses have the opportunity to find out what health information the client has how the client views his or her own health what actions the client takes for health maintenance

HEALTH
King defined health as "dynamic life experiences of a 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 affirms that health is not a continuum but a holistic state and identifies the characteristics of health as "genetic, subjective, relative, dynamic, environmental, functional, cultural and perceptual ". King defines illness as a deviation from or imbalance in persons normal functioning. This deviation may be related to biological structure, psychological make-up, or social relationships.

ENVIRONMENT
Environment and Society are indicated as major concepts in Kings conceptual system but are not specifically defined in her work. Society may be viewed as the social systems portion of her conceptual system. Although Kings definition of health mentions both internal and external environments, King also stated that environment is a function of balance between internal and external interactions. King presented her material based on open systems and it is assumed that the definition of external environment was drawn from the general systems theory.

ENVIRONMENT
Systems are considered to have semipermeable boundaries that help differentiate their internal components from the rest of the world. The external environment for a system is the portion of the world that exists outside of the system.

NURSING
Nursing is defined as the nurse and client using action, reaction and interaction in a health care situation to share information about their perception of each other and the situation. This communication enables them to set goals and choose the methods for meeting the goals. Action is defined as a sequence of behaviors involving mental and physical activity. Reaction is not specifically defined but might be considered to be included in the sequence of behaviors described in action.

NURSING
ACTION
Mental Action Physical Action Mental Action Physical Action

Recognize the presenting conditions.

Begin activities related to those conditions.

Effort to exert control over the situation.

Seeking to achieve goals.

INTERACTING SYSTEMS THEORY

INTERACTING SYSTEMS THEORY

Personal Systems The relevant concepts are perception, self, growth and development, body image, space and time. Perception is the concept that influences all behaviors or to which all other concepts are related. King discusses perception as a process in which data is obtained through the senses and from memory are organized, interpreted and transformed.

INTERACTING SYSTEMS THEORY

Personal Systems The characteristics of self are the dynamic person who is an open system and whose actions are oriented toward achieving goals. Kings definition of self includes self as made up of those thoughts and feelings related to ones awareness of being a person separate from others and influencing ones view of who and what he or she is.

INTERACTING SYSTEMS THEORY

Personal Systems
The characteristics of growth and development include changes in behavior at the cellular and molecular levels in individuals. These changes usually occur in an orderly manner, one that is predictable but has individual variations. Growth and development can be defined as as the processes in peoples lives through which they move from a potential for achievement to actualization of self.

INTERACTING SYSTEMS THEORY

Personal Systems
Body image is characterized as very personal and subjective, acquired or learned, dynamic and changing as the person redefines self. Space is characterized as universal because everyone has some concept of it. Individual definitions of space are influenced by culture. Time is characterized as universal and inherent in life processes. King defines time as an interval between the two events that is experienced differently by each person.

INTERACTING SYSTEMS THEORY

Interpersonal Systems Interpersonal systems 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. The complexity of the interactions increases as the number of people interacting increases. The relevant concepts are interaction, communication, transaction, role and stress.

INTERACTING SYSTEMS THEORY

Interpersonal Systems Interaction is defined as the observable behaviors of two or more persons in mutual presence. Communication involves the exchange of information between two persons. Transactions are derived from cognition and perception. King defines transactions as a series of exchanges between human beings and the environment that include observable behaviors that seek to reach goals of worth to the participants.

INTERACTING SYSTEMS THEORY

Interpersonal Systems The characteristics of role include reciprocity in that a person may be a giver at one time and a taker at another time. The three major elements of role are: Role consists of a set of expected behaviors of those who occupy position in a social system. Role is a set of procedures or rules that define the obligations and rights associated with a position in an organization. Role is a relationship of two or more persons who are interacting for a purpose in a particular situation.

INTERACTING SYSTEMS THEORY

Interpersonal Systems The nurses role can be defined as interacting with one or more others in a nursing situation in which the nurse as a professional uses the skills, knowledge and values identified as belonging to nursing to identify goals with others and help them achieve goals. The characteristics of stress are that it is universal dynamic as a result of open systems being in continuous exchange with the environment. King defines stress as an ever changing condition in which an individual, through environmental interaction, seeks to keep equilibrium to support growth and development and activity.

INTERACTING SYSTEMS THEORY

Social Systems
A social system is a structured large group in a system that includes the roles, behaviors and practices defined by the system for the purposes of sustaining desirable attributes and for creating methods to maintain the practices and rules of the system. Examples of social systems include peers, families, community groups, religious groups, educational organizations, government and work systems. An organization is characterized by a structure that orders positions and activities and includes formal and informal arrangements of people to gain both personal and organizational goals.

INTERACTING SYSTEMS THEORY

Social Systems
King defines organization as being made up of individuals who have prescribed roles and positions and who make use of resources to meet goals both personal and organizational. King defines authority as an active, reciprocal process of transaction in which the actors experience, understanding and values influence the meaning, legitimacy and acceptance of those in organizational positions associated with authority. King defines power in a variety of ways including organizational capacity to use resources to meet goals, one person influencing others and capability to attain goals.

INTERACTING SYSTEMS THEORY

Social Systems
King defines status as the relationship of ones place in a group to others in a group or of a group to other groups. Decision making in an organization is defined as a changing and orderly process through which choices related to goals are made among identified possible activities and individual or group actions are taken to move toward the goal.

THEORY OF GOAL ATTAINMENT

The basic assumption of the theory - is that nurses and clients communicate information, set goals mutually, and then act to attain goals also the basic assumption of the nursing process.

King describes the steps of the nursing process as a system of interrelated actions and identifies concepts from her work that provide the theoretical basis for the nursing process as a method.

THEORY OF GOAL ATTAINMENT

Assessment occurs during the interaction of the nurse and the client, who are likely to meet as strangers. Assessment may be viewed as paralleling action and reaction. The nurse brings to this meeting special knowledge and skills, whereas, the client brings knowledge of self and perceptions of the problems that are of concern.

THEORY OF GOAL ATTAINMENT

Assessment, interviewing and communication skills are needed by the nurse as is the ability to integrate knowledge of natural and behavioral sciences for application to a concrete situation.

The nurse needs to collect data about the clients level of growth and development, view of self, perception of current health status, communication patterns and role socializations.

THEORY OF GOAL ATTAINMENT

Factors influencing the clients perception include: The functioning of the clients sensory system Age Development Sex Education Drug and diet history Understanding of why contact with the health care system is occuring.

THEORY OF GOAL ATTAINMENT

Factors influencing the perception of the nurse include: Cultural background of the nurse Socio-economic background of the nurse Age of the nurse Diagnosis of the client Perception is the basis for gathering and interpreting data thus making it the basis for assessment. Communication is necessary to verify the accuracy of perceptions. Without communication, interaction and transaction cannot occur.

THEORY OF GOAL ATTAINMENT

The information shared during assessment is used to derive a nursing diagnosis. It is defined by King as a statement that recognizes the distresses, difficulties or worries identified by the client and for which help is sought. After the nursing diagnosis is made, outcomes are identified and planning occurs. King indicates that goal attainment equates to outcomes. King says that the concepts involved are decision making about goals and agreeing to means to attain goals. King describes planning as setting goals and making decisions about how to achieve these goals.

THEORY OF GOAL ATTAINMENT

Implementation occurs in the activities that seek to meet the goals. King stated that implementation is the continuation of the transaction. Evaluation involves descriptions of the outcomes identified as goals are attained. According to Kings description, evaluation not only speaks to the attainment of the clients goals but also to the effectiveness of nursing care.

THEORY OF GOAL ATTAINMENT

Although all theory concepts apply throughout the nursing process, communication with perception, interaction and transaction are vital for goal attainment and need to be apparent in each phase.

King emphasizes the importance of mutual participation in interaction that focuses on the needs and welfare of the client and of verifying perceptions while planning and activities to achieve goals are carried out together.

Think about this It is not enough to take steps which may some day lead to a goal; each step must be itself a goal and a step likewise.
Johann Wolfgang von Goethe

German Writer 28 August 1749 22 March 1832

REFERENCE
George, Julia B., 2008, Nursing Theories: The Base for Professional Nursing Practice. Fifth Edition. Prentice Hall