By Nicole Hilliard Lisa Kilgore Staci Leyko Imogene King By Nicole Hilliard Lisa Kilgore Staci Leyko

Introduction Theory of Goal Attainment first dev. In 1960s Theory first published in 1971 Theory effectively allows nurse to help clients achieve their goals Gives clients tools necessary to help themselves

Purpose of Theory Develop Interpersonal relationship between nurse and client Work together to communicate information Set goals Develop actions to attain goals Achieve goal for client to maintain health and function independently in their role as individuals

3 Fundamental Needs of Theory Need for health information Need for care that seeks to prevent illness Need for care when clients are unable to care for themselves

Questions/Problems to Solve Do the nurse and client have a working relationship? Are the set goals attainable? Is communication between nurse and client effective? Is the client willing to participate in achieving goals set?

Assumptions Nurse and client communicate information Nurse and client mutually set goals Act together to attain goals Clients interact with their environment Client maintains ability to function in social role

Nursing Paradigm: Person People exist as spiritual beings in open system Rational thinkers Make choices Select courses of action Record history through language and symbols

Nursing Paradigm: Person cont. Persons are unique, holistic, have different needs Each person has wants, goals

Nursing Paradigm: Health Dynamic life experiences Continuous adjustments to internal and external stressors in environment Use of one’s resources Strive to achieve maximum potential for daily living

Nursing Paradigm: Environment Background for human interactions Internal environment: transforms energy, allows adjustment to external environment changes External environment: formal, informal organizations

Clarification of Origins King’s “specific motivation to develop her conceptual framework was the need to select essential content for a new master’s degree program in nursing” (Fawcett, 2001). Her “initial interest in theory was to develop a conceptual frame of reference to focus and organize nursing knowledge with the goal of identifying a systems theory for nursing” (Frey, 2006).

Origins cont. Commenting on the origin of her conceptual framework, “King (1971) explained, “Concepts that consistently appeared in nursing literature, in research findings, in speeches by nurses, and were observable in the world of nursing practice were identified and synthesized into a conceptual frame- work” (Fawcett, 2001).

Spouses can learn to mutually set goals together King’s model outside of nursing Spouses can learn to mutually set goals together Teachers and students can also be taught to set mutual goals (Fawcett, 2001).

Theory of Goal Attainment “Derived from personal and interpersonal system concepts” (Frey, 2006). Main focus was on the “nurse-client interactions that lead to transactions and goal attainment” (Frey, 2006).

Other Theories/Models Figures 2 and 3 show an example of how the Model of Transactions “provides theoretical knowledge that is used to implement the nursing process method of assess, diagnose, plan, implement, and evaluate nursing care” (King, 2007)

Theories cont. These processes are also related to the “North American Nursing Diagnoses Association (NANDA), Nursing Intervention Classification (NIC), and Nursing Outcomes Classification (NOC)” (King, 2007). “Use of the transaction process leads to goal attainment and outcomes. Outcomes represent evidence-based practice” (King, 2007). “Outcomes are defined as goals achieved and can be used to evaluate the effectiveness of nursing care” (Frey, 2006).

King’s conceptual framework Very complex and multifaceted. Based on General System Theory She stated, “After studying the research on General System Theory, [von Bertalanffy] I was able to synthesize my analysis of the nursing literature and my knowledge from other disciplines into a conceptual framework” (Fawcett, 2001).

Global concepts Kings model clearly describes the four global concepts of human being, environment, health and nursing. King states “The focus of nursing is human beings interacting with their environments leading to a state of health for individuals, which is the ability to function in social roles” (Frey, 2006).

King’s theory of goal attainment, the Transaction Process Model Useful in any area of nursing. Described as mutual goal setting In the perioperative area, the nurse works with the patient on goals of procedural understanding The inpatient setting, the patient and nurse set goals together to facilitate discharge and recovery King states, “Nursing administrators…use this when interacting and communicating with other nurses and other health professionals” (Fawcett, 2001).

Imogene King Conclusion Born in 1923 Basic nursing education from St. John’s Hospital School of Nursing in St. Louis in 1945 Also received bachelor’s, masters, and doctor of education degrees Spent much of career in academic settings First published early theoretical work in 1971 First claim to a nursing theory in 1981 with A Theory for Nursing: Systems, Concepts, Process Framework to view whole persons in their family and social contexts

Imogene King Conclusion cont. Broad theory that encompasses person, health, environment and nursing Can be used across all areas of nursing Human beings have three fundamental needs The need for health information that is unable 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

Imogene King Conclusion cont. King’s concept focuses on persons and three interacting systems: Personal, Interpersonal, Social Personal-refers to the individual Concepts include: perception, self, body image, growth and development, time, and space Interpersonal-involves individuals interacting with one another Concepts include: interaction, transaction, communication, role, and stress Social-groups of people within a community or society that share common goals, interests and values Examples include: family, school, church Within these groups beliefs, attitudes, values, and customs are formed The relationship between these three systems led to King’s Theory of Goal Attainment

Imogene King Conclusion cont. Theory of Goal Attainment King believed that the major elements of goal attainment are discovered in the interpersonal systems in which two people who are usually strangers come together in a health care organization to help and to be helped to maintain a state of health that permits functioning in roles Communication between nurse and patient leads to transactions that result in goal attainment Ten major concepts from personal and interpersonal systems to support theory of goal attainment-human interactions, perception, communication, role, stress, time, space, growth and development, and transactions

Imogene King Conclusion cont. Nurse and client interactions are characterized by: verbal and non-verbal communication, in which information is exchanged and interpreted Transactions in which values, needs, and wants of each member are shared Perceptions of nurse and client and the situation Self in role of client and self in role of nurse Stressors influencing each person and the situation in time and space

Imogene King Conclusion cont. King summarized the connections among the concepts in the following statement “An individual’s 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 perception of self” (Williams, 2001).

Imogene King Conclusion cont. Propositions of Goal Attainment If perceptual interaction accuracy is present in nurse-patient interactions, a transaction will happen If nurse and client make transaction, goal will be attained If goal are attained, satisfaction will occur If goals are met, efficient nursing care will happen If transactions are made in nurse-client interactions, growth and development will be enhanced If role expectations and role performance as perceived by nurse and client are congruent, transaction will occur If role conflict is experienced by nurse or client or both, stress in nurse-client interaction will occur If nurse with special knowledge and skills communicates appropriate information to client, mutual goal setting and goal attainment will occur

Imogene King Case Study A young college student presents to the intensive care unit following a motor vehicle accident in which his arm was traumatically amputated. The patient went to surgery to repair the arm along with many facial lacerations and a collapsed lung. The patient was placed on a ventilator overnight and was extubated today prior to your shift. The patient is now awake and has many questions for you as his nurse. He does not remember the accident and is confused at what has happened to him over the last 24 hours. He is experiencing phantom pain in his arm and is worried about how he looks with only one arm. He wonders if he will be treated differently now. Will he be able to work and play with his friends as he used to? How will he take care of himself with one arm? He then sees his face in the mirror and begins to cry due to the lacerations he has received. He asks you if he will look “normal” again. Finally, he is having trouble catching his breath and wonders why he is so “out of breath”? Please answer the following questions based on King’s theory of nursing

Imogene King Case Study Answers According to King’s Personal System-what concepts is the patient dealing with at this time? Perception that he will be treated differently Change in body image Feelings of loss and separation Within the interpersonal system-what can the nurse do to interact in a positive way with this patient? Communicate what has happened to the patient in a way that he understands Give the patient a comforting touch Do not use facial expressions toward the loss of the arm that give the patient a reason to feel different

Case Study Answers Cont. According to the Social System-what beliefs, attitudes, value and customs are apparent from the patient’s thoughts and questions? People with one arm will be treated differently People with facial scars do not “look normal” People with only one arm cannot work and play What goals could the nurse and patient work on together based on the patient’s questions and feelings? Improving the patient’s self-esteem, learning how to care for himself with one arm, looking into support groups for those with a limb loss, how to care for the facial lacerations to limit scarring

References   Fawcett, J. (2001, October). The Nurse Theorists: 21st-Century Updates-Imogene M. King. Nursing Science Quarterly, 14(4), 311-315. doi:10.1177/089431840101400407 Frey, M. (2006). King’s Conceptual System and Theory of Goal Attainment In Fitzpatrick, J & Wallace, M. (Eds.), Encyclopedia of Nursing Research (2nd ed., pp. 314-315). New York, NY: Springer Publishing Co. King, I. M. (1981). A theory for nursing: Systems, concepts, process. Albany, NY: Delmar Publishers. King, I. M. (1997). The theory of goal attainment in practice. Nursing Science Quarterly, 10, 180-185. King, I. M. (2007, April). King's Conceptual System, Theory of Goal Attainment, and Transaction Process in the 21st Century. Nursing Science Quarterly, 20(2), 109-111. doi:10.1177/0894318407299846

Imogene King References Nursing theory by Imogene King: Goal attainment theory. (2013). Nursing Theories: Theoretical Models and Frameworks of Nursing. Retrieved from http://nursingtheories.info/nursing-theory-by-imogene-king-goal-attainment- theory/ Williams, L. A. (2001). Imogene King’s interacting systems theory: application in emergency and rural settings. Online Journal of Rural Nursing and Health Care, 2(1), 25-30. Retrieved from http://www.rno.org/journal/index.php/online-journal/article/viewFile/93/89