GOAL ATTAINMENT THEORY

Imogene King GOAL ATTAINMENT THEORY (King, 1981)

The assumptions state that the human beings are open systems in constant interaction with their environment; that the focus of nursing is on human beings interacting with their environment; and that the goal is to help individuals and groups maintain health; NURSING FOCUS- HUMAN BEINGS INTERACTING WITH ENVIRONMENT NURSING GOAL HEALTH MAINTENANCE (INDIVIDUAL AND GROUPS) Three interacting components are present in Kings theoretical framework personal systems, interpersonal systems and social systems. Specific elements or concepts characterize each of these components. All of the elements or concepts are interrelated in the human-environment interaction. Each integrating system is composed of major elements. Perception, a major element in personal systems, influences all behaviors. It is universal (experienced by all, subjective, selective for each person and action oriented based on the information available. Perception is involved in transactions where individuals are active participants. It involves a process where data obtained by the senses are processed, organized, transformed. Interaction is an element of the interpersonal system. It is influenced by perceptions and characterized by values. Interaction is a mechanism for establishing human relations through verbal and nonverbal communication, and includes learning when communication is effective. Interaction is also defined as the observable behaviors of two or more persons in mutual presence. Communication has several characteristics. It maybe verbal or nonverbal. Touch is a form of non-verbal communication as well as distance, posture, facial expression, physical appearance, and body movements. Transactions refer to the process of interaction in which human beings communicate with the environment to achieve goals that are valued. It encompasses all goal-directed behaviors. The elements of the social systems also include those of the personal and interpersonal systems. Social systems include families, religious groups, educational systems, work systems and peer groups.

The nature bedside nursing care places the nurse in strategic position. You are usually the first health professional to meet the patient (client). It is possible that you and the patient are looking at the same situation; your perceptions of the situation differ. EXAMPLE: A post thoracic surgery patient may not want to be moved due to discomfort and pain. You may have observed that even a slight movement can make post-thoracic surgery patients complain. Yet the nurse thinks that coughing exercises and turning to sides may be beneficial. To the nurse, these actions are important since these will improve circulation and thus facilitate early recovery. The patient may not know the implications of prolonged immobilization; complications like pneumonia may develop. Both nurse and the patient realize that something has to be done. However, they differ in the perception of the situation. Communication may be initiated, but may not be effective. Nursing, according to King (Parse, 1987, p.113) is a process of human interaction between the nurse and the client whereby each person perceives the other and the situation and through communication, they set goals, explore the means to achieve them, agree to the means, and perform appropriate actions. These processes indicate movement toward goal achievement. Reciprocal relationship and a shared perception of the situation are required for goal attainment, then interaction can be said to be effective. The nurse should clarify to the patient the reason why coughing and turning to sides are important. This way, a common perception is developed in both. GOAL ACHIEVEMENT is explained b y a background framework. This will enhance understanding of the theory. A conceptual framework provides a system of organizing concepts. It provides explanations for the essential elements or components of the framework. Basic to Kings conceptual framework are several assumptions.

King proposed four parameters for organization. Human values, behavior, patterns, needs, goals, expectations A natural environment in which material and human resources are essential for achieving goals Employers and employees, or parents and children, who form groups that collectively interact to achieve goals Technology that facilitates goal attainment GOAL ATTAINMENT The major elements of the theory of goal attainment are seen in the interpersonal system. Two people, the nurse and the patient, come to a health care organization to help and be helped in order to maintain a state of health that allows functioning. Goal Attainment Theoryi----------- interpersonal systems (the practice of nursing is differentiated from that of other health professions by what nurses do with and for individuals) Interaction is defined as a process of perception and communication between a person and the environment or between persons represented by verbal and non-verbal behaviors that are goal directed In the interaction process as explained by kings theory, individuals have different ideas, attitudes, and perceptions. The individuals come together for a purpose and perceive each other; each makes a judgment and takes mental action or decides to act. Each of then reacts to the other and the situation. It brings about the following elements perception, judgment, action reaction. According to King, only interaction and transaction are directly observable Communication refers to the 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. Communication is the information component of interaction. Transactions represent the valuation component of human interactions and involve bargaining, negotiating, and social exchange. When transactions occur between nurses and clients, goals are attained. ELEMENTS The elements of the conceptual framework further explain the concept of goalattainment. The assumptions about human

beings, health, environment/society, and nursing, according to King are the following: Human beings are social, sentient, rational, reacting, perceiving, controlling, purposeful, action-oriented and timeoriented. Human beings have three fundamental 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 that seeks to prevent illness The need for care when human beings unable to help themselves. Nurses according to King, are in the position to assess what people know about their health, what they think about their health, how they feel about it, and how they can act to maintain about it. Health is a functional, holistic state. Illness is an interference of that functional state. Health refers to the dynamic life experiences of a human being, which call for continuous adjustment to stressors in the internal and external environment through optimum use of ones resources. This allows the achievement of the maximum potential for daily living. Environment was described by King as a function of the balance between internal and external interactions. The term is often used to refer to the external environment. The idea of open systems proposes that each system or unit has a boundary that separates internal components from other existing boundaries. The external environment of a system is the portion of the world that exists outside the boundary. In Kings theory, the term environment is not clearly defined and correlated with other major components. Nursing is defined as a process of action, reaction, and interaction whereby nurse and client share information about their perceptions in the nursing situation. Nursing is also defined as a process of human interaction between nurse and client whereby each perceives the other and the situation; and through communication, they set goals, explore means and agree on means to achieve goals. Nursing process is a series of thoughts and actions to attain a goal. This description is similar to the theory of goal-attainment that nurses and clients communicate information, set goals mutually, and then act to attain these goals.

Nursing Process Assessment

Nurse Dynamics

Theory of Goal Attainment Interaction of nurse and client (action, reaction: perception, communication, interaction) Information shared during assessment (identification of disturbances or concerns about which patients seek help) Decision-making about goals exploration of means to achieve goals identification of means Attainment of outcomes Evaluation of effectiveness of nursing care

From the interplay of the three systems, abstract conceptualization of human beings, health, environment and society provided the framework for Kings theory of goalattainment. The major concepts of the theory of goal-attainment are interaction, perception, communication, transaction, role, stress, growth and development. From the interplay of the three systems, abstract conceptualization of human beings, health, environment and society provided the framework for Kings theory of goal-attainment. The major concepts of the theory of goal-attainment are interaction, perception, communication, transaction, role, stress, growth and development.

Plan Care

CHAPTER SUMMARY: CLIENT-NURSE DYANMICS Four theories explaining nurse-client dynamics provided the content of Module 4. insights from historical perspectives serve to explain the development process of the interaction theories. Some conceptualization and interpretation processes were included. A model with five main questions provided a framework for comparing, contrasting and explaining the interrelatedness of the concepts and propositions. The key points of the four theories are: interpersonal process is a maturing force for personality (Peplau), the interpersonal process alleviates distress (Orlando), transactions provide a frame of reference toward goal-setting (king), and caring is a moral ideal of mind-body-soul engagement with another (Watson). What can we derive so far from the interaction (nurse-client dynamics theories? Nursing is a deliberate process which can be described in different ways. Nursing encompasses two important key concepts help and assistance. Nursing is an interpersonal; process occurring between a person (client/patient) needing help and the nurse (professional) providing assistance and services.

Evaluation

UTILIZATION The theory of goal-attainment may be applicable to any dyadic nursing situation. It can be used to guide and improve nursing practice. There are several hypotheses derived from the theory of goal attainment. Mutual goal setting will increase the ability to perform activities of daily living. Mutual-goal setting by the nurse and patient leads to goal attainment. Goal-attainment will be greater in patients who participate in goal setting than in those who do not participate. Mutual goal setting will increase elderly patients morale. Goal-attainment decreases stress anxiety in nursing situations To summarize, the framework of the theory of goal-attainment consists of thee interacting systems personal, interpersonal and social , which are in continuous exchange with their environment. The open systems framework provides an explanation for the interaction of the systems