Goal Attainment

Imogene King

Punusingon,Febriana lidia
 Early Life

 Imogene King was born Jan. 30, 1923, in West Point,

Iowa. During her early high school years, she decided
to pursue a career in teaching. However, her uncle, the
town surgeon, offered to pay her tuition to nursing
school. She eventually accepted the offer, seeing
nursing school as a way to escape life in a small town.
Thus began her remarkable career in nursing.
 Education

 Imogene King excelled in her nursing studies despite the

fact that it was not her first choice to consider. In 1945, she
received a diploma in Nursing from St. John’s Hospital
School of Nursing in St. Louis, Missouri.

 While working in a variety of staff nurse roles, King

started coursework toward a Bachelor of Science in
Nursing Education, which she received from St. Louis
University in 1948. In 1957, she received a Master of
Science in Nursing from St. Louis University.

 She went on to study with Mildred Montag as her

dissertation chair at Teacher’s College, Columbia University,
New York, and received her EdD in 1961.
 WORK EXPERIENCES

 Administrator (Ohio State University)

 Educator (St. John’s Hospital School of Nursing;

Loyola University; University of South Florida)

 Practitioner (Adult Medical-Surgical Nursing)

 Assistant chief of the Research Grants Branch,

Division of Nursing, Department of Health,
Education and Welfare

 Professor emeritus at University of South Florida

 Death

 Imogene King died on December 24, 2007, two days after suffering
from stroke. Patricia Quigley, PhD, ARNP, CRRN, FAAN, announced
King’s passing to nursing colleagues with these words: “May we all burn a
candle today for the light that Imogene shined on us with her smile,
laughter, knowledge and passion for each day. We all shared in our love for
her. Combining religion and science through nursing, her inspired voice
was never weak—but strong with passion and conviction.”

 Midori Sugimori, Naomi Funashima, Kyoko Yokoyama and Tomomi

Kameoka, four of the Japanese nurses whom King had mentored, traveled
to Florida to pay their respects upon hearing of King’s death.

 King’s memorial services were held January 4 in St. Pete Beach, Florida,
and January 19 in Fort Madison, Iowa, where she was buried. Her last
moments were attended by her friends, relatives and colleagues.

 During both services, Patricia Messmer read the Nightingale Tribute, which
included a synopsis of King’s career and a poem, “Imogene Was There.”
Seven green Irish roses symbolized the seven decades of her nursing
career. A Nightingale Lamp from the University of Pittsburgh, her
graduation picture from St. John’s Hospital School of Nursing and a
current photo were also displayed for the memorial services.
 What is Theory of Goal Attainment?

 The Theory of Goal Attainment states that “Nursing is a process of

action, reaction and interaction by which nurse and client share information about
their perception in a nursing situation” and “a process of human interactions
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.”

 In this definition, the action is a sequence of behaviors involving

mental and physical action, and the reaction is included in the sequence
of behaviors described in action. King states that the goal of a nurse is
to help individuals to maintain their health so they can function in their
roles. The domain of the nurse “includes promoting, maintaining, and
restoring health, and caring for the sick, injured and dying.” The
function of a professional nurse is “to interpret information in the
nursing process to plan, implement, and evaluate nursing care.”
 Propositions

The following propositions are made in Imogene King’s Theory of Goal

Attainment:

(1) If perceptual interaction accuracy is present in nurse-patient interactions,

transaction will occur.

 (2) If the nurse and patient make transaction, the goal or goals will be achieved.

 (3) If the goal or goals are achieved, satisfaction will occur.

 (4) If the goal or goals are achieved, effective nursing care will occur.

 (5) If transactions are made in nurse-patient interactions, growth and

development will be enhanced.

 (6) If role expectations and role performance as perceived by the nurse and
patient are congruent, transaction will occur.

 (7) If role conflict is experienced by either the nurse or the patient (or both),
stress in the nurse-patient interaction will occur.

 (8) If a nurse with special knowledge communicates appropriate information to

the patient, mutual goal-setting and goal achievement will occur.
 Assumptions

 Imogene King’s personal philosophy about human beings and life influenced her
assumptions related to environment, health, nursing, individuals, and nurse-patient
interactions. King’s conceptual system and Theory of Goal Attainment were “based on
an overall assumption that 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.”

 The assumptions are:

 (1) The focus of nursing is the care of the human being (patient).

 (2) The goal of nursing is the health care of both individuals and groups.

 (3) Human beings are open systems interacting with their environments constantly.

 (4) The nurse and patient communicate information, set goals mutually, and then act to
achieve those goals. This is also the basic assumption of the nursing process.

 (5) Patients perceive the world as a complete person making transactions with
individuals and things in the environment.

 (6) Transaction represents a life situation in which the perceiver and the thing being
perceived are encountered. It also represents a life situation in which a person enters the
situation as an active participant. Each is changed in the process of these experiences.
 Major Concepts and Subconcepts

 Nursing

 Nursing is a process of action, reaction, and interaction whereby nurse

and client share information about their perceptions in the nursing
situation. The nurse and client share specific goals, problems, and
concerns and explore means to achieve a goal.

 Health

 Health is a dynamic life experience of a human being, which implies

continuous adjustment to stressors in the internal and external
environment through optimum use of one’s resources to achieve
maximum potential for daily living.
 Individual

 Individuals are social beings who are rational and sentient.

Humans communicate their thoughts, actions, customs, and
beliefs through language. Persons exhibit common
characteristics such as the ability to perceive, to think, to feel,
to choose between alternative courses of action, to set goals, to
select the means to achieve goals, and to make decisions.

 Environment

 Environment is the background for human interactions. It is

both external to, and internal to, the individual.
 Action

 Action is defined as a sequence of behaviors involving mental

and physical action. The sequence is first mental action to
recognize the presenting conditions; then physical action to
begin activities related to those conditions; and finally, mental
action in an effort to exert control over the situation, combined
with physical action seeking to achieve goals.

 Reaction

 Reaction is not specifically defined but might be considered to

be included in the sequence of behaviors described in action.
Human being /person
 Human being or person refers to social being who are rational and sentient.

 Person has ability to :

 perceive
 think
 feel
 choose
 set goals
 select means to achieve goals and
 to make decision

 Human being has three fundamental needs:

 The need for the health information that is unable at the time when it is needed and
can be used
 The need for care that seek to prevent illness, and
 The need for care when human beings are unable to help themselves.
 Interacting Systems of Theory of Goal Attainment

 According to King, there are three interacting systems in the

Theory of Goal Attainment. These are the personal system,
the interpersonal system, and the social system. Each system is
given different concepts. The concepts for the personal system are:
perception, self, growth and development, body image, space, and
time. The concepts for the interpersonal system are: interaction,
communication, transaction, role, and stress. The concepts for the
social system are: organization, authority, power, status, and
decision making.
 1. Personal Systems

 Each individual is a personal system. King designated an example of a

personal system as a patient or a nurse. King specified the concepts
of body image, growth, and development, perception, self, space,
and time in order to comprehend human beings as persons.

 “The self is a composite of thoughts and feelings which constitute a

person’s awareness of his individual existence, his conception of who
and what he is. A person’s self is the sum total of all he can call his. The
self includes, among other things, a system of ideas, attitudes, values,
and commitments. The self is a person’s total subjective environment. It
is a distinctive center of experience and significance. The self constitutes
a person’s inner world as distinguished from the outer world consisting
of all other people and things. The self is the individual as known to the
individual. It is that to which we refer when we say “I.”
 Growth and development can be defined as the processes in
people’s lives through which they move from a potential for the
achievement to the actualization of self.

 King defines body image as the way one perceives both one’s body
and others’ reactions to one’s appearance.

 Space includes that space exists in all directions, is the same

everywhere, and is defined by the physical area known as “territory”
and by the behaviors of those occupying it.

 Time is defined as “a duration between one event and another as

uniquely experienced by each human being; it is the relation of one
event to another event.”

 King (1986) added learning as a subconcept in the personal system

but did not further define it.
 2. Interpersonal Systems

 These 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. As the number of interacting individuals
increases, so does the complexity of the interactions. Understanding the
interpersonal system requires the concepts
of communication, interaction, role, stress, and transaction.
 Interactions are defined as the observable behaviors of two or more
individuals in mutual presence.

 King (1990) defines communication as “a process whereby information is

given from one person to another either directly in a face-to-face meeting or
indirectly through telephone, television, or the written word.”

 King defines transactions as “a process of interactions in which human

beings communicate with the environment to achieve goals that are
valued… goal-directed human behaviors.

 The characteristics of the role include reciprocity in that a person may be a

giver at one time and a taker at another time, with a relationship between
two or more individuals who are functioning in two or more roles that
learned, social, complex, and situational.

 Stress is “a dynamic state whereby a human being interacts with the

environment to maintain balance for growth, development, and
performance, which involves an exchange of energy and information
between the person and the environment for regulation and control of
stressors.”
 3. Social Systems

 A more comprehensive interacting system consists of groups that make up

society, referred to as the social system. Religious, educational, and health
care systems are examples of social systems. The influential behavior of an
extended family on an individual’s growth and development is another social
system example. Within a social system, the concepts of authority, decision
making, organization, power, and statusguide system understanding.
 Power is the capacity to use resources in organizations to achieve goals…
is the process whereby one or more persons influence other persons in a
situation… is the capacity or ability of a person or a group to achieve
goals… occurs in all aspects of life and each person has potential power
determined by individual resources and the environmental forces
encountered. Power is a social force that organizes and maintains society.
Power is the ability to use and to mobilize resources to achieve goals.

 Status is “the position of an individual in a group or a group in relation

to other groups in an organization” and is identified that status is
accompanied by “privileges, duties, and obligation.”

 Decision making 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, 1990).

 King (1986) added control as a subconcept in the social system but did
not further define the concept.
 Dynamic Conceptual Systems


King has interrelated the concepts of interaction, perception,
communication, transaction, self, role, stress, growth and
development, time, and space into a theory of goal attainment. Her
theory deals with a nurse-client dyad, a relationship to which each
person brings personal perceptions of self, role, and personal levels
of growth and development. The nurse and client communicate, first
in interaction and then in transaction, to attain mutually set goals.
The relationship takes place in space identified by their behaviors
and occurs in forward-moving time.

 She believed that her “framework differs from other conceptual

schema in that it is concerned not with fragmenting human beings
and the environment but with human transactions in different kinds
of environments.”
 Process of Interaction
Interaction
 Interaction is a process of perception and communication between person
and environment and between person and person represented by verbal and
nonverbal behaviors that are goal-directed.
 Transaction
 Transaction is a process of interactions in which human beings
communicate with the environment to achieve goals that are valued;
transactions are goal-directed human behaviors.
 Perception is “each person’s representation of reality.”
 Communication
 Communication is defined as “a 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.”
 Role

 Role is defined as “a set of behaviors expected of persons occupying a position in a

social system; rules that define rights and obligations in a position; a relationship
with one or more individuals interacting in specific situations for a purpose.”

 Stress

 Stress is “a dynamic state whereby a human being interacts with the environment to
maintain balance for growth, development, and performance… an energy response
of an individual to persons, objects, and events called stressors.”

 Growth and Development

 Growth and development can be defined as the “continuous changes in individuals

at the cellular, molecular, and behavioral levels of activities… the processes that
take place in the life of individuals that help them move from potential capacity for
achievement to self-actualization.”
 Time
 Time is “a sequence of events moving onward to the
future… a continuous flow of events in successive order
that implies a change, a past and a future… a duration
between one event and another as uniquely experienced by
each human being… the relation of one event to another.”
 Space
 Space exists in every direction and is the same in all
directions. Space includes that physical area called territory.
Space is defined by the behaviors of those individuals who
occupy it
 Theory of Goal Attainment and The Nursing Process
 Imogene King gives emphasis about the nursing process in her model of nursing.
The steps of the nursing process are: assessment, nursing diagnosis, planning,
implementations, and evaluation.
 Assessment

 Assessment occur during interaction.

 The nurse brings special knowledge and skills whereas client brings knowledge of self and
perception of problems of concern, to this interaction.

 During assessment nurse collects data regarding client (his/her growth & development,
perception of self and current health status, roles etc.)

 Perception is the base for collection and interpretation of data.

 Communication is required to verify accuracy of perception, for interaction and transaction.

 Nursing diagnosis

 The data collected by assessment are used to make nursing diagnosis in nursing process.

 In process of attaining goal the nurse identifies the problems, concerns and disturbances about
which person seek help.
 Planning
 After diagnosis, planning for interventions to solve those problems is done.
 In goal attainment planning is represented by setting goals and making
decisions about and being agreed on the means to achieve goals.
 This part of transaction and client’s participation is encouraged in making
decision on the means to achieve the goals.
 Implementations
 In nursing process implementation involves the actual activities to achieve the
goals.
 In goal attainment it is the continuation of transaction.
 Evaluation
 It involves to finding out whether goals are achieved or not.
 In king description evaluation speaks about attainment of goal and
effectiveness of nursing care.
  Nursing Process and
Theory of Goal Attainment
 Nursing process method Nursing process theory
Nursing process method
 Nursing process theory
 ADecision making
system of aboutconcepts
oriented the
A
system of oriented
A system actions
of oriented actions goals
Be agree on the means to
 A system of oriented concepts Perception,
attain the goals
communication and
Assessment interaction of nurse and client
 Assessment  Implementation
Planning
 Perception, communication
Decision making about the goals
 Transaction made
and interaction of nurse and Be agree on the means to attain
client  the goals
Evaluation
Implementation
 Planning  Transaction
Goal attainedmade

Evaluation Goal attained

 Analysis

 The social systems portion of the open systems framework is less

clearly connected to the theory of goal attainment than are the
personal and interpersonal systems.

 The citation of the individual being in a social system was not

clearly explained considering that the social system encompasses
other concepts and subconcepts in her theory

 The model presents interaction which is dyadic in nature which

implies that its applicability cannot be adapted to unconscious
individuals.

 Multitude of views and definition is confusing for the reader.

Because of multiple views on one concept such as what have been
discussed in her concept of power blurs the point that the theorist
is trying to relate to the readers.
 Strengths

 A major strong point of King’s conceptual system and Theory of

Goal Attainment is the ease with which it can be understood by
nurses.

 The theory of goal attainment also does describe a logical sequence

of events.

 For most parts, concepts are concretely defined and illustrated.

 King’s definitions are clear and are conceptually derived from research
literature. Her Theory of Goal Attainment presents ten major
concepts, and the concepts are easily understood and derived from
research literature, which clearly establishes King’s work as important
for knowledge building in the discipline of nursing.
 Weaknesses

 Theory of Goal Attainment has been criticized for having limited

application in areas of nursing in which patients are unable to interact
competently with the nurse. King maintained the broad use of the theory
in most nursing situations.

 Another limitation relates to the lack of development of application of

the theory in providing nursing care to groups, families, or communities.

 King’s theory also contains some inconsistencies: (1) She indicates that
nurses are concerned about the health care of groups but concentrates
her discussion on nursing as occurring in a dyadic relationship. (2) King
says that the nurse and client are strangers, yet she speaks of their
working together for goal attainment and of the importance of health
maintenance.
 Conclusion

 King contributed to the advancement of nursing knowledge

through the development of her conceptual system and middle-
range Theory of Goal Attainment. By focusing on the attainment
of goals, or outcomes, by nurse-patient partnerships, King
provided a conceptual system and middle-range theory that has
demonstrated its usefulness to nurses. Nurses working in a variety
of settings with patients from around the world continue to use
King’s work to improve the quality of patient care.