Kingdom of Saudi ‫المملكة العربية السعودية‬

Arabia Ministry of ‫وزارة التعليم‬

IMOGENE KING’S GOAL ATTAINMENT

By: Mariam Saud

Name of Professor:
I. INTRODUCTION

In 1923, the world was blessed for the birth of Imogene King. She is well known within the nursing world

for "Kings Conceptual Framework” and “Goal Attainment Theory”.

Imogene King is known as a "mid-range theorist". She formulated her theory while she was an associate

professor of nursing at Loyola University in Chicago. At that time, nursing was emerging as a profession

and some nurses sought to challenge the existing role of nurses. She began her work in nursing theory

with a conceptual framework and she considers her theory as a deviation from systems theory, with

emphasis on interaction theory. In 1981, she refined her concepts into a nursing theory that consisted of

the following basis: an open system framework as the basis of goal attainment, nursing as a major system

within the healthcare system, and nursing process emphasis on interpersonal processes. King used a

“systems” approach in the development of her Dynamic Interacting Systems Framework and in her

subsequent Goal Attainment Theory.

King’s theory offers insight into nurses’ interactions with individuals and groups within the environment.

It highlights the importance of client’s participation indecision that influences care and focuses on both

the process of nurse-client interaction and the outcomes of care.

The Goal Attainment Theory by Imogene King is a great theory because nowadays it is used by the

nurses in their profession wherein it served as a standard where nurses purposely interact with their

patients, establish goals mutually, and agree to achieve the goals they set. The goals cannot be achieved

mutually unless the nurse and the patient share their perceptions, feelings, and values.
II. RELATIONSHIP BETWEEN STRUCTURE AND FUNCTION

II.A Structural Components

Assumptions

The Theory of Goal Attainment lists several assumptions relating to individuals, nurse–

client Interactions, and nursing. When describing individuals, the model shows that

individuals are social, sentient, rational, reacting beings and are controlling, purposeful,

action oriented, and time oriented in their behavior (King, 1995).

Regarding nurse–client interactions, King (1981) believed that perceptions of the nurse and client

influence the interaction process; goals, needs, and values of the nurse and client influence the interaction

process; individuals have a right to information around themselves; individuals have a right to take part in

the choices that influence their lives, health, and community services; individuals have a right to

acknowledge or reject care; and goals of health professionals and goals of recipients of health care may

not be congruent. With regard to nursing, King (1995) wrote that nursing is the care of human beings;

nursing is perceiving, thinking, relating, judging, and acting vis-à-vis the behavior of individuals who

come to a health care system; a nursing situation is the immediate environment in which two individuals

establish a relationship to cope with situational events; and the goal of nursing is to help individuals and

groups attain, maintain, and restore health. If this is not possible, nurses help individuals die with dignity.

Concepts

King’s Theory of Goal Attainment defines the metaparadigm concepts of nursing as well as a number of

additional concepts.

Nursing -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.

the internal and external environment through optimum use of one’s resources to achieve maximum

potential for daily living.

Individuals- 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- The background for human interactions. It is both external to and internal to the individual.

Perception- The process of human transactions with environment. It involves organizing, interpreting, and

transforming information from sensory data and memory.

Communication- A process by which information is given from one person to another, either directly in

face-to-face meetings or indirectly. It involves intrapersonal and interpersonal exchanges.

Interaction- 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- A process of interactions in which human beings communicate with the environment to

achieve goals that are valued; transactions are goal-directed human behaviors.

Stress- A dynamic state in which a human interacts with the environment to maintain balance for growth,

development, and performance; it is the exchange of information between human and environment for

regulation and control of stressors.

Propositions

The following propositions are made in Imogene King’s Theory of Goal Attainment: If perceptual

interaction accuracy is present in nurse-patient interactions, the transaction will occur; If the nurse and

patient make the transaction, the goal or goals will be achieved; If the goal or goals are achieved,
satisfaction will occur; If the goal or goals are achieved, effective nursing care will occur; If transactions

are made in nurse-patient interactions, growth and development will be enhanced; If role expectations and

role performance perceived by the nurse and patient are congruent, the transaction will occur; If role

conflict is experienced by either the nurse or the patient (or both), stress in the nurse-patient interaction

will occur; If a nurse with special knowledge communicates appropriate information to the patient,

mutual goal-setting and goal achievement will occur.

II.B Functional Components

The central focus of King's framework is man as a dynamic human being whose perceptions of objects,

persons, and events influence his behavior, social interaction, and health (King, 1971). King's conceptual

framework includes three interacting systems with each system having its own distinct group of concepts

and characteristics. These systems include personal systems, interpersonal systems, and social systems.

King's basic assumption maintained that nursing is a process that involves caring for human beings with

health being the ultimate goal (Torres, 1986). The three systems that constitute King's conceptual

framework provided the basis for the development of her Theory of Goal Attainment.

The personal system that King speaks of refers to the individual. The concepts within the personal system

and fundamental in understanding human beings are perception, self, body image, growth and

development, time, and space (King, 1981). King (1981) viewed perception as the most important

variable because perception influences behavior. 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 perceptions of self" (King, 1981, p. 19).

Interpersonal systems involve individuals interacting with one another. King refers to two individuals
interacting as dyads, three individuals as triads, and four or more individuals as small or large groups

(King, 1981). The concepts associated with interpersonal systems are interaction, transaction,

communication, role and stress. The interactions and transactions that occur between the nurse and the

client, or the dyad

, represent an example of an interpersonal system. Communication between the nurse and the client can

be classified as verbal or nonverbal. Verbal exchanges include both spoken and written communication,

while nonverbal communication includes such things as appearance, distance, facial expressions, posture

and touch (Seiloff, 1991).

The third and final interacting system in King's model is the social system. Social systems are groups of

people within a community or society that share common goals, interests, and values. Social systems

provide a framework for social interaction and relationships, and establish rules of behavior and courses

of action (King, 1971). Examples of social systems include the family, the school, and the church. It is

within these organizations that individual's beliefs, attitudes, values and customs are formed. The

concepts that King identified as relating to social systems are organization, authority, power, status, and

decision-making. The relationships between these three systems led to King's Theory of Goal Attainment.

The conceptual framework of the interpersonal system had the greatest influence on the development of

this theory. King (1981) stated, "Although personal systems and social systems influence quality of care,

the major elements in a theory 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" (p. 142). King believed that

interactions between the nurse and the client lead to transactions that result in goal attainment.
Furthermore, King proposed that through mutual goal setting and goal attainment, transactions result in

enhanced growth and development for the client (Woods, 1994). King used ten major concepts from the

personal and interpersonal systems to support the Theory of Goal Attainment. Those concepts include

human interactions, perception, communication, role, stress, time, space, growth and development, and

transactions. To capture the essence of these interrelated

 concepts, King stated that "nurse and client interactions are characterized by verbal and nonverbal

communication, in which information is exchanged and interpreted; by transactions, in which values,

needs, and wants of each member of the dyad are shared; by perceptions of nurse and client and the

situation; by self in role of client and self in role of nurse; and by stressors influencing each person and

the situation in time and space".

ENVIRONMENT:

Time and space, stress, growth and development

ACTION

NURSE
PERSON

Perception INTERACTION react

DISTURBANCE/ PROBLEM
 TRANSACTION
EXPLORE MEAN
MUTUAL GOAL
TO ACHIEVE
SET
GOAL

GOAL
ATTAINMENT

HEALTH

IV. CIRCLE OF CONTAGIOUSNESS

1. Parts of the Theory of Goal Attainment have been tested, and a number of research studies reported in the

literature used the model as a conceptual framework. For example, recent research includes a study by L.

Joseph (2013) who used King’s Theory of Goal Attainment to evaluate the effectiveness of a teaching

program to improve accuracy on pediatric growth measurements.

2. In other works, Chacko, Kharde, and Swamy (2013) used King’s theory as the framework to assess the

efficacy of use of infrared lamps on reducing pain and inflammation due to episiotomy, and Isac,

Venkatesaperumal, and D’Sousa (2013) used King’s theory to develop and evaluate the efficacy of a

nurse-led information desk on assisting patients to manage their sickle cell disease.

3. Rooda (1992) derived propositions from the midrange theory of goal attainment as the framework for a

conceptual model for multicultural nursing.

4. In Japan, a culture very different from the United States with regard to communication style, Kameoka

(1995) used the classification system of nurse–patient interactions identified within the theory of goal

attainment (King, 1981) to analyze nurse–patient interactions.

5. Harih and Pajnkihar (2009) applied King’s model in treating elderly diabetes patients. Joseph et al. (2011)

examined the implementation of whole-person care. As stated previously, diseases or diagnoses are often

identified as the focus for the application of nursing knowledge.

the theory in examining the empowerment of nursing assistants. Li et al. (2010) explored the

“development of the concept of holistic nursing” (p. 33).

7. M. L. Joseph, Laughon, and Bogue (2011) examined the “sustainable adoption of whole-person care” (p.

989) in a Florida hospital guided by King’s Theory of Goal Attainment.

V. USEFULNESS

PRACTICE

1. The framework served as the basis for the development of a middle-range theory relating to practice in a

nursing home. (Zurakowski, 2007)

2. The theory of goal attainment has been proposed as the practice model for case management (Hampton,

1994; Tritsch, 1996). King’s work can find application beyond nursing-specific situations. Two specific

examples of this include the application of King’s work to case management (Hampton, 1994; Sowell &

Lowenstein, 1994) and to managed care (Hampton, 1994). Both case management and managed care

incorporate multiple disciplines as they work to improve the overall quality and cost-efficiency of the

health care provided. These applications also address the continuum of care, a priority in today’s health-

care environment.

3. King’s conceptual system is an organizing guide for nursing practice. In one example, Caceres (2015)

used King’s Theory of Goal Attainment to explore and expand upon the concept of functional status,

concluding that evaluation of functional status is vital and should be incorporated within mutual decision-

making processes from the client family’s perspective.

1. Gemmill and colleagues (2011) assessed nurses’ knowledge about and attitudes toward ostomy care using

King’s Theory of Goal Attainment to guide the research. Their findings explained that it is difficult for

staff nurses to maintain their clinical abilities when there are few opportunities. Maintaining currency

may require creative teaching interventions, such as simulations.

2. Maloni (2007) and Nwinee (2011) conducted research with patients with diabetes, and women with breast

cancer were the focus of the work of Funghetto, Terra, and Wolff (2003). In addition, clients with chronic

obstructive pulmonary disease were involved in research by Wicks, Rice, and Talley (2007).

3. Clients experiencing a variety of psychiatric concerns have also been the focus of work, using King’s

conceptualizations (Murray & Baier, 1996; Schreiber, 1991). Client’s concerns ranged from psychotic

symptoms (Kemppainen, 1990) to families experiencing chronic mental illness (Doornbos, 2007), to

clients in short-term group psychotherapy (Laben, Sneed, & Seidel, 1995).8

EDUCATION

1. King’s Theory of Goal Attainment has enhanced nursing education. For example, it served as a

framework for the baccalaureate program at the Ohio State University School of Nursing, where it

determined the content and processes taught at each level of the program (Daubenmire, 1989).

2. Similarly, in Sweden, King’s model was used to organize nursing education (Frey, Rooke, Sieloff,

Messmer, & Kameoka, 1995).

3. In more recent years, King’s model has been useful in nursing education programs in Sweden, Portugal,

Canada, and Japan (Sieloff & Messmer, 2014).

ADMINISTRATION
 1. Applicable to administration and management in a variety of settings, a middle-range theory of group

power within organizations has been developed and revised to the theory of group empowerment within

organizations (Sieloff, 1995, 2003, 2007; Sieloff & Dunn,2008; Sieloff & Bularzik, 2011).

VI. EXTERNAL COMPONENT OF THEORY

Personal Values

King’s published books, book chapters, and journal articles predominantly focused on her ideas

and work in nursing theory, and also the theory movement within nursing. These contributions came at an

important time in nursing when nurse leaders were trying to legitimize nursing as a profession. The

influences of King’s theory were invaluable both to the development of nursing per se and to the

standards for clinical practice, based on her theory that was developed by her students and disciples.

Application of King’s theory to practice was facilitated when certain hospitals chose her theory to be the

conceptual framework for the structure of a nursing practice for the hospital. Because an important

characteristic of a profession is its body of knowledge, King’s work in the early movement in nursing

theory to establish knowledge unique to the profession of nursing helped 240 lay the foundation for future

work in research and in knowledge development that influenced the practice of nursing for the following

decades.

Professional Values
 King’s work in the development of a curriculum for the diploma, associate, baccalaureate, and

master’s level of education is another way in which she shared her knowledge and expertise in the

profession of nursing. These efforts have largely lacked acclaim. Rather, King’s work as both a theorist

and an educator established her reputation as a leader in the profession. For all her work, in theory,

education, and curriculum development, King also made substantial contributions as an active member

and leader in professional nursing associations, especially the American Nurses Association and Sigma

Theta Tau International. Although she predominately worked at the local levels with each of these groups,

King’s contributions did not go unnoticed at the national level. King was the recipient of several

prestigious and national awards. From an early age, King understood the importance of civic engagement.

From her earliest days in the profession, she became very actively involved in making nursing a

profession on a par with other professions.

Social Values

The theory focuses on communication between the nurse and the patient which is the most

common human function. Goal attainment theory places the patient at the center focus with the nurse

facilitating and supporting people in maintaining and caring for themselves.

Social Significance

The benefit this theory has to advance practice nursing is that it allows the advanced clinical nurse to

view the patient in their entirety. It facilitates a view that embraces the dynamic person to include not just

the individual or illness at hand, but the individual and their role and responsibility to their family, their

social place and all the other aspects that come with daily life (Stewart & DeNisco, 2013).

VII. REFERENCES

1. Parker, M. E. (2010). Nursing Theories & Nursing Practice (3rd ed.). F.A. Davis Company
2. McEwen, M. (2019). Theoretical Basis for Nursing (5th ed.). Wolters Kluwer Health

3. Kotowski, M. M. (2018). Exploring the legacy of Imogene King in the making of a Nurse Educator,

Leader, and Nurse Theorist. Loyola University Chicago.

4. Gonzalo, A. (2021). Imogene King: Theory of Goal Attainment. Retrieved from

https://nurseslabs.com/imogene-m-kings-theory-goal-attainment/#propositions

5. Alligood, M. R. (2014). Nursing Theory Utilization & Application (5th ed.). Mosby Inc.