Theory of Goal Attainment

HER LIFE
Born in January 30, 1923
(West Point, Iowa).

Youngest of three
children.

Died on December 24,

2007, two days after
suffering stroke.
EDUCATIONAL BACKGROUND
 1945 – Nursing diploma from St. John’s Hospital of Nursing,
St. Louis, Missouri

 1948 – BS Nursing & Education with minors in

philosophy & chemistry from St. Louis University, St. Louis,
Missouri

 1957 – MS Nursing from St. John’s University

 1961 – Ed.D. from Teachers College, Columbia University

 1980 – Honorary Ph. D from Southern Illinois University

 Postdoctoral study in research design, statistics and computer

 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
 ACHIEVEMENTS
Founder ofKing International
Nursing Group (KING) (1998)

Jessie M. Scott award (ANA

convention)
Award presented to a registered
nurse whose accomplishments in a
field of practice, education, or
research with significance for the
improvement of nursing and health
care.
 HER STORY
1963.. challenged by her
philosophy professors with a
question, “Have you or any
other nurses defined the
‘nursing act’?”

1972.. reading course work led

King to the Literature Systems
analysis and General Systems
Theory and hence to another
set of questions
 HER THOUGHTS
What is the goal of
nursing?

What are the functions of

nurses?

How can nurses continue

to expand their knowledge
to provide quality care?
King’s Theory and Nursing’s
Metaparadigm
 PERSON
…social beings who are rational
and sentient

…communicate their thoughts,

actions, customs, and beliefs
through language

…exhibit common characteristics

like ability to perceive, to think, to
feel, to choose between alternative
courses of action, to set goals, to
select means to achieve goals, and
to make decisions
 ASSUMPTIONS
Human Beings
 Open systems in constant interaction
with environment

 Individuals are social beings.

 Individuals are sentient beings.
 Individuals are rational beings.
 Individuals are reacting beings.
 Individuals are perceiving beings.
 Individuals are controlling beings.
 Individuals are purposeful beings.
 Individuals are action-oriented beings.
 Individuals are time-oriented beings.
 HUMAN NEEDS
 According to King, human being
has three fundamental needs:

1. The need for the health

information that is usable at the
time when it is needed and can be
used
2. The need for care that seek to
prevent illness, and

3. The need for care when human

beings are unable to help
themselves.
 NURSING
…a process of action,
reaction, and interaction
whereby nurse and client
share information about their
perceptions in the nursing
situation

… nurse and patient share

goals, problems, and
concerns and explore
means to achieve a goal.
 ASSUMPTIONS
Nursing
The care of human beings

Perceiving, thinking, relating, judging, and acting of

same behaviors of patients
Nursing situation: The immediate environment in
which two individuals establish a relationship to cope
with situational events
Goal of Nursing: Help individuals and groups to attain,
maintain, restore health or help individuals die with
dignity.
 NURSING
Goal of nurse: To help individuals
to maintain their health so they
can function in their roles.

Domain of nurse: Includes

promoting, maintaining, and
restoring health, and caring for the
sick, injured and dying.

Function of professional nurse:

To interpret information in nursing
process to plan, implement and
evaluate nursing care.
 ASSUMPTIONS; Nurse-Client Interactions
 Perceptions of nurse & client influence interaction process.

 Goals, needs & values of nurse & client influence

interaction.
 Individuals have a right to know (knowledge) about
themselves.
 Individuals have a right to participate in decisions that
influence their life, their health, and community services.
 Health professionals have responsibility to share
information to helps individuals make decisions about their
health care.
 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.
 NURSING
 ACTION

Mental Physical Mental Physical

Action Action Action Action

Begin Effort to
Recognize Seeking
activities exert
the to
related to control
presenting achieve
those over the
conditions. goals.
conditions. situation.
 HEALTH
…dynamic life experience of a human being which
implies continuous adjustment to stressors in the
external and internal environment through optimum
use of one’s resources to achieve maximum potential
for daily living.

She discusses health as a functional state and illness

as an interference with that functional state.
 ENVIRONMENT
…the background for human actions

Environment and Society are indicated as major

concepts in King’s conceptual system but are not
specifically defined in her work.

Society may be viewed as the social systems portion

of her conceptual system.

Although King’s definition of health mentions both

internal and external environments, King also stated
that ‘environment is a function of balance between
internal and external interactions’.
 ENVIRONMENT

Internal environment:
transforms energy to enable
person to adjust to
continuous external
environmental changes

External environment:
involves formal and informal
organizations. Nurse is a part
of the patient’s environment.
DYNAMIC INTERACTING SYSTEMS/ King’s open
systems framework
Three systems in the
conceptual framework:
Personal System (the individual)

Interpersonal Systems
(individuals interacting with one
another)
Social System (groups of people
in a community/society sharing
common goals, interests, and
values)

Study systems as a whole

rather than as isolated parts of
a system.
Contd….
Elements of each System
 Goal: Health.
 Structure: 3 open systems.
 Functions: identified in the
reciprocal relationships as they
interact.
 Resources: essential to keep
systems in harmony
 People, money, goods and items
needed to carry out specific
activities.
 Decision making: occurs when
choices are made in resource
allocation to attain goals.
 Personal System Concepts
 Perception; A process in which data obtained
through the senses and from memory are
organized, interpreted and transformed.
 Self; Awareness of being a person separate from
others.
 Growth and Development; cellular, molecular
and behavioral changes in human beings.
 Body Image; Personal & subjective; acquired or
learned; dynamic and changing. Includes how
person sees self & other’s reactions to one’s
appearance.
 Space; Exist in all directions, is the same
everywhere, and is defined by the physical area
known as “territory” and by the behaviors of those
who occupy it.
 Time; A duration between one event and another
as uniquely experienced by each human being.
 Learning (1986, not defined)
 Interpersonal System Concepts
 Interaction; Observable behaviors of two or
more persons in mutual presence.
 Communication; A process whereby
information is given from one person to
another either directly in face to face meeting
or indirectly through telephone, television or
the written word.
 Transactions; A process of interactions in
which human beings communicate with the
environment to achieve goals that are
valued.
 Role; Nurses role is interacting with one or
more others in a nursing situation to identify
goals and help others to achieve the goals.
 Stress; A dynamic state whereby a
human being interacts with the
environment to maintain balance for
growth, development and performance.
 Social System Concepts
 Organization; Made up of persons with roles and positions
who make use of resources to meet both personal and
organizational goals.
 Authority; Active reciprocal process of regularity, direction
and responsibility for actions.

 Power; Capacity to use resources in organizations to achieve goals.

 Status; The position of an individual in a group or a group in relation

to other groups in an organization.

 Decision Making; A dynamic and systematic process by which

goal-directed choice of perceived alternatives is made and acted upon
by individuals or groups to attain a goal.
 THEORY OF GOAL ATTAINMENT
 …elements are seen in the
interpersonal systems in which two
people, who are usually strangers,
come together in a health care
organization to help and be helped to
maintain a state of health that permits
functioning of roles.

 …reflects King’s belief that the practice

of nursing is differentiated from other
healthcare professions by what nurses
do with and for individuals.

 Nurse and client communicate

information, set goal mutually and
then act to attain those goals
MAJOR CONCEPTS OF THE
THEORY
Interaction
Process of perception and communication
between person and environment and between
person and person.
Represented by verbal or non-verbal behaviors
that seek to reach goals.
KING’S DIAGRAM OF INTERACTION
Feedb
ack

Feedb
ack
 MAJOR CONCEPTS OF THE
THEORY (contd…)
Perception
Reality as seen by an individual
The elements of perception are the importing of energy
from the environment, Organizing it by information,
interpreting, and transforming information from sensory to
memory.
MAJOR CONCEPTS OF THE
THEORY (contd…)
Communication
Exchange of information between people (face-
to-face, electronic media, written)
May be intrapersonal / interpersonal
 MAJOR CONCEPTS OF THE
THEORY (contd…)
Transaction
Process of interactions in which
human beings communicate with
the environment to achieve goals
that are valued.

Goal-directed human behaviors.

Mutual goal setting.

 MAJOR CONCEPTS OF THE
THEORY (contd…)
Role
Set of expected behaviors
occupying a Position in a social
system.
Rules that define Rights and
responsibilities.
Relationship between individuals
interacting in specific situations
for a purpose.
 MAJOR CONCEPTS OF THE
THEORY (contd…)
 Stress
Ever changing condition where an
individual 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.

Although stress may be positive or

negative, too high a level of stress
may decrease an individual’s ability
to interact and to attain goals.
MAJOR CONCEPTS OF THE
THEORY (contd…)
Growth and Development
Ever occurring changes in behavior and at the
cellular and molecular level of an individual.
Moves a person from potential capacity for
achievement to self actualization.
 MAJOR CONCEPTS OF THE
THEORY (contd…)
Time
An interval between two events that is experienced
differently by each person.
The relation of one event to another.
 MAJOR CONCEPTS OF THE
THEORY (contd…)
Space
Exists in every direction
and is the same in all
directions.
Includes that physical
area named territory.
Defined by the behaviors
of a person who occupy
it.
THEORETICAL ASSERTIONS
If perceptual accuracy (PA) is present in nurse-
client (I) interactions, transactions (T) will occur.

PA (I) =T
THEORETICAL ASSERTIONS
(contd…)
If nurse and client make transactions (T), goals
will be attained (GA).
THEORETICAL ASSERTIONS
(contd…)
If goals are attained (GA), satisfactions (S) will
occur.
THEORETICAL ASSERTIONS
(contd…)
If goals are attained (GA), effective nursing care
(NC) will occur.
THEORETICAL ASSERTIONS
(contd…)
If transactions (T) are made in nurse-client
interactions (I), growth and development (GD) will
be enhanced.
THEORETICAL ASSERTIONS
(contd…)
If role expectations and role performance as
perceived by nurse and client are congruent
(RCN), transactions (T) will occur.
THEORETICAL ASSERTIONS
(contd…)
If role conflict (RC) is experienced by nurse and
client or both, stress (ST) in nurse-client
interactions (I) will occur.
THEORETICAL ASSERTIONS
(contd…)
If nurses with special knowledge and skills
communicate (CM) appropriate information to
clients, mutual goal setting (T) and goal
attainment (GA) will occur
 Usefulness of Theory: RESEARCH
Basis for development of
middle-range nursing
theories
Model for Multicultural
Nursing Practice (Rooda,
1992)
Theory of Personal System
Empathy (Alligood & May,
2000)
Theory of Family Health
(Doornbos, 2000)
Usefulness of Theory:
EDUCATION
Framework for the baccalaureate program (Ohio
State University School of Nursing)
Educational reform resulting in nursing education
(Sweden)
Usefulness of Theory: PRACTICE
A model for bedside nursing practice in the
hospital setting (Coker & Schreiber, 1990)
Managed care program in hospital settings
(Hampton, 1994)
Goal-Oriented Nursing Record system for
documentation
Structure of Quality Assurance Program
Theory of Goal Attainment and
Nursing Process
Assumptions

Basic assumption of goal attainment theory is that

nurse and client communicate information, set
goal mutually and then act to attain those goals.
Assessment
 King indicates that 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.
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.
Implementation
In nursing process implementation involves the
actual activities to achieve the goals.

This step results in transactions being made.

Transactions occur as a result of perceiving the

other person and the situation, making judgments
about those perceptions, and taking some actions
in response.

Reactions to action lead to transactions that

reflect a shared view and commitment
Evaluation
It involves to finding out whether goals are
achieved or not.

In King’s description evaluation speaks about

attainment of goal and effectiveness of nursing
care.
 Nursing process Theory of goal attainment (King)

A system of oriented A system of oriented concepts.

actions.

Assessment Perception, communication and

interaction of nurse and client.

Nursing Diagnosis Information shared during assessment.

Planning Decision making about the goals.

Agree on the means to attain the goals

Implementation Transaction made

Evaluation Goal attained, evaluation of
effectiveness of nursing care.
 CASE-1
Mr. Sanjeev is 74yrs married, got admitted in surgical
ward of ...Hospital on 14/4/13with a diagnosis of
indirect inguinal hernia underwent herniorraphy.
NURSING PROCESS
Assessment
• King indicates that 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,