Imogene King: Theory of Goal Attainment and Interacting Systems Framework

2. BRIEF BIOGRAPHY: Who is Imogene King?
 January 30, 1923: Born in West Point,
Iowa. Youngest of the 3 children
 1945: Nursing Diploma from St. John’s
Hospital School, St. Louis, Missouri
 1948: BSN from St. Louis University
 1957: MSN from St. Loius University
 1961: EdD from Teacher’s College,
Columbia University, New York

3.  1947-1958: Med-Surg Nursing Instructor
and Asst. Director of St. John’s Hospital
School of Nursing
 1966-1968: Asst. Chief, Research Grants
Branch, Division of Nursing, Washington
D.C.
 1968-1972: Director, School of Nursing at
Ohio State University
 1961-1966: Associate Professor at Loyola
University, Chicago
 1971-1980: Professor at Loyola University,
Chicago

4.  1990: Retired with the title Professor
Emeritus after serving as Professor at
University of South Florida, College of
Nursing
 Continued to speak at conferences around
the world and consulted with students who
were using and studying her theory
 December 24, 1997: She died, 2 days after
suffering from stroke

6. CONCEPTUAL
FRAMEWORK
 Imogene King’s Interacting Systems
Framework emphasizes the importance
of the interaction between nurses and
patients.
 It views this interaction as an open
system which is in constant interaction
with a variety of environmental factors.
 3 Systems: Personal, Interpersonal and
Social Systems

7. PERSONAL SYSTEM: perception,
self, growth and development, body image, space,
and time
 Perception— a process of organizing,
interpreting, and transforming information
from sense data and memory that gives
meaning to one's experience, represents
one's image of reality, and influences one's
behavior.
 Self— a composite of thoughts and feelings
that constitute a person's awareness of
individual existence, of who and what he or
she is.

8.  Growth and development— cellular, molecular,
and behavioral changes in human beings that
are a function of genetic endowment,
meaningful and satisfying experiences, and an
environment conducive to helping individuals
move toward maturity.
 Body image—a person's perceptions of his or
her body.
 Time—the duration between the occurrence of
one event and the occurrence of another event.
 Space—the physical area called territory that
exists in all directions.
 Learning—gaining knowledge.

9. INTERPERSONAL SYSTEM: interaction,
communication, transaction, role, and stress
 Interactions—the acts of two or more persons in
mutual presence; a sequence of verbal and
nonverbal behaviors that are goal directed.
 Communication—the vehicle by which human
relations are developed and maintained;
encompasses intrapersonal, interpersonal,
verbal, and nonverbal communication.
 Transaction—a process of interaction in which
human beings communicate with the
environment to achieve goals that are valued;
goal-directed human behaviors.

10.  Role—a set of behaviors expected of a
person occupying a position in a social
system.
 Stress—a dynamic state whereby a human
being interacts with the environment to
maintain balance for growth, development,
and performance, involving an exchange of
energy and information between the person
and the environment for regulation and
control of stressors.
 Coping—a way of dealing with stress.

11. SOCIAL SYSTEM: organization, authority, power,
status, decision-making and control
 Organization—composed of human beings with
prescribed roles and positions who use
resources to accomplish personal and
organizational goals.
 Authority—a transactional process
characterized by active, reciprocal relations in
which members' values, backgrounds, and
perceptions play a role in defining, validating,
and accepting the authority of individuals within
an organization.
 Power—the process whereby one or more
persons influence other persons in a situation.

12.  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 answer a question
and attain a goal.
 Control—being in charge.
 Among the three systems, the conceptual
framework of Interpersonal system had the
greatest influence on the development of her
theory

14. THEORY ASSERTIONS
 King’s Theory of Goal Attainment focuses
on the interpersonal system and the
interactions that take place between
individuals, specifically in the nurse-patient
relationship.
 King developed eight propositions in her
Theory of Goal Attainment. These
propositions are the following:

15. 1. If perceptual congruence is present in
nurse-client interactions, transactions will
occur.
2. If nurse and client make transactions, goals
will be attained.
3. If goals are attained, satisfactions will occur.
4. If goals are attained, effective nursing care
will occur.
5. If transactions are made in nurse-client
interactions, growth and development will
be enhanced.

16. 6. If role expectations and role performance as
perceived by nurse and client are
congruent, transactions will occur.
7. If role conflict is experienced by nurse and
client or both, stress in nurse-client
interactions will occur.
8. If nurses with special knowledge and skills
communicate appropriate information to
clients, mutual goal setting (transactions)
and goal attainment will occur.

18.  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 is not specifically defined but might
be considered to be included in the sequence
of behaviors described in action.

19.  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 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.

20. METAPARADIGM: PERSON
 King described a person existing in an
open system as a spiritual being and
rational thinker who makes choices,
selects alternative courses of action,
and has the ability to record their history
through their own language and
symbols, unique, holistic and have
different needs, wants and goals.

21.  King’s theory of goal attainment identified
three basic health needs of man/person:
1. The need for the health information that is
unable at the time when it is needed and
can be used.
2. The need for care that seek to prevent
illness.
3. The need for care when human beings are
unable to help themselves.

22. METAPARADIGM: HEALTH
 It is a dynamic state in the life cycle;
illness interferences with that process.
 Health implies continuous adjustment to
stress in the internal and external
environment through optimum use of
one’s resources to achieve maximum
potential for daily living.

23. METAPARADIGM:
ENVIRONMENT
 King defined Environment as the process
of balance involving internal and external
interactions inside the social system.
 Reactions from the interaction between the
internal and external environment can be
biological, psychological, physical, social
or spiritual.
 It has a direct exchange of information
between the internal and external.

24. METAPARADIGM: 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.

25.  In addition, King also discusses the following:
 GOAL of a NURSE: To help individuals to
maintain their health so they can function in
their roles.
 DOMAIN of a NURSE: Includes promoting,
maintaining, and restoring health, and caring
for the sick, injured and dying.
 FUNCTIONS of a NURSE: To interpret
information in nursing process to plan,
implement and evaluate nursing care.

26. APPLICATIONS OF THE
THEORY
PRACTICE:
 Professionals have used King’s theory in
different specialized area with the use of
dynamic interactive communication
between the nurse and the client as
proof.
 Professionals need communication to
successfully and correctly make
decisions for their plan of care.

27.  King also developed the Goal Oriented
Nursing Record (GONR) from her theory.
GONR have been useful in documenting the
outcomes of care that was performed by
nurses.
 It helps nurses to easily facilitate the present
problem from careful assessment of the
client gathered through the interactive
communication process between the nurse
and the client.
 Her record management facilitates proper
and correct range for the use of evaluation
system.

28.  The significance of King’s Goal
Attainment Theory have been applied to
different professional practice setting
such as in nursing administration, theory-
based practice in the emergency
department , in tertiary hospitals and in
the community.

29. EDUCATION:
 King’s interacting system has been used to
design the nursing curriculum in different
schools and universities and framework for
nursing education.
 It provides a systematic means of viewing
the nursing profession, organizing nursing
knowledge and clarifying the nursing
discipline.

30.  Based on King’s guidelines, the focus of
a Nursing curriculum must be the
dynamic nurse-client interaction.
 Nursing education programs must
prepare nursing students to become
useful, productive, and relatively happy
citizens as well as professional
practitioners as they acquire knowledge,
values and skills in the practice of
nursing.

31. RESEARCH
 King’s theory has been one of the
theoretical basis of some researches that
helped in formulating a system view of
application of the nursing practice.
 Some researchers have formulated a
middle range theory out of King’s theory
such as patient’s satisfaction from nursing
care, clients with chronic illness and family
health.

32.  Here are two of out of the many researches which
based upon King’s Goal Attainment Theory and
Interacting System:
 Application of King's Theory of Dynamic
Interacting Systems to the Study of Child Abuse
and the Development of Alcohol
Use/Dependence in Adult Females
by Mckinney and Dean
 Imogene King's Interacting Systems Theory:
Application to emergency and rural nursing
by Williams

33. CRITIQUE OF THE
THEORY
SIMPLICITY
 King’s definitions are clear and are
conceptually derived from research literature
that existed at the time the definitions were
published.
 Her theory presents ten major concepts,
making the theory complex.
 However, these concepts are easily
understood and, with the exception of the
concept of self, they have been derived from
the research literature.

34. GENERALITY
 King’s theory has been said to have limited
application for the nursing practice.
 It was stated that the interaction between
the nurse and the client also comprises
non-verbal communication that cannot be
clearly defined and evaluated.
 This has been the issue of the
communication barriers that exist between
the nurse-patient relationships.

35.  King believed that critics assume that a
theory will address every person, event,
and situation, which is clearly impossible.
King addresses this critique through
concepts of other theorist that cannot also
be tested.

36. EMPIRICAL PRECISION
 King gathered empirical data on the nurse-
patient interaction process that leads to goal
attainment.
 King believe that, if nursing students were
taught the transactual process in the Theory
of Goal Attainment and it is used in nursing
practice, goal attainment can be measured
and the effectiveness of nursing care can be
demonstrated.

37.  Multiple research studies provide
additional and ongoing research evidence
of the empirical precision of the Theory of
Goal Attainment.
 As her theory has been used by different
nursing students and other allied nursing
practitioner, it is noted that her theory can
be used to measure the effectiveness of
nursing care provided to clients.

38. DERIVABLE CONSEQUENCES
 King’s Theory of Goal Attainment focuses
on all aspects of the nursing process:
assessment, planning, implementation and
evaluation.
 She believed that nurses must assess to
set mutual goals, plan to provide
alternative means to achieve goals, and
evaluate to determine whether goals are
attained.

39.  Healthcare professionals have used, and
continue to use, King’s conceptual
system and middle range: Theory of Goal
Attainment to implement theory-based
practice in various nursing practice in
worldwide settings.
 King’s work has demonstrated over time
to be a structured framework for
curriculum development at various
educational levels.

40. INTEGRATION OF THE
11 KEY AREAS OF
RESPONSIBILITIES IN
NURSING

41. SAFE & QUALITY NURSING CARE
 Through constant interactions and
transactions between the patient and the
nurse, the nurse could identify health needs
and problems of the patient so that mutual
goals are attained.
 Both the utilization of the King’s theory and
the GONR, nurses could provide
individualized plans of care.
 Thorough assessment of the patient’s need,
nurses could prevent unnecessary actions
and mistakes in giving safe and quality
nursing care to the patients.

42. MANAGEMENT OF RESOURCES AND
ENVIRONMENT
 King’s theory somehow may not be relevant or
applicable in matters of resource management.
HEALTH EDUCATION
 In the Goal Attainment Model, interaction between
nurse and patient occurs, transaction is achieved
or goal is attained furthermore the theory
encourages feedback especially from the patient
in order for the nurse to determine if methods are
effective or not.
 Learning is a two-way process and one of the
ways that the nurse could educate his/her patient
is through mutual interaction which could possibly
lead to goal attainment.

43. LEGAL RESPONSIBILITY
 King’s theory somehow may not be
relevant or applicable in matters of legal
responsibilities.
ETHICO-MORAL RESPONSIBILITY
 In respecting patient’s rights, King’s
theory encourages the importance of
interaction between nurses and patients
so that there is an active participation of
patients in the decision-making phase of
the nursing care plan.

44. PERSONAL AND PROFESSIONAL
DEVELOPMENT
 King’s theory provides enough direction
to how nurses should be able to behave
or act in the presence of patients.
 Since majority of nursing activities
involve direct interaction with patients,
nurses should understand the basic
implications of the action-reaction-
interaction-transaction model of nurse-
client relationships.

45. QUALITY IMPROVEMENT
 The theory emphasizes interaction
between the nurse and client with that the
nurse encourages the patients to verbalize
relevant changes and concerns regarding
his/her care.
 The nurse could gather and analyze data,
implement proper actions and evaluate
care through the use of King’s theory and
possibly through GONR.
 If goals are attained, patient satisfaction
occurs and quality improves.

46. RESEARCH
 The theory can help set a framework for
nursing studies which can further prove
the use and advantages of the nursing
practice.
 The nurse can also utilized King’s
GONR which is a method of collecting
data, identifying problems, implementing
and evaluating care that has been used
effectively in patient settings.

47. RECORDS MANAGEMENT
 King developed a documentation
system, Goal-Oriented Nursing Record
(GONR) which documents the
effectiveness of nursing care.
 The major elements in this record
system are: database, nursing
diagnosis, goal list, nursing orders, flow
sheets, progress notes and discharge
summary.

48. COMMUNICATION
 Communication is a vital concept in the
Theory of Goal Attainment because it
emphasizes the importance of the
interaction between nurses and patients.
 Through this, the nurse could establish
rapport with the patients, folks and also
colleagues in order for them to achieve their
goals in a mutual setting.
 If there is no communication, there is no
interaction and it follows that transactions
can’t occur, therefore, no goals are
attained.

49. COLLABORATION AND TEAMWORK
 King’s theory and the GONR are useful
in practice because nurses have the
ability to provide individualized care
plans while encouraging active
participation from the patients and
colleagues in the decision-making
phase.
 Through this theory, we could achieve
good interpersonal relationship with
clients, folks and colleagues as well.

50. REFERENCES
 Tomey, AM & Alligood, MR (2008) Nursing Theorists
and their Work, 6th Edition, Mosby and Philadelphia
 Octaviano, E. & Balita, C. (2008) Theoretical
Foundations of Nursing: The Philippine Perspective,
Ultimate Learning Series
 Bautista, J. (2009) Theoretical Foundations of
Nursing: A Beginner’s Journey into Professional
Nursing, Revised Edition
 http://imogenekingtheory.blogspot.com
 http://nursingtheories.weebly.com/imogene-m-
king.html
 http://currentnursing.com/nursing_theory/goal_attain
ment_theory.html