KING’S GENERAL SYSTEMS FRAMEWORK THEORY James Madison University NSG 463 Ashley Simon IMOGENE KING, RN, MSN, EDD, FAAN • Born: January 30, 1923 in West Point, Iowa • The youngest of three children • Died: December 24, 2007 in Saint Petersburg two days after suffering from a stroke. ¹ IMOGENE KING’S EDUCATION • 1945-Completed her diploma in nursing education at St. John’s Hospital in St. Louis, Missouri • 1948-Received her BS in Nursing from St. Louis University • 1957-Obtained her MS in Nursing from St. Louis University • 1961-Obtained her Doctorate in Education(Ed.D.) from Teacher’s College in Columbia University, N.Y.¹ • 1971- Published “Toward a theory of nursing: general concepts of human behavior” • 1980-Honoary Ph. D from Southern Illinois University • Postdoctoral study in research design, statistics and computer² KING’S EXPERIENCE • Practiced as an office nurse, staff nurse, school nurse, nurse educator, and nurse administrator • Administrator at Ohio State University • Educator at St. John’s Hospital School of Nursing, Loyola University, and the University of South Florida • Adult Medical-Surgical Nursing Practitioner • Assistant chief of the Research Grants Branch, Division of Nursing, Department of Health, Education and Welfare • Professor emeritus at the University of South Florida³ IMOGENE KING CONT’D • Formulated her theory while she was an associate professor at Loyola University in Chicago³ “A search for literature in nursing and other behavioral science fields, discussion with colleagues, attendance at numerous conference, inductive and deductive reasoning, and some critical thinking about the information gathered, lead me to formulate my own theoretical framework.” • During this time nursing was emerging as a profession and some sought to challenge the existing role of nurses. JOURNEY TOWARDS THE THEORY • According to King humans have three fundamental needs • Information on health that can be accessed and utilized • Care that aims to prevent illness • Care in times of need or illness² • In 1981 King refined her concepts into a nursing theory that consisted of: • 1. An open system framework as the basis of goal attainment • 2. Nursing as a major system within the health care system • 3. Nursing process emphasis on interpersonal processes⁴ • Used a “systems” approach in the development of her Dynamic Interacting Systems Framework and in her subsequent goal attainment theory. JOURNEY CONT’D • Interacting Systems Framework included three systems: • Personal System-the individual • Interpersonal System -individuals interacting with one another • And Social system-groups of people in a community or society sharing common goals, interests and values.³ • King studied the systems as a whole rather than as isolated parts SYSTEMS FRAMEWORK • The three systems included: • Personal system concepts includes: coping, spirituality, perception, self, body image, growth and development • Interpersonal system concepts includes: interaction, communication, transaction, role, stress and coping • Social system concepts includes: organization, authority, power, status, and decision making⁵ • In order to identify problems and establish goals, the nurse and patient has to perceive one another, act and react, interact, and transact. THEORY OF GOAL ATTAINMENT • Describes the importance of the participation of all individuals in decision making as well as choices, alternatives, and outcomes of nursing care. • It pertains to the importance of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and personal space. • Reflects King’s belief that the practice of nursing is differentiated from other healthcare professions by what nurses do with and what they do for individuals • The nurse and patient/client communicates information in order to set goals mutually and then acts to attain those goals. SEVEN HYPOTHESIS IN GOAL ATTAINMENT 1. Perceptual congruence in nurse-patient interactions increases mutual goal settings 2. Communication increases mutual goal setting between nurses and patients which leads to satisfaction 3. Satisfaction in nurses as well as patients increases goal attainment 4. Goal attainment decreases stress and anxiety in nursing situations 5. Goal attainment increases patient learning and coping in nursing situations 6. Role conflict experienced by nurses, patients, or both decreases transactions in nurse-patient interactions 7. Congruence in role expectations and role performance increases transactions in nurse-patient interactions.⁵ PUTTING THE THEORY TO USE • King believed that if nursing students are taught the theory of goal attainment and it is used in nursing practice, then goal attainment can be measured and the effectiveness of nursing care can be demonstrated. • This theory focuses on all aspects of nursing process: assessment, planning, implementation, and evaluation. • King believed that a nurse must assess in order to set mutual goals, plan to provide alternative means to achieve goals, and evaluate to determine if the goal was reached. ³ PUTTING THE THEORY TO USE CONT’D • It is useful in nursing practice to create individualized plans of care while encouraging active participation from clients in decision making • One current way in practice of doing this is Bedside report-this allows for the patient to interact and know their plan of care during the stay at the hospital. • This theory has also been used fro curriculum design in nursing programs and used as frameworks for books. ³ • It provides a systematic means of viewing nursing as a profession, organizing a body of knowledge for nursing, and clarifying nursing as a discipline. THEORY ANALYSIS • Not a perfect theory but easily understood • Clear and conceptual defined from research literature at the time of development • Some has critiqued the theory to have limited application to nursing especially in patients who are unable to competently interact with the nurse. KING’S RESPONSE TO CRITIQUE • 70% of communication is non-verbal • It is impossible for a theory to address every person, event, and situation⁴ SUMMARY • King presented an open systems framework from which she derived a theory of goal attainment. The framework consists of 3 systems including personal, interpersonal, and social. • The major concepts of the theory are interaction, communication, transaction, role, stress, growth and development, space and time. • This theory is useful, testable, and applicable to nursing practice, although it is not a perfect theory. KING’S THEORY APPLIED IN CURRENT PRACTICE • In current practice the use of this theory relies on participation of both the nurse and the patient for effectiveness • It can be used in most any practice • Reviewing the patient’s plan of care and providing the patient with information as well as education each day • Providing the patient with options for their plan of care • Keeping the patient “in the loop” during their process of care • Making decisions with the patient rather than for the patient • Bedside report is a good start to this theory. REFERENCES • 1. Texas Woman’s University (2014). Nursing Theorist. Retrieved from http://libguides.twu.edu/content.php?pid=387632&sid=3179434 • 2. George, J.B. (Ed.) (2008). Nursing theories: the base for professional nursing practice. Upper Saddle River, N.J.:Prentice Hall. • 3- Retrieved from: http://www.nurses.info/nursing_theory_person_king_imogene.htm • 4. Nursing theories. (2008). Retrieved October 2, 2014 from http://www.currentnursing.com/nursing_theory. • 5. Blais, K. & Hayes, J. (2011). Professional nursing practice: concepts and perspectives. Boston: Pearson.