Nurse Theorist
Imogene King
Kaitlyn Baldwin, Patricia Burgess, Beth Langenburg
Outline
Educational Background
Introduction
Interacting Systems:Personal, Interpersonal, Social
Theory of Goal Attainment
Conceptual Framework
Propositions and Utilization of the Theory
Goals of Nurse
Nursing Process
Case Study
Theory Limitations
Evaluation
Conclusion
References
Educational Background
1945: Earned her Nursing diploma from St.John's
Hospital School of Nursing.
1948: Earned Bachelors of Nursing, and by 1957,
had earned a Masters in Nursing.
1961: Earned Doctoral Degree in Nursing from
Teachers College, Columbia University.
1980: Awarded honorary Ph.D. from Southern
Illinois University.
Introduction
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Initially King's goal was to develop a conceptual
framework for a nursing curriculum.
King's theory of goal attainment was first
published in 1971. It was developed from her
conceptual framework of three interacting
systems.
o Personal systems (individuals)
o Interpersonal systems (groups)
o Social systems (society)
Kings Development of
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Interacting Systems Framework
King organized her concepts based on research
and evidence from the scientific community.
King included the global concepts. Her
philosophy is used in nursing studies and taught
in nursing schools.
Kings personal philosophy about human beings
and life influenced her assumptions, including
those related to the environment, health, nursing,
individuals, and nurse-patient interactions.
Social Systems (society)
Interpersonal
Systems (groups)
Personal
Systems
(individuals)
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Basic Assumptions
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Nursing focus is the care of human beings.
Goal of nursing is the health care of individuals and
groups.
Human beings are open systems that interact with
their environment.
Interacting systems include: Personal system,
Interpersonal system, Social system.
Personal Systems Concepts
Understanding the patient as a whole is critical for
the nurse. Concepts include...
Body Image
(personal and
unique)?
Self
(an open system)
Growth and
Development
(behavioral, cellular and
molecular changes)
Perception
(occurs through
sensory and
intellectual tools)
Space
Time
(knowledge of
personal space)
(individual
perceptions)
Interpersonal Systems
Concepts
This is where the nursing process primarily occurs.
Interaction vs Transaction
Interaction
Transaction
The patient and nurse share
different ideas and
perceptions with each other.
Observation occurs both
verbally and nonverbally.
Both the nurse and the
patient make perceptions and
decide to act on the shared
information.
From the ideas and perceptions
shared between the nurse
and the patient, goals are
set. Setting goals requires
compromising and social
exchange.
When transactions occur, goals
are attained.
Bargaining and negotiation of
priorities occurs in
Social Systems Concepts
The nurse works with the patient to address their
health needs. To effectively work with the
patient, the nurse must understand the impact of
social systems on the patient's behaviors.
Concepts include...
Authority
Decision Making
Power
(ability to guide action
of self and others)
(leads to decreased resistance
to implementation)
(related to a
situation)
Organization
(focus is to achieve
goals)
Status
(prestige attached to
a role)
Human Interaction
Communication between two individuals, the nurse
and the patient. Both verbal and nonverbal.
The theory that the nurse and patient come together
and set goals to achieve together.
They each have a purpose, they perceive, judge, act
and react upon each other.
The transaction is made with same goal in sight.
Theory of Goal Attainment
The core of goal attainment theory
is that the nurse and the patient
work together to define and reach
health goals that they set
together.
GOAL
ATTAINMENT
THEORY
Propositions
(Identifies the relationship between concepts)
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If awareness is present in nurse-patient
interactions, transactions will occur.
If nurse and patient make transactions, goals will
be achieved.
If goals are met, satisfaction will occur.
If goals are met, effective nursing care will occur.
If role conflict is experienced by the nurse and/or
the patient, stress in nurse-patient interactions will
occur.
Utilization of the Theory
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Provides a theoretical base for nursing process.
Demonstrates a way for nurses to interact
purposefully with patients.
To assist nurses in arranging facts into
meaningful wholes.
For more information on King's influence on
nursing, visit:
Goals of the Nurse
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Help the patient to maintain health so that they can
function in their individual roles.
Interpret the information in the nursing process; to
assess, diagnose, plan, implement, and to evaluate
nursing care.
To be guided by each of the concepts at each of the
systems levels.
Nursing Process
Assess the patient: Subjective and Objective data
collection.
Diagnose: Problems the nurse sees the patient
experiencing from disease process.
Plan for interventions: Set goals with patient.
Implement the plan according to the diagnosis and
goals.
Nursing Process
King emphasized the importance of joint goal
setting by nurse and patient, clearly specifying
that the goal is attaining or regaining health
(Chitty & Black,2011 p.312).
"King's middle-range theory of goal attainment
focuses on all aspects of the nursing process:
assessment, planning, implementation and
evaluation." (Tomey & Alligood, 2006)
King's Metaparadigm Definition
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 (King, 1981).
Frey, M., Sieloff,C., & Norris,D.(2002).King’s Conceptual System and Theory of Goal
Attainment: Past, Present, and Future.Nursing Science Quarterly, April 2002; vol.
Case Study
Mr. Jones comes in from home with a COPD
exacerbation. He arrives with his daughter. The
nurse notes that the patient's hygiene and nutrition
status appear neglected. The daughter states that
she is concerned about her father's forgetfulness.
1. With King's theory, in what interacting
system does the nursing process primarily
occur?
Case Study
Mr. Jones hears his daughter's conversation with the
nurse and is quick to state that he wants to return
to his home. The nurse, patient and daughter
share their individual discharge goals.
2. The discussion between the nurse, patient and
daughter regarding discharge goals indicate
interaction or transaction?
Case Study
Assessment, Mutual Goal setting
Perceptions of Nurse,
Client and Situation.
Would
visiting
nurses be
an option?
Goals to be
achieved to
implement
Self care?
Patient does not
want the assisted
living option.
Goal of
patient
and
daughter
may be
different
Case Study
The situation is that the patient thinks he can go back
home once his exacerbation subsides. His perception
(Personal system) of his own health is not what his
daughter (Interpersonal system) sees. The daughter
is obviously stressed about the state of her dad and
her own ability to continue taking care of him.
3. When all parties have agreed on mutually set
goals, King's theory states that a ______________
has occurred, which is required for goal
achievement.
Case Study
The patient initially set a goal to return home
without assistance. The nurse and the daughter
agreed that the patient needed assistance in order
for the patient to return home.
4. According to King's theory, if conflict in goalsetting occurs between the patient and the
nurse, what will happen in the nurse-patient
relationship?
Case Study
The goal is health restoration and maintenance for the patient.
The assessment and implementation of goals or Plan of Care is
mutually set by the nurse and the patient.
The Plan of Care will also involve the daughter for assistance
with goal setting and decision making.
5. What part of the interacting systems framework is the
daughter a part of?
With the involvement of Social Work, visiting nurses are set up
three times a week for bathing assistance. Adult Day Care is
arranged twice a week to provide social interaction for the
patient and respite care for his daughter.
6. What part of the interacting systems framework is MSW
and Home health Nurses part of?
Case Study
Evaluation of goals indicate that both Mr. Jones and his daughter,
as well as the nurse, are in agreement with the discharge plan.
7. What theory was used to achieve this final
goal?
Theory Limitations
The theory focuses on the nurse-patient relationship
versus nurse-group or nurse-community
relationships.
Social System is not clearly connected to the theory,
which leads to limitations of utilizing the theory
in nursing care with groups, families and
communities.
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Evaluation
"King's 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 has stated that "she is the only nurse theorist who has
provided a theory that deals with choice, alternatives,
participation of all individuals in decision making and
specifically deals with outcomes of nursing care"
"King and other nurse scientists and researchers have used
her framework for theory testing and theory development at
the grand and middle range levels."
(Tomey & Alligood, 2006).
Conclusion
With King's THEORY OF GOAL ATTAINMENT, elements are
seen in the interpersonal systems in which two people, who are
usually strangers, come together in a healthcare organization to
help and be helped to maintain a state of health that permits
functioning of roles. This 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 goals mutually and
then act to attain those goals.
Imogene King contributed to the advancement of nursing
knowledge through the development of her interacting systems
framework and middle range theory of goal attainment.
(Frey, M., Norris,D., & Sieloff,C.(2002)
·
References
Alligood, M. R.(2010). Family Healthcare With King's Theory of Goal Attainment.
Nursing Science Quarterly, 23(2) 99-104. Thousand Oaks, CA: Sage
Chitty, K. K.,& Black, B. P. (2011). Professional nursing: Concepts and Challenges (6th
ed.). Maryland Heights, MO: Saunders
Clarke, P. N., Killeen, M. B., Messmer, P. R., & Sieloff, C. L. (2009). Imogene M.
King's scholars reflect on her wisdom and influence on nursing science. Nursing
Science Quarterly, 22(2) 128-133. doi: 10.1177/0894318409332568
Fitzpatrick, J. J., & Whall, A. L. (2005). Conceptual Models of Nursing: Analysis and
Application (4th ed.). Upper Saddle River, NJ: Pearson.
Frey, M., Norris, D., & Sieloff, C. (2002). King’s Conceptual System and Theory of
Goal Attainment: Past, Present, and Future. Nursing Science Quarterly, April 2002; vol.
15, 2: pp. 107-112.
References
http://nursing-thery.org/nursing-theorists/Imogene-King.php Imogene Kin's Interacting
Systems Theory-Application in Emegency and Rural Nursing
King, I. M., (2007). King's Conceptual System, Theory of Goal Attainment, and
Transaction Process in the 21st Century. Nursing Science Quarterly, 20(2), 108111.
Sieloff, C. L., Frey, M. A., (2007). Middle range theory development using king’s
conceptual system. [D X Reader version]. Retrieved from http://0site.ebrary.com.libcat.ferris.edu/lib/ferris/docDetail.action?docID=101761
Tomey, A. M., & Alligood M. R., (2006). Nursing theorists and their work. (6th ed.),
Imogene king:interacting systems framework and middle range theory of goal
attainment, pp.297-317, St. Louis, Missouri: Mosby, inc.
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Imogene King's nursing
theory.