Running Head: Perspectives on Imogene King’s Nursing Theories
Perspectives on Imogene King’s Nursing Theories
Greg Alan
ETSU
Perspectives on Imogene King’s Nursing Theories
I chose to research Imogene King because I was interested in learning more about her
theory of Goal Attainment. At a basic level one may ask what value theory has to nursing
practice and why time should even be devoted to its study. According to King (1971), “Theory
gives an organized, efficient, and economical way of learning and practicing nursing, and gives
some idea of the consequences of nursing action” (p.?). Secondly, how does a theory of Goal
Attainment specifically have relevance to practicing nursing? Killeen and King (2007) explain:
“King’s Theory of Goal Attainment describes the nature of nurse–patient interactions that lead to
transactions and achievement of goals. It presents a standard whereby nurses purposefully
interact with patients, mutually establish goals, and agree to the means to use to achieve the
goals.” (p.56). As a goal oriented person, I believe that establishing goals and working towards
those goals helps to give a person a sense of purpose. Furthermore, I believe the goals should be
realistically set to allow one the opportunity to reach his or her goals. This is important because
of the psychological effects it can have on a person. Reaching the goal gives one a sense of
accomplishment and enhances motivation, while continual failure to reach an unrealistic goal can
lead to frustration and despair, decreasing motivation.
Setting appropriate goals can be a complex issue with many facets to consider.
According to King (1971) the nurse is responsible for interacting with groups and individuals to
identify the specific needs of each person in each nursing situation. To demonstrate some of the
facets to consider, King (1971) also states it is essential for nurses to recognize differences in
patient attitudes, beliefs, feelings, and customs. Such differences can occur in regards to birth,
death, sleep, food, pain, separation from family, body image, status, power, and authority when
identifying patient needs and goals (King,1971). At the heart of setting appropriate goals are the
nurse-patient transactions. King (1981) explains the importance of transactions by stating,
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Perspectives on Imogene King’s Nursing Theories
“working together they experience a new kind of relationship in the health care system, one in
which the patient is recognized as having a part in making decisions that affect him now and in
the future and is recognized as a person whose participation gives him some independence and
control in the situation” (p.86). I think this explains how empowering the patient to meet the
needs that are important to him or her positively impacts the process.
It is logical to assume that when most patients are faced with illness the patient’s initial
goal is to recover to the pre-illness state of health. In some cases this may be an appropriate
goal. In other cases returning to a pre-illness state may be an unattainable goal. This leaves the
nurse with the sensitive task of directing the patient’s goals into realistic/attainable goals. King
(1971) suggests, "Nurses who structure communication and information, tend to guide
individuals to recognize their health needs, to express their feelings about meeting them, and to
share in decisions about the means and the goals to be achieved” (p.99). Furthermore Killeen and
King (2007) state, “Mutual goal-setting is based on the nurses’ assessment of patients’ concerns,
problems, and disturbances in health” (p.56). For proper assessment of the patient’s needs and
concerns nurses must rely on their perception of the patient. In fact, “perception is a critical
concept for nurses because it is the basis for gathering and interpreting information” (Killeen and
King, 2007, p.55). In today’s healthcare setting and especially moving into the future I feel that
an individual nurse’s own ability to perceive the individual patient’s needs is of the utmost
importance.
King (1971) relates perception to the individual by describing the relationship in the
following manner, “The perceptual tools, sensory (functioning sense organs) and intellectual
(brain processes), vary from person to person. One’s perception is related to past experiences,
self-concept, socioeconomic groups, biological inheritance, and educational background” (p.?).
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Perspectives on Imogene King’s Nursing Theories
It is also suggested that perception and communication have roots in cultures (Hustling, 1997).
With more and more varied nursing specialties and cultural backgrounds of patients each year, I
feel that it is important to staff nursing positions with equally varied backgrounds, interests, and
cultures to promote the most effective nurse-patient transactions. While this most certainly
includes aspects of race and gender on a larger lever, it could be as detailed as personality on a
smaller level. For example, a nurse who naturally excels in interactions with older adults by
personality could potentially be highly successful in treating pediatric patients with education
and experience pertaining to that specific population. However, it is also likely that even with
experience and training he or she will never reach the level of effectiveness that a person with
the natural abilities in dealing with children will reach given the same education and experience.
Much of the buzz in the field of nursing currently surrounds evidenced-based practice.
The nursing perspective of evidence-based practice includes many concepts initially defined by
King (Killeen and King, 2007). Setting goals through nurse-patient transactions presents a
framework to measure success. Critically reviewing the nursing process by the success of the
outcome provides a a means to implement the most beneficial strategies using evidenced-based
practice.
While I feel that Imogene King’s theories hold a valid place and have contributed greatly
to the field of nursing, I do not think they are without some flaws. To begin my critique I would
like to reference an aspect of criteria that King, herself, established for evaluating a theory. King
(1971) asks, “Are the terms universal, that is, applicable to all members of a class, or are they
specific and thus limited in time and place” (p.?)? The first flaw I have is that King neglects to
emphasize the importance of one of the metaparadigm concepts of nursing (Sieloff Evans 1991).
King addresses environment through personal health and social networks instead of designating
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Perspectives on Imogene King’s Nursing Theories
it as factor capable of independent causation. While linking environment to social factors that
relate to health may apply in cases of domestic abuse, I would argue that it would not apply to
health concerns related to radon exposure in the home. Another problem with King’s theory is
that she assumes individuals are social beings who are rational (Hanucharurnkul, 1989). Indeed,
this may apply to most individuals the majority of the time, but, I do not think that this applies to
every individual all of the time – even with cultural consideration taken into account. I think that
the potential exists for individuals to behave irrationally, especially, when faced with the
combination of stress, illness, and medications. In this case I feel the needs of the patient should
be more proactively addressed by the nurse’s perception of the situation rather than a shared
decision between the nurse and patient.
In conclusion I feel the field of nursing has benefited greatly from the contribution of Dr.
King’s theories. Even the minor shortfalls stimulate thoughts to improve and progress the field
and thus contribute in a positive manner.
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Perspectives on Imogene King’s Nursing Theories
References
Hanucharurnkul, Somchit (1989). Comparative analysis of Orem’s and King’s theories. Journal
Advanced Nursing, 14, 365-372.
Hustling, P.M. (1997). A transcultural critique of Imogene King’s theory of goal attainment. The
Journal of Multicultural Nursing and Health, 3(3), 15-20.
Killeen, Mary B. & King, Imogene (2007). Viewpoint: use of King’s conceptual system, nursing
informatics, and nursing classification systems for global communication. International
Journal of Nursing Terminologies and Classifications, 18(2).
King, Imogene (1971). Toward a Theory for Nursing: General Concepts of Human Behavior.
King, Imogene (1981). A Theory for Nursing: Systems, Concepts.
Sieloff Evans, Christina L. (1991). Imogene King, a conceptual framework for nursing.
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