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Dr. Imogene M. King was the foremost nurse theorist of the 20th century. Her years of
clinical experience, education, critical thinking abilities and belief system qualified
her to make an enormous impact on the practice and goals of nursing with her nursing
theory.
King's Theory of Goal Attainment was presented first in the 1960s after years of study
and reflection. In 1981, the final version of her theory was explained in her book, A
Theory for Nursing: Systems, Concepts, Process. The basic concepts are patient and nurse
communication, goal setting and actions taken to attain these goals. The theory relies
heavily on the interaction between nurses and patients. King stated that patients have
three fundamental needs: the need for health information, the need for care to prevent
illness and the need for care when they cannot care for themselves. She explained that
health is a product of patients' life experiences and their responses to stresses in the
environment, both internal and external. She considered nurses to be a part of that
environment.
The Theory of Goal Attainment has three related systems and each system has different
concepts. The systems and concepts are as follows:
Personal
- Perception
- Self
- Growth and development
- Body image
- Space
- Time
Interpersonal
- Interaction
- Communication
- Transaction
- Role
- Stress
Social
- Organization
- Authority
- Power
- Status
- Decision making
Requirements for Subsystems
- The system must be protected from harmful influences.
- The system must be nurtured with suitable input from the environment.
- Growth does not occur without stimulation.
It can be seen from these systems and concepts that patient-nurse communication and
cooperation is vital for healing to take place. Further propositions and assumptions
are defined in the theory.
Propositions
- Action will occur if both the patient and the nurse understand the goals accurately.
- Goals will be achieved if the nurse and the patient reach an agreement.
- Satisfaction will occur if goals are achieved.
- When agreement is reached between the patient and the nurse, there will be growth.
- Action will occur if expectations and performance are mutually agreeable to the patient and the nurse.
- Stress will occur in the nurse-patient relationship if there is role conflict by either party.
- Specialized knowledge that is communicated to the patient usually results in goal setting and achievement.
Assumptions
- The primary purpose of nursing is care of people.
- Nursing care focuses on the health care of both individuals and groups.
- People are constantly interacting with their environments, both internal and external.
- Nurses and patients exchange information, mutually set goals and select actions to achieve the goals.
- Patients' perceptions of the world include interactions with individuals, groups and the environment.
- An agreement between a patient, nurse and environment changes each in the process.
The nursing process provides the framework for the theory. The following steps are followed as the nurse cares for the patient.
Assessment of Patients
- Growth and development
- Self perception
- Health status
- Communication skills
Nursing Diagnosis
- Problems
- Concerns
- Areas in which patients are seeking help
Care plan
- Interventions to solve problems
- Goal setting
- Decisions on how to achieve goals
- Communication with patients concerning goal achievement
Implementation
- Actions to achieve goals
- Continued communication with patients concerning actions
Evaluation
- Determining if goals were met
- Effectiveness of nursing care
King's theory emphasizes the importance of involving patients in their own care and
allowing them to make choices within the framework of good health care. She describes
patients as rational and spiritual beings who have the ability to make wise choices
and select alternative treatments. They should be made aware of the results of their
choices and given information and alternatives that affect the outcome of their nursing
care. Each person is unique and has different wants, needs and goals, and those differences
need to be taken into consideration when providing nursing care.
The theory also provides information concerning the positive effects that nurses'
interactions have on patients and groups of people. Nurses are at the forefront of
patient care and have many opportunities to make a difference in patients' health.
Effective communication is the key, and nurses need to ensure that they and their patients
are pursuing the same goals. Nurses must be knowledgeable in both art and science and be
able to communicate that to their patients.
Dr. King was a visionary who laid much of the groundwork for modern nursing practice. Her
Goal Attainment Theory is documented in most nursing textbooks and forms the framework for
many nursing programs. Her goal-directed theory has had a huge impact on nursing as it is
practiced today.
Publications related to Goal Attainment Theory
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