Theory of Goal Attainment Imogene King’s Theory of Goal Attainment is a prominent nursing theory that offers a comprehensive framework for understanding the interactions between nurses and patients, aiming to achieve mutually set health goals. This theory is part of King’s broader Conceptual System, which organizes nursing knowledge and practice within a systems theory perspective.
King’s Conceptual System and Theory
Imogene King developed her conceptual system to focus and organize nursing knowledge, intending to identify a systems theory specifically for nursing (King, 1981). Introduced in 1981, King’s theory focuses on three types of systems:
- Personal Systems: These refer to individual patients and their perceptions, self-concept, growth and development, body image, learning, time, personal space, and coping mechanisms.
- Interpersonal Systems: These involve two or more individuals interacting with one another, such as patient-nurse interactions. Key concepts include interaction, communication, role stress/stressors, and transaction.
- Social Systems: These include larger organizational and societal structures that influence nursing practice, such as healthcare organizations or communities. Key concepts in this category are organization, authority, power, status, and decision-making.
King’s theory proposes that interactions within and across these systems influence human behavior and health outcomes. Concepts and relationships are interconnected both within and between these systems, consistent with general systems theory. Interpersonal systems are composed of personal systems, and interactions with social systems influence both interpersonal and personal systems. These interactions affect behavior, attitudes, beliefs, values, and customs.
Concepts of the Theory
King’s Theory of Goal Attainment revolves around three main concepts that relate to the different systems:
- Perception: A fundamental concept for personal systems, perception is the process of organizing, interpreting, and transforming information from sensory data and memory (King, 1981, p. 24).
- Interaction: This concept is central to understanding interpersonal systems and involves mutual presence and a sequence of goal-directed behaviors between two or more individuals (King, p. 85).
- Organization: Pertinent to social systems, this concept defines a system whose continuous activities are carried out to achieve specific goals (King, p. 119).
Paradigms of the Theory
King’s theory aligns with the metaparadigm concepts of nursing: person, health, environment, and nursing. She explicitly links these concepts:
- Person: Human beings interacting with their environment.
- Health: The ability of individuals to function in social roles.
- Environment: The context within which human beings interact, including social systems and organizational settings.
- Nursing: Actions aimed at achieving and maintaining health through interaction with the environment.
These paradigms clarify the focus of nursing as facilitating interactions that lead to health and the ability to perform social roles (King, p. 143). King has expanded and clarified these concepts over multiple publications, addressing concerns and explicating the philosophical and ethical basis of the conceptual system (Frey, 2004).
Focus of the Theory
As a grand-level theory, King’s Conceptual System provides a broad focus for the discipline of nursing, the nursing process, and a framework for deriving middle-range theories. The first middle-range theory derived from this conceptual system was King’s Theory of Goal Attainment (King, 1981). This theory specifically focuses on nurse-client interactions that lead to transactions and goal attainment.
Key behaviors in the process of transactions include mutual goal setting, exploration of means to achieve goals, and agreement on methods to accomplish those goals. The Theory of Goal Attainment specifies the process of nursing and reflects King’s emphasis on nursing outcomes, defined as the goals achieved through these interactions. These outcomes are used to evaluate the effectiveness of nursing care.
Extensions and Adaptations in Theory
Over the past two decades, King’s Conceptual System and Theory of Goal Attainment have seen significant extensions and applications across various nursing contexts (Frey & Sieloff, 1995; Sieloff, Frey, & Killeen, in press). These extensions include:
- Application in different patient populations, nursing specialties, and work settings.
- Implementation in both hospital and community settings.
- Integration with evidence-based practice, the nursing process, standardized nursing languages, performance improvement, and technology.
- Development of new middle-range theories derived from the conceptual system.
Additional middle-range theories derived from King’s theory address various areas, such as family dynamics (Doornbos, 2000; Wicks, 1995), health outcomes in children with chronic conditions (Frey, 1995), empathy (Alligood, 1995), and nursing department power (Sieloff, 2003). Each of these theories represents a focused research program, reflecting the versatility and applicability of King’s conceptual system.
Outcomes of the Theory
Imogene King is a strong advocate for theory-based education and practice in nursing. Her conceptual system provides a broad, enduring framework for guiding nursing practice, deriving middle-range theories, and integrating ongoing changes in nursing and the healthcare system. The outcomes of King’s theory can be summarized as follows:
- Guidance for Nursing Practice: The theory offers a structured approach for nurse-client interactions, focusing on setting mutual goals and achieving positive health outcomes.
- Framework for Middle-Range Theories: King’s conceptual system has served as a basis for developing various middle-range theories that address specific nursing concerns and contexts.
- Support for Evidence-Based Practice: The theory aligns with evidence-based practice by providing a model for goal setting, interaction, and evaluating the effectiveness of nursing interventions.
- Integration with Healthcare Changes: King’s framework accommodates ongoing changes in healthcare, such as shifts towards patient-centered care, technological advancements, and interprofessional collaboration.
Conclusion
Imogene King’s Theory of Goal Attainment is a vital nursing theory that emphasizes the importance of nurse-patient interactions in achieving health goals. By providing a comprehensive framework that incorporates personal, interpersonal, and social systems, King’s theory offers a holistic approach to nursing care. The theory’s adaptability and its extensions to various settings and patient populations demonstrate its enduring relevance and effectiveness in guiding nursing practice, research, and education.