King's Theory of Goal Attainment
The Theory of Goal Attainment was developed by Imogene King in the early 1960s. It describes a dynamic, interpersonal relationship in which a patient grows and develops to attain certain life goals. The theory explains that factors which can affect the attainment of goals are roles, stress, space, and time.
The model has three interacting systems: personal, interpersonal, and social. Each of these systems has its own set of concepts. The concepts for the personal system are perception, self, growth and development, body image, space, and time. The concepts for the interpersonal system are interaction, communication, transaction, role, and stress. The concepts for the social system are organization, authority, power, status, and decision-making.
The following propositions are made in the Theory of Goal Attainment:
- If perceptual interaction accuracy is present in nurse-patient interactions, transaction will occur.
- If the nurse and patient make transaction, the goal or goals will be achieved.
- If the goal or goals are achieved, satisfaction will occur.
- If transactions are made in nurse-patient interactions, growth and development will be enhanced.
- If role expectations and role performance as perceived by the nurse and patient are congruent, transaction will occur.
- If role conflict is experienced by either the nurse or the patient (or both), stress in the nurse-patient interaction will occur.
- If a nurse with special knowledge communicates appropriate information to the patient, mutual goal-setting and goal achievement will occur.
There are also assumptions made in the model. They are:
- The focus of nursing is the care of the human being (patient).
- The goal of nursing is the health care of both individuals and groups.
- Human beings are open systems interacting with their environments constantly.
- The nurse and patient communicate information, set goals mutually, and then act to achieve those goals. This is also the basic assumption of the nursing process.
- Patients perceive the world as a complete person making transactions with individuals and things in the environment.
- Transaction represents a life situation in which the perceiver and the thing being perceived are encountered. It also represents a life situation in which a person enters the situation as an active participant. Each is changed in the process of these experiences.
According to King, a human being refers to a social being who is rational and sentient. He or she has the ability to perceive, think, feel, choose, set goals, select means to achieve goals, and make decisions. He or she has three fundamental needs: the need for health information when it is needed and can be used; the need for care that seeks to prevent illness; and the need for care when he or she is unable to help him or herself.
Health involves dynamic life experiences of a human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of resources to achieve maximum potential for daily living. Environment is the background for human interaction. It involves the internal and external environments. The internal environment transforms energy to enable a person to adjust to continuous external environment changes. The external environment involves formal and informal organizations. In this model, the nurse is part of the patient’s environment.
The Theory of Goal Attainment defines nursing as “a process of action, reaction and interaction by which nurse and client share information about their perception in a nursing situation” and “a process of human interactions between nurse and client whereby each perceives the other and the situation, and through communication, they set goals, explore means, and agree on means to achieve goals.” In this definition, action is a sequence of behaviors involving mental and physical action, and reaction is included in the sequence of behaviors described in action. King states that the goal of a nurse is to help individuals to maintain their health so they can function in their roles. The domain of the nurse “includes promoting, maintaining, and restoring health, and caring for the sick, injured and dying.” The function of a professional nurse is “to interpret information in the nursing process to plan, implement, and evaluate nursing care.”
King gives detailed information about the nursing process in her model of nursing. The steps of the nursing process are: assessment, nursing diagnosis, planning, implementations, and evaluation.
The theory explains that assessment occurs during interaction. The nurse brings special knowledge and skills whereas the patient brings knowledge of him or her self, as well as the perception of problems of concern to the interaction. During the assessment, the nurse collects data regarding the patient including his or her growth and development, the perception of self, and current health status. Perception is the base for the collection and interpretation of data. Communication is required to verify the accuracy of the perception, as well as for interaction and translation.
The nursing diagnosis is developed using the data collected in the assessment. In the process of attaining goals, the nurse identifies problems, concerns, and disturbances about which the patient is seeking help.
After the diagnosis, the nurse and other health care team members create a care plan of interventions to solve the problems identified. The planning is represented by setting goals and making decisions about the means to achieve those goals. This part of transaction and the patient’s participation is encouraged in making decisions on the means to achieve the goals.
The implementation phase of the nursing process is the actual activities done to achieve the goals. In this model of nursing, it is the continuation of transaction.
Evaluation involves determining whether or not goals were achieved. The explanation of evaluation in King’s theory addresses meeting goals and the effectiveness of nursing care.