Goal Attainment Theory

A professional nurse, with special knowledge and skills, and a client in need of nursing, with knowledge of self and perception of personal problems, meet as strangers in natural environment. They interact mutually, identify problems, establish and achieve goals.

A. Getting to know the Theorist

Imogene King was born in West Point, Iowa on January 30, 1923, youngest of three children. She completed her diploma in nursing education in 1945, at St. John's Hospital in St. Louis,

Missouri. She received her BS and MS in nursing from St. Louis University in 1957, She obtained her Doctorate in Education from Columbia University, N.Y.

 She has practiced as a staff nurse, nurse educator, and nurse administrator.
She formulated her theory while she was an

associate professor of nursing at Loyola University in Chicago. This was at the time nursing was emerging as a profession and some nurses sought to challenge the existing role of nurses. King began her work in nursing theory with a conceptual framework. King considers her theory as a deviation from systems theory, with emphasis on interaction theory.

 In 1981 she refined her concepts into a nursing theory that consisted of the following basis:

1. An open system framework as the basis of goal attainment.

2. Nursing as a major system within the health care system. 3. Nursing process emphasis on interpersonal processes.
She Died on December 24, 1997, 2 days after suffering from stroke.

B. Theoretical Sources
1971, 1981: students, academic colleagues, nurse

researchers, and clinicians thinking

1981: General System Theory (Von Bertalanffy)

conceptual framework
1988:Kaufman, Orlando and Peplau

thinking

Kaufmans 1958 doctoral dissertation explore concepts of perception, time and stress Research conducted at Yale University School of Nursing to test Orlandos (1961) theory of the deliberative nursing process thinking King and Peplau (as cited in Takahashi, 1992) pointed out the connections between their works with regard to patient outcome. A review of her 1971 book by Rosemary Ellis encouraged her to continue her work by deriving a theory from the General Systems Framework.
The result

The Theory of Goal Attainment.

C. Use of Empirical Evidence

King used a systems approach in the development of her Dynamic Interacting Systems Framework and in her subsequent Goal-Attainment Theory. INTERACTING SYSTEMS FRAMEWORK

Three systems in the conceptual framework: Personal System (the individual) Interpersonal System (individuals interacting with one another) Social System (groups of people in a community/society sharing common goals, interests, and values) Study systems as a whole rather than as isolated parts of a system.

THEORY OF GOAL ATTAINMENT

Elements are seen in the interpersonal systems in

which two people, who are usually strangers, come together in a health care organization to help and be helped to maintain a state of health that permits functioning of roles.

Reflects Kings belief that the practice of nursing is

differentiated from other healthcare professions by what nurses do with and for individuals goal mutually and then act to attain those goals

Nurse and client communicate information, set

D. Metaparadigm in Nursing:
1.Person: Imogene King described a person existing in an open system as a spiritual being and rational thinker who makes choices, selects alternative courses of action, and has the ability to record their history through their own language and symbols, unique, holistic and have different needs, wants and goals.

According to Imogene King, human being has three fundamental needs:

Information on health that can be

accessed and utilized when needed

Care that aims to prevent illness

Care in times of illness/helplessness

2.Health : According to Imogene King, 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 ones resources to achieve maximum potential for daily living.

3.Environment : It is the background for human interactions.

It involves:
a. Internal environment transforms energy to enable person to adjust to continuous external environmental changes.

b. External environment involves formal and informal organizations. Nurse is a part of the patients environment.

4. Nursing:
Nursing for Imogene King is an act wherein the nurse interacts and communicates with the client. The nurse helps the client identify the existing health condition, exploring and agreeing on activities to promote health. The goal of the nurse in Imogene Kings theory is to help the client maintain health through health promotion and maintenance, restoration, and caring for the sick and dying.

E. Theoretical Assertion
From the theory of goal attainment Imogene King developed predictive propositions, which includes:
If perceptual interaction accuracy

is present in nurse-patient interactions, a transaction will happen. be attained.

If nurse and client make transaction, goal will If goal are attained, satisfaction will occur.

 If goals are met, efficient nursing care will

happen.
If transactions are made in nurse-client

interactions, growth and development will be enhanced

If role expectations and

role performance as perceived by nurse and client are congruent, transaction will occur

 If role conflict is experienced by nurse or

client or both, stress in nurse-client interaction will occur

If nurse with special knowledge and skill

communicate appropriate information to client, mutual goal setting and goal attainment will occur.

The interaction of the person and the nurse is goal-directed and through this, both parties reach a common and accurate perception of the problem and means are explored on how to resolve it. After the means exploration, goalsetting is made which is subject for agreement. Finally, transaction happens when the agreed goals are acted upon and necessary actions are taken to achieve them. Finally, if the goals are attained, satisfaction will occur and the health need fulfilled.

G. Analysis
Clarity: Clear and conceptually derived from research Generality: It has been criticized for having limited

literature at the time the theory was developed.

applications in areas of nursing in which patients are unable to competently interact with the nurse.

King has responded that 70% of communication is nonverbal.

Empirical Precision:
From a study of 17 patients, goals were attained in 12

cases (70%).

King believes that if nursing students are taught the

theory of goal attainment and it is used in nursing practice, goal attainment can be measured and the effectiveness of nursing care can be demonstrated.

Derivable Consequences:
It focuses on all aspects of the nursing process:

assessment, planning, implementation and evaluation.

goals, plan to provide alternative means to achieve goals, and evaluate to determine if the goal was attained.

King believes that nurses must assess to set mutual