The Theory of Goal AttainmentImogene M. King Prepared By Prof.Dr Nefissa A. kader Vice Dean of Education and Student Affairs Faculty of Nursing – Cairo university
Outlines • Historical background. • Origin of the Conceptual Model • Model of transaction • King's theory Assumptions. • Strategies for Knowledge Development of the system framework. • Influences from other scholars. • World View • Unique focus of the model • Concepts and Components of the framework. • Basic paradigm concepts. • The three dimensional Nursing Process based on King's Theory. • Relationship Among the four Process of nursing . • Propositions of the model.
Historical background • Imogene King completed her diploma in nursing education in 1945,from st. John’s hospital in st.louis. • A bachelor’s of science in nursing education(1948). • In 1957, She received her MS in nursing. • In 1961, She obtained her Doctorate in Education from Columbia U. N.Y.
Historical background • She has practiced as a staff nurse, nurse educator, and nurse administrator. • From 1961 to 1966, king was an associate professor of nursing. • Her first theory article appeared in 1964 in a journal edited by Dr. Martha Rogers titled Nursing Science. • From 1968 to 1972, King was the director of the school of Nursing at The Ohio State University in Columbus. While at Ohio State, her book Toward aTheory for Nursing was published.
Historical background • In 1980, she was appointed as a professor at the university of South Florida College of Nursing. The manuscript for her second book, A Theory for Nursing: Systems, Concepts, Process, was published. • In 1981 , addition to her first two books, she has authored multiple book chapters and articles in professional journals. • In 1986 , published a third book, Curriculum andInstruction in Nursing,. - King retired in 1990, is currently a professor at the University of South Florida.
Historical background • In 1994, she was a member in the American Academy of Nursing. • In 1997, she is one of the founding members of a nursing organization (King International Nursing Group) established to facilitate utilization of her systems framework and Theory of Goal Attainment. • In 1996, she received the Jessie Scott Award at the American Nurses Association convention.
The Origin of the Conceptual Model • king’s philosophical perspective, as both personal and derived from general system theory, and the theory of goal attainment with emphasis on interaction theory. • king’ selected systems theory because it reflected perspectives of wholeness, rather than reductionism. • King’s conceptual system can be inferred based on Morgan and Smircich’s(1980) discussion of subjectivity and objectivity within the socialsciences. King posed several questions: • What is the goal of nursing? • What are the functions of nurses? • How can nurses provide quality care?
King's theory Assumptions Explicit Assumptions: • The central focus of nursing is the interaction of human beings and environment, with the goal being healthy for human being. (King, 1982) • Individuals are social, sentient, rational, reacting, perceiving, controlling, purposeful, action-oriented, and time oriented being. (King, 1981) • The interaction process is influenced by perceptions, goals, needs, and values of both the client and the nurse. (1981, 92)
King's theory Assumptions • Human being as patients have rights to obtain information, to participate in decisions that may influence their life, health, and community services, and to accept or reject care. (1981). • It is the responsibility of health care members to inform individuals of all aspects of health care to help them in making ''informed decision''. (19981) • Incongruities may exist between the goals of health for caregivers and recipients. Persons have the right to either accept or reject any aspect of health care. (1981).
King's theory Assumptions Implicit Assumptions: • Patients want to participate actively in the care process. • Patients are conscious, active, and cognitively capable to participate in decision making (Austin and Champion, 1983, p. 56)
Strategies for knowledge Development of the Systems Framework • An awareness of the complex dynamics of human behavior in nursing situations prompted King’s formulation of conceptual framework that represents (personal, interpersonal, and social systems) as a domain of nursing. • King’s process of concept development is one of synthesis and reformulation using inductive and deductive processes, critical thinking, empirical observations, extensive reviews of the nursing and other literature.
Influences from Other Scholars • King (1971,1975. 1981 1989 and 1992) has repeatedly mentioned the influence of the literature of nursing and adjunctive disciplines on the development of the general systems framework and theory of goal attainment: • Influence of general system theory (Bertalanffy, 1968 ) focused on wholism. • Among the numerous authors from many disciplines (Erikson,1950), (Freud,1966), (Orem,1969), (Parson,1951), (Selye, 1956)(Piaget,1969)&(Peplau, 1952)
Influences from Other Scholars • The term transaction came from a study of Dewey’s theory of knowledge. • Influence of students , academic colleagues, nurse researchers, and clinicians. • Kaufman’s( 1958) doctoral dissertation to explore the concepts of perception, time and stress.
World View • The general systems framework reflects reciprocal interaction world view. • The holistic element indicated by the focus of the framework on three systems- the personal, interpersonal, and social as wholes. • Reciprocal interaction world view reflected by King’s view of human beings as active participants in interaction with one another and her philosophical claim “a science of wholeness” • Change is view as continuous, natural & desirable as King’s (1981) comment that normal changes in growth and development take place continuously.
Unique Focus of the model • King identified the unique focus of the general systems framework as “human beings interacting with their environment”. • Particular attention is given to the continuing ability of the individuals to meet their basic needs to function in their socially defined roles. • King’s framework addresses most of the characteristics of systems models. • System is addressed through the personal, interpersonal, and social systems, which King(1981) viewed as open, dynamic, and interacting.
Unique Focus of the model • King’s framework addresses environment in terms of internal and external components. She referred to the interaction between open systems and environment and indicated that matter, energy and information are exchanged. • King’s (1981) framework characteristics of tension, stress, strain and conflict is addressed in her discussion of stress and transaction as they relate to the interpersonal system. • She commented “when transactions are made, tension or stress is reduced in a situation” • The characteristic of feedback is dealt within a dynamic manner in King’s(1971) discussion of nurse-patient interaction. This is a continuous dynamic process rather than separate incidents in which the action of one person influences the perceptions of the other.
Unique Focus of the model • The framework also addresses each of the characteristics of interaction model. A major feature is the social act of human interaction that occurs in the relationship between nurse and patient. • The characteristic of perception is considered in detail as a major concept of personal system, it is a central aspect of the process of human interaction. • Communication is a concept associated with the interpersonal system. Communication is used to establish and maintain relationship between human beings(King,1981). Nurses and patients communicate to establish mutual goals and decide on the means to achieve these goals.
Unique Focus of the model • Role is another concept related to the interpersonalsystem. King’s definition of health as “an ability to function in social roles”. • The interaction model characteristic of self concept is addressed in King’s framework through the concept of self which associated with the personal system. • King’s defined self as “a composite of thoughts and feelings which constitute a person’s awareness of his individual existence, his conception of who and what he is”.
Concepts and Components of the Framework • I - Personal systems( individuals) The basic elements in the system, are best understood by the concepts of perception, self, growth and development, body image, learning time, personal space, and coping. a. Perception: the person's representation of reality and it is unique to each individual “process of organizing interpreting & transforming information from sense data and memory ( King, 1981). • b. Self: The person's subjective environment, values, ideas, attitudes, and commitment( composite of thoughts& feedings). • C. Growth and Development:the processes that take place in an individual’s life that help the individual move from potential capacity for achievement to self actualization (King, 1981).
Concepts and Components of the Framework • D. Body Image: The way a person perceive his/ her body and the reaction of others to his/ her appearance. Body image is subjective and changes as the person changes physically or emotionally. • E. Personal space:existing in all directions and is the same every where. • F. Time: duration between the occurrence of one event and occurrence of another event. • G. Learning: a process of sensory perception, conceptualization, and critical thinking involving multiple experiences in which changes in concepts, skills, symbols, habit and values can be evaluated in observable behaviors. • H. Coping: the constantly changing cognitive and behavioral efforts to manage specific external and internal demands that are appraised as taxing the resourses (Lazarus & Folkman's def.1993).
Concepts and Components of the Framework • II- interpersonal systems: (dyadic or triadic or small group) Requires an understanding of the concepts of communication, interaction, role. Stress/Stressors and transaction. • A.Interaction:acts of two or more persons in mutual presence. • B. Communication: information processing, a change of information from one state to another. • C. Transaction: a process of interaction between a person and another person or a person and the environment to achieve goals that are valued.
Concepts and Components of the Framework • D. Role: Set of behaviors expected when occupying a position in social system. • E. Stress: dynamic state whereby a human being interacts with the environment to maintain balance for growth , development and performance which involves an exchange of energy & information between the person and the environment for regulation& control stressors.
Concepts and Components of the Framework III Social Systems Social systems occur when interpersonal systems come together to form larger systems; such as families, religious groups, school, work, and peer groups. The social systems are comprised of: Social roles, behaviors, and practices that are developed to maintain values and include organizations, authority, power, status, and decision making.
Concepts and Components of the Framework • Organization:a system whose continuousactivities are conducted to achieve goals. • Authority: is the power or the individual who make decisions that guide other's actions. • Power:capacity to use resources in organizations to achieve goal. • Status: the position of an individual in a group or a group in relation to other groups in an organization. • Decision Making: Dynamic and systematic process by which a goal directed choice of perceived alternatives is made and acted upon by individuals or groups to attain a goal.
Basic Paradigm Concepts 1- King's concept of Man: • Man is an important focus of King's framework. • Man is defined as personal system. I- The major concept associated with personal system is perception and the sub concepts are self growth& development , body image, time, space and learning.
Basic Paradigm Concepts King's concept of Man: • King (1989) maintained that perception “ is a comprehensive concept in personal system. • Knowledge of perception is essential for nurses to understand self & to understand other individuals. • She defined perception as “ a process of organizing, interpreting & transforming information from sense data& memory. • It is a process of human transactions with the environment.
Basic Paradigm Concepts King's concept of Man: • The self is a composite of thoughts & feelings which constitute a persona's awareness of his individual existence, his conception of who & what he is • The self is the individual as known to the individual. • King’s (1981) description of growth & development drew from the works of Erikson (1950), Freud (1966) & Piaget (1969). She identified two characteristics of growth& development: • Growth & development include cellular, molecular, &behavioral changes in human beings. • Growth & development are a function of genetic endowment , meaningful & satisfying experiences & an environment conducive to help individuals move toward maturity.
Basic Paradigm Concepts King's concept of Man: • King defined the concept of body image as “a person’s perception of his own body , others reaction to his appearance & is a result of other reactions to self. • King defined time (1981) as “ the duration between the occurrence of one event & the occurrence of another event”. • She defined space as “ existing in all directions &is the same everywhere ….. As the physical called territory.
King's concept of Man • King(1986)added learning to the list of concepts related to the personal system in her discussion of use of the general systems framework as a guide for curriculum development. She did not define or describe that concept. • King linked all concepts except learning related to the personal system in the following statement. • An individual’s perceptions of self, of body image, of time and space influence the way he or she responds to persons, objects and events in his or her life. • As individuals grow and develop through the life span, experiences with changes in structure and function of their bodies over time influence their perceptions of self .
King's concept of Man II-The interpersonal system: • Composed of “two , three, or more individuals interacting in a given situation”. • King(1990) explained that “ at the interpersonal systems level, individuals increase consciousness and are open to interpersonal perceptions in the communications and interactions with persons and things in the environment. • The interpersonal system moves the focus from the individual alone to individuals interacting in dyads, triads, small groups and large groups (King,1989). • The major concept of the interpersonal system is interaction the subconcepts are communication, transaction, role, stress, and coping (King,1986).
She defined interaction as “ the act of two or more persons in mutual presence . Interactions can reveal how one person thinks and feels about another person, how each perceives the other & what the other does to him. • According to king(1981)”the process of interactions between two or more individuals represents a sequence of verbal & nonverbal behaviors that are goal directed”.
King(1981) viewed communication as “ the vehicle by which human relations are developed and maintained”, she added that “all behavior is communication”. • Communication is involved in transactions, which is defined as “ a process of interaction in which human beings communicate with environment to achieve goals that are valued. Transactions are goal directed human behaviors (1981)”. • She viewed role in 3 dimensions : • Role is a set of behaviors expected when occupying a position in asocial system. • Rules or procedures define rights and obligation in a position in an organization. • Role is a relationship with one or more individuals interacting in specific situations for a purpose.
King (1981) viewed stress as negative and positive as well as constructive and destructive. • King (1981) explained that stress is reduced when transactions are made • King (1987) maintained that coping is an essential area of knowledge related to the interpersonal system . III-Social system : King the defined a social system as ”an organized boundary system of social roles, behaviors and practice developed to maintain values and the mechanisms to regulate the practice and rules”.
King (1989) pointed out that organization is “ a comprehensive concept in social system “. • An organization is composed of human beings with prescribed roles and positions who use resources to accomplish personal and organizational goals. • The concept of power was defined as “ the process whereby one or more persons influence other persons in a situation • King(1981) defined status as “ the position of individual in group or a group in relation to other groups in an organization • Decision making in organizations is a dynamic and systematic process by which goal-directed choice of perceived alternatives is made and acted upon by individuals or groups to answer a question and attain a goal. • King (1986) added control to be the list of concepts related to the social system as a guide for curriculum development. • She did not however, provide a definition or description of that concept.
King's concept of Man: She proposes three basic premises; man is: 1. Man is a reactive being • is aware of other things; persons and events in the environment. • At various times this awareness makes the being respond to the environment based upon his perceptions, expectations and needs.
a time-oriented being • Man as : • Is influenced by time orientation. • Each person presents with by his past experience that influences his actions. • His awareness of the present helps shape the future. • Has a continuous exchange with persons in the environment. • Language is a social link and facilitates interpersonal communication. a social being
King identifies seven (7) other characteristics of man: 1. The ability to perceive: these perceptions will influence behavior and thus life and health. 2. The ability to think: thinking is based upon the inquiring mind of man. When man thinks he has the ability to discriminate and identify relationships. 3. The ability to feel--or to have emotions about the environment.
King identifies seven (7) other characteristics of man: 4. The ability to choose between alternative course of action. 5. The ability to set goals. 6. The ability to select means to achieve the goals. 7. The ability to make decisions dependent on other characteristics.
Kings' concept of environment: • King used the terms environment, health care environment, internal environment, external environment. • Internal environment of human beings transforms energy to enable them to adjust to continues external environmental changes. • The person continuously adjusts to stressors in the internal and external environment. • King (1990a) stated that “environment is a function of balance between internal and external actions”.
Kings' concept of environment: • King makes the assumption that humans are open systems which are in constant interactions with their environment through three interacting systems: (ecological perspective) • 1)Personal system • 2)Interpersonal system • 3) Social system • Systems have both internal and external environments; the internal environment of human beings exchange energy, matter, and information to enable them to adjust to continuous external environmental changes.
Kings' concept of Health: • Health:is a dynamic life experiences of human being, which implies continuous adjustment to stressors in the internal and external environment through optimum use of one’s resources to achieve maximum potential for daily living (King,1981) . • She also defined health as (an ability to function in social roles).
Kings' concept of Health • King did not use the term wellness, and although she did mention illness, she “rejects a linear continuum of wellness-illness” ( King 1989a). • King(1989a) regards health as (a dynamic state of an individual in which change is a constant and ongoing process). • Disturbances in the dynamic state are regarded as illness or disability. • King(1981) explicitly defined illness as “ a deviation from normal, that, an imbalance in a person’s biological structure or in his psychological make-up, or a conflict in a person's social relationships” .
Kings' concept of Health • The dynamic state of health occurs in the life cycle from conception to death (King,1989). • Illness is an interference in the continuation of the life cycle. • There is no consideration of age group or point of time in King's definition of health.
Kings' concept of Nursing: Nursing: • "is a process of actions, reaction, interaction, and transaction whereby nurses assist individuals of any age and socioeconomic group to meet their basic needs in performing activities of daily living and to cope with health and illness at some particular point in the life cycle." (1991) • The domain of nursing “includes promotion of health, maintenance and restoration of health, care of the sick and injured and care of the dying (King, 1981). Furthermore King viewed nursing as a helping profession that ”provides a service to meet a social need”. • According to King(1976), nurses are key figures in health care delivery as partners with physicians, social workers, and allied health professionals in promoting health, in preventing disease, and in managing patient care. They cooperate with physicians, families, and others to coordinate plans of health care.
Kings' concept of Nursing • As a goal of nursing is to help individuals and groups attain, maintain, and restore health. • King(1973) defined the nursing process as “a dynamic, ongoing interpersonal process in which the nurse and the patient are viewed as a system with each affecting the behavior of the other and both being affected by factors within the situation. • Emphasis on client participation in goal setting and goal achievement is a major strength of this model. • King's Goal Attainment Theory the focus of nursing is human beings interacting with their environment leading to a state of health for individuals, which is an ability to function in social roles.
The three dimensional Nursing Processbased on King's TheoryThe nursing process is elaborated through the theory of Goal Attainment.
Kings' concept of Nursing: • Recently, King(1989a) began to refer to the nursing process described by the theory as an “interaction-transaction process model”. • The components of the nursing process, or transactional model, where identified as perception, judgment, action, reaction, disturbance, mutual goal setting, exploration of means to achieve the goal, agreement on means to achieved goal, transaction, and attainment of the goal.
Kings' concept of Nursing • The process, which is depicted in the figure(4.2) follows a sequence that encompasses two people-the nurse and the client. • In the assessment phase the nurse and the client perceive each other, make mental judgments about the other, take some mental action, react to each one’s perception of the other, communicate, and begin to interact (King, 1992). • In the planning phase, interaction can be observed directly, and the data about those interactions can be recorded.
Kings' concept of Nursing • King (1992a) explained that goal setting “ is based on the nurse’s assessments of the clients 'concerns, their problems, and disturbances in health, perception of problems, and their sharing of information with clients and families to move toward quality improvement in their health. • In the implementation phase of the process is when transactions are made. Transactions, which are the valuational components of the interaction can be observed in the form of goal attainment measures . • The evaluation phase of the process requires a decision to be made with regard to whether the goal was attained and, if necessary, the determination of why the goal was not attained (King,1992).