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1923 – Born at West Point, Iowa

1945 – Nursing Diploma from

St. John’s Hospital School

1948 – Bachelor of Science in

Nursing degree from St.

Louis University

1957 – Masters of Science in

Nursing at St. Louis

University

1961 – Doctoral degree for

education from Teachers

College, Columbia

University

SUMMARY

Case Study

  • King's theory is simple and easily understood.

  • The concept of the theory is to serve as an aid for nurse to improve nurse-client relationship.

  • King strongly believes that if theory of goal attainment is used by all nurses daily, the effectiveness of nursing care given can be improved

See handout....

* Conclusion

* Critique

Importance of Theory

Advantages

Implications on practice

Clinical Significance

+ Clearly defined purpose: Goal Attainment

+ Provides key definitions which are consistent throughout concepts

+ Uses a step by step approach

+ Concrete concepts: Definitions of key components

+ Establishes a framework for nurse-patient interactions to achieve positive patient outcomes in a variety of clinical settings

+ Framework can be easily altered to fit other situations such as individuals versus group

*HISTORY

Overview of King's Theory of Goal Attainment

1961–1966 – Associate Professor at

Loyola University, Chicago

1966–1968 – Assistant Chief of the

Research Grants Branch

of the Division of Nursing

in Washinton, D.C.

1968–1972 – Director of Ohio State

University, School of

Nursing

1971–1980 – Went back to Loyola

University to be a

Professor

1990 – Retired after serving as a

professor in University of

South Florida, College of

Nursing

2007 – Death at the age of 84

  • The basic concept of the theory is that the nurse and patient communicate information, set goals together, and then take actions to achieve those goals.

  • It describes a system of relationships that allow a person to grow and develop in order to attain certain

  • King’s conceptual framework includes three interacting systems with each system having its own distinct group of concepts and characteristics (Personal systems, Interpersonal systems, and Social systems).

  • An overall assumption is that the focus of nursing is human beings interacting with their environment leading to health (King, 2007)
  • Nurses empower the patients by helping patients identify significant goals and establishing plans to achieve those goals
  • Patients become more responsible for their own healthcare
  • Kings theory has been found meaningful and effective for nurses to practice at bedside

  • As this theory focuses on setting goals and meeting them with the involvement of the patient, quality of care provided increases which in turn leads to higher patient satisfacation

  • King's theory helps nurses to be be more goal oriented.

Criticisms

- Too many concepts

- Patient may not be able to competently interact with the nurse (i.e. Infants not able to interact to set goals)

- Patient's goals may not be the same as the nurse's

Imogene King

Theory of Goal Attainment

Case Study

Michelle Anglehart & Stacey McFarlane

N3082: Winter, 2013

Week 6

Emergency Room Example

Assessment

  • King indicates that assessment occurs during interaction with client and nurse. The nurse brings special knowledge and skills. The client brings knowledge of self and perception of problems of concern

  • During assessment, nurse collects data regarding the client (his/her growth &development, perception of self, and current health status and roles)

  • Perception is the base for collection and interpretation of data

  • Communication is required to verify accuracy of perception for interaction and transaction

c

* Conceptual Model

* Case study: a patient with Anorexia Nervosa.

Assumptions of the Nurse-Client Interaction

Amy is a 16-year-old female adolescent who appears much younger than her age. She is 165cm (5’5”) and weighs 42 kilograms (92 pounds). She has been treated unsuccessfully in an outpatient clinic and now is being admitted to a hospital to stabilize her weight. She does not believe that she is too thin or needs hospitalization. However, the gymnastic team that she is a member of had asked her to seek help due to her low body weight.

You are assigned as Amy’s nurse. From your assessment, she appears thin and frail. She explains she eats less and exercises a lot because she thinks she is overweight. She was also tearful because she thinks nobody’s like her because she’s fat.

Developed for nursing in the mid 1960’s

Application of King's Theory

Following the steps of King’s Theory of Goal Attainment:

1. How will you interact with this patient?

2. What problems can you identify that needs to be addressed?

3. What are the goals that you will help develop with this patient?

4. How would evaluate how Amy has met the goals?

Social System

Regarding nurse-client relationships King believed that:

  • Perceptions of the nurse and client influence the interaction process

  • Goals, needs, and values of the nurse and client influence the interaction process

  • Individuals have the right to participate in decisions that influence their lives, health and community services

  • Individuals have the right to accept or reject care

  • Goals of health professionals and goals of recipients of health care may not be congruent

Conceptual Framework

  • Groups of people within a community or society that share common goals, interests and values.

  • Usually large groups such as educational system, the government system, the religious system

  • Provide a framework for social interaction and relationships, and establish rules and courses of action

OVERVIEW of APPLICATION

  • Kings theory offers insights into the nurses interaction with individuals and groups within the enviroment

  • It highlights the importance of client participation

  • Focuses on process of nurse-client interaction and outcomes of care (goals attained)

Evaluation

Interacting Systems

Interpersonal System

Personal System

Theory of Goal Attainment

References

It involves finding out whether goals were achieved or not

In King's description, this is "Goal attainment" and thus effectiveness of nursing care

  • Interaction
  • Communication
  • Transaction
  • Role
  • Stress
  • Perception
  • Self
  • Growth & development
  • Body image
  • Space
  • Time

Nursing Meta-Paradigms/Assumptions

Persons

Environment

  • Social beings that communicate with each other
  • Rational and sentient
  • Are open systems in constant interaction with the environment
  • Background for human interactions (Both external and internal to the individual)

Social System

Nursing

Health

  • Organization
  • Authority
  • Power
  • Status
  • Decision making
  • The care of human beings
  • Goal of nursing is to help individuals and groups attain, maintain, and restore health or help individuals die with dignity
  • The ability to adapt to changes in life.
  • A dynamic life experience of a human being, which implies continuous adjustment of stressors in the internal and external environment through optimum use of one's resources to achieve maximum potential for daily living (McEwen &Willis, 2011)

Implementation

Nurse-Patient Interaction

Personal System

Interpersonal System

Patient

Nurse

Planning

  • Individuals interacting with one another

  • The interactions and transactions that occur between the nurse and the client, or dyad represent an example of interpersonal system

  • Communication between nurse and client can be verbal or nonverbal

  • Verbal exchanges include written, and spoken communication
  • Non-verbal includes, appearance, distance, facial expression, posture and touch

Connections among the concepts in Personal System:

"An individual's perception 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, 1981, p.11).

  • Knowledge of self and perception of personal problems
  • Specialized body of knowledge and skills

Theory of Goal Attainment Overview

Interaction

  • In goal attainment, planning is represented by setting goals and making decisions about the means to achieve these goals

  • The client's participation is encouraged in making these decisions
  • The theory mainly explains the dynamic interpersonal relationship between a nurse and a patient which grows towards the development of certain goals that leads to the well-being of the patient

  • The theory explains that the factors that affect goal attainment are roles, stress, space and time

The goal is to promote better patient outcome

  • Interact mutually
  • Identify problems
  • Establish goals
  • Plan to achieve goals
  • Implementation
  • Evaluate
  • In the nursing process, implementation involves the actual activities to achieve the goals (the steps in transactions being made)

  • Transactions occur as a result of perceiving the other person and the situation, making judgements about those perceptions and taking some actions in response

  • Reactions to actions lead to transactions

  • This reflects the shared view and commitment

Concepts Explained....

Assumptions of the Nurse-client relationship

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