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Imogene King

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Krista Stoll

on 12 November 2013

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Transcript of Imogene King

Who is Imogene King & Why Did I Choose Her??
Why I chose the Theory of Goal Attainment...
Use theory daily in my practice of facial plastic surgery
It is my job as a plastic surgery nurse to help my patients in setting realistic and obtainable goals to achieve the best possible cosmetic or surgical outcome
Can be very difficult at times, but by listening, proper interaction, and setting goals with my patients, I am able to successfully help them obtain what it is they want.
Imogene King
Background & Education
Conceptual Framework & Theory of Goal Attainment
is presented in 3 open systems
is demonstrated in reciprocal relations of individuals in interaction
includes both people (health professionals & their clients) and money, goods, and services for items needed to carry out specific activities
Decision Making:
occurs when choices are made in resources allocation to support attaining system goals

Analysis of Theory:
The social systems portion of the open systems framework is less clearly connected to the theory of goal attainment than are the personal and interpersonal systems.

The citation of the individual being in a social system was not clearly explained considering that the social system encompasses other concepts and subconcepts in her theory

The model presents interaction which is dyadic in nature which implies that its applicability cannot be adapted to unconscious individuals.

Multitude of views and definition is confusing for the reader. Because of multiple views on one concept such as what have been discussed in her concept of power blurs the point that the theorist is trying to relate to the readers.

Conclusion: Enjoy!
Overall King's theory is very applicable to Nursing and it's practices
It can be applied in education, the clinical setting, and research.
I believe it will continue to be useful in the years to come, as other Mid-Range theories are built from her Grand Theory
Imogene Speaks About Nursing Curriculum
Critique of Theory:

King’s theory of goal attainment does describe a logical sequence of events.
For the most part, concepts are clearly defined.
Although the presentation appears to be complex, King’s theory of goal attainment is relatively simple.
King formulated assumptions that are testable hypotheses for research.

King’s theory contains major inconsistencies:
(1)She indicates that nurses are concerned about the health care of groups but concentrates her discussion on nursing as occurring in a dyadic relationship.
(2) King says that the nurse and client are strangers, yet she speaks of their working together for goal attainment and of the importance of health maintenance.
A major limitation is the effort required of the reader to sift through the presentation of a conceptual framework and a theory with repeated definitions to find the basic concepts.
Another limitation relates to the lack of development of application of the theory in providing nursing care to groups, families, or communities.
Application of model:
King's Career & Achievements
King practiced as a staff nurse, nurse educator & nurse administrator
She formulated her theory while she was an associate professor of nursing at Loyola University in Chicago, Illinois
It was at this time, nursing was emerging as a profession & some nurses sought to challenge the existing role of nurses
Toward a Theory of Nursing: General Concepts of Human Behavior (1971)
A Theory for Nursing: Systems, Concepts, Process was published (1981)
King has published many papers in relation to her theory
King: An Active Member/Awards
Florida Nurses Association & American Nurses Association
Sigma Theta Tau International (STTI)
Fellow in American Academy of Nursing
Was one of the original STII Virginia Henderson Fellows
Inducted into the American Academy of Nursing, Florida Nurses Association Hall of Fame (2003), & ANA Hall of Fame (2004).
Named a Living Legend in the American Academy of Nursing (2005)
Career & Achievments Con't...
After 10 years of teaching at South Florida's Nursing School, King retired with the title "Professor Emeritus"
King began her work in nursing theory with a Conceptual Framework & considers her theory as a deviation from systems theory, with an emphasis on interaction theory
Known as a nurse futurist, theorist, scholar, & educator whose leadership has been recognized nationally & internationally
How her Theory Evolved...
King's theory evolved in the mid-1960's
She questioned: how nurses make decisions in their daily practice & how to define the nursing act, leading her to focus and develop the concept "human act" (King 1977)
She wanted to describe the essence of nursing and the interactional patterns & goals that govern the nurse-patient relationship
King began to explore different aspects of nursing that stayed the same, although the world was changing around it.
King interrelated the concepts of interaction, perception, communication, transaction, self, role, stress, growth, and development, time, and space into a Theory of Goal Attainment
1. Personal System:
each individual is a personal system

2. Interpersonal System:
involves individuals interacting with one another

3. Social Systems:
groups of people within a community or society that share common goals, interests, and values

3 Interacting Systems:
Personal System
a process of organizing, interpreting, and transforming information from sense data and memory that gives meaning to one's experience, represents one's image of reality, and influences one's behavior.

a composite of thoughts and feelings that constitute a person's awareness of individual existence, of who and what he or she is.

Growth & development—
cellular, molecular, and behavioral changes in human beings that are a function of genetic endowment, meaningful and satisfying experiences, and an environment conducive to helping individuals move toward maturity.

Body image—
a person's perceptions of his or her body.

the duration between the occurrence of one event and the occurrence of another event.

the physical area called territory that exists in all directions.

gaining knowledge.

Interpersonal System
the acts of two or more persons in mutual presence; a sequence of verbal and nonverbal behaviors that are goal directed.

the vehicle by which human relations are developed and maintained; encompasses intrapersonal, interpersonal, verbal, and nonverbal communication.

a process of interaction in which human beings communicate with the environment to achieve goals that are valued; goal-directed human behaviors.

a set of behaviors expected of a person occupying a position in a social system.

a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance, involving an exchange of energy and information between the person and the environment for regulation and control of stressors.

a way of dealing with stress.
Social System
composed of human beings with prescribed roles and positions who use resources to accomplish personal and organizational goals.

a transactional process characterized by active, reciprocal relations in which members' values, backgrounds, and perceptions play a role in defining, validating, and accepting the authority of individuals within an organization.

the process whereby one or more persons influence other persons in a situation.

the position of an individual in a group or a group in relation to other groups in an organization.

Decision making—
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.

being in charge.
King proposed that the nurse interacts in the system simultaneously at the 3 different levels: personal, interpersonal, & social frameworks.
Interacting Systems Model
These levels are independent & at the same time co-exist to influence over-all nursing practice
Interacting Framework
King believes the conceptual framework of Interpersonal system had the greatest impact on the development of her theory.

She states
"Although personal systems & social systems influence quality of care, the major elements in a theory of goal attainment are discovered in the interpersonal systems in which two people, who are usually strangers, come together ina health care organization to help & to be helped to maintain a state of health that permits functioning in roles"

Serves several purposes:
1. to identify concepts that are essential knowledge for nursing as a discipline
2. to derive theories & test them in research which may result in scientific knowledge for nursing
3. to serve as a structure to develop a curriculum for nursing education
4. to implement theory-based practice to deliver quality care to all individuals in hospitals, community healthcare agencies, and in families
Theory of Goal Attainment
Elements found in King's Goal Attainment Theory originated from the concepts in her Interacting Systems Framework, but it focuses on the
Interpersonal System
& interactions, communications, & transactions b/t two individuals, the nurse & the patient come together, communicate, & make transactions- they set goals & work to achieve the goals they set.

They each have a purpose, they perceive, judge, act & react upon each other; at the end of their communication, a goal is set & with this transactions are made.

11 concepts were used to support Theory of Goal Attainment: perception, communication, interaction, transaction, self, role, growth & development, stress, coping, time, and space.
Model of Nurse-Patient Interaction
When transactions are made between nurses, patients, and families, one can begin to predict that goals will be attained.
Contributions to Nursing Practice
Influence is recognized globally:
King has had a great impact
Nursing Research
Nursing Curriculum
Administration processes
Can be used in daily practices
She has encouraged advancement
Wrote many publications: books, articles, and
research studies

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.

Elements of Goal Attainment Theory
Nursing Research
King believes that her theory & framework contain various concepts that can be used as the basis for research...An example is
A study of perceptual congruency b/t clients & nurses was conducted to examine the interrelationship of the concepts of perception & transaction (Froman, 1995)
Mary Killean (1996) used King's concept of perception to explore a theory regarding patient satisfaction
King stresses "There is no particular research method for any theory, as the method used relates to the problem being studied"

Nursing Practice
The Transaction Process Model can be used in daily practice
Mutually-set goals are created & achieved
These outcomes now become evidence-based practice (Fawcwtt, 2001)
Nursing Education
King's Conceptual Framework has been used to create nursing curriculum for various programs
Ohio State University undergraduate program
Loyola University Chicago graduate program
King points out that a theory alone should not be used as the basis for nursing school curriculum (Fawcett, 2001)
King's Response to Critique:
70% of communication is non-verbal
It is impossible for a theory to address every person, event, and situation

King was born Jan. 30, 1923 in West Point, Iowa
1945~ Nursing Diploma from St. Johns Hospital School of Nursing, St. Louis, Missouri
1948~ Bachelors of Science in Nursing from St. Louis University
1957~ Masters of Science in Nursing from St. Louis University
1961~ Doctoral Degree in Education from Teachers College, Columbia University
Basic Concept of Theory: Goal Attainment
The basic concept of the theory is that the nurse & patient communicate information, set goals together, & take actions to achieve those goals.
It describes a system of relationships that allows a person to grow & develop in order to attain certain life goals.
Nursing Process
The goal of the nurse is to help patients maintain health so they can function in their individual roles.
The nurse's function is to interpret information in the nursing process, to plan, implement, and evaluate nursing care.
In the nurse-patient relationship, the nurse first uses his or her knowledge base to assess the patient and make a diagnosis.
After the diagnosis, the nurse creates a plan for interventions to solve problems that were identified in the assessment and diagnosis.
Once a care plan is created, actions are implemented to achieve the patient's health goals.
Finally, the nurse evaluates the patient to determine whether or not the goals were achieved.

According to King:
Nursing Paradigms:
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, 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 one’s resources to achieve maximum potential for daily living.

It is the background for human interactions. It involves:

a. Internal environment
– transforms energy to enable a person to adjust to continuous external environmental changes.

b. External environment
– involves formal and informal organizations. The nurse is a part of the patient’s environment.

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 King’s theory is to help the client maintain health through health promotion and maintenance, restoration, and caring for the sick and dying.

King's Propositions:

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.
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