This material is designed to augment your study of Imogene King. It does not replace the responsibility for reading the required material.
 

Required reading:
 Clemon-Stone, S., McGuire,S. & Eigsti, D. (1998).  Comprehensive Community Health Nursing (pp. 164-168, 226-228), St. Louis, Mo., Mosby, Inc.

Handout: Wesley, Ruby L. (1995). Nursing Theorist and Models.(2nd ed). Chapter 13-King's Goal Attainment Theory. Springhouse Corp. Springhouse, Pa.

Review:
Niesworthy, R. (1998).  Foundations in Nursing Research (pp.89-107), Stamford, CN., Appleton-Lange.
 
 

 Imogene King completed her diploma nursing education in 1945, at St. John's Hospital in St. Louis, Mo.
 

She received her BS and MS in nursing from St. Louis U. in 1957,

She obtained her Doctorate in Education from Columbia U. 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 U. 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's 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 systems 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.
 

King's concept of Man:
 

Man is an important focus of King's framework.

She proposes three basic premises; man is:

1. A reactive being

2. A time oriented being

3. A social being

Man as 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.

Man as a time-oriented being 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.

Man as a social being has a continuous exchange with persons in the environment.
Language is a social link and facilitates interpersonal communication.

 King identifies six (6) other characteristics of man:
 

1. The ability to perceive--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 have emotions.

4. The ability to choose between alternative course of action.

5. The ability to set goals

6. The ability to select means of accomplishing goals.

Example of the use of mans abilities:
 

Two students are in college and the tuition has increased.

The students are Deanna and Jane and they are both 21 years old.

Neither have the financial means to enroll in the current term.
 

Both ladies are in the same situation, but they adapt in different ways.

Deanna applies for a student loan.

Jane accepts a full time job and suspends her education pursuits.
 

The difference came from the past.

Deanna has a good credit rating due to prompt payment of a car loan.

Joan has never had a loan and had no established credit rating.
 

The present also exerts and influence.

The only job Deanna could find barely meets her living expenses.

Jane has a job that will allow her to save for her future college expenses.
 

The future plays a part into the adaptation. Deanna is a first term senior who has a promise of a good job after graduation.

Jane has at least three more years before she will graduate.
 

Deanna applied for a loan because she had a successful past experience in loan repayment, and because she cannot find adequate job at this time.

In one years time she will be working and repay the loan.
 

Jane has no experience with loans but has a job that can eventually help her earn a degree.

Jane would have needed a loan or other financial assistance for another three years before she would graduate and be able to work.
 

The adaption of both Deanna and Jane is based on perception, thinking, decision making, goal setting, alternate selection and feelings.
 

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: 1)Personal system, 2)Interpersonal system, &

3) Social system:
 

I Personal System
 

The personal interacting system consists of:

a. The Individual's Perception--the person's representation of reality and it is unique to each individual
 

b. Self--The person's subjective environment, values, ideas, attitudes, and commitment.
 

C. Growth and Development--involves all the changes that occur (cellular, molecular, and behavioral). These change are usually orderly and predictable, but may vary with individuals.
 

D. Body Image--The way a person perceive their body and the reaction of others to their body. Body image is subjective and changes as the person changes physically or emotionally.
 

E. Space--is the immediate physical territory occupied by the person and person's behavior.
 

F. Time--is the order of events and their relationship to each other.
 
 

II Interpersonal Systems
 

Interpersonal system occur when humans socialize. This includes:
 

a. Interaction--verbal and nonverbal behavior between the individual and the environment or between two or more individuals.
 

B. Communication--The transmission of information directly, between persons or indirectly by other media (phone, letter, etc)
 

c. Transaction--interaction between a person and another person or a person and the environment for the purpose of goal attainment.
 

D. Role--the expected behavior of a person in a specific position and the rules that govern the position and affect the interactions between two or more person.
 

E. Stress--the exchange of energy that is either positive or negative between a person and the environment, object, events and persons can serve as stressors.
 

F. Coping--was considered important by King but defined.
 

III Social System
 

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.
 

Authority--is the seat of power or the individual who make decisions that guide other's actions.

Power may be official or functional, and it may not exist in the same person.
 

Status--the role one occupies within the system of status-position.
 

Decision Making--comes from developing and acting on perceived choices to obtain goals.
 
 
 
 

Kings' concept of Health:
 

Health--is a dynamic, ever changing process that is a state of being.

It is not a point to be achieved, it is an ongoing fluid existence, rather than a static state.

The dynamic state of health occurs in the life cycle from conception to death.

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.

All of society is involved in health, if a society is to be healthy, it must be at least partially composed of healthy individuals.

The individual is constantly in adaption to meet the need of the internal and external environment.

The individual's internal environment consist of the organs systems, cells, hormones, and inner thought processed.

The external environment consist of things that impact the individual from the outside, sound air pollution, food, people.
 
 

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."
 
 
 
 

King's Goal Attainment Theory involves the nurse and the patient mutually communicating information, establishing goals, and taking action to obtain goals.
 

Two people who are usually strangers come together in a health care organization to help or to be helped to a mutual state of health.
 

The goal attainment theory is based on personal and interpersonal systems, including interaction, communication, transaction, role, stress, growth and development, time and space.
 

She also described a theory of goal attainment through a goal-oriented nursing record. This consist of five major elements: a data base, a problem list, a goal list, a plan and progress notes.

The theory of Goal attainment has been tested and has received support, advancing nursing knowledge.

The Goal-Oriented Nursing Record (GONR), derived from the theory of goal attainment, has been implemented in many health service agencies.
 
 

Emphasis on client participation in goal setting and goal achievement is a major strength of this model.
 

King's model is a useful framework for nurses whose social interactions with clients are a key focus of their practice.
 

King's Theory includes the major concepts of man, health, society, and nursing.
 

King's definition of the process of nursing is different from the nursing process as we know it today.

She identified the process of nursing as the action, reaction, interaction and transaction.
 

Today's nursing process consist of assessment, nursing diagnosis, planning, implementation and evaluation.
 

Limitations:

1. Theory statement about nursing does not clearly indicate the relationship to society/environment.
 

2. Potential confusion in her definition of the process of nursing which is similar to the nursing process but not as inclusive.
 
 

Learning Outcomes:
 

Check off the following items once you've mastered them:
 

__ Describe King's open systems framework.
 

__ Identify the concepts of the Goal Attainment Theory.
 

__ Discuss How King addresses the four concepts of the nursing metaparadigm.
 
 

1. Introduction
 

A. Imogene King completed her basic nursing education in 1945 when she received her diploma in nursing from St. John's Hospital School of Nursing, St. Louis
 

B. In 1948, she received her BS in nursing education, and in 1957, her MS in nursing from St. Louis University
 

C. In 1961, she was awarded a doctorate in education from Teachers College, Columbia University, New York City
 

D. She has held positions in nursing education, administration, and practice
 

E. King began formulating her theory while an associate professor of nursing at Loyola University, Chicago, where she developed a master's degree program in nursing, using a conceptual framework
 

F In 19 7 1, she published Toward a Theory for Nursing: General Concepts of Human Behavior, in which she proposed a conceptual framework for nursing rather than a theory
 

G. In 198 1, she refined her ideas in A Theory for Nursing: Systems, Concepts, and Process

I . King proposes an open systems framework as a basis for her theory Of goal attainment

2. She links the concepts essential to understanding nursing as a major system within the health care system

3. Her vision of the nursing process places a strong emphasis on interpersonal processes.
 

H. King bases her theory on general systems theory, the behavioral sciences, and deductive and inductive reasoning
 

I II. Open systems framework
 

A. General information

1. Is based on the assumption that humans are open systems in constant interaction with their environment.

2. Consists of three interaction systems: Personal, interpersonal, and social (see King's Open Systems Framework).

B. Personal system
 

1. This personal system consists solely of the individual and includes perception, self, growth, and development body image , space, and time.
 

2. Perception, the primary feature of the personal system because it influences all other behaviors, refers to a person@s representation of reality; it is universal, yet highly subjective and unique to each person.
 

3. Self refers to a person's subjective environment, which constitutes everything that makes up the person; it includes ideas, attitudes, values, and commitments
 

4. Growth and development refers to all the changes (cellular, molecular, and behavioral) occurring in a person; these changes are usually orderly and predictable, yet subject to individual variations
 

5. Body image refers to the manner in which one perceives one's body and the reaction of others to it; body image is highly subjective and changes as the person changes physically or emotionally
 

6. Space refers to the immediate physical territory occupied by a person and to the person's behaviors
 

7. Time refers to a sequence of events and their relationship to each other
 

C. Interpersonal system
 

1. This system occurs when humans socialize and includes interaction, communication, transaction, role, stress, and coping.
 

2. The greater the number of interacting individuals, the more complex the interaction; two interacting persons form a dyad, three form a triad, and four or more form a small or large group.
 

3. Interaction refers to verbal and nonverbal behavior between an individual and the environment or between two or more individuals; it involves goal-directed perception and communication
 

4. Communication refers to the transmission of information from one person to another, either directly (as in a face-to-face meeting) or indirectly (as through a telephone call or written message); it is the

information component of interaction
 

5. Transaction refers to the interaction between a person and the environment for the purpose of goal attainment
 

6. Role refers to the expected behaviors of a person in a specific position and to the rules that govern the position and affect interaction between two or more persons.
 

7. Stress refers to an exchange of energy, either positive or negative, between a person and the environment; objects, persons, and events can serve as stressors.
 

8. Coping, although considered important by King, is not defined by her
 

D. Social systems
 

1. When interpersonal systems come together, they form larger systems (called social systems), which include families, religious groups, schools, workplaces, and peer groups
 

2. A social system comprises the social roles, behaviors, and practices developed to maintain values and includes organization, authority, power, status, and decision making
 

3. Organization refers to a group of people with similar interests who have prescribed roles and positions and who use resources to achieve personal and organizational goals
 

4. King proposes four parameters of organization: human values, behavior patterns, needs, goals, and expectations; natural environment containing essential materials and resources; individuals who form groups and interact for goal achievement; and technology to facilitate goal attainment
 

5. Authority refers to the observable behavior of providing guidance and order and being responsible for actions; it is active and reciprocal
 

6. Power, which is situational, dynamic, and goal-directed, is

characterized by the ability to use resources for goal achievement; power is also a means by which one or more persons can influence others
 

7. Status refers to the position occupied by a person in a group or the position occupied by a group in relation to other groups in an organization; it is accompanied by certain duties, privileges, and obligations
 

8. Decision making results from developing and acting on perceived choices for goal attainment
 
 

111. Goal Attainment Theory
 

A. General information
 

1. Represents an expansion of King's original ideas to incorporate the concept of the nurse and the patient mutually communicating information, establishing goals, and taking ACTION to attain goals
 

2. Describes a situation in which two people usually strangers, come together

in a health care organization to help or be help to maintain a sate of health
 

3. Is based on the concepts Of the personal and interpersonal systems, including interaction, perception, communication, transaction role, stress, growth and development, time, and space
 

B. Interaction
 

1. According to King, each individual brings to an interaction a different set of values, ideas, attitudes, and perceptions to exchange
 
 

2. Individuals come together for a purpose; each person makes a judgment, takes mental or physical action, and reacts to the other individuals and the situation
 

C. Perception
 

1. A person imports energy from the environment and transforms,

processes, and stores it
 

2. The individual then exports this energy, as demonstrated by observable behaviors
 
 

D. Communication
 

1. A person provides information directly or indirectly to another person

2. The other person receives this information and processes it
 

E. Transaction

1. Two individuals mutually identify goals and the means to achieve them

2. They reach an agreement about how to attain these goals and then set about to realize them
 

F. Role

1. Each person occupies a position in a social system that has specific rules and obligations

2. Roles can be congruent (resulting in transactions) or in conflict (resulting in stress)
 

G. Stress
 

1. When an individual interacts with the environment, an energy response occurs to objects, events, and persons

2. The individual uses this energy response to maintain balance for growth, development, and performance
 

H. Growth and development

1. Individuals are in a constant state of molecular, cellular, and behavioral change

2. As these changes occur, transactions are made, moving the individual toward a level of maturity and self-actualization
 

1. Time

1. A person experiences a sequence of events that move toward the future

2. As the individual moves forward, changes occur
 

J. Space

1. Each person has a designated physical area or territory that extends from the individual equally in all directions

2. Specific behaviors exist for the person occupying that space
 

IV. King's theory and the four concepts of the nursing metaparadigm
 

A. Person
 

1. Is a social, sentient, rational, perceiving, controlling, purposeful,

action-oriented, time-oriented being
 

2. Has a right to self-knowledge, participation in decisions that affect life

and health, and acceptance or rejection of health care
 

3. Has three fundamental health needs: timely and useful health information, care that prevents illness, and help when self-care demands cannot be met
 

B. Environment
 

1. Is not specifically defined by King, although she uses the terms

internal environment and external environmentin her open systems

approach
 

2. Could be interpreted from the general systems theory as an open system with permeable boundaries that allow the exchange of matter, energy, and information
 

C. Health
 

1. Is described by King as a dynamic state in the life cycle; illness is viewed as and interference in the continuum of the life cycle
 

2. Implies continuous adjustment to stress in the internal and external environments, using personal resources to achieve optimal daily living
 

a Nursing
 

I . Refers to observable nurse-client interaction, the focus of which is to help the individual maintain health and function in an appropriate role
 

2. Is viewed as an interpersonal process of action, REACTION, interaction and transaction; a nurse's perception and those of the client influence the interaction
 

3. Promotes, maintains, and restores health and cares for a sick, injured, or dying client
 

4. Is a service profession that meets a social need
 

5. Entails planning, implementing, and evaluating nursing care
 

6. Encourages a nurse and a client to share information about their perceptions (if perceptions are accurate, then goals are attained, growth and development is enhanced, and effective nursing care results; additionally, if a nurse and a client perceive congruent role expectations and performance, transactions occur; if role conflict ensues, stress occurs)
 

7. Uses a goal-oriented approach in which individuals within a social system interact; the nurse brings special knowledge and skills to the nursing process, and the client brings self-knowledge and perceptions
 
 

The goal of nursing is to help individuals maintain health so that they can function in their roles.
 

The open systems framework consists of three interacting systems: personal, interpersonal, and social.
 

The Goal Attainment Theory addresses interaction, perception, time, space, communication, transaction, role, stress, and growth and development.
 

King describes "person, as a social, sentient, rational, perceiving, controlling, purposeful, action-oriented, time-oriented being.
 
 

1. According to King's Theory, what is the focus of nursing?
 

2. Review and summarize an article on the application of nursing theory as the foundation for nursing practice.

(attach a copy of your article)