Theory Critique

Theory Critique:
Theory of Health as Expanding Consciousness and
Conceptual Framework and Theory of Goal Attainment
Jaymica Rose L. Dacquil
Saint Paul University Philippines

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Abstract
This paper describes and analyzes Imogene M. King's Conceptual Framework and Theory of
Goal Attainment and Margaret Newmans Theory of Expanding Consciousness. Discussions of
the critiques of both King and Newmans theory as well as some concepts of the theories are also
included. Major areas of concern of the critics include clarity, generality, empirical precision,
cultural limitations, patient competence, and lack of specific guidelines to work within the
nursing process.

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Margaret Newmans Theory of Expanding Consciousness
The theory of health as expanding consciousness arose from Rogers theory of unitary
human beings. It was stimulated by concern for those for whom health as the absence of disease
or disability is not possible. The theory has developed to include the health of all persons
regardless of the presence or absence of disease. Newmans theory asserts that every person in
every condition, no matter how hopeless and disordered it seems, is an aspect of the universal
process of expanding consciousness. This is a process of becoming more of oneself, of finding
greater meaning in life, and of reaching new dimensions of connectedness with other people, as
well as the entire human population.
Clarity
The theory is clear and describes all of the main components of the model clearly, which
includes the definitions, descriptions, and dimensions of the concepts of the theory.
Simplicity
The deeper denotation of the theory of health as expanding consciousness is complex.
The theory as a whole must be comprehended, not just the isolated concepts. If an individual
utilize a positivist approach, Newmans original propositions would serve up as guides for
hypothesis development. However, researchers who tried that approach have concluded that it is
inadequate to study the theory. As Newman have advocated in the 1994 Edition of her book,
Theory of Helalth as Expanding Consciousness, the holistic approach of the hermeneutic
dialectic method is consistent with the theory and requires a high level of understanding the
theory in praxis research.
Generality
The concepts in Newmans theory are broad in scope because they all relate to health.

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The theory has been applied in several different cultures and is applicable across the spectrum
of nursing situations. This renders the theory genralizable.
Empirical Precision
In the early stages of development, aspects of the theory were operationalized and tested
within a traditional scientific method. However, quantitative methods are inadequate in
capturing the dynamic, changing nature of this theory.
Derivable Consequences
The focus on Newmans theory of health as expanding consciousness provides an
evolving guide for all health-related disciplines. In the quest for understanding the
phenomenon of health challenges nurses to make a difference in nursing practice by the
application of this theory.
Overall, Newmans theory is considered a grand nursing theory. She states that humans
cannot be divided into parts. Health is central to the theory, and is seen as a process of a
developing awareness of the individual self and the persons environment. She also states that
consciousness is a manifestation of an evolving pattern of person- environment interaction.
Also, Newmans theory is beneficial because it can be applied in any setting and generates
caring interventions. However, its drawback are that it is abstract, multidimensional, and
qualitative, and there is little discussion on environment within the model.

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Imogene Kings Theory of Goal Attainment
King first published her conceptual framework in 1971 and further developed it into the
theory of goal attainment in 1981 (Johson and Webber 2001). Kings systems framework is based
on the assumption that human beings are the focus of nursing. The goal of nursing is health: its
promotion, maintenance, and/or restoration; the care of the sick or injured; and the care of the
dying (King 1992). Husting (1997) stated: Kings theory evolved from the General Systems
Theory of Von Bertalanffly. The components of a system theory are: (a) goal; (b) structure; (c)
functions; (d) resources; and (e) decision making (p.15). King (1996) further stated that the
nursing domain involves human beings, families, and communities as a framework within
which nurses make transactions in multiple environments with health as a goal (Norris and Frey
2001).
Clarity
Assumptions remain consistent and clear in regards to nurse-patient interaction.
Language is easily understood and tautology is not evident. Connections of the metaparadigm:
person, health, nursing, and environment are clearly defined. The conceptual systems framework
provides structure and clearly defines relationships. The process of transaction and consistency
of ideas provides more clarity. Theory is considered of high clarity, as parsimony is evident.
Simplicity
King used multiple concepts, which lead to increased in complexity. Her concepts was
derived from Von Bertanlanffys general systems theorya and King has given them a new
meaning in defining nurse-patient relationships, which is central to her theory of goal attainment.
The more phenomena the theory considers, the more potential relationships it could generate,
and the more complex the theory is ( Meleis , 2012, p. 195).

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Generalizability
Kings theory is a middle range theory, which means that, this theory is not too broad or
too limited. The theory provides foundation for the following: nursing practice, research, and
development of middle-range theories. Generalizability is of high ranking.
Accessibility
Accessibility refers to the extent to which empirical indicators can be identified for
concepts within the theory. Theory of goal attainment is a grand theory, which has highly abstract
concepts and does not lend itself to empirical testing. Development of middle-range theories
were derived from Kings. Accessibility is of low ranking.
Importance
According to Chinn and Kramer, the importance of a theory is closely related to the idea
of its clinical significance. Implementation of theory in practice, resulting in positive outcomes:

Through means of nurse-patient interaction

Nursing school programs and curriculum

Goal Oriented Nursing Record

Quality Assurance programs

H igh rank of importance and usefulness of Kings theory in nursing practice.

Overall, Kings theory of goal attainment does describe a logical sequence of events. For
the most part, concepts are clearly defined. King formulated assumptions that are testable
hypotheses for research. A major limitation is the effort required of the reader to shift 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. ssssss

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References
Alligood, M.R. and Marriner-Tomey A. 2002. Nursing Theory,Utilization and Application.
London: Mosby.
Gustafson, W. (1990). Application of Newman's theory of health: Pattern recognition as nursing
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National League for Nursing.
Husting, P.M. 1997. A Transcultural Critique of Imogene Kings Theory of Goal Attainment. The
Journal of Multicultural Nursing and Health, 3(3):15-20. John, M. 2003 The best route.
Modern Healthcare, 33(19):1-4.
Johson, B.M. and Webber, P.B. 2001. An Introduction to Theory and Reasoning in Nursing: New
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Kalb, K. A. (1990). The gift: Applying Newman's theory of health in nursing practice. In M.
Parker (Ed.), Nursing theories in practice (pp. 163-186). New York: National League for
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King, I.M. 1997. Kings theory of goal attainment in practice. Nursing Science Quarterly,
10(4):180-185.
King, I.M. 1999. A theory of goal attainment: Philosophical and ethical. Nursing Science
Quarterly, 12(4):292-296.
Newman, M. A. (1990). Shifting to higher consciousness. In M. E. Parker (Ed.), Nursing
theories in practice (pp. 129-139). New York: National League for Nursing.
Norris, D.M. and Frey M.A. 2002. Kings Interacting Systems Framework and Theory in
Nursing Practice. In M.R. Alligood and A. Marriner-Tomey (eds.), Nursing Theory:
Utilization and Application. London: Mosby. pp.173-183

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