____________________

Imogene King

Daynalyn N. De Leon, RN
The Theory of Goal Attainment states that “Nursing
is a process of action, reaction and interaction by
which nurse and client share information about their
perception in a nursing situation” and “a process of
human interactions between nurse and client
whereby each perceives the other and the situation,
and through communication, they set goals, explore
means, and agree on means to achieve goals.”

Goal Attainment Theory

It describes a dynamic, interpersonal
relationship in which a patient grows and
develops to attain certain life goals.

The model has three interacting systems:

personal, interpersonal, and
social. Each of these systems has its own
set of concepts.
 Set of Concepts

Personal Interpersonal Social System

System System
• Perception • Interaction • Organization
• Self
• Growth and • Communication • Authority
development • Transaction • Power
• Body image • Role • Status
• Space
• Time • Stress • Decision-
• Learning making
Level of the Theory

Middle-range nursing theories are

narrower in scope than grand nursing theories and
offer an effective bridge between grand nursing
theories and nursing practice

Present concepts and a lower level of abstraction and

guide theory-based research and nursing practice
strategies.
The theory of goal attainment was developed in
1960 by Imogene King. (Varghese, 2012)

1923> King was born in West Point, Iowa

1945> She received a diploma in Nursing from St.
John’s Hospital School of Nursing in St. Louis,
Missouri.
1948> She received Bachelor of Science in Nursing
Education at St. Louis University
1961> She received her EdD at Teacher’s College,
Columbia University, New York.
(January 30, 1923 – December 24, 2007)

Kings theory of goal attainment’s main

Kings defines the main purpose of her theory as: focus is for the nurse and patient to have
“Theory of Goal Attainment is a theory of effective communication, set acceptable
nursing [that] deals with phenomena called goals and work toward those goals
process and outcomes. King “defines outcomes in
together
the form of the goals to be attained”
(Wisniewski, 2013)
 Most of the people pursue a career in nursing because they want to
be instrumental in helping patients get healthy. In order to do that,
it is necessary to set health goals with the patient, and then take
steps to achieve those goals. In hospital settings, as nurses, we
have proved that when the nurse and client communicate and work
together toward mutually selected goals, the goals are more likely
to be attained
Imogene King’s concepts focus on these methods to help
nurses in the nurse-patient relationship. King used
a “systems” approach in the development of her dynamic
interacting systems framework and in her subsequent Goal-
Attainment Theory

Goal Attainment Theory

 • Nursing is a process of action, reaction, and interaction
whereby nurse and client share information about their
Nursing perceptions in the nursing situation. The nurse and client
share specific goals, problems, and concerns and explore
means to achieve a goal.

• Health is a dynamic life experience of a human being,

which implies continuous adjustment to stressors in the
Health internal and external environment through optimum use of
one’s resources to achieve maximum potential for daily
living.

• Individuals are social beings who are rational and sentient.

Humans communicate their thoughts, actions, customs, and
beliefs through language. Persons exhibit common
characteristics such as the ability to perceive, to think, to
Individual feel, to choose between alternative courses of action, to set
goals, to select the means to achieve goals, and to make
decisions.
 • Environment is the background for human
Environment interactions. It is both external to, and internal
to, the individual.

• Action is defined as a sequence of behaviors

involving mental and physical action. The
sequence is first mental action to recognize the
presenting conditions; then physical action to
begin activities related to those conditions; and
Action finally, mental action in an effort to exert
control over the situation, combined with
physical action seeking to achieve goals

• Reaction is not specifically defined but might be

considered to be included in the sequence of
Reaction behaviors described in action.
the processes in people’s lives through which they move from a potential for achievement to actualization of self.

• “each person’s representation of reality.”

PERCEP
TION
• composite of thoughts and feelings which constitute
a person’s awareness of his individual existence,
his conception of who and what he is. A person’s
SELF self is the sum total of all he can call his.

GROWTH
the processes in people’s lives through which they
AND move from a potential for achievement to
DEVELOPMENT actualization of self.
 BODY the way one perceives both one’s body and others’
IMAGE reactions to one’s appearance.

includes that space exists in all directions, is the same

everywhere, and is defined by the physical area known as
SPACE “territory” and by the behaviors of those occupy it.

“a duration between one event and another as

uniquely experienced by each human being; it is the
TIME relation of one event to another event.”

LEARNING gaining knowledge.

 observable behaviors of two or more individuals in
mutual presence.
INTERACTIONS

“a process whereby information is given from one person to

another either directly in face-to-face meeting or indirectly
through telephone, television, or the written word.”
COMMUNICATION

“a process of interactions in which human beings communicate

TRANSACTIONS 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

ROLE a social system.
 “a dynamic state whereby a human being interacts with the
environment to maintain balance for growth, development, and
STRESS performance, which involves an exchange of energy and
information between the person and the environment for
regulation and control of stressors.”
 composed of human beings with prescribed roles and
positions who use resources to accomplish personal and
ORGANIZATION organizational goals.

a transactional process characterized by active, reciprocal

relations in which members' values, backgrounds, and
AUTHORITY 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
POWER persons in a situation.

the position of an individual in a group or a group in relation to

other groups in an organization.
STATUS

a dynamic and systematic process by which goal-directed choice of

DECISION perceived alternatives is made and acted upon by individuals or
MAKING groups to answer a question and attain a goal.

being in charge.
CONTROL
Among the three systems, the conceptual framework of Interpersonal
system had the greatest influence on the development of her theory.
She stated that “Although personal systems and 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 in a health care
organization to help and to be helped to maintain a state of health
that permits functioning in roles” ( King, 1981 p. 142).

Imogene KIng
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
 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.
will be enhanced
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
 According to King, a human being refers to a social being
who is rational and sentient. He or she has the ability to
perceive, think, feel, choose, set goals, select means to
achieve goals, and make decisions. He or she has three
fundamental needs:
 the need for health information when it is needed and
can be used;
 the need for care that seeks to prevent illness;
 the need for care when he or she is unable to help him
or herself.

Imogene King
The theory explains that assessment occurs during interaction. The nurse brings
special knowledge and skills whereas the patient brings knowledge of him or her
self, as well as the perception of problems of concern to the interaction.

During the assessment, the nurse collects data regarding the patient including his
or her growth and development, the perception of self, and current health status.

Perception is the base for the collection and interpretation of data.

Communication is required to verify the accuracy of the perception, as well as for

interaction and translation.
We can directly link King’s theoretical concept into the NURSING PROCESS.

Assessment

Evaluation Nursing
Diagnosis

Implementation Planning
Assessment

• takes place during interaction. The nurse uses his or her special
knowledge and skills while the patient delivers knowledge of him or her
self, as well as the perception of problems of concern to the interaction.

Nursing Diagnosis

• This phase is developed using the data collected in the assessment. In

the process of attaining goals, the nurse identifies problems, concerns,
and disturbances about which the patient is seeking help.

Planning

• The nurse and other health care team members create a care plan of
interventions to solve the problems identified. This phase is represented
by setting goals and making decisions about the means to achieve those
goals. This part of transaction and the patient’s participation is
encouraged in making decisions on the means to achieve the goals.
Implementation

• The actual activities done to achieve the goals

make up the implementation phase of the nursing
process. Whereas in this model of nursing, it is the
continuation of transaction

Evaluation

• the nurse evaluates the patient to determine

whether or not the goals were achieved.
Evaluation involves determining whether or not
goals were achieved. The explanation of
evaluation in King’s theory addresses meeting
goals and the effectiveness of nursing care.
 In the healthcare field, the final goal in the nurse-
patient relationship is to help the patient achieve
his or her goals for getting healthy. By using the
nursing process described in King’s Theory of Goal
Attainment, a nurse can be more effective in
working with a patient to achieve those goals, and
can truly help patients.

Imogene King
Basavanthappa, B. (2007). Kings theory of goal attainment. In Nursing theories
(1st ed., pp. 147- 168). Retrieved from
King, I.M. (1971). Toward a theory for nursing: General concepts of human
behavior. New York: Wiley.
King, I.M. (2006). Part One: Imogene M. King’s theory of goal attainment. In M.E.
Parker, Nursing theories and nursing practice (2nd ed., pp. 235-243).
Philadelphia: F.A. Davis.
https://nurseslabs.com/imogene-m-kings-theory-goal-attainment/#description

http://www.nursing-theory.org/theories-and-models/king-theory-of-goal-
attainment.php
http://nursingtheories.weebly.com/imogene-m-king.html
http://imogenekingtheory.blogspot.com/p/key-concepts.html
https://pdfs.semanticscholar.org/ee1b/9de4fe39ef2c882dcfe3de7c034fdc7
5f580.pdf
________________________
A Theory Evaluation

Jessica Christel S. Maglalang RN

Globally,

ICN, 2002
“…assist patients to assess their responses to their
health status and to assist them in the
performance of those activities
contributing to health in such a way as to help
them gain full or partial independence to
perform their roles”
Locally,

Philippine Nursing Act of 2002. Art. VI Sec. 28.

“…initiates and performs nursing services to

individuals, families and communities”
Locally,

Philippine Nursing Act of 2002. Art. VI Sec. 28.

“…curative, preventive, and rehabilitative
aspects of care, restoration of health,
alleviation of suffering, and when recovery is not
possible, towards a peaceful death”
Locally,

Philippine Nursing Act of 2002. Art. VI Sec. 28.

“…provide nursing care through the utilization of

the nursing process”
Locally,

NNCCS, 2014
NNCCS, 2014
NNCCS, 2014
 THEORY OF • nursing as a “process
GOAL of human interaction”
ATTAINMENT
• normative
NURSING ACT
and
HUMAN ACT
“…from her “personal concern about the
changes influencing nursing, a conscious
awareness of the knowledge explosion,
and a hunch that some of the essential
components of nursing have persisted.”
 “In another recounting of the
development of her theory, King
(1990b) explained, “After studying the
research on General System Theory, I
was able to synthesize my analysis of the
nursing literature and my knowledge
from other disciplines into a conceptual
framework.”
“King (1971) explained, “Concepts that
consistently appeared in nursing
literature, in research findings, in
speeches by nurses, and were observable
in the world of nursing practice were
identified and synthesized into a
conceptual framework and later on, into
the theory.”
 Researches on aging, parenting,
psychiatric-mental health, and
ambulatory care (Alligood et al.,
1995; Benedict & Frey, 1995; Norris
& Hoyer, 1993; Woods, 1994)
 Frey (1995) proposed a theory of
family, children, and chronic illness and
continues to test it in research.
Killeen’s dissertation (1996) studied
patient-consumer perceptions and
responses to professional nursing care
that resulted in an instrument that
measures patient satisfaction.
• Imogene King’s Interacting Systems Theory: Application
in Emergency and Rural Setting by Leigh Ann Williams

“Of all the concepts mentioned in regard to

interpersonal systems, communication requires
the most attention in the emergency
department. …poor communication
skills lead to poor transactions and
interactions…”
• Imogene King’s Interacting Systems Theory: Application
in Emergency and Rural Setting by Leigh Ann Williams

“The nurse working with rural clients must

consider the client’s perception of
health when conducting an assessment.”
• King’s Theory of Goal Attainment: Exploring Functional
Status by Billy Caceres RN, 2015

“Functional status is an important outcome in

healthcare that deserves increased attention from
nurses and other healthcare professionals. King’s
work provides a useful lens for nurses to assess
the functional status of clients and to guide
nursing practice to provide client-family-centered
healthcare.”
• Nurse-patient relationship based on the Imogene
King’s TGA by Mohsen Adib-Hajbaghery, 2018

“According to the TGA, …effective nurse-

patient interaction helps nurses understand
patients’ conditions, enhance quality of care
and improve patient’s quality of life.”
• An examination of the sustainable adoption of whole-
person care (WPC), 2011

The theory of goal attainment was adopted

in this study as a framework to evaluate
nurses’ experience with and adoption of WPC
within the complex hospital setting.
• Utilization of king’s interacting systems
framework and theory of goal attainment with
new multidisciplinary model: clinical pathway,
2006
“Recently, clinical pathways have
provided opportunities of interaction
and transaction among the health
team.”
 Sieloff (1995) developed a theory of
power for nursing administration.
 An examination of the sustainable
adoption of whole-person care
(WPC), 2011
 Served as a framework for the
baccalaureate program at the Ohio
State University School of Nursing,
where it determined the content and
processes taught at each level of the
program (Daubenmire, 1989).
 In Sweden, King’s model was used to
organize nursing education (Frey,
Rooke, Sieloff, Messmer, & Kameoka,
1995).
 King’s model has been useful in
nursing education programs in Sweden,
Portugal, Canada, and Japan (Sieloff,
2002, 2006).
• Theory is relevant to individuals,
families, and groups, irrespective of age
or socioeconomic status.
 urban vs. rural
 ER vs. community vs. acute care
 nurse practitioners vs. educators vs.
administrators vs. reserachers
• Nurses in Japan, Sweden, and Canada have
conducted studies in their cultures to test the
Theory of Goal Attainment (Coker et al.,
1990; Kameoka, 1995; Rooke, 1995).
• There is also a study on it application in
nursing education in Portugal.
 STRENGTHS WEAKNESSES
Ease of understanding Limited application in some
patients who are not able to
interact competently
Logical sequence of events Lack of development in
application in groups
Concretely-defined concepts With inconsistencies: (1) dyadic
relationships (2) strangers but
works together
Clear definitions Multitude of views and
definition is confusing for the
reader
Derived from research
literature
________________________
(King, 1995)