1. Goal Attainment Theory

2. “A professional nurse, with
special knowledge and skills, and
a client in need of nursing, with
knowledge of self and perception
of personal problems, meet as
strangers in natural
environment. They interact
mutually, identify problems,
establish and achieve goals.”

3. A. Getting to know the Theorist
 Imogene King was born in West Point, Iowa on
January 30, 1923, youngest of three children.
 She completed her diploma in nursing education
in 1945, at St. John's Hospital in St. Louis,
Missouri.
 She received her BS and MS in nursing from St.
Louis University in 1957,
 She obtained her Doctorate in Education from
Columbia University, N.Y.

4.  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
University 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 considers her theory as a deviation from
systems theory, with emphasis on interaction
theory.

5.  In 1981 she refined her concepts into a nursing
theory that consisted of the following basis:
1. An open system 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.
 She Died on December 24, 1997, 2 days after
suffering from stroke.

6. B. Theoretical Sources
 1971, 1981: students, academic colleagues, nurse
researchers, and clinicians
 thinking
 1981: General System Theory (Von Bertalanffy)
 conceptual framework
 1988:Kaufman, Orlando and Peplau
 thinking

7. Kaufman’s 1958 doctoral dissertation  explore
concepts of perception, time and stress
Research conducted at Yale University School of
Nursing to test Orlando’s (1961) theory of the
deliberative nursing process  thinking
King and Peplau (as cited in Takahashi, 1992)
pointed out the connections between their works with
regard to patient outcome.
A review of her 1971 book by Rosemary Ellis
encouraged her to continue her work by deriving a theory
from the General Systems Framework.
The result…
The Theory of Goal Attainment.

8. C. Use of Empirical Evidence
King used a “systems” approach in the development of her Dynamic Interacting Systems
Framework and in her subsequent Goal-Attainment Theory.
INTERACTING SYSTEMS FRAMEWORK
Three systems in the conceptual
framework:
Personal System (the individual)
Interpersonal System (individuals
interacting with one another)
Social System (groups of people in
a community/society sharing
common goals, interests, and
values)
Study systems as a whole rather
than as isolated parts of a system.

9. THEORY OF GOAL ATTAINMENT
 Elements are seen in the interpersonal systems in
which two people, who are usually strangers,
come together in a health care organization to
help and be helped to maintain a state of health
that permits functioning of roles.
 Reflects King’s belief that the practice of nursing is
differentiated from other healthcare professions
by what nurses do with and for individuals
 Nurse and client communicate information, set
goal mutually and then act to attain those goals

10. D. Metaparadigm in Nursing:
1.Person:
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.

11. According to Imogene King, human being
has three fundamental needs:
Information on health that can be
accessed and utilized when needed
Care that aims to prevent illness
Care in times of illness/helplessness

12. 2.Health :
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.

13. 3.Environment : It is the background for
human interactions.
It involves:
a. Internal environment – transforms
energy to enable person to adjust to
continuous external environmental
changes.
b. External environment – involves formal
and informal organizations. Nurse is a part
of the patient’s environment.

14. 4. Nursing:
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.

15. E. Theoretical Assertion
From the theory of goal attainment Imogene
King developed predictive propositions, which
includes:
 If perceptual interaction accuracy
is present in nurse-patient interactions, a
transaction will happen.
 If nurse and client make transaction, goal will
be attained.
 If goal are attained, satisfaction will occur.

16.  If goals are met, efficient nursing care will
happen.
 If transactions are made in nurse-client
interactions, growth and development will
be enhanced
 If role expectations and
role performance as perceived by nurse
and client are congruent, transaction will
occur

17.  If role conflict is experienced by nurse or
client or both, stress in nurse-client
interaction will occur
 If nurse with special knowledge and skill
communicate appropriate information to
client, mutual goal setting and goal
attainment will occur.

18. The interaction of the person and the
nurse is goal-directed and through this,
both parties reach a common and accurate
perception of the problem and means are
explored on how to resolve it.
After the means exploration, goal-
setting is made which is subject for
agreement.
Finally, transaction happens when the
agreed goals are acted upon and necessary
actions are taken to achieve them. Finally,
if the goals are attained, satisfaction will
occur and the health need fulfilled.

19. F. Acceptance by the Nursing Community
Research:
Basis for development of middle-range nursing
theories:
 Model for Multicultural Nursing Practice (Rooda,
1992)
 Theory of Personal System Empathy (Alligood & May,
2000)
 Theory of Family Health (Doornbos, 2000)

20. Education:
 Framework for the baccalaureate program (Ohio State
University School of Nursing)
 Educational reform resulting in nursing education
(Sweden)
Practice:
 A model for bedside nursing practice in the hospital
setting (Coker & Schreiber, 1990)
 Managed care program in hospital settings (Hampton,
1994)
 Goal-Oriented Nursing Record system for documentation
 Structure of Quality Assurance Program

21. G. Analysis
Clarity:
 Clear and conceptually derived from research
literature at the time the theory was developed.
Generality:
 It has been criticized for having limited
applications in areas of nursing in which patients
are unable to competently interact with the nurse.
 King has responded that 70% of communication is
nonverbal.

22. Empirical Precision:
 From a study of 17 patients, goals were attained in 12
cases (70%).
 King believes that if nursing students are taught the
theory of goal attainment and it is used in nursing
practice, goal attainment can be measured and the
effectiveness of nursing care can be demonstrated.
Derivable Consequences:
 It focuses on all aspects of the nursing process:
assessment, planning, implementation and evaluation.
 King believes that nurses must assess to set mutual
goals, plan to provide alternative means to achieve
goals, and evaluate to determine if the goal was
attained.