IMOGENE M.

KING’S THEORY

Introduction (1) - The theory of goal attainment was developed by Imogene King in the early
1960s. The theory explains that factors which can affect the attainment of goals are roles, stress,
space, and time. King’s theory of goal attainment was derived from her interacting systems
framework and addresses nursing as a process of human interaction. The theory focuses on the
interpersonal system interaction in the nurse-client relationship. During the nursing process,
the nurse and the client each perceive each other, make judgements, and take action that results
in reaction. Interaction results, and if perceptual congruence exists, transactions occur.
Outcomes are defined in terms of goals to be attained. If the goals are related to patient
behaviors, then they become criteria by which the effectiveness of nursing care can be
measured.

King’s Open System Framework (2) - The framework suggest that the essential characteristics
of nursing are those properties that have persisted in spite of environmental changes. In
conceptual framework, the structure of a system with semipermeable boundaries between
individual, groups and society, all of which interact with the environment. King determined
that health concerns related to nursing could be grouped into categories known as dynamic
interacting system.
King conceptualize three levels of dynamic interacting system –
¨ Personal system
SOCIAL SYSTEMS
¨ Interpersonal system
(Society)
¨ Social system
INTERPERSONAL SYSTEMS
(Group)
(Society)
PERSONAL
SYSTEMS
(Individuals)

King’s Conceptual Model (3)

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¨ Personal System (2)
- Individuals are personal system. Each individual is an open total,
unique system in constant interaction with the environment. The following concept provide
foundational knowledge that contribute to understanding individual as personal system.
• Perception
• Self
• Growth and development
• Body image
• Learning
• Time
• Personal space
• Coping

§ Perception: - A process of organizing, interpreting and transforming information from

sense data and memory.
§ Self: - The self is a composite of thoughts and feelings which constitute a person’s
awareness of his/her conception of who and what he/she is. It is that to which we refer
when we say I.
§ Growth and Development: - The processes that take place in an individual’s life that
help the individual move from potential capacity for achievement to self-actualization.
§ Body Image: - An individual’s perception of his/her own body.
§ Learning: - A process of sensory perception, conceptualization and critical thinking
involving multiple experience in which changes in concept, skills, symbols, habits and
values can be evaluated in observable behaviors.
§ Time: - Duration between the occurrence of one event and occurrence of another event.
§ Personal Space: - Existing in all direction and is the same everywhere.
§ Coping: - Coping is a constantly changing cognitive behavioral efforts to manage
specific external and internal demands that are appraised as texting or exceeding the
resources.

¨ Interpersonal System: - Two or more individual in interaction form interpersonal system.

Interaction between individual is defined as follows:
• Communication
• Interaction

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 • Role
• Stress
• Stressors
• Transaction

§ Communication: - Information processing, a change of information from one state to

another.
§ Interaction: - acts of two or more person in mutual presence.
§ Role: - Set of behaviors expected when occupying a position in a social system
§ Stress: - Dynamic state whereby a human being interacts with environment to maintain
balance for growth, development and performance which involves on exchange of
energy and information between the person and the environment for regulation and
control of stressors.
§ Stressors: - Event that produce stress.
§ Transaction: - observable behaviors of human being interacting with their
environment.

¨ Social System: - A social system is defined as an organized boundary system of social roles,
behavior and practice developed to maintain values and the mechanism to regulate the practice
and rules.
Concepts that are useful to understand interaction within social system are as follows-
• Organization
• Authority
• Power
• Status
• Decision making

§ Organization: - A system whose continuous activities are conducted achieve goals.

§ Authority: - Transactional process characterized by active reciprocal relation in which

members value, background and perception play a role in defining, validating and
accepting the direction of individuals within the organization.

§ Power: - The capacity or ability of a group to achieve goals.

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 § Status: - The position of an individuals in a group or a group in relation to other group
in an organization.

§ Decision Making: - Dynamic and systematic process by which a goal directed choice
of perceived alternatives is made, and acted upon by individuals or groups to answer a
question and a attain goal.

Basic Assumption of King’s Open System Framework (2) -

• Nursing focus is the care of human being.
• Nursing’s goal is the health of individuals and health care for groups.
• Human beings are open system in constant interaction with their environment
• Patients perceive the world as a complete person making transactions with individuals
and things in the environment.
• The nurse and patients communicate information, set goals mutually and then act to
achieve those goals.

Theory of Goal Attainment (1) - The theory of goal attainment addressed nursing as a process
of human interaction. Indeed, King states that the theory of goal attainment is a normative
theory that it should set the standard of practice for all nurses-patient interaction. King’s law
of nurse-patient interaction: nurse and patient in mutual presence interacting purposefully,
make transaction in nursing situation based on each individual’s perception, purposeful
communication and valued goals.

(1)
Major Concepts of Nursing According to King - In addition to the concepts already
presented, the four metaparadigm concepts of nursing are identified in King’s theory. These
concepts are summarized as-
• Person
• Environment
• Health
• Nursing

§ Person: - The individuals conceptualize as a personal system. The personal system

focuses on individuals as human beings. Characteristics of human being identified by

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 King include being a complex, open living system that copes with a wide range of
events, persons, and things overtime. Human beings react as a whole and therefore,
must be viewed as an entire living system. The concepts of body image, growth, and
development, perception, self, space, and time are relevant to the personal system.

§ Environment: - King defines the environment as the social system surrounding the
concept in question. It can be both external and internal. The external environment is
the context within which human beings grow, develop and perform daily activities; the
internal environment of human beings transforms energy to enable them to adjust to
continuous external environmental changes. In this holistic view of environment,
external and internal aspects of the environment are interrelated.

§ Health: - According to King, health is reflected in dynamic life experiences of human

being. This implies continuous adjustment to stressors in the external and internal
environment through optimum use of one’s resources to achieve maximum potential
for daily living. Health is a “functional state in the life cycle” and illness has to do with
“some interference in the cycle”.

§ Nursing: - “Nursing is a process of human interactions between nurse and client

whereby each person perceives the other and the situation, and through communication
they set goals, explore means, and agree on means to achieve goals.”

Assumptions of the Theory of Goal Attainment (2)- The theory of goal attainment is based
on the following specific assumption about Human Being:
• Individuals are social beings.
• Individuals are sentient beings.
• Individuals are rational beings.
• Individuals are reacting beings.
• Individuals are perceiving beings.
• Individuals are controlling beings.
• Individuals are action-oriented beings.
The theory is based on the following specific assumption about nurse-client interaction:
• Perception of nurse and of client influence the interaction process.
• Goals, needs, and values of nurse and client influence the interaction process.

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 • Individual have a right to knowledge about themselves
• Individuals have a right to participate in decision that influence their life, their health,
and community services.
• The goals of health professionals and the goals of recipients of health care may be
incongruent.

(4)
Propositions of the Theory of Goal Attainment - Propositional statements are identified
by King for the theory of goal attainment and include the following:
• If perceptual accuracy is present in nurse-client interaction, transactions will occur.
• If the nurse and client make transactions goals will be attained.
• If the goals are attained, satisfaction will occur.
• If goals are attained, effective nursing care will occur.
• If transactions are made in the nurse-client interaction, growth and development will be
enhanced.
• If role expectations and role performance as perceived by nurse and client are
congruent, transactions will occur.
• If role conflict is experienced by the nurse, the client, or both, stress in nurse-client
interactions will occur.
• If nurses with special knowledge and skills communicate appropriate information to
clients, mutual goal setting and goal attainment will occur.

Critique of the Theory (5)-

Simplicity: -
• King’s definitions are clear and are conceptually derived from research literature that
existed at the time the definitions were published.
• Her theory presents ten major concepts are easily understood and, with the exception
of the concept of self, that have been derived from the research literature.

Generality: -
• King’s theory has been said to have limited application for the nursing practices.
• It was stated that the interaction between the nurse and the client also comprises non-
verbal communication that cannot be clearly defined and evaluated.

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 • This has been the issue of the communication barriers that exist between the nurse-
patient relationships.
• King believed that critics assume that a theory will address every person, event and
situation, which is clearly impossible. King addresses this critique through concepts of
another theorist that cannot be tested.

King’s theory of goal attainment and interacting system framework with nursing process
(2)
- The model of transactions, also known as the interaction-transaction process, provides a
theoretical basis for the nursing process as a method. Application of the model of transactions
in practice may be approached by using the nursing process -

• Assessment
• Planning
• Implementation
• Evaluation

Decision
making,
Exploration, Goal attainment
• Communication Agreement • Reactions to (Evaluation)
including actions lead to
(Planning) interactions
gathering
information, • Synthesis, between nurse Assess
validating Interpretation, and patient, attainment of
perceptions and and analysis of which then lead goals and if
concerns, and data totransactions goals are not
establishing • Mutual goal • Transactions attained,
trust setting with reflect shared
decision related commitment determine why
Perception, to action to
Communication, meet goals. Transaction
Interaction
(Assessment) (Implementation)

§ Assessment (Perception, Communication, Interaction): - During the phase

corresponding to the assessment phase of the nursing process, the patient and the nurse
perceive each other and the situation. Interaction is an ongoing process characterized
by communication. Communication during this phase of the process includes the nurse

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 gathering additional information, validating, perceptions, delineating and validating
patient concerns, and establishing mutual trust.
§ Planning (Decision Making, Exploration, Agreement): - Nursing functions during
the planning phase include the synthesis, interpretation, and analysis of data within the
context of the nursing process, followed by making decision about mutually set goals.
§ Implementation (Transaction): - The next step of the process results in the occurrence
of transactions. Transactions take place as a result of perceiving the person or situation,
making judgement about perceptions and taking actions. Reactions to actions leads to
interactions between the nurse and patient, which in turns lead to transactions that
reflect a shared view and commitment.
§ Evaluation (Goal Attainment): - The primary aim of the evaluation phase is to assess
the attainment of goals and if goals are not attained, to determine why they are not
attained. Unmet goals can result from the identification of incorrect or incomplete data;
incorrect interpretation of data as a result of perceptual error, lack of knowledge, or
goal conflict or barriers related to the nurse, patient, or system.

Application of King’s Theory in Nursing-

Education (3)-
• King’s interacting system has been used to design the nursing curriculum in different
schools and universities and framework for nursing education.
• It provides a systematic means of viewing the nursing profession, organizing nursing
knowledge and clarifying the nursing discipline.
• Based on King’s guidelines, the focus of a nursing curriculum must be the dynamic
nurse-client interaction.
• Nursing education programs must prepare nursing students to become useful,
productive, and relatively happy citizens as well as professional practitioners as they
acquire knowledge, values and skills in the practice of nursing.

Practice (3)-
• Professionals have used King’s theory in different specialized areas with the use of
dynamic interactive communication between the nurse and the client as proof.
• Professionals need communication to successfully and correctly make decision for their
plan of care.

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 • King also developed the Goal Oriented Nursing Record (GONR) from her theory.
GONR has been useful in documenting the outcomes of care that was performed by
nurses. In GONR, the nurse first identifies the patient problem, prioritize the problem
and collect scientific information related to the problem, implementing the nursing care
and evaluates the effectiveness based on the goals.
• It helps nurses to easily facilitate the present problem from careful assessment of the
client gathered through the interactive communication process between the nurse and
the client.
• GONR record management facilitate proper and correct range for the use of evaluation
system.
• Setting goals helps the nurse to be more focused and move towards the attainment of
the goals. This goals also helps in systematic evaluation of the nursing care provided to
the patient.

Research (3) -
• King’s theory has been one of the theoretical bases of some research that helped in
formulating a system view of application to nursing practice.
• Selloff & Frey (1981) have formulated a middle range theory out of King’s theory such
as patient’s satisfaction from nursing care, clients with chronic illness and family health
(3).

• King’s theory of dynamic interacting system has been applied to the study of child
abuse and the development of alcohol use/dependence in adult females (7).
McKinney & Dean (2000)

• Imogene King’s interacting system theory has been applied to emergency and
rural nursing in order for appropriate goal setting and attainment (6).
William (2001)
A busy emergency department often creates an intimidating environment for patient
they may feel threatened, or feel that they have no control over decision that affect their
care. In regards of the concept of selfhood, King stated “if nurses and other
professionals interact with patients as human beings, and let the individual be
themselves, even if they do not match the stereotype of the ‘good patient’, nurses and

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 patient would help each other grow in self-awareness and in understanding of human
behavior, especially in stressful situation. Good communication skills are imperative in
emergency department and poor communication resulted in goal not being attained.

Case Scenario: - Illustrating nursing care framed by King’s system framework and theory of
goal attainment utilizing the nursing process-

(8)
Case - A 29-year-old male patient Harry had been hospitalized in a psychiatric unit many
times in the past and the staff member were familiar with Harry’s homosexual lifestyle and his
delusional psychotic behavior. However, when he was readmitted with the added medical
diagnosis of HIV infection, the situation changed. A relationship with a familiar patient became
fearful and uncomfortable. The members of the psychiatric nursing staff on the inpatient unit
found themselves confronting all the intense psychological issues surrounding AIDS as well
as the additional dimension of a preexisting psychosis. The nursing theory of Imogene King
provided the psychiatric clinical nurse specialist with a framework for viewing the complex
interactions that began to occur between Harry and the member of psychiatric nursing staff and
a direction of action.

Open System Framework: -

Evaluating Personal Systems: -
• According to King’s theory, individuals comprise one type of system called a personal
system. The clinical nurse specialist viewed both Harry and each individual nurse as a
personal system and considered the interrelated concepts of perception, self -growth
and development, body image, space and time.
• Here Harry’s perception is altered by severe anxiety over a diagnosis that represented
an eventual death sentence to him. As a result, he suffered a period of withdrawal.
• The nurses’ perception was affected not only by AIDS but also with the terminal nature
of disease.
• This also affected the self-image and self-esteem; he had a sense of embarrassment and
shame and Harry’s self-concept was decreased by negative responses.

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Interpersonal System: -
• The interaction between the nurses and the client is characterized by communication,
clinical nurse noted that Harry seemed torn between needing to express fear and anxiety
and complete denial
• Interaction led to transaction but in the absence of transaction resulted in increased
stress.

A Framework of Action: - In addition to providing a framework for evaluating the nurse-

client interactions, the goal attainment theory directed planning.

Goals: -
Increasing Perceptual Accuracy: -
• The initial goal related to increasing perceptual accuracy in the nurse-patient
interaction. Before nurses on the psychiatric unit could deal effectively with Harry.
They need to become aware of factors that were affecting their own and perception and
how Harry was perceiving current predicament.
• A series of group discussion led by the clinical specialist helped to alter the perceptions
that affected transaction.

Decreasing Stress: -
• A second goal related to decreasing stress in the nurse-client interaction. In order for
the nurse to become more sensitive to the concept of stress. A second session of
teaching was conducted that focused on stress factor affecting nurse-client relationship.
• The nurses began to identify sources of stress for Harry. They also began to evaluate
Harry’s behavioral response to the stress of an overwhelming diagnosis.
• Clinical specialist helped to reduce Harry’s stress by providing support.

Increasing Transactions: -
• The clinical specialist identified a third goal, which include increasing transaction
between Harry and nurses so that the goal would be attained
• Through the teaching sessions the nurses learned more about the factors affecting the
transaction, they began to use open communication with Harry and focused on his
needs.

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 • They also help the Harry to understand the event occurring and gathered data about
Harry’s anxiety, interaction led to transaction and as Harry felt more secure, he began
to reach out to the nurses.

Conclusion: - In this situation, Imogene King’s theory enabled the clinical nurse specialist to
view a complex challenging situation that emerged when a psychotic client with HIV infection
was admitted to psychiatric unit. The theory provides the framework as a result of the action,
the psychiatric clinical specialist nurse was able to affect a satisfactory nurse-client relationship
that led to successful achievement of nursing goals.

Summary: - Imogene King has presented an open systems framework from which she derived
a theory of goal attainment. The framework consists of 3 systems- personal, interpersonal and
social.
The major concepts of the theory are person, environment, health and nursing. This theory
based on a philosophy of human beings and open systems framework. This theory is useful,
testable and applicable to nursing practice.

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Bibliography: -

1. Alligood M.R. & A.M. Tomey. King’s theory of goal attainment: nursing theory
utilizing and application. 3rd ed. St. Louis: Elsevier Mosby; 2006. p.181-87.
2. Maters K. King’s theory of goal attainment: Nursing theories: A framework for
professional practice. 2nd ed. Burlington: Jones & Bartlett learning books; 2015.
p.89-99.
3. Parker ME. King’s theory of goal attainment: Nursing theories & nursing practice.
2nd ed. Philadelphia: F.A. Davis company; 2005. p.235-36, 240-42.
4. George J.B. Nursing theories: The base for professional nursing practice.3rded.
Norwalk: Appleton & Lange; 1980. p.234-38.
5. Wills M.E.& Melanie M. King’s theory of goal attainment: Theoretical basis for
nursing. 4th.ed. Philadelphia: Lippincott Williams & Wilkins; 2014.p.173, 422.
6. Williams Leigh Ann. Imogene King’s interacting system theory; Application in
Emergency and Rural nursing, June 2001; vol.24(1): p 41-45.
7. McKinney N.L. & Dean P.R. Application of King’s theory of dynamic interacting
systems to the study of child abuse and the development of alcohol dependence in
adult females; Journal of Addiction nursing, January 2000; vol.12(2): p 73-82.
8. Kemppainen J.K. Imogene King’s theory: A nursing case study of a psychotic client
with HIV infection; December 1990; vol.4(6): p 384-88.

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