IMOGENE KING

Goal Attainment Theory

yder, Cheryl Veres
 Imogene King
- Born on January 30, 1923 in West Point, Iowa
- 1945 Received nursing diploma from St. John's Hospital
School of Nursing in St. Louis Missouri
- 1948 Received her BSN in nursing education from St.
Louis University
- 1957 Acquired Master's of Science in Nursing also from
St. Louis University
- 1961 Earned Doctoral of education degree from Teacher's
College, Columbia University in New York City.
- 1966-1968 Spent in the academic settings of Ohio State,
University, Loyola University, and the University of
South Florida.
- Died on December 24, 2007

(http://currentnursing.com/nursing_theory/goal_attainment_theory.html)

(Chitty and Black, 2011)

 King's Attainment Goal Theory

(http://www.palmbeachstate.edu/x3194.xml)

Assumption is that the patient and nurse communicate, participate in

mutual goal setting, and take actions to achieve those goals together.

(http://currentnursing.com/nursing_theory/goal_attainment_theory.html) (Williams, L. A., 2001)

 King's Interacting and Open Systems Model

(http://nursingtheories.blogspot.com/2009/07/queen-who-is-king.htmltp:)

The focus is on the person and the three interacting systems:

personal, interpersonal, and social, within their interpersonal
relationships and social contexts.
(http://currentnursing.com/nursing_theory/goal_attainment_theory.html) (Williams, L. A., 2001)
 According to King
A Human Being/ Patient/ Person...
• Refers to social beings that are rational and sentient
• The focus of nursing care
• Are open systems constantly interacting with their environment
• Consists of three systems which include:
1. Individual~Personal System
2. Groups~Interpersonal System
3. Society~Social System
• Have the ability to perceive, think, feel, choose, set goals, select ways to achieve goals,
and make decisions
• Requires three basic needs:
1. The need for health information that can be used when needed
2. The need for care to prevent illness
3. The need for care when a person is unable to help themselves
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(http://currentnursing.com/nursing_theory/goal_attainment_theory.html)
(Octaviano & Balita, 2008)
 According to King
The Environment...
• Is consistently changing
• Is the background for human interaction
• Involves two types of environment:
• Internal Environment: Transforms energy to allow the
person to adjust to the continuous external environment
changes
• External Environment: Includes formal and informal
organizations with the nurse being part of the patient's
environment
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(http://currentnursing.com/nursing_theory/goal_attainment_theory.html)
(Octaviano & Balita, 2008)
 According to 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 resource to achieve
maximum potential for daily living.

(http://nursingtheories.info/nursing-theory-by--imogene-king-goal-attainment-theory/)

(Octaviano & Balita, 2008)

 According to King
Nursing...
“Is an act wherein the nurse interacts and communicates
with the patient. The nurse helps the patient 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 patient maintain health
through health promotion and maintenance, restoration, and
caring for the sick and dying."

http://nursingtheories.info/nursing-theory-by-imogene-king-goal-attainment-theory/)

(Octaviano & Balita, 2008)

What is the Theory of Goal Attainment?
• Definition: "A process of action, reaction, and interaction by which
nurse and patient share information about their perception in the
nursing situation." and "a process of human interaction between
nurse and patient whereby each perceives the other and the
situation, and through communication, they set goals, explore
means, and agree on means to achieve goals."

• Action:
is a means of behavior or activities that are towards the
accomplishment of a certain act. It is both physical and mental.

• Reaction: which is considered as included in the sequence of

behaviors described in action.
(Octaviano & Balita, 2008)
Nursing in Goal Attainment Theory:
• Interaction: as defined by king, is any situation wherein the nurse
relates and deals with a clientele or patient.

• Open system: is the absence of boundary existence, where a

dynamic interaction between the internal and external environment
can exchange information without barriers.

(Octaviano & Balita, 2008)

Imogene King's Theory of goal
attainment was first introduced in
the 1960's.

( http://nursing-theory.org/nursing-theorist/Imogene-King.php)
Interacting Systems of Theory of Goal Attainment
1. Personal Systems
Each individual is a personal system. King specified the concepts
of body image, growth, and development, perception, self, space,
and time in order to comprehend human beings as persons.
• self is a composite of thoughts and feelings which constitute a
person’s awareness of his individual existence, his conception of
who and what he is.
• growth and development can be defined as the processes in
people’s lives through which they move from a potential for the
achievement to the actualization of self.
• body image as defined by King is the way one perceives both one’s
body and others’ reactions to one’s appearance.
 • Space includes that space exists in all directions, is the same
everywhere, and is defined by the physical area known as
“territory” and by the behaviors of those occupying it.
• Time is defined as “a duration between one event and another as
uniquely experienced by each human being; it is the relation of
one event to another event.”
• Learning - King (1986) added learning as a subconcept in the
personal system but did not further define it.
2. Interpersonal Systems
Are formed by human beings interacting. Two interacting individuals
form a dyad; three form a triad, and four or more form small or large
groups. Understanding the interpersonal system requires the concepts
of communication, interaction, role, stress, and transaction.
• Interactions are defined as the observable behaviors of two or more
individuals in mutual presence.
• Communication as defined by king, is “a process whereby information is
given from one person to another either directly in a face-to-face meeting
or indirectly through telephone, television, or the written word.”
• Transactions as defined by king is “a process of interactions in which
human beings communicate with the environment to achieve goals that
are valued… goal-directed human behaviors.
• Role - include reciprocity in that a person may be a giver at one time and
a taker at another time, with a relationship between two or more
individuals who are functioning in two or more roles that learned, social,
complex, and situational.
• Stress is “a dynamic state whereby a human being interacts with the
environment to maintain balance for growth, development, and
performance, which involves an exchange of energy and information
between the person and the environment for regulation and control of
stressors.”
3. Social Systems
A more comprehensive interacting system consists of groups that make up
society, referred to as the social system. Within a social system, the concepts
of authority, decision making, organization, power, and status guide system
understanding.
• Power is the capacity to use resources in organizations to achieve
goals… is the process whereby one or more persons influence other
persons in a situation… is the capacity or ability of a person or a group
to achieve goals…
• Status is “the position of an individual in a group or a group in relation
to other groups in an organization” and is identified that status is
accompanied by “privileges, duties, and obligation.”
• Decision making is “a dynamic and systematic process by which goal-
directed choice of perceived alternatives is made and acted upon by
individuals or groups to answer a question and attain a goal” (King,
1990).
• Control - King (1986) added control as a subconcept in the social system
but did not further define the concept.
 Concepts under the different interacting
systems in the Goal Attainment Theory
• Personal system
o body image, growth and development, perception, self, space,
and time

• Interpersonal system
o interaction, communication, transaction, role, and stress.

• Social system
o organization, authority, power, status, and decision making.

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Proposition of King’s Goal Attainment Theory
• If a continuous accuracy is currently in a nurse-patient interaction, a
transaction will happen.
• If the nurse and patient will build a transaction, goals will be achieved.
• If goals are achieved, satisfaction will happen.
• If goals are met, efficient nursing care will happen.
• If transactions are done in a nurse-client interaction, growth and development
will increase.
• If role anticipation and performance in the nurse and patient are the same,
transactions will happen.
• If role disagreement happens in both nurse and patient, stress would be the
result.
• If nurse with exceptional skill and knowledge correspond adequate
information to patient, the same goals and accomplishment will happen.
Assumptions
• (1) The focus of nursing is the care of the human being (patient).
• (2) The goal of nursing is the health care of both individuals and groups.
• (3) Human beings are open systems interacting with their environments constantly.
• (4) 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.
• (5) Patients perceive the world as a complete person making transactions with individuals
and things in the environment.
• (6) 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.

Can The Theory of Goal Attainment be implemented in
the emergency department?

 A busy emergency department often creates an intimidating

environment for patients and they may feel threatened, or feel that
they have no control over decisions that affect their care.
 The primary complaint of emergency room patients is the length
of waiting time. Waiting two hours may seem like an eternity for
the patient, but for the nurse, time passes swiftly.
 In an environment that requires one to be reactive and responsive,
clients often perceive the nurses as being too busy or too hurried
(Williams, 2001).
• Remember that:
• "An individual's perceptions of self, of body image, of time and space influence the
way he or she responds to persons, objects, and events in his or her life span,
experiences with changes in structure and function of their bodies over time What can the nurse in
influence their perceptions of self" the emergency department
• (King, 1981),(Williams, 2001). do for the patient using
• King used ten major concepts from the personal and interpersonal system to support King's Theory of
the Theory of Goal Attainment: Goal Attainment.

• Human interactions and perception- clients often perceive nurses as being

too busy or hurries, nurses need to be aware of how they present themselves to
their clients.
• Communication- Poor communication skills lead to poor transactions and
interactions between the nurse and client. Poor communication skills also affect
goal setting and goal attainment. Good communication skills are crucial.
• Role- The nurse needs to know their role to help the patient through their
encounter, and help them attain their health goals.
• Stress- An emergency room can be a stressful place for the patient and
family. Providing appropriated care, proper communication skills,
and decreasing stress in every was possible.
 Continued....
o Time- In the emergency department, the patient's complain of a long wait time. Interventions that
have proven to be successful in this situation, is placing telephones and televisions in the patient
rooms. This seems to pass the time and relieve frustration.
o Space- usually in the emergency department, the room is crowded, so as much as possible the
nurse must do her best to perform the necessary procedures on the client so that she may endorse
the patient to the respective ward as soon as possible.

• These points fit into the concepts of the theory personal, interpersonal, and social.
o Personal being the time that the patient feels they are waiting, and the interventions that can be
done to help reduce the wait time.
o Interpersonal being the good or poor communication skills between the patient and the nurse. It
can also be the stress that the patient feels when they are in the emergency department, and what
the nurse does to relieve that stress.
o Social is the decision making that the nurse makes to get the patient to their goal. The patient
comes into the emergency department with complaints of difficulty breathing. There can be
several outcomes. Does the nurse listen to the patient, the family, what decisions are made to get
to the goal.

(Williams,2001) http://nursing-theory.org/theories-and-models/king-theory-of-goal-attainment.php
Clarification of Origins...
"King's philosophy is
unique because it
provides a view of
persons from the "The theory of goal
perspective of their attainment was
interactions (or derived from
communications, both King's conceptual
verbal and nonverbal) system."
with other people at
three levels of
interacting systems."
(Messmer, 2006)

(Chitty, K.K. & Black, B.P.)

 Goal Attainment theory can be used Narrow
in any setting. Nurses should always
be in communication with the patient
View
to reach the goal of health.

"Several individuals have developed theories

from King's conceptual system along with
instruments to measure the concepts. Nurses
have published multiple examples of the
usefulness of the conceptual systems and
theory of goal attainment in practice."
"The concepts of Goal Attainment
are very specific. The nurse and
patient must communicate, set goals
together, and take action to achieve
(Messmer, 2006)
the goals."
What practice situations can/has this model
been used in? Here are two examples...
• Theory of Goal Attainment has been used in numerous practice
situations. According to Messmer, "the neonatal intensive care unit (NICU) used
this theory to transform their practice. The nurses in the NICU feel that parents
believe the NICU prevents them from assuming a parental role. Thus, when the
nurses and parents work together to set goals it helps the parents function in the
parental role."

• Knowledge of concepts of health, self, role, perception, transaction, stress, and

power in transforming practice with five elderly women in a nursing home. In this
scenario, the nurse made a diagnosis and mutually set goals with the women then
described her actions in helping them achieve their goals. The application of
knowledge of the concepts in King's theory attests to its value in caring for the
residents in a nursing home.

(Messmer, 2006)
 So What can we Conclude??

• Nurse-client interactions increase mutual goal setting

• Open communication increases the likelihood of nurse-client goal setting and
satisfaction
• Nurse-client satisfaction increases goal attainment
• Reaching goal attainment decreases stress and anxiety and increases client
learning and the ability to cope in nursing situations
• Nurse-client role and conflict results in decreased interactions
• Nurse-client agreement in role expectations and performance increases
meaningful nurse-client interactions

(http://nursingbuddy.com/2011/02/25/imogene-king)
 Case Study
A 23 year old pregnant female, 39 weeks, gravida 1 para 0 arrives on
the Obstetrics Unit with her significant other complaining of
"frequent contractions". Upon examination the nurse determines the
patient is in labor. Vital signs are stable and orders have been
obtained from the physician. After having the patient change into a
gown, the nurse then begins to hook the patient to the monitor. As
she is attaching the monitor, she explains the purpose of the monitor
and what the patient should expect such as frequent blood
pressures. The nurse than begins her admission assessment. During
the assessment the nurse explains the different stages of labor and
what to expect during those stages. They discuss the patients and
her significant others birthing plan. Expectations between the nurse,
the patient and her significant other are discussed. They all agree on
a plan of care.
 Case Study Cont.

Based on the information given, which of King's interacting systems

are utilized? Is there more than one used? Please explain your
answer. You can refer to the "Human Being" slide for assistance.
 APA Format for References
TEXT

Chitty, K.K., & Black, B.P. (2011). Professional nursing: Concepts and challenges (6th ed.) Maryland Heights,
MO: Saunders.
Current Nursing. (2012). Nursing theories: Imogene King's theory of goal attainment. Retrieved
from http://currentnursing.com/nursing_theory/goal_attainment_theory.html
Nursing Science Quarterly 1997 King's Theory of Goal Attainment in Practice.
King's Theory of Goal Attainment in Practice (1997). Nursing Science Quarterly, 10(180), 180-185, doi:
10.1177/089431849701000411.
Manayan and Manlapaz (2009) Manayan M C Manlapaz K K 20090716 Nursing Theories: the Queen Who is
KingManayan, M. C., & Manlapaz, K. K. (2009, July 16). Nursing Theories: the Queen Who is King.
Retrieved from http://nursingtheories.blogspot.com/2009/07/queen-who-is-king.html
Messmer P R 2006 Professional Model of Care: Using King's Theory of Goal Attainment.
Messmer, P. R. (2006). Professional Model of Care: Using King's Theory of Goal Attainment. Nursing
Science Quarterly, 19(227), 227-229, doi: 10.1177/0894318406289887.
NursingBuddy: Online Nursing Resource (2011, February 25) NursingBuddy: Online Nursing Resource
20110225NursingBuddy: Online Nursing Resource (2011, February 25). Retrieved from
http://nursingbuddy.com/2011/02/25/imogene-king
 References cont.
Williams, L. A. (2001). Imogene King’s interacting systems theory: Application in emergency and rural
nursing. Online Journal of Rural Nursing and Health Care, (2)1, 25, 26. Retrieved from
http://www.rno.org/journal/index.php/online-journal/article/viewFile/93/89
Imogene King. (2011) Nursing Theory. Retrieved from http://nursing-theory.org/nursing-theorist/Imogene-
King.php
King's Theory of Goal Attainment. (2011) Nursing Theory. Retrieved from http://nursing-
theory.org/theories-and-models/king-theory-of-goal-attainment.php
IMAGES
Palm Beach State College. Goal attainment. Retrieved, 2012, from http://www.palmbeachstate.edu/x3194.xml
UPOU N207 Students. (2008). Blog archive: Reflections from the past and a vision for the future: King's theory and
its application. Retrieved from http://imogene-king.blogspot.com/
UPOU N207 Students. (2009). Blog archive: The queen who is king: Imogene King: The queen of goal attainment
theory. Retrieved from http://nursingtheories.blogspot.com/2009/07/queen-who-is-king.html
Dorothy Johnson
“Behavioral System Model”

• Born on August 21, 1919 in Savannah,

Georgia.
• Youngest in a family of 7 children.
• In 1938, she finished her associates degree in
Armstrong Junior College in Savannah,
Georgia.
• In 1942 she obtained her BSN degree from
Vanderbilt University, Nashville, Tennessee.
• In 1948 she received her masters in Public
Health from Harvard University in Boston,
Massachusetts.
• After graduation, Dorothy Johnson’s professional experiences involved
mostly teaching, although she was a staff nurse at the Chatham-Savannah
Health Council from 1943 to 1944. She was an instructor and an assistant
professor in pediatric nursing fom 1944-1949 at Vanderbilt University
School of Nursing.
• From 1949 until her retirement in 1978 and her subsequent move to Key
Largo, Florida, Johnson was an assistant professor of pediatric nursing, an
associate professor of nursing, and a professor of nursing at the University
of California, Los Angeles.
• In 1955 and 1956, Johnson was a pediatric nursing advisor assigned to the
Christian Medical College School of Nursing in Vellore, South India.
• From 1965 to 1967, she served as chairperson on the committee of the
California Nurses Association that developed a position statement on
specifications for the clinical specialist.
• Died at the age of 80 in the year 1999.
Major Concepts
Human Beings
• Johnson views human beings as having two major systems: the
biological system and the behavioral system. It is the role of
medicine to focus on the biological system, whereas nursing’s focus
is the behavioral system.
• The concept of human being was defined as a behavioral system
that strives to make continual adjustments to achieve, maintain, or
regain balance to the steady-state that is adaptation.
Environment
• Environment is not directly defined, but it is implied to include all
elements of the surroundings of the human system and includes
interior stressors.
Major Concepts
Health
• Health is seen as the opposite of illness, and Johnson defines it as
“some degree of regularity and constancy in behavior, the
behavioral system reflects adjustments and adaptations that are
successful in some way and to some degree… adaptation is
functionally efficient and effective.”
Nursing
• Nursing is seen as “an external regulatory force which acts to
preserve the organization and integration of the patient’s behavior
at an optimal level under those conditions in which the behavior
constitutes a threat to physical or social health, or in which illness
is found.”
The Behavioral System Model of Nursing
Dorothy Johnson is known for her “Behavioral System Model of
Nursing,” which was first proposed in 1968.

Her nursing model states that “Each individual has patterned,

purposeful, repetitive ways of acting that comprises a behavioral
system specific to that individual.”

It advocates the fostering of efficient and effective behavioral

functioning in the patient to prevent illness.
The Seven Behavioral Subsystems:
The patient is defined as a behavioral system composed of seven behavioral subsystems:

1. Affiliative - is the “social inclusion intimacy and the formation and attachment of a strong
social bond.”
2. Dependency - is the “approval, attention or recognition and physical assistance.”
3. Ingestive - is the “emphasis on the meaning and structures of the social events surrounding
the occasion when the food is eaten.”
4. Eliminative - states that “human cultures have defined different socially acceptable behaviors
for excretion of waste, but the existence of such a pattern remains different from culture to
culture.”
5. Sexual - is both a biological and social factor that affects behavior. It has the dual functions of
procreation and gratification.
6. Aggressive - relates to the behaviors concerning protection and self-preservation, generating
a defense response when there is a threat to life or territory.
7. Achievement - provokes behavior that tries to control the environment. It attempts to
manipulate the environment.
The are four assumptions about structure and function that are common to
each of the seven subsystems:

(1) “From the form the behavior takes and the consequences it achieves can
be inferred what ‘drive’ has been stimulated or what ‘goal’ is being
sought.”

(2) Each individual person has a “predisposition to act with reference to the
goal, in certain ways rather than the other ways.” This predisposition is
called a “set.”

(3) Each subsystem has a repertoire of choices called a “scope of action.”

(4) The individual patient’s behavior produces an outcome that can be

observed.
• Each of the subsystem has three functional requirements which
include:
1. protection from noxious influences,
2. provision for a nurturing environment, and
3. stimulation for growth.
• An imbalance in each system results in disequilibrium. The nurse’s
role is to help the patient maintain his or her equilibrium.
Goals
The goals of nursing are fourfold, according to the Behavior System Model:

(1) To assist the patient whose behavior is proportional to social demands.

(2) To assist the patient who is able to modify his behavior in ways that it
supports biological imperatives.

(3) To assist the patient who is able to benefit to the fullest extent during illness
from the physician’s knowledge and skill.

(4) To assist the patient whose behavior does not give evidence of unnecessary
trauma as a consequence of illness.
Assumptions
(1) There is “organization, interaction, interdependency and integration of
the parts and elements of behaviors that go to make up the system.”

(2) A system “tends to achieve a balance among the various forces operating
within and upon it, and that man strive continually to maintain a
behavioral system balance and steady state by more or less automatic
adjustments and adaptations to the natural forces occurring on him.”

(3) A behavioral system, which requires and results in some degree of

regularity and constancy in behavior, is essential to man. It is functionally
significant because it serves a useful purpose in social life as well as for
the individual.

(4) “System balance reflects adjustments and adaptations that are successful
in some way and to some degree.”
References
1.Alligood, M., & Tomey, A. (2010). Nursing theorists and their work,
seventh edition. Maryland Heights: Mosby-Elsevier.
2.Dorothy E. Johnson Biographical File. (n.d.). Retrieved August 7,
2014, from
https://www.mc.vanderbilt.edu/diglib/sc_diglib/archColl/1014.html
3.Johnson, D. E. (1959a). A philosophy of nursing. Nursing Outlook,
7(4), 198–200.
4.Johnson, D.E. (1968). One conceptual model of
nursing. Unpublished lecture, Vanderbilt University, Nashville, TN.
5.Johnson, D. E. (1980). The behavioral system model for nursing. In
McEwen, M. and Wills, E. (Ed.). Theoretical basis for nursing. USA:
Lippincott Williams & Wilkins.
6.Octviano, E. & Balita, C (2008) Theoretical Foundations of Nursing:
The Philippine Perspective. Philippines: Balikatan Prints and Binding
Enterprises.