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. She developed a general systems framework and a theory of goal attainment where the framework refers to the three interacting systems - individual or personal, group or interpersonal, and society or social, while the theory of goal attainment pertains to the importance of interaction, perception, communication, transaction, self, role, stress, growth and development, time, and personal space. King emphasizes that both the nurse and the client bring important knowledge and information to the relationship and that they work together to achieve goals.
The relationship of three interacting systems led to King’s Theory of Goal Attainment are the personal system (individual), the interpersonal system (nurse-patient dialogue), and the social system (the family, the school, and the church). Each system is given different concepts.
The concepts for the personal system are: perception, self, growth and development, body image, space, and time. These are fundamentals in understanding human being because this refers to how the nurse views and integrates self based from personal goals and beliefs. Among all these concepts, the most important is perception, because it influences behavior. King summarized the connections among these concepts as “An individual Perception of self, of body image, of time, of space influences the way he or she responds to object and events in his/her life. As individual grow and develop trough the lifespan,experiences with changes in structure and function of their bodies over time influence their perceptions of self” (King, 1981, p. 19). Personal systems are individuals, who are regarded as rational, sentient, social beings. Concepts related to the personal system are:
- Perception— a process of organizing, interpreting, and transforming information from sense data and memory that gives meaning to one's experience, represents one's image of reality, and influences one's behavior.
- Self— a composite of thoughts and feelings that constitute a person's awareness of individual existence, of who and what he or she is.
- Growth and development— cellular, molecular, and behavioral changes in human beings that are a function of genetic endowment, meaningful and satisfying experiences, and an environment conducive to helping individuals move toward maturity.
- Body image—a person's perceptions of his or her body.
- Time—the duration between the occurrence of one event and the occurrence of another event.
- Space—the physical area called territory that exists in all directions.
- Learning—gaining knowledge.
The concepts associated for the interpersonal system are: interaction, communication, transaction, role, and stress. King refers to two individuals as dyads, three as triads and four or more individuals as small group or large group (King, 1981). This shows how the nurse interrelates with a co-worker or patient, particularly in a nurse-patient relationship. Communication between the nurse and the client can be verbal or nonverbal. Collaboration between the Dyads (nurse-patient) is very important for the attainment of the goal. The concepts associated with this system are:
- Interactions—the acts of two or more persons in mutual presence; a sequence of verbal and nonverbal behaviors that are goal directed.
- Communication—the vehicle by which human relations are developed and maintained; encompasses intrapersonal, interpersonal, verbal, and nonverbal communication.
- Transaction—a process of interaction in which human beings communicate with the environment to achieve goals that are valued; goal-directed human behaviors.
- Role—a set of behaviors expected of a person occupying a position in a social system.
- Stress—a dynamic state whereby a human being interacts with the environment to maintain balance for growth, development, and performance, involving an exchange of energy and information between the person and the environment for regulation and control of stressors.
- Coping—a way of dealing with stress.
The final interacting system is the social system. This shows how the nurse interacts with co workers, superiors, subordinates and the client environment in general. These are groups of people within the community or society that share a common goals, values and interests. It provides a framework for social interaction and relationships and establishes rules of behavior and courses of action(King, 1971). Social systems are organized boundary systems of social roles, behaviors, and practices developed to maintain values and the mechanisms to regulate the practices and roles. The concepts related to social systems are:
- Organization—composed of human beings with prescribed roles and positions who use resources to accomplish personal and organizational goals.
- Authority—a transactional process characterized by active, reciprocal relations in which members' values, backgrounds, and perceptions play a role in defining, validating, and accepting the authority of individuals within an organization.
- Power—the process whereby one or more persons influence other persons in a situation.
- Status—the position of an individual in a group or a group in relation to other groups in an organization.
- Decision making—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.
- Control—being in charge.
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).
Elements found in King’s Goal Attainment Theory originated from the elements or concepts in her Interacting Systems Framework. But it focuses on the Interpersonal System and the interactions, communications and transactions between two individuals, the nurse and the patient.The essence of her theory is that the nurse and the patient come together, communicate, and make transactions – they set goals and work to achieve the goals they set. They each have a purpose, they perceive, judge, act and react upon each other. At the end of their communication, a goal will be set and with this transactions are made. King believed that the goal of nursing “is to help individuals maintain their health so they can function in their roles” (King, 1981), transactions occur to set goals related to the health of the patient.
Furthermore, King proposed that through mutual goal setting and goal attainment, transactions result in enhanced growth and development for the client (Woods, 1994). King used ten major concepts from the personal and interpersonal systems to support the Theory of Goal Attainment. Those concepts include human interactions, perception, communication, role, stress, time, space, growth and development, and transactions. To capture the essence of these interrelated concepts, King stated that “nurse and client interactions are characterized by verbal and nonverbal communication, in which information is exchanged and interpreted; by transactions, in which values, needs, and wants of each member of the dyad are shared; by perceptions of nurse and client and the situation; by self in role of client and self in role of nurse; and by stressors influencing each person and the situation in time and space” (King, 1981, p. 144).
Finally according to her, nursing's focus is on the care of the patient, and its goal is the health care of patients and groups of patients.
References:
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Imogene King's Interacting Systems Theory - Application in Emergency and Rural Nursing
Leigh Ann Williams, Graduate Student Capstone College of Nursing, The University of Alabama. (Online Journal of Rural Health Nursing and Health care, vol.2, no.1, p.25-30)
Theoretical Foundations of Nursing:The Philippine Perspective By: Octaviano E. and Balita C. Ultimate Learning Series
Systems Framework and Theory of Goal Attainment: Imogene M. King. Retrieved from: http://wps.prenhall.com/wps/media/objects/86/88508/banner.gif)
Retrieved from: http://nursing-theory.org/nursing-theorists/Imogene-King.php
Imogene King’s System Interaction Model and Theory of Goal Attainment: Introduction.
Imogene King's Theory of Goal Attainment: Retrieved from: http://currentnursing.com/nursing_theory/.htm
King, I.M. (1971). Toward a theory for nursing: General concepts of human behavior. New York: Wiley.
King, I.M. (1992). King's theory of goal attainment.Nursing Science Quarterly, 5, 19–26.
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.
