Nurse Theorist

Imogene KingKaitlyn Baldwin, Patricia Burgess, Beth Langenburg

OutlineEducational Background

Introduction

Interacting Systems:Personal, Interpersonal, Social

Theory of Goal Attainment

Conceptual Framework

Propositions and Utilization of the Theory

Goals of Nurse

Nursing Process

Case Study

Theory Limitations

Evaluation

Conclusion

References

Educational Background

1945: Earned her Nursing diploma from St.John's Hospital School of Nursing.

1948: Earned Bachelors of Nursing, and by 1957, had earned a Masters in Nursing.

1961: Earned Doctoral Degree in Nursing from Teachers College, Columbia University.

1980: Awarded honorary Ph.D. from Southern Illinois University.

Introduction

• Initially King's goal was to develop a conceptual framework for a nursing curriculum.

• King's theory of goal attainment was first published in 1971. It was developed from her conceptual framework of three interacting systems.o Personal systems (individuals)o Interpersonal systems (groups)o Social systems (society)

Kings Development of Interacting Systems Framework

• King organized her concepts based on research and evidence from the scientific community.

• King included the global concepts. Her philosophy is used in nursing studies and taught in nursing schools.

• Kings personal philosophy about human beings and life influenced her assumptions, including those related to the environment, health, nursing, individuals, and nurse-patient interactions.

Social Systems (society)

Interpersonal Systems (groups)

Personal Systems (individuals)

http://0-site.ebrary.com.libcat.ferris.edu/lib/ferris/docDetail.action?docID=101761

• Nursing focus is the care of human beings.

• Goal of nursing is the health care of individuals and groups.

• Human beings are open systems that interact with their environment.

• Interacting systems include: Personal system, Interpersonal system, Social system.

• Concepts are defined for each of the three systems.

Basic Assumptions

Personal Systems ConceptsUnderstanding the patient as a whole is critical for

the nurse. Concepts include...

Body Image(personal and unique)?

Growth and Development

(behavioral, cellular and molecular changes)

Perception (occurs through

sensory and intellectual tools)

Self (an open system) Space

(knowledge of personal space)

Time (individual

perceptions)

Interpersonal Systems Concepts

This is where the nursing process primarily occurs.

Interaction vs Transaction

Interaction

The patient and nurse share different ideas and perceptions with each other. Observation occurs both verbally and nonverbally. Both the nurse and the patient make perceptions and decide to act on the shared information.

Transaction

From the ideas and perceptions shared between the nurse and the patient, goals are set. Setting goals requires compromising and social exchange.

When transactions occur, goals are attained.

Bargaining and negotiation of priorities occurs in transaction.

Social Systems ConceptsThe nurse works with the patient to address their

health needs. To effectively work with the patient, the nurse must understand the impact of social systems on the patient's behaviors. Concepts include...

Decision Making (leads to decreased resistance

to implementation)

Status (prestige attached to

a role)

Organization (focus is to achieve

goals)

Authority (ability to guide

action of self and others)

Power(related to a

situation)

Human InteractionCommunication between two individuals, the nurse

and the patient. Both verbal and nonverbal.

The theory that the nurse and patient come together and set goals to achieve together.

They each have a purpose, they perceive, judge, act and react upon each other.

The transaction is made with same goal in sight.

The core of goal attainment theory is that the nurse and the patient work together to define and reach health goals that they set together.

If the goals are identified as behaviors, they become criteria to measure effectiveness of nursing care.

Theory of Goal Attainment

GOALATTAINMENT

THEORY

Propositions (Identifies the relationship between concepts)

• If awareness is present in nurse-patient interactions, transactions will occur.

• If nurse and patient make transactions, goals will be achieved.

• If goals are met, satisfaction will occur.

• If goals are met, effective nursing care will occur.

• If role conflict is experienced by the nurse and/or the patient, stress in nurse-patient interactions will occur.

Utilization of the Theory• Provides a theoretical base for nursing process.

• Demonstrates a way for nurses to interact purposefully with patients.

• To assist nurses in arranging facts into meaningful wholes.

• For more information on King's influence on nursing, visit:

http://nsq.sagepub.com/content/22/2/128

Goals of the Nurse• Help the patient to maintain health so that they can

function in their individual roles.

• Interpret the information in the nursing process; to assess, diagnose, plan, implement, and to evaluate nursing care.

• To be guided by each of the concepts at each of the systems levels.

• To pay attention to what the patient says, in order for mutual goals to be set.

Nursing Process

Assess the patient: Subjective and Objective data collection.

Diagnose: Problems the nurse sees the patient experiencing from disease process.

Plan for interventions: Set goals with patient.

Implement the plan according to the diagnosis and goals.

Evaluate patient to determine if goals are appropriate or met.

Nursing ProcessKing emphasized the importance of joint goal

setting by nurse and patient, clearly specifying that the goal is attaining or regaining health (Chitty & Black,2011 p.312).

"King's middle-range theory of goal attainment focuses on all aspects of the nursing process: assessment, planning, implementation and evaluation." (Tomey & Alligood, 2006)

King's Metaparadigm Definition

The focus of nursing is human beings interacting with their environment leading to a state of health for individuals, which is an ability to function in social roles (King, 1981).

Frey, M., Sieloff,C., & Norris,D.(2002).King’s Conceptual System and Theory of Goal Attainment: Past, Present, and Future.Nursing Science Quarterly, April 2002; vol. 15, 2: pp. 107-112.

Case StudyMr. Jones comes in from home with a COPD

exacerbation. He arrives with his daughter. The nurse notes that the patient's hygiene and nutrition status appear neglected. The daughter states that she is concerned about her father's forgetfulness.

1. With King's theory, in what interacting system does the nursing process primarily occur?

Case StudyMr. Jones hears his daughter's conversation with the

nurse and is quick to state that he wants to return to his home. The nurse, patient and daughter share their individual discharge goals.

2. The discussion between the nurse, patient and daughter regarding discharge goals indicate interaction or transaction?

Case StudyAssessment, Mutual Goal setting

Perceptions of Nurse,

Client and Situation.Goals to be achieved to implement Self care?

Patient does not want the assisted living option.

Would visiting nurses be an option?

Goal of patient and daughter may be different

Case StudyThe situation is that the patient thinks he can go back

home once his exacerbation subsides. His perception (Personal system) of his own health is not what his daughter (Interpersonal system) sees. The daughter is obviously stressed about the state of her dad and her own ability to continue taking care of him.

3. When all parties have agreed on mutually set goals, King's theory states that a ______________ has occurred, which is required for goal achievement.

Case StudyThe patient initially set a goal to return home

without assistance. The nurse and the daughter agreed that the patient needed assistance in order for the patient to return home.

4. According to King's theory, if conflict in goal-setting occurs between the patient and the nurse, what will happen in the nurse-patient relationship?

Case Study The goal is health restoration and maintenance for the patient.

The assessment and implementation of goals or Plan of Care is mutually set by the nurse and the patient.

The Plan of Care will also involve the daughter for assistance with goal setting and decision making.

5. What part of the interacting systems framework is the daughter a part of?

With the involvement of Social Work, visiting nurses are set up three times a week for bathing assistance. Adult Day Care is arranged twice a week to provide social interaction for the patient and respite care for his daughter.

6. What part of the interacting systems framework is MSW and Home health Nurses part of?

Case StudyEvaluation of goals indicate that both Mr. Jones and his daughter,

as well as the nurse, are in agreement with the discharge plan.

7. What theory was used to achieve this final goal?

Theory Limitations

The theory focuses on the nurse-patient relationship versus nurse-group or nurse-community relationships.

Social System is not clearly connected to the theory, which leads to limitations of utilizing the theory in nursing care with groups, families and communities.

Evaluation• "King's Theory of Goal Attainment has been criticized for

having limited application in areas of nursing in which patients are unable to interact competently with the nurse"

• King has stated that "she is the only nurse theorist who has provided a theory that deals with choice, alternatives, participation of all individuals in decision making and specifically deals with outcomes of nursing care"

• "King and other nurse scientists and researchers have used her framework for theory testing and theory development at

the grand and middle range levels."

(Tomey & Alligood, 2006).

Conclusion· With King's THEORY OF GOAL ATTAINMENT, elements are

seen in the interpersonal systems in which two people, who are usually strangers, come together in a healthcare organization to help and be helped to maintain a state of health that permits functioning of roles. This 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 goals mutually and then act to attain those goals.

Imogene King contributed to the advancement of nursing knowledge through the development of her interacting systems framework and middle range theory of goal attainment.

(Frey, M., Norris,D., & Sieloff,C.(2002)

ReferencesAlligood, M. R.(2010). Family Healthcare With King's Theory of Goal Attainment.

Nursing Science Quarterly, 23(2) 99-104. Thousand Oaks, CA: Sage

Chitty, K. K.,& Black, B. P. (2011). Professional nursing: Concepts and Challenges (6th ed.). Maryland Heights, MO: Saunders

Clarke, P. N., Killeen, M. B., Messmer, P. R., & Sieloff, C. L. (2009). Imogene M. King's scholars reflect on her wisdom and influence on nursing science. Nursing Science Quarterly, 22(2) 128-133. doi: 10.1177/0894318409332568

Fitzpatrick, J. J., & Whall, A. L. (2005). Conceptual Models of Nursing: Analysis and Application (4th ed.). Upper Saddle River, NJ: Pearson.

Frey, M., Norris, D., & Sieloff, C. (2002). King’s Conceptual System and Theory of Goal Attainment: Past, Present, and Future. Nursing Science Quarterly, April 2002; vol. 15, 2: pp. 107-112.

Referenceshttp://nursing-thery.org/nursing-theorists/Imogene-King.php Imogene Kin's Interacting

Systems Theory-Application in Emegency and Rural Nursing

King, I. M., (2007). King's Conceptual System, Theory of Goal Attainment, and Transaction Process in the 21st Century. Nursing Science Quarterly, 20(2), 108-111.

Sieloff, C. L., Frey, M. A., (2007). Middle range theory development using king’s conceptual system. [D X Reader version]. Retrieved from http://0-site.ebrary.com.libcat.ferris.edu/lib/ferris/docDetail.action?docID=101761

Tomey, A. M., & Alligood M. R., (2006). Nursing theorists and their work. (6th ed.), Imogene king:interacting systems framework and middle range theory of goal attainment, pp.297-317, St. Louis, Missouri: Mosby, inc.

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