theory week 4

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Chapter 9

Imogene King’s Theory of Goal Attainment

Developed by S. Gordon (2010)

Updated by D. Gullett (2014)

On completion of this chapter, students will be able to:

Describe the evolution of King’s theory from her personal writings.

Identify and discuss a variety of literature related to King’s theory.

Describe various settings and populations in which King’s Conceptual System (KCS) and middle range theory have been applied.

Discuss future applications of KCS and middle range theory as it relates to an evidence based practice.

Theory of Goal Attainment Initial Ideas

Problems and prospect of knowledge development in nursing
Lack of professional nursing language
Atheoretical nursing phenomena
Limited concept development

Original Levels of Interaction

Human being (or individual or person)
Perception
Communication
Interpersonal relations
Health
Social institutions

Philosophical Underpinning

Von Bertalanffy’s General Systems Theory
Refutes logical positivism and reductionism
Proposes isomorphism and perspectivism in knowledge development
Wholeness, systems in interaction
Organized complexity as whole systems

Conceptual System

A concept is an organization of reference points
Provides structure for organizing multiple ideas into meaningful wholes
Shows unity and relationships among concepts
Consists of individual systems, interpersonal systems, and social systems

Developing a Concept

1) Review, analyze, and synthesize research literature related to concept.

2) From the review, identify the characteristics (attributes) of the concept.

3) From the characteristics, write a conceptual definition.

4) Review literature to select an instrument or develop an instrument.

Developing a Concept (continued)

5) Design a study to measure the characteristic or concept.

6) Select the population to be sampled.

7) Collect data.

8) Analyze and interpret data.

9) Write results of findings and conclusions.

10) State implications for adding to nursing knowledge.

King’s Conceptual System Personal System

Self
Perception
Time
Growth and development

Body image

Learning

Personal space

Substantive knowledge about human beings

King’s Conceptual System Interpersonal Systems

Related to small groups
Interaction
Communication
Role
Transactions
Stress

King’s Conceptual System Social System

Related to large groups
Decision making
Organization
Power
Status
Authority

Theory of Goal Attainment

Derived from the goal of nursing:
Help individuals maintain or regain health (King, 1990)
Uses the following concepts:
Self, perception, communication, interaction, transaction, role, growth and development, stress, time, personal space

Transaction Process Model

Describes a human process that can be observed when two or more people interact.
Information is exchanged, goals are set, and transactions are made during the process.
Nurses should document their conversations and determine if goals were met.

Documentation System

Implements the nurse-patient transaction process leading to goal attainment
Method used is generally nursing process:
Assess, diagnose, implement, and evaluate
Nurse and patient agree to goals, means, and evaluation :
Entered into patient’s chart
Eliminates need for multiple forms
Documents patient involvement in care decisions

Instrument Development

Goal Attainment Scale (King, 1989b)
Nurse Performance Goal Attainment (NPGA) (Kameoka, Funashima & Sugimori, 2007)

Examples of Practice Applications

Development of Middle-Range Theories from:

King’s Interacting Systems Framework

Theory of Perceptual Awareness (Brooks & Thomas, 1997)

Interpersonal System

Family Health Theory (Doornbos, 2007)

Model for collaboration through reciprocation in heath care organizations (Thomason & Lagowski, 2008)

Examples of Practice Applications (cont)

Development of Middle-Range Theories from:

Interpersonal Systems

Theory of Group Empowerment within Organizations (Sieloff & Bularzik (2011).

Examples of Practice Applications

Midrange theory used in several categories
Used across the life span
Used in different client systems
Focus on phenomena of concern to clients

Examples of Practice Applications

Used with different nursing specialties
Used in varied work settings
Multicultural applications
Evidence based practice

References

Brooks, E. M., & Thomas, S. (1997). The perception and judgment of senior baccalaureate student nurses in

clinical decision making. Advances in Nursing Science, 19(3), 50–69.

Doornbos, M. M. (2007). King’s conceptual system and family health theory in the families of adults with persistent mental illness—An evolving conceptualization. In C. L. Sieloff & M. A. Frey (Eds.), Middle range theory development using King’s conceptual system (pp. 31-49). New York: Springer.

Kameoka, T., Funashima, N., & Sugimori, M. (2007). If goals are attained, satisfaction will occur in nurse- patient interaction: An empirical test. In C. L. Sieloff & M. A. Frey (Eds.), Middle Range Theory Development Using King’s Conceptual System (pp. 261-272). New York: Springer.

References

King, I. M. (1989b). King’s systems framework for nursing administration. In B. Henry (Ed.), Dimensions of nursing administration: Theory, research, education (p. 35). Cambridge, UK: Blackwell Scientific.

King, I. M. (1990). Health as a goal for nursing. Nursing Science Quarterly, 3, 123–128.

Sieloff, C. L., & Bularzik, A. M. (2011). Group power through the lens of the 21st century and beyond: further validation of the Sieloff-King Assessment of Group Power within Organizations. Journal Of Nursing Management, 19(8), 1020-1027. doi:10.1111/j.1365- 2834.2011.01314.x

Thomason, D., & Lagowski, L. (2008, December). Business and leadership. Sustaining a healthy work force in the 21st century -- a model for collaborating through reciprocation. AAOHN Journal, 56(12), 503-513.