N_Theory350

Interacting Systems Framework and Theory of 


Goal Attainment: Imogene King

Chapter 8


 Overview of King’s Interacting 


Systems Framework 


• Health concerns related to nursing could be grouped into categories known as dynamic interacting systems

• Three levels of dynamic interacting systems: personal systems (individuals), interpersonal systems (groups), and social systems (society).

Overview of King’s Theory of 
 Goal Attainment

• Derived from the interacting systems framework

• Addresses nursing as a process of human interaction

• Theory focuses on the interpersonal system interactions in the nurse–client relationship

• Outcomes are defined in terms of goals to be attained


 Major Concepts of Nursing 


According to King


• Person: a personal system that interacts with interpersonal and social systems

• Environment: both external and internal • Nursing: process of human interaction with

the goal of helping patients achieve to their goals

Major Concepts of Nursing 
 According to King

• Health: life experiences of a human implies continuous adjustment to stressors in the environment through optimum use of resources to achieve maximum potential for daily living

Assumptions of the Theory of 
 Goal Attainment: Human Beings

• 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 purposeful beings

• Individuals are action- oriented beings

• Individuals are time- oriented beings


 Assumptions of Theory of 


Goal Attainment: Nurse-Client Interactions 


• Perceptions of nurse and of client influence the interaction process

• Goals, needs, and values of nurse and client influence the interaction process

• Individuals have a right to knowledge about themselves

• Individuals have a right to participate in decisions that influence their life, their health, and community services

Assumptions of Theory of 
 Goal Attainment: Nurse-Client Interactions

• Health professionals have a responsibility to share information that helps individuals make informed decisions about their health care

• Individuals have a right to accept or reject health care

• The goals of health professionals and the goals of recipients of health care may be incongruent


 Propositions of the Theory of 


Goal Attainment 


• If perceptual accuracy is present in nurse– client interactions, transactions will occur

• If the nurse and the client make transactions, goals will be attained

• If goals are attained, satisfactions will occur • If goals are attained, effective nursing care

will occur

Propositions of the Theory of 
 Goal Attainment

• If transactions are made in the nurse– client interactions, growth and development will be enhanced

• If role expectations and role performance as perceived by the nurse and the client are congruent, transactions will occur

Propositions of the Theory of 
 Goal Attainment

• 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


 Brief Critique of the Theory of 


Goal Attainment 


• Theory fairly complex although understandable • Empirical data were used in the development

and refinement of the theory • Some criticism based on the claim that the

theory of goal attainment has limited application in areas of nursing in which patients are unable to interact competently with the nurse


 King’s Theory as a Framework for Nursing Practice


• Nursing is a process of interactions that lead to transactions

• Transactions lead to goal attainment • Goal attainment is a measure of effective

nursing care • Nurse–patient interactions can be

classified into one of eight categories


 Eight categories of Nurse–Patient Interactions


• Action • Reaction • Disturbance • Mutual goal setting • Exploration of means to achieve the goal

• Agreement on means to achieve the goal

• Transaction • Attainment of goal


 The Interaction–Transaction Process 


• Assessment (Perception, Communication, Interaction)

• Planning (Decision Making, Exploration, Agreement)

• Implementation (Transaction) • Evaluation (Goal Attainment)


 Assessment 


(Perception, Communication, Interaction) 


• Patient & nurse perceive each other and situation

• Interaction is ongoing process characterized by communication

• Nurse gathers information, validates perceptions, delineates and validates patient concerns, and establishes mutual trust

• Nursing functions include viewing, recognizing, observing, and measuring


 Planning: 


Decision Making, Exploration, Agreement 


Decisions are made related to actions to meet the agreed-upon goals by asking questions:

– Which goals will serve the patient’s best interest?

– What are the patient’s goals? – Are the patient’s goals and the nurse’s goals

for the patient congruent?

Planning: 
 Decision Making, Exploration, Agreement – If the goals are not congruent, what further

communication and interaction are needed? – What are the priority goals? – What does the patient perceive is the best way

to attain goals? – Is the patient willing to work toward goal

attainment? – What does the nurse perceive as the best way to

attain the goals?


 Implementation: Transaction 


During this phase of the process, the nurse will ask: – Am I doing what we have agreed upon? – How and when do I carry out the actions? – Why am I carrying out the action? – Is it reasonable to think that carrying out this

action will allow attainment of goals?


 Evaluation: Goal Attainment


• Primary aim of the evaluation phase is to assess attainment of goals and, if goals are not attained, to determine why they are not attained

• Unmet goals can result from incorrect or incomplete data incorrect interpretation of data as a result of perceptual error, lack of knowledge, goal conflict or barriers related to the nurse, patient, or system