Discussion Post 6.1: Evaluation of Imogene King’s Theory of Goal Attainment
Evaluation of Imogene King’s Theory of Goal Attainment
Patient outcomes are affected by nursing practice. Nursing frameworks and theories often influence nursing practice. King’s theory of goal attainment is one of those theories. Imogene King spent many years asking questions that led to the development of her theory of goal attainment. The writer believes that King’s theory of goal attainment has contributed to increased patient satisfaction scores and better outcomes as she brings together several essential concepts allowing increased communication between patients and nursing staff.
Theory Description
Before King developed her theory of goal attainment, she developed a framework she titled “A Conceptual Framework for Nursing” (King, 1982). King asked what the goal of nursing was as she began to explore and develop the conceptual framework. From there, she determined that the goal of nursing was “to help individuals maintain their health so they can function in their roles” (King, 1982, pp. 2-3). This can also be said to be the theory’s purpose derived from her framework. She then determined her belief that the focus of nursing is basically to care for other human beings. From these questions, she built her conceptual framework that became the basis for King’s theory of goal attainment. In explaining her theory, she describes a significant thesis of her framework: people use perception to view the world and transact with other people and their environment (King, 1982). People’s perception or view of the world is affected by those interactions.
The context King based her framework on includes the idea that nurses and patients do not know each other. The patient needs services that are to be provided by a nurse. They each bring something to the agreement in that the nurse has the specialized nursing knowledge to help the patient with health, and the patient has vital information about their health needed to move forward. Both parties interact to attain the goals set (Sieloff, 1991). The structure of the theory is also based on King’s conceptual framework (King, 1981). It explains how mutual nurse-patient interactions establish goals to improve or maintain the patient’s health and then explore and agree on ways to achieve those goals. The scope of the theory focuses on the interpersonal relationship between a nurse and patient to set goals and work together towards reaching the goals of the patient’s health. Meleis (2018) goes as far as to state that the theory’s scope may be limited to interaction focusing on the patient’s perceptions to achieve goals. Its purpose is to establish guidelines for nurses to work with patients to set and achieve goals.
The theory’s main concepts include self, perception, role, communication, interaction, transaction, growth and development, time, space, and stress (King, 1999). King defines self as an open system where the nurse and patients need to know who they are and who the other is, including any perceptions they might bring (Sieloff, 1991). The concepts of perception, interaction, and transaction were previously mentioned.
Role is a fundamental concept that Sieloff described as the expected behaviors of people in social systems (1991). King relayed in her explanation of role applications to nursing as “each role enacted by an individual helps the self shine through for genuine dialogue with another” (King, 1991, p. 95). A person can function in several roles at once, and it is essential to acknowledge them all when working together.
Communication is a critical concept in the theory of goal attainment. Without communication, progress toward goals cannot be attained. According to Meleis (2018), communication is enhanced when it is evolved from a guiding framework and is understandable by all parties. Communication interacts with the concept of growth and development in that a nurse needs to know where the patient is on the growth spectrum to set achievable goals and developmentally appropriate actions to attain said goals.
Space is used in reference to personal space. According to King (1981), space is important because of one’s perception, body image, and how everyone uses personal space. She also included time as a concept based on her belief that understanding one’s perception of time may enhance communication. The final concept is stress which can present in many ways. While one may verbally express that they are stressed, another may internalize stress and show physical symptoms such as tachycardia.
Theory Analysis
There are several assumptions in this theory. The primary assumption the theory is based on is that people interact with their environment leading to a state of health that allows them to function in social roles (King, 1981). Assumptions about people include that they are social, sentient, rational, reacting, perceiving, controlling, purposeful, action-oriented, and time-oriented beings.
There are also several assumptions made about the nurse-patient relationship follow. Perceptions, goals, needs, and values of both parties in the goal-setting relationship influence the interactions between the two. Patients have the right to know about themselves, participate in decisions that influence them, and accept or reject the options. Healthcare professionals are responsible for sharing information with patients to help them make informed decisions. The goals of each party in the process may be incongruent with those of the other party, making it harder to achieve the goals (King, 1981).
The theory references several concepts and her definition of the concepts but leaves some concepts undefined. For example, while King states that the focus is a nurse interacting with a patient in their environment, she fails to discuss the concept of environment in her theory of goal attainment. Moreover, as Meleis (2018) points out, focused guidelines for assessing, diagnosing, or intervening with the patient are not given, leaving an area of vulnerability for an advanced nurse practitioner regarding interactions.
King’s theory can be generalized and has been applied to several nursing practices, including general medical/surgical nursing practice, family care, and NICU care, to help make a better workplace and decrease carpal tunnel in the workplace, psychiatric care, women’s care, and chronic illness such as diabetes (Meleis, 2018). King’s theory is critical to the nurse-patient relationship as it brings together the necessities for achieving goals: the nurse and the patient working together. She has established guidelines that both can work within, making achieving goals and increasing positive patient outcomes more successful. Her early statement that patients have a right to information about their care to make informed decisions (King, 1982) predates the progress in healthcare, including equity, justice, and quality outcomes.
Theory Evaluation
King’s theory is rather broad and thus able to be used across a wide scope of nursing practices. It can be used across both general and advanced nursing practice. The theory focuses on setting goals between nurse and patient, collaborating to enact interventions to attain goals and increase or restore the patient’s health (King, 1982). The focus on the area of interaction through communication help to increase the faster achievement of goals and better-quality outcomes by allowing the nurse to stop and think about how the patient may feel and what unconscious biases the nurse might bring to the table.
Theory Development
King’s theory is testable and has been tested across a broad spectrum of nursing situations. When King was still living, as there was criticism regarding some nursing situations that may not apply, King would also expand her theory and test it in those areas challenging the criticisms. Because it can be used across a large spectrum of inpatient and outpatient nursing practices, further refinement could be conducted, including nailing down discussion of how the patient’s environment affects the role of attaining the goals.
References
King, I. M. (1981). A theory for nursing: Systems, concepts, process. Wiley.
King, I. M. (1999). A Theory of Goal Attainment: Philosophical and Ethical Implications. Nursing Science Quarterly, 12(4), 292–296. Retrieved from
https://doi-org.proxy.library.maryville.edu/10.1177/08943189922107205Links to an external site.
Meleis, A. I. (2018). Imogene King-A Theory of Goal Attainment. In Theoretical nursing: Development and progress (6th ed., pp. 220–232). essay, Wolters Kluwer Heath.
Sieloff, E. C. L. (1991). Imogene King: A conceptual framework for nursing. Sage Publications.
Rubric:
7 Points
Provides two peer responses by day 6 of the discussion forum.
Provides two peer posts on two different days.
Demonstrates building on peer postings and extending the discussion.
Questions posed are thoughtful and relevant. Includes substantial factually correct content which demonstrates evidence of comprehension, application, and/or appraisal.
Includes evidence of self-reflective content which demonstrates views, beliefs, and/or feelings.
Interaction demonstrates respect and sensitivity to others.
2 Points
Provides 2 or more references with in-text citations to current literature and assigned readings to support assertions made on initial post and at least one or more references on peer discussion posts.
All postings are in correct APA format per the current edition of the Style Guide/Manual.
2 Points
Provides clear, concise postings.
Demonstrates the ability to synthesize literature and readings making postings in own words with credit to the author.
All postings are grammatically correct with proper spelling and structure.