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Goal Attainment Theory
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A professional nurse, withspecial knowledge and skills, anda client in need of nursing, with
knowledge of self and perceptionof personal problems, meet asstrangers in natural
environment. They interactmutually, identify problems,establish and achievegoals.
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A. Getting to know the Theorist
Imogene King was born in West Point, Iowa on
January 30, 1923, youngest of three children.
She completed her diploma in nursing education
in 1945, at St. John's Hospital in St. Louis,Missouri.
She received her BS and MS in nursing from St.
Louis University in 1957, She obtained her Doctorate in Education from
Columbia University, N.Y.
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She has practiced as a staff nurse, nurse
educator, and nurse administrator.
She formulated her theory while she was an
associate professor of nursing at Loyola
University in Chicago.
This was at the time nursing was emerging as aprofession and some nurses sought to challenge
the existing role of nurses.
King began her work in nursing theory with a
conceptual framework.
King considers her theory as a deviation from
systems theory, with emphasis on interaction
theory.
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In 1981 she refined her concepts into a nursing
theory that consisted of the following basis:
1. An open system framework as the basis
of goal attainment.
2. Nursing as a major system within thehealth care system.
3. Nursing process emphasis on
interpersonal processes.
She Died on December 24, 1997, 2 days after
suffering from stroke.
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B. Theoretical Sources
1971, 1981: students, academic colleagues, nurseresearchers, and clinicians
thinking
1981: General System Theory (Von Bertalanffy)
conceptual framework
1988:Kaufman, Orlando and Peplau thinking
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Kaufmans 1958 doctoral dissertation exploreconcepts of perception, time and stress
Research conducted at Yale University School ofNursing to test Orlandos (1961) theory of thedeliberative nursing process thinking
King and Peplau (as cited in Takahashi, 1992)pointed out the connections between their works withregard to patient outcome.
A review of her 1971 book by Rosemary Ellisencouraged her to continue her work by deriving a theoryfrom the General Systems Framework.
The result
The Theory of Goal Attainment.
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C. Use of Empirical EvidenceKing used a systems approach in the development of her Dynamic Interacting Systems
Framework and in her subsequent Goal-Attainment Theory.
INTERACTING SYSTEMS FRAMEWORK
Three systems in the conceptual
framework:
Personal System (the individual)
Interpersonal System (individuals
interacting with one another)
Social System (groups of people in
a community/society sharingcommon goals, interests, and
values)
Study systems as a whole rather
than as isolated parts of a system.
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THEORY OF GOAL ATTAINMENT
Elements are seen in the interpersonal systems inwhich two people, who are usually strangers,come together in a health care organization tohelp and be helped to maintain a state of healththat permits functioning of roles.
Reflects Kings belief that the practice of nursing isdifferentiated from other healthcare professionsby what nurses do with and for individuals
Nurse and client communicate information, setgoal mutually and then act to attain those goals
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D. Metaparadigm in Nursing:
1.Person:
Imogene King described a person existing in
an open system as a spiritual being andrational thinker who makes choices,selects alternative courses of action, and hasthe ability to record their history through
their own language and symbols, unique,holistic and have different needs, wants andgoals.
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According to Imogene King, human being
has three fundamental needs:
Information on health that can be
accessed and utilized when needed
Care that aims to prevent illness
Care in times of illness/helplessness
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2.Health :
According to Imogene King, health involves
dynamic life experiences of a human being,
which implies continuous adjustment to
stressors in the internal and externalenvironment through optimum use of ones
resources to achieve maximum potential
for daily living.
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3.Environment : It is the background for
human interactions.
It involves:
a. Internal environment transformsenergy to enable person to adjust tocontinuous external environmentalchanges.
b. External environment involves formaland informal organizations. Nurse is a partof the patients environment.
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4. Nursing:
Nursing for Imogene King is an act wherein the
nurse interacts and communicates with the client.
The nurse helps the client identify the existing
health condition, exploring and agreeing onactivities to promote health. The goal of the nurse
in Imogene Kings theory is to help the client
maintain health through health promotion and
maintenance, restoration, and caring for the sick
and dying.
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E. Theoretical Assertion
From the theory of goal attainment ImogeneKing developed predictive propositions, whichincludes:
If perceptual interaction accuracyis present in nurse-patient interactions, atransaction will happen.
If nurse and client make transaction, goal willbe attained.
If goal are attained, satisfaction will occur.
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If goals are met, efficient nursing care will
happen.
If transactions are made in nurse-clientinteractions, growth and development will
be enhanced
If role expectations androle performance as perceived by nurse
and client are congruent, transaction willoccur
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If role conflict is experienced by nurse orclient or both, stress in nurse-clientinteraction will occur
If nurse with special knowledge and skillcommunicate appropriate information toclient, mutual goal setting and goal
attainment will occur.
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The interaction of the person and the
nurse is goal-directed and through this,both parties reach a common and accurateperception of the problem and means areexplored on how to resolve it.
After the means exploration, goal-setting is made which is subject foragreement.
Finally, transaction happens when the
agreed goals are acted upon and necessaryactions are taken to achieve them. Finally,if the goals are attained, satisfaction willoccur and the health need fulfilled.
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G. AnalysisClarity:
Clear andconceptually derived from researchliterature at the time the theory was developed.
Generality:
It has been criticized for having limitedapplications in areas of nursing in which patientsare unable to competently interact with the nurse.
King has responded that 70% of communication isnonverbal.
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Empirical Precision: From a study of 17 patients, goals were attained in 12
cases (70%).
King believes that if nursing students are taught thetheory of goal attainment and it is used in nursingpractice, goal attainment can be measured and the
effectiveness of nursing care can be demonstrated.
Derivable Consequences: It focuses on all aspects of the nursing process:
assessment, planning, implementation and evaluation.
King believes that nurses must assess to set mutualgoals, plan to provide alternative means to achievegoals, and evaluate to determine if the goal wasattained.