This paper examines Imogene King's theory of goal attainment, a humanistic nursing framework built on systems theory that structures the nurse-patient relationship around shared communication and collaborative goal-setting. The paper outlines the theory's three interconnected systems — personal, interpersonal, and social — and the constructs that emerge from each. It explores the philosophical and ethical underpinnings of the theory, including patient autonomy and dignity, and describes the transactional process through which nursing care is planned and evaluated. The paper also analyzes the theory against standard criteria for evaluating nursing theories, including logical structure, generalizability, hypothesis generation, and cross-theoretical validity, before concluding with reflections on how aligning nursing practice with nursing theory strengthens clinical judgment and patient outcomes.
The thrust of Imogene King's theory of goal attainment is a loosely coupled partnership between the nurse and the patient that enables communication about the patient's condition, their health goals, and a plan of action to achieve those goals. The conceptual framework is based on systems theory, and King employs three classic systems in her representation of the theory: (1) the personal system, (2) the interpersonal system, and (3) the social system. As the conceptual framework takes shape for the personal system (Yonge, 2007), several constructs emerge: body image, self, growth and development, perception, space, and time. As the framework moves to the interpersonal system, the constructs take on a more integrated form: communication, interaction, transaction, time, and space. In the final component of the conceptual framework, the constructs of authority, status, power, decision-making, and organization become important.
Undergirding King's theory is the principle that a patient is able to develop and grow, moving toward the attainment of life goals. It is not illness or disease that erodes this ability to be goal-focused so much as the constraints of individual roles and issues of stress, time, and space (Stizman & Eichelberger, 2011). The internal and external environments of the patient and the nursing context serve as the backdrop for the interactions that take place during the time of care or treatment (Stizman & Eichelberger, 2011). Both the patient and the nurse must make adjustments in response to stressors in these environments as they encounter them (Stizman & Eichelberger, 2011; Zust et al., 2010).
The external environment entails the informal and formal social arrangements of the lives of both the patient and the nurse (Stizman & Eichelberger, 2011). The internal environment is not directly observable, but it is the context in which energy is transformed, facilitating adjustment to and management of the external environment (Stizman & Eichelberger, 2011). The interactions of these systems form the basis of the nursing relationship. Nursing is qualitatively defined in the theory as the actions, reactions, and interactions between the nurse and the patient as they share information about their perceptions of the nursing situation (Stizman & Eichelberger, 2011).
According to King, the focus of the nurse must be squarely on patient care, and the goal of nursing and healthcare is quality caretaking of patients (Stizman & Eichelberger, 2011). An extension of this orientation is the nurse's effort to help patients be and stay healthy so that they can function in their life roles. For their part, nurses' objectives are to provide and interpret information about the nursing process, to plan for the provision of care, to implement care in a best-practices format, and to evaluate the nursing care provided in an effort to continuously improve on the first two objectives (Stizman & Eichelberger, 2011).
King's theory of goal attainment is fundamentally a humanistic theory in which the patient retains the rights, strengths, and liabilities of any social being, regardless of their physical, mental, or emotional state (Zust et al., 2010). Without explicitly articulating the following principles, King makes it nonetheless clear that certain attributes of nursing care will shape the patient-nurse relationship (Yonge, 2007). These attributes reflect the highest order of human relationships, including an overarching reverence for living things and for life, a determination to act on professionally and personally held beliefs, and a fundamental respect for the autonomy, dignity, individuality, and worth of each patient.
These three components are the ethical and philosophical building blocks of nursing theory (Tomey & Alligood, 2002). Philosophy is held in the mind and heart, but it is conditioned by purpose and manifested in practice (Plager & Conger, 2008). Purpose is connected to a nurse's theoretical foundation as a nexus between philosophy and practice. Practice encompasses all observable nursing actions directed toward meeting patients' needs and working for the overall good of the patients under a nurse's care (Tomey & Alligood, 2002).
"Three core patient needs and the care planning process"
"Evaluating King's theory against seven academic criteria"
The art of nursing is an overlay of the philosophy, purpose, and practice of nursing. It consists of the understanding that the nurse brings to the reality of patients' needs and concerns, the care plan designed to enhance patients' abilities, and the coordination and direction of activities that will improve patients' conditions. The juxtaposition of planning, skill, and responsiveness ensures that the nurse focuses on preventing new concerns or complications and the recurrence of presenting problems.
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