king's theory

KING'S THEORY

by:Firoz qureshiDept. psychiatric nursnig

KING'S THEORY OF GOAL ATTAINMENT

History Imogene king was born on Jan 30,1923. She earned a diploma in Nursing from St. John's of Nursing in St. Louis

in 1945. She then worked as an office nurse, school nurse and staff nurse to

support herself while studying for Bachelor degree which she received in 1948, a Bachelor of science in Nursing Education from St. Louis University.

1947-1958 ->She worked as an instructor in Medical Surgical Nursing and then as an assistant director at St. John's Hospital School of Nursing.

1961-1966 ->King was an associate professor of nursing at Loyola University in Chicago. During this time her book , Towards a Theory for Nursing; General Concept of Human Behaviour, was conceptualised, the literature reviewed, and a contract from a publishing company signed.

HISTORY CONT... 1972->She returned to Chicago as a professor in the Loyola

University graduate programme. 1972-1975->She was a member of Defence Advisory Committee

of women in the service for the department of defence. 1980->She was awarded an honorary PhD. from Southern

Illinois University. 1981->A Theory for Nursing System, concept, process was

established. King has been a member of American Nurses Association, the

Florida Nurses Association, National League for Nursing. 1986->A third book , curriculum and instruction in nursing. 1990->King retired. 2007->December 24 she died at St. Petersburg, Florida.

EVOLUTION OF THEORY King states in the preface of Towards a Theory for Nursing that

the book's purpose "is to propose a conceptual frame work of reference for nursing to be utilised by students and teachers, and also by researchers and practioners to identify and analyze events in specific nursing situations.

The frame work suggests that essential characteristic of nursing are those properties that have persisted in spite of environmental changes.

King proposed that her first book was "a way of thinking about the real world of nursing" that is suggested "an approach for selecting concepts perceived to be fundamental for the practice of professional nursing" and that it showed a process of developing concepts that symbolised experiences within the physical, psychological, and social environment in nursing.

EVOLUTION OF THEORY CONT...

She identified in this system 3 distinct levels of functions of dynamic interacting systems are as follows:

1.Individuals 2.Groups 3.Society King defines theory as "a set of concepts which, when defined, are

interrelated and observable in the world of nursing practice". In this study, she described the nurse-patient interaction process

that leads to goal attainment.

EVOLUTION OF THEORY CONT... King descriptive study relating to the theory of goal attainment

resulted in means for analysing interaction. Classification system of nurse-patient interaction that lead to

transactions, which includes the elements in interaction are:-> Action, Reaction, Disturbances, Mutual goal setting, Explore means to achieve to goal, Agree on means to achieve to goal, Transactions, Goal achieved.

Both client and nurse perceive throughout the process; they communicate, thus creating action. Actions result in reactions and, if there is disturbances, goal is set. At this point, means for goal achievement are explored and agreed upon, transactions are made, and goal attainment results.

The patient and nurse are composed of personal systems as subsystem within interpersonal and social systems.

EVOLUTION OF THEORY CONT... Nurse and patient meet in a health care organisation-a patient who

needs help and a nurse who offers help. Nurse and patient perceive one another, act and react, interact and transact.

The goal of nursing process interaction is transaction, which leads to attainment of goals set in relation to health promotion, maintenance, and recovery from illness.

She identifies the conceptual frame work as an open system framework and the theory as one goal attainment.

OPEN SYSTEM FRAME WORK

The conceptual framework represents knowledge essential for nursing and has an additional purpose of allowing the construction and testing of theories from view of nursing.

The conceptual framework includes goal, structure, function, resources and decision making, which are essential elements.

In her conceptual framework, King (1989) presents several assumptions which include the assumptions that human being are open system in constant with their environment, that nursing focus is human being, interacting with their environment, and that nursing goal is to help individuals and groups to maintain health.

OPEN SYSTEM FRAME WORK Nursing phenomenon are organised within 3 dynamic interacting

system. 1.Personal Systems (individuals) 2.Interpersonal System (friends, small and large groups) 3.Social system(family, school, industry, social organisations and

health care delivery system) All concepts are interrelated in the human environment

interaction. 1.Personal System Individual is a personal system. It includes perception, self,

growth and development, body image, space, learning and time. a)Perception It refers to person's representation of reality. According to King, it

includes the import and transformation of energy and processing, storing and exporting information.

OPEN SYSTEM FRAME WORK CONT....

b)Self It is a composite of thought and feeling which constitutes a

person's awareness of his individual existence, his conception of who and what he is. It is that to which we prefer when we say 'I'.

According to King: Self characterise as dynamic individual an open system and goal orientations.

c)Growth and Development It is defined as a continual changes in individuals at the cellular,

molecular and behavioural levels of activities, conducive to helping individuals move towards maturity.

d)Body Image It is a part of each stage of growth and development. King

defines body image as way one perceives both one's body and others reactions to one's appearance.


e)Space "Space is defined as existing in all directions and is the same

everywhere and it is this immediate environment in which nurse and client interact"."It is defined by the physical area known as territory" and by the behaviour of those who occupy it .

f)Time It is defined as a sequence of events moving onwards to the future.

It is a duration between one event and another as uniquely experienced by each human being, it is the relation of an event to another event.

OPEN SYSTEM FRAME WORK CONT.... 2) Interpersonal System

It is formed by interaction of human beings. Two interacting individual from a dyad, three form a triad, and four or more form small or large groups.

a)Interaction

King defines interaction as "a process of perception and communication between person and environment and between person and person, represented by verbal or non-verbal behaviours that are goal directed".

OPEN SYSTEM FRAME WORK CONT.... b)Communication

King defines communication as "a process whereby information is given from one person to another either directly in face to face meeting or indirectly through telephone, television or written word.

c)Transaction Is defined as purposeful interaction that leads to goal

attainment. King defines as observable behaviours of human beings interacting with environment.

When transaction occur between nurses and clients goals are attained.

OPEN SYSTEM FRAME WORK CONT.... d)Role Is defined as "a set of behaviour expected and persons

occupying a position in a social system; rules that define rights and obligation in a position". The nurse's role can be defined as interacting with one or more others in a nursing situation in which, the nurse as a professional uses those skills, knowledge and values identified as belonging to nursing to identify goals and help others achieve the goals.

e)Stress It is a dynamic state whereby a human being interacts with the

environment to maintain balance for growth, development and performance ....an energy response of an individual to persons, objects, and events called stressors.


3)Social System Is defined as "an organised boundary system of social roles,

behaviours, and practices developed to maintain values and the mechanisms to regulate the practice and rules". e.g. families ,religions, groups, education systems and peer groups. It includes:-

a)Organisation King defines organisation as being made up of human beings

who have prescribed roles and position and who make use of resources to meet both personal and organisational goal.

OPEN SYSTEM FRAME WORK CONT.... b)Authority It is an active, reciprocal process of transaction . The

characteristic of authority include observable through provisions of order, guidance and responsibility of actions, universal, essential in formal organisation, reciprocal because it requires cooperation, essential to goal achievement and associated with power.

c)Power King defines power is the capacity to use resources in an

organization's to achieve goals. Power is the process whereby one or more persons influence

other person in a situation.


d)Status It refers to the position of an individual in a group or groups in

relation to other group in an organisation and identifies that status is accompanied by privileges, duties and obligations. It is characterised as situational, position dependent and reversible.

e)Decision Making It is in organisation defined as "a systemic and dynamic process by

which goal-directed choice of perceived alternatives is made and acted upon by individuals or groups to answer a question and attain a goal".

f)Control It is added as sub concept in social system and not defined by King.

THEORY OF GOAL ATTAINMENT

The Theory's focus on interpersonal systems reflect her belief that the practice of nursing is differentiated from that of other health professions by what nurses do with and for individuals. The concept of theory are interaction, self, role, stress, growth and development, time and personal space. These concepts are interrelated in every nursing situations.

PARADIGSM OF KING'S THEORY Here she discussed 4 major concepts of human beings, health

environmental society and nursing and defined. 1.Human Being Her conceptual framework and theory of goal attainment "are based

on overall assumption that focus on nursing is human beings interacting with their environment leading to a state of health for individuals, which have the ability to function in social roles". she described human being as social beings, sentiment, rational reacting, controlling, purposeful, action-oriented and time-oriented.

2.Health she affirms that health is not continuum but a holistic state. she

discuss health as a functional state and illness is an interference with that functional state. she defines "a dynamic state of an individuals in which change is constant and ongoing and may be viewed as the individual's ability to function in his or her usual roles.

PARADIGSM OF KING'S THEORY 3. Environment king's frame work does not specifically define environment,

but views as the social system, portion of her open system fame work. she stated, environment is a function of balance between internal and external interactions. Adjustment to life and health are influenced by an individual's interaction with environment.

4. Nursing Nursing is viewed as "interpersonal process of action,

reaction, interaction and transaction whereby nurse and client share information about their perceptions in the nursing situation and as a process of human interaction and through communications and their develop a goal attainment.

KING'S WORK AND CHARACTERISTICS OF A THEORY

1.Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. Her theory deals with a nurse-client dyad, a relationship to which each person brings personal perceptions of self, role and personal levels of growth and development. The nurse and client communicate, first in interaction and then in transaction, to attain mutually set goals.

2.Theories must be logical in nature. King's theory of goal attainment does describe a logical sequence of events. She says that the nurse and client are strangers, yet they work together for goal attainment and of importance of health maintenance.

3.Theories should be relatively simple yet generalizable:-Although presentation appears to be complex, King's theory of goal attainment, is relatively simple.

KING'S WORK AND CHARACTERISTICS OF A THEORY

4.Theories can be the basis for hypothesis that can be treated or for theory to be expanded. Her hypothesis are as follows.

Mutual goal setting will increase ability to perform activity of daily living.

Mutual goal setting by nurse and patient leads to goal attainment. Goal attainment decreases stress and anxiety in nursing situation. 5.Theories contribute to and assist in increasing the general body

knowledge within the discipline through the research implemented to validate them. e.g. to investigate nurse's attitude towards the attending behaviour and mental status measurements promoting postoperative participation in self care and parenting.

KING'S WORK ANDCHARACTERISTICS OF A THEORY

6.Theories can be used by practitioners to guide and improve and their practice :King's theory of goal can be used as a guide to practice in nursing record in an effort to assist the practice of nursing.

7.Theories must be consisted with other validated theories, law and principles but will leave open answered questions that need to be investigated.

THEORY OF GOAL ATTAINMENT AND IT’S APPLICATION IN NURSING PROCESS

Assessment Assessment occur during interaction. The nurse brings special knowledge and skills whereas client

brings knowledge of self and perception of problems of concern, to this interaction.

During assessment nurse collects data regarding client (his/her growth & development, perception of self and current health status, roles etc.)

Communication is required to verify accuracy of perception, for interaction and transaction.

THEORY OF GOAL ATTAINMENT AND NURSING PROCESS

Nursing diagnosis The data collected by assessment are used to make nursing

diagnosis in nursing process. In process of attaining goal the nurse identifies the problems,

concerns and disturbances about which person seek help. Planning After diagnosis, planning for interventions to solve those

problems is done.

THEORY OF GOAL ATTAINMENT AND NURSING PROCESS

Implementation In nursing process implementation involves the actual activities to

achieve the goals. In goal attainment it is the continuation of transaction. Evaluation It involves to finding out whether goals are achieved or not. In king description evaluation speaks about attainment of goal and

effectiveness of nursing care.

EVALUATION OF THEORY

1.King's theory 9 major concepts (like interaction, perceptions, communication, transaction, role, stress, growth and development, time, space and health), thus making the theory complex.

2.King's theory has been criticized for having limited application in areas of nursing where patients are unable to interact completely with the nurse. e.g. interaction with comatose patient, newborns or psychiatric patient.

3. King has gathered experimental data on the nurse-patient interaction process that leads to goal attainment. A descriptive study was conducted to test the goal attainment theory.

EVALUATION OF THEORY 4. For theory to be useful in nursing practice, it should focus at

least one aspect of nursing process. King’s theory focuses on planning and implementation phases of nursing process. Thus nurse patient dyad interact, devise mutually agreed on goals, explore means to achieve goals, transact and attain goals.

Her theory is based to implement theory based practice in several areas of nursing practice.