Could Imogene King’s theory of goal attainment be applied to your current practice setting?

Could Imogene King’s theory of goal attainment be applied to your current practice setting?

 

            A common fact is that a health practitioner’s decision-making will impact the patient’s condition/situation in ways more than one. Imogene King recognized the necessity of putting daily decisions in perspective and in accordance with practice and actions of health practitioners especially the nurses for the purpose of encouraging more positive health outcomes. King (1987) developed the theory of goal attainment that has the client goals at the heart of client-nurse relationship during the mid-1960s. Nursing, whom King (1981) defined as a helping profession that assists individuals and groups in society to attain, maintain and restore health, is the central tenet of health promotion. As such, the theory of goal attainment provides a way by which the nurse’s action and the client progresses could be effectively tracked (Calladine, 1996). In this report, the strengths and limitations of King’s theory will be assessed as well as its value and relevance. Insights and perceptions will be built upon the theory’s application in clinic setting.

 

King’s Theory of Goal Attainment

 

            As already mentioned, King’s theory of goal attainment puts emphasis on the goals that govern the nurse-patient relationship. King’s basic assumption is that nurses as human beings interact with patients as human beings and both are open systems that also interact with the environment (Meleis, 2007, p. 330). As Boyd (2005) puts it, the theory is a systems model which derived its conceptual framework from three dynamic interacting systems: persona, interpersonal and social. Individual system embraces the concept of perception, self, growth and development, time and space. Perception is considered to be the most important within the personal system because of its influence on behaviour (1981, p. 19). Individuals or group(s) reacting to one another made up the interpersonal systems, and comes in three: as a dyad, a triad or a larger group. Kozier et al (1995) relate that concepts associated with such system include interaction, transaction, communication, role and stress. Social systems, finally, comprise of groups of people in a community or society that share common goals, interests and values (Williams, 2001) and are linked with the concepts of organisation, authority, power, status and decision-making.

 

The Clinic Setting

 

Simply, within the clinic setting, the personal systems (nurse and patient) interact with each other in an interpersonal system (small and large groups) and the environment that is the social systems (institutional organisations). The clinic that I am working is situated as part of a public hospital in Hong Kong providing subsidised healthcare services. In general, it is an out-patient clinic, offering general diagnoses and treatments minus the need to stay overnight. Within this setting, several interactions and transaction occur within the day aside from the nurse and patients, including nurses and medical assistants, nurses and the family of the patient, nurses and doctors and nurses and other nurses.

 

Theory of Goal Attainment’s Application in Clinic Setting

 

            According to King (1996), the value of the theory is its applicability in any nursing situation. Basically, the goal of nursing is the “attainment, maintenance or restoration of health to allow clients to achieve maximum potential for daily living” (as cited in Kozier et al, 1995). Naturally, the same goal goes with the clinical practitioners including the nurses. Interactions are fundamental in the clinical context; individuals are purposeful and goal-directed particularly for the nurses who have direct interface with the patients. Nonetheless, the individuals who are involved in interaction bring various perceptions to the exchange. Plausibly, there must be a basic understanding that perception occurs differently in the nurse and in the client. This is because the distorted perceptions of a role may negatively impact upon achievement of goal set.   

 

Nurses, as I always believed, hold a specific power of influence among the patients. Such condition basically manifests the varying perception of nurses and clients. As a nurse, I have more authority and influence to the health care system and it always shows when I have to do some explaining to the clients and their family, friends or relative. One of the basic strength of the theory of goal attainment is its multi-paradigmatic nature. Two among these paradigms that support the power inserted by the nurses over a professional yet therapeutic relationship is evident on systems and psychoanalytical. The former is central on structural-functional view of role, open systems and social systems while the latter focuses on the self which is either the patient or the nurse. This also points out that an individual as a social element is both an actor and a reactor. Meleis (2007, p. 336) argued that an individual is also constantly structuring and restructuring his perceptions about the world and his/her environment per se hence communicating. The author also relates that the nurse and patient interactions occur with the perpetual repertoire of both. On the other hand, the theory of goal attainment limits its view of human as only a social being instead of as a biopsychosocial being, or a holistic being for that matter (Meleis, 2007, p. 337).   

 

Four among the roles of the nurses that requires constant interaction with the patients are assessment, intervention, documentation and education, all of which are desired goals each day. Since I have the ability to advocate, I hold the capability to collaborate with the clients in order to meet the needs and goals of the client. Through such collaboration I can understand the patient’s position which works toward arriving at an informed decision. According to King (1999), patient involvement in the care and in the decision-making process is significant as well as the collaboration itself and the humanity of nurse and patient encounter. King presented the theory with clear evidences of interactionist approach when she made use of roles and the personal element of perception and interpretation. The problem of the theory, however, is that there are particular situations that decisions are yet to be conclusive and how decisions are made during times of uncertainty is conflict-laden (Meleis, 2007, p. 331 and 336).

 

As I have witnessed, nurses offers much of the stimulation that the patient will need. Clients are always in the vulnerable position and so the necessity to build a relationship that is embedded on professional intimacy. There are two goals that are present, for the nurses to gain trust and respect and for the patients to be given empathy during the process. The significance of the theory of goal attainment is that all individuals should be respected as human beings of equal worth and who have their own set of value (King, 1999). Within the outpatient clinic, it is expected among nurses to distance themselves emotionally with the client for the purpose that the profession will not be jeopardised. Objectivity and an appropriate professional response are upheld in this area at all times especially because the goal of the clinic experience is the betterment of the client. King (1982, p. 143) stresses that the central focus of nursing is the interaction of human beings and environment, with the goal being health for human beings. Although the theorist clarified the relationship between concepts of interaction and growth and development as well as communication and transaction, it is not clear how these major concepts related to human beings. Perception appears to be at the central concept of the theory but the criticism lies on inaccurate reflection of King’s ideas (as cited in Meleis, 2007, p. 332).  

 

Aside from the client’s personal information, the professional intimacy between a nurse and a patient is realised through the psychological and social elements associated with the encounter. In the outpatient clinical setting, it is unavoidable that a nurse will have to console a patient for something concerning his or her health. I observed that such situation creates a unique closeness between the nurse and the patient. For instance, the in charge nurse attending to the needs of a kid for a supposed injection will be sought or looked for upon the second or third visit. I figured that this nurse, and also the child, had honed a special closeness that only they can understand. This is yet another goal of the nurses which is to involve in a therapeutic relationship without sacrificing the professionalism of the job. Such situation manifests that in the previous encounter of the nurse and the patient, effective communication had occurred either verbal or non-verbal or the combination of both. According to Meleis (2007, p. 336), the theory of goal attainment correlates with the foundation on symbolic interactionism in explaining the nursing process and the process of interaction although King explicitly discloses that she did not involved any symbolic interactionism school of thought. King relates that:

 

‘the goal of nursing is to help patients attain their goals through the nursing process. Nurses interact purposefully with the clients with information sharing, setting of mutual goals, participation in the decision about the goals and means, implementing plans and evaluations in mind’ (1981, p. 176; Meleis, 2007, p. 335).

 

As I was working in this outpatient clinic, I have realised a lot about the nurse-patient relationship which is basically founded on specific boundaries, and that crossing such boundary may impose serious consequences. The purpose of the relationship is goal-oriented; simply to provide care to client, that is. Of course, the emphasis is on the role of the nurses. The nurses are responsible for establishing and sustaining the professional relationship and so his/her behaviour is guided by code of ethics and professional standards. These nurses also have the responsibility to prepare for the relationship via acquiring formal knowledge, orientation and training. Nonetheless, the time spent in the relationship is only under what is stipulated in the contract of the nurses (i.e. hours of work) and it is time-limited depending on the need for a nursing care. If King’s theory would be expanded, I assumed that this will be covered. King (1981) stressed that aside from being rational and action-oriented, they are also time-oriented beings.

 

In sum, the theory of goal attainment could be applied in the nurse and patient interaction in the clinic setting. But the limited relationships involved could not be employed on a wider, holistic concept. At the onset, the theory should highlight the importance of human as a biological and psychological beings rather than being just a social being. Goal attainment appears to be very individualistic and that applying it to nursing care would be problematic as well as equating with satisfaction achieved within the relationship. Generally, however, the theory of goal attainment has been widely accepted in the nursing community.

 

  

References

Bogard, P. (n.d.). Synopsis of King’s Theory of Goal Attainment. Montgomery: Troy University.

 

Nurse-Client Relationships. College of Registered Nurses in British Columbia.

 

 

Bibliography

Boyd, M. A. (2005). Psychiatric nursing: Contemporary Practice (3rd ed). Lippincott Williams & Wilkins.

 

Calladine, M. L. (1996). Nursing Process for Health Promotion Using King’s Theory. Journal of Community Health Nursing, 13(1): 51-57.  

 

King, I. M. (1981). A theory for nursing: Systems, concepts, process. New York: John Wiley & Sons.

 

King, I. M. (1982). The effect of structured and unstructured pre-operative teaching: A replication. Nursing Research, 31, 324-329.

 

King, I. M. (1987). King’s theory of goal attainment. In R. R. Parse (Ed.), Nursing science: Major paradigms, theories and critiques (pp. 107-113). Philadelphia: W. B. Saunders.

King, I. M. (1996). The theory of goal attainment in research and practice. Nursing Science Quarterly. 9(2):61-6, Summer.

King, I. M. (1999). King’s theory of goal attainment: Philosophical and ethical implications. Nursing Science Quarterly, 12, 292-296.

 

Kozier, B., Erb, G., Blais, K. and Wilkinson, J. M. (1995). Fundamentals of nursing: concepts, process, and practice (5th ed). Redwood City, CA: Addison-Wesley.

 

Meleis, A. F. (2007). Theoretical Nursing: Development and Progress. Lippincott Williams & Wilkins.

 

Williams, L. A. (2001). Imogene King’s interacting systems theory – Application in emergency and rural nursing. Online journal of rural nursing and health care, 2(1).

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