Imogene King developed the King’s Conceptual System Theory or the Theory of Goals Attainment. In her theory, King explains how the relationship between the nurse and the patient is instrumental in the attainment of the patient’s goals. Such goals (which should be mutual) are often developed through communication and interaction, which is set in a social environment. The King’s framework, as recorded by Murray and Frenk (2000), can be useful in the assessment of maintenance of a healthy social system that would support patients (clients) to pursue and attain their desired goals. The theory, according to Smith and Parker (2015) is based on concepts of communication, mutual goal setting, and implementation of goals. The theory has three systems that need to work in synchrony for everything to go as expected under the theory. Each system has its own concepts. The three systems are the personal (individual) system, the interpersonal system (nurse-patient dialogue), and the social system.
Personal systems are individuals who the theory expects and regards to as rational, social, and capable of feelings. Concepts in the personal system include self, body image, time, learning, perception, growth and development, and personal space. The nurse uses these fundamentals to decipher the patient. In all the concepts under the Personal System, perception comes out strongly as it influences behavior to a great extent. To connect all the concepts, King (1981) on page 19 said, “An individual Perception of self, of body image, of time, of space influences the way he or she responds to object and events in his/her life. As individuals grow and develop throughout their lifespan, experiences with changes in structure and function of their bodies over time influence their perceptions of self”. Perception, as understood in the theory, is the process of giving meaning to a patient’s experiences and behaviors through mental representations.
The Interpersonal System pertains to a situation where two or more individuals interact and socialize. The system has the following concepts interaction, stress, communication, role, and transaction. Communication is the process of communication exchange between individuals who are socializing. It is the means that the individual’s concerned use to connect. Transactions are human behaviors, which are aimed at achieving certain set goals. Stress is a state of dynamism where human beings interact with the environment and to ensure that they maintain a balance for growth, development, and performance that involves the exchange of information. Coping is a way of handling the stress. Nurse-patient communication, whether verbal or non-verbal is critical to the attainment of the established goals.
This is the system that shows how the nurse interacts with other people in her ecosystem. People in the ecosystem include co-workers, subordinates, and supervisors. These are the people in the same ecosystem as the nurse that share the same goals, objectives, values, and interests. The system provides a framework for social interactions and relationships besides establishing the rules of behavior and action plans as described by King (1992). The system establishes boundaries for aspects such as roles, behaviors, and practices that fall within the social realm. The system has the following concepts organization, authority, power, status, decision-making, and control/being in charge. Organization refers to a group of people who get together to achieve some defined goal. Authority is the element of having power or control. Power is the ability to influence decisions or behaviors. Status is the social standing of an individual.
The three systems form the basis of King’s Theory of Goal Attainment. The systems and their concepts influence goal attainment in different aspects. As such, they can positively or negatively influence the attainment of a goal. Each system is interlinked with the other. The personal system affects the interpersonal system. For instance, it might be difficult for nurses and other healthcare staff to take care of and relate to a patient with difficult personalities. A nurse’s perception might be different from other members of staff and this is likely to affect how well goals will work. The social system affects relationships and mood. A well-set ecosystem with functional social systems facilitates the mood in the work environment. In this case, the social system can determine the speed at which goals are attained. With the advent of social media, social systems have greatly been impacted by online social spaces. Thus, nurses must be averse and well presented in online social places to ensure that they portray a positive picture that makes them trustworthy to their clients.
King’s theory is applicable to different practical settings of a healthcare organization. One way the theory has been proven to work is in the data collection and implementation of changes aimed at impacting the different concepts that are defined in the King’s Theory three systems. Working as a ward nurse is an opportune moment to put the theory to practical use. In normal ward rounds, it becomes imminent that all the three systems described in the theory must work efficiently for the patients to achieve their goals.
During patient-nurse interactions, the theory is useful in developing, maintaining, and improving a rapport that can be monitored for improvement purposes. The theory guides the interaction of patients, individual nurses, and other members of staff to ensure optimal participation. As such, it becomes easier to formulate common objectives and plotting the course of action. To achieve all these, communication is critical. In normal sessions, nurses are encouraged to identify and evaluate underlying problems in personal and interpersonal systems. In return, as King (2007) notes, nurses are thus able to become better by strengthening their relations with clients.
The personal system for the majority of our patients is heavily influenced by their background. A majority live a standard American life and are well averse to their rights. Besides, they are opinionated and have high expectations. With this in mind, it becomes easy to interact with them. In the interaction with such patients, it becomes easy to help them formulate their goals and gather data and information, which is critical in improving the kind of services that they receive from us. To ensure that the patient’s goals are achieved fully, we ensure that we are able to follow up with the patients even when they are discharged. This methodology acts as a promotional and a means to ensure that we achieve our goals.
A quality committee can use the King’s theory to define its basis for outcomes. Such a committee can be in a position to have proper outcomes that are defined by results capable of delivering high-quality service. In this sense, the theory can be used by the committee to chart their plan of action. With either of the systems, for instance, the personal system, the committee should define the problem and gather relevant data about it. From this position, the committee should aim at designing a solution, which should be tested before deployment. To test the solution to a defined problem, the committee should focus on small groups and apply the solution and monitor such a group to gain more insights about corrective measures that would further make the solution more successful. The above methodology is applicable to the development of solutions. All systems and effectiveness would be enhanced if data is collected from all the systems and merged to develop tenable and sustainable goals.
The Theory of Unitary Human Beings by Martha Rodger can also be aligned to enhance the quality of practice. The theory focuses on looking at patients as a whole and with the capacity to participate in a knowledgeable fashion to the process of change. The theory can help in the advancing of improvements in change management by ensuring that the patient is informed and participates in the change process. The theory has two major concepts, nursing as a science and as an art as described by Rogers (1994). The nurse holds the science part and would welcome the patient to participate in the art part.
King, I.M. (1971). Toward a theory for nursing: General concepts of human behavior. New York: Wiley.
King, I.M. (1992). King’s theory of goal attainment. Nursing Science Quarterly, 5, 19–26.
Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: F.A. Davis.
Murray, C. J., & Frenk, J. (2000). A framework for assessing the performance of health systems. Bulletin of the World Health Organization, 78, 717-731.Rogers, M. E. (1994). The science of unitary human beings: current perspectives. Nursing Science Quarterly, 7(1), 33-35
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