Imogene King

Sarah Knoll, RN
Karla Whitaker, RN
Jonathon Rospieski, RN

Nursing
Theory

Nursing as a profession has a distinct

theoretical orientation to practice. This
means that the practice of nursing is based
on a specific body of knowledge that is built
on theory, (Chitty & Black, 2011). This
presentation will focus on the works of
Imogene Kings interacting systems framework
and theory of goal attainment.

Short Video Featuring:

Imogene King
http://www.youtube.com/watch?v=1sZPa

j-RioE

Who is Imogene King?

Born:

January, 30 1923 in West Point, Iowa.

Nearly 60 years of nursing experience,
practicing as a staff nurse, nurse
educator, and nurse administrator.
Faithful Catholic and avid Golfer.
Died: December 24, 2007

What Influenced her

Philosophy?
Hildegard Peplau
Read and reviewed original manuscript
(Toward a Theory for Nursing) denied by John Wiley Publishers
Provided constructive review to influence Imogenes change and re-submission
(A Theory for Nursing: Systems, Concepts, Process) to Wiley Publishers
(King, 2008)
Adversity influenced from rejected manuscript
Did adversity influence the development of my theory and/or modify it. It is
my belief that one does not change a theory or modify (King, 2008)?
Clarified theory in response to questions from nurses and undergraduate and
graduate students from which she taught at and was on faculty
Education- This is where her basis of learning was performed
St. Johns Hospital School of Nursing, 1945 (basic nursing education)
St. Louis University, 1948 (BSN)
St. Louis University, 1957 (MSN)
Teachers College, 1961(EdD)

What Influenced her

Philosophy, ctd.
Teaching and Faculty Member- This is where she clarified theory in response to the
nurses and undergraduate and graduate students for her theory (King, 2008)
Loyola University, 1961-1966, 1972-1980
Ohio State University, 1968-1972
University of South Florida, 1980-1990
(Chitty and Black, 2011)
A Theory for Nursing: Systems, Concepts, Process- 1st claim to Theory of Goal Attainment

Focused on persons, their

interpersonal relationships,
and social contexts in a
conceptual framework

These involved 3 interacting

systems: personal, interpersonal,
and social

Focus of nurse is on the phenomena

of the importance of the patient
(Chitty and Black, 2011)

Imogene Kings Influence on the Four Global

Concepts of Nursing

Imogene King spent the majority of her career in academic

settings. She defined the four global concepts of nursing
exclusively to why they are important to her nursing
model/goal attainment.
Human being

Health

Nursing

Environment

Content of the Theory of Goal

Attainment
Human Being

Refers to the social being- rational and sentient

Person is able to:

Perceive
Think
Feel
Choose
Select means to achieve goals
Make decisions

3 fundamental needs of human

For health information that is unable at time when needed and

able to be used
For care that seek to prevent illness
For care when person is unable to provide self-care
(George,1994)

Health

Involves dynamic life experiences of a human being

Implies continuous adjustment to stressors in internal and external environment

Uses ones resources to obtain maximum potential for daily living

Content of the Theory of Goal

Attainment, ctd.
Environment

The background for human interaction

Involves:

Internal environment: energy is transformed to enable human to adjust to changes from

external environment

External environment: nurse is a part of this which involves formal and informal groups
(George, 1994)
Nursing

Definition: action, reaction, and interaction between nurse and patient which involves
sharing information and their perception of the situation. Through communication, they set
goals, decide the means, and evaluate achievement of goals

Action: order of behaviors between the mental and physical action

Reaction: order of behaviors in the action

Goal: help patients maintain their health for daily living function

Domain: promoting, maintaining, and restoring the health. Caring for

the injured, sick, and dying

Function: Interpret the nursing process in design of the care plan,

so that it can be implemented and evaluated.
(George, 1994)

Inference/Interpretation &
Implications/Consequences
Inference/Interpretation
1.
If interaction is perceived accurately
and present in the nurse-patient
interactions
2.
If the nurse and patient make
transaction
3.
If goals are met
4.
If transactions occur in the nursepatient interactions
5.
If role expectations and performance
are seen in the same way by the nurse
and patient
6.
If conflict is seen by either the nurse or
the patient
7.
If the nurse utilizes her skills of
appropriate information through
effective communication

Implications/Consequences
1.
Then, transaction will occur
2.
Then a goal will be obtained
3.
Then satisfaction will have been
made
4.
Then growth and development
will be up front
5.
Then transaction will occur
6.
Then stress will occur
7.
Then a mutual setting of a goal
and its obtainment will happen
(Afaf, 1997)

Motivation for Kings Nursing

Theory

Development of a conceptual framework of

reference to focus and organize nursing
knowledge with the goal or identifying
a systems theory for nursing.
The focus of nursing is human beings
interacting with their environment leading to
a state of health for individuals, which is the
ability to function in social roles, (Fitzpatrick &
Wallace, 2006 p. 314).

Nursing Process as a Theory

A system of interrelated concepts:
Perception of nurse and client
Communication of nursing and client
Interaction of nurse and client
Decision making about goals
Agree to means to attain goal
Decisions made
Goal attained (if not, why not)

Assumptions and Viewpoints

The focus of nursing is the care of human
beings.
The goal of nursing is the health care of both
patients and their families.
Human beings are open systems interacting
with their environment constantly.
The nurse and patient communicate
information, set goals mutually,
and then act to achieve those
goals.

Knowledge Development
Advocate

for theory-based education

and nursing practice.
Kings theory provides a framework to
guide nursing practice, incorporate
nursing theories, and integrate ongoing
changes in the nursing and healthcare
systems.

Evaluation of the Nursing Model

When using Kings work, nurses focus on goal attainment

for and by the patient (Chitty & Black, 2011).
The steps of the nursing model occur simultaneously as the
nurse and patient work towards achieving their goals.

Assessment: The nurse and patient must

communicate closely with each other, working as a team.
The nurse brings special knowledge and skills
whereas client brings knowledge of self and
perception of problems of concern, to this
interaction (Current Nursing).
Diagnosis: Both the patient and nurse must
agree on the nursing diagnoses they are
focusing on so that they can start the next step,
planning.
Planning: This requires the patient to participate with the nurse
to develop the goals they plan to achieve.
Implementation: The patient completes the tasks and skills
necessary to achieve their goals with the help and guidance
from their nurse.
Evaluation: Did the patient achieve their goals?

Influence on Every Area of

Nursing

Kings nursing theory is beneficial to all areas of nursing,

ranging from emergency medicine, to obstetrics, behavioral medicine, etc
because it is an abstract concept model.
Every patient is dealing with some sort of problem or issue. They are working on
being well and setting goals and working to achieve those goals will aid in the
recovery process.
Example:
In behavioral medicine all patients are required to have two daily goals. These
are set in the morning with the assistance of the RN. Throughout the day open
communication and a lot of hard work goes into the patient achieving their
goals. At the end of the day, the patients must evaluate if they successfully
completed their goals and what they still need to work on for the future.
In emergency medicine the patient may have several short term goals to first
stabilize their health. A perfect example of this would be to maintain an SaO2 of
92% or higher while in the ED. The patient will work towards this goal by focusing
on their breathing and maintain a healthy rate while the nurse will administer
oxygen/suction as needed.

Imogene Kings Legacy

Imogene Kings nursing theory of goal attainment is one

that can be used in every aspect of nursing, from short term
to long term patient care.
When she was inducted into the American Nurses
Association Hall of Fame in 2004, her biography noted that
King modeled nurses' responsibility to actively contribute to
the advancement of the profession. As a result, she has
personally influenced the life, community, and profession of
nurses and nursing (Kennedy, 2008).

Case Study
Mr. Jones is an 76 year old admitted to your cardiac
unit for recurrent fainting spells, hypertension, and
lethargy. Recently, his wife unexpectedly passed
away. Mrs. Jones was in charge of ensuring that Mr.
Jones received his blood pressure, cholesterol, and
arthritis medication. During your intake assessment
you find that Mr. Jones has been intermittently taking
his medications. You discuss the factors that are
precluding him from taking medication regularly and
find that he cannot see the small tablets to clearly
identify them, he is unsure how his wife requesting
refills, and he no longer has a reminder to take his
pills.

Case Study (cont)

You explain to Mr. Jones the consequences of missing
medications and set a expectation that medication should be
given every day as prescribed by his physician. Mr. Jones is in
agreement and he, along with his adult children, agree on the
plan of care you have set for him. A plan is set for a timer to
remind him of medication, a weekly pill box that his daughter will
help set up each week, and you have arranged for his pharmacy
to place reminder calls when a refill is due.

Case Study Questions:

Based

on information provided, has the

nurse addressed the four global concepts
of Kings theory of goal attainment? If so,
how? If not, what should the nurse have
done differently?

References

Afaf, M.I. (1997), Theoretical nursing : Development & progress (3rd ed.). Philadelphia,PA. Lippincott.

Chitty, K., & Black, B. (2011). Nursing theory: The basis for professional nursing. In Heights: Saunders
Elsevier (sixth ed.). Professional Nursing Concepts & Challenges. 311-312

Current Nursing. (2012). Imogene Kings theory of goal attainment. Theory of goal attainment and
the nursing process. Retrieved from
http://currentnursing.com/nursing_theory/goal_attainment_theory.html.

Davidson, H. (2006). King Theory of Nursing. Gale Encyclopedia of Nursing and Allied Health, (3rd ed.).

Fitzpatrick, J., & Wallace, M. (2006). Encyclopedia of Nursing Research. pp. 314-315.

George B. J. (1994). Nursing Theories: The base for professional nursing practice (3rd ed.)
Norwalk, CT. Appleton & Lange.

Kennedy, M. (2008). In memoriam: nursing loses a legend. Imogene King. American Journal Of
Nursing, 108(3), 87. DOI: 10.1097/01.NAJ.0000312271.47979.7b

Killeen, M., & King, I. (2007). Viewpoint: Use of King's Conceptual System, Nursing Informatics, and
Nursing Classification Systems for Global Communication. International Journal of Nursing
Technologies and Classifications, 18(2), 55. DOI: 10.1111/j.1744-618X.2007.00050.x

King, I.M. (2008). Adversity and theory development. Nursing Science Quarterly.
doi:10.1177/0894318408316406

21(137). 137-138.