N491 Concepts and Theories in Nursing
Professor Denys Goozee MSN,RN,CRRN
December 23, 2019
! 2 King’s Theory
Kings Theory of Conceptual System or Theory of Goal Attainment
In the mid-1960s, Imogene King wrote of the need for focus, organization, and use of a
nursing knowledge base (King, 1968). She proposed that knowledge for nursing resulted from
the systematic use and validation of knowledge about concepts relevant to nursing situations.
The use of knowledge in critical thinking results in decisions that are implemented in
professional nursing practice. “She developed a conceptual system which provides structure for
organizing multiple ideas into meaningful wholes” (Smith and Parker, 2015)
The Three Systems
The personal system that King speaks of refers to the individual. The concepts within the
personal system and fundamental in understanding human beings are perception, self, body
image, growth and development, time, and space (King, 1981). King (1981) viewed perception
as the most important variable because perception influences behavior.
King summarized the connections among the concepts in the following statement: “An
individual’s perceptions of self, of body image, of time and space influence the way he or she
responds to persons, objects, and events in his or her life. As individuals grow and develop
through the life span, experiences
Interpersonal systems involve individuals interacting with one another.
King refers to two individuals interacting as dyads, three individuals as triads, and four or more
individuals as small or large groups (King, 1981). The concepts associated with interpersonal
systems are interaction, transaction, communication, role and stress. The interactions and
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transactions that occur between the nurse and the client, or the dyad, represent an example of an
interpersonal system.
Communication between the nurse and the client can be classified as verbal or nonverbal.
Verbal exchanges include both spoken and written communication, while nonverbal
communication includes such things as appearance, distance, facial expressions, posture and
touch.
The third and final interacting system in King’s model is the social system.
Social systems are groups of people within a community or society that share common goals,
interests, and values. Social systems provide a framework for social interaction and relationships,
and establish rules of behavior and courses of action (King, 1971). Examples of social systems
include the family, the school, and the church. It is within these organizations that individual’s
beliefs, attitudes, values and customs are formed. The concepts that King identified as relating to
social systems are organization, authority, power, status, and decision-making.
The relationships between these three systems led to King’s Theory of Goal Attainment.
The conceptual framework of the interpersonal system had the greatest influence on the
development of this theory. King (1981) stated, “Although personal systems and social systems
influence quality of care, the major elements in a theory of goal attainment are discovered in the
interpersonal systems in which two people, who are usually strangers, come together in a health
care setting for the purpose of one of them requiring care and the other providing the care (Royal
Nurse Organization, 2001)
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How the systems Affect Goal Attainment
The model has three interacting systems: personal, interpersonal, and social. Each of
these systems has its own set of concepts. The concepts for the personal system are perception,
self, growth and development, body image, space, and time. The concepts for the interpersonal
system ( nursing Theory, n.d) are interaction, communication, transaction, role, and stress. The
concepts for the social system are organization, authority, power, status, and decision-making.
The conceptual frame work have given rise to the development of prepositions that can guide
goal attainment. For example, in an obstetric unit;
If perceptual interaction accuracy is present in nurse-patient interactions, transaction will occur.
Most patients in labor are anxious and are facing a huge knowledge deficit regarding their
condition and environment, a nurse who is mindful of how she presents and interact with the
patient, communicate her special knowledge and is able to assure the patient the the patient and
her unborn baby are the priority if the nurse and the entire unit, this nurse is able to strike a
transaction with this patient because, the patient can be seen to visibly relax and allow the nurse
to care for her.
If the nurse and patient make transaction, the goal or goals will be achieved. The nurse together
with the patient will discuss the patient’s birth plan. The Nurse is aware not to push any
procedures on the patient but duly clarifies and explains. The duty of the nurse is to support
patient’s plans. Many times, a woman in labour will want to go as far into labor as she can
without any medications, she will however make a plan with the nurse to be ready to medicate
her when ever she rates her pain at at least 8 out of 10 labor pain.
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If the goal or goals are achieved, satisfaction will occur.Whether the patient delivers with any
pain medication or she gets a dose of fentanyl at the beginning of second stage of labor, once the
outcome desired is achieved, which is a delivery of a viable newborn, satisfaction of the new
mom is attained.
If transactions are made in nurse-patient interactions, growth and development will be enhanced-
It is easier and recommended for practice form a medical and legal point of view that the nurse
makes -nurse-patient transaction versus any other interactions with anyone else for the sake of
the patient. If role expectations and role performance as perceived by the nurse and patient are
congruent, transaction will occur. The views of the nurse and patient have to be in harmony for
goals attainment. If role conflict is experienced by either the nurse or the patient (or both), stress
in the nurse-patient interaction will occur and there my be no transaction. If a nurse with special
knowledge communicates appropriate information to the patient, mutual goal-setting and goal
achievement will occur.
How King’s Theory Can Help Define a Clinical Quality Problem
When a clinical quality question arises, the nurse is better guided to define the problem using the
King theory. First, the use of King’s theory will help guide the literature search to include studies
that address interventions or processes that lead to favorable patient outcomes or goals among
patients similar to the population on the unit.(Smith and Parker, 2015)
Knowing that the quality Improvement committee is a type of interpersonal system that is
comprised of individuals interacting to achieve common goals, the nurse should take the
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unclear clinical situations to the QI committee. Together the QI and the primary nurse will
embark on a goal attainment of defining the clinical problem for the benefit of patients.
Applying King’s Theory To a Potential Clinical Practice Quality Initiative
Every unit has a group of individuals with specialized knowledge, they work together to achieve
a common goal. This committee uses King’s conceptual system for quality improvement when
the opportunity presents itself. For example when a nurse is facing a scenario where what is
taught is not what is being practiced as in the case of a nurse graduate who witnessed the use of
saline in breaking up secretions in patient with endotracheal intubations. The nurse graduate
brought her clinical question to the QI committee, a type of interpersonal system. An
interpersonal system encompasses individuals in groups interacting to achieve goals. The QI
committee is engaged in the committee’s goal attainment for the benefit of patients. “Role
expectations and role performance of nurses and clients influence transactions” (King, 1981, p.
147). When used in interdisciplinary teams, the transaction process in King’s theory facilitates
mutual goal setting with nurses, and ultimately patients, based on each member of the team’s
specific knowledge and functions. Multidisciplinary care conferences, an example of a situation
where goal-setting among professionals occurs, is a label for an indirect nursing intervention
within the Nursing Interventions Classification (NIC; Bulechek, Butcher, & Dochterman, 2008).
Some of the activities listed under this NIC reflect King’s (1981) concepts: “establish mutually
agreeable goals; solicit input for patient care planning; revise patient care plan, as necessary;
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discuss progress toward goals; and provide data to facilitate evaluation of patient care plan” (Sith
and Parker, 2015)
How a Quality Committee Can Align Outcomes with Kings Conceptual System Theory
As illustrated in the obstetric situation, the goals of the patient became the goals of the nurse. The
goals were mutually greed upon. According to King, for goals attainment, the QI committee have
to mutually agree because goals are similar to outcomes and goals lead to outcomes.
Effectiveness of care will be measured by whether the patient goals (i.e., outcomes) have been
attained. The QI Committee engages in goal attainment through communication by setting goals,
finding means, and agreeing on means to achieve goals. In a QI scenario , members will gather
information, examine data and evidence, interpret the information, and participate in developing
a protocol for patients to achieve quality patient outcomes, that is, goals.
Additional Nursing Theory from That Align With an Improved Quality of Practice
Initiative
The most closely associated theory in quality improvement initiative is the Orlando Nursing
theory, Henderson theory and Johnson theory because they all are incorporated with the concept
of goal setting wit the patient and attainment of that goal.
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Conclusion
In conclusion, an essential component in the analysis of conceptual frameworks and theories is
the consideration of their adequacy (Ellis, 1968). Adequacy depends on the three interrelated
characteristics of scope, usefulness, and complexity. Conceptual frameworks are broad in scope
and are sufficiently complex to be useful for many situations, which makes them more versatile
than theories. Theories on the other hand, are narrower in scope, usually addressing less abstract
concepts, and are more specific in terms of the nature and direction of relationship and focus
(Smith and Parker, 2015)
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References
Williams, L.A. (2001). Imogene King’s Interacting Systems Theory: Application in Emergency
and Rural Nursing.Retrieved from
Nursing Theory. (n.d). Kings Theory of Goals Attainment. Retrieved from https://nursing-
theory.org/theories-and-models/king-theory-of-goal-attainment.php
Smith, M. C., & Parker, M. E. (2015). Nursing Theories and Nursing Practice (4th ed.).
Philadelphia, PA: F.A. Davis.
