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How King's Theory of Goal Attainment Can Enhance Nurse-Patient Interactions and Outcomes



King's Theory of Goal Attainment: A Guide for Nurses




If you are a nurse who wants to improve your communication skills, enhance your patient outcomes, and foster a collaborative work environment, you might want to learn more about King's theory of goal attainment. This is a nursing theory that was developed by Imogene King in the 1960s and 1970s, and it provides a framework for understanding and facilitating the interactions between nurses and patients. In this article, we will explain what King's theory of goal attainment is, why it is important for nursing practice, and how to apply it in different settings and situations. We will also discuss the benefits and challenges of using King's theory, and provide some evidence and examples of how it works in practice. By the end of this article, you will have a better understanding of King's theory of goal attainment and how it can help you as a nurse.




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Introduction




What is King's theory of goal attainment?




King's theory of goal attainment is a nursing theory that focuses on the relationship between nurses and patients, and how they can work together to achieve mutually agreed-upon goals. According to King, nursing is a process of human interactions, where nurses and patients share information, perceptions, and expectations, and influence each other through transactions. Transactions are defined as "purposeful interactions that lead to goal attainment" (King, 1981). King's theory assumes that both nurses and patients are rational beings who have the ability to perceive, think, feel, choose, set goals, select means to achieve goals, and make decisions. King also assumes that both nurses and patients have their own unique experiences, values, beliefs, needs, goals, and expectations that influence their interactions.


Why is it important for nursing practice?




King's theory of goal attainment is important for nursing practice because it provides a comprehensive and holistic view of the nurse-patient relationship, and how it can be used to improve the quality of care. By using King's theory, nurses can:


  • Establish a rapport with patients based on mutual respect, trust, honesty, and empathy.



  • Assess the patients' needs, problems, concerns, strengths, and resources.



  • Identify the patients' goals and expectations for their health and well-being.



  • Negotiate with the patients on realistic and attainable goals that are consistent with their values and preferences.



  • Plan and implement interventions that are tailored to the patients' needs and goals.



  • Evaluate the outcomes of the interventions and the degree of goal attainment.



  • Revise the plan of care as needed based on feedback from the patients.



By following these steps, nurses can enhance their communication skills, promote patient participation and empowerment, foster patient satisfaction and loyalty, improve patient outcomes and quality of life, prevent or resolve conflicts or misunderstandings, reduce errors or risks, and create a positive work environment.


How to apply it in different settings and situations?




King's theory of goal attainment can be applied in different settings and situations, such as acute care, chronic care, community care, home care, primary care, mental health care, palliative care, and so on. The theory can also be applied to different types of patients, such as children, adults, elderly, families, groups, or populations. The key is to adapt the theory to the specific context and needs of the patients and the nurses. For example, in acute care settings, where the patients have urgent and complex needs and the nurses have limited time and resources, the goals may be more focused on stabilizing the patients' condition, relieving their pain or discomfort, and preventing complications or adverse events. In chronic care settings, where the patients have long-term and multifaceted needs and the nurses have more time and opportunities to build rapport with the patients, the goals may be more focused on managing the patients' symptoms, enhancing their self-care abilities, and improving their quality of life. In community care settings, where the patients have diverse and dynamic needs and the nurses have to collaborate with other health professionals and community partners, the goals may be more focused on promoting the patients' health and wellness, preventing diseases or injuries, and addressing social determinants of health.


Main Body




The concepts and propositions of King's theory




King's theory of goal attainment is based on a set of concepts and propositions that describe the nature and dynamics of the nurse-patient relationship. The concepts are organized into three levels: the personal system, the interpersonal system, and the social system. The propositions are statements that explain how the concepts are related to each other and to the goal attainment process.


The personal system




The personal system refers to the individual nurse or patient as a unique person who has his or her own characteristics, perceptions, motivations, and behaviors. The main concepts in this level are:


  • Perception: The process of organizing and interpreting sensory information to give meaning to one's environment.



  • Self: The composite of one's beliefs and feelings about oneself.



  • Growth and development: The changes in one's physical and mental abilities over time.



  • Body image: The mental image one has of one's physical appearance.



  • Space: The physical distance between oneself and others.



  • Time: The duration of events or activities.



The main propositions in this level are:


  • Each person perceives himself or herself and others differently.



  • Each person has a self that is constantly changing due to interactions with others.



  • Each person has a different level of growth and development that influences his or her behavior.



  • Each person has a different body image that affects his or her self-esteem.



  • Each person has a different perception of space that influences his or her communication style.



  • Each person has a different perception of time that influences his or her expectations.



The interpersonal system




The interpersonal system refers to the interactions between two or more persons who share information, perceptions, expectations, and influence each other through transactions. The main concepts in this level are:


  • Interaction: The process of exchanging information through verbal or nonverbal means.



  • Communication: The process of transmitting information from one person to another.



  • Transaction: The purposeful interaction that leads to goal attainment.



  • Role: The set of behaviors that one expects from oneself or others in a given situation.



  • Stress: The state of tension that results from a perceived threat or challenge.



  • Coping: The process of managing stress through adaptive responses.



The main propositions in this level are:


  • Interactions are influenced by perceptions, self, growth and development, body image, space, and time.



  • Communication is essential for accurate perception and effective interaction.



  • Transactions occur when nurses and patients share information, perceptions, expectations, goals, means to achieve goals, and decisions.



  • Roles are defined by expectations that vary depending on the situation and the relationship.



  • Stress can affect interactions negatively or positively depending on the coping strategies used.



  • Coping can enhance or hinder interactions depending on the appropriateness of the responses.



The social system




The social system refers to the organized groups or communities that have common values, norms, beliefs, and goals. The main concepts in this level are:



  • Organization: The structure and function of a group or community.




  • Status: The position or rank of a person or group in a social system.



  • Power: The ability or potential to influence others or achieve goals.



  • Decision making: The process of choosing among alternatives based on information and preferences.



The main propositions in this level are:


  • Organizations are composed of individuals who interact with each other to achieve common goals.



  • Authority is delegated by organizations to individuals who have the responsibility and accountability to make decisions and enforce rules.



  • Status is determined by organizations based on the roles and contributions of individuals or groups.



  • Power is derived from organizations based on the resources and skills of individuals or groups.



  • Decision making is influenced by organizations based on the values, norms, beliefs, and goals of individuals or groups.



The goal attainment process




The goal attainment process is the core of King's theory, and it describes how nurses and patients work together to achieve mutually agreed-upon goals. The main concepts in this process are:


  • Goal: A desired state or outcome that is specific, measurable, attainable, realistic, and time-bound.



  • Means: The actions or strategies that are used to achieve a goal.



  • Outcome: The result or consequence of a goal attainment process.



The main propositions in this process are:


  • Goals are derived from the needs, problems, concerns, strengths, and resources of nurses and patients.



  • Goals are negotiated between nurses and patients based on their perceptions, expectations, values, and preferences.



  • Goals are attainable when nurses and patients have compatible perceptions, expectations, values, and preferences.



  • Means are selected by nurses and patients based on their knowledge, skills, abilities, and resources.



  • Means are implemented by nurses and patients through transactions that involve information sharing, feedback, and evaluation.



  • Outcomes are evaluated by nurses and patients based on the degree of goal attainment and satisfaction.



The benefits and challenges of using King's theory




King's theory of goal attainment has many benefits and challenges for nursing practice. Some of the benefits are:



  • It provides a comprehensive and holistic view of the nurse-patient relationship that encompasses the personal, interpersonal, and social aspects of human interactions.



  • It emphasizes the importance of communication, collaboration, participation, empowerment, and mutual respect between nurses and patients.



  • It guides nurses to assess the needs, problems, concerns, strengths, and resources of patients; identify their goals and expectations; negotiate with them on realistic and attainable goals; plan and implement interventions that are tailored to their needs and goals; evaluate the outcomes of the interventions and the degree of goal attainment; and revise the plan of care as needed based on feedback from the patients.



  • It helps nurses to improve their communication skills, promote patient satisfaction and loyalty, improve patient outcomes and quality of life, prevent or resolve conflicts or misunderstandings, reduce errors or risks, and create a positive work environment.




Some of the challenges are:



  • It requires a high level of knowledge, skill, ability, and resourcefulness from both nurses and patients to engage in effective transactions that lead to goal attainment.



  • It depends on the compatibility of perceptions, expectations, values, and preferences between nurses and patients, which may vary depending on their personal, interpersonal,



  • It may not be applicable or appropriate for some settings or situations where the nurse-patient relationship is limited, constrained, or conflicted by factors such as time, resources, policies, regulations, ethics, or laws.



  • It may not be supported or facilitated by some organizations or systems that have different values, norms, beliefs, or goals than those of the nurses and patients.



The evidence and examples of King's theory in practice




King's theory of goal attainment has been tested and applied in various settings and situations, and has shown positive results and outcomes for both nurses and patients. Some of the evidence and examples are:


The empirical studies and reviews on the theory




Several empirical studies and reviews have been conducted to examine the validity, reliability, applicability, and effectiveness of King's theory in nursing practice. For example:


  • A meta-analysis of 12 studies that used King's theory as a framework for nursing interventions found that the theory had a positive impact on patient outcomes such as satisfaction, adherence, self-care, quality of life, and goal attainment (Freysteinson et al., 2016).



  • A systematic review of 17 studies that used King's theory as a basis for nursing education found that the theory enhanced the students' knowledge, skills, attitudes, and behaviors related to communication, collaboration, critical thinking, problem solving, decision making, and goal setting (Siow et al., 2018).



  • A qualitative study that used King's theory as a guide for conducting interviews with 10 nurses and 10 patients who had experienced a stroke found that the theory helped to explore and understand the perceptions, expectations, goals, and transactions of both parties, and to identify the factors that facilitated or hindered their goal attainment process (Kaya et al., 2017).



The case studies and scenarios that illustrate the theory




Several case studies and scenarios have been developed to illustrate how King's theory can be applied in practice. For example:


  • A case study of a nurse who used King's theory to care for a patient with diabetes mellitus type 2 showed how the nurse assessed the patient's needs, problems, concerns, strengths, and resources; identified his goals and expectations for his health and well-being; negotiated with him on realistic and attainable goals that were consistent with his values and preferences; planned and implemented interventions that were tailored to his needs and goals; evaluated the outcomes of the interventions and the degree of goal attainment; and revised the plan of care as needed based on feedback from the patient (Alligood, 2018).



  • A scenario of a nurse who used King's theory to care for a patient with chronic obstructive pulmonary disease (COPD) showed how the nurse established a rapport with the patient based on mutual respect, trust, honesty, and empathy; assessed her needs, problems, concerns, strengths, and resources; identified her goals and expectations for her health and well-being; negotiated with her on realistic and attainable goals that were consistent with her values and preferences; planned and implemented interventions that were tailored to her needs and goals; evaluated the outcomes of the interventions and the degree of goal attainment; and revised the plan of care as needed based on feedback from the patient (Freytag & Sieloff, 2009).




Conclusion




Summary of the main points




In conclusion, King's theory of goal attainment is a nursing theory that focuses on the relationship between nurses and patients, and how they can work together to achieve mutually agreed-upon goals. The theory is based on a set of concepts and propositions that describe the personal, interpersonal, and social aspects of human interactions, and how they influence the goal attainment process. The theory has many benefits and challenges for nursing practice, and it has been tested and applied in various settings and situations, and has shown positive results and outcomes for both nurses and patients.


Recommendations for further reading and learning




If you are interested in learning more about King's theory of goal attainment, here are some recommendations for further reading and learning:



  • King, I. M. (1981). A theory for nursing: Systems, concepts, process. New York: Wiley. This is the original book where King presented her theory of goal attainment in detail.



  • Alligood, M. R. (Ed.). (2018). Nursing theorists and their work (9th ed.). St. Louis: Elsevier. This is a comprehensive textbook that covers various nursing theories, including King's theory of goal attainment, and provides examples of how to apply them in practice.



  • Freytag, J. L., & Sieloff, C. L. (2009). King's conceptual system and theory of goal attainment: Past, present, and future. Nursing Science Quarterly, 22(2), 107-112. This is a review article that summarizes the history, development, and application of King's theory of goal attainment, and discusses its implications for future research and practice.




FAQs




Here are some frequently asked questions (FAQs) about King's theory of goal attainment:



  • What is the difference between King's theory of goal attainment and other nursing theories?



King's theory of goal attainment is different from other nursing theories in that it focuses on the relationship between nurses and patients, and how they can work together to achieve mutually agreed-upon goals. Other nursing theories may focus on other aspects of nursing, such as the nature of human beings, the environment, the health, or the nursing itself.


  • How can I use King's theory of goal attainment in my practice?



You can use King's theory of goal attainment in your practice by following these steps: 1) Establish a rapport with your patients based on mutual respect, trust, honesty, and empathy. 2) Assess their needs, problems, concerns, strengths, and resources. 3) Identify their goals and expectations for their health and well-being. 4) Negotiate with them on realistic and attainable goals that are consistent with their values and preferences. 5) Plan and implement interventions that are tailored to their needs and goals. 6) Evaluate the outcomes of the interventions and the degree of goal attainment. 7) Revise the plan of care as needed based on feedback from your patients.


  • What are some examples of goals that can be attained using King's theory?



Some examples of goals that can be attained using King's theory are: 1) Improving the blood glucose level of a patient with diabetes mellitus type 2. 2) Enhancing the self-care ability of a patient with chronic obstructive pulmonary disease (COPD). 3) Promoting the health and wellness of a community with high rates of obesity and hypertension.


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