Imogene King’s initial interest in theory was to develop a
conceptual frame of reference to focus and organize nursing knowledge with the goal of
identifying a systems theory for nursing (King, 1981). Introduced in 1981, King’s theory
focused on individuals as personal systems, two or more individuals as
interpersonal systems, and organized boundary systems that regulate roles,
behaviors, values, and roles as social systems.
Interactions within and across systems influence human acts, or behavior, and subsequently, health outcomes. According to King, systems, and interactions are best understood by concepts, the building blocks of theory. Concepts for understanding personal systems are perception, self, growth and development, body image, learning, time, personal space, and coping. Concepts important for understanding interpersonal systems are interaction, communication, role stress/stressors, and transaction.
Concepts useful for understanding social systems are organization, authority, power, status, and decision making. King identified that concepts and relationships are interrelated both within and between systems, which is consistent with general systems theory. Interpersonal systems are composed of personal systems, and interactions with social systems influence both interpersonal and personal. Interactions influence behavior, attitudes, beliefs, values, and customs.
Interactions within and across systems influence human acts, or behavior, and subsequently, health outcomes. According to King, systems, and interactions are best understood by concepts, the building blocks of theory. Concepts for understanding personal systems are perception, self, growth and development, body image, learning, time, personal space, and coping. Concepts important for understanding interpersonal systems are interaction, communication, role stress/stressors, and transaction.
Concepts useful for understanding social systems are organization, authority, power, status, and decision making. King identified that concepts and relationships are interrelated both within and between systems, which is consistent with general systems theory. Interpersonal systems are composed of personal systems, and interactions with social systems influence both interpersonal and personal. Interactions influence behavior, attitudes, beliefs, values, and customs.
Perception, interaction, and organization are comprehensive
concepts for personal, interpersonal, and social systems, respectively.
Perception is a process of organizing, interpreting, and transforming
information from sense data and memory (King, 1981, p. 24). Interaction is defined
as two or more persons in mutual presence and includes a sequence of goal-directed
behaviors (King, p. 85). Organization is a system whose continuous activities are conducted to
achieve goals (King, p. 119). The metaparadigm concepts of person, health, environment,
and nursing are well-defined and explicitly linked: “The focus of nursing is human beings
interacting with their environments leading to a state of health for individuals, which is
the ability to function in social roles” (King, p. 143). There have been few
changes to the conceptual system since it was first published. King has, however, provided
clarification, explanation, and expansion of concepts through multiple publications; addressed
concerns and questions raised by others; and explicated the philosophical and
ethical basis of the conceptual system (Frey, 2004).
As a grand level theory, King’s Conceptual System provides a distinct
focus for the discipline, the process of nursing, and a frame-work for deriving
middle-range theories. The first middle-range theory derived from the conceptual system was
King’s Theory of Goal Attainment (King, 1981). The Theory of Goal Attainment was derived from
personal and interpersonal system concepts and focused on nurse-client interactions
that lead to transactions and goal attainment. A descriptive study of nurse-client
interactions by King resulted in the Model of Transactions and a classification system of
behaviors in nurse-patient interactions that lead to transactions and goal attainment. Key behaviors
in the process of transactions include mutual goal setting, exploration of means to
achieve goals, and agreement on means to achieve goals. The theory of goal attainment
specifies the process of nursing. In addition, it clearly reflects King’s historical emphasis
on nursing outcomes. Outcomes are defined as goals achieved and can be used to
evaluate the effectiveness of nursing care. In the past 2 decades there
has been a considerable extension and application of King’s Conceptual System
and Theory of Goal Attainment (Frey & Sieloff, 1995; Sieloff, Frey, &
Killeen, in press). Sieloff, Frey,and Killeen present a state-of-the-art perspective
by reviewing application of the conceptual system and theory of goal attainment across systems, client
concerns, patient populations, nursing specialties, and work settings;
implementation in hospitals and com-munity settings; the fit of the conceptual system and theory of goal
attainment with evidence-based practice, nursing process, standardized nursing
languages, performance improvement, and technology; and middle-
range theories derived from
the conceptual system. In addition to King’s theory of goal attainment,
middle-range theories derived by others address family (Doornbos, 2000; Wicks, 1995), health
outcomes in children with chronic conditions (Frey, 1995), empathy (Alligood, 1995),
and nursing department power (Sieloff, 2003). Each theory represents an ongoing program
of research.
Imogene King is a strong advocate for theory-based education and
practice for nursing. Her conceptual system for nursing provides a broad and enduring
framework to guide nursing practice, derive middle-range theories, and integrate
ongoing changes in nursing and the health care system.
EmoticonEmoticon