Nursing Research: (Imogene) King’s Conceptual System and Theory of Goal Attainment

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.
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.