Imogene King Theory of Goal Attainment 1971 (USA)

Imogene King Theory of Goal Attainment 1971 (USA)
Imogene King was born in 1923. She received her basic nursing education from St.John’s Hospital School of Nursing, Missouri and M.S. in nursing from St.Louis University and Ed.D from Colombia University. She also did her post doctoral study in research design, statistics and computers.
King’s ‘Toward a Theory for Nursing: General concepts of Human Behavior ‘was published in 1971 at the age of 48 years and ‘Theory of Nursing: systems, concepts and process’ in 1981. In 1997, King identified her framework as a conceptual system. The conceptual system includes goal, structure, functions, resources and decision making.  Here, the health as the goal of nursing, structure is three open systems, functions are demonstrated in relations of interaction and transaction. Resources include people, money and services for items needed to carry out specific activities. Decision making occurs when choices are made in resources allocation to support attaining system goals. The conceptual system is composed of three interacting system: the personal, interpersonal and social systems.
Personal system
The sub concepts are perception, information, energy, self growth and development, body image, apace, time and learning. King discusses perception as a process in which data obtained through the senses and from memory are organized, interpreted and transformed. The characteristics of self are the dynamic person, who is an open system and whose actions are oriented. The growth and development is the process in people lives through which they move from potential for achievement to actualization of self. Body image is characterized as very personal and subjective. The space is a physical area known as territory and by the behaviors of those who occupy it. She defines time as interval between the4 two events that is experienced differently by each person. She stated that when personal systems come in contact with one another, they form interpersonal systems.
Interpersonal system
The sub concepts are interpersonal relations, communication, interaction, transaction, role and stress. King included interpersonal relations as a concept of interpersonal system. Interaction is defined as the observable behavior of two or more persons in mutual presence. Communication involves the exchange of information between persons. Transaction is a series of exchanges between human being and environment. The role has three elements such as a set of expected behaviors in the social system, a set of rules with a position and relationship of two or more persons who are interacting in a particular situation. King defines stress as an ever changing condition in which as individual, through environmental interaction, seeks to keep equilibrium to support growth and development and activity. These interpersonal systems join together to form layer systems known as social system.
Social system
The sub concepts are social organization, role, status, authority, power, decision making and control. An organization is characterized by a structure that orders positions and activities and ruled by individuals who make use of resources to meet organizational goals. King defines authority as an active, reciprocal process of transaction in which the actor’s experience, understanding and values influence the meaning, legitimacy and acceptance of those in organizational positions associated with authority. Power includes organizational capacity, to use resources to meet goals. Decision making is defined as the orderly process through which choices related goals are made among identified possible activities. From the above mentioned conceptual model, she derived the theory of goal attainment.
King’s theory of goal attainment
The original concepts of theory are interaction, perception, communication, transaction, self, role, stress, growth and development, time and personal space. Interaction is the observable verbal and non verbal goal directed behaviors of two or more people in mutual presence and includes perception and communication. Interaction brings different ideas, attitudes and perceptions to the exchange called transaction. Perception is the reality as seen and experience by the individual. The elements of perception are the importing of energy from the environment and organizing it by information, transforming energy, processing, storing and exporting information.
Role is defined as set of behaviors, decision making is the process of making choices from the many available choices and health is goal of nursing. King indicates the outcome is an individual’s state of health or ability to function in social roles. From the theory of goal attainment, she has developed predictive propositions that a) perceptual accuracy, role congruence and communication leads to transaction 2) transaction leads to goal attainment 3) goal attainment leads to satisfaction and effective nursing care.
The theory is useful, testable and applicable to nursing practice. It is widely generalized and not situation specific. It is based on the review of literature and provides the reader with a set of resources for further study. Her work provides nursing with an excellent example of profession.

Nursing and theory development

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Nursing and theory development

 
“Nursing is a profession with unique body of knowledge and well principled skills, emphasis on care of human being during ill health to health continuum by meeting the needs physically, psychologically, socially and medically with modification of environment of individual, family and community through nursing practice, education and research”.

Theoretical thinking
The first unit of theory is concept. A concept is an idea or thought comes to mind through experience or observation. The concepts are divided into two; empirical and abstract. The empirical concepts (phenomena) are observed through senses, for example, heart rate and abstract concepts (intuition) are not observable, for example, caring.
The term metaparadigm indicates the boundaries of a discipline which summarizes the mission of the same discipline. There are four metaparadigm related to nursing; person, health, environment and nursing. The person represents individual, family or community. Health is a state of well being and environment is the surroundings of the person and nursing is the practice of the science based on the aspect of ‘care’, ‘cure’ and ‘prevention’. A proposition explains the relationships between the concepts. 

“A theory is a creative arrangement of concepts with definitions and its propositions in general, which describes the phenomena or intuition and its relationships, predict the actions and reactions through the research and solve problems in the reality”.

“A conceptual framework is a pictorial representation of theory or conceptual model”.

“A conceptual model is a creative arrangement of concepts related to specific event or problem in the reality with definitions and its propositions, which describes the phenomena or intuition and its relationships, predict the actions and its reactions through the research and solve the problems in the reality”. 

Barnum (1998) stated that a complete nursing theory is one that contains context, content and process. Context is an environment, content is the subject and process is the way of act to use the theory.
Smith and Liehr (2003) suggested three rungs for the model; philosophical, theoretical and empirical. The philosophical (highest) rung represents the beliefs and assumptions which are true and fundamental to a theory. The theoretical (middle) rung is abstract and consists of the symbols, ideas and concepts of the theory and empirical (lowest) rung is concrete, which is observed by senses. 

Levels of theory
Chinn and Kramer (2004) stated that theory is divided into micro, macro, midrange, atomistic or wholistic. Micro and atomistic suggests narrow range, where as, macro and wholistic implies a broad range. Middle range theories deal with a portion of nursing’s total concern but not with the totality of the discipline. Grand theory covers broad areas of concern with a discipline and meta theory is about theoretical process and theory development. Middle range theories are based on day to day research, narrow in scope, limited number of concepts and propositions, less abstract and more applicable to practice.
Im (1999) stated that situation specific theories are focused on specific nursing intervention phenomena, limited to specific population, are not intended to be universal theories and are may or may not be testable.

Dickoff and James (1968) developed theory on four levels:
Level 1: factor isolating – is descriptive in nature and naming or classifying the events.
Level 2: factor relating – associating or correlating factors
Level 3: situation relating – explains and predicts how situations are related
Level 4: situation producing – it requires sufficient knowledge about how and why situations are related. Level 4 being the most powerful, as it controls rather than description, explanation or prediction. 

Fawcett (2005) described various types of middle range theory. She stated that middle range theories describe what a phenomenon is, explain why it occurs and predict how it occurs. Middle range descriptive theories describe only one concept or classify a phenomenon. Middle range explanatory theories specify relations between two or more concepts and middle range predictive theories predict relationship between concepts. 

Johnson and Webber (2005) propose a criterion based critique model for nursing theories.
Phase 1: Intention of the theory

• Criterion I: understandable meaning
• Criterion II: consistent boundaries
• Criterion III: understandable language

Phase 2: Concepts and propositions

• Criterion IV: identify the major concepts
• Criterion V: formulation of propositions
• Criterion VI: understand and interpret the propositions

Phase 3: Usefulness in nursing practice

• Criterion VII: explains and predicts the phenomena
• Criterion VIII: influences nursing practice

Theories provide a platform to facilitate critical thinking to explain phenomena, identify the relationship between the concepts, solve the problems in the reality and predict the actions and reactions in the future. As new knowledge and discoveries emerge in nursing realms, the boundary of art and science of the discipline of nursing dissolves and fuses together.

Martha Rogers Science of Unitary Human Beings Model, 1970 (USA)

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Martha Rogers Science of Unitary Human Beings Model, 1970 (USA)

Martha Rogers was born on 1914 and earned a bachelor’s degree in nursing from George Peabody College, master’s degree in public health nursing from Columbia University and doctorate in nursing from the John Hopkins University. She was a teacher and mentor to an impressive list of nursing scholars and theorists. Rogers continued her work and writing until her death in 1994. 

Martha Rogers described her theory of Unitary Man in 1961 and stated that person was a ‘Unitary energy system’ in ‘continuous mutual interaction with the universal energy system’, ‘dramatically influenced nursing by encouraging nurses to consider the person as a whole entity when planning and delivering care’.

She published the book in 1970 at the age of 56 years; An introduction to the theoretical basis of nursing science, Rogers outlined the five assumptions that provide the foundation for the discipline of nursing.

1. Man is a unified whole possessing his own integrity and manifesting characteristics that are more than and different from the sum of his parts.
2. Man and environment are continuously exchanging matter and energy with one another.
3. The life process evolves irreversibly and unidirectionally along the space time continuum.
4. Pattern and organization identify man and reflect his innovative wholeness.
5. Man is characterized by the capacity for abstraction and imagery, language and thought, sensation and emotion.

Rogers condensed the assumptions to five blocks of the conceptual system (Rogers, 1992):

1. Energy fields
2. Pan dimensionality
3. Pattern
4. Unitary persons
5. Environment 

An energy field is defined as the distinguishing characteristics of an energy field perceived on a single wave. It is the unique configuration of relationships of a particular system. Areas of human field’s pattern that have been explored include pain, stress, hope, time etc.

She identified two energy fields of concern to nurses, which are integrated; human field and environmental field. The human field can be conceptualized as a person or groups, family or community. These fields can not be broken into sub systems. She interpreted the nursing care is holistic, meaning a summation of parts to arrive at the whole, where a nurse would assess the domains, subsystems identified, then synthesize the accumulated data to arrive at a picture of the total person. A change in one field causes alterations in other field. Both are integrated, can not be separated.

The fields are pan dimensional, defined as ‘a non linear domain with out spatial or temporal attributes’. Pan dimensional reality transcends traditional notions of space and time, which can be understood as perceived boundaries only.

Principles of homeodynamics

She defined the three principles of homeodynamics are reasoning, helicy and integrality. It describes the nature of change in the human environmental field process.

Principle of resonancy specifies the continuous change from lower to higher frequency wave pattern in human and environmental fields. Rogers elaborated: ‘individuals experience lesser diversity and greater diversity, time as slower, faster and unmoving’.

The principle of helicy is the continuous innovative unpredictable, increasing diversity of human and environmental field patterns. This describes the nature of change. The principle of integrality is continuous mutual human fields and the environmental field process. It specifies the context of change as the integral human environmental field process where person and environment are inseparable.

Together, postulates of Rogerian nursing science suggest that the human and environmental field change continuously, flow in lower and higher frequencies. Rogers believed that they serve as guides both to the practice of nursing and to research in the science of nursing.

Dorothy Johnson Behavior System Model 1968 (USA)

Dorothy Johnson Behavior System Model 1968 (USA)

Dorothy Johnson was born in Savannah, Georgia in 1919. She earned her bachelor of science in nursing from Vanderbilt University and her master’s in public health from Harvard University. At the age of 49 years, Johnson proposed the nursing care facilitated the client’s maintenance of a state of equilibrium. She said that clients were ‘stressed’ by internal and external stimulus. The nursing care should reduce the stimulus and facilitate the client’s natural defenses. She defined nursing as ‘external regulatory force which acts to preserve the organization and integration of the patient’s behavior at an optimum level under those conditions in which the behavior constitutes a threat to physical and social health or in which illness is found’.

Based on the definition, the four nursing goals are to assist the patient to become a person whose behavior is commensurate with social demands, who is able to modify his behavior in ways that support biologic imperative, who is able to benefit to the fullest extent during illness from the physician’s knowledge and skill and whose behavior does not give any evidence of unnecessary trauma as a consequence of illness.

Major concepts of the model

Person

The client is seen as a collection of behavioral subsystems that interrelate to form the behavioral subsystems. The system may be defined as those complex, overt actions or response to stimulate in the environment. Johnson has identified seven behavioral subsystems in the client. According to this, each subsystem has to be protected from noxious stimulus. Second, it must be nurtured and last, it must be stimulated to prevent stagnation of growth. 

The subsystems are:

• Attachment and affiliation
• Dependency
• Elimination
• Sexuality
• Ingestion
• Aggression
• Achievement

Attachment and affiliation–It is identified as first response systems to develop in an individual. It allows social inclusion, intimacy and the formation and maintenance of a strong bond, which provides the individual with sense of security.

Dependency- It allows and develops cooperative and independent role relationships with in human social system. They use interpersonal skills to achieve intimacy. 

Ingestion – It is related to food intake. The aim of the subsystem is to sustain life, to relieve discomfort and to obtain physical pleasure from intake of food.

Elimination- It relates to behavior surrounding the excretion of waste products from the body. It also helps the client to adjust to alterations in biological capabilities related to waste excretion while maintaining a sense of control over waste excretion.

Sexuality- It relates to procreate, to gratify or attract to fulfill expectations associated with one’s sex, to care for others and to be cared about by them.

Aggression- It relates to behaviors concerned with protection and self preservation. Johnson views the aggressive subsystem as one that generates defensive response from the individual when life or territory is threatened.

Achievement- It means mastery or control of self or the environment. Intellectual, physical, creative, mechanical, social skills are some of the areas that Johnson (1980) recognizes.

To conclude, Johnson’s behavioral system model is based on nursing care, advocates on behavioral functioning of the patient. The client is composed of 7 subsystems and each subsystem related to 4 structural characteristics: drive, set, choices and observable behavior. An imbalance in any behavioral subsystem results in diseases and nurse’s role is to assist the client to return to a state of equilibrium.