Ross, B., & Cobb, K. (1990). Family nursing: A nursing process approach. Redwood City, CA: Addison-Wesley Nursing.
Imogene King: Goal Attainment Model
In the goal attainment model developed by Imogene King, human beings and health are two major concepts. Basic to the model is the assumption that the focus of nursing is "human beings interacting with their environment leading to a state of health for individuals, which is an ability to function in social roles" (King, 1981). The structure of King’s framework includes individuals or personaI systems; groups or interpersonal systems and society or social systems. Families are considered social systems (King. 1983). King described these systems through a set of related concepts. These concepts include growth and development, self, perception, role, communication, transaction, stress, space and time, and interaction.
Personal Systems [Definition of Concepts]
Individuals are characterized as social beings who are rational, [conscious and aware] (King, 1981). Through the individual’s senses, inputs are processed from the environment. Concepts that are related to the individual include perception, self, growth and development, body image, and time and space (George, 1985; Fawcett, 1984).
Perception, as defined by King (1981), is "a process of organizing, interpreting, and transforming information from sense data and memory. It is a process of human transactions with the environment" (p. 24). For King (1983), perception is a key concept for nurses caring for families. Through interactions with the family, the nurse’s and the family’s perceptions are verified and specific problems are identified. Once perceptions have been validated for accuracy, goals can be etablished.
Self is viewed as a sum total of the individual. Growth and development processes include cellular, molecular, and behavioral changes and are a function of genetic endowment, meaningful and satisfying experiences, and an environment conducive to helping individuals move toward maturity (King. 1981).
Families, as social systems, influence growth and development patterns as individuals move from dependence to independence (King, 1983). Nurses caring for families can make observations [and determinations regarding] the growth and development patterns [within families].
King (1981) defined body image as "a person’s perceptions of his own body, others’ reaction to his appearance, and is a result of others’ reaction to self" (p. 33).
She defines time as "the duration between the occurrence of one event and the occurrence of another event. The term is used to give order to events and to determine duration based on perceptions of each person’s experiences" (King, 1981, pp. 44).
Space is defined by King as "existing in all directions and is the same everywhere...as the physical area called territory and by the behavior of individuals occupying space " (King, 1981, pp. 37). In applying this concept to families,, King states, "Family movement through social space is called vertical movement: movement through physical space is geographic mobility" (King, 1983, p. 182)
Interpersonal Systems
When two or more human beings interact, interpersonal systems are formed.
Related concepts associated with these systems include role. transaction, and stress. Through verbal and nonverbal communication that is goal directed. the process of interaction occurs between two or more individuals (King. 1981). Individuals acting in specific roles communicate their needs, values, and wants …[thus] transactions occur (King, 1983).
Stress is dynamic because open systems are in constant interaction with the environment. While a certain amount of stress is necessary for [constructive] human functioning, it can precipitate crisis and be destructive when the degree of stress is overwhelming (King, 1983).
Social Systems
Larger systems known as social systems are formed when interpersonal systems join together. "A social system is defined as an organized boundary system of social roles, behaviors, and practices developed to maintain values and the mechanisms to regulate the practices and rules" (King, 1981. p. 115). Families can be viewed as social systems (King, 1983).
Concepts related to social systems include organization.power, status, authority and decision making. When individuals act in specific roles or positions and use their resources to accomplish goals--organization exists. In this sense, families can be considered as small organizations.
King (1981) defines power as the ability to influence others in a particular situation. The specific position of an individual within a particular group is termed "status" while authority is defined as "a transactional process characterized by active, reciprocal relations in which members’ values, background and perception play a role in defining, validating, and accepting the authority of individuals within an organization" (King, 1981, p. 124). Decision making occurs when individuals make a goal-directed choice from various alternatives to answer a question or attain a specific goal (King, 1981).
Other terms used by King in her model include environment, health care environment, internal environment, and external environment. Interactions occur within the environment, and individuals are continually adjusting to the stressors within the environment. Health is seen as a functional state while illness is viewed as dysfunctional or as an interference with being in a functional state.
Nursing is viewed as a process of interactions with clients. Through this interaction, the nurse and the client share information as well as their perceptions of the situation. Through the communication process, nurses and clients set mutual goals and identify methods to achieve the goals (King, 1981). King (1981)believes nursing involves "perceiving, thinking, relating, judging, and acting vis-a-vis the behavior of individuals who come to a nursing situation" (p. 2). Nursing practice is accomplished through the nursing process which includes action, reaction, interaction and transaction (King, 1981). Nursing goals are designed to assist clients to meet the mutually established goals that have been identified.
In using King’s model for nursing care of families, assessment occurs during interactions with the family. King believes that the goal-oriented nursing record, an adaptation of the Weed problem-oriented medical record, provides a systematic approach in the implementation of the goal attainment model (King,
1981, pp. 167–177). Using King’s model (King.1983; King, 1981), the following outline provides guidelines for family assessment.
Applying King’s Model to Families
Fawcett, J. (1984). Analysis and evaluation of conceptual models of nursing. Philadelphia: F.A. Davis.
George, B. (1985). Nursing theories: The base for professional practice. Englewood Cliffs, NJ: Prentice-Hall.
King, I. (1981). A theory for nursing. New York: Wiley.
King, I. (1983). King’s theory of nursing. In Clements, J. & Roberts, F (Eds.), Family health: A theoretical approach to nursing. New York: Wiley.