Imogene King’s Theory of Goal Attainment is one of the essential nursing theories about the nurse-patient relationship. However, it is still being determined why this theory is not used in everyday nursing practice. The purpose of this study was to evaluate the application of King’s theory in the nurse-patient relationship.
Communication, Nurse-patient relationships, Nursing Theory
This article should be cited as follows:
M. Adib-Hajbaghery and M. Tahmouresi. A nurse-patient relationship based on Imogene King’s goal attainment theory. Nursing and Midwifery Studies 7:141-4, 2018.
This URL should be cited as follows:
M. Adib-Hajbaghery and M. Tahmouresi. A nurse-patient relationship based on Imogene King’s goal attainment theory. Nursing and Midwifery Studies [online serial] 2018 [cited 3 February 2023];7:141-4. The following link is available: https://www.nmsjournal.com/text.asp?2018/7/3/141/235636
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Top of the introduction
Nursing, as a scientific discipline, is founded on professional knowledge. The development of new approaches to nursing practice necessitates adequate knowledge of nursing theories.  The nursing theory consists of concepts, definitions, and models derived from logical and inductive reasoning.  It provides frameworks and goals for assessment, recognition, and nursing diagnoses, making nursing care delivery much more accessible.  The application of nursing theories in clinical practice demonstrates nurses’ self-sufficiency and self-awareness.  These theories advocate for better patient care, lower healthcare costs, and, most importantly, improved patient quality of life. , 
Nursing theories commonly used include, but are not limited to, Orem’s Self-Care Theory, Roy’s Adaptation Model, and Orlando’s Nursing Process Theory. All of these theories are based on humanistic relationships and client dignity.  Imogene King’s Theory of Goal Attainment is another relational nursing theory (TGA). TGA is based on nurses’ and patients’ mutual perceptions and facilitates patient- and family-centred care.  It is classified as a mid-range theory.  Although the TGA provides an excellent humanistic framework for establishing a mutual and therapeutic relationship between nurses and their clients, many nurses need to become more familiar with it, limiting its use in clinical practice.
Review of the literature
In 1968, King published her theory in a nursing journal and then expanded and presented it in her book, “General concepts of human behavior.”
 King defines health as the interaction of humans and their surroundings. She believes that each human being is an open system with distinct needs, motivations, and desires that differ from those of other humans. She also stated that needs, motivations, and desires all significantly impact health. 
King’s theory is based on four main elements:
Health is achieved through an appropriate nurse-patient relationship.
The nurse and the patient must have a mutual understanding.
The goals and functions of the nurse and patient must be aligned.
The nurse must use their knowledge to establish the relationship and set goals.
These four elements aid in goal achievement. 
Nursing, according to King, is the interaction and relationship of a person with their environment in order to achieve health and improve human well-being. As a result, nurses must understand how people interact with their surroundings.  Nursing, according to King, is a process with the ultimate goal of achieving health. 
TGA comprises three effective systems: personal, interpersonal, and social.
 In the personal system, King regards each individual as a distinct being and a whole constantly interacting with his surroundings. As a result, each person should be viewed as a personal system with dimensions such as perception, self, growth and development, body image, personal space, learning, and coping. Perception plays a vital role in the nurse-patient relationship because an accurate perception of oneself facilitates the perception of others and even the perception of body image, time, place, and daily life events. It helps a person establish better interaction with their surroundings. ,
According to the findings of a Kemppainen study on a male patient with human immunodeficiency virus (HIV), when healthcare providers realized the patient was HIV-positive, they began to show inappropriate behaviours toward him during the process of care delivery, to the point where he perceived nurses’ behaviours as uncomfortable and bothersome. On the other hand, HIV infection harmed the patient’s perception of himself and his system, as well as his body image and self-esteem.  Perception, according to King, is an essential dimension of the personal system, and each person requires an accurate perception of their own and others’ systems.  Kemppainen observed that nurses and other healthcare providers’ incorrect perceptions of the HIV-positive patient harmed their relationships with him and his self-perception. 
Another dimension of the TGA personal system is body image. Any changes in body image can have an impact on the personal system.  The findings of Kemppainen’s study revealed that changes in the behaviours of others toward the HIV-positive patient altered his body image, gave him hope for the future, and made him feel ashamed of his body. 
Time is an additional dimension of the TGA personal system. Williams emphasized the importance of time in care delivery by stating that most patients were dissatisfied with the long waiting time for medical visits, describing it as an eternity; however, nurses perceived such a period as very short.  Nurses must have an accurate understanding of time because spending extended periods of time on patient care may be perceived as bothersome and exhausting by some patients. Accurately understanding time by nurses can also positively impact their relationships with their patients. Time is of greater importance in pediatric care wards. Longer patient education and medication administration times on these wards are associated with better patient outcomes. As a result, the meaning of time for patients and nurses is heavily influenced by the characteristics of the immediate situation. In other words, in one situation (emergency room), care services should be delivered in a limited amount of time to avoid tired or bothering patients. Also, spending more time with patients can improve outcomes and enhance recovery. 
According to the TGA personal system, there will only be effective interaction between nurse and patient if they have a thorough understanding of each other. In other words, accurate perception of patients’ systems by nurses facilitates goal achievement and nurse-patient interaction. 
The interpersonal TGA system is the second TGA system. The interactions of two or more people in small and large groups create this system. An example of an interpersonal system is the nurse-patient reciprocal relationship. This system requires understanding interaction, communication, transaction, role, stress, and stressors.  These ideas are discussed further below.
Communication with and understanding another person is referred to as interaction. It is usually judgmental and can have an impact on goals. Communication is the process of passing information from one state to another, whereas transaction is a meaningful interaction between people and the environment to achieve the goal of health. ,
Nurses must be well-versed in comprehending the interaction process. This process incorporates both sides of the interaction’s behaviours. A reaction follows each action. This set of actions and reactions is known as interaction. When both sides of an interaction share a common goal and work together to achieve it, an effective interaction occurs, known as a transaction. Only during a transaction do people effectively perform their roles, achieve their predetermined goals, and cope with their surroundings. This cycle includes feedback chains for assessing the interpersonal system continuously. 
The interpersonal system greatly aided TGA’s development. King believed the interpersonal system was far more critical to care quality than the personal and social systems. She also mentioned that the nursing process primarily occurs in the interpersonal system. 
Communication between the nurse and the patient is the foundation of the interpersonal system and the essential requirement for a transaction. It is possible to establish it both verbally and nonverbally.  Williams researched nurse-patient communication in critical situations. In her study, a middle-aged female patient with weakness and feebleness was referred to the emergency room. The attending physician diagnosed acute pulmonary oedema. To manage her acute condition, emergency personnel needed to initiate invasive interventions. They did not, however, understand her condition and did not provide her with adequate treatment information. As a result, she did not consent to treatments, which were not carried out.  This example demonstrates that nurses and physicians must prioritize the development of effective communication with patients to assist them in making wiser decisions that keep their health as their primary goal. Furthermore, they must allow patients to express their perceptions of their illnesses, personal illness-related experiences, and level of stress. Only in this manner can a nurse and a patient assist each other and create a favourable environment for decision-making.  As a result, the goal of health is achieved when both sides of the relationship appropriately interact with each other and collaborate to achieve their goals. 
The social system is the third TGA system. This system establishes a framework for social interactions and interpersonal communications in settings such as schools, workplaces, and organizations. This system enables nurses to manage their caring roles, achieve their professional goals in hospital-based care systems, and have a suitable public status as public health nurses. This system’s dimensions include organization, authority, power, status, and decision-making.
Power is the ability to use organizational resources to attain a goal. At the same time, decision-making is a “dynamic and systematic process by which a goal directed choice of perceived alternatives is made, and acted on, by individuals or groups to answer a question and attain a goal”.
 King defined power as a situation in which people agree to perform either a desirable or adverse action. , In TGA, power is recognized as the goal’s controller and director. Nurses can help patients by using their power. Furthermore, power influences people’s functions and decision-making abilities. Nurses must thoroughly understand the power because identifying and utilizing power sources can help nurses establish relationships and achieve their goals. , Nonetheless, studies have revealed that nurses need a greater understanding of the concept of nursing executive power. In this situation, they cannot find their social status within their organizations and, as a result, cannot play significant roles in maintaining and restoring patient health. 
According to King’s TGA, adequate relationship knowledge and effective communication are absolute requirements of nursing practice. An effective nurse-patient relationship assists nurses in better understanding patients’ conditions, improving care quality, and improving patients’ quality of life.
Discuss and explain King’s Conceptual System Theory.
First explain the 3 systems and provide examples of each system
Explain how the systems influence goal attainment
How could King’s theory help define a clinical quality problem?
Apply this theory to a potential practice quality improvement initiative within your clinical practice.
How could a quality committee align outcomes with King’s Conceptual System Theory?
What additional nursing theory from our readings could also align with an improved quality of practice initiative?