Imogene King

1. Imogene King Sarah Knoll, RN Karla Whitaker, RN Jonathon Rospieski, RN

2. NursingTheory • “Nursing as a profession has a distinct theoretical orientation to practice. This means that the practice of nursing is based on a specific body of knowledge that is built on theory,” (Chitty & Black, 2011). This presentation will focus on the works of Imogene King’s interacting systems framework and theory of goal attainment.

3. Short Video Featuring: Imogene King • http://www.youtube.com/watch?v=1sZPaj-RioE

4. Who is Imogene King? • Born: January, 30 1923 in West Point, Iowa. • Nearly 60 years of nursing experience, practicing as a staff nurse, nurse educator, and nurse administrator. • Faithful Catholic and avid Golfer. • Died: December 24, 2007

5. What Influenced her Philosophy? Hildegard Peplau • Read and reviewed original manuscript • (Toward a Theory for Nursing) denied by John Wiley Publishers • Provided constructive review to influence Imogene’s change and re-submission (A Theory for Nursing: Systems, Concepts, Process) to Wiley Publishers (King, 2008) Adversity influenced from rejected manuscript • ‘“Did adversity influence the development of my theory and/or modify it.’ It is my belief that one does not change a theory or modify (King, 2008)?” • Clarified theory in response to questions from nurses and undergraduate and graduate students from which she taught at and was on faculty Education- This is where her basis of learning was performed • St. John’s Hospital School of Nursing, 1945 (basic nursing education) • St. Louis University, 1948 (BSN) • St. Louis University, 1957 (MSN) • Teachers College, 1961(EdD)

6. What Influenced her Philosophy, ctd. Teaching and Faculty Member- This is where she clarified theory in response to the nurses and undergraduate and graduate students for her theory (King, 2008) • Loyola University, 1961-1966, 1972-1980 • Ohio State University, 1968-1972 • University of South Florida, 1980-1990 (Chitty and Black, 2011) A Theory for Nursing: Systems, Concepts, Process- 1st claim to Theory of Goal Attainment • Focused on persons, their interpersonal relationships, and social contexts in a conceptual framework • These involved 3 interacting systems: personal, interpersonal, and social • Focus of nurse is on the phenomena of the importance of the patient (Chitty and Black, 2011)

7. Imogene King’s Influence on the Four Global Concepts of Nursing • Imogene King spent the majority of her career in academic settings. She defined the four global concepts of nursing exclusively to why they are important to her nursing model/goal attainment.

8. Content of the Theory of Goal Attainment Human Being • Refers to the social being- rational and sentient • Person is able to: • Perceive • Think • Feel • Choose • Select means to achieve goals • Make decisions • 3 fundamental needs of human • For health information that is unable at time when needed and able to be used • For care that seek to prevent illness • For care when person is unable to provide self-care (George,1994) Health • Involves dynamic life experiences of a human being • Implies continuous adjustment to stressors in internal and external environment • Uses one’s resources to obtain maximum potential for daily living

9. Content of the Theory of Goal Attainment, ctd. Environment • The background for human interaction • Involves: • Internal environment: energy is transformed to enable human to adjust to changes from external environment • External environment: nurse is a part of this which involves formal and informal groups (George, 1994) Nursing • Definition: action, reaction, and interaction between nurse and patient which involves sharing information and their perception of the situation. Through communication, they set goals, decide the means, and evaluate achievement of goals • Action: order of behaviors between the mental and physical action • Reaction: order of behaviors in the action • Goal: help patients maintain their health for daily living function • Domain: promoting, maintaining, and restoring the health. Caring for the injured, sick, and dying • Function: Interpret the nursing process in design of the care plan, so that it can be implemented and evaluated. (George, 1994)

10. Inference/Interpretation & Implications/Consequences Inference/Interpretation • If interaction is perceived accurately and present in the nurse-patient interactions… • If the nurse and patient make transaction… • If goals are met… • If transactions occur in the nurse-patient interactions… • If role expectations and performance are seen in the same way by the nurse and patient… • If conflict is seen by either the nurse or the patient… • If the nurse utilizes her skills of appropriate information through effective communication… Implications/Consequences • Then, transaction will occur • Then a goal will be obtained • Then satisfaction will have been made • Then growth and development will be up front • Then transaction will occur • Then stress will occur • Then a mutual setting of a goal and its obtainment will happen (Afaf, 1997)

11. Motivation for King’s Nursing Theory • Development of a conceptual framework of reference to focus and organize nursing knowledge with the goal or identifying a systems theory for nursing. • “The focus of nursing is human beings interacting with their environment leading to a state of health for individuals, which is the ability to function in social roles,” (Fitzpatrick & Wallace, 2006 p. 314).

12. Nursing Process as a Theory A system of interrelated concepts: • Perception of nurse and client • Communication of nursing and client • Interaction of nurse and client • Decision making about goals • Agree to means to attain goal • Decisions made • Goal attained (if not, why not)

13. Assumptions and Viewpoints • The focus of nursing is the care of human beings. • The goal of nursing is the health care of both patients and their families. • Human beings are open systems interacting with their environment constantly. • The nurse and patient communicate information, set goals mutually, and then act to achieve those goals.

14. Knowledge Development • Advocate for theory-based education and nursing practice. • King’s theory provides a framework to guide nursing practice, incorporate nursing theories, and integrate ongoing changes in the nursing and healthcare systems.

15. Evaluation of the Nursing Model • “When using King’s work, nurses focus on goal attainment for and by the patient” (Chitty & Black, 2011). • The steps of the nursing model occur simultaneously as the nurse and patient work towards achieving their goals. • Assessment: The nurse and patient must communicate closely with each other, working as a team. • “The nurse brings special knowledge and skills whereas client brings knowledge of self and perception of problems of concern, to this interaction” (Current Nursing). • Diagnosis: Both the patient and nurse must agree on the nursing diagnoses they are focusing on so that they can start the next step, planning. • Planning: This requires the patient to participate with the nurse to develop the goals they plan to achieve. • Implementation: The patient completes the tasks and skills necessary to achieve their goals with the help and guidance from their nurse. • Evaluation: Did the patient achieve their goals?

16. Influence on Every Area of Nursing • King’s nursing theory is beneficial to all areas of nursing, ranging from emergency medicine, to obstetrics, behavioral medicine, etc because it is an abstract concept model. • Every patient is dealing with some sort of problem or issue. They are working on being well and setting goals and working to achieve those goals will aid in the recovery process. • Example: • In behavioral medicine all patients are required to have two daily goals. These are set in the morning with the assistance of the RN. Throughout the day open communication and a lot of hard work goes into the patient achieving their goals. At the end of the day, the patients must evaluate if they successfully completed their goals and what they still need to work on for the future. • In emergency medicine the patient may have several short term goals to first stabilize their health. A perfect example of this would be to maintain an SaO2 of 92% or higher while in the ED. The patient will work towards this goal by focusing on their breathing and maintain a healthy rate while the nurse will administer oxygen/suction as needed.

17. Imogene King’s Legacy • Imogene King’s nursing theory of goal attainment is one that can be used in every aspect of nursing, from short term to long term patient care. • “When she was inducted into the American Nurses Association Hall of Fame in 2004, her biography noted that King modeled nurses' ‘responsibility to actively contribute to the advancement of the profession. As a result, she has personally influenced the life, community, and profession of nurses and nursing’” (Kennedy, 2008).

18. Case Study Mr. Jones is an 76 year old admitted to your cardiac unit for recurrent fainting spells, hypertension, and lethargy. Recently, his wife unexpectedly passed away. Mrs. Jones was in charge of ensuring that Mr. Jones received his blood pressure, cholesterol, and arthritis medication. During your intake assessment you find that Mr. Jones has been intermittently taking his medications. You discuss the factors that are precluding him from taking medication regularly and find that he cannot see the small tablets to clearly identify them, he is unsure how his wife requesting refills, and he no longer has a reminder to take his pills.

19. Case Study (con’t) You explain to Mr. Jones the consequences of missing medications and set a expectation that medication should be given every day as prescribed by his physician. Mr. Jones is in agreement and he, along with his adult children, agree on the plan of care you have set for him. A plan is set for a timer to remind him of medication, a weekly pill box that his daughter will help set up each week, and you have arranged for his pharmacy to place reminder calls when a refill is due.

20. Case Study Questions: • Based on information provided, has the nurse addressed the four global concepts of King’s theory of goal attainment? If so, how? If not, what should the nurse have done differently?

21. References • Afaf, M.I. (1997), Theoretical nursing : Development & progress (3rd ed.). Philadelphia,PA.  Lippincott. • Chitty, K., & Black, B. (2011). Nursing theory: The basis for professional nursing. In Heights: Saunders Elsevier (sixth ed.).  Professional Nursing Concepts & Challenges. 311-312 • Current Nursing. (2012). Imogene King’s theory of goal attainment. Theory of goal attainment and the nursing process. Retrieved from http://currentnursing.com/nursing_theory/goal_attainment_theory.html. • Davidson, H. (2006). King Theory of Nursing. Gale Encyclopedia of Nursing and Allied Health, (3rd ed.). • Fitzpatrick, J., & Wallace, M. (2006). Encyclopedia of Nursing Research. pp. 314-315. • George B. J. (1994). Nursing Theories: The base for professional nursing practice (3rd ed.) Norwalk, CT. Appleton & Lange. • Kennedy, M. (2008). In memoriam: nursing loses a legend. Imogene King. American Journal Of Nursing, 108(3), 87. DOI: 10.1097/01.NAJ.0000312271.47979.7b • Killeen, M., & King, I. (2007). Viewpoint: Use of King's Conceptual System, Nursing Informatics, and Nursing Classification Systems for Global Communication. International Journal of Nursing Technologies and Classifications, 18(2), 55. DOI: 10.1111/j.1744-618X.2007.00050.x • King, I.M. (2008). Adversity and theory development. Nursing Science Quarterly. 21(137). 137-138. doi:10.1177/0894318408316406