Planning care through a nursing theory Due Tuesday by 11:9pm Word doc in APA 7th edition with no plagiarism. The purpose of this paper is to demonstrate your ability to plan care through a nursing m

Information from my class that can be used as a basis for this paper. Please write paper on Imogene King’s Goal attainment theory with paragraph headers as seen in APA 7. Template attached.

Theory of Goal Attainment developed by Imogene King. 

Outcomes:

1. Describe King’s early life and the foundations/assumptions of her model.

2. State basic concepts described in the model.

3. Describe care given through the model using the nursing process.

Begin by reading your text, chapter 9, “Imogene King’s Conceptual System and Theory of Goal Attainment “

Theorist early life

Born in 1923, Imogene King grew up in Iowa and received a diploma in nursing from St John’s Hospital School of Nursing in 1945.  She completed a BSN in 1948, a MSN in 1957 and an Ed.D in 1961.  Her model was originally published in 1968 and underwent several revisions after that.  She remained active in nursing until her death in 2007.

The Theory is derived from the interacting systems framework and addresses nursing as a process of human interaction.  This theory focuses on the interpersonal system interactions in the nurse-client relationship.  Outcomes are defined in terms of goals to be attained.  The theory in a “nutshell” states the following:

1. Nurse and client interactions are characterized by verbal and nonverbal communication.

2. Information is exchanged between nurse and client.

3. Disturbance or the problem is noted.

4. Some goal is mutually agreed upon to address the problem.

5. Exploration of a means to attain the goal is initiated.

6. Agreement to the means to achieve the goal and both nurse and client move toward that goal.

7. Transactions are made and the goal is attained.

Theory assumptions

1. Perceptions of the nurse and of the client will influence interactions. When a patient tells you there perception of what is wrong with them and you see other problems that see much more important to you, whose perceptions should you act on?  Whose do you act on?

2. Human Beings are the focus of nursing.

3. Individuals have a right to knowledge about themselves and a right to participate in decisions that influence their life and health. I think this is especially important because of the time this model was developed.  In that time in medicine, physicians did not always tell patients their medical situation and certainly did not include the patient in the decision making process.  It was very much a “Doctor knows best” situation.

4. Health professionals have a responsibility to share information so a person can make informed decisions about health care. This assumption always reminds me of a situation I found myself in when I had only been a nurse for about 2 year.  I was working as a staff nurse in the NICU and admitted a baby with a significant heart defect.  I knew about a new surgery that was being done for this defect in Philadelphia and I knew that the physician also knew about it because we had discussed it.  When I went with him to talk to the parents, they asked him if there wasn’t anything that could be done and he told them “no” there was no treatment for this defect.  When we left the room I asked him why he didn’t tell them about the surgery that was being done in Philadelphia and he said that he didn’t think it was a viable option.  Later when I was with the parents, they said they just couldn’t believe that there wasn’t anything that could be done.  Long story short, I told them about the surgery, they took the baby to Philadelphia and I “got” to go to the nursing office and stay home three days without pay.  Did I do the right thing?  King would say “yes”.

5. People have a right to accept or reject health care. I think this is pretty easy to accept when the patient is an adult who is oriented and really knows what they want.  However, it gets a little less clear when the patient is a child or someone who is no longer oriented and has not left written instructions….

6. The goals of health professionals and recipients of health care may be incongruent. This assumption can be difficult in actual practice.  Do you really believe this?  Can you resist the temptation to try to talk the patient into doing something they don’t want to?

7. Individuals are social, sentient, rational, reacting beings. They are perceiving and controlling with a purpose.  They are action-oriented and time-oriented.

Metaparadigm Definitions

Person – a personal system that interacts with interpersonal and social systems.  They are an open system interacting with the environment each exhibiting permeable boundaries, permitting an exchange of matter, energy and information.  Each person is unique and has rights and responsibilities.  Humans react to persons, events, and objects in terms of perceptions, expectations, needs, values and goals. 

Health- It is a dynamic life experience of human beings.  It involves continuous adjustment to stressors in the internal and external environment through optimum use of one’s resources to achieve maximum potential for daily living.  It can be quantified by the ability to function in social roles.  The ability to deal with stressors of growth and development while functioning within the cultural pattern is a reflections of the level of health.  Illness is an interference in the life cycle.

Environment- The environment is both internal and external.  It is permeable and permits an exchange of energy and information.  Energy transformation exists between internal and external environments.  Nurses must understand the way human beings interact with their environment to maintain health.

Nursing – Nursing is a process of action, reaction, and interaction whereby nurse and client share information about their perceptions in the nursing situation.  The domain of nursing includes promotion of health, maintenance and restoration of health, care of the sick and injured, and care of the dying.  Nurses are partners with physicians, social workers, and allied health professionals in promoting health, in preventing disease, and in managing patient care.  Nurses assist individuals and groups in society to attain, maintain and restore health.  They do this at a point in time in the lifecycle when they cannot do this for themselves.  An understanding of basic human needs in the physical, social, emotional,, and intellectual realm of the life process from conception to old age, within the context of social systems of the culture in which nurses live and work is essential and basic content for learning the practice of nursing.  I think this might have been the answer Dr. Alligood was looking for when she asked me, “What is the nature of the knowledge needed for nursing.”

King defines the Goal of Nursing is to help individuals maintain their health so they can function in their roles.  This goal is reached through a process of human interactions between nurse and client whereby each perceives the other and the situation; and through communication, they set goals, explore means, and agree on a means to achieve the patient’s goals.

Nuts and Bolts – As with all of the models, there are some vocabulary words that must be mastered before the model can be understood.  Let’s look at those.

*Dynamic interacting systems – Health concerns can be grouped into categories known as dynamic interacting. The 3 levels described by King (see p. 137, figure 9-1 in your text) are personal systems (individuals), interpersonal systems (groups) and social systems (society).

*Personal system is the term used for self.  It includes thoughts and feelings that constitute awareness and self-concept, i.e. what we mean when we say “I”.  I also includes growth and development, body image, learning, personal space and coping.  It also includes personal perception of time as it elapses between one event to the next event.

*Interpersonal system is the term used for small groups such as the patient’s family.  When assessing the interpersonal system, the nurse should assess communication, interaction, behaviors expected for a given role, stress/stressors and transaction or the behaviors of human interaction with the environment.

*social system is the term for large groups.  When looking at a large organization/group the nurse should assess organization, authority, power, status and decision making.

Application- the Theory of Goal Attainment has a very logical set of propositions for application.  They are summed up in figure 9-2 on p. 138 or your text.  Examine these propositions in light of what they would look like if you used them with a patient you have cared for recently.

Proposition I

Accurate perceptions between nurse and patient

Leads to

Transactions

Leads to

Goals attained

Leads to

Satisfaction and effective nursing care

Proposition II

Nurses with special knowledge and skills

Leads to

Communication of appropriate information to clients

Leads to

Mutual goal setting

Leads to goal attainment

Proposition III

Congruent role expectations and role performance as perceived by the nurse and client

Lead to

 Transactions

Proposition IV

Transaction made between the nurse and client

Lead to

Enhanced growth and development

* Interaction-Transaction Process – The process begins with assessment which includes perception, communication and interaction between the nurse and client. The patient & nurse perceive each other and the situation.  Then they interact, with the nurse gathering information, validating perceptions, delineating and validating patient concerns, and establishing mutual trust.  Nursing functions include viewing, recognizing, observing, and measuring.

 This is followed by Planning which requires decision making, exploration, and agreement between nurse and client.  Questions to ask include “which goals will serve the patient’s best interest?” What are the patient’s goals?” and “Are the patient’s goals and the nurse’s goals for the patient congruent?”

If the goals are not congruent, the nurse should assess “what further communication and interaction are needed?”, “What are the priority goals?”, “Is the patient willing to work toward goal attainment?” 

As in the nursing process, implementation (transaction) is the next step in giving care.  There are 8 categories of nurse-patient interactions.  They include action, reaction, disturbance, mutual goal setting, exploration of means to achieve the goal, agreement of means to achieve the goal, transaction and attainment of goal.  During this step, the nurse will ask “Am I doing what we have agreed upon?”, How and when do I carry out the actions?”, Why am I carrying out the action”?, and “Is it reasonable to think that carrying out this action will allow attainment of goals?”

Evaluation is the final step and involves evaluation of goal attainment.  If goals are not attained, the

Nurse should attempt to determine why they are not attained.  Unmet goals may result from incorrect or incomplete data, incorrect interpretation of data as a result of perceptual error, lack of knowledge, goal conflict or barriers related to the nurse, patient, or system.