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King’s Conceptual System Theory in Clinical Practice

Introduction

Imogene M. King coined conceptual system theory to help nurses care for patients. The theory is known as the goal attainment theory and was introduced in 1968-1971 and then expanded since 1981, focusing on the nurse-patient relationship to obtain set health goals (Friend & Sieloff, 2014). The theory contains three systems that influence goal attainment:

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  1. personal,
  2. interpersonal,
  3. social.

Conceptual system theory addresses healthcare quality improvement, and healthcare providers can implement the theory in clinical practice.

Conceptual Systems of the Goal Attainment Theory

The first system is personal, which King attributes to the nurse-patient relationship as the relationship between two individuals. King allocates “body image, growth, development, perception, self, space, and time” in the system description (Gonzalo, 2021, Personal Systems section, para. 1). Perception and self are how an individual perceives his surroundings and himself. Self includes awareness of one’s existence, ideas, attitudes, values, experience, etc. (Gonzalo, 2021). Perception and self are the central concepts of the personal system, shaping responses in other system concepts.

Consequently, body image is one’s perception of his body and responses to external reactions to his body. Space and time define where, when, and how long events occur and how participants perceive them. Growth and development are readiness to improve to achieve set goals. The potential for improvement and its actual results are connected to the process of learning (Gonzalo, 2021). An example of the personal system is the nurse’s understanding of the patient’s attitude towards himself and presented health issues, efficient time-management not to bother the patient more than needed, and mutual respect for personal boundaries.

The interpersonal system is defined as individuals interacting to attain goals. King highlights “communication, interaction, role, stress, and transaction” as the main concepts of the system (Gonzalo, 2021, Interpersonal Systems section, para. 1). Communication as the direct or indirect exchange of information is the basis for interactions, how individuals behave in the presence of each other (Gonzalo, 2021). The individuals take on specific roles in communication, giving or receiving information, while the transaction is an outcome, namely actions to achieve set goals. The last concept is stress which is, simply put, the “regulation and control of stressors” in the individual’s communication with the environment (Gonzalo, 2021, Interpersonal Systems section, para. 6). The interpersonal system covers all forms of communication between healthcare providers and patients and helps avoid miscommunication, therefore adverse healthcare outcomes. One example of the system is a patient interview during which healthcare providers attain the patient’s medical, family, personal, and social history and the patient’s perception of his health issue.

The final system is social; it encompasses groups in the society, enabling social communication within these groups and between them. The system includes such concepts as “authority, decision making, organization, power, and status” (Gonzalo, 2021, Social Systems section, para. 1). Status in a group determines authority and power to use the group’s resources and influence the group’s members to achieve goals (Gonzalo, 2021). Authority and power also determine a group’s permissibility to pursue set objectives. The organization grants status to each member of a group and allocates resources. The organizational framework enables control over a group’s activities and goals. Each member of a group partakes in decision-making depending on their status. King (1990) states that decision-making involves a “goal-directed choice” that “is made and acted upon by individuals or groups to … attain a goal” (as cited in Gonzalo, 2021, Social Systems section, para. 4). An example is the nurse’s organizational power to assess patients’ responses to health conditions, evaluate risks and create a nursing care plan. The nurse should understand their status within a healthcare facility to efficiently implement nursing care and appropriately react to possible complications during treatment.

Influence of Conceptual Systems on Goal Attainment

Conceptual systems are interrelated and influence goal attainment as a whole. Insufficiency in one system may jeopardize healthcare practice despite the efficacy of other systems. Adib-Hajbaghery and Tahmouresi (2018) argue how “others’ behaviors toward the HIV‑positive patient altered his body image, gave him feeling of despair over the future, and made him feel ashamed of his body” (p. 142). Changes in one’s body image contribute significantly to mental instability and affect healthcare outcomes. Healthcare providers’ wrong perception of the HIV‑positive patient negatively influenced their relationships and communication and resulted in poor medical practice overall (Adib-Hajbaghery & Tahmouresi, 2018). Negative feelings relating to the nurse-patient interactions, treatment, and the organization always hinder the goal attainment.

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The ineffectiveness of the interpersonal system can result in drastic consequences as well. For example, not providing complete treatment‑related information leads to the patient’s lack of understanding of the health issue and its treatment. Adib-Hajbaghery and Tahmouresi (2018) note a case in which a patient refused treatment of acute pulmonary edema because he did not understand the scope of the problem. Such missteps from healthcare providers are life-threatening and question the institution’s reputation. As for the social system, the nurse’s accurate knowledge regarding their role and power in the facility can guarantee a beneficial relationship with a patient and goal attainment (Adib-Hajbaghery & Tahmouresi, 2018). Conversely, a nurse without a proper understanding of their status is not able to “play significant roles in maintaining and restoring patient health” (Adib-Hajbaghery & Tahmouresi, 2018, p. 143). In conclusion, understanding conceptual systems and acting upon them enables healthcare providers to attain set goals without obstacles.

Application of the Theory Regarding Clinical Quality

Various clinical problems may arise due to poor healthcare practice. Friend and Sieloff (2014) note: “[initially] the problems were identified as (1) a lack of a professional nursing language, (2) lack of theoretical nursing phenomena, and (3) limited concept development” (p. 136). Nowadays, comprehension of King’s ideas helps define and avoid some of the medical errors, notably misdiagnoses, amenable mortality, lack of clarity in diagnoses, and other preventable mistakes. The theory is well structured, and concepts are clear and supported by examples, enabling knowledge-building in nursing (Gonzalo, 2021). As a result, nurses are equipped with guidelines for establishing appropriate relationships with patients and setting goals. Poor practice displayed in the examples above could be avoided with empathy, extensive communication, and awareness of one’s responsibilities as a healthcare professional.

Quality Improvement Initiative in Clinical Practice

King identified how her ideas might be integrated into the nursing process. The process involves actively working with patients to understand their health issues, set goals, apply treatment, and prevent risks. Using personal and interpersonal systems, a nurse collects information about a patient during the assessment, for example, a patient with chronic obstructive pulmonary disease (Gonzalo, 2021). The nurse makes sure that the patient with COPD understands his condition and realizes the risk factors associated with the disease. The patient is a heavy smoker and suffers from obesity, having no interest in physical activity; hence the nurse communicates the risks to the patient. Then, the nurse promotes the cessation of smoking and increased physical activity. The goal is mutually set to reduce symptoms of COPD and avoid possible complications. The means to achieve the goal are agreed upon, and the nurse assists the patient to follow them. They include giving up smoking, physical and breathing exercises, proper rest, and regular food and water consumption. The nurse supervises oxygen usage and intake of medications. Such nursing care will help the patient alleviate symptoms and avoid risks.

Quality Improvement Committee and Goal Attainment

Quality improvement committee (QIC) is established in healthcare facilities to improve clinical care utilizing nursing theories, providing training, and overseeing professionals, patients, and services. To align improvement outcomes with King’s ideas, the committee should develop and suggest training for nurses’ communication and leadership skills improvement (Friend & Sieloff, 2014). Training to enhance nurses’ professional knowledge, including briefings about their status and power, may be implemented. The committee should also supervise nurses’ usage of the standardized nursing language as it improves communication and fosters the development of King’s theory “by building on concepts unique to nursing” (Friend & Sieloff, 2014, p. 141). Regarding goal attainment, QIC establishes active communication with institution personnel, sets goals, explores means to achieve them, and agrees on the means (Friend & Sieloff, 2014). QIC emphasizes that the nursing process’s primary goal is helping patients achieve their healthcare goals.

Florence Nightingale’s Theory of Nursing

Florence Nightingale’s environmental theory is nearly two centuries old, but it corresponds to patients’ needs that do not change with time. The approach concerns healthcare environments, their impact on patients, and how to configure healthcare environments to be most efficient (Dunphy, 2014). Modern healthcare facilities should provide patients with safe and caring surroundings. Combining the environmental theory revised for modern perspective with the goal attainment theory will enhance the nursing process, making it patient and goal-oriented.

Conclusion

The introduction of King’s goal attainment theory inspired nurses to apply it to practice. Understanding personal, interpersonal, and social systems guarantees fruitful implementation of care, thus achieving set goals. King’s ideas foster qualities necessary for nursing and propagate behaviors that minimize medical errors. The objective is to establish trust-based relationships understanding patients’ health issues, potential risks, and needs. Nurses should be professional and have a therapeutic perspective being open-minded, attentive to detail, and polite. It is essential to reflect on the provided nursing care and make adjustments for future practice.

References

Adib-Hajbaghery, M., & Tahmouresi, M. (2018). Nurse-patient relationship based on the Imogene King’s theory of goal attainment. Nursing and Midwifery Studies, 7(3), 141-144. Web.

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Dunphy, L. M. H. (2014). Florence Nightingale’s conceptualizations of nursing. In M. C. Smith and M. Parker (Eds.), Nursing theories and nursing practice (4th ed., pp. 35-54). F. A. Davis Company.

Friend, M. L., & Sieloff, C. L. (2014). Imogene King’s conceptual system and theory of goal attainment. In M. C. Smith and M. Parker (Eds.), Nursing theories and nursing practice (4th ed., pp. 135-148). F. A. Davis Company.

Gonzalo, A. (2021). Imogene King: Theory of goal attainment. Nurseslabs. Web.

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