King’s Theory of Goal Attainment in Care Delivery


In healthcare, issues and problems should be addressed in the most effective manners to obtain optimal outcomes, satisfaction, and positive patient perception of the quality of care. Various techniques, especially on nurse practice, are employed to optimize performance in health care systems and facilities. For instance, King’s Theory of Goal Attainment is one of the most effective techniques that has been adopted in addressing vital concerns in care delivery (Alligood, 2013).

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It is worth noting that various health care systems adopt theories as solutions to numerous issues affecting nursing practice. Nursing theories form an integral part of the systemization of nursing practice and knowledge in the diverse fields of health care delivery (Alligood, 2013).

Imogene King put a care framework forward in 1968 as an approach to obtain, validate, and adapt nursing knowledge (Alligood, 2013). The conceptualization and development of the Goal Attainment Theory were later done in 1971 and 1981 respectively. The theory is based on the interaction between nurses and patients in the processes of attaining set goals and the assumption that human beings are the central aspect of nursing, whose key goals include restoration, promotion, and maintenance of health, caring for the ailing and the dying (Alligood, 2013; Leon-Demare, MacDonald, Gregory, Katz, & Halas, 2015). As such, the fundamental concepts of the theory can be broadly classified into personal systems, interpersonal relationships, and social systems and they include perception, communication, interaction, transaction, self, role, and decision-making, which are vital elements in care delivery and the core essence of nursing (Alligood, 2013).

The essence of this article, therefore, is to illustrate the application of the King’s Theory of Goal Attainment in nurse practice. To demonstrate the applicability of the theory, a major concern affecting care delivery is adopted. The issue used is the patients’ negative perception of care delivery in emergency departments EDs, especially due to ineffectiveness and overcrowding.

Description of the Issue

In many healthcare systems, the emergency departments (commonly referred to as EDs) face significantly huge problems, including overcrowding, access-related issues, cost containment, and high expectations and demands from patients and their family members. As such, efficiency in many EDs is oftentimes not achieved and, therefore, patients’ perceptions are negatively affected. It is worth noting that when the perception of a patient is negatively affected, positive outcome and satisfaction are hindered (Shah, Patel, Rumoro, Hohmann, & Fullam, 2015). The negative perception of care is a concern that affects many EDs globally.

The essence of the nurse profession is to provide care to the patients (Alligood, 2013). It is worth noting that effective use of resources and positive outcomes are some of the ways to measure the success in nursing. When resources are used properly, patients’ outcomes are augmented and consequently improving the perception of the quality of care. Nevertheless, the increasing number of patients in EDs have resulted in ineffectiveness that has led to the unsmooth flow of patients and overcrowding in EDs (Handel, et al., 2011; Grafstein, et al., 2013).

The nurse professional should be concerned about patients’ perception of the quality of care since perception is vital in attaining satisfaction and augmenting outcome. Moreover, patients use perception in selecting EDs (Grafstein, et al., 2013). Research indicate that patients would choose an ED depending on how effective they perceive it to be, especially in reducing the waiting hours (Grafstein, et al., 2013).

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Numerous literature has been published to address the issue of enhancing patient perception and augmenting outcome and satisfaction.

Handel et al. (2011) appreciate the fact that there are increasing demands for EDs and consequently, many EDs are overcrowded. However, efficacy in many EDs is not attained and, therefore, resource wastage and negative outcomes are evident. As such, it is apparent that there are needs to improve timeliness in EDs. The article provides some of the interventions, including the use of technology, and effective personnel/resource allocation.

Mehmet et al. (2011) recognize the tremendous challenges faced by the nursing profession in EDs, including giving care to overstressed patients, dealing with patients’ relatives among other encounters. As such, improving efficacy in EDs is vital. The article is based on improving communication skills among nurses as an approach to enhancing efficiency since poor communication is an impediment to efficacy, perception, and customer satisfaction.

Shah, Patel, Rumoro, Hohmann, and Fullam (2015) recognize that ineffectiveness in EDs, characterized by overcrowding, long waits, and uncomfortable waiting room conditions can be associated with lower patient perception and satisfaction. Nevertheless, overcrowding in EDs is evident in many EDs globally. As such, dealing with efficacy issue is important. Therefore, the article suggests the use of timely communication, including communication on delays and binary communication, as a technique to augment patient satisfaction, perception, and outcomes.

Baker and Esbenshade (2015) address a key cause of overcrowding and the consequent compromised efficacy in the EDs. Undue boarding of patients is a key cause of overcrowding in EDs. The article suggests that the problem of overcrowding can be solved through effective partnerships among health care stakeholders. Moreover, (Baker & Esbenshade, 2015) suggest that proactive communication, teamwork among stakeholders, and goal setting strategies can effectively reduce overcrowding by proper resource, (especially bed) allocation and as a result increase patient perception of the quality of care.

To address the concern of negative perception of care in EDs, it is imperative to understand some of the key stakeholders involved. The center of nursing and care provision is the patient (Alligood, 2013). As such, they are the most affected stakeholders when EDs do not operate effectively. They are subjected to long waits and harsh conditions that hinder satisfaction, perceptions, and outcomes. Second, the patients’ family members are also involved in the problems associated with ineffective and overcrowded EDs. The ineffectiveness in EDs place family members of patients in uncertain and stressful circumstances (Handel, et al., 2011).

Third, the nurses are also affected by the delays in EDs since they play significant roles in augmenting patient satisfaction. Working in crowded EDs could be stressful to nurses who are supposed to provide optimal care to patients while maintaining high perception and satisfaction (Mehmet, et al., 2011). Fourth, overcrowded EDs affect physicians and other hospital staffs. They are forced to work with strained resources and work under stressful environments with tight schedules (Handel, et al., 2011; Baker & Esbenshade, 2015).

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Applying the King’s Theory in Augmenting Patients’ Perception and Satisfaction in EDs

As stated earlier, the King’s Theory of Goal Attainment is based on the relationship between caregivers/nurses and patients (Alligood, 2013). As such, the theory’s major concepts include personal, interpersonal, and community systems. The theory’s concepts are applicable in a number of departments in a healthcare facility including the ED (Alligood, 2013).

It is evident that overcrowding and ineffectiveness in EDs negatively affect the patients’ perception and consequently impede optimal satisfaction. However, applying the key concepts of the King’s Theory of Goals Attainment, which emphasizes clinician-patient and nurse-patient relationships could positively enhance efficacy in EDs and, therefore, improve patients’ perceptions of the quality of care.

Strategists concerned with addressing negative patients’ perception and low satisfaction can adopt the interpersonal concept of the King’s Theory of Goals Attainment. The fundamental aspect of the interpersonal system is the effective interaction among healthcare stakeholders, especially between nurses and patients. Various concepts are linked to the interpersonal system, including interaction, transaction, communication between caregivers and patients.

Implementing the interpersonal system in EDs would not only augment efficacy but also improve patients’ satisfaction and perception of the quality of care. The system could be implemented through exercising the key concepts. Transactions between caregivers and patients could be done and mutual goals set. The method of attaining the goals could be discussed between the patient, the nurses, and other care providers.

Moreover, patient-centered communication techniques could be adopted. Communication on the health status, medication/treatment, and any other issue, including possible delays should be made promptly and constantly to the client. Communication can be enhanced by providing mechanisms that allow both formal and informal communication and that let the patients express themselves freely.

Further, communication can be enhanced through training of nurses and other stakeholders on good communication skills (Mehmet, et al., 2011). It is worth noting that good communication has been linked to augmented satisfaction and positive perception of the quality of care (Shah, Patel, Rumoro, Hohmann, & Fullam, 2015; Mehmet, et al., 2011).

Patient satisfaction is a key aspect in care delivery. Optimal satisfaction is linked to positive outcomes and positive perception of the quality of care (Grafstein, et al., 2013; Handel, et al., 2011). Therefore, it is imperative to understand what drives patients’ satisfaction and what measures a customer uses to weight the quality of care. Future research, therefore, should focus on other key drivers of patients’ satisfaction and expectations on EDs. As such, researchers should consider finding out more drivers to satisfaction and ways to address them and augment satisfaction and outcomes in EDs and healthcare in general.


It is evident that theories can be adopted to address pressing concerns and issues in healthcare and nursing practice. Nursing theories are based on concepts, which are important in providing direction, decision-making techniques, management frameworks, and courses of action among other aspects of the nursing practice.

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This paper has discussed the application of the King’s Theory of Goal Attainment, which was developed in 1981 by Imogene King, in addressing the issue of low patients’ satisfaction in EDs and the consequent negative perception of the quality of care.

The King’s Theory is based on patient-centered care delivery and the patient-nurse interaction and its fundamental concepts include personal system, interpersonal system, and societal system. Applying the King’s theory in crowded EDs can be done using the three concepts.

Nevertheless, this paper has emphasized the use of the interpersonal concept in addressing the issue of low patients’ satisfaction and the consequent negative perception of the quality of care in EDs. Some of the key elements that make it considerably applicable to the issue of crowded EDs are communication and interaction. Effective interactions and patient-centered communication can be adopted to address the concern and augment patients’ satisfaction and perception of the quality of care. Moreover, it is evident that research should be done on drivers of patient satisfaction to effectively address concerns of low satisfaction in EDs, nurse practice and healthcare delivery in general.


Alligood, M. R. (2013). Nursing theory: utilization & application. St. Louis, MO: Elsevier Health Sciences.

Baker, S. J., & Esbenshade, A. (2015). Partnering Effectively With Inpatient Leaders for Improved Emergency Department Throughput. Advanced Emergency Nursing Journal, 37(1), 65–71. Web.

Grafstein, E., D, W., R, S., C, J., M, T., I, P., & FX, S. (2013). A Regional Survey to Determine Factors Influencing Patient Choices in Selecting a Particular Emergency Department for Care. Academic Emergency Medicine, 20(1), 63-70. Web.

Handel, D., Epstein, S., Khare, R., Abernethy, D., Klauer, K., Pilgrim, R., & Soremekun, O. (2011). Interventions to Improve the Timeliness of Emergency Care. Academic Emergency Medicine, 18(12), 1295–1302. Web.

Leon-Demare, K., MacDonald, J., Gregory, D. M., Katz, A., & Halas, G. (2015). Articulating nurse practitioner practice using King’s theory of goal attainment. American Association of Nurse Practitioners, 27(11), 631–636. Web.

Mehmet, A., Cinar, O., Sutcigil, L., Congologlu, E. D., Haciomeroglu, B., Canbaz, H.,… Ozmenler, K. N. (2011). Communication Skills Training For Emergency Nurses. International Journal Medical Science 8(5), 397–401.

Shah, S., Patel, A., Rumoro, D. P., Hohmann, S., & Fullam, F. (2015). Managing Patient Expectations at Emergency Department Triage. Patient Experience Journal, 2(2), 31-44.

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