Introduction
Nursing theories have emerged as an attempt to systematize the nursing practices and the knowledge relevant to the field. Since then, many of them were modified to include other healthcare fields or focus on certain aspects of nursing. King’s Theory of Goal Attainment is one example of such frameworks, equally applicable to practice, data processing, staff development, and leadership activities (Alligood, 2013). This paper explores the latter application. It first overviews the nursing theories as a construct and their value for the nursing profession. Then the core concepts of the theory are outlined and defined, with the theoretical implications for the applicability to the managerial practices. Finally, relevant research is provided to strengthen the theory and support the paper’s theoretical implications.
Importance of Nursing Theory
Before proceeding to the justification of certain nursing theories, it is first necessary to determine the importance of the concept in general and its relevance to the nursing practice. The necessity of nursing theories has been approached from various angles and remains a subject of criticism. Nevertheless, it can be argued that the study of nursing theories is a necessary part of the master’s program. The nursing profession is a multidisciplinary field. Besides the initially broad scope of activities and the constant expansion to the areas of social, psychological, and cultural domains, the current trends contribute to the diversity of the goals, objectives, and means at the disposal of nursing. In particular, some of the activities reserved for clinical doctors are now more often reassigned to nurses.
While this ensures the fluent and adaptive nature of the field, it also results in vagueness and uncertainty regarding the scope of its competencies. The studies regularly demonstrate the lack of understanding of the responsibilities and tasks among the practicing nurses and the disparities in administrative and managerial nursing practices (Kunic & Jackson, 2013). The inclusion of nursing theories in the education process can systematize the existing knowledge and solidify the boundaries between the marginal fields, leading to more consistent practices. This systematizing effect can also be used to separate the nursing profession from the other healthcare professions by outlining the tasks and responsibilities known to be bound to different healthcare fields throughout the development of the discipline.
Aside from that, the utilization of nursing theory can be useful for the nursing profession in several ways. First, the systematized approach of the theories eliminates the ambiguity regarding the physical and mental needs of the patients, as their list has considerably expanded since the formation of the nursing discipline. Second, they help to improve the interaction between personnel and patients, which has been conclusively tied to improved outcomes. Finally, some theories introduce predictive capabilities, which allow the exclusion of uncertainties in the planning of the healthcare process (Fawcett & Desanto-Madeya, 2012).
Admittedly, the use of theories is somewhat limited by the same factor which they try to address. The diversity of the discipline usually restricts each of them to a certain domain or viewpoint. As a result, some of the theories pay closer attention to the medical aspect and ignore interpersonal interaction, or vice versa, making it difficult to select one comprehensive theory.
Summary of the King’s Theory
One of the nursing theories which was successfully utilized for several aspects of nursing practice is Imogene King’s Theory of Goal Attainment, which is itself derived from the conceptual system by the same author. Initially conceived in 1968 as an approach to obtaining, validating, and adapting nursing knowledge by using the knowledge from the bordering fields, it was transformed into the conceptual framework in 1971. The key concepts have remained largely unchanged in the latest editions of the theory (Alligood, 2013). They are divided into three categories: personal systems, interpersonal relationships, and social systems. Each category features its set of concepts. Personal systems are individual stakeholders who participate in the healthcare process: patients, nurses, family members, and clinicians are the main examples. The understanding of these individual is defined by the concepts of perception (obtaining data from sensory information), self (reflection), growth and development (capacity building through self-improvement), body image (appearance as a defining factor), learning (similar to development and perception but involving the external sharing of experience by peers), time, personal space, and coping (the way of stress mitigation) (Alligood, 2013).
The interpersonal interactions deal with the entities formed by the interaction of several individuals and are defined by different concepts: communication (the process of data exchange), interaction (the combined influence of the multitude of factors resulting from individual behaviors), role (expected behaviors emerging from a certain position in society), stress (defined as a result of complex interactions with the environment), stressors (actors that lead to stress), and transaction (means of goal attainment) (Alligood, 2013). Finally, social systems, which are a more complex version of interpersonal ones, are defined by the organization, authority, power, status, and decision making (Alligood, 2013). The first category extensively addresses the personal metaparadigm of nursing by covering all relevant aspects of individuals. The core presumption of the theory is that individuals are the sole focus of nursing, which characterizes it as an interaction theory. The social systems fall within the general understanding of the environment, as it includes the healthcare establishments and local communities, so this metaparadigm is also inherent to the theory’s structure. Finally, the Goal Attainment theory specifies the setting of health goals by the nurses and ways of achieving them, mostly by suggesting appropriate behaviors, which are viewed as the means of providing health to stakeholders (Alligood, 2013).
Finally, the theory is flexible and encompassing enough to be successfully utilized not only for nurse practitioners but to managerial practices. The focus on data systematization and education provide development opportunities, and the extensive analysis of principles which govern the interpersonal relationships provide a concise background for leadership practices.
Application of the Theory to Selected Professional Nursing Practice Area
While the Theory of Goal Attainment does not explicitly define leadership practices as the intrinsic component of the patient-nurse interactions, both the “human interaction” and “conceptual focus” dimensions presume the involvement of authority. The authority is characterized as a transactional process, which aligns with the current trend of empowerment and responsibility distribution. Similarly, the decision making is described as a dynamic and fluent process rather than a rigid set of unalterable instructions. This provides opportunities to view management as an interpersonal interaction which provides the necessary amount of professional autonomy. Several attempts have been made to frame the existing practices into the Goal Attainment theory to support these implications and to directly assess the effectiveness of using the theory to achieve certain managerial goals.
A study conducted by Bularzik, Tullai-McGuinness, and Sieloff (2013) has used the theory as a framework to determine and measure the goal-attainment capability. The results have conclusively tied the capability to the professional autonomy at the workplace, which confirms the predictive value of the framework. Besides, the study has determined the relation between the leader’s competency and the practitioners’ performance (Bularzik, Tullai-McGuinness, & Sieloff, 2013), which confirms the theory’s practical value.
Another study has exemplified the overseeing capabilities of the King’s theory useful for HR management. The recorded clinic visits were analyzed using the framework. The results showed the full applicability of the concepts to a real-life setting, which allowed the research team to conclude on the possibility of successful utilization of the theory in reduction of the disturbances and discrepancies in nursing practice (Leon‐Demare, MacDonald, Gregory, Katz, & Halas, 2015). While not explicitly emphasized in the original study, this conclusion can be equally valid for the managers for organizational and leadership purposes.
Conclusion
The nursing theories are a necessary element of the healthcare field. They provide systematic knowledge and are useful frameworks for organizing the healthcare process. The King’s Theory of Goal Attainment, which was initially conceived to create the means of providing nurses with the relevant data and guide their practices, has since been modified and expanded to include other fields, such as the leadership activities and oversight of the operations. Its concepts are easily applicable to a wide range of activities and at the same time approachable enough to be favored by a wide array of stakeholders.
In addition to the managerial applications, which were the focus of my paper, I have also found that King’s theory is diverse and flexible enough to be used in informatics due to its data processing implications and education due to the focus on development and growth. Besides, the framework is easily scaled to individual use in everyday practice, which I am going to utilize in professional practice.
References
Alligood, M. (2013). Nursing theory: utilization & application. St. Louis, MO: Elsevier Health Sciences.
Bularzik, A. M., Tullai-McGuinness, S., & Sieloff, C. L. (2013). Nurse’s perceptions of their group goal attainment capability and professional autonomy: a pilot study. Journal of Nursing Management, 21(3), 581.
Fawcett, J., & Desanto-Madeya, S. (2012). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories. Philadelphia, PA: Davis.
Kunic, R. J., & Jackson, D. (2013). Transforming nursing practice: Barriers and solutions. AORN journal, 98(3), 235-248.
Leon‐Demare, K., MacDonald, J., Gregory, D. M., Katz, A., & Halas, G. (2015). Articulating nurse practitioner practice using King’s theory of goal attainment. Journal of the American Association of Nurse Practitioners, 27(11), 631-636.