How to Use King’s Theory of Goal Attainment

In modern healthcare, patient engagement is a clinical necessity, not just a preference. Patients actively involved in their care demonstrate significantly better outcomes and adherence. Imogene King’s Theory of Goal Attainment provides the theoretical blueprint for this partnership. Developed in the 1970s, King’s theory posits that nursing is a process of action, reaction, and interaction whereby nurse and patient share information about their perceptions of the nursing situation. This guide details how to apply King’s concepts of mutual goal setting and transaction to everyday nursing practice.

The Goal Attainment Framework

King’s theory is built on the belief that individuals are open systems interacting with the environment. The central focus is the Nurse-Patient Relationship, which leads to goal attainment. Unlike theories that view the patient as a passive recipient of care, King views the patient as a rational, sentient being capable of making choices.

According to recent research published in NCBI (PMC), the theory asserts that if goals are set mutually, they are more likely to be achieved. If goals are achieved, satisfaction occurs for both the nurse and the patient, leading to effective nursing care.

The Three Interacting Systems

King views the world through three dynamic, interacting systems. The nurse must assess all three to understand the patient holistically and identify barriers to goal attainment.

1. Personal System (The Individual)

This system focuses on the individual’s perception of self, body image, growth, and development.
Key Concepts: Perception (how the patient views reality), Self (thoughts/feelings), Body Image, and Space/Time.
Clinical Application: Assessing a diabetic patient’s perception of their disease. Do they view insulin as a failure or a tool?

2. Interpersonal System (Groups/Dyads)

This system forms when two or more individuals interact. The nurse-patient dyad is the core here.
Key Concepts: Interaction, Communication, Transaction, Role, and Stress.
Clinical Application: Evaluating the communication style between the nurse and patient. Is there trust? Are roles clearly defined?

3. Social System (Society)

This is the larger context in which interactions occur: family, religious groups, schools, and the healthcare system itself.
Key Concepts: Organization, Authority, Power, Status, and Decision-making.
Clinical Application: Considering how hospital policies (organization) or family hierarchy (power/status) impact the patient’s ability to make decisions.

The Transaction Process (Action-Reaction-Interaction)

This is the operational engine of the theory. It describes the specific sequence of events that leads to a goal.

• Action: Mental or physical activity directed toward a goal (e.g., Nurse approaches patient to give meds).
• Reaction: The response to the action (e.g., Patient frowns and turns away).
• Interaction: The exchange of information (verbal/non-verbal) to verify perceptions (e.g., Nurse asks, “Are you worried about this medication?”).
• Transaction: The result. A value-based compromise where a goal is set and achieved (e.g., “We will wait 10 minutes until you feel less nauseous, then take the pill”).

Clinical Application: Mutual Goal Setting

King’s theory rejects paternalism (“The nurse knows best”). It demands Mutual Goal Setting, where the patient’s values determine the outcome.

Scenario: A hypertensive patient has high blood pressure but refuses medication because of side effects (dizziness affecting work).
Traditional Approach: Nurse educates on stroke risk and insists on compliance. Result: Non-compliance.
King’s Approach (Transaction):
1. Perception: Nurse perceives non-compliance; Patient perceives medication as a threat to livelihood.
2. Interaction: Nurse asks about the barrier. Patient explains the dizziness.
3. Transaction: They agree on a mutual goal: “Patient will take medication at night to minimize dizziness while maintaining BP <140/90."

This successful transaction respects the patient’s role in the Social System (worker) and Personal System (body image/sensation).

Metaparadigm Concepts in King’s Theory

Person: A spiritual being and rational thinker capable of making choices, perceiving, and recording data.
Health: Dynamic life experiences of a human being, implying continuous adjustment to stressors in the internal and external environment. It is the ability to function in social roles.
Environment: The background for human interactions (internal and external) that constantly changes.
Nursing: A process of action, reaction, and interaction to assist individuals to share information about their health status and adjust to changes.

Integration with SMART Goals

King’s “Mutual Goal Setting” aligns perfectly with the SMART framework used in modern care plans.
Specific (Defined clearly in the transaction).
Measurable (Did the transaction occur? Did the behavior change?).
Achievable (Agreed upon by the patient as realistic).
Relevant (Fits the patient’s personal system/values).
Time-bound (Set during the interaction phase).

For more on writing these, see our SMART Goals Guide.

FAQs on King’s Theory

Conclusion

King’s Theory of Goal Attainment reminds nurses that we do not “fix” patients; we partner with them. By focusing on mutual goal setting and clear communication within the three dynamic systems, nurses can achieve higher rates of compliance, satisfaction, and positive health outcomes.