Goal Attainment Theory Of Imogene King In Nursing And Its Application For Diabetes Self-Management Education

1)Who created this theory and why? (You may have to read widely about the author or theory to find out why) Articles that argue for something different in healthcare? How do you know? Provide evidence for your ideas.

2)Who contributed to the creation of this theory – not just co-authors- but through ideas that the author adopted.

3)How has this theory changed over time and what changed? Why did it change? If it has not changed, explain why you think it hasn’t changed (think socio-political, financial impacts, or new scientific knowledge? –find evidence in the author’s writings to explain the change – or in other articles that describe the framework)

Is the theory improved or is it less effective because of the changes? Or if it did not change, is it less effective because it hasn’t changed. This can be your opinion. But you must have a clear, well described opinion, that is supported with facts (i.e. citations that support your claims)

Introduction to Goal Attainment Theory

The Goal Attainment Theory of Imogene King has drawn much attention in the nursing field. The Goal Attainment Theory of Imogene King has drawn much attention in the nursing field. The theory aims at describing an interpersonal, dynamic relationship through which patients can grow and attain certain goals in life. The theory further gives an explanation for the factors which affect the attainment of goals, namely roles, stress, space, and time. The model has three systems in dynamic interaction with each other: personal, interpersonal and social. King’s theory serves as an in-depth, informative source in relation to the process of care delivery in healthcare setting. The steps that a care professional is to follow while delivering care includes assessment, diagnosis, planning, implementation and evaluation. The assessment takes place through interaction in which health care professionals are to bring in special skills and knowledge. Diagnosis follows the next step in which data collection is done adequately. Creation of an appropriate care plan is the next step in the series that is represented by the decision making process. The implementation of the care plan is the actions taken for achieving the set goals. An evaluation would determine whether the set of goals has been fulfilled or not (Alligood, 2014).

Care planning and goal setting are of prime importance in case of diabetes management, as patients are to be educated and motivated to achieve desired outcomes. Self-management support is crucial for enabling patients to care for themselves, and this entails an application of the best nursing theory aligned with this motive. Goal attainment theory can be applied for improving diabetes management among patients through utilisation of mhealth in a home care setting. Self-management education can be improved by medication adherence, suitable self-monitoring of blood glucose (SMBG), increased eating healthy and physical activity, and regular monitoring for complications. Research indicates that the theory behind self-management rests on the significance of self-efficacy through a goal-setting process that is personalised. Individualised and specific care can, therefore, be given to diabetic patients by adapting the goal attainment theory. Through mHealth support group, the medical doctors can interact with the patients and understand the environmental factors that influence their perception of self management techniques for diabetes. The patients can be motivated and encouraged as per their individualised needs, and goals for their education can be set accordingly (Anderson et al., 2010).

The mid-range theory of Goal Attainment, developed by King was based on the principles of Conceptual System theory, also created by the same scholar. The conceptual system had its origin in 1971 on the basis of systems theory and systems analysis literature. Though it was initially referred to as a conceptual framework, the terminology was later changed to Conceptual System. The focus of the system was on decision making in nursing, that organised around a set of distinct systems; Social systems, Interpersonal systems and Personal systems. In 1978, the idea came into the mind of King that nursing field had to be promoted and perceived as a science and that the association between research and nursing had to be utilised a guide for building scientific knowledge. Drawing insight from this Conceptual System, King, in 1981, outlined the Goal Attainment systems. The core ideas embedded within the theory were communication, perception, transaction and interaction. The overall assumption of the goal attainment theory, as per King, was that the key emphasis of nursing practice must be the interaction of humans with the surrounding environment and the consequent impact on health (Sieloff & Messmer, 2017).

Application of Goal Attainment Theory in Diabetes Self-Management Education

Though there had been some changes made to the goal attainment theory, a number of scholars have taken part in an ongoing debate for clarifying the philosophical positions taken in theory. The most prominent change include the inclusion of the idea of the personal system. Further, spirituality has been perceived as a fundamental aspect demonstrated by human beings (Williams, 2017).  Alligood (2014) brought into limelight the fact that the theory of goal attainment was put in place to highlight the fact that nursing is an amalgamation of interaction, action, and reaction by which clients and professionals share valuable information about the health condition of the clients. Nursing is further to be perceived as the process of significant interactions between the two parties whereby each individual sets goals and explores them for achieving a desired set of outcomes. As per the authors, King wanted care professionals to engage in maintaining, promoting and restoring health, and implement proper care delivery.

Leon?Demare et al., (2015) highlighted some key strengths of the goal attainment theory of King. As per the scholars, the most noteworthy point of the theory is its simplicity, as nurses can understand the embedded concepts with ease and apply them in practice. The theory further describes a logical sequence of events and that clearly defined. Since the theory has evolved from the research literature, it can be stated that the work on the theory is importance for crucial knowledge building in the nursing field.

In my opinion, the goal attainment theory of King is not flawless, and the changes made to it have not been accurate in a comprehensive manner. McEwen and Wills (2017) argue that King had emphasised on maintaining the wide range use of the articulated theory in most crucial nursing situations. Further, the absence of development application of the theory to nursing care for communities and families is another limitation. The goal attainment theory is marked by some very important inconsistencies. Firstly, King had indicated that healthcare profesisonals have focused on healthcare of groups, but the discussion of the theory concentrated on nursing practice in a sociological relationship. Moreover, while on the one hand King had stated that client and nurse are strangers, she had also spoken about the working relationship of the two parties on the other hand, while drawing in the significance of health maintenance (Kiresuk, 2014). 

Goal setting for self-management education for diabetic patients can be made simpler and effective by using the Goal Attainment theory of King. It has been indicated through research that mutual goal setting is an useful nursing intervention in patients suffering from chronic illness such as diabetes. Abiding by the principles of the theory, a nurse practitioner would consider the factors that influence the personal system of the patient, namely realisation of self, perception, body image and space. By addressing these aspects, professionals can motivate and encourage patients to take part appropriate decision making pertaining to education on self-management techniques. The noteworthy advantage of applying this theory would be that the focus of the care would solely be the patient (Smith & Parker 2015).

Under circumstances of the theory being not capable of improving the set objective in healthcare, changes would be imperative to be brought about in one particular aspect of the application of the process. This would relate to the communication between the nurse practitioner and the patient. The nature of interaction occurring between the two ends would need to be changed is goals are to be achieved. Communication would need to be more accurate and more formal so that optimal extraction of information is possible in relation to patient condition, mental health status, values and preferences.

The goal attainment theory of King considers the interpersonal relationship between patients and nurses for setting life goals and attaining them. The propositions and assumptions made in theory are multidimensional. As per this model, patients are to be perceived as a social being, whose thoughts and feelings are to be considered while making decisions in the care process. A nurse practitioner adapting this theory for self-management education for diabetic patients must address the needs of the patient by considering health as a dynamic life experience of the patient. However, certain modifications might be needed in particular aspects of the application process of the theory as per the needs of the circumstance. In a nutshell, Goal Attainment theory has a number of advantages for the field of nurse practitioner. However, certain changes might be required as per the need for the care system to enhance care delivery. 

References

Alligood, M. R. (2014). Nursing theorists and their work. Elsevier Health Sciences.

Anderson, D. R., Christison-Lagay, J., & Procter-Gray, E. (2010). Self-Management goal setting in a community health center: the impact of goal attainment on diabetes outcomes. Diabetes Spectrum, 23(2), 97-105.

Kiresuk, T. J. (2014). Goal attainment scaling: Applications, theory, and measurement. Psychology Press.

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.

McEwen, M., & Wills, E. M. (2017). Theoretical basis for nursing. Lippincott Williams & Wilkins.

Sieloff, C. L., & Messmer, P. R. (2017). and Middle-Range Theory of Goal Attainment. Nursing Theorists and Their Work-E-Book, 213.

Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice. FA Davis.

Williams, L. A. (2017). Imogene King’s interacting systems theory: Application in emergency and rural nursing. Online Journal of Rural Nursing and Health Care, 2(1), 40-50.