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262 UNIT III Nursing Conceptual Models

personal, interpersonal, and social systems as the that motivated King to develop this theory was, “What
domain of nursing” (King, 1981, p. 130). Each system is the nature of nursing?” (King, 1995b, p. 25). She
identifies human beings as the basic element in the noted the answer to be: “the way in which nurses, in
system, thus “the unit of analysis in [the] framework their role, do with and for individuals that differentiates
[was] human behavior in a variety of social environ- nursing from other health professionals” (King, 1995b,
ments” (King, 1995a, p. 18). King designated an ex- p. 26). This thinking guided her development of the
ample of a personal system as a patient or a nurse. Theory of Goal Attainment using the following theory
King specified the concepts of body image, growth development process:
and development, perception, self, space, and time in • “What are the philosophical assumptions?”
order to comprehend human beings as persons. • “Are the concepts clearly identified and defined?”
Interpersonal systems form when two or more indi- • “Are the concepts related in propositional statements
viduals interact, forming dyads (two people) or triads or models?”
(three people). The dyad of a nurse and a patient is one • “Does the theory generate questions to be answered
type of interpersonal system. Families, when acting as or hypotheses to be tested in research to generate
small groups, also can be considered interpersonal knowledge and affirm the theory?”
systems. Understanding the interpersonal system re- “The human process of interactions formed the
quires the concepts of communication, interaction, basis for designing a model of transactions that de-
role, stress, and transaction. picted theoretical knowledge used by nurses to help
A more comprehensive interacting system consists individuals and groups attain goals” (King, 1995b,
of groups that make up society, referred to as the p. 27) (Figure 15–2).
social system. Religious, educational, and health care King (1995b) stated the following:
systems are examples of social systems. The influen- Mutual goal setting [between a nurse and a cli-
tial behavior of an extended family on an individual’s ent] is based on (a) nurses’ assessment of a client’s
growth and development is another social system concerns, problems, and disturbances in health;
example. Within a social system, the concepts of (b) nurses’ and clients’ perceptions of the interfer-
authority, decision making, organization, power, and ence; and (c) their sharing of information whereby
status guide system understanding. Thus, concepts each functions to help the client attain the goals
in the framework are organizing dimensions and identified. In addition, nurses interact with family
represent knowledge to understand interactions members when clients cannot verbally participate
among the three systems (King, 1995a).
in the goal setting” (p. 28).
King’s Middle-Range Theory of Goal To test her theory, King (1981) conducted re-
Attainment search, identifying that her study varied from previ-
In 1981, King derived her middle-range Theory of Goal ous studies in that it “described the nurse-patient
Attainment from her conceptual system. The question interaction process that leads to goal attainment”

Feedback
Perception
Nurse Judgment
Action
Reaction Interaction Transaction
Action
Patient Judgment
Perception
Feedback
FIGURE 15-2 A process of human interactions that lead to transactions: A model of transaction. (From
King, I. [1981]. A theory for nursing: Systems, concepts, process [p. 61]. New York: Delmar. Used with permis-
sion from I. King.)