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CHAPTER 15 Imogene M. King 265

environment. King also revised her terminology, using
Logical Form adjustment instead of adaptation, and person, human
In her 1968 article, King set forth her first conceptual being, and individual rather than man.
frame of reference with the following four concepts Clements and Roberts (1983) illustrated King’s
that center on human beings: ideas, applying the Theory of Goal Attainment for the
1. Health health of families.
2. Interpersonal relationships
3. Perceptions Acceptance by the Nursing Community
4. Social systems
Although King’s original framework was abstract Practice
and dealt with “only a few elements of concrete situ- King’s (1971) early publication led to nursing curricu-
ations” (King, 1981, p. 128), she maintained that her lum development and practice application at Ohio
four “universal ideas (social systems, health, percep- State University and other universities. Professionals
tion, and interpersonal relations) were relevant in in most nursing specialty areas have used the concepts
every nursing situation” (King, 1981, p. 128). King of King’s (1981) Theory of Goal Attainment in nursing
(1981) began further development of her conceptual practice. Its relationship to practice is obvious because
system and proposed her middle-range Theory of nurses function primarily through interactions with
Goal Attainment to describe “the nature of nurse- individuals and groups within the environment. King
client interactions that lead to achievement of goals” (1984) proposed “nurses, who have knowledge of
(p. 142) as follows: the concepts of this Theory of Goal Attainment, are
able to perceive what is happening to patients and
Nurses purposely interact with clients to mutually family members and are able to suggest approaches
establish goals, and to explore and agree on means for coping with the situations” (p. 12).
to achieve goals. Mutual goal setting is based on King developed a documentation system, the goal-
nurses’ assessment of clients’ concerns, problems, oriented nursing record (GONR), to accompany her
and disturbances in health, their perceptions of middle-range Theory of Goal Attainment and to re-
problems, and their sharing information to move cord goals and outcomes. The GONR was a method
toward goal attainment (pp. 142–143).
of collecting data, identifying problems, and imple-
A logical progression of development existed in menting and evaluating care that has been effective in
the conceptual system from 1971 to 1981, with King patient settings. Nurses can use the GONR approach
deriving her middle-range Theory of Goal Attain- to document the effectiveness of nursing care. “The
ment from her conceptual system. The Theory of major elements in this record system are: (a) data base,
Goal Attainment “organize[s] elements in the process (b) nursing diagnosis, (c) goal list, (d) nursing orders,
of nurse-client interactions that result in outcomes, (e) flow sheets, (f) progress notes, and (g) discharge
that is, goals attained” (King, 1981, p. 143). summary” (King, 1995b, pp. 30–31).
King (1971) initially had stated the following: Health care professionals have implemented
King’s (1981) conceptual system and middle-range
. . . [I]f nurses are to assume the roles and respon- Theory of Goal Attainment in various national and
sibilities expected of them, . . . the discovery of international practice settings (King, 2006, 2007).
knowledge must be disseminated in such a way The following identifies some settings, and references
that they are able to use it in their practice. . . . De- additional settings. Jolly and Winker (1995) applied
scriptive data collected systematically provide cues the Theory of Goal Attainment in nursing adminis-
for generating hypotheses for research in human tration. Coker and colleagues (1995) implemented
behavior in nursing situations (p. 128).
nursing diagnoses in a Canadian community hospi-
In 1981, King spoke of fewer dichotomies between tal, and Fawcett, Vaillancourt, and Watson (1995)
health and illness, referring to illness as interference in applied the conceptual system in a large Canadian
the life cycle. Through reformulation, King provided a hospital. Williams (2001) applied King’s work in emer-
more open system relationship between person and gency and rural nursing. Elberson (1989) described