Nursing Theory Analysis Theory-based nursing is the phenomenon that has been researched much during the past two decades. Nursing theory has become the foundation for nursing practice with its own knowledge base. The current paper is an analysis of King's theory of goal attainment. King acquired her goal attainment theory model from an interpersonal system and a behavioral science. The nurse and patient communicate to achieve a common goal of patient satisfaction and better health outcomes. To achieve this goal, there is a need for nurses to explore patients' perceptions and expectations. It has been found in research that patients' satisfaction with healthcare is strongly linked to their satisfaction with nursing care. King attained that if the nurse is aware of patients' expectations of care that they can achieve the goal of patients' satisfaction. This theory is also applicable in the nursing education program for those nursing students having poor academic performance and for those at-risk students. Students and mentors can communicate to achieve the shared goal of student's academic improvement.

I. Examination of the origins of nursing theory

Modern nursing practice officially started from Nightingale and she also described that nursing knowledge and medical knowledge are different disciplines. Nursing practice based on theory is the phenomenon that has been researched extensively. Wold (1981) noted that "as a result of the broad client systems to be served and the duality of the school nurse's expected allegiances; school nursing today is a complex practice specialty" (p.30). In recent times, it has been necessary to base nursing and clinical practice on a theory or conceptual framework. Indeed, today's nursing theorists truly stand on the shoulders of giants in the field, and it is not surprising that new evidence-based approaches continue to be developed and refined today. In this regard, the origins of modern nursing theory can be conceptualized as existing along a continuum beginning with Nightingale and continuing to the present with theorists such as Dorothy Johnson and Dorothea Orem dominating the early stages of nursing theory evolution, and others such as Virginia Henderson and Imogene King building on their seminal work during the mid-20th century. An analysis of King's Theory of Goal Attainment following the guidance provided by Fawcett that stipulates "Theory analysis involves a nonjudgmental, detailed examination of the theory" including its (a) context, (b) content and (c) scope which is provided in the sections below.

II. Introduction to nursing theory and theory context

The current recognition of the need to base nursing practice on theory is reflected in Standard I of the American Nurses' Association's Standards of School Nursing Practice. These standards state: the school nurse applies appropriate theory as basis for decision making in nursing practice" (American Nurses Association, 1983, p. 3). Consequently, today, nursing has been established as a profession that requires a divergent knowledge base. During the initial years of the twentieth century, "nursing practice was based on rules, principles, and traditions that were passed along through limited apprenticeship forms of education" (Chang, Chenoweth, & Hancock, 2003, p. 36). Most of the principles mentioned were adopted from disciplines such as physics and biology. It was thought that these are valid for nursing but was not assessed as regards to nursing practice.

In the middle 20th century, nursing practice trends changed from a fact-oriented view point to an effective practice. The reason behind this was that nursing programs started to prepare nurses for practice in higher education institutions. Early nursing theories emerged with the initiation of nursing practice and attainment of nursing skills and scientific methodology by nurses.

The usual role of a nurse has changed during the last twenty years. Previously, it was not the duty of nurses to make independent and complicated decisions. Today, nurses are independent professionals who have to operate multifaceted equipment, calculate drug dosages, and choose appropriate treatment options for their patients (LeTourneau, 2004).

Nurses have gained credibility with not only the patients, but, also the healthcare team who appreciate their knowledge, skills, and value in providing holistic care. Nursing observations and assessments guide the plan of care and resulting interventions. Nurses can determine priorities based on nursing assessment of an individual/group need using their knowledge as well as current research. Both independent and interdependent interventions, though, require nursing judgment and are important nursing functions (Logan, 1990). These interventions can include communications along with physical activities. Nurses help to organize and develop the plan utilizing the information and physical data that has been collected.

A number of so-called philosophical and grand nursing theories have been developed over the years to facilitate the delivery of high-quality health care services by nursing staff, including King's theory of goal attainment in the field of patient care; representative examples of these nursing theories are set forth in Table 1 below.

Table 1

Representative Nursing Theories over Time

Theorist, theory and date of early work

Concepts/definitions / assumptions

Disease is a reparative process.
2. Rejected germ theory.

3. Imbalance between patients and their physical environment frustrates energy conservation and decreases the capacity for health.

Environment/sanitation

Philosophical

Dorothy Johnson: behavioral systems, 1959

Seven behavioral subsystems which can be analyzed in terms of their structure and function.

Ethological systems

Grand

Dorothea Orem: self-care model, 1959

1. Constituted from three related theories: self-care, self-care deficit, and nursing systems.

2. People have a fundamental need for the provision and management of self-care actions on a continuing basis to sustain life and health and to recover from disease.

3. When an individual's self-care agency is not adequate to their requirements, or that of their dependents, deficit is created.

Henderson

Grand

Virginia Henderson: Developmental model, 1961

The patient is a person who requires help towards independence.

Thorndike Rehabilitation principles; Orlando; Maslow.

Philosophical

Ida Jean Orlando: Interpersonal theory, 1961

1. Distinguishes automatic from deliberate action.

2. Perceptions, thoughts, and feelings are not explored in automatic actions.

3. Deliberate actions yield solutions and prevention of problems.

Eclectic

Mid-Range (psychiatric nursing)

Imogene King: open systems model, 1964

1. The dynamic nature of life assumes continuous adjustment to life's stressors.

2. The self is a person's total subjective environment, and is a distinctive center of experience and significance for each.

3. Adjustment entails the three open systems interacting with the environment: personal, individual, and social.

Highly eclectic; Piaget, Erikson, Etzioni, Bennis (among others)

Grand

Source: Adapted from Joel & Kelly, 2002, pp. 180, 182.

The Theory of Goal Attainment developed by King that describes the nurse-client relationship stems from the grand theory outlined in Table 1 above. The tenets of the King's Theory of Goal Attainment have taken their place among the other influential grand and philosophical nursing models that emerged during the mid-20th century due in large part to the need for such models as discussed above and the contents of which are discussed further below.

III. Explanation of Content of King's Theory of Nursing

For this study, it was determined that a focus on King's theory of goal attainment in the field of patient care was highly appropriate. Recent research studies reveal that one of the most important factors in patient care is the patient's satisfaction with the care provided by nurses. This satisfaction is achieved through patients' and nurses' mutual interaction.

King (1992) presented her goal attainment theory which can be applied to nursing care and patient satisfaction with it. It is a theoretical framework for patient satisfaction with nursing care specifically, because, its main focus is the interrelationship of patient and nurse. King derived her Theory of Goal Attainment (TGA) from the General Systems Framework (GSF). From King's perspective, a system is defined as "a series of functional components connected by communication links exhibiting purposeful, goal-directed behavior" (1997, p. 22). King took her philosophical approach from system thinking and holism which was developed all through the behavioral sciences. King's GSF consists of three vibrant interacting systems: "personal (individuals), interpersonal (groups), and social (society)." Individuals involved in a dyadic are referred to as 'personal systems'. Preferred ideas that are recognized related to understand human behavior and humans as individual are there view points, self and body image, growth and development and time and space. There are many types of interpersonal systems. For an instance two individuals who interact are called dyads. There are many concepts that help to understand communication and interactions within human beings. These are referred to as "role, interaction, communication, transaction, and stress." We can also call interpersonal systems as small or large groups. Social groups or social forces are built in the dynamics of society. Nurses hold many concepts that assist them in functioning in the social system. These are organization where they work, power to make decision, their authority and status, decision making, and role.

King (1981) has defined nursing as "a process of interactions between nurse and client whereby each perceives the other and the situation; through communication, they set goals and explore and agree on the means to achieve the goals. Actions are taken as necessary by both the patient and the nurse to achieve their mutual goals. Transactions have occurred when goals are attained" (King, 1992, p.23). The nursing practice occurs in a sequence where nurse-patient interpersonal relationships or dyads happen. While transactions continued between patients, nurses and family, it can be predicted whether the goal will…