The role of theory to the profession of nursing is a foundational one. The presence of theory and a specialized scientific knowledge base coupled with unique practice abilities establish nursing as a profession (Alligood, 2013a). Theories provide nursing with a perspective that emphasizes the knowledge focused thinking pattern and decision making skills that are concentrated on the patient. Additionally, theories allow continued generation of knowledge to further advance the professions goals for positive health (Alligood, 2013a). In this analysis, Imogene King’s theory of goal attainment will be interpreted to demonstrate the importance of nursing theory, not only in an academic milieu but also in practice. The key concepts of King’s theory will be explained and applied to nursing’s metaparadigm to demonstrate congruity. Finally, relevance will be exhibited through the theories application to advance practice nursing through validated and peer reviewed journal research.
Importance of Nursing Theory
Theory in science is essentially an explanation. Without theory, evidence is not science. In essence, theory is associated concept, that when assembled, should be able to describe, explain, predict, or control the circumstance (Aliakbari, Parvin, Heidari & Haghani, 2015). Because the degree being sought is science based (master’s of science in nursing), theory is indispensable. The presence of theory in nursing serves to establish perspectives to guide a systematic approach, process data, evaluate evidence and influence decision making, all in an effort to produce quality nursing care (Alligood, 2013a). The American Association of Colleges of Nursing (AACN) mandates a theoretical foundation in nursing education to engineer nurses that are capable of meaningful utilization of the abundance of scientific knowledge available (Alligood, 2013a; American Association of Colleges of Nursing (AACN), 2011; Dracup, n.d.). In preparing master’s students with a theoretical background, academia is allowing for the improvement of health care (Wilson et al., 2015). Additionally, with the proliferation of nursing research, theoretical aptitude is necessary to advance nursing’s knowledge base and professional status (Alligood, 2013b).
The importance of theory to the profession is evident throughout nursing’s history. Analysis of the first 25 years of nursing research revealed a disconnect among in concepts and frameworks that led to isolated benefit (as cited in Alligood, 2013a). It was not until the 1980’s that the traditional nursing paradigm was developed (as cited in Alligood, 2013a). This led to the unification of nursing research under the metaparadigm’s four sentinel elements. The metaparadigm created a method of organization that led to meaningful structure of nursing research that illuminated and enhanced understanding of knowledge development by realigning the theorist’s works in a larger framework allowing the expansion of knowledge (Alligood, 2013a). Emphasis is placed on theoretical instruction to enable students to synthesize and develop research so they may practice nursing at an advanced level (Canadian Association of Schools of Nursing (CASN), 2014).
Nursing theories are specific to the profession in several ways. One way being that they are enmeshed with the concepts of the nursing’s metaparadigm, secondly, because they serve to guide nursing practices, specifically the nursing process and lastly because they establish criteria to measure the quality of nursing care (Alligood, 2013a; Institute of Medicine (IOM), 2011). Nursing theory is crucial to secure and defend the focus and precision of nursing’s specific benefaction to health care (Wilson et al., 2015).
A challenge to nursing theory is the ability to apply it to practice. Because today’s healthcare landscape is vast and dynamically fluid, nurses are inundated with information at every opportunity. Combined with nurses at various practice levels and education preparation, theory can easily becomes lost. Coincidentally, many nursing theories have pursued resolution and understanding to the theory-practice gap, but it has yet to be concluded (University of Saint Mary, 2016).
Summary of Theory of Goal Attainment
Imogene M. King developed the theory of goal attainment in 1981 while revising a previously published conceptual system (Alligood, 2013b). The conceptual system is important to mention because through the refinement of that work, King identified symbiotic thoughts and ideas that she was able to structure and define which later became the theory at hand (Sitzman, & Eichelberger, 2015). The long standing theory is still very much practical and applicable across a variety of nursing environments, one might even venture to say all of them, and has not been updated or altered in its basic form, but rather adapted to changing times by adding additional definitions and supporting concepts (Alligood, 2013b; Schub, 2016).
The reason King’s theory has sustained time and basic alteration is that it is based upon the central tenet of communication and interaction (Schub, 2016). The theory posits that nurses work with patients to achieve a mutually agreed upon health goal (Schub, 2016). Goal attainment theory places the patient at the center focus with the nurse facilitating and supporting people in maintaining and caring for themselves. Kings theory relies on three synergistic systems with each system having its own supporting concepts. The personal system, comprised of space, time, self body image, perception and growth and development describe the importance that King places on the wholeness of the individual (Alligood, 2013b). The interpersonal system includes the concepts of interaction, communication, transaction, role and stress illustrates the emphasis placed upon the interaction between individuals. Lastly, the social system includes organization, authority, power, status and decision making to demonstrates the influence that social systems have in governing behavior and interaction.
Despite the presence of many concepts, King herself identified transaction as the main point of the theory because it places the patient as an active participant in goal setting and health attainment (Schub, 2016). The personal system addresses the metaparadigm concept of human by recognizing the holistic individual and their value (Sitzman, & Eichelberger, 2015). The interpersonal system addresses the metaparadigm concept of health by acknowledging health as a fluid concept with which the individual must adapt to achieve (Sitzman, & Eichelberger, 2015). All of King’s three systems address the environment concept by appreciating the influence of the concept of self, the relationships of the individual as well as the circumstances that comprise environment as dynamic concepts that influence the holistic landscape (Sitzman, & Eichelberger, 2015).
Kings theory was chosen based on its simple and practical analysis of the most common human function of communication. Communication is so pervasive in daily life that one rarely stops to ponder its significance, let alone develop a lasting theory. Additionally, this theory was chosen because of its origins during establishment of a master’s program curriculum (Fawcett, & Desanto-Madeya, 2012). The benefit this theory has to advance practice nursing is that it allows the advanced clinical nurse to view the patient in their entirety. It facilitates a view that embraces the dynamic person to include not just the individual or illness at hand, but the individual and their role and responsibility to their family, their social place and all the other aspects that come with daily life (Stewart & DeNisco, 2013).
Application of the Theory of Goal Attainment to Nurse Practitioners
Application of King’s theory seamlessly follows the nursing process towards the goal of health attainment by focusing on meaningful interaction and partnership formation (Stewart & DeNisco, 2013). Because of this parallelism, advanced practice nursing is defined by the theory in that health attainment is achieved through full utilization of the NP’s scope of practice and by truly valuing the individuality, dimensions and perspective of the patient (Leon-Demare, Macdonald, Gregory, Katz, & Halas, 2015). The theory maneuvers the patient interaction to one of a holistic approach that allows the NP to provide direct, thorough and individualized care to patient (Leon-Demare et al., 2015). Advanced practice nursing can be defined by King’s theory in that a problem is identified, care is sought, a goal is agreed upon and both parties work to achieve that goal. The process of problem identification, communication and subsequent goal achievement of improved health is the primary purpose of nurse practioners. Essentially, the theory emphasizes nursing’s foundational influence on the advanced practice nurse role (Leon-Demare et al., 2015).
An excellent example of this is the current research regarding patient satisfaction surveys of NP care. Numerous studies have demonstrated that satisfaction with NP’s is on par to that of physician’s (Leon-Demare et al., 2015). Further inquiry indicated that favorable ratings were assigned to NPs in the quantity of health information provided and longer length of consultation areas (Leon-Demare et al., 2015). A literature review supported that the NP style of patient-centered communication resulted in increased patient satisfaction, greater adherence to plan of care and overall positive patient outcomes (Leon-Demare et al., 2015). Furthermore, patients rated the amount of time spent discussing health issues and the subsequent time saved with issue resolution as important in their scoring of NP care (Leon-Demare et al., 2015).
An additional example of practical application of King’s theory is the degree and effect of patient participation on outcomes. In considering this phenomena, research that scrutinized the interaction of NP’s and patients found that when disturbances, or health issues, are indentified in this pairing, the clinical interactions resulted in the establishment of mutual goals, inadvertently causing the patient to become active in their care (Silva & Ferreira, 2016). This end result is what King termed the transaction. The implication of this work is that a higher degree of participation by the patient is directly correlated to better goal achievement (Silva & Ferreira, 2016). Research has shown that patient participation has a positive effect on discharge plan adherence and a better sense of bodily function in regards to time and space (Silva & Ferreira, 2016). To achieve the best results for the patient, the NP must involve the patient to a degree where cooperation and accountability are foundational.
In summary, theory is a group of interconnected notions that, when put together, should be able to explain or predict the area of inquiry (Aliakbari et al., 2015). Theory grounds nursing by providing a focus and direction to the field that results in a clearly defined practice with a specific knowledge base anchoring it as a profession (Alligood, 2013a). Collectively, King’s theory, through mutual respect, autonomy, and meaningful communication, places a responsibility upon involved parties to share information so that decisions that impact their life and health can be made together (Silva & Ferreira, 2016).
In researching King’s theory I am able to see the practicality and application of the theory in nearly every patient interaction. The theory has shifted my thought process during clinical interactions from simply gathering information to truly listening to what the patient is imparting, but directly and indirectly. This paper has resulted in a generous degree of self reflection that will likely transform future interactions and provide a basis from which to assess my communicative approach.
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