King’s Conceptual System Theory

The King’s Conceptual System Theory, also known as the Theory of Goals Attainment, was the result of Imogene King’s work. The theory informs of the relationship between a patient and a nurse. It recognizes that such a relationship is critical in the attainment of a patient’s goals, which should be developed through effective interaction and communication, an element of the social environment. As explained by Caceres (2015), the theory is important in the maintenance of a supportive and healthy social system, necessary to support patients in the pursuance of their desired health goals. Smith and Parker (2015) explain that the theory is based on mutual communication between the patient and the nurse, goal setting, and the collaborative implementation of goals. To understand effectively the theory, it is important to understand its three systems, which must work synchronously to get the expected results as indicated by Imogene King. The three systems include the personal, interpersonal, and the social systems. 

The Personal System

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These are the individuals and each individual can be described as a personal system. The theory expects and regards these individuals as rational, social, and with the capability to feel. The Personal System has several concepts, which include personal space, growth and development, body image, learning, perception, and self. The self is a combination of thoughts and feelings, which cumulate to the total subjective environment as explained by Williams (2017). Using these concepts, the nurse is expected to understand the patient. The concepts have varying importance where perception emerges as a strong influencer of behavior on the patient’s side. To cement all the concepts together, King (1971) on Page 19 of her book said that, “An individual Perception of self, of body image, of time, of space, influences the way he or she responds to object and events in his/her life. As an individual grow and develop through the lifespan, experiences with changes in structure and function of their bodies over time influence their perceptions of self”. The theory alludes to perception as the process through which a nurse gives meaning to a patient’s experiences and behaviors using mental representations. 

The Interpersonal System

The system is formed by the interaction between two or more individuals. With an increasing number of individuals interacting, the complexity of interactions increases. Just like the Personal System, the Interpersonal System too has concepts, which include interaction, stress, role, communication, and transaction. Interactions are behaviors of two or more individuals that are observable, and communication, in this case, means the exchange of information using whatever media among individuals. Transactions according to the theory are interactions where humans communicate with the environment to achieve goals that are of importance to the individuals (King, 1992). Stress, on the other hand, is the struggle to maintain a balance between goals and the environment. Coping is a mechanism that humans develop to enable them to handle stress.

The Social System

The system indicates how nurses interact with other people in their ecosystem. Other people in the ecosystem include co-workers, subordinates, and supervisors among others. In other words, they are people that share an ecosystem with the nurse and further share goals and objectives, interests, and value. Kings (1992) explain that the social system provides a platform or a framework for social interactions complete with rules to guide behavior as well as action plans. Further, the system sets the boundaries for social dimensions such as roles, behaviors, and practices. Just like the other systems, the social system has its own concepts, which are organization, power, status, decision making, authority, and control.  Organization refers to a group of people who gather together with an aim of achieving a specific goal. Authority is the element of being in charge and with power. Power is the ability to influence or dictate behavior while status is the position an individual has been placed by the society. 

The three systems as described above form the basis of King’s Theory of Goal Attainment. Each of the system and its specific concepts have a unique influence on goal attainment. To this end, the influence on the goal can be either positive or negative. The systems and their corresponding concepts do not operate in isolation; they are interlinked. In practical setups, for instance, a nurse might experience difficulties helping patients with difficult personalities since, at this point, the interpersonal system does not match. This will affect the social system since interaction will be a problem, and consequently affect operational mood and relationships. The setting of the social system needs to be evaluated on a regular frequency since it determines the speed of goal attainment. The role of technology and its impact on social systems is becoming phenomenal, especially now that people are adopting online lives. Nurses need to embrace the changes and bear in mind that their online self-representation has an impact on the perception their clients will have of them. 

Clinical Quality Improvement Practice

The theory has been applied to different settings in the field of healthcare. A good example is its applicability in the operation of nurses in wards and the implementation of changes that are intended to improve the different concepts defined in the three systems of King’s Theory. In wards, the nurse will need all the three systems to ensure that patients get value and achieve their goals. In inpatient settings, a nurse interacts with patients, other nurses, and junior and senior staff. The interaction of all members of the ecosystem should allow optimal participation of all. In this case, communication is critical. To ensure that there is sufficient communication, the personal and interpersonal systems need to be evaluated in case of communication problems to identify underlying problems. As such, nurses are able to pivot their relationships hence a favorable environment. 

Quality Committee and King’s Conceptual System Theory

 A quality committee can utilize the King’s theory to set the basis for its outcomes and as such, be in a position to oversee the delivery of high-quality service to its clients. Most importantly, the committee can use the theory to develop a plan of action, especially using one or all of the three systems. When a system is selected, the committee should understand the situation on the ground using data collection and action planning to guide implementation. Before the implementation of such a program, there should be sufficient piloting to ensure that bottlenecks and pitfalls are identified and mitigation measures implemented. 

Additional Nursing Theory

The Self-Care Theory by Dorothea E. Orem is emphatic about the wholeness of developed human structures and bodily and mental functioning. The theory is anchored on physical, psychological, social, and interpersonal aspects as elaborated by Smith and Parker (2015). The theory, however, has assumptions. First, the theory assumes that people should be self-reliant and responsible on a personal level to take care of themselves as well as others in the family. Secondly, the theory assumes that people have sufficient knowledge in healthcare. The theory emphasizes the need of one to adapt to the immediate environment and become as independent as possible. 

References

Caceres, B. A. (2015). King’s Theory of Goal Attainment: exploring functional status. Nursing science quarterly, 28(2), 151-155.

King, I.M. (1992). King’s theory of goal attainment. Nursing Science Quarterly, 5, 19–26.

King, I.M. (1971). Toward a theory for nursing: General concepts of human behavior. New York: Wiley.

Smith, M. C., & Parker, M. E. (2015). Nursing theories and nursing practice (4th ed.). Philadelphia, PA: F.A. 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.

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