untitled

central to nursing has clear relevance for evidence-
based practice when using King’s (1981) concepts,
such as perception.
Research conducted with a King theoretical base
is well positioned for application by nurse care-
givers, nurse administrators (Sieloff, 2003), and
client-consumers (Killeen, 1996) as part of an
evolving definition of evidence-based nursing
practice. For example, King (1971) addressed client
preference, a possible part of an evidence-based
nursing definition, as satisfaction. In an update
of the concept of satisfaction, King submits that
satisfaction is a subset of her central concept of
perceptions (Killeen, 1996).

KING’S CONCEPTS, THE NURSING
PROCESS, AND STANDARDIZED
NURSING LANGUAGES

The steps of the nursing process have long been in-
tegrated within King’s interacting systems frame-
work and midrange Theory of Goal Attainment
(Daubenmire & King, 1973; Husband, 1988;
Woods, 1994). In these process applications, assess-
ment, diagnosis, and goal-setting occur, followed
by actions based on the nurse-client goals. The
evaluation component of the nursing process con-
sistently refers back to the original goal state-
ment(s). With the use of standardized nursing
languages (SNLs), the nursing process is further
refined. Standardized terms for diagnoses, inter-
ventions, and outcomes potentially improve com-
munication among nurses.
Using SNLs enables the development of middle-
range theory by building on concepts unique to
nursing, such as those concepts of King that can be
directly applied to the nursing process: action, reac-
tion, interaction, transaction, goal-setting, and goal
attainment. Biegen and Tripp-Reimer (1997) sug-
gested middle-range theories be constructed from
the concepts in the taxonomies of the nursing lan-
guages focusing on outcomes. Alternatively, King’s
framework and theory may be used as a theoretical
basis for these phenomena and may assist in knowl-
edge development in nursing in the future.
With the advent of SNLs, “outcome identifica-
tion” is identified as a step in the nursing process
following assessment and diagnosis (McFarland &
McFarland, 1997, p. 3). King’s (1981) concept of
mutual goal-setting is analogous to the outcomes
identification step, because King’s concept of goal

attainment is congruent with the evaluation of

client outcomes.

In addition, King’s concept of perception (1981)

lends itself well to the definition of client out-

comes. Johnson and Maas (1997) define a nursing-

sensitive client outcome as “a measurable client or

family caregiver state, behavior, or perception that

is conceptualized as a variable and is largely influ-

enced and sensitive to nursing interventions”

(p. 22). This is fortuitous since the development of

nursing knowledge requires the use of client out-

come measurement. The use of standardized client

outcomes as study variables increases the ease with

which research findings could be compared across

settings and contributes to knowledge develop-

ment. Therefore, King’s concept of mutually set

goals could be studied as “expected outcomes.” In

addition, using SNLs, King’s (1981) midrange

Theory of Goal Attainment could be conceptual-

ized as “attainment of expected outcomes” as the

evaluation step in the application of the nursing

process.

IMPACT OF MANAGED CARE AND

TECHNOLOGY ON KING’S CONCEPTS

Both managed care and increasing use of technol-

ogy have challenged existing conceptual frame-

works of nursing, requiring adaptation and

evolution. The following is an overview of the ways

that King’s concepts have evolved within this

changing health-care climate.

Managed Care

With managed care, nursing is increasingly in-

volved with collaboratively developing evidence-

based care planning tools and critical pathways,

protocols, and guidelines with other disciplines.

King (1981) has always promoted cooperation and

collaboration among disciplines.

In the managed care environment, personal, in-

terpersonal, and social systems need to include an

expanded conceptualization of King’s concept of

goal-setting. Personal and professional goal-setting,

nurse-client/consumer dyad goal-setting, nurse

task force and team goal-setting, and nurse leader-

organization goal-setting are examples of broader

applications common in nursing situations.

Multidisciplinary care conferences, an example

of a situation where goal-setting among profes-

sionals occurs, is a label for an indirect nursing

CHAPTER 16 Applications of King’s Theory of Goal Attainment 261