Family Health
The use of my conceptual system and Theory of
Goal Attainment in family health was suggested
(King, 1983). The family is usually the immediate
social environment in which individuals grow and
develop and learn through interactions to set
goals. Nurses work with families and with individ-
ual family members. The family is seen as a social
system, a group of interacting individuals. The
family is also viewed as an interpersonal system.
For example, nurses’ perceptions of family mem-
bers and family members’ perceptions of the nurse
influence their responses in situations and their
openness in giving information. Congruence in
perceptions of nurse and family members helps in
assessing a situation to identify concerns and/or
problems in the interpersonal system. Knowledge
of a concept or role is essential and related to
growth and development and to stress in family en-
vironments. Two cases were presented and the use
of the Theory of Goal Attainment was described in
each situation.
Community Health
Community health nursing involves a variety of
populations within a variety of social systems. For
example, school nurses must understand the edu-
cation system. Occupational health nurses must
understand the political system, the economic sys-
tem, and the belief system in a community. Some
nurses have used the Transaction Process Model in
the Theory of Goal Attainment in community
health programs as they interact and set goals with
interdisciplinary teams to manage health care
(Hampton, 1994; Sowell & Fuszard, 1989; Sowell &
Lowenstein, 1994). Nurses in community health
focus on different populations. In this sense, they
are relating to the interpersonal systems in the
framework. This is done within a variety of social
systems in the community. Although the focus is
groups, nurses work with individuals for whom
they provide services. My conceptual system (Fig.
16–1) shows the interactions of the three systems in
community health.
Use in Hospitals
Two case studies were presented to demonstrate
nurses’ use of the transaction process and knowl-
edge of the concepts of perception, communica-
tion, interaction, and role (King, 1986b). Nurses in
a Canadian hospital used the framework to struc-
ture the delivery of nursing care. They determined
that nurses could identify the published nursing di-
agnoses in 1990 with the concepts in the frame-
work (Coker et al., 1990). Nurses in Canada, in
which two hospitals were involved at a distance
from each other, used the conceptual framework to
design a system for delivery of nursing care
(Fawcett, Vaillancourt, & Watson, 1995). A director
of nursing research and education in a large mu-
nicipal hospital in the United States reported the
implementation of theory-based nursing practice
using my conceptual system (Messmer, 1995).
Theory-based practice in an emergency depart-
ment used my framework and Theory of Goal
Attainment (Benedict & Frey, 1995). The Theory of
Goal Attainment was used in adult orthopedic
nursing (Alligood, Evans, & Wilt, 1995).
The transaction process was used in short-term
group psychotherapy settings. Laben, Dodd, and
Sneed (1991) stated that my interactive systems ap-
proach of goal attainment is an ideal basis for
short-term group psychotherapy. This group used
my theory with inpatient juvenile sexual offenders,
offenders in maximum security, and community
parolees.
Continuous Quality Improvement
Continuous quality improvement in nursing and
health care is a reality. Three major categories have
been suggested as a way to develop a program.
These elements are: (1) structure, (2) process, and
(3) outcomes.Structureprovides an overall organi-
zation of the program.Processrelates to nursing
activities.Outcomesare separate from but related
to performance criteria for evaluation of nursing
care and nurses’ performance. My conceptual
system provides structure for a continuous quality-
improvement program (King, 1994). The Trans-
action Process Model in my Theory of Goal
Attainment gives a process that leads to goal attain-
ment that represents outcomes. Outcomes indicate
effective nursing care. An example was given to
document effectiveness of nursing care if one uses
a goal-oriented nursing record (King, 1984a). The
record system is an information system based on
my Theory of Goal Attainment. The record system
can be designed and adapted to most health-care
systems. For nurses, it was designed to gather data
from assessments of the patient, make a nursing
diagnosis, construct a goal list, write orders for242 SECTION III Nursing Theory in Nursing Practice, Education, Research, and Administration