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Kings Theory of Goal Attainment in Nursing Practice

King’s Theory of Goal Attainment in Nursing Practice

Imogene King’s Theory of Goal Attainment was chosen because not only can it be used in the nurse-patient relationship, it can also be used in the education and mentoring of new nurses.  King’s Theory of Goal Attainment (TGA) is also known as the Interaction-Transaction Process (Kearney-Nunnery, 2016).

The 10 steps of this process include perception, judgment, action, reaction, disturbance, mutual goal setting, exploration of means to achieve goals, agreement on means to achieve goals, transaction, and attainment of goals (Kearney-Nunnery, 2016, p. 36).  Caceres states the King’s TGA is based on the nursing process.  Perception, judgment, action, and reaction are related to the assessment phase where we develop our thoughts about the patient and learn more about their goals. During the nursing diagnosis, we learn about problems and concerns that the patient may have is related to disturbance.  The planning phase incorporates the steps of mutual goal setting, exploration of means to achieve goals, agreement on means to achieve goals, and transaction.  During the final phase of the nursing process, implementation, we continue to use the step of transaction to achieve attainment of goals (Caceres, 2015).

There are many areas of nursing practice where TGA may be used today.  One area of interest in nursing is the functional status of our patients.  There doesn’t appear to be a clear-cut definition of functional status as it is interpreted differently in different professions.  One view of functional status looks at the physical capabilities of patients, their ability to perform activities of daily living (ADLs) (Caceres, 2015).  In my practice of nursing, the patient’s ability to perform ADLs such as ambulating, bathing, feeding themselves, toileting, dressing, and brushing their teeth is important in the planning of their care while in the hospital and when they are discharged.  While they are in the hospital, we are always looking ahead to discharge and what needs they may have.  Some patients can attend to all their ADLs while others may become weak and need assistance in getting up and out of bed, going to the bathroom or they may come in not being able to do anything for themselves.  We may have many disciplines such as physical therapy, occupational therapy and speech therapy working with the patients to determine their needs while in the hospital and at discharge.  Another view of functional status also includes “social, cognitive, psychological, and spiritual domains” (Caceres, 2015, p, 151).

As a preceptor and mentor for new nurses, finding ways to educate and help them advance in their nursing practice can be a challenge.  King’s TGA is a tool that has been used by nurse educators in the last several years for mentoring millennial nurses.  Millennial students are very tech-savvy, goal-oriented and confident in their abilities.  Using King’s TGA can be helpful for the “millennial students and educators as it relates to the importance of communication, transaction, self, stress, growth and development, personal space, and time in both their work and personal lives” (McQueen, Cockroft, Mullins, 2017, p.223).  While precepting and mentoring millennial students, I have learned that not only are they technologically savvy, but most are willing to share their knowledge and skills.  The millennial students are also proficient in multi-tasking and using multiple devices such as a laptop and mobile phone (McQueen et al., 2017).  One of the struggles I see in my practice as a nurse is the perceptions of the patient and family members when they see a nurse or student nurse using their mobile phone.  Many times, it is quicker to look up information on medications or medical conditions on a mobile phone than the medication administration carts (MAK).  It is easier and faster to use one’s mobile phone for a calculator than trying to locate it on MAK, but due to the perception of the patient and their family members, nurses and nursing students are not allowed to have mobile phones in patient care areas.  This may change in the future as mobile devices are usually the preferred means of communication between the millennial student and millennial practitioners.  With the onset of these technological advances, nurse educators and mentors will need to continually update their technological skills to be able to engage the millennial students (McQueen et al., 2017).

Millennial students also expect immediate feedback.  They expect assignments to be graded quickly and are impatient when they do not get this feedback in a timely manner.  While the millennial students are confident in their academic and technological knowledge, they want to be acknowledged for this by their instructors and mentors.  King’s TGA may useful in helping educators understand the needs of millennial students in both the classroom and clinical environment (McQueen et al., 2017).  “The expressive learning style and engagement in learning and technology are key to millennial success and goal attainment” (McQueen et al., 2017, p. 225).

In my practice as a nurse, I can see myself using King’s TGA to help with developing a nursing care plan for my patients.  The TGA will be helpful in encouraging patients and their families to participate in setting goals for the patient to achieve while they are in the hospital.  This may also be helpful in encouraging better communication with the patient, their family, and their provider.  TGA may also be useful in helping the patient set and achieve goals in relation to their functional status.  Functional status can include performing ADL’s and addressing psychological or spiritual needs.  This may require getting orders for physical therapy or requesting a chaplain come see the patient and their family.  I also plan to see how I can use King’s TGA to help nursing students that I precept set goals they would like to achieve during the clinical hours they spend with me.  My goal is usually to give them as much hands-on experience as possible and seek out new or interesting things for them to see or skills for them to perform.  I am just starting as a mentor in the new residency program at my hospital, so I am hoping the TGA will help me and my mentee in setting goals for our meetings and individual goals for them during their residency.

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