Imogene King

Imogene King
Imogene King

Goal Attainment Theory (1971,1981,1986,1987,1989)


Three interacting systems; individuals (personal system), groups (interpersonal system), and society (social system); the personal system is a unified, complex, whole self who perceives, thinks, desires, imagines, decides, identifies goals, and selects means to achieve them.


Adjustments to life and health are influenced by an individual;s interactions with environment. The environment is constantly changing.


A dynamic state in the life cycle; illness is an interference in the life cycle. Health implies continuous adaptation to stress in the internal and external environment through the use of one’s resources to achieve a maximum potential for daily living.


A helping profession that assists individuals and groups in society to attain, maintain, and restore health. If this is not possible, nurses help individuals die with dignity. Nursing is perceiving, thinking, relating, judging and acting a vis-avis the behavior of individuals who come to a nursing situation.  A nursing situation is the immediate environment, spatial and temporal reality, in which nurse and client establish a relationship to cope with health state and adjust to changes in activities of daily living if the situation demands adjustment. It is an interpersonal process of action, reaction, interaction, and transaction whereby nurse and client share information about their perceptions in the nursing situation.

King’s Goal Attainment Theory

Imogene King’s theory of goal attainment, first published in 1971, was derived from conceptual framework of three dynamic interacting systems; (a) personal systems (individuals), (b) interpersonal systems (groups), and social systems (society). Key concepts are identified for each system as follows:

1. Personal system concepts: perception, self, body image, growth and development, space and time

2. Interpersonal system concepts: interaction, communication, transaction, role and stress

3. Social system concepts: organization, authority, power, status, and decision making.

The client ans nurse are personal systems subsystems within interpersonal and social systems. To identify problems and to establish goals, the nurse and client perceive one another, act and react, interact, and transact. Transactions are defined as purposeful interactions that lead to goal attainment. Transactions have the following characteristics:

1. They are basic to goal attainment and include social exchange, bargaining and negotiating, and sharing a frame of reference toward mutual goal setting.

2. They require perceptual accuracy in nurse-client interactions and congruence between role performance and role expectation for nurse and client.

3. They lead to goal attainment, satisfaction, effective care, and enhanced growth and development.

King postulates seven hypothesis in goal attainment theory:

1. Perceptual congruence in nurse-client interactions increases mutual goal setting.

2. Communication increases mutual goal setting between nurses and clients and leads to satisfactions.

3. Satisfaction in nurses and clients increase goal attainment.

4. goal attainment decreases stress and anxiety in nursing situations.

5. Goal attainment increases client learning and coping ability in nursing situations.

6. Role conflict experienced by clients, nurses, or both decreases transactions in nurse-client interactions.

7. Congruence in role expectations and role performance in creases transactions in nurse-client interactions.

King’s theory highlights the importance of the participation of all individuals in decision making and deals with the choices, alternatives, and outcomes of nursing care. The theory offers insight into nurses’ interactions with individuals and groups within the environment t.



Kozier, Barbara Fundamentals of Nursing  5th edition

Addison-Wesley Publishing Company, Inc pp.48-49

204 RLE Procedures



Crutches are artificial supports and assists patients who need aid in walking because of disease, injury, or a birth defect.


> To assist client who cannot bear  any weight on one leg.

> To assist client who have full weight bearing on both legs.

> Prevent injury to client who has difficulty in ambulation.


> Assess client’s physical limitations to determine safety and comfort.

> Take time to show patients how to walk with crutches for them to learn

> Maintain proper body mechanics.


> Gait belt                                         > Tape measure

> Crutches                                        > Sturdy footwear, properly fitted

Crutch Walking

1. Inform the client you will be teaching crutch ambulation.

Rationale:  Reduces anxiety. Helps increase comprehension and cooperation, promotes client independence.

2. Assess the client for strength, mobility, ROM, visual acuity, perceptual difficulties and balance. Note: nurse and therapist often collaborate on this assessment.

Rationale: Helps determine the clients capabilities and amount of assistance required.

3. Adjust crutches to fit the client. With the client supine, measure from the heel to the axilla. With the client standing, set the crutch position at a 4-5 inches lateral to the client and 4-6 inches in front of the client. The crutch pad should fit 1.5 – inches below the axilla (3 finger width). The hand grip should be adjusted to allow for  the client to have elbows bent at 30 degree flexion.

Rationale: Provide broad base of support for the client. Space between the crutch pad and axilla prevents pressure on radial nerves. The elbow flexion allows for space between the crutch pad and axilla.

4. Lower the height of the bed.

Rationale: Allows the client to sit with feet on the floor for stability.

5. Have the client dangle legs. Assess for vertigo.

Rationale: Allows for stabilization of blood pressure, thus preventing orthostatic hypotension.

6. Instruct the client to position crutches lateral to and forward to feet. Demonstrate correct positioning.

Rationale: Increases client comprehension and cooperation.

7. Apply the gait belt around the client’s waist if needed.

Rationale: Provides support, promotes client safety.

8. Assist the client to a standing position with crutches.

Rationale: Standing for a few minutes will assist in preventing orthostatic hypotension.

Four-Point Gait

9. a. Position crutches to the side and in front of each foot.

b. Move the right crutch forward 4 to 6 inches.

c. Move the left foot forward, even with the left crutch.

d. Move the left crutch forward 4 to 6 inches.

e. Move the right foot forward, even with the left crutch.

f. Repeat the four-point gait.

Rationale: The four point gait provides greater stability. Weight bearing is on three points at all times. The client must be able to bear weight with both legs.

Three-Point Gait

10. a. Advance both crutches and the weaker leg forward together.

b. Move the stronger leg forward, even with crutches.

c. Repeat three-point gait.

Rationale: The three point gait provides a strong base of support. This gait can be used if the client has a weak or non-weight-bearing leg.

Two-Point Gait

11. a. Move left crutch and right leg forward 4 – 6 inches.

b. Move right crutch and left leg forward 4 – 6 inches.

c. Repeat two-point gait.

Rationale: The two pint gait provides a strong base of support. The client must be able to bear on both legs. This gait is faster than four-point gait.

Walking UP stairs

12.a.  Instruct the client to position the crutches as if walking.

b. Place the strong leg on the first step.

c. Pull weak leg up and move the crutches up to the first step.

d. Repeat for all steps

Rationale: Prevents weight bearing on the weaker leg.

Walking DOWN stairs

13. a. Position the crutches as if walking.

b. Place weight on the strong leg.

c. Move crutches down the next lower step.

d. Place partial weight on hands and crutches.

e. Move the weak leg down to the step with crutches.

f. Put the total weight on arms and crutches.

g. Move strong leg same step as weak leg and crutches.

h. Repeat for all steps.

Rationale: Prevents weight bearing on weaker leg.

14. Set realistic goals.

Rationale: Crutch walking takes up to 10 times the energy required for unassisted ambulation.

15. Consult with a physical therapist.

Rationale: The physical therapist is the expert on the health care team for crutch-walking techniques.

16. Wash hands.

Rationale: Reduces the transmission of microorganisms.


Kozier, Barbare, Fundamentals of Nursing. Philippines: Pearson Education South Asia PTE LTD. pp. 1102-1104