How it took shape
The theory of goal attainment comes from Imogene King (1923–2007), who trained in St. Louis and in the 1960s worked in the Division of Nursing at the U.S. Department of Health, Education, and Welfare. Nursing knowledge was growing fast, she noticed, but nothing tied it together. Starting from the question "On what basis do nurses make decisions?", she laid out a conceptual framework in Toward a Theory for Nursing (1971), then derived the theory of goal attainment from it in A Theory for Nursing: Systems, Concepts, Process (1981).
At the time, a wide gap separated grand theories from bedside practice. King tried to bridge it by building a testable middle-range theory on an abstract systems foundation. She carried forward Peplau's view of the relationship as therapeutic but made its purpose—reaching shared goals—explicit.
Three interacting systems
King's interacting systems framework layers three open systems. The personal system is described through perception, self, growth and development, body image, time, and space; the interpersonal system through interaction, communication, transaction, role, and stress; and the social system through organization, authority, power, status, and decision-making. Nurse and patient each bring a personal system, form an interpersonal system together, and meet inside social systems like hospitals and families.
From perception to transaction
The core sequence runs like this: nurse and patient perceive and judge each other, act, and react, producing interaction; when, within that interaction, they set goals together, explore means, and agree, a transaction occurs—and goals get met. King stated testable propositions, such as: if perceptual accuracy is present and transactions are made, goals will be attained, and goal attainment leads to satisfaction and effective nursing care. She also designed a goal-oriented nursing record that many compare to management by objectives.
In practice
The theory shines wherever patient engagement drives outcomes, especially chronic disease management. Picture a patient with type 2 diabetes: instead of the nurse announcing "normal blood sugar" as the goal, the two of them uncover what the patient actually cares about—having the stamina to walk with the grandkids—and agree on a 20-minute walk after dinner and logging glucose three times a week. That agreement is the transaction, and mutual goal setting like this also builds self-efficacy.
Strengths and limitations
By formalizing shared goals and outcome-based evaluation, King anticipated today's patient-centered care and shared decision-making, and her clear propositions invited plenty of research. The theory does assume a patient who can communicate verbally and reason through decisions, which limits its use with unconscious patients, people with severe cognitive impairment, or infants, and its social-system concepts are less developed.
See also
Nursing theory · Peplau's interpersonal relations theory · Neuman systems model · General systems theory · Self-efficacy
FAQ
- Interaction vs. transaction?
- Interaction is the whole back-and-forth of perception and communication; a transaction is the moment within it when goals and means are actually agreed on.
- Grand theory or middle-range?
- The interacting systems framework is a grand-level conceptual framework; the theory of goal attainment derived from it is middle-range.
Sources reviewed: 2026-10-26
References
- King, I. M. (1971). Toward a Theory for Nursing: General Concepts of Human Behavior. New York: Wiley.
- King, I. M. (1981). A Theory for Nursing: Systems, Concepts, Process. New York: Wiley.
- King, I. M. (1997). King's theory of goal attainment in practice. Nursing Science Quarterly, 10(4), 180–185.
- Alligood, M. R. (Ed.). (2021). Nursing Theorists and Their Work (10th ed.). Elsevier.