A. Compare and contrast two of the models or theories presented in this chapter considering their usefulness in practice, research, education and administration. For the purposes of this discussion, I have selected King’s Theory of Goal Attainment and Peplau’s Theory of Interpersonal Relations. On a broad perspective, both theories aim at explaining the interaction processes that happen between a nurse and her patient. Imogene King’s basic assumption of her theory is that the nurse and the client communicate information, set goals mutually, and act to attain those goals.
The same can actually be said with Peplau’s theory wherein she states that nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal, the attainment of which is achieved through the use of a series of steps, and that the nurse and patient work together so both become mature and knowledgeable in the process.
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A lot of similarities can be seen from both works as they try to explain the nursing process in a nurse-patient interaction level. see fig. 1) The concepts of person, health, environment and nursing are recurring themes on both theories as they attempt to integrate it with each of their own interaction models. The deviation between the two theories occur where the focus of their study lie in the current nursing practice. King focused on the major concept of interacting systems: Personal, interpersonal and social systems, and how the accuracy of determining which system is most applicable would lead to eventual transaction.
Because of the severity of her condition, the emergency room nurses attending for this particular patient immediately began taking actions to stabilize her condition, such as securing an IV line, drawing blood for labs, applying oxygen and doing an ECG all at the same time. When asked by a nurse to take her ordered dose of aspirin the patient fearfully verbalized, “What are you doing to me? ” Soon after, when the patient’s condition did not significantly improve but got worse, the physician advised the husband that patient be brought to the cardiac catheterization laboratory for an angiogram. The client was adamant that she did not want to take drastic measures, but the husband indicated that he wanted whatever was necessary to improve his wife’s condition. This is an excellent example of a client losing the sense of self-hood.
In regard to the concept of self, King (1981) stated “If nurses and other professionals interact with patients or clients as human beings, and let the individuals be themselves, nurses and patients would help each other grow in self-awareness and in understanding of human behavior, especially in stressful life experiences. ” In an environment that requires one to be reactive and responsive, clients often perceive nurses as being too busy or too hurried. King (1981) encouraged nurses to be aware of how they present themselves to their clients because the manner in which nurses enter a client’s room sets the tone for the entire encounter. Poor communication skills lead to poor transactions and interactions between the nurse and the client.
Poor communication skills also affect goal setting and goal attainment (Williams, 2001). It is solely because of this perception that proper “scripting” with the patients has been constantly reiterated to all nursing personnel and including even the support staff. In stark contrast with the example presented above, here is a situation where King’s Theory of Goal Attainment was used in the emergency room setting. Patient ST, a 32-year old male trauma patient who went to the emergency room due to a traumatic amputation of an arm secondary to a motor vehicle accident. The assessment phase of the nursing process can take in the concepts associated with the personal system.
Once the patient has been hemodynamically stabilized, the nurse’s attention is now focused on assisting the patient cope with the feelings of loss, separation and anger that he is experiencing. The patient’s feelings of perception, self body image, growth and development, time and space must be considered after doing the primary survey of airway, breathing and circulation. In fact, this is even specified in my institution’s “Emergency Room Nursing Database” in its attempts to fulfill the JCI requirements in documentation. Attempting to restore the patient’s self-esteem in the light of the traumatic loss is a mutually established goal between the nurse and the client. It is also important for the nurse to realize that the patient’s perceptual field is narrowed because of the pain and emotion that he is currently experiencing.
King’s theory highlights the importance of the participation of the individuals in decision making and deals with the choices, alternatives, and outcomes of nursing care. The theory offers insight into the nurses’ interactions with the individuals and groups within the environment (Williams, 2001). Element of the theory of Imogene King is usually applied specifically in interpersonal and social systems. More often than not, the mode of interaction being used in the emergency department is a dyad (2 people interacting), where the perception of a patient is changed because of a communication that takes place providing education to a patient with knowledge deficit.
Such an example occurs in ensuring a patient and its significant others’ compliance; if the patient does not understand the importance of a certain intervention or medication, cooperation and adherence will be very difficult to achieve. But once the nurse educates them with proper nurse-patient interaction and therapeutic communication, compliance and adherence to medical regimen can be achieved. King’s Goal Attainment Theory (Client-Centered Theory) is indeed what we are practicing in the daily routine of the hospital and in any other clinical setting. Giving the patient the pertinent information of what is going to happen or what is happening will lessen the patient’s anxiety that contributes to tachycardia, restlessness and give them a sense of control of the situation.