Imogene King

Nursing theorist

• Born: January 30, 1923
• Birthplace: West Point, Iowa
• Died: December 24, 2007
• Place of death: South Pasadena, Florida

Education: St. John’s School of Nursing (St. Louis); St. Louis University; Teachers College, Columbia University

Significance: Imogene King revolutionized the clinical practice of nursing by creating innovative conceptual models to define the relationship between a nurse and a patient. King’s models emphasize patient-environment and patient-nurse interactions, as well as goal-setting.

Background

Imogene Martina King was born in 1923 in the small Iowa town of West Point, a crossroads town in the southeastern corner of the state. King was precocious child who early on felt restless within the tight confines of rural life. By the time she was a teenager, she had decided she would be a teacher. But money was tight—King was one of three sisters. When an uncle, the town’s only practicing doctor, offered to pay her tuition if she went to nursing school, King accepted his offer.

Raised Catholic, King enrolled at the St. John’s School of Nursing in St. Louis. It was affiliated with the St. Louis University School of Nursing and run by the Sisters of Mercy, an order long devoted to patient care. Although at the time certification was all that was required for nurses (King completed hers in 1945), King went on to earn a bachelor’s degree in nursing at St. Louis University in 1948. King began hands-on nursing in 1945, accepting a position as clinical instructor in medical-surgical nursing at St. John’s. But she was frustrated by the nursing curriculum which, at the time, regarded nurses as appendages of doctors, providing care at the instruction of the attending physician. King felt that nurses were far more crucial, and their role far more complex.

Life’s Work

From 1952 to 1958, King served as an instructor and as assistant director of nursing at St. John’s School of Nursing. During that time, King began to gather first-hand data on the actual work nurses performed. After she completed her doctoral work in education at Teachers College, Columbia University, King accepted a teaching position at Chicago’s Loyola University in 1961. In 1966 she worked as assistant chief in the nursing division’s research grants department at the Bureau of Health, Manpower, and Welfare. She then left to direct the nursing program at The Ohio State University from 1968 to 1972, before returning to Loyola as a professor in the university’s graduate nursing program.

In the late 1960s, King first promulgated what became known as the Theory of Goal Attainment, a landmark conceptual model of nursing. A patient, King argued, was a person in constant interaction with themselves and with their environment. A nurse, far from simply administering service at the direction of a physician, was involved in promoting, maintaining, restoring, and sustaining good health in a patient who day to day, really hour to hour, changed. In fact, a nurse could be seen only in relation to the patient, an ongoing dyad that had to be open to change as the care protocol developed. A patient could best be seen as a complex system of interrelated levels: a personal level (how the patient sees and evaluates themselves, their health, and their body); the interpersonal relationship (how the patient responds to and interacts with the nurse as primary caregiver); and the larger social system (how the patient interacts with family and friends). Each system needed to be factored in to how the nurse would best approach the ultimate goal of restoring the patient to health.

To achieve that goal, King proposed a five-step model: nurses (1) assess the patient, the patient’s background and attitude; (2) diagnose the patient’s medical record, examine the monitored signs and understand the specific health issue(s) by drawing on experience as well as their skills and expertise; (3) create a clear plan for achieving a return to health, a doable and realistic plan with a specific time schedule; (4) implement that plan in carefully measured steps with the patient’s cooperation; and (5) most importantly, evaluate the plan even as it is being executed, and continue to adjust and improve its efficiency as needed. If the nurse was not in tune with the patient, stress would be generated and the goal of good health could not be attained. King argued there must be open communication with the patient—the lack of such openness only created anxiety.

King’s model—first published in 1968, further developed in Toward a Theory of Nursing (1971), and formally named in 1997—became a template for nursing care even as King herself tirelessly promoted the concept of transactional nursing in conference forums and in professional publications. She relocated in 1980 to St. Petersburg, Florida, accepting a professorship at the University of South Florida. Even when she retired from teaching as professor emeritus in 1990, she maintained an international presence in the nursing community as a consultant for curriculum development in nursing schools around the world.

King was widely recognized for her contributions to nursing theory and practice. Her honors include an honorary doctorate from Loyola in 1989, the American Nurses Association’s Jessie Scott Award in 1996, and a gold medallion from the governor of Florida for advancing the nursing profession in 1997. In 2004 she was inducted in the American Nurses Hall of Fame; in 2005, she was given the Living Legend Award by the Academy of American Nursing. She died on December 24, 2007, two days after suffering a stroke.

Impact

King merged nursing theory with nursing experience. Her principle, that a nurse interacted with a patient by both communicating and listening, was a radical concept when it first appeared. By interacting with the patient, a nurse maintained clear and specific goals and initiated clear and specific steps toward each goal. Goal setting became a way for nurses to direct a patient’s recovery. King was a teacher by nature—her greatest achievement, she told audiences, was not her writing but rather the impact she had on each new generation of nurses in her classroom and the impact they would have, in turn, on their patients.

Principal Works

• Toward a Theory for Nursing: General Concepts of Human Behavior (1971)
• A Theory for Nursing: Systems, Concepts, Process (1981)
• Curriculum and Instruction in Nursing: Concepts and Process (1986).

Bibliography

Alligood, Martha Raile. Nursing Theorists and Their Work. 8th ed. Maryland Heights: Mosby, 2013. Print.

Evans, Christina L. Sieloff. Imogene King: A Conceptual Framework for Nursing. Newbury Park: Sage, 1991. Print.

Frey, Maureen A., and Christina L. Sieloff, eds. Advancing King’s Systems Framework and Theory of Nursing. Thousand Oaks: Sage, 1995. Print.

Sitzman, Kathleen, and Lisa Wright Eichelberger. Understanding the Work of Nurse Theorists: A Creative Beginning. Burlington: Jones, 2015. Print.

Smith, Marlaine C., and Marilyn E. Parker. Nursing Theories and Nursing Practice. 4th ed. Philadelphia: Davis, 2015. Print.