Purpose: The purpose of this assignment is to stimulate thinking about how specific care might be approached using the King Theory of Goal Attainment as a framework for practice.

Instructions:

1. After reading the assigned scenario in the discussion board, identify 1 more problem or potential problem along with interventions to the plan of care for Mr. B. based on those typical for a patient with his medical problems or symptoms and demographics (in other words, you can assume that he may have other problems such as anxiety or pain or may be at risk for other problems). 

2. Develop plan of care and interventions for nursing problem using King’s Theory of Goal Attainment as the basis for practice.

3. Be sure that you include a title page and reference page as appropriate.

Scenario

Mr. B. is a 78-year-old African American, married male who was referred to the home health nurse after his discharge from the local hospital. He has been prescribed a low-sodium diet due to fluid volume over-load secondary to congestive heart failure.

During the initial visit, the nursing assessment focuses on the perceptions of the nurse and the client, communication of the nurse and the client, and interaction of the nurse and the client. The nurse begins by asking Mr. B. questions about his perception of the situation and his conclusions related to the situation. The nurse also asks the same questions of herself. Communication includes the nurse gathering additional information, validating her perceptions of Mr. B., validating the concerns f Mr. B., and establishing mutual trust. Nursing functions during assessment include viewing, recognizing, observing, and measuring; they reveal that Mr. B. consumes a diet high in sodium.

Planning for the care of Mr. B. will involve decisions about goals and agreement as to how to attain goals. These decisions are made by the nurse asking questions such as the following: (1) Which goals will serve Mr. B’s best interest? (2) What are Mr. B.’s goals? (3) Are Mr. B.’s goals and the nurse’s goals for Mr. B, congruent? (4) If the goals are not congruent, what further communication and interaction are needed to achieve congruence? (5) What are the priority goals? (6) What does Mr. B. perceive to be the best way to attain goals? (7) Is Mr. B. willing to work toward attainment of goals? (8) What does the nurse perceive as the best way to attain the goals?

There is agreement that Mr. B. needs to adhere to the prescribed low-sodium diet. To achieve that goal as well as his ultimate goal of not being hospitalized again for fluid retention, Mr. B. will require some additional information related to his dietary restrictions.

The next step of the process results in the occurrence of transactions. During this phase of the process, the nurse and Mr. B. participate in teaching sessions related to his low-sodium diet. The nurse will need to ask questions to evaluate whether she is doing what she and Mr. B. agreed upon as well as questions related to the feasibility of meeting the goals based on the transaction.

The primary aim of the evaluation phase is to assess if the goals set by the nurse and Mr. B. have been attained and, if goals were not attained, then to determine why they were not attained. Throughout this model of transactions process, the nurse continues to assess and intervene to apply the model simultaneously to problems other than the low-sodium diet as indicated by the condition of Mr. B. and current best clinical practices.