Theory Critique

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Theory Critique:

Theory of Health as Expanding Consciousness and

Conceptual Framework and Theory of Goal Attainment

Jaymica Rose L. Dacquil

Saint Paul University Philippines

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Abstract

This paper describes and analyzes Imogene M. King's Conceptual Framework and Theory of

Goal Attainment and Margaret Newman’s Theory of Expanding Consciousness. Discussions of

the critiques of both King and Newman’s theory as well as some concepts of the theories are also

included. Major areas of concern of the critics include clarity, generality, empirical precision,

cultural limitations, patient competence, and lack of specific guidelines to work within the

nursing process.

Theory Critique

3Margaret Newman’s Theory of Expanding Consciousness

The theory of health as expanding consciousness arose from Roger’s theory of unitary

human beings. It was stimulated by concern for those for whom health as the absence of disease

or disability is not possible. The theory has developed to include the health of all persons

regardless of the presence or absence of disease. Newman’s theory asserts that every person in

every condition, no matter how hopeless and disordered it seems, is an aspect of the universal

process of expanding consciousness. This is a process of becoming more of oneself, of finding

greater meaning in life, and of reaching new dimensions of connectedness with other people, as

well as the entire human population.

Clarity

The theory is clear and describes all of the main components of the model clearly, which

includes the definitions, descriptions, and dimensions of the concepts of the theory.

Simplicity

The deeper denotation of the theory of health as expanding consciousness is complex.

The theory as a whole must be comprehended, not just the isolated concepts. If an individual

utilize a positivist approach, Newman’s original propositions would serve up as guides for

hypothesis development. However, researchers who tried that approach have concluded that it is

inadequate to study the theory. As Newman have advocated in the 1994 Edition of her book,

Theory of Helalth as Expanding Consciousness, the holistic approach of the hermeneutic

dialectic method is consistent with the theory and requires a high level of understanding the

theory in praxis research.

Theory Critique

4Generality

The concepts in Newman’s theory are broad in scope because they all relate

to health.

The theory has been applied in several different cultures and is applicable across

the spectrum

of nursing situations. This renders the theory genralizable.

Empirical Precision

In the early stages of development, aspects of the theory were

operationalized and tested within a traditional scientific method. However,

quantitative methods are inadequate in capturing the dynamic, changing nature of

this theory.

Derivable Consequences

The focus on Newman’s theory of health as expanding consciousness

provides an evolving guide for all health-related disciplines. In the quest for

understanding the phenomenon of health challenges nurses to make a difference

in nursing practice by the application of this theory.

Overall, Newman’s theory is considered a grand nursing theory. She states

that humans cannot be divided into parts. Health is central to the theory, and is

seen as a process of a developing awareness of the individual self and the person’s

environment. She also states that “consciousness is a manifestation of an evolving

pattern of person- environment interaction.” Also, Newman’s theory is beneficial

because it can be applied in any setting and “generates caring interventions”.

However, its drawback are that it is abstract, multidimensional, and qualitative,

and there is little discussion on environment within the model.

Theory Critique

5Imogene King’s Theory of Goal Attainment

King first published her conceptual framework in 1971 and further developed it into the

theory of goal attainment in 1981 (Johson and Webber 2001). King’s systems framework is based

on the assumption that human beings are the focus of nursing. The goal of nursing is health: its

promotion, maintenance, and/or restoration; the care of the sick or injured; and the care of the

dying (King 1992). Husting (1997) stated: ‘King’s theory evolved from the General Systems

Theory of Von Bertalanffly. The components of a system theory are: (a) goal; (b) structure; (c)

functions; (d) resources; and (e) decision making’ (p.15). King (1996) further stated that the

‘nursing domain involves human beings, families, and communities as a framework within

which nurses make transactions in multiple environments with health as a goal’ (Norris and Frey

2001).

Clarity

Assumptions remain consistent and clear in regards to nurse-patient interaction.

Language is easily understood and tautology is not evident. Connections of the metaparadigm:

person, health, nursing, and environment are clearly defined. The conceptual systems framework

provides structure and clearly defines relationships. The process of transaction and consistency

of ideas provides more clarity. Theory is considered of high clarity, as parsimony is evident.

Simplicity

King used multiple concepts, which lead to increased in complexity. Her concepts was

derived from Von Bertanlanffy’s general systems theorya and King has given them a new

meaning in defining nurse-patient relationships, which is central to her theory of goal attainment.

“The more phenomena the theory considers, the more potential relationships it could generate,

and the more complex the theory is” ( Meleis , 2012, p. 195).

Theory Critique

6Generalizability

King’s theory is a middle range theory, which means that, this theory is not too broad or

too limited. The theory provides foundation for the following: nursing practice, research, and

development of middle-range theories. Generalizability is of high ranking.

Accessibility

Accessibility refers to the extent to which empirical indicators can be identified for

concepts within the theory. Theory of goal attainment is a grand theory, which has highly abstract

concepts and does not lend itself to empirical testing. Development of middle-range theories

were derived from King’s. Accessibility is of low ranking.

Importance

According to Chinn and Kramer, the importance of a theory is closely related to the idea

of its clinical significance. Implementation of theory in practice, resulting in positive outcomes:

Through means of nurse-patient interaction

Nursing school programs and curriculum

Goal Oriented Nursing Record

Quality Assurance programs

H igh rank of importance and usefulness of King’s theory in nursing practice.

Overall, King’s theory of goal attainment does describe a logical sequence of events. For

the most part, concepts are clearly defined. King formulated assumptions that are testable

hypotheses for research. A major limitation is the effort required of the reader to shift through the

presentation of a conceptual framework and a theory with repeated definitions to find the basic

concepts. Another limitation relates to the lack of development of application of the theory in

providing nursing care to groups, families, or communities. ssssss

Theory Critique

7References

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