King’s theory as foundation for and Advance Directive Decision-Making Model. Nursing Science Quarterly. Article


King’s theory of Goal attainment (developed in the 1960’s) outlines a dynamic interpersonal relationship where a patient cultivates certain life goals. The theory has been applied over the years to help patients set health goals and achieve them. This is evident with the enactment of the Patient Self-Determination Act (PSDA) in the United States of America in 1990. It is on this basis that the article discusses the application King’s theory as a foundation of an Advance Directive Decision Making Model (ADDM). The aim of the ADDM model is to assist in the achievement of set client goals and PSDA compliance (Goodwin et al., 2002, p. 1).


The article begins by outlining the reasons for developing an Advance Directive Decision Making Model. Studies have shown that allowing the patients to make decisions regarding their health and advocating for those decisions is not an easy task. Most challenges being faced by clients include the lack of proper knowledge and the lack of required support and resources (Goodwin et al., 2002, p. 1).

The Patient Self Determination Act (PSDA) is also discussed in length. It was the first national legislation policy to inform patients of their medical treatment rights. It provides the right to accept or decline medical treatment and allows the preparation of advance directives (ADs) in written form (Goodwin et al., 2002, p. 1).

The article further discusses the role played by both the registered nurses and nursing practitioners in educating and empowering clients. Nurses are claimed to be the best placed practitioners to help the clients make health goals. In any interaction between the client and the nurse, the discussion of end of life scenarios will arise. Therefore, the fact that most nurses are unprepared or do not feel a need to discuss end of life issues with their clients is alarming (Goodwin et al., 2002, p. 2).

The King’s theory offers a foundation as it presents the concept of interacting systems of the individual, the group and the society. The three systems interact and incorporate the four domains of nursing, the client, the environment and health (Goodwin et al., 2002, p. 2). The Advance Directive Decision Making Model (ADDM) graphically outlines the role played by nursing practitioners. Seven concepts from King’s theory are replicated. The model considers the challenges faced by nurses in addressing end of life issues and provides a model to help them frame the interaction with the client (Goodwin et al., 2002, p. 3).


The nurse – client relationship is an important aspect when developing and implementing the client’s health goals. Nurses interact with patients more and therefore get to know them at a personal level. But whilst the Advance Directive Decision Making Model aims to ease the interaction between nurses and client, there seems to be major assumptions towards its practicability. It would be important to understand the different perception scenarios affecting each subject. More importantly it would be of benefit to explore the implications of these scenarios towards setting the client’s goals and achieving them.


Goodwin, Z., Kiehl, E. M., & Peterson, J. Z. (2002). King’s theory as foundation for and Advance Directive Decision-Making Model. Nursing Science Quarterly, 15(3), 237-241.