Christina L. Sieloff and Patricia R. Messmer
Conceptual system and middle-range theory of goal attainment
“Theory is an abstraction that implies prediction based in research. Theory without research and research without some theoretical basis will not build scientific knowledge for a discipline”
(King, 1977, p. 23).
Imogene M. King, EdD, RN, FAAN
1923 to 2007
Credentials and background of the theorist
The nightingale tribute to imogene king
Imogene M. King was born on January 30, 1923, in West Point, Iowa. She died December 24, 2007, in St. Petersburg, Florida, and is buried in Fort Madison, Iowa. In 1945, King received a diploma in Nursing from St. John’s Hospital School of Nursing in St. Louis, Missouri. While working in a variety of staff nurse roles, King began course work toward a Bachelor of Science in Nursing Education, which she received from St. Louis University in 1948. In 1957, she received a Master of Science in Nursing from St. Louis University. From 1947 to 1958, King worked as an instructor in medical-surgical nursing and was an assistant director at St. John’s Hospital School of Nursing. King went on to study with Mildred Montag as her dissertation chair at Teachers College, Columbia University, New York, and received her EdD in 1961.
Photo courtesy of Patricia Messmer, PhD, RN-BC, FAAN.
Previous authors: C. L. Sieloff, M. L. Ackermann, S. A. Brink, J. A. Clanton, C. G. Jones, A. Marriner-Tomey, S. L. Moody, G. L. Perlich, D. L. Price, & B. B. Prusinski.
The authors encourage all readers to read Dr. King’s original materials in conjunction with this chapter.
From 1961 to 1966 at Loyola University in Chicago, King developed a master’s degree program in nursing based on a nursing conceptual framework. Her first theory article appeared in 1964 in the journal, Nursing Science, which nurse theorist Martha Rogers edited.
Between 1966 and 1968, King served under Jessie Scott as Assistant Chief of Research Grants Branch, Division of Nursing at the U.S. Department of Health, Education, and Welfare. While King was in Washington, DC, her article “A Conceptual Frame of Reference for Nursing” was published in Nursing Research (1968).
From 1968 to 1972, King was the director of the School of Nursing at Ohio State University in Columbus. While at Ohio State, her book, Toward a Theory for Nursing: General Concepts of Human Behavior (1971) was published. In this early work, King concluded, “a systematic representation of nursing is required ultimately for developing a science to accompany a century or more of art in the everyday world of nursing” (1971, p. 129). Her book received the American Journal of Nursing Book of the Year Award in 1973 (King, 1995a).
King then returned to Chicago in 1972 as a professor in the Loyola University graduate program. She also served from 1978 to 1980 as Coordinator of Research in Clinical Nursing at the Loyola Medical Center Department of Nursing. In 1980, King was awarded an honorary PhD from Southern Illinois University (Messmer, 2000). In May 1998, she received an honorary doctorate from Loyola University, where her “Nursing Collection” is housed. From 1972 to 1975, King was a member of the Defense Advisory Committee on Women in the Services for the U.S. Department of Defense. She also was elected alderman for a 4-year term (1975 to 1979) in Ward 2 at Wood Dale, Illinois.
In 1980, King was appointed professor at the University of South Florida College of Nursing, in Tampa (Houser & Player, 2007). In 1981, the manuscript for her second book, A Theory for Nursing: Systems, Concepts, Process, was published. In addition to her first two books, she authored multiple book chapters and articles in professional journals, and a third book, Curriculum and Instruction in Nursing: Concepts and Process, was published in 1986. King retired in 1990 and was named professor emeritus at the University of South Florida.
King continued to provide community service and to help plan care through her conceptual system and theory at various health care organizations, including Tampa General Hospital (Messmer, 1995). King never really retired, as she was always there for students, faculty, and colleagues who were using her theory, and even went “round the clock” to implement her theory at Tampa General Hospital. King also served on the nursing advisory board, and guest lectured at the University of Tampa.
King was a long-time member of the American Nurses Association (ANA), first with the Missouri Nurses Association, and she was also active in Illinois and Ohio. Upon her move to Tampa, Florida, she became a member in the Florida Nurses’ Association (FNA) and FNA District 4, Tampa. King held offices such as president of the Florida Nurses Foundation, served on the FNA and the FNA District IV boards, and was a delegate from the FNA to the ANA House of Delegates. In 1997, King received a gold medallion from Governor Chiles for advancing the nursing profession in the State of Florida. She was inducted into the FNA Hall of Fame and the ANA Hall of Fame in 2004. In 1994, King was inducted into the American Academy of Nursing (AAN) and served on the AAN Theory Expert Panel. In 2005, she was inducted as a Living Legend. In 1996, King received the Jessie M. Scott Award. King was thrilled that Jessie Scott was there. King was in the ANA House of Delegates to hear President Clinton’s congratulations on the ANA’s 100th anniversary and his admiration of his mother as a nurse anesthetist.
In 2000, King was keynote speaker for the 37th Annual Isabel Maitland Stewart Conference in Research in Nursing at Teachers College, Columbia University (Messmer & Fawcett, 2008; Messmer, 2008) and was pleased that Mildred Montag was present. In 1999, King was inducted into the Teachers College, Columbia University of Hall of Fame. The King International Nursing Group (K.I.N.G.) was created to facilitate the dissemination and utilization of King’s conceptual system, the Theory of Goal Attainment, and related theories. King consulted with members of the organization on an individual basis regarding her theory and continues to be active (www.kingnursing.org).
King was one of the original Sigma Theta Tau International (STTI) Virginia Henderson Fellows, and she received the STTI Elizabeth Russell Belford Founders Award for Excellence in Education in 1989 (Messmer, 2007). King was keynote speaker at two STTI theory conferences in 1992, and presented application of her theory at multiple regional, national, and international STTI conferences. King communicated regularly with students who were learning about theories within her conceptual system.
King (1971, 1981) was recognized as one of the early nurse theorists through her publications, which were translated into Japanese, Spanish, and German. She authored numerous articles and served on the editorial board of Nursing Science Quarterly. King authored several book chapters, for example, Frey & Sieloff’s Advancing King’s Systems Framework and Theory of Nursing (1995), and Sieloff and Frey’s Middle Range Theories for Nursing Practice Using King’s Conceptual System (2007), which highlighted her studies by other authors.
Theoretical sources
King (1971) described the purpose of her first book as follows:
…propos[ing] a conceptual frame of reference for nursing …. intended to be utilized specifically by students and teachers, and also by researchers and practitioners, to identify and analyze events in specific nursing situations. The conceptual system suggests that the essential characteristics of nursing are those properties that have persisted in spite of environmental changes (p. ix). It is a way of thinking about the real world of nursing; …. an approach for selecting concepts perceived to be fundamental for the practice of professional nursing; [and] shows a process for developing concepts that symbolize experiences within the physical, psychological, and social environment in nursing (p. 125).
King’s (1981) concepts are presented in the Major Concepts & Definitions box.
Use of empirical evidence
King (1971) spoke of concepts as “abstract ideas that give meaning to our sense perceptions, permit generalizations, and tend to be stored in our memory for recall and use at a later time in new and different situations” (pp. 11–12). King (1984) defined theory as “a set of concepts, that, when defined, are interrelated and observable in the world of nursing practice” (p. 11). Theory serves to build “scientific knowledge for nursing” (King, 1995b, p. 24).
King (1975a) identified two methods for developing theory: (1) a theory can be developed and then tested in research, and (2) research provides data from which theory may be developed. King (1978) believed that building knowledge for a complex profession such as nursing required these two strategies.
King cited research studies in her 1981 book, A Theory for Nursing: Systems, Concepts, Process. Within the personal system, King examined studies related to perception by Allport (1955), Kelley and Hammond (1964), Ittleson and Cantril (1954), and others. For her definition of space, King cited studies from Sommer (1969), Ardrey (1966), and Minckley (1968). For the concept of time, she acknowledged Orme’s (1969) work.
Within the interpersonal system, King cited the studies of Watzlawick, Beavin, and Jackson (1967) and Krieger (1975). She examined studies by Whiting (1955), Orlando (1961), and Diers and Schmidt (1977) for interaction. King noted Dewey and Bentley’s (1949) theory of knowledge, which addressed self-action, interaction, and transaction in Knowing and the Known, and Kuhn’s (1975) work on transactions.
Commenting on research existing at that time, particularly operations research regarding patient care, King (1975b) noted that “…most studies have centered on technical aspects of patient care and of the health care systems rather than on patient aspects directly …. Few problems have been stated that begin with what the patient’s condition demands or what the patient wants” (p. 9). King (1981) noted “several theoretical formulations about interpersonal relations and nursing process have been described in nursing situations” (pp. 151–152) and cited Peplau (1952), Orlando (1961), Paterson and Zderad (1976), and Yura and Walsh (1978) supporting the transactional process in her theory of goal attainment.
Developing the conceptual system
King posed the following questions in preparation for the 1971 book, Toward a Theory for Nursing: General Concepts of Human Behavior:
• What is the goal of nursing?
• What are the functions of nurses?
• How can nurses continue to expand their knowledge to provide quality care? (pp. 30, 39)
Figure 15–1 demonstrates the conceptual system that provided “one approach to studying systems as a whole rather than as isolated parts of a system” (King, 1995a, p. 18) and was “designed to explain (the) organized wholes within which nurses are expected to function” (1995b, p. 23).
King (1981) used a systems approach in the development of her conceptual systems and her middle-range Theory of Goal Attainment. King noted that “some scientists who have been studying systems have noted that the only way to study human beings interacting with the environment is to design a conceptual framework of interdependent variables and interrelated concepts” (King, 1981, p. 10). King (1995a) believed that her “framework differs from other conceptual schema in that it is concerned not with fragmenting human beings and the environment but with human transactions in different kinds of environments” (p. 21).
“An awareness of the complex dynamics of human behavior in nursing situations prompted [King’s] formulation of a conceptual framework that represented personal, interpersonal, and social systems as the domain of nursing” (King, 1981, p. 130). Each system identifies human beings as the basic element in the system, thus “the unit of analysis in [the] framework [was] human behavior in a variety of social environments” (King, 1995a, p. 18). King designated an example of a personal system as a patient or a nurse. King specified the concepts of body image, growth and development, perception, self, space, and time in order to comprehend human beings as persons.
Interpersonal systems form when two or more individuals interact, forming dyads (two people) or triads (three people). The dyad of a nurse and a patient is one type of interpersonal system. Families, when acting as small groups, also can be considered interpersonal systems. Understanding the interpersonal system requires the concepts of communication, interaction, role, stress, and transaction.
A more comprehensive interacting system consists of groups that make up society, referred to as the social system. Religious, educational, and health care systems are examples of social systems. The influential behavior of an extended family on an individual’s growth and development is another social system example. Within a social system, the concepts of authority, decision making, organization, power, and status guide system understanding. Thus, concepts in the framework are organizing dimensions and represent knowledge to understand interactions among the three systems (King, 1995a).
King’s middle-range theory of goal attainment
In 1981, King derived her middle-range Theory of Goal Attainment from her conceptual system. The question that motivated King to develop this theory was, “What is the nature of nursing?” (King, 1995b, p. 25). She noted the answer to be: “the way in which nurses, in their role, do with and for individuals that differentiates nursing from other health professionals” (King, 1995b, p. 26). This thinking guided her development of the Theory of Goal Attainment using the following theory development process:
• “What are the philosophical assumptions?”
• “Are the concepts clearly identified and defined?”
• “Are the concepts related in propositional statements or models?”
“The human process of interactions formed the basis for designing a model of transactions that depicted theoretical knowledge used by nurses to help individuals and groups attain goals” (King, 1995b, p. 27) (Figure 15–2).
King (1995b) stated the following:
Mutual goal setting [between a nurse and a client] is based on (a) nurses’ assessment of a client’s concerns, problems, and disturbances in health; (b) nurses’ and clients’ perceptions of the interference; and (c) their sharing of information whereby each functions to help the client attain the goals identified. In addition, nurses interact with family members when clients cannot verbally participate in the goal setting” (p. 28).
To test her theory, King (1981) conducted research, identifying that her study varied from previous studies in that it “described the nurse-patient interaction process that leads to goal attainment” (p. 153) and determines whether nurses made transactions. King used a method of nonparticipant observation to collect information about nurse-patient interactions on a patient care unit in a hospital setting with patients and nurses volunteering to participate in the study. King trained graduate students in nonparticipant observation technique to collect data. She examined multiple interactions and recorded verbal and nonverbal behaviors data. King further tested her Criterion-Reference Measure of Goal Attainment Tool, a measure of functional abilities and goal attainment in the University of Maryland Measurement of Nursing Outcomes project. She reported the instrument to have a CVI of .88 and reliability of .99 for assessing functional abilities of patients in making decisions about goal setting with and for patients to measure goal attainment (King, 1988, 2003).
Major assumptions
King’s personal philosophy about human beings and life influenced her assumptions related to environment, health, nursing, individuals, and nurse-patient interactions. King’s conceptual system and Theory of Goal Attainment were “based on an overall assumption that the focus of nursing is human beings interacting with their environment, leading to a state of health for individuals, which is an ability to function in social roles” (King, 1981, p. 143).
Nursing
“Nursing is an observable behavior found in the health care systems in society” (King, 1971, p. 125). The goal of nursing “is to help individuals maintain their health so they can function in their roles” (King, 1981, pp. 3–4). Nursing is an interpersonal process of action, reaction, interaction, and transaction. Perceptions of a nurse and a patient influence the interpersonal process.
Person
King detailed specific assumptions related to persons in 1981 and in subsequent works:
• Individuals are spiritual beings (I. King, personal communication, July 11, 1996).
• Individuals have the ability through their language and other symbols to record their history and preserve their culture (King, 1986).
• Individuals are unique and holistic, of intrinsic worth, and capable of rational thinking and decision making in most situations (King, 1995b).
• Individuals differ in their needs, wants, and goals (King, 1995b).
Health
Health is a dynamic state in the life cycle, while illness interferes with that process. Health “implies continuous adjustment to stress in the internal and external environment through the optimum use of one’s resources to achieve the maximum potential for daily living” (King, 1981, p. 5).
Environment
King (1981) believed that “an understanding of the ways that human beings interact with their environment to maintain health was essential for nurses” (p. 2). Open systems imply that interactions occur constantly between the system and the system’s environment. Furthermore, “adjustments to life and health are influenced by [an] individual’s interaction with environment …. Each human being perceives the world as a total person in making transactions with individuals and things in the environment” (King, 1981, p. 141).
Theoretical assertions
King’s Theory of Goal Attainment (1981) focuses on the interpersonal system and the interactions that take place between individuals, specifically in the nurse-patient relationship. In the nursing process, each member of the dyad perceives the other, makes judgments, and takes actions. Together, these activities culminate in reaction. Interactions result and, if perceptual congruence exists and disturbances are conquered, transactions will occur. The system is open to permit feedback because each phase of the activity potentially influences perception.
King (1981) developed eight propositions in her Theory of Goal Attainment that describe the relationships among the concepts detailed in Box 15–1. Diagrams follow each proposition. When the propositions were analyzed, 23 relationships were not specified, 22 relationships were positive, and no relationship was negative (Austin & Champion, 1983) (Figure 15–3). King (1981) also derived seven hypotheses from the Theory of Goal Attainment.
BOX 15-1
Propositions Within King’s Theory of Goal Attainment
1. If perceptual congruence (PC) is present in nurse-client interactions (I), transactions (T) will occur.
PC(I) 
T
2. If nurse and client make transactions (T), goals will be attained (GA).
T 
GA
3. If goals are attained (GA), satisfactions (S) will occur.
GA 
S
4. If goals are attained (GA), effective nursing care (NCe) will occur.
GA 
NCe
5. If transactions (T) are made in nurse-client interactions (I), growth and development (GD) will be enhanced.
(I)T 
GD
6. If role expectations and role performance as perceived by nurse and client are congruent (RCN), transactions (T) will occur.
RCN 
T
7. If role conflict (RC) is experienced by nurse and client or both, stress (ST) in nurse-client interactions (I) will occur.
RC(I) 
ST
8. If nurses with special knowledge and skills communicate (CM) appropriate information to clients, mutual goal setting (T) and goal attainment (GA) will occur. [Mutual goal setting is a step in transaction and thus has been diagrammed as a transaction.]
CM 
T 
GA
From Austin, J. K., & Champion, V. L. (1983). King’s theory of nursing: Explication and evaluation. In P. L. Chinn (Ed.), Advances in nursing theory development (p. 55). Rockville, (MD): Aspen.
Logical form
In her 1968 article, King set forth her first conceptual frame of reference with the following four concepts that center on human beings:
Although King’s original framework was abstract and dealt with “only a few elements of concrete situations” (King, 1981, p. 128), she maintained that her four “universal ideas (social systems, health, perception, and interpersonal relations) were relevant in every nursing situation” (King, 1981, p. 128). King (1981) began further development of her conceptual system and proposed her middle-range Theory of Goal Attainment to describe “the nature of nurse-client interactions that lead to achievement of goals” (p. 142) as follows:
Nurses purposely interact with clients to mutually establish goals, and to explore and agree on means to achieve goals. Mutual goal setting is based on nurses’ assessment of clients’ concerns, problems, and disturbances in health, their perceptions of problems, and their sharing information to move toward goal attainment (pp. 142–143).
A logical progression of development existed in the conceptual system from 1971 to 1981, with King deriving her middle-range Theory of Goal Attainment from her conceptual system. The Theory of Goal Attainment “organize[s] elements in the process of nurse-client interactions that result in outcomes, that is, goals attained” (King, 1981, p. 143).
King (1971) initially had stated the following:
…[I]f nurses are to assume the roles and responsibilities expected of them, …. the discovery of knowledge must be disseminated in such a way that they are able to use it in their practice …. Descriptive data collected systematically provide cues for generating hypotheses for research in human behavior in nursing situations (p. 128).
In 1981, King spoke of fewer dichotomies between health and illness, referring to illness as interference in the life cycle. Through reformulation, King provided a more open system relationship between person and environment. King also revised her terminology, using adjustment instead of adaptation, and person, human being, and individual rather than man.
Clements and Roberts (1983) illustrated King’s ideas, applying the Theory of Goal Attainment for the health of families.
Acceptance by the nursing community
Practice
King’s (1971) early publication led to nursing curriculum development and practice application at Ohio State University and other universities. Professionals in most nursing specialty areas have used the concepts of King’s (1981) Theory of Goal Attainment in nursing practice. Its relationship to practice is obvious because nurses function primarily through interactions with individuals and groups within the environment. King (1984) proposed “nurses, who have knowledge of the concepts of this Theory of Goal Attainment, are able to perceive what is happening to patients and family members and are able to suggest approaches for coping with the situations” (p. 12).
King developed a documentation system, the goal-oriented nursing record (GONR), to accompany her middle-range Theory of Goal Attainment and to record goals and outcomes. The GONR was a method of collecting data, identifying problems, and implementing and evaluating care that has been effective in patient settings. Nurses can use the GONR approach to document the effectiveness of nursing care. “The major elements in this record system are: (a) data base, (b) nursing diagnosis, (c) goal list, (d) nursing orders, (e) flow sheets, (f) progress notes, and (g) discharge summary” (King, 1995b, pp. 30–31).
Health care professionals have implemented King’s (1981) conceptual system and middle-range Theory of Goal Attainment in various national and international practice settings (King, 2006, 2007). The following identifies some settings, and references additional settings. Jolly and Winker (1995) applied the Theory of Goal Attainment in nursing administration. Coker and colleagues (1995) implemented nursing diagnoses in a Canadian community hospital, and Fawcett, Vaillancourt, and Watson (1995) applied the conceptual system in a large Canadian hospital. Williams (2001) applied King’s work in emergency and rural nursing. Elberson (1989) described King’s conceptual system applied to nursing administrative practice. Sieloff (1995) defined the health of a social system. Olsson and Forsdahl (1996) examined the role of the new nurse in Norway. King (2007) clarified application of her conceptual system in a health care organization. Abraham (2009) explored planned teaching programs in environmental health. D’Souza, Somayaji,and Subrahmanya Nairy (2011) examined “determinants of reproductive health and related quality of life among Indian women in mining communities” (p. 1963).
Frey, Sieloff, and Norris (2002) provided an overview of the impact of King’s work in the past, present, and future. King (2000) discussed evidence-based nursing practice and, in 2007, described her theory of goal attainment and the transaction process as viewed in the twenty-first century. Khowaja (2006) described the use of King’s conceptual system and Theory of Goal Attainment in the development of a clinical pathway. Lane-Tillerson (2007) emphasized that “the idea of continuous advancement is central to Imogene King’s (1981) conceptual framework” (p. 141), imagining nursing practice in 2050. Killeen and King (2007) provided additional support and addressed the use of King’s conceptual system with nursing informatics and nursing classification systems for global communications. Clarke, Killeen, Messmer, and Sieloff (2009) described King’s influence on nursing science. Bond and colleagues (2011) analyzed the use of King’s Theory of Goal Attainment in five years of publications. Messmer and Cooper (2011) described the application of King’s Theory of Goal Attainment in understanding a pediatric fall prevention and fall injury risk program.
Education
Nursing faculty at several universities used King’s concepts to design nursing curricula, such as King and Daubenmire (1973) at Ohio State University; Gold, Haas, and King (2000) at Loyola University in Chicago; and Gulitz and King (1988) at the University of South Florida. In 1980, Brown and Lee reported that King’s concepts were useful in developing a framework for “use in nursing education, nursing practice, and for generating hypotheses for research …. [They] provide a systematic means of viewing the nursing profession, organizing a body of knowledge for nursing, and clarifying nursing as a discipline” (p. 468). Other studies report use of King’s conceptual system to improve educational strategies (Ward, 2010).
King’s conceptual system and theory have nursing education applications internationally described by Rooke (1995b) for a Swedish educational setting. Bello (2000) conducted research with Portuguese undergraduate students. Palmer (2006) identified patient education implications for nurses working with older adults. Costa and colleagues (2007) described a model of care for families at-risk.
Research
Many research studies have used King’s work as a theoretical basis. Several studies are mentioned here, and others are listed in the bibliography.
Langford (2008) incorporated the concept of transactions in research with “nurse practitioners and weight loss in obese adolescents,” and Firmino, de Fatmina, Cavalcante, and Celia (2010) used personal and interpersonal concepts for research with patients experiencing hypertension. Others listed as follows have used King’s (1981) conceptual system:
• Khowaja (2006) utilized King’s conceptual system and theory of goal attainment to develop a clinical pathway.
• Frey, Ellis, and Naar-King (2007) examined the congruency between King’s conceptual system and multisystemic therapy.
• Taha (2009) utilized King’s conceptual system to explore “factors relating to the disposition status in children with severe traumatic brain injury” (p. 417).
• Talbott (2009) also used King’s conceptual system to study “characteristics of students requiring specialized physical health care services” (p. 418).
• George, Roach, and Andrade (2011) examined the view of nursing held by consumers, surgeons, and nurses.
Researchers have developed many middle-range theories using King’s conceptual system (King, 1978; Sieloff & Frey, 2007). These theories include Frey’s theory of families, children, and chronic illness (Frey, 1995), Killeen’s theory of patient satisfaction with professional nursing care (2007), Sieloff’s theory of group power/empowerment within organizations (2010, Sieloff & Bularzik, 2011; Sieloff & Dunn, 2008), Wicks’ theory of family health (Wicks, Rice, & Talley, 2007), Doornbos’ (2007) theory of family health, and the advance directive decision-making model of Goodwin, Kiehl, and Peterson (2002). Fairfax (2007) derived a theory of quality of life of stroke survivors. Nwinee (2011) used King’s work to develop the Nwinee Socio-Behavioral Self-Care Management Nurse Model.
Maloni (2007) examined a cognitive interactive nursing intervention and health outcomes with patients with type 2 diabetes. Ritter (2008) studied benefits from participation by academically at-risk students in a mentor/tutor program. Sivaramalingam (2008) studied perceptions of surgical nurses held by surgical patients. Stevens (2009) examined the relationships among structural empowerment, collaboration with physicians and team work, and patient safety culture. Alligood (2010) examined exemplars of King-based research in family health care. Bond and colleagues (2011) conducted a “univariate descriptive analysis of five years’ research articles” (p. 404).
Further development
Over the years, King consistently demonstrated her belief in the need for further testing of the Theory of Goal Attainment. “Any profession that has as its primary mission the delivery of social services requires continuous research to discover new knowledge that can be applied to improve practice” (King, 1971, p. 112).
In 1995, Fawcett and Whall identified five major areas in which further development of King’s work would be helpful:
1. The concept of environment would benefit from additional definition and clarification.
3. Future linkages between King’s (1981) conceptual system and other existing middle-range theories should continue in a manner that ensures congruency between the conceptual system and the specific middle-range theory.
4. Empirical testing should continue for the Theory of Goal Attainment (King, 1981) and other middle-range theories developed within King’s conceptual system (Fawcett & Whall, 1995) (e.g., Sieloff & Dunn, 2008; Sieloff, & Bularzik 2011).
5. Middle-range theories that are implied rather than explicit, such as those of Rooke (1995b), would benefit from development into formal theories (e.g., Nwinee, 2011).
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