INTERACTIVE
THEORIES
Interaction
with our client is very important especially in aspects of the nursing
profession. The nurse patient-relationship, also called therapeutic relationship, is the professional interaction of the
nurses to client directed preferment of wellness and health of the bottommost.
The most imperative portion of the nursing care relinquished to the health consumers.
A nurse
theorist introduced the therapeutic nurse-patient relationship that marked a
change in the nursing profession. Hildegard Peplau highlighted to the vital
manifestation of social interaction between the nurse and the patient was
regarded little and lacking in replication the health needs of the client.
However because of the holistic approach, new nursing leaders seek to give
value on the positive results of an effective nurse-patient relationship.
Hildegard Peplau
Interpersonal Relationship
Theory
“The kind of person that the nurse becomes makes a substantial
difference in what each patient will learn as he or she receives nursing care.
“
Background
- Respected as the “Psychiatric Nurse of the Century”.
- Born September 1, 1909 at Reading, Pennsylvania
- Graduated from Pottstown, Pennsylvania Hospital School of Nursing in 1931.
- Worked as an operating room supervisor at Pottstown Hospital.
- 1943 received a Bachelor of Arts in Interpersonal Psychology from Bennington College, Columbia, Vermont.
- 1947 received a Master of Arts in Psychiatric Nursing from Teacher’s College, Columbia, New York.
- 1953 received a Doctor of Education in Curriculum Development from Columbia.
- Became a member of the Army Nurse Corps and work in a neuropsychiatric hospital in London, United Kingdom during the World War II.
- 1951-1960 considered as one of the renowned nursing leaders of her time that her writings and research are repeatedly featured at the American Journal of Nursing.
- 1952 published her first book, “Interpersonal Relations in Nursing”.
- Received awards like The Christians Reimann Prize.
- March 7, 1999, Hildegard Peplau died peacefully at her home in Sherman Oaks, California after a brief illness at the age of 89.
Metaparadigm
in Nursing
Person
Person
was defined by Peplau as a “man” considered
as an organism that lives in an unstable balance of a given system.
Health
Health
was considered by Peplau as a symbol of movement in the personality and other
active human processes that direct the person towards creative, constructive,
productive and community living. Peplau believes that a man must achieved and
maintain the value and perspective for one’s health, it is the factor that he
must be met. These needs are called physiological
demands and interpersonal conditions.
Environment
Environment was defined
by Peplau as external influences of the organism and in the context of the
socially-approved way of living, from which the vital human social processes will
derive such norms, customs and beliefs. However, these conditions that lead to
health will always include the interpersonal process.
Nursing
Nursing
was described by Peplau as special, therapeutic interpersonal process. This
work with the support of human processes that present health as a attainable
goal for individuals. In collaboration of the nurses and the health care team,
health services offered must be projected in holistic approach in consideration
of the socio-economic, spiritual, emotional and physical aspect of every
person. The process of interaction with the patient or client in various
setting and situation must be always available. Nurses must use the
interpersonal model as a way to explore and to identify the needs of the man
seeking professional help.
Interpersonal
Relations Theory
Peplau categorized the
nurse-patient relationship as a four-phase phenomenon. Nurse-patient
interaction is a major component of each phenomenon that exists apart from
other things, having its own independent existence. Each phase is unique and
has distinguished contributions on the outcome of the nurse-patient
interaction.
Psychiatric
Nursing or the nursing of the mentally ill introduced by Peplau is very
important factor in the practice of this discipline.
Phase of Nurse-Patient Relationship
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1. Orientation
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The initial interaction between the nurse and the
patient wherein the latter has a felt need and expresses the desire for
professional assistance.
The nurse assists the patient in recognizing and
understanding the “patient” experience.
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2.
Identification
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The patient and the nurse explore the experience
and the needs of the patient which leads to a feeling of relatedness. It is
very important in the relationship that the nurse assist the patient in
reorienting his feelings and sustaining a constant positive environment.
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3. Exploitation
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In this phase, the patient derives the full value
of the relationship as he moves on from a dependent role to an independent
one. New goals are projected by the nurse, but the power is shifted to the
patient as these goals would be achieved through personal or self-effort.
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4. Resolution
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In its final stages, the patient earns
independence over his care as he gradually puts aside old goals and
formulates new ones. Even though the patient and the nurse end the
relationship, it is very apparent that the experience leaves a lasting
impression on the patient since illness and assuming a dependent role is a
unique human experience.
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The Interpersonal Therapeutic Process is based on the theory proposed by Peplau and particularly useful in helping psychiatric patients become receptive for therapy. It is often referred by Peplau as “Psychological Mothering,” it includes the following steps:
·
The patient is accepted unconditionally as a
participant in a relationship that satisfies his need;
·
There is recognition of and response to the
patients readiness for growth, as his initiative; and
·
Power in the relationship shifts to the patient,
as the patient is able to delay gratification and to invest in goal
achievement.
Interpersonal Roles
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Nursing Role
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The role of nurse is to undertake such
distinctive roles which will empower and equip her in meeting the needs of
the patient. It is expected that different nursing situations and phases of Interpersonal Relationship will going
to happen. These roles could overlap one over the other
and could be observed as soon as the situation comes up.
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Role of the Stranger
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The nurse and the patient are strangers to
one another. Getting to know the patient better, the nurse must treat him
with outmost courtesy, which include acceptance of the patient as a person
and due respect over his individually. This role coincides with the Identification Phase.
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Role of the Resource Person
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Nurse must be supportive and educative as
the patient acts dependently. Nurse must provide specific answers to his
queries which include health information, advices and a simple explanation of
the healthcare team’s course of care it is the responsibility of the nurse to
appropriately change her responses to the patient’s level of understanding.
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Teaching Role
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For
the progress of interaction, the nurse take over a teaching role as she gives
much importance for self-care and in helping him understand the therapeutic plan.
In bearing this role, the nurse must determine how the patient understands
the subject at hand. She must develop her discussion around the interest of
the patient and his ability of using the information provided.
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Leadership Role
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The health team over the nurse care, the
patient is still considered vital in making choices of care would take. The
nurse as a leader must act in behalf of the patient’s best interest and at
the same time enable him to make decisions over his own care. This is
achieved through cooperation and active participation.
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Surrogate Role
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The
surrogate role is when the patient completely or fully take-over his care to
the nurse (temporary care giver) role. It is wherein feelings are reactivated
and nurtured. Despite the facts that the patients recognizes the similarity of the nurse with the person
whom he recalls in previous relationship, the nurse must assist the patient
to make sure that her surrogate role is differently and only temporary.
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Counseling Role
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Peplau believes that the counseling role
has the greatest important and emphasis in nursing. This role strengthens the
nurse-patient relationship as the nurse becomes a listening friend, and
understanding family member and someone who gives sound and emphatic advises.
The very core of the interpersonal technique is for the patient to remember
and to understand the experience and how could it be integrated into his
daily life.
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Contributions
of Nursing Theorists
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Hildegard Peplau
(Psychodynamic Nursing)
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Practice
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Education
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Research
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Provides clear design for the practice of
psychiatric nursing.
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Emphasized the development of interpersonal
relationship between the patient and the nurse.
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Author of “Interpersonal Relations in Nursing”
which aids nurses.
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Formulated effective psycho therapeutic
methods.
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Formulated concepts of anxiety as a means to
constructively resolve angry feelings through experimental learning the
nurse-patient relationship.
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The major focus of Peplau’s theory interpersonal
relations, are very easy to comprehend. The theory’s basic assumptions and
key concepts were clearly given, explained, broken down and outlined. In turn,
she also demonstrated how this model could be used as a process when she
introduced the Four Phases of Nurse-Patient
Relationship. The different roles of the nurse added further understanding
on how nurses could effectively use the Interpersonal
Model.
Hildegard Peplau closely observed relationships of the interpersonal
process, nurse, patient and psychobiological experiences. She was able to
discover patterns that enabled the nurses and the patient to achieve the full
measure of their relationship. Peplau’s theory could be described as the
meeting of the quality with simplicity.
Peplau believed that all nurses, regardless of their area or clinical
setting, could effectively utilize her model. However, the theory can be used
only to situations that communication ca occur between the nurse and the
patient. The use of the method is limited or impossible in working with senile,
comatose or newborn patients. The function of the nurse is to be educative,
therapeutic and maturing force, understanding the meaning of the experience to
the patient is very important.
