M8

• Hildegard Peplau's Theory of Interpersonal Relationship


  Nursing is the interpersonal therapeutic process of functioning cooperatively with other human processes that make health possible for individuals in communities through education that aims to promote forward movement of personality

  
• Hildegard Peplau

  • Considered the "Mother of Psychiatric Mental Health Nursing" and "Nurse of the Century"
  • Served as Executive Director and President of the American Nurses Association (ANA)
  • Taught the first classes for graduate psychiatric nursing students at Teachers College, Columbia University
  • Contributed to the advancement of the nursing profession more than what she gave for this special area of clinical nursing
  • Her seminal book is recognized as the first nursing theory textbook since Nightingale's work in the 1850s
  • Promoted professional standards and regulation through credentialing
  • Introduced the concept of advanced nursing practice
  • Stressed the importance of psychodynamics in nursing practice
  • Proponent of the nurse's unique ability to understand his or her own behavior in order to help others identify their perceived difficulties
• 4 Phases of the Nurse-Patient Relationship

  1. Orientation

  2. Identification

  3. Exploitation

  4. Resolution

  
• 6 Proposed Nursing Roles

  • Stranger Role
  • Resource Role
  • Teaching Role
  • Counseling Role
  • Surrogate Role
  • Active Leadership Role
• Nurse and the patient can interact
• Peplau emphasized that both the patient and nurse mature as the result of the therapeutic interaction

  
• Communication and interviewing skills remain fundamental nursing tools
• Peplau believed that nurses must clearly understand themselves to promote their client's growth and avoid limiting their choices to those that nurses value
• Nursing (Peplau's view)


  A significant, therapeutic, interpersonal process. Defined as a human relationship between an individual who is sick, or in need of health services, and a nurse specially educated to recognize and to respond to the need for help

  
• Person (Peplau's view)


  An organism that strives in its own way to reduce tension generated by needs. The client is an individual with a felt need
• Health (Peplau's view)


  A word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living
• Environment (Peplau's view)


  Although Peplau does not directly address society/environment, she does encourage the nurse to consider the patient's culture and mores when the patient adjusts to the hospital routine
• Ida Jean Orlando's Theory of Deliberative Nursing Process


  Nursing is a profession that seeks to find out and meet the patient's immediate need for help

  
• Ida Jean Orlando


  • Developed her theory from a study conducted at the Yale University School of Nursing, integrating mental health concepts into basic nursing curriculum
  • One of the first nursing leaders to identify and emphasize the elements of the nursing process and the critical importance of the patient's participation in the nursing process
  • Orlando's theory focuses on how to produce improvement in the patient's behavior. Evidence of relieving the patient's distress is seen as positive changes in the patient's observable behavior
  • Orlando analyzed the content of 2000 nurse-patient contacts and created her theory based on analysis of these data
  • One of the early thinkers in nursing who proposed that patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before drawing conclusions

  
• Persons become patients who require nursing care when

  They have needs for help that cannot be met independently because they have physical limitations, have negative reactions to an environment, or have an experience that prevents them from communicating their needs
• Patients experience

  Distress or feelings of helplessness as the result of unmet needs for help
• When individuals are able to meet their own needs, they do not feel distress and do not require care from a professional nurse
• Orlando emphasizes that it is crucial for nurses to share their perceptions, thoughts, and feelings so they can determine whether their inferences are congruent with the patient's need

  
• Orlando's theory remains a most effective practice theory that is especially helpful to new nurses as they begin their practice
• Nursing Process Theory


  • The nursing process is an interaction of three basic elements: the behavior of the patient, the reaction of the nurse, and the nursing actions which are designed for the patient's benefit
  • The role of the nurse is to find out and meet the patient's immediate need for help
  • Nursing process helps the nurse find out the nature of the distress and what helps the patient
  • The use of this theory keeps the nurse's focus on the patient
  • The strength of the theory is that it is clear, concise and easy to use

  
• Need


  A situationally defined requirement of the patient which relieves or diminishes his immediate distress if this is supplied
• Presenting behavior of patient


  Any observable verbal and nonverbal behavior of the patient
• Immediate reactions


  The nurse's and patient's individual perceptions, thoughts, and feelings
• Nursing process discipline


  Includes the nurse communicating to the patient his or her own immediate reaction, made in order to ask for validation, clarification, or correction from the patient. Once referred to as the "deliberative nursing process"

  
• Automatic nursing actions


  Nursing activities that are decided upon for reasons other than the patient's immediate need
• Deliberative nursing actions


  Those decided upon after ascertaining a need and then meeting this need
• Theory Assertions (Orlando)


  • When patients cannot cope with their needs on their own, they become distressed by feelings of helplessness
  • In its professional character, nursing adds to the distress of the patient
  • Patients are unique and individual in how they respond
  • Nursing offers mothering and nursing analogous to an adult who mothers and nurtures a child
  • The practice of nursing deals with people, the environment, and health
  • Patients need help communicating their needs; they are uncomfortable and ambivalent about their dependency needs
  • People can be secretive or explicit about their needs, perceptions, thoughts, and feelings
  • The nurse-patient situation is dynamic; actions and reactions are influenced by both the nurse and the patient
  • People attach meanings to situations and actions that aren't apparent to others
  • Patients enter into nursing care through medicine
  • The patient cannot state the nature and meaning of his or her distress without the nurse's help or him or her first having established a helpful relationship with the patient
  • Any observation shared and observed with the patient is immediately helpful in ascertaining and meeting his or her need or finding out that he or she is not in need at that time
  • Nurses are concerned with the needs the patient is unable to meet on his or her own
• Nursing (Orlando's view)

  Unique and independent in its concerns for an individual's need for help in an immediate situation. The efforts to meet the individual's need for help are carried out in an interactive situation and in a disciplined manner that requires proper training
• Person (Orlando's view)


  Emphasizes individuality and the dynamic nature of the nurse-patient relationship. Humans in need are the focus of nursing practice

  
• Health (Orlando's view)


  Replaced by a sense of helplessness as the initiator of a necessity for nursing. Nursing deals with individuals who require help
• Environment (Orlando's view)

  Completely disregarded, only focusing on the patient's immediate need, chiefly the relationship and actions between the nurse and the patient. The effect that the environment could have on the patient was never mentioned
• Since the premise of Orlando's theory is in the immediacy of help needed by patients, this framework will be important for nurses who are assigned in special clinical areas that require quick decision making and critical thinking skills such as the OR, ER, and ICU/Critical Care Unit

  
• Orlando's theory stresses the reciprocal relationship between patient and nurse remains a most effective practice theory that is especially helpful to new nurses as they begin their practice