Peplau and Orem's nursing theories

1. PEPLAU AND OREM
A TALE OF TWO THEORIES
Hildegard E. Peplau
Psychiatric Nurse of the
Century
Sept. 1, 1909 – March 17, 1999
Dorothea Orem
Self-Care Deficit Theory
June 15, 1914 – June 22, 2007
Jeannette McGough
Aspen University
Concepts and Theories in Nursing
Denys Goozee, MSN, RN, CRRN
June 24, 2018

2. PART ONE – PRESENTATION OBJECTIVES – PEPLAU’S THEORY
 Definition of Peplau’s Theory of Interpersonal Relations
 Description of the phases
 Correlation and example of current practice
"Nursing has made great progress from being an occupation to becoming a profession
in the 20th. Century. As the 21st. Century approaches, further progress will be
reported and recorded in Cyberspace - The Internet being one conduit for that.
Linking nurses and their information and knowledge across borders - around the world
- will surely advance the profession of nursing much more rapidly in the next century" -
Hildegard Peplau
(Hildegard Peplau, n.d.)

3. THE THEORY OF INTERPERSONAL RELATIONS AS
DEVELOPED BY HILDEGARD PEPLAU
• Published in 1952 and in 1968, interpersonal techniques became the crux of psychiatric nursing.
• Peplau had many influences that guided her including Abraham Maslow, Neal Elger Miller,
Henry Stack Sullivan and Percival Symonds.
Her theory revolves around psychodynamic nursing. The nurse seeks to understand her own and
others behavior and to apply the principles of human relations to one's identified needs.
THE EVOLUTION OF THE FOUR PHASES

4. The Four Phases of Interpersonal Relations
Initiated by a patient’s
perceived problem who
seeks out assistance
with it.
Orientation
Respect for each other
increases and the nurse uses
education and skill to help
the patient meet the need
Identification
Shifting the patient’s
behavior toward
resolving the problem so
the nurse is no longer
needed.
Exploitation
Discharge from the nurse’s
care and patient moves forward
with self reliance
Termination

5. ORIENTATION PHASE

6. In the beginning…….
Relationship formally begins during the orientation
phase.
Greeting the patient properly sets the tone for the
interaction.
Nurse must be consistent with words and actions to
foster trust and open communication with the client.
Data collection also occurs during the orientation
phase.
Most important goal is for the nurse to TAKE TIME
TO LISTEN!
While not necessarily a formal document, a
therapeutic contract explains the roles of the nurse,
patient and the goals of the relationship.
(Kennedy-Sheldon, 2018)

7. IDENTIFICATION PHASE
Where do we go from here?

8. Identification: the act of finding out who someone is or what something
is: a feeling that you share and understand the problems or experiences
of another person.
Problems are identified
The nurse may adopt many roles to help the
client work with available resources and
professional assistance
Goal is for patient to begin expressing
feelings of capability and decreased feeling of
helplessness and / or hopelessness
The client and nurse mutually set goals
through identification and nursing diagnosis
and planning.
Client works interdependently with the nurse
and begins to feel stronger
The Many Roles of Nursing using Peplau’s
Theory
Stranger- non-judgmental acceptance and
courtesy demonstrated in the orientation phase.
Resource person – using other professional
services if needed
Teacher – assisting client to learn in a venue
client understands and can assimilate
Surrogate – helps patient identify similarities
and differences
Counselor – promoting client’s healthy
expression of feelings
(Smith & Parker, 2015)

9. EXPLOITATION AND
TERMINATION
PHASES
A Toolbox Full of Help

10. Exploitation Phase Termination Phase
• Client makes full use of services
offered.
• Services used are based on needs and
interests of patient.
• Client feels as a member of the helping
environment.
• Nurses’ goal is shifting the patient’s
behavior to resolving the problem so the
nurse is no longer needed.
• Nurses and clients relationship can
fluctuate and phases of communication
evolve.
• Exploring, understanding and
adequately addressing the underlying
problem is main focus of this phase.
Also known as resolution phase.
Client no longer needs professional services and
gives up dependent behavior.
The relationship ends.
The therapeutic relationship needs to dissolve the
links between them.
Patient drifts away and breaks bond with nurse
resulting in healthier emotional balance
demonstrated by both individuals.
Most difficult step for both as psychological
dependence may persist.
(Wayne, 2014)

11. Application of Peplau’s Theory in a Correctional Setting
Advantages
 Orientation phase – Nurse establishes
trust at initial assessment with non-
judgmental communication skills.
 Identification phase – Conditions –
chronic physical and/or mental issues
can be identified.
 Orientation phase – Opportunities for
nurse to educate and refer
inmate/patient to other resources
 Termination phase – Nurse’s therapeutic
relationship terminates with client
Disadvantages
 Orientation phase – environment is not
conducive to an open relationship. Nurse
is professional but non-disclosing.
 Identification phase – multiple issues
cannot adequately be addressed within
the policies of the facility. Nurse is
basically triaging one specific request.
 Orientation phase – Nurse refers inmate
to chronic care or mental health clinics
and is not assigned to follow patient.
 Termination phase – Issue is resolved
using standard protocols that the patient
may or may not follow through with.

12. Part One – Peplau’s Theory
Conclusion
(Ricks, E.P. 2015)
Hildegard Peplau’s theory on interpersonal relations is lauded as the forefront of contribution to
nursing knowledge and considerably so in the realm of psychiatric/mental health nursing.
Correctional nursing is a challenge and while components of Peplau’s theory can be applied, the
environment conflicts with the practice.
As correctional healthcare staff strive to provide the highest level of care to our patient
population, Peplau’s interpersonal relations theory can be used in the overall interaction with the
client, however, in contrast to the primarily nonjudgmental and rehabilitative therapeutic
environment, prisons primarily serve to isolate and punish.

13. PART TWO – PRESENTATION OBJECTIVES – OREM’S THEORY
 Definition of Dorothea Orem’s Self-Care Deficit Theory
 Identify and explain the three parts
 Use a current nursing practice example.
(Parrenas, 2011)

14. Defining The Self-Care Deficit Theory
 Composed of three interrelated theories
1. The theory of self-care:
The performance or practice of activities that individuals initiate and perform on their
own behalf to maintain life, health and well-being.
2. The self-care deficit theory:
Nursing is required when a person is incapable of or limited in the provision of
continuous effective care.
3. The theory of nursing systems:
The method in determining self-care deficits and to define the roles of persons or nurse
to meet the self-care demands.
(Smith & Parker, 2015)

15. THE THEORY OF SELF-CARE
Includes universal self-care requisites associated with life processes and the maintenance of human
functioning consisting of eight basic components:
Sufficient intake of air
Sufficient intake of water
Sufficient intake of food
Care associated with elimination process and excrements
Balance between activity and rest
Balance between solitude and social interaction
Prevention of hazards to human life, human functioning and human well-being
Promotion of human functioning and development within social groups
(Wayne, 2014)
Health deviation self-care requisites happen when conditions of illness, injury or disease require seeking
medical assistance.

16. THEORY OF SELF-CARE DEFICIT
Nursing care is needed.
Orem identified 5 methods of helping:
Acting for and doing for others
Guiding others
Supporting another
Providing an environment conducive to wellness
Teaching another

17. THEORY OF NURSING SYSTEM
This system is activated when an individual is in a situation and is unable to use self-care actions.
They are dependent on others for their continued well-being. Orem also identified a method to
define roles of persons or nurse to meet the self-care demands.
ASSESSMENT
Collects data in six areas
1. Health Status of patient
2. Physician’s view of person’s health status
3. The patient’s perspective of their health status
4. Health goals of patient
5. Patient’s requirements for self-care
6. Patient’s capacity to perform self-care
NURSING DIAGNOSIS AND PLAN
Designs a plan that supports and
educates patient using two actions
ACTION STEPS
1. Organizing the components of the patient’s self-care
demands in a logical and achievable manner.
2. Effective and efficient selection of ways or combination
of ways of helping that will promote overcoming
patient’s self-care deficits.
IMPLEMENTATION AND EVALUATION: Nurse assists the patient and/or family in self-care
matters with actions that are directed by the components of the nursing diagnosis.

18. OREM’S THEORY: THE CORE OF CORRECTIONAL NURSING
 Through Orem’s theory a correctional nurse can make a difference by using her concept of self-
care as a primary goal. Her theory establishes self-care as assessing, initiating and performing
actions that promote a patient’s well-being.
 The triaging of sick call requests by inmates satisfies most of the components of this theory.
 On any given day I triage requests ranging from common cold symptoms, to constipation and
recreation yard injuries. With wholly compensatory, partially compensatory, or supportive-
education I am able to effectively provide optimum care to the patient.
 Review of systems is essential and approved OTC medications are dispensed. In the case of the
recreation yard injury, consultation with a provider for x-ray and follow up orders are obtained.
 The inmate with the common cold and the inmate with constipation will be educated to return
to the clinic if symptoms do not improve. A follow up will be scheduled for the recreation yard
injury for x-rays and RICE education will be provided.
Schoenly, L. (2015)

19. References
Hildegard Peplau. (n.d.). AZQuotes.com. Retrieved June 25, 2018, from AZQuotes.com Web site:
http://www.azquotes.com/author/46337-Hildegard_Peplau
Kennedy-Sheldon, L. (2018). The Nurse-Patient Relationship. Retrieved from
http://samples.jbpub.com/9781449691776/9781449691776_CH05_Pass2.pdf
Parrenas, J. (2011). Dorothea Orem. Retrieved from
https://www.slideshare.net/JacquilineParrenas/dorothea-orem-9065604
Schoenly, L. (2018). Dorothea Orem Would Make a Great Correctional Nurse!. Retrieved from
https://essentialsofcorrectionalnursing.com/2015/05/13/dorothea-orem-would-make-a-great-correctional-nurse/
Smith, M., & Parker, M. (2015). Nursing Theories and Nursing Practice (4th ed.). Philadelphia: F.A. Davis Company.
Wayne, G. (2014). Hildegard Peplau - Interpersonal Relations Theory - Nurseslabs. Retrieved from
https://nurseslabs.com/hildegard-peplaus-interpersonal-relations-theory/