Theories of nursing

1. Peplau’s Interpersonal Relations
Theory
By,
Jannet maria elias
1st
year msc nursing
Mosc college of nursing
kolenchery

2. Hildegard E. Peplau’s
Interpersonal Relations in
Nursing
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3. • As Peplau entered nursing school. she made the
conscious decision that if she was going to be a
nurse. then she should be a good one.
• Peplau served as college head nurse and later
as executive of health service at Bennington
College, Vermont.
• Prior to it, psychiatric nurses were viewed only
as companion to patients but her goal was to
prepare nurse psychotherapists.
• Peplau require of her students examining their
own verbal and nonverbal communications.
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4. • Born in Reading. Pennsylvania (1909), USA.
Diploma program in Pottstown, Pennsylvania in
1931.
• She is the only person who has been the
executive director and president of ANA.
• Peplau was adviser to WHO, member of their first
advisory committee.
• BA in interpersonal psychology from Bennington
College in I943.
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5. • MA in psychiatric nursing from Columbia University
New York in 1947.
• Started first post baccalaureate program in nursing.
• Published Interpersonal Relations in Nursing in 1952.
• 1968 : Interpersonal techniques-the crux of psychiatric
nursing.
• In 1974, Peplau retired from Rutgers, this allowed her
more time to devote to larger profession of nursing.
• Worked as executive director and president of ANA.
• Worked with WHO, NIMH and Nurse Corps.
• Died in 1999.
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6. Interpersonal Relations in Nursing
Theory
• Stresses the importance of nurses’ ability to
understand their own behaviors to help others
identify perceived difficulties.
• Emphasizes the focus on the interpersonal
processes and therapeutic relationship that
develops between the nurse and client.
• Four phases of the nurse-patient relationship are
identified
• Six primary roles of the nurse
• Six secondary roles of the nurse
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7. PEPLAU’S THEORY AND NURSING’S METAPARADIGM
Person
• According to Peplau, it is defined as an organism that
“strives in its own way to reduce tension generated by
needs“.
Health
•It is defined as '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 defined“ it in terms 0f existing forces outside the
organism and in the context of culture from where customs
and beliefs are acquired”.
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8. Nursing
•“It is a significant, therapeutic, interpersonal
process”.
•She defines it as a “human relationship between
an individual who is sick or in need of health
services, and a nurse especially educated to
recognize and to respond to the need for help.”
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9. MAJOR CONCEPTS OF PEPLAU’S THEORY
•Nurses should apply principles of human
relations to the problems that arise at all levels of
experience.
•Peplau’s theory explains the phases of
interpersonal process, roles in nursing situations
and methods for studying nursing as an
interpersonal process.
•Nursing is therapeutic in that it is a healing art,
assisting an individual who is sick or in need of
healthcare.
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10. • Nursing is an interpersonal process because it involves
interaction between two or more individuals with a
common goal.
• The attainment of goal is achieved through the use of a
series of steps following a series of pattern.
• The nurse and patient work together so that both
become mature and knowledgeable in the process.
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11. Roles of Nurses
Primary
Stranger
Teacher
Resource person
Counselor
Surrogate
Leader
Secondary
Technical expert
Mediator
Safety agent
Researcher
Tutor
Manager of
environment
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12. Different nursing roles assumed during the various
phases of nurse -patient relationship
•Stranger: Receives the client in the same way one meets a stranger
in other life situations. provides an accepting climate that builds
trust.
•Teacher: Who imparts knowledge in reference to a need or interest.
•Resource person: One who provides a specific needed information
that aids in the understanding of a problem or new situation.
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13. • Counselors: Help to understand and integrate the
meaning of current life circumstances. provide
guidance and encouragement to make changes.
• Surrogate: Helps to clarify domains of dependence,
interdependence and independence and acts on clients
behalf as an advocate.
• Leader: Helps client assume maximum responsibility
for meeting treatment goals in a mutually satisfying
way.
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14. ELEMENTS INVOLVED IN NURSE-PATIENT
RELATIONSHIP
Contract
•The time, place and purpose of meetings as well
as conditions for termination are established
between the nurse and the client.
Boundaries
•Roles of participants are clearly defined, the
nurse is defined as a professional helper, the
client’s needs and problems focus of the
interaction.
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15. Confidentiality
•The nurse should share information only with
professional staff who need to know. The nurse should
obtain client’s written permission to share information
with others outside the treatment team.
Therapeutic Nurse Behaviors
•Self-awareness
•Genuineness .
•Warmth and respectfulness .
•Empathy
•Cultural sensitivity
•Responsibility .
•Ethical practice. peplau's inter personal theory 15
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16. 4 Phases of nurse-patient relationship
 Orientation-client seeking
assistance, meeting of
nurse-patient, identifying
the problem and services
needed ( interview
process), and guidance.
 Identification- identifying
who is best to support
needs, patient addresses
personal feelings about the
experience and is
encouraged to participate
in care to promote personal
acceptance and satisfaction.
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17. Phases cont.
Exploitation- patient attempts to explore,
understand and deal with the problem, and
gains independence on achieving the goal
 Resolution- termination of the therapeutic
relationship to encourage emotional balance
for nurse and patient ( difficult for both
patient and nurse as psychological
dependence persists)
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18. PEPLAU‘S WORK AND CHARACTERISTICS OF A THEORY
Interrelation of concepts .
•Four phases inter-relate the different components of
each phase
Applicability
•The nurse-patient interaction can apply to the concepts
of human being, health, environment and nursing
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19. Theories must be logic in nature
•This theory provides a logical systematic way of viewing
nursing situations .
•Key concepts such as anxiety, tension, goals and
frustration are indicated with explicit relationships
among them and progressive phases.
Generalizability
• This theory provides simplicity in regard to the natural
progression of the NP relationship
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20. Theories can be the bases for hypothesis that can be
tested
•Peplau’s theory has generated testable hypotheses.
Theories can be utilized by practitioners to guide and
improve their practice
• Peplau's anxiety continuum is still used in anxiety
patients.
Theories must be consistent with other validated
theories , laws and principles but will leave open
unanswered questions that need to be investigated
•Peplau s theory 15 consistent with various theories.
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21. LIMITATIONS
•personal space considerations and community social
service resources are considered less
•health promotion and maintenance were less
emphasized
•Cannot be used in a patient who does not have a felt
need eg.withdrawn patients, unconscious patients
•some areas are not specific enough to generate
hypothesis.
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22. Application of Interpersonal Theory in
Nursing Practice
• An article in Current Nursing evaluated using the
theory in nursing practice
– Assessment= Orientation phase
– Nursing diagnosis
– Planning=Identification phase
– Implementing=Exploitation phase
– Evaluation=Resolution phase
(the theory allowed client’s needs to be assessed.
Application of the theory helped provide
comprehensive care to the client)
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23. Assessment Orientation
• Data collection and
analysis(continuous)
• May not be a felt need
Nursing diagnosis
Planning
• Mutually set goals
Implementation
• Plans initiated toward
achievement of mutually set goals
• May be accomplished by patient ,
nurse or family.
Evaluation
• Based on mutually expected
behaviours.
• May lead to termination and
initiation of new plans
• Non- continuous data collection
• Felt need
• Define needs
Identification
• Interdependent goal setting
Exploitation
• Patient actively seeking and
drawing help
• Patient initiated
Resolution
• Occurs after other phases are
completed successfully
• Leads to termination.
INTERPERSONAL THEORY AND NURSING PROCESS
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24. Education
•The theory urged the nurses to use nursing situations as
a source of observations from which unique concepts
could be derived.
•By applying this theory in clinical areas, nurse acts as a
participant observer and thus upgrades her previously
acquired theoretical knowledge.
•Interpersonal Relations in Nursing-used as a manual of
instructions to nursing students.
•Foundation of psychiatric nursing education.
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25. Research
• Urology Nursing used the theory to educate
newly diagnosed bladder cancer patients with
the need for a urinary diversion, and ensure
understanding.
Outcome shows that the scope of a patient’s needs
requires a competent nurse to assume the
changing roles in the four phases of the theory,
expressing the importance of involving the
patient in establishing goals and reviewing the
goals frequently.
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26. Research
• British Journal of Nursing had an article researching
the credibility of Peplau’s theory, in mental health
care, due to the expansion of nursing knowledge and
the dynamics of a multidisciplinary team currently
used in today’s practice.
• Public Health Nursing did a study, in homecare visits,
(testing the use of Peplau’s theory) to work with multi-
problem families, to identify interventions,
individualized for the members, to see if relationship
progression was increased within the family system
resulting in optimized care of the patient.
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