Application of Nursing Theories

3. How Nursing Theory can be used for evidence
based practice
Every great practice came from someone’s idea or theory. We need these
theories so we can study them and test them to see if the evidence shows if
they are safe or effective Even after it has been determined that a certain
theory is safe and effective, another person may be tweaking that theory to
make it even safer. That is why healthcare is always changing. Evidence based
practice provides care for patients by applying the best available evidence by
scientific method for making clinical decisions.

5. DEFINITIONS
 Person: A developing organism that tries to reduce anxiety caused by needs.
 Environment: Existing forces outside the organism and in the context of culture
 Health: 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.
 Nursing: A significant therapeutic interpersonal process. It functions cooperatively with other
human process that make health possible for individuals in communities.

7. MAJOR CONCEPTS
 The theory explains the purpose of nursing is to help others
identify their felt difficulties.
 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.

8.  Nursing is therapeutic in that it is a healing art, assisting an individual
who is sick or in need of health care.
 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 both become mature and
knowledgeable in the process

9. Purpose of Theory of Interpersonal Relations
 To aid in the development of problem solving skills through interpersonal relationships
between the nurse and the client with the utilization of education through therapeutic
interactions.
 Psychodynamic nursing facilitates
 Understanding ones own behavior.
 Helping others identify felt difficulties.
 Nurse-patient relationship as partners.
 The application of human relations to problems
at all levels of experience.

10. THE FOUR PHASES OF NURSE-PATIENT
RELATIONSHIPS

11. 1. Orientation Phase
The nurse’s orientation phase involves engaging the client in treatment, providing
explanations and information, and answering questions.
 Problem defining phase
 It starts when the client meets the nurse as a stranger.
 Defining the problem and deciding the type of service needed
 Client seeks assistance, conveys needs, asks questions, shares preconceptions and
expectations of past experiences.
 Nurse responds, explains roles to the client, identifies problems, and uses available
resources and services.

13. 2. Identification Phase
The identification phase begins when the client works interdependently with
the nurse, expresses feelings, and begins to feel stronger.
 Selection of appropriate professional assistance
 Patient begins to have a feeling of belonging and a capability of dealing with
the problem, which decreases the feeling of helplessness and hopelessness.

14. 3. Exploitation Phase
In the exploitation phase, the client makes full use of the services offered.
 In the exploitation phase, the client makes full use of the services offered.
 Use of professional assistance for problem-solving alternatives
 Advantages of services are used based on the needs and interests of the
patients.
 The individual feels like an integral part of the helping environment.
 They may make minor requests or attention-getting techniques.

15.  Patient may fluctuate on independence.
 The principles of interview techniques must be used to
explore, understand and adequately deal with the
underlying problem.
 Nurse must be aware of the various phases of
communication.
 Nurse aids the patient in exploiting all avenues of help, and
progress is made towards the final step.

16. 4. Resolution Phase
In the resolution phase, the client no longer needs professional services and gives up
dependent behavior. The relationship ends.
 In the resolution phase, the client no longer needs professional services and gives
up dependent behavior. The relationship ends.
 Termination of professional relationship
 The patient’s needs have already been met by the collaborative effect of patient
and nurse.

17.  Now they need to terminate their therapeutic relationship and dissolve the
links between them.
 Sometimes may be difficult for both as psychological dependence persists.
 The patient drifts away and breaks the nurse’s bond, and a healthier emotional
balance is demonstrated, and both become mature individuals.

18. 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)

19. Application of theory in “MY” nursing practice
 This theory would be useful with our newly diagnosed cancer patients and
their family. Resistance is met when trying to educate them about the
treatment, encouraging enrolment in studies, and education about how to
care for the patient in their home setting.
 Orientation-patient gets admitted to the unit, nurse helps the patient to
recognize and understand that they have cancer and the importance of
treatment.
 Identification-Patient takes the time to internalize the diagnosis, the nurse
participates in helping the patient to do so

20.  Exploitation-the nurse works to have the patient explore what help is needed to
meet goals, incorporating other disciplines to problem solve (oncologists,
therapists, alternative medicine, etc.).Patient test the limits of the nurses
availability, and the nurse encourages patient to evaluate ways to meet their final
goals.—
 Resolution-when in-patient treatment is complete, the nurse has to evaluate
feelings and remove themselves from the bond that is made, allowing the patient
and family to move on and regain balance in their own lives.

32. Working/Identification
Case Study Match:
 in first meeting with patient, nurse identified potential community resources and discussed ways to
continue patient's business through support provided.
 Patient was much more receptive and willing to talk about his diagnosis and treatment plan after the
nurse addressed his initial concerns.
 Nurse gave patient information to take home to review before returning for the next appointment.
 Short-term goals established:
 Maintaining the urinary diversion
 Returning to normal activity

33.  Improving nutrition
 Focusing on psychosocial needs during while recovering
 Long-term goals established (see Resolution)
 Nurse educated the patient about self-catheterization, voiding
techniques and schedules, and journaling

39. PEPLAU’S THEORY APPLICATION NURSING PROCESS:
The nursing process for Mrs. JL based on Peplau’s theory is as follows:
 Mrs. JL
 27 years
 Diagnosis: Inter vertebral disc prolapse

40. assessment
(Orientation phase)
Nursing
diagnosis
Planning
(Identification phase)
Implementation
(Exploitation phase)
Evaluation (Resolut
ion
phase)
Mrs. JL is
on pelvic
traction
and she is
restricted
to bed.
The need
for bed
rest and
restrictio
n was
discussed.
Impaired physical
mobility related to
the presence of pelvic
traction.
Goal setting was done along with
patient
Patient will have improved
physical mobility as evidenced by
participating in self care within
the limits.
Provide active and passive
exercises to all the extremities to
improve the muscle tone and
strength.
Make the patient to perform the
breathing exercises which will
strengthen the respiratory
muscle.
Massage the upper and lower
extremities which help to
improve the circulation.
Provide articles near to the
patient and encourage doing
activities within limits.
Provide positive reinforcement
for even a small improvement to
increase the frequency of the
desired activity.
Carried out plans mutually agreed
upon.
Provided active and passive
exercises to all the extremities
Made the patient to perform
breathing exercises
Massaged the upper and lower
extremities
Provided article within the reach of
the patient
Provided positive reinforcement to
the patient
Mrs. JL was free to express problems
regarding difficulty in mobilizing.
She expressed satisfaction when able to
move without difficulty.

41. Assessment
(Orientation phase)
Nursing diagnosis Planning (Identification
phase)
Implementation
(Exploitation phase)
Evaluation (Resoluti
on phase)
Mrs. JL expresses
pain in the low back
region.
Regarding pain,
discussion was made
to assess the severity
and the type and
duration of pain. Also
the measures to reduce
pain were discussed.
Pain related to the
degenerative changes
in the lumbar region.
Goal setting was done along
with patient
Mrs. JL will have reduction
in pain as evidenced by her
verbalisation of reduction in
pain responses.
Provide non-
pharmacological measures
for pain relief such as
diversional activity which
diverts the patients mind.
Give the client a neutral
position
Always use back support
while turning the patient that
reduces the strain on the
back.
Support the areas with extra
pillow to allow the normal
alignment and to prevent
strain.
Administer analgesics as
prescribed by the physician.
Provide pelvic traction to
Carried out plans mutually
agreed upon.
Provided non pharmacological
measures like diversion,
massaging, and pelvic traction.
Provided supine position to
the client
Supported the back during
position change
Used pillows to support the
back.
Administered Tab. Hifenac P
and Cap. Myoril 4mg as
prescribed.
Given pelvic traction and
explained the need for traction
Mrs. JL was free to express
problems of pain.
Expressed that she got slight
relief from pain.

42. Assessment
(Orientation phase)
Nursing
diagnosis
Planning
(Identification phase)
Implementation
evaluation
(Exploitation phase)
(resolutionphase
Mrs. JL expresses that
she need assistance to
get down from bed.
Regarding self care
discussion was done
and discussed regarding
the measures to solve
the problems.
Self care deficit
related to the
presence of pelvic
traction.
Goal setting was done along
with patient
Client will achieve and
maintain self care activities
with assistance of caregiver
or within her limits.
Keep all the articles within
the reach of the patient.
Provide a call bell to the
patient to call in any
emergency
Frequently visit the patient
and enquire for any needs.
Assist the patient in doing
her self care activities.
Remove the weight of the
traction as needed by the
patient.
Carried out plans mutually
agreed upon.
Kept the articles within t he
reach of the client
Frequently visited the patient
and enquired for any needs
Assisted the client in doing
her self care activities
Removed the weight as and
when needed.
Mrs. JL was
free to
express
problems of
self care.
She used to
call for the
needs and all
her needs
were met
appropriately
She achieved
and
maintained
self care
activities
within her
limits

45. The following are the roles of the Nurse in the
Therapeutic relationship identified by Peplau:
 Stranger: offering the client the same acceptance and
courtesy that the nurse would respond to any stranger
 Resource person: providing specific answers to questions
within a larger context

46.  Teacher: helping the client to learn formally or informally
 Leader: offering direction to the client or group
 Surrogate: serving as a substitute for another such as a
parent or a sibling
 Counselor: promoting experiences leading to health for the
client such as expression of feelings
 Technical Expert: providing physical care for the patient and
operates equipment

47.  Peplau also believed that the nurse could take on
many other roles, but these were not defined in
detail. However, they were “left to the intelligence
and imagination of the readers.” (Peplau, 1952)

48. Additional roles include
 Technical expert
 Consultant
 Health teacher
 Tutor
 Socializing agent
 Safety agent
 Manager of environment
 Mediator
 Administrator
 Recorder observer
 Researcher

50. Conclusion
 Peplau’s theory has proved greatly used to later nurse theorists and clinicians in developing more
sophisticated and therapeutic nursing interventions, including the seven nursing roles, which
show the dynamic character roles typical in clinical nursing. It entails that a nurse’s duty is not
just to care, but the profession also incorporates every activity that may affect the client’s
health.
 However, the idea of nurse-client cooperation is found narrow with those individuals who are
unfit and powerless in conversing, specifically those who are unconscious and paralyzed.
 Studying Peplau’s Interpersonal Relations Theory of Nursing can be very substantial, especially to
aspiring to be part of the profession. Knowing the seven nursing roles, future nurses can apply for
different roles in different situations, which will guarantee their patients acquire the best care
possible and ultimately speed along with treatment and recovery.

51. THANK YOU