THEORETICAL FRAMEWORK FOR A FAMILY AND PALLIATIVE NURSING PRACTITIONER Presented by: Iriabel Nepravishta * INTRODUCTION Peplau’s Theory Interpersonal Relationship Challenge Facing Palliative Care Practitioners Impact of Society Perception of Palliative Care on Health Care Outcomes Ways in which Peplau’s Theory can be used to address the Scope of Practice Restriction Challenge Perspective Offered through the Application of Peplau’s Theory Conclusion References A Palliative Nurse Practitioner (PNPR) is an advanced practice registered nurse. PNPR is trained to assess patient needs, diagnose disease, interpret diagnostic results and provide palliative medicine to treat illness with complex pain and symptoms. Additionally, PNPR will anticipate and meet the needs of the patient and family facing terminal illness and bereavement (Forchuk, 2015). * PEPLAU’S THEORY INTERPERSONAL RELATIONSHIP Three phases: orientation, working and termination phases Establish therapeutic relationship to provide better patient care. A guide for resolution of the issues and concerns Peplau’s Theory Views a Palliative Nursing Practitioner as a professional that establishes therapeutic relationship with patients. Peplau’s theory consist in 3 phases which are orientation, working and termination stages. During the orientation phase, the patient, family and nurse work together to recognize, clarify, and define existing problem. The working phase includes deliver and application of interventions, and services of care to treat, explore and change a situation. Finally, the termination phase includes resolution and successful completion of all the other two stages on finalization of care (Townsend, 2015). This theory is significant in palliative care because it will allow me to determine the needs of my patients and their families through the use of the orientation, working concepts. In doing so, I can serve as a resource person, a counselor and surrogate. In addition, I can provide individualized care that will meet the needs of my patients and their families. But most importantly, this theory is significant to palliative care because it will help me to transition patients and their families through end of life care by applying the concepts of the termination phase (Townsend, 2015 p. 40) , (Forchuk, 2015). * CHALLENGE FACING PALLIATIVE CARE PRACTITIONERS Perception of Palliative Care. Different approaches of care among health care providers Family conflicts. Cultural differences Today’s society struggles with the subject of death. We live in a decade where modern technology and treatments are prolonging life and the concept of natural death is seeming a vague illusion and almost an impossible concept to accept and face. We are dragged into the philosophy that there is nothing worse than letting our loves ones go and we hold them tight without acknowledging and respecting their wishes. Palliative Care Nurse Practitioners (PNPR) play an importan.

1. THEORETICAL FRAMEWORK FOR A FAMILY AND
PALLIATIVE NURSING PRACTITIONER
Presented by: Iriabel Nepravishta
*
INTRODUCTION
Peplau’s Theory Interpersonal Relationship
Challenge Facing Palliative Care Practitioners
Impact of Society Perception of Palliative Care on Health Care
Outcomes
Ways in which Peplau’s Theory can be used to address the
Scope of Practice Restriction Challenge
Perspective Offered through the Application of Peplau’s Theory
Conclusion
References
A Palliative Nurse Practitioner (PNPR) is an advanced practice
registered nurse. PNPR is trained to assess patient needs,
diagnose disease, interpret diagnostic results and provide
palliative medicine to treat illness with complex pain and

2. symptoms. Additionally, PNPR will anticipate and meet the
needs of the patient and family facing terminal illness and
bereavement (Forchuk, 2015).
*
PEPLAU’S THEORY INTERPERSONAL RELATIONSHIP
Three phases: orientation, working and termination phases
Establish therapeutic relationship to provide better patient care.
A guide for resolution of the issues and concerns
Peplau’s Theory Views a Palliative Nursing Practitioner as a
professional that establishes therapeutic relationship with
patients. Peplau’s theory consist in 3 phases which are
orientation, working and termination stages. During the
orientation phase, the patient, family and nurse work together to
recognize, clarify, and define existing problem. The working
phase includes deliver and application of interventions, and
services of care to treat, explore and change a situation. Finally,
the termination phase includes resolution and successful
completion of all the other two stages on finalization of care
(Townsend, 2015).
This theory is significant in palliative care because it will allow
me to determine the needs of my patients and their families
through the use of the orientation, working concepts. In doing
so, I can serve as a resource person, a counselor and surrogate.
In addition, I can provide individualized care that will meet the

3. needs of my patients and their families. But most importantly,
this theory is significant to palliative care because it will help
me to transition patients and their families through end of life
care by applying the concepts of the termination phase
(Townsend, 2015 p. 40) , (Forchuk, 2015).
*
CHALLENGE FACING PALLIATIVE CARE PRACTITIONERS
Perception of Palliative Care.
Different approaches of care among health care providers
Family conflicts.
Cultural differences
Today’s society struggles with the subject of death. We live in a
decade where modern technology and treatments are prolonging
life and the concept of natural death is seeming a vague illusion
and almost an impossible concept to accept and face. We are
dragged into the philosophy that there is nothing worse than
letting our loves ones go and we hold them tight without
acknowledging and respecting their wishes. Palliative Care
Nurse Practitioners (PNPR) play an important role on assessing
patient and family needs. They focus on providing patient-
centered care to relieve symptoms and stress of a serious
illness. The goal of PNPC is to improve quality of life for both
the patient and the family (Townsend, 2015). Unfortunately,
palliative care carries a negative stigma associated with death.
Because of this there is fear and avoidance of palliative care
because it is usually associated with precipitation of death
(Meleis, 2014).

4. On the other hand, conflicting approaches to patient care can
lead to conflicts among providers which can result in a
decrease of the overall quality of care. Fortunately, the
application of Peplau’s theory promotes a stronger therapeutic
relationship which will allow the PNPRs to be a better advocate
to patients and families. Another challenge, somehow unique to
PNPR, is ensuring that the family is supportive and honors the
patient’s wishes during what can be a difficult time. Again, the
relationship created through the use of this theory can provide
the PNPR with the tools to help families transition through the
grieving process (Peplau, 2017).
Finally, overcoming the stigma of what is palliative care and
the barriers of cultural perceptions of surrounding end of life is
a challenge often face by PNPRs.
However, through education and strong therapeutic
relationships built using Peplau’s theory, PNPRs can
successfully overcome these challenges (Manley, 2016).
The scope of practice restriction could include lacking of the
authorization to order lab tests and diagnostic testing necessary
when providing care. As a result PNPR must consult primary
care providers or hospitalist which can lead to delay of patient
care.
*
IMPACT OF SOCIETY PERCEPTION OF PALLIATIVE CARE
ON HEALTH CARE OUTCOMES
Lack of palliative care integration into routine advanced care
Rapidly declined on patient’s health.
Decline on management of symptoms, patient safety and quality

5. of care.
Prevention of natural death and increase of suffering.
Society tend to confuse Hospice and palliative care, but they are
two distinct entities. For instance, Palliative care is intended to
alleviate symptoms and improve quality of life, and is
appropriate for all patients with serious illness, not just those
who are at the end of life. While, hospice care is end-of-life
care (Shuler, 2013).
Unfortunately due to the stigma, palliative care is only a
treatment of choice when curative or life-prolonging treatments
are ineffective or undesired. Because of this, there is a rapidly
decline on patient's health because symptoms of disease are not
properly treated. According to World Health Organization
(WHO), people with a terminal or advance disease benefit
physically and mentally from palliative care treatments (Potter,
2013).
At times, the lack of knowledge of palliative care can actually
result in the prevention of natural death. For instance, terminal
ill patients and their families will opt to continue aggressive
treatments which are usually focused on treating the underling
diseases. Unfortunately, they won’t have a meaningful impact
on their chronic or advances conditions. As a result, these
patients will struggle with symptoms and side effects of
therapies, pain, rapid decline and many times undergo
uncomfortable and painful treatments (Forchuk, 2015).
*
USE OF PEPLAU’S THEORY TO ADDRESS PERCEPTION
OF PALLIATIVE CARE.
Better interpersonal relationships will lead to high quality

6. health services
Increase of palliative care education.
Emphasize awareness of shared decision-making conversations.
Some of the Ways in which Peplau’s Theory can be used to
address the societal perception of palliative care is by
improving interpersonal relationship with patients. Better
interpersonal relationships will lead to high quality health
services because it improves the delivery of holistic care
(Manley, 2016).
In the same manner, through the process of orientation and
working phase, PNPR can educate and inform patients and
families regarding palliative care treatments and options at the
time of terminal diagnosis or when there is not meaningful hope
of recovery (Peplau, 2017).
The importance of promoting awareness and shared decision-
making between patients and their families about end of life
care lends to the equally important acknowledgment, and
honoring of patients’ last wishes (Shuler, 2013).
*
PERSPECTIVE OFFERED THROUGH THE APPLICATION OF
PEPLAU’S THEORY
Establish a sustainable relationship with my patients and their
families.
Termination phase
The application of Peplau’s theory promotes effective

7. communication and education among patient and family
regarding comfort measurements, and palliative medicine
during or at the end of life care. Furthermore, strong patient-
nurse relationship increases patient participation in care and
autonomy because allow patients to have more control over
their care by improving their understanding of treatment options
and matching their goals. It also supports family caregivers and
provides practical support and referrals (Potter, 2013).
The termination phase of Peplau’s theory has significant impact
when providing palliative care because once the design patient
centered care has been applied during the working phase, it is
on the termination phase that PNPC can finalized continuity of
care by improve patients ‘s level of comfort , pain and suffering
until their last moment of care. When finalizing these
intervention on the termination phase, PNPR can ensure that
patient has dignified, respected and peaceful death (Meleis,
2014).
*
CONCLUSION
Better interpersonal relationships with patients lead to high
quality health services
Peplau’s Theory emphasize awareness of shared decision-
making conversations.
Negative Society Perception of Palliative Care on Health Care
Outcomes lead to Lack of palliative care integration into routine
advanced care and rapidly declined on patient’s health
The quality of patient care is determined by the type of
relationship that a nurse practitioner has with patient
Restrictions on practice should be eliminated to improve
interpersonal relationship with patients

8. In conclusion, Peplau’s Theory is relevant in the explanation of
what palliative nursing care entails. A Palliative Nursing
Practitioner as per Peplau’s Theory is a professional that
establishes therapeutic relationship with patients. The quality of
patient care is determined by the type of relationship that a
Palliative Nursing Practitioner has with patient. Restrictions on
practice should be eliminated to improve interpersonal
relationship with patients (Peplau, 2017).
*
REFERENCES
Forchuk, C., Metzger McQuiston, C., & Webb, A. (2015).
Hildegarde E Peplau: Interpersonal Nursing Theory (Notes on
Nursing Theories). Newbury Park, CA: Sage.
Manley, K. (2016). A conceptual framework for advanced
practice: An action research project operationalizing an
advanced practitioner/consultant nurse role. Journal of clinical
nursing, 6(3), 179-190.
Meleis, A. I. (2014). Theoretical nursing: Development and
progress. Lippincott Williams & Wilkins.
Peplau, H. E. (2017). Peplau's theory of interpersonal
relations. Nursing science quarterly, 10(4), 162-167.
model: A theoretical framework for nurse practitioner
clinicians, educators, and researchers, Part 1.Journal of the
American Academy of Nurse Practitioners, 5(1), 11-18.
Shuler, P. A., & Davis, J. E. (2013). The Shuler nurse
practitioner practice
*

9. REFERENCES
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M.
(2013). Fundamentals of Nursing (8th ed.). St. Louis, Missouri:
Elseiver Inc
Townsend, M. C. (2015). Psychiatric Mental Health
Nursing: Concepts of Care in Evidence-Based
Practice. Philadelphia, PA: Davis Company.
THEORETICAL FRAMEWORK FOR A FAMILY AND
PALLIATIVE NURSING PRACTITIONER
Presented by: Iriabel Nepravishta
INTRODUCTION
Peplau’s Theory Interpersonal Relationship
Challenge Facing Palliative Care Practitioners
Impact of Society Perception of Palliative Care on Health Care
Outcomes
Ways in which Peplau’s Theory can be used to address the
Scope of Practice Restriction Challenge
Perspective Offered through the Application of Peplau’s Theory
Conclusion
References

10. A Palliative Nurse Practitioner (PNPR) is an advanced practice
registered nurse. PNPR is trained to assess patient needs,
diagnose disease, interpret diagnostic results and provide
palliative medicine to treat illness with complex pain and
symptoms. Additionally, PNPR will anticipate and meet the
needs of the patient and family facing terminal illness and
bereavement (Shuler, 2013).
*
PEPLAU’S THEORY INTERPERSONAL RELATIONSHIP
Three phases: orientation, working and termination phases
Establish therapeutic relationship to provide better patient care.
A guide for resolution of the issues and concerns
Peplau’s Theory Views a Palliative Nursing Practitioner as a
professional that establishes therapeutic relationship with
patients. Peplau’s theory consist in 3 phases which are
orientation, working and termination stages. During the
orientation phase, the patient, family and nurse work together to
recognize, clarify, and define existing problem. The working
phase includes deliver and application of interventions, and
services of care to treat, explore and change a situation. Finally,
the resolution includes resolution and successful completion of
all the other two stages on finalization of care. This theory is
significant in palliative care because it will allow me to
determine the needs of my patients and their families through
the use of the orientation, working concepts. In doing so, I can
serve as a resource person, a counselor and surrogate. In
addition, I can provide individualized care that will meet the

11. needs of my patients and their families. But most importantly,
this theory is significant to palliative care because it will help
me to transition patients and their families through end of life
care by applying the concepts of the termination phase
(Townsend, 2015 p. 40) , (Forchuk, 2015).
*
CHALLENGE FACING PALLIATIVE CARE PRACTITIONERS
Perception of Palliative Care.
Different approaches of care among health care providers
Family conflicts.
Cultural differences
Today’s society struggle with the subject of death. We live in a
decade where modern technology and treatments are prolonging
life and the concept of natural death is seeming a vague illusion
and almost an impossible concept to accept and face. We are
dragged into the philosophy that there is nothing worse than
letting our loves ones go and we hold them tight without
acknowledging and respecting their wishes. Palliative care
Nurse Practitioners (PNPR) play an important role on assessing
patient and family needs. They focus on providing patient-
centred care to relief symptoms and stress of a serious illness.
The goal of PNPC is to improve quality of life for both the
patient and the family.
Unfortunately, palliative care carries a negative stigma
associated with death. Because of this there is fear and
avoidance of palliative care because it is usually associated with
precipitation of death.

12. On the other hand, conflicting approaches to patient care can
lead to conflicts among providers which can result in a
decrease of the overall quality of care. Fortunately, the
application of Peplau’s theory promotes a stronger therapeutic
relationship which will allow the PNPRs to be a better advocate
to patients and families. Another challenge, somehow unique to
PNPR, is ensuring that the family is supportive and honors the
patient’s wishes during what can be a difficult time. Again, the
relationship created through the use of this theory can provide
the PNPR with the tools to help families transition through the
grieving process
Finally, overcoming the stigma of what is palliative care and
the barriers of cultural perceptions of surrounding end of life ,
it is a challenge often face by PNPRs.
However, through education and strong therapeutic
relationships built using Peplau’s theory, PNPRs can
successfully overcome these challenges.
The scope of practice restriction could include lacking of the
authorization to order lab tests and diagnostic testing necessary
when providing care. As a result PNPR must consult primary
care providers or hospitalist which can lead to delay of patient
care.
*
IMPACT OF SOCIETY PERCEPTION OF PALLIATIVE CARE
ON HEALTH CARE OUTCOMES
Lack of palliative care integration into routine advanced care
Rapidly declined on patient’s health.
Decline on management of symptoms, patient safety and quality
of care.

13. Prevention of natural death and increase of suffering.
Society tend to confuse Hospice and palliative care, but they are
two distinct entities. For instance, Palliative care is intended to
alleviate symptoms and improve quality of life, and is
appropriate for all patients with serious illness, not just those
who are at the end of life. While, hospice care is end-of-life
care.
Unfortunately due to the stigma, palliative care is only a
treatment of choice when curative or life-prolonging treatments
are ineffective or undesired. Because of this, there is a rapidly
decline on patient's health because symptoms of disease are not
properly treated. According to World Health Organization
(WHO), people with terminal or advance disease benefits
physically and mentally from palliative care treatments.
Prevention of natural death. For instance, terminal ill patients
and their families will opt to continue aggressive treatments;
despite these treatments will only treat underling diseases, but
they won’t have a meaningful impact on their chronic or
advances conditions. On the contrary, these patients will
struggle with symptoms and side effects of therapies, pain,
rapid decline and many times undergo through uncomfortable
and painful treatments.
*
USE OF PEPLAU’S THEORY TO ADDRESS PERCEPTION
OF PALLIATIVE CARE.
Better interpersonal relationships will lead to high quality
health services
Increase of palliative care education.

14. Emphasize awareness of shared decision-making conversations.
Some of the Ways in which Peplau’s Theory can be used to
address the society perception of palliative care is by improving
interpersonal relationship with patients. Better interpersonal
relationships will lead to high quality health services because it
improves deliver of holistic care.
In the same manner, through the process of orientation and
working phase, PNPR can educate and inform patients and
families regarding palliative care treatments/options at the time
of terminal diagnosis or when there is not meaningful hope of
recovery.
Importance of promoting awareness of shared decision-making
between patients and their families about end of life care and
equally important to acknowledging, and honoring patient’s last
wishes
*
PERSPECTIVE OFFERED THROUGH THE APPLICATION OF
PEPLAU’S THEORY
Establish a sustainable relationship with my patients and their
families.
Termination phase
The application of Peplau’s theory promotes effective
communication and education among patient and family
regarding comfort measurements, and palliative medicine
during or at the end of life care. Furthermore, strong patient-
nurse relationship increases patient participation in care and
autonomy because allow patients to have more control over

15. their care by improving their understanding of treatment options
and matching their goals. It also support family caregivers and
provides practical support and referrals.
The termination phase of Peplau’s theory has significant impact
when providing palliative care because once the design patient
centered care has been applied during the working phase, it is
on the termination phase that PNPC can finalized continuity of
care by improve patients ‘s level of comfort , pain and suffering
until their last moment of care. When finalizing these
intervention on the termination phase, PNPR can ensure that
patient has dignified, respected and peaciful death.
*
CONCLUSION
Peplau’s Theory is reasonable in explanation of what Palliative
Nursing care entails
A Palliative Nursing Practitioner as per Peplau’s Theory is a
professional that establishes therapeutic relationship with
patients
The quality of patient care is determined by the type of
relationship that a nurse practitioner has with patient
Restrictions on practice should be eliminated to improve
interpersonal relationship with patients
In conclusion, Peplau’s Theory is reasonable in explanation of
what Palliative Nursing care entails. A Palliative Nursing
Practitioner as per Peplau’s Theory is a professional that
establishes therapeutic relationship with patients. The quality of
patient care is determined by the type of relationship that a
Palliative Nursing Practitioner has with patient. Restrictions on
practice should be eliminated to improve interpersonal

16. relationship with patients (Peplau, 2017).
*
REFERENCES
Forchuk, C., Metzger McQuiston, C., & Webb, A.
(2015).Hildegarde E Peplau: Interpersonal Nursing Theory
(Notes on Nursing Theories). Newbury Park, CA: Sage.
Manley, K. (2016). A conceptual framework for advanced
practice: an action research project operationalizing an
advanced practitioner/consultant nurse role. Journal of clinical
nursing, 6(3), 179-190.
Meleis, A. I. (2014). Theoretical nursing: Development and
progress. Lippincott Williams & Wilkins.
Peplau, H. E. (2017). Peplau's theory of interpersonal
relations. Nursing science quarterly, 10(4), 162-167.
Shuler, P. A., & Davis, J. E. (2013). The Shuler nurse
practitioner practice model: A theoretical framework for nurse
practitioner clinicians, educators, and researchers, Part
1.Journal of the American Academy of Nurse
Practitioners, 5(1), 11-18.
REFERENCES
Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M.
(2013). Fundamentals of Nursing (8th ed.). St. Louis, Missouri:
Elseiver Inc
Townsend, M. C. (2015). Psychiatric Mental Health
Nursing: Concepts of Care in Evidence-Based
Practice. Philadelphia, PA: Davis Company.