INTERPERSONAL RELATIONS Helping Patients Help Themselves - Rather than feeding them, Teaching them “to cook” --- Theorist - Hildegard. E. Peplau (HILDA)

Helping Patients Help Themselves - Rather than feeding them, Teaching them “to cook” ---

 Theorist - Hildegard. E. Peplau (HILDA)

INTERPERSONAL RELATIONS

                      Peplau’s text interpersonal relation in nursing published in 1952 is still application in theory & practice. The core of peplau’s theory of nursing is the interpersonal process, which is an integral part of present day nursing. The process consists of orientation, identification; exploitation and resolution.These phases are overlap interrelate and vary in time duration.

Peplau's theory is also refered as psychodynamic nursing, which is the understanding of one’s own behavior.

Background

v Hildegard Peplau (1909-1999)

“Mother of psychiatric nursing” (ANA, 2012)

Ø  Diploma program in Pottstown, PA, 1931

Ø  BA in Interpersonal Psychology, Bennington  College, 1943

Ø  MA in Psychiatric Nursing, Columbia University, 1947

Ø  EdD in Curriculum Development, Columbia University, 1953

Ø  Interpersonal Relations in Nursing (1952)

Ø  Professor emeritus from Rutgers University

Ø  Started first post-baccalaureate program in nursing

Ø  Worked as Executive Director and President of ANA

Ø  Worked with WHO, NIMH and Nurse Corps

Theory Level

·       Grand theory (McEwen & Wills, 2007)

·       Middle range descriptive classification theory (Nursing Theory, 2011)

VISUAL MODEL OF MAJOR CONCEPTS

Peplau’s framework:  Major Concepts and their Interrelationships (Forchuk, 1993, p. 8)

ü  The theory explains the purpose of nursing is to help others identify their felt difficulties.

ü  Nurses should apply principles of human relations to the problems that arise at all levels of experience.

ü  Peplau's theory explains the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process.

ü  Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care.

ü  Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal.

Main Goal of Theory

     Focus on nurse-patient relationship

     Identify different roles nurses take on when working with patients.  

Key Definitions

• Person/Client : A developing organism that tries to reduce anxiety caused by needs.
• Environment(family, peer groups, society, community etc.): 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 processes that make health possible for individuals in communities.

Phases of interpersonal relationship

Identified four sequential phases in the interpersonal relationship:

1.   Orientation
2.   Identification
3.   Exploitation
4.   Resolution

1. Orientation phase

• Problem defining phase
• Starts when client meets nurse as stranger
• Defining problem and deciding type of service needed
• Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations of past experiences
• Nurse responds, explains roles to client, helps to identify problems and to use available resources and services

Factors influencing orientation phase

2.Identification phase

• 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

3. Exploitation phase

• Use of professional assistance for problem solving alternatives
• Advantages of services are used is based on the needs and interests of the patients
• Individual feels as an integral part of the helping environment
• They may make minor requests or attention getting techniques
• The principles of interview techniques must be used in order to explore, understand and adequately deal with the underlying problem
• Patient may fluctuates on independence
• Nurse must be aware about the various phases of communication
• Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step

4. Resolution phase

• Termination of professional relationship
• The patients needs have already been met by the collaborative effect of patient and nurse
• Now they need to terminate their therapeutic relationship and dissolve the links between them.
• Sometimes may be difficult for both as psychological dependence persists
• Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals

Roles of nurse

1)     Stranger: receives the client in the same way one meets a stranger in other life situations provides an accepting climate that builds trust.

2)     Teacher: who imparts knowledge in reference to a need or interest

3)     Resource Person : one who provides a specific needed information that aids in the understanding of a problem or new situation

4)     Counselors : helps to understand and integrate the meaning of current life circumstances ,provides guidance and encouragement to make changes

5)     Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate.

6)     Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way

Additional Roles include:

                                                    i.     Technical expert

                                                  ii.     Consultant

                                                iii.     Health teacher

                                                iv.     Tutor

                                                  v.     Socializing agent

                                                vi.     Safety agent

                                              vii.     Manager of environment

                                            viii.     Mediator

                                                ix.     Administrator

                                                  x.     Recorder observer

                                                xi.     Researcher

Interpersonal theory and nursing process

• Both are sequential and focus on therapeutic relationship
• Both use problem solving techniques for the nurse and patient to collaborate on, with the end purpose of meeting the patients needs
• Both use  observation communication and recording as basic tools utilized by nursing

Assessment Data collection and analysis [continuous] May not be a felt need	Orientation Non continuous data collection Felt need Define needs
Nursing diagnosis Planning Mutually set goals	Identification Interdependent goal setting
Implementation Plans initiated towards achievement of mutually set goals May be accomplished by patient , nurse or family	Exploitation Patient actively seeking and drawing help Patient initiated
Evaluation Based on mutually expected behaviors May led to termination and initiation of new plans	Resolution Occurs after other phases are completed successfully Leads to termination a

How Nursing Care Enhanced

Ø  Interactive care

Ø  Relationships enhance healing

Ø  Personal fulfillment

Application

Psychiatric nursing

Ø  “Mother of psychiatric nursing”

Ø  Therapeutic relationship

 All nursing and practitioners

Ø  Interactive care

Ø  Increased compliance

Ø  Better outcomes

Example of Application

·       Psychiatric examples

o   Depression and Psychosis

o   Trust

o   Accept help

o   Education

o   Support

o   Compliance

o   Termination

o   Follow up

Evidence of Improved Care (Research Based on Peplau’s Theory)

v Power to Gain Knowledge (Bradbury- Jones, 2012)

j      Studied nursing students 2007-2009

j      Effect of interpersonal relationships on education

j      Students felt empowered

j      Increased clinical ability

j      Increased ability to empower patients

v Other Examples

j      Hays .D. (1961). Phases and steps of experimental teaching to patients of a concept of anxiety: Findings revealed that when taught by the experimental method, the patients were able to apply the concept of anxiety after the group was terminated.

j      Burd .S.F. Develop and test a nursing intervention framework for  working with anxious patients: Students developed competency in beginning interpersonal relationship.

j      Nursing Organizations -  APNA all-purpose discussion

j      Nursing Practice  - Renal patients

j      Nursing Education - Increased participation and empowerment

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 doesn’t have a felt need eg. With drawn patients, unconscious patients 
• Some areas are not specific enough to generate hypothesis 

References

1. Alligood, M.R. & Tomey, A.M. (2010). Nursing theorists and their work (7thed.). Maryland Heights: Mosby.
2. American Nurses Association (2012).

http://www.nursingworld.org/HildegardPeplau

3. Bradbury-Jones, C. (2012). Power to gain knowledge.

Nursing Standard, 26(24), 72.

4. Chinn, P. & Kramer, M. (2007). Integrated knowledge development in nursing (7th ed.). St. Louis: Mosby.
5. Current Nursing (2012).

http://currentnursing.com/nursing_theory/interpersonal_theory.html

6. McEwen, M. & Wills, E. (2007). Theoretical basis for nursing (2nd ed.). Philadelphia: Williams & Wilkins.
7. Nursing Theory (2011).

http://nursing-theory.org/nursing-theorists/Hildegard-Peplau.php

8. Timber BK. Fundamental skills and concepts in Patient Care, 7th edition, LWW, N
9. George B. Julia , Nursing Theories- The base for professional Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
10. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for Nursing Philadelphia. Lippincott Williams& wilkins.
11. Taylor Carol,Lillis Carol (2001)The Art & Science  Of Nursing Care 4th ed. Philadelphia,  Lippincott.
12. Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurs. 2006 Jul; 27(6) : 605-15
13. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q. 2006 Jul;19(3):225