Introduction
Hildegard E Peplau believes that nursing helps a person learn and grow during the time of illness by strengthening the person’s intellectual and interpersonal competencies through the process of nurse-client interactions. This assignment is going to discuss how to apply Hildegard E Peplau’s theory and how this theory could help me in reviewing and developing my own nursing practice. Also, the essay will focus on the strengths, limitations, value and relevance of Hildegard E Peplau’s Theory of interpersonal relations in my current nursing practice.
Concept of Hildegard E Peplau’s Theory
Hildegard E. Peplau’s theory of interpersonal relations mainly views on the interpersonal relationship process between nurse and patient during the implement of nursing care process. Using the professional nursing knowledge and clinical decisions, nurse can help patient find out his or her health problems. During the nursing process, nurse should establish a mutual trust relationship with patient and acquire patient’s confidence. The patient, also a complex individual, has a unique personality and is knowledgeable within his or her own frame of reference (Peplau, 1992). The nurse-patient relationship is initiated with a change in the health status of the patient, and the availability of a nurse with the ability to provide specific skills (Peplau, 1992). The nurse-patient relationship evolves through the phases of orientation, identification, exploitation, and resolution. The nurse must adapt to different roles so that the needs of the patient are met within each different phase (Forchuk, 1991; Peplau, 1997). Nursing roles include stranger, teacher, leader, surrogate, counselor, and resource person (Peplau, 1997). Thereby, nurse can able to provide the inimitable nursing care and nursing education for each patient and help each patient seek his or her health needs. Patient will follow and co-operate with the nurse to solve his or her personal health problems. This theory is effective to apply in clinical environment.
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Three phases of interpersonal relationships
There were three phases of Hildegard E. Peplau’s theory, orientation phase, working phase and termination phase. Nurses and their patients gradually establish a trustful and therapeutic relationship during the nursing process. This relationship not only help the patient trust nurse’s advice and to follow the nursing care plan. But also, it should be able to help the patient build up his or her own personality and learn how to develop self-care and adapt in daily life and daily activities (Peplau, 1997). In orientation phase, patient who has physical or psychological health problems, requires and seeks professional medical or nursing assistances to help his or her solve health problem. Nurse carries out health assessment to analyze patient’s situation and health problems and makes a nursing diagnosis to recognize patient’s impatient health problems (Belcher & Fish, 2002). Moreover, it is important to make a mutual agreement and establish a trustful relationship between the nurse and the patient (Pearson, Vaughan & Fitzgerald, 2005). In working phase, nurse will set a specific nursing care plan for each patient, nurse will play different roles, such as teacher, resource person, counselor, technical expect, leader and surrogate. For example, nurse provides relative nursing care, and arranges relative medical interventions and recovery services to patient during nursing process. Nurse should respect and concern about patient. On the other hand, patient should co-operate and respond to nurse to maintain a trustful and therapeutic relationship (Belcher & Fish, 2002). Finally, patient understands and solves his or her present health problems, and he or she becomes from dependence to independence and self-sufficiency. Both nurse and patient achieve the mutual health aim (Howk, 2002). In termination phase, nurse have to evaluate the outcome of nursing care plan. If the nursing outcome is effective, nurse will plan for discharge of patient. Conversely, if the nursing outcome is ineffective, nurse should rearrange patient’s nursing care plan until the health aim is achieved (Peplau, 1997).
Case study
Betty, who was a fit and willowy 33 years old lady. She was an artist and model. Because of her job, she had to wear different types of beautiful clothes every day. One day, she met her old friend. Her friend found that her neck had mild swelling. She didn’t take it into account. 2 weeks later, she found that her neck swelling had becoming larger in size but not painful. She went to consult doctor and the doctor suggested Betty to be hospitalized in order to carry out examinations and tests. She did medical investigations, such as blood for thyroid function test and ultrasound thyroid with fine needle aspiration cytology. The investigation result showed that she had thyroid tumors. Doctor suggested her to do the operation of total thyroidectomy and took a thyroid medication for long term after operation. However, she was afraid of wound pain and the risk of operation. She also worried about the surgical scar on her neck will affect her appearance, thus her work and income.
Orientation phases, I will introduce myself and my colleagues to Betty at the first meeting with her. Then I will show my support, respect and concern to her. Giving enough time for Betty to express her worries and concerns about the disease and operation of thyroidectomy. I will be a good listener and not to interrupt her when she is talking about her problems. After collected Betty’s personal information, I will define Betty’s problems, such as being afraid of wound pain and worrying about the surgical scar and her work and make a mutual agreement with her. In this phase, a trustful therapeutic relationship will be established.
For working phase, I should clarify Betty’s misunderstanding of her disease, operation and complication. I should explain that if she does not carry out operation of thyroidectomy, her thyroid tumor may have a chance of increasing size in the future. And it is life threatening if the thyroid tumor keeps increasing in size and blocks her airway. I should also discuss the post-operation care with Betty and give support to her, let her know that she may have a scar on the neck and need to take thyroid medication for a long time after the operation. Furthermore, I should encourage Betty’s family and friends to help and support her to face the changing image and long-term medication in the future. I should make a specific nursing care plan for Betty and encourage her to actively participate in it. In addition, helping Betty to identify her strengths, recognize her ability to overcome the wound pain and recover from the worries about scar of neck and her income. After Betty finished the operation, providing related nursing care, such as post operation care and counseling. Finally, I may arrange necessary services to Betty, such as referral to psychologist for changing her exterior appearance and a social worker for financial problem.
Termination phase, I should evaluate Betty’s nursing care plan is effective or not. When Betty successfully achieved the goal of nursing, I will plan her for discharge. Before discharge, I should educate her the steps of wound care at home and give her some information about her thyroid disease, such as diet and thyroid medication side effects.
The strengths, limitations, and its value and relevance to nursing Hildegard E. Peplau’s theory should apply on every clinical nursing practice. Nurse through interpersonal relationship with patient to establish a trustful therapeutic relationship. However, this theory has its strengths and limitations in clinical situations. The strengths are providing a systematic method for nursing assessment and prepare a specific nursing care plan for each patient. Peplau’s theory provides a unique view for understanding the purposeful nurse-patient relationship and the expanded nursing roles (Belcher & Fish, 2002). It has contributed to nursing in the areas of practice and research. Peplau’s theory is most commonly applied in psychiatric nursing practice and in the delivery of patient education. The core of Peplau’s theory is a process of development of interpersonal relationship between a nurse and a patient. The relationship is initiated by the patient’s felt needs and terminated when the needs are met. According to Peplau, the use of verbal and nonverbal communication are required for establishment of the nurse-patient relationship; Therefore, her theory is limited in serving unconscious patients who are unable to communicate with nurses both verbally and nonverbally. It is difficult to apply to patients who are incapable of communication, such as comatose and senile patients, or patients in critical condition, since in these situations the nurse-patient communication is often unidirectional (Howk, 2002). The generalizability of the theory is therefore not adequate. Another limitation of Peplau’s theory is that it is lack of appreciation for human environmental interactions, as it focuses heavily on interpersonal interactions. Moreover, many contemporary theorists believe that nurses should take the lead in identifying patients’ health needs rather than waiting for patients to seek help from them (Belcher & Fish, 2002). Both the nurse and the patient grow as a result of their interaction. Outcome evaluation is a critical step in the nursing process to decide if the planned goals are achieved. Peplau’s three phases of interpersonal relationship (orientation, working, and termination) are relatively coherent to the nursing process. Peplau’s orientation phase is consistent with the assessment phase and development of nursing diagnoses once the health problems are identified. The working phase parallels the outcomes planning and implementation phases, when individualized plans are selected to resolve patient’s problems. To sum up the similarities, both focus on therapeutic interactions and application of problem-solving approach to solve the patient’s health problems. In contrast, Peplau’s phases emphasize on meeting patients’ felt needs by facilitating the work initiated by the patient, such as seeking professional help, responding selectively and drawing resources actively. However, evaluation is not well elaborated in Peplau’s framework, and it implies the readiness of the patient to proceed through the termination phase (Belcher & Fish, 2002).
Conclusion
Peplau’s theory has had much influence on both general and psychiatric nursing, particularly in settings in which nurse-patient communications and interactions are held in high regard. Peplau also helped introduce the value of nursing during patients’ progress towards recovery. Peplau delineated six nursing roles that may emerge during the interpersonal process. Nurses also change their roles as they and their patients move through three phases of interpersonal relationships. The limitations are difficult to apply on patient of incapable communication and neglect to assess environmental health factor and promote health
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