Nursing Theories: Interpersonal Relations Theory

Abstract

Nursing information has tremendously grown since the days of Florence Nightingale. While we cannot definitively state what constituted nursing information or knowledge, nursing as a field can be viewed as a constantly evolving body whose development is embodied by advancing clinical knowledge, empirical knowledge as well as conceptual knowledge. Nursing in general has been perceives as a moral practice given the constant developments particularly to the ethics of care. Nonetheless, while most philosophical and ethical conjectures of nursing theories are yet to be fully clarified, there is substantial works that can properly elucidate on the nursing practice. Hildegard E. Peplau is one person whose input to the profession of nursing has been tremendous as used as a benchmark for setting nursing standards especially through her theories. Dr. Peplau’s Interpersonal Relations Theory described nursing as “An interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help.” (Peplau, 1991).

Hildegard E. Peplau’s theory of interpersonal relations

This paper analyses Hildegard E. Peplau’s theory of interpersonal relations with a keen look on the relationship between clients and nurses, major components, phases, its relation to evidence based theory and finally its relation to mental health nursing.

Nursing Theories and Role Development

Introduction

Nurse scholars have for the longest time recognized that nurses utilize some form of nursing theory and conceptual theories in their day-to-day activities and they insist that nursing theory is a critical part to the field of medicine. Today, the need for a working partnership between a patient and a nurse is very crucial in nursing practice as it enables healthcare providers and physicians to come up with effective therapeutic interventions that are beneficial to the clients. As such, through nursing theory analysis, nurses can gain the necessary skills and power by understanding knowledge that characterizes the nursing activity. It’s from such interventions that Hildegard E. Peplau conceptualized her prominent –Interpersonal Relations Theory- in 1952 which is still used even today. Dr. Peplau’s contribution to nursing is remarkable and quite significant in the evolution of nursing. In her attempts to bridge the gap between nursing theory and practice, she was successful in showcasing how an individual’s experiences, their clinical practice and societal aspects of empiricism can impact a person’s knowledge base and identity. The following paragraphs will showcase how Dr. Peplau’s theory and conceptual framework of interpersonal relations impacted clinical, conceptual and empirical knowledge and not just on the psychiatry front, but also to nursing in general.

Assumptions, Major Concepts and Phases

The theory also holds several assumptions. First, the theory states that a nurse and a patient can interact. Secondly, Dr. Peplau insisted that both the nurse and his/her patient mature depending on how effective their therapeutic interaction is. Third, communication and interviewing skills play a fundamental role in nursing and finally, Dr. Peplau emphasized that nurses ought to understand themselves first in order to enhance their client’s growth and to ensure that they do not limit their clients’ choices to only those they value (Peplau, 1991).

This nursing theory also embraces certain nursing theories that are accentuated according to different aspects. Generally, the nursing theory describes the purpose of nursing as the capacity to aid others to identify their felt complicatedness and urges them to apply the values of human relations to issues that come up at all levels. Man in this nursing theory is explained as a life form that “strives in its own way to reduce tension generated by needs” (Peplau, 1991). A client is a being that has a felt need. Dr. Peplau defines health as a word symbol used to embody the forward movement of personality as well as other individual processes that are creative, constructive, fruitful, and personal as well as community living (Peplau, 1991).

The other key concept associated with this nursing theory is society or environment and even though Dr. Peplau does not address these aspects directly, she urges the nurses to recognize and be mindful of the client’s culture especially when the client adjusts to hospital routine. Lastly, in regards to nursing as a whole, Dr. Peplau regards nursing as a major therapeutic process describing it as the human relationship between a sick individual and a nurse who has been specially educated to identify the specific needs of a patient and respond to them (Peplau, 1991).

Relevance of the Theory to Evidence-based Practice

According to Dr. Peplau, therapeutic nurse-client relationship is an intended professional bond between as patient and their nurse that concerns itself with the patient’s specific needs, issues, feelings, perceptions as well as ideas. This relationship involves communication and contact between two or more people who embrace a mutual objective that is attained by adhering to a structured and sequential pattern. There are four phases of this relationship namely: Orientation phase, Identification phase, Exploitation stage and Resolution stage (Peplau, 1991).

During the orientation phase, the client has a felt need and thus seeks professional and medical help. The nurse in this stage helps this individual to identify and understand their problem in order to determine the best care needed. This stage is relevant because it’s where the client first develops trust: it’s the juncture where first impressions are made about the nurse and the healthcare system in general (Peplau, 1991). During the identification phase, the client recognizes those that can help him/her and thus they begin to work together with the nurse. Interactions in this phase are crucial as they provide the foundation for understanding, faith in the clinical process and acceptance as the client thus assumes the role of an active participant in the treatment process (Peplau, 1991).

Third, the exploitation stage entails the client taking full advantage of the services rendered hence exploiting his/her relationship with the nurse to address treatment objectives. Finally, in the resolution phase, due to the effective communication laid by the initial stages, the client’s needs are fully met and satisfied. As such, they are released to full independence as they no longer need professional help which signifies the end of their relationship with the nurse.

One other significance relevance is how the nurse assumes several roles in the provision of care. First, she adopts the role of a stranger where she/he encounters client and assesses him or her in a objective an non-judgmental manner to evaluate his need. Secondly, she/he becomes a resource person by providing relevant information to him (Jones, Fitzpatrick, & Rogers, 2012). The nurse then becomes a teacher by educating the client and informing them to enhance the understanding of their need. Fourth, as a leader the nurse leads the client by ensuring there is cooperation and active participation from both ends as they try to fulfill the patient’s needs. The nurse also assumes the role of a surrogate and aids the client to recognize the similarities and differences that exist between him/her and the patient which is crucial in determining one’s dependency or independency. Lastly, the nurse can act as a counselor and assist their client to learn from their own experiences in order for them to increase their understanding of the problems the face (Jones, Fitzpatrick, & Rogers, 2012).

Generally, Dr. Peplau’s theory and the Nursing Process embrace a sequential aspect. This is highlighted by how they focus on the therapeutic relationship through a formulation of problem solving methods that nurses and their clients can collaborate on with the final goal being fulfilling and satisfying the client’s needs. Additionally, they both apply observation communication as well as recording as their fundamental tools (Jones, Fitzpatrick, & Rogers, 2012).

To put this into perspective, we ought to explore the fundamental basics from each side and see the results. First, assessment can be aligned with orientation where during assessment, there is continuous data collection and psychoanalysis but there may not be a felt need. However, in during the orientation phase, there is non-continuous data collection but there is a felt need as well as definite needs by the patient. Secondly, nursing diagnosis and planning phase entails mutually set objectives while the identification phase in Dr. Peplau’s theory involves interdependent goal setting procedures. Third, the implementation stage involves plans initiated focusing on achieving mutually set objectives and they may be attained by the nurse or the patient. On the other hand, exploitation phase entails the patient dynamically seeking and getting help (Jones, Fitzpatrick, & Rogers, 2012).

In regards to the evaluation stage, care focuses on mutually expected behaviors and can lead to termination of old plans and consequently initiating new ones. On the other hand, the resolution phase happens after other phases have been implemented successfully and the final outcome is termination. Most importantly, Dr. Peplau’s theory has been significant in assisting later nursing theorists and clinicians to come up with more therapeutic interventions especially in regards to roles that manifest the dynamic character synonymous with clinical nursing (Peplau, 1991). The theory’s phases offer a certain aspect of simplicity in regards to the natural sequence of the nurse-client relationship which is relevant because it leads to flexibility during interactions involving the patient and the nurse.

How the Theory Relates to Evidence-based Practice and Quality Outcomes

Dr. Peplau was among the first authors to borrow from other scientific fields and apply the acquired information in the discipline of nursing. Her dedication to integrate existing knowledge into her conceptual framework productively fused together ideas and knowledge from various fields of enquiry as a conceptual model is supposed to be (Jones, Fitzpatrick, & Rogers, 2012). Her theory’s main objective was for the nurse to initiate build a therapeutic relationship with a client through a series of progressive phases and assuming of various roles with the aims of identifying and satisfying the patient’s needs. Key to note was how her focus was on providing care to a point where the nurses’ intervention was no longer required (Jones, Fitzpatrick, & Rogers, 2012).

Her model brought the nurse closer to the patient making him/her actively involved unlike what was previously practiced and permitted. This theory outlined roles that placed the nurse in close proximity with his/her client as they teach, counsel, lead and even surrogate patients. By so doing, especially in assuming the role of a stranger so as to properly ass the patient, the nurse is objectively “accepting” the client and dedicated in assisting him and his needs. Dr. Peplau provides these distinct and abstract descriptions of her theories of nurse roles with keen emphasis on meeting the client’s needs (and how to) thus demonstrating how the theory is a true conceptual model as illustrated by its internal consistencies (Peplau, 1991).

How the Theory can be Applied in Clinical Practice Today

To accentuate more on this theory, we ought to look at a few scenarios. First, on a screening encounter in a correctional interaction and secondly: involving older citizens. For instance, a 40 year old husband who’s also a father of three is being booked into a county jail for a one month jail sentence. A nurse is carrying out receiving screening and ready to place a TST when he states that he just wants to get it done over with. The “patient” goes ahead to state how he intends to stay out of trouble by minding his own business since he believes he’ll be left alone by other inmates. The nurse notices how nervous he is and using Dr. Peplau’s theory, here is how the nurse can handle the situation.

Using the orientation approach, the nurse can use an accepting tone and exhibit open body language in telling the patients that she/he knows how tough it might be and asking him what his concerns might be since she might have some solutions. The identification phases follows with the patient opening up on that being his first time to prison and his fears about gangs, physical and sexual assault as well. This presents the nurse a chance to become a teacher, resource person as well as a counselor to the patient. He/she then acknowledges his pains/fears and anxiety in the exploitation stage further advising him on options available, support services like chaplain services available. She also informs the inmate that there is little gang activity and the right channels to report any cases of sexual advances. Finally, the resolution stage entails the patient instilling calmness to the patient and assuring him that he can make it. The nurse advices the client to focus on what the experience will teach him before proceeding with the final part of the health screening.

This theory can also be applied to promote holistic communications between nurses and older adults. Today, older adults (people aged 65yrs and older) account for 13% of the U.S population. Most of these are battling with acute and chronic conditions that have to be properly managed through proper care. As such, nurses ought to apply Dr. Peplau’s theory to enable them meet the clinical practicum requirements as they also meet the needs of these older citizens (Deane & Fain, 2015).

Interpersonal Relations Theory in Relation to Mental Health Nursing

Dr. Peplau’s input in the field of medicine has contributed greatly to nursing’s clinical knowledge and is still be referenced significantly today more so in psychiatric nursing. Her theory of interpersonal relations was a contributing factor to mental health nursing as a clinical specialty. First, one direct relevance of her theory to mental health is signified in her description and analysis of the four levels of anxiety. Notably, Dr. Peplau had been exposed to Harry Stack Sullivan’s work and this played a key role in her subsequent works. Sullivan had described personality as one’s behavior towards other beings and Dr. Peplau expounded more on this by indentifying the four levels of anxiety and their impact (Jones, Fitzpatrick, & Rogers, 2012).

Dr. Peplau described mild anxiety as a positive state of sensitive awareness and sharpened senses that enable an individual to learn new behaviors and get solutions to their problems (Jones, Fitzpatrick, & Rogers, 2012). Moderate anxiety was analyzed to include a perceptual field whose focus in on immediate task only. This means that an individual can only solve problems or learn new behaviors only through assistance. Third, severe anxiety was accentuated as feelings or dread and terror where an individual can never be redirected to a certain responsibility since they only focus on scattered bits of information and has physiologic symptoms (chest pains, tachycardia etc). Lastly, panic anxiety Dr. Peplau asserted that panic anxiety can entail loss of rational thought where an individual can experience hallucinations and delusions. Some can be mute and suffer from physical immobility while others can run aimlessly risking physical injuries to their bodies (Jones, Fitzpatrick, & Rogers, 2012).

Selection of this theory stemmed from Dr. Peplau’s focus to conceptualize a theory that is clinically focused. Her work is pragmatically accurate and it gives guidance to nursing practice as a whole and not just mental health nursing. More precisely, she emphasized on how critical it is for nurses to identify anxiety and intervene appropriately so as to improve the patient’s state (Jones, Fitzpatrick, & Rogers, 2012). She believed that interpersonal competences of nurses are crucial in helping patients regain their health and wellbeing. She urged nurses to understand their own behaviors and feel within themselves what other individuals are trying to say both verbally and non-verbally. In most occurrences, these feelings are either panic or anxiety and nurses should strive to identify them before integrating their understanding and self awareness to help patients recognize their problems (Jones, Fitzpatrick, & Rogers, 2012).

Conclusion

Studying and fully integrating Dr. Peplau’s theory of interpersonal relations is crucial to those aspiring to play a role in the nursing profession. Having the knowledge of her works and fully knowing the 7 roles of nursing is essential as it applies to a myriad of different situations that all have one similar outcome: providing the best care possible for patients. Her theory is an instrumental contribution to mental health nursing and should be fully understood by all students since it aids in speeding treatment as well as the recovery process. Generally, this theory is instrumental because it focuses on quality care through empowering the nurses and according them a chance to explore and determine their contribution to health care in a dynamic and innovative manner. Usually, nurses’ time is consumed by administrative duties but with this theory, they can shift their focus on providing care to patients and assisting them with their needs.

References

Jones, J. S., Fitzpatrick, J. J., & Rogers, V. L. (2012). Psychiatric-mental health nursing: An interpersonal approach. New York: Springer Pub.

Peplau, H. E. (1991). Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. New York: Springer Publishing Company.

Deane, W.E. & Fain, J.A. (2015). Incorporating Peplau’s Theory of Interpersonal Relations to Promote Holistic Communication Between Older Adults and Nursing Students. Journal of Holistic Nursing. Sage Pub.