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Hildegard Peplau
8
Hildegard Peplau
MONICA ADELPHONSE
ASHLEY GALLO
KRISTIN GALLO
FRANCIS HOGAN
TASHIA RICHARDS
DANIELLA RODRIGUEZ
RENZO RODRIGUEZ
Nursing Caring Theorist
INTERPERSONAL RELATIONS THEORY
INTERPERSONAL RELATIONS THEORY
Emphasizes the nurse-patient relationship as the foundation of nursing practice
The interpersonal model focuses on the need for a partnership between the nurse and the patient
COMPONENTS OF THE THEORY
COMPONENTS OF THE THEORY
HEALTH
Defined as an "implied forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living.”
HEALTH
ENVIRONMENT
ENVIRONMENT
Forces outside the organism, within the context of culture.
RESEARCH
RESEARCH
Considers that the focus of research in nursing should be patients, their needs, and their perceptions about the care they received from nurses.
NURSING
NURSING
The therapeutic interpersonal relationship between the nurse and the nursed.
PERSON
PERSON
Peplau defines person as an organism that "strives in its own way to reduce tension generated by needs."
FOUR PHASES of the
Therapeutic nurse-client relationship
THERAPEUTIC NURSE-CLIENT RELATIONSHIP:
FOUR PHASES
1. ORIENTATION PHASE
This phase is controlled by the nurse and involves explaining the patient's treatment as well as providing information and answering questions.
Orientation Phase
2. IDENTIFICATION PHASE
Identification Phase
This phase starts when the patient works interdependently with the nurse. The patient expresses their feelings and feeling confident in themselves.
3. EXPLOITATION PHASE
Exploitation Phase
In this phase the patient uses all of the services provided.
4. RESOLUTION PHASE
Resolution Phase
In this phase, the patient no longer needs professional assistance and is no longer dependent.
Our Patient
Nursing Situation
- Karen David (KD)
- 45 year old female
- Non-insulin Dependent Diabetes Mellitus type 2
- Body Mass Index (BMI) of 30
- Average BP of 148/88
- HbA1C is 6.5%
- Recently unemployed
- Recently ended engagement of 2 years
- Ms. David has expressed that she has not come to terms with her recent diagnosis.
- She has poor eating habits.
- The patient also stated that she finds it difficult to find time to exercise regularly.
- The patient would prefer to just relax and distress on the couch watching TV.
Concerns
The patient is currently prescribed:
- Metformin 500mg, one tablet by mouth twice daily.
- Captopril 25mg, one tablet by mouth twice daily.
- The patient has admitted that she is not adherent to her medication.
Medications
Karen David
Karen David
Calls for Nursing
Calls
- Acknowledgment and affirmation of the patient's constant changing individuality
- Requires supporting or encouragement of the nursed
- Recognize the Karen is living caring and desires to grow
Karen has lost her job and was just broken up with by her fiance.
Nursing
Call #1
Calls cont.
- The nurse acknowledged her feelings regarding the recent circumstances that have occurred.
- Affirm that she gone through a lot of change in a certain period of time.
- Play the role as the counselor for her underlying need for therapeutic care.
Karen does not accept her recent Diagnosis
Nursing
Call #2
- Affirm that she has not come to terms with her recent diagnosis and is worried about managing her diagnosis.
- Acknowledge that she is expressing her disbelief.
- Play the role of teacher and counselor to address her primary concerns
Calls Cont.
Two ways of knowing
Ways of Knowing
EMPIRICS - THE SCIENCE OF NURSING
EMPIRICS - THE SCIENCE OF NURSING
- This way of knowing asks:
- What is this?
- How does it work?
EMPIRICS - THE SCIENCE OF NURSING
ENVIRONMENT
- The nurse creates a nonjudgmental environment
- The patient feels comfortable asking questions
- The nurse can educate patient in a way that is understandable
EMPIRICS - THE SCIENCE OF NURSING
EDUCATION
- The nurse explains to the patient what the diagnosis is:
- Hypertension
- Type II Diabetes
- The patient was educated on contributing factors that lead to Hypertension and Type II Diabetes
- The patient was educated on ways they can reduce the risk
PERSONAL KNOWLEDGE
PERSONAL KNOWLEDGE
- This way of knowing asks:
- Do I know what I do?
- Do I do what I know?
PERSONAL KNOWLEDGE
PATIENT - NURSE RELATIONSHIP
- The nurse has provided a comforting environment while providing care to the patient.
- Patient – Nurse relationship
- Understand patient goals
- Patient is educated and understands her diagnosis
Application of Theory:
Application
Orientation: Beginning of Relationship
Orientation
- Initiated by patient
- Expectations from patient and Nurse
- Nurse sets expectations to move beyond Introduction & Maintains Professional Demeanor
- Quick Head-to-Toe Assessment and General Health History Gathered
- Transition from Orientation Phase to Identification Phase
Identification: Diagnosis & Planning
Examples of nursing diagnoses that could have been presented to KD by nurse are:
Identification
- Ineffective Health Maintenance r/t complexity of therapeutic regimen
- Ineffective Health Management
- Powerlessness r/t perceived lack of personal control
- Risk for Unstable Blood Glucose Level
- Risk for Injury: Risk Factors: Hypo- or Hyper-glycemia from failure to consume adequate calories/failure to take medication.
- Readiness for Enhanced Health Management.
- Risk for Overweight: Risk Factor: Lack of knowledge of relationship between diet and disease process
- Readiness for Enhanced Communication: Willingness to Share Feelings and Thoughts
Exploitation or Implementation
Exploitation
Phase when the agreed upon care plan is executed upon the client with nurse assisting when necessary
Nurse as Teacher
Teacher
- Patient has deficient knowledge of disease process
- Nurse teaches:
- Disease Process
- Ways affects body
- Regain control
- Empathizes with client feelings of powerlessness
- Dietitian referral:
- Meal Plans
- Exercise Plan
Nurse as Counselor
Counselor
- Patient is Human
- Identifies with past personal experiences
- Patient needs to be heard
- Healing begins
- Continued healing through interdisciplinary counseling
Resolution or Evaluation
Resolution
Final phase of interpersonal relationship
Nurse and Client will evaluation how the plan has worked, ways the plan has not worked, and ways the plan can be improved.
References
- Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2017). Nursing diagnosis handbook: An evidence-based guide to planning care (11th ed.). St, Louis, MO: Elsevier.
- Gonzalo, A. (2019, August 24). Hildegard Peplau: Interpersonal Relations Theory Guide. Retrieved from https://nurseslabs.com/hildegard-peplaus-interpersonal-relations-theory/.
- Hagerty, T. A., Samuels, W., Norcini-Pala, A., & Gigliotti, E. (2017, April). Peplau's Theory of Interpersonal Relations: An Alternate Factor Structure for Patient Experience Data? Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831243/.
- Pritchard, K. (2019). Fundamental Patterns of Knowing in Nursing. (31 Powerpoint Slides). Retrieved from https://canvas.fau.edu/courses/73419/files/16301938?module_item_id=1649175
- Smith, M. C., Turkel, M. C., & Wolf, Z. (2013). Caring in nursing classics: An essential resource. New York: Springer Publishing, 231-233.
- Staff, F. E. (2017, October 27). High Blood Pressure: Prevention, Causes, and Treatment. Retrieved from https://familydoctor.org/condition/high-blood-pressure/.