INTERPERSONALRELATIONS

Hildegard E. PeplauA Middle-Range Nursing Theory Analysis

By

Argi Virgona, S.Kp. M.Kep

“A Light in the Darkness”

GOALS OF THE THEORY

She wanted “only to convey to the nursing profession ideas [she] thought were important to improve practice”

Fokus Peplau adalah kualitas interaksi nurse-patient dan nursing education

(O’Toole, 1989; Forchuk, 1993, p. 3)

Hilda in 1951

INTERPERSONAL RELATIONS THEORY

BASIC ELEMENTS: the patient the nurse the interaction between them

DEFINITIONS: CLIENT/PATIENT – orang,

pasangan, kelompok, komunitas layak mendapatkan asuhan manusiawi dengan dignity, privacy, ethics

ENVIRONMENT - Physiological, psychological & social yang mempengaruhi sakit & sehat

HEALTH – Forward movement of personality & human processes in the direction of creative, constructive, personal, and community living

INTERPERSONAL – Phenomena that occur between persons

NURSE – The medium of the art of nursing; a maturing force. “The unique blend of ideals, values, integrity, and commitment to the well-being of others…”

NURSING ROLES - to assist client starting as stranger, then technical expert, resource person, surrogate, counselor, teacher and others

(Forchuk, 1993; Peterson, 2009)

RELATIONSHIPS HAVE FOUR PHASES

ORIENTATION PHASE Preconceptions Parameter dibangun &

diidentifikasi Tahapan awal trust

dikembangkan Peran mulai dipahami

IDENTIFICATION PHASE Klien mulai mengidentifikasi

masalah Tujuan perawat : membantu

pasien mengenali his/her own interdependent/participation role & meningkatkan responsibility for self

(Belcher, 2002; Peterson, 2009)

RELATIONSHIP PHASES (CONT’D)

EXPLOITATION PHASE Klien mempercayai perawat

mampu mengeksplorasi seluruh potensialnya

Klien mengoptimalkan manfaat dari asuhan keperawatan

Memecahkan masalah dengan segera

Mengidentifikasi & mengorientasikan diri untuk pencapaian tujuan

RESOLUTION PHASE Fase terakhir dari nurse-patient

relationship Rasa aman klien terpenuhi Klien meningkatkan

kemampuannya untuk mengatasi masalahnya

(Belcher, 2002; Peterson, 2009)

THE NURSE ASSISTS THROUGH ROLES ROLES of NURSE:

Stranger (Orientation phase) Technical Expert & Authority

Figure Surrogate for significant

others Resource Person Change-Agent Researcher Counselor Teacher & More

Specific roles bervariasi pada setiap situasi nurse-client situation, terbatas hanya pada imajinasi & keterampilan perawat

Helping PatientsHelp Themselves- - Rather than feeding them,

Teaching them “to fish” --

INFLUENCED PSYCHOBIOLOGICAL EXPERIENCES

Setiap orang memiliki kebutuhan, frustrasi, konflik, & kecemasan yang saling mempengaruhi

Setiap orang memiliki basic needs & harapan dalam setiap hubungan

Nurse’s own self-understanding merespon tensions & coping mechanisms

Nurse memandu pasien utk pulih; tension and anxiety are converted into purposeful action as the result of the therapeutic relationship

(Peterson, 2009)

VISUAL MODEL OF MAJOR CONCEPTS

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

THEORY INSIGHTS - PROFESSIONALISM

Nurse memperoleh kompetensi dengan memahami > lanjut ttg self, concepts, roles & proses utk membantu pasien tumbuh & pulih

Peplau memperingatkan: danger of ‘social talk’ with patients – Perawat tdk diperbolehkan utk berbicara dgn cra yg sama pada px, kelg, atau kelompk. Harus mengarah pada efek therapeutic – promoting long-term well-being

Kebutuhan emosional perawat tidak boleh mempengaruhi pemberian askep

Interpersonal Relations theory membantu pasien untuk :

Observe more intelligently Intervene more sensitively

(O’Toole, 1989)

Check your emotional baggage

at the door of patient care

EVALUATION OF THEORY ADEQUACY:

Contributes to the nursing process

Clearly consistent with nursing’s values and mission

Limited in groups of people

Fairly narrow set of cultural assumptions

(Meiers & Sheran, 2009)

I disagree that it’s limited in groups - Lego demonstrates it has potential for group work

(Lego, 1998)

It can be used in any specialty area of nursing with patient contact

It is holistic in nature

CLARITY: Clear and logical fashion Definitions are readily

understandable Though concepts are at a

high level of abstraction, they can be learned with practice

EVALUATION OF THEORY

CONSISTENCY: Concepts and ideas

are parsimonious Worldview is

phenomenological in nature and remains consistent throughout the theory

(Meiers & Sheran, 2009)

LOGICAL DEVELOPMENT: Logically inductively

and deductively based

Many psychological theorists’ works integrated into development

Nursing role promotes the patient’s movement through the steps of the nursing process (Meiers & Sheran, 2009)

EVALUATION OF THEORY LEVEL OF

DEVELOPMENT: Remains at the

descriptive level Focusing on phases of

relationships and interactional/inter- and intrapersonal phenomena

Not changed significantly since Peplau’s original writings were published over 50 years ago

DISCRIMINATION: Peplau is clear about

making distinctions between the nursing and the medical profession

But theory can be used by all helping professions in practically all areas of the relationship arena

(Meiers & Sheran, 2009)

The patients who have overwhelming physiological needs (or unconscious) are not good candidates for this theory application (Belcher, 2002)

Use with family members would be appropriate

EVALUATION OF THEORY COMPLEXITY:

Theory has breadth, life and fluidity

The basic core of the theory is simple, but certain aspects of the psychology in communication make it more complex

(Meiers & Sheran, 2009)

The concepts are at a fairly high level of abstraction

Both inductive and deductive reasoning ability are part of this theory

Both quantitative and qualitative research can take place

REALITY CONVERGENCE: The basic tenants reality based,

particularly in nursing situations requiring healing nurse-patient communication

Real life Application: Nurses should be treating patients in a holistic fashion, no matter the context - It should be utilized more than it is, for the patient’s sake

It requires time & practice to master – start with the basics: a continual process improvement

Considering the economy & managed care, Jones reports (1996) “…the need to provide cost-effective quantifiable care may negate the value of Peplau’s theory”

I disagree - This theory is valuable as part of human development, maturity and individual healing in many contexts

EVALUATION OF THEORY PRAGMATIC UTILITY:

Nurses’ critical thinking, therapeutic-intervention/communication - beyond task oriented nursing

Requires self-scrutiny of motives and expectations by the nurse (maturity)

(Belcher, 2002) Requires understanding of

inductive reasoning skills It is the basis of higher levels of

caring Directly affects interventions

dealing with communication The interactions with the patient

spawn deeper thinking in both the patient and the nurse towards positive healthcare outcomes

(Meiers & Sheran, 2009) Utility based on individual use by

nurse to invest energy and vision into relationship understanding & healing

SCOPE: Used in practice domains where

interpersonal or intrapersonal difficulties are taking place – [all (?)]

Uses are broad; not confined to only psychiatric nursing, but other areas of nursing as well

(Meiers & Sheran, 2009) Limited in realm of

physiological/medical issues – but helpful to patients with concerns or “issues” –most pts have these to some degree

Very useful in settings of nursing education where focus on nurse-patient relationship and communication are discussed

EVALUATION OF THEORY

SIGNIFICANCE/CONTAGIOUS/CONTEMPORARY USE:

Criterion for significance has been met for the nursing discipline

(Meiers & Sheran, 2009)

Continued references to the theory in contemporary research and literature attests to continued utility

Many elements of the theory have become public domain and integrated into nursing practice without Peplau being credited

Theory has stood the test of time, though only moderate and variable use for formal research has occurred

(Belcher, 2002; Meiers & Sheran, 2009)

Used internationally in Australia

and New Zealand, Belgium, Canada, the UK, Ireland and the United States

Translated into multiple languages

Use of the theory by psychiatric nurses and advanced practice nurses is not uncommon

Documented as useful in many other areas of nursing: health education, palliative care, oncology, AIDS care, quality of life and many others (Belcher, 2002)

PREVIOUS APPLICATION TO PRACTICE Used widely around the

world – nursing education Often integrated into

policies without credit to Peplau – Public Domain

Patient health education, palliative care, oncology, AIDS care, quality of life, private practice, nurse practitioners, home care & of course, psychiatric nursing

Nurse counseling of individuals and groups

(Belcher, 2002; Lego, 1998; McNaughton, 2005; Beeber, 2001)

RECOMMENDED FOR NURSING PRACTICE ROUTINE

INTEGRATION into daily practice within any area of clinical nursing, with multi-faceted effects

Nurses in private counseling practice would increase

Theory requires the mature nurse to look deeply at own behavior, attitudes, motives, & actions during daily practice & in relationships – self-scrutiny

(Belcher, 2002)

Invites the nurse to be less self-gratifying, and more in tune to the needs of the patient (and support systems), as well as filtering into peer and professional relationships

RESULTS: All interactions within practice would be more mature and healing in a context of caring, potentially improving peer relations as well

Near elimination of disrespect between staff members with improved focus on the welfare of the patient – better focused care plans

RECOMMENDED FOR NURSING PRACTICE Patients would

perceive being better understood Would comprehend

instruction with less anxiety Would give higher scores in

levels of satisfaction regarding their nursing care

Re-admissions would decrease Increased comprehension

of teaching in patients Patient and staff increased

sense of responsibility for selves

Empowerment of both patients & staff

Improved health outcomes

Success stories and patient comments could be shared in staff meetings and newsletters to reinforce the new staff behaviors

Role modeling by nursing & management would give the atmosphere of healing and caring – less stressful environment

RECOMMENDED FUTURE RESEARCH

Quantitative & qualitative research demonstrating positive health-care outcomes needs to take place (Jones, 1996)

Focus on quantitative research would verify the theory’s contemporary value, even with today’s financial constraints It might require a blended effort of

Psychology and Nursing scholars

Specifically, quantitative studies needed to support the efficacy of the theory in relation to patient outcomes Improved mental and physical health

status Positive patient education results Favorable patient satisfaction

UPCOMINGNURSING RESEARCH

HAVE ANY QUESTIONS ???