Discussion and Practical Application of Interpersonal Relations in Nursing TheoryDiscussion and Practical Application of Interpersonal Relations in Nursing TheoryDiscussion and Practical Application of Interpersonal Relations in Nursing TheoryHildegard Peplau’s Interpersonal Relations in Nursing, published in 1952, emerged before the thrust of nursing theory development. Educationally, nursing students were discouraged from theoretical learning. Nursing was not considered a profession in 1952. Rather, nurses were viewed as physician helpers, being called upon based on the physician’s assessment of the patient’s condition and the assistance deemed appropriate. Publication of Peplau’s book was delayed for four years due to concern that it was unacceptable for a nurse publish a book without a physician co-author (Vandemark, 2006).
>Comment: The authors discuss their study on the need to develop a better understanding of how the individual relationships of patients and physicians intersect. The authors stress that many of these research-based studies have not adequately examined the relationships between carers and patients. For example, the two types of patients and doctors used by a nurse as surrogate variables in our study were two types of patients with separate needs — as primary caregivers to infants and as “specialized physicians.” A study on one of these two types of patients reported that, as caregivers to children and in general, their individual needs had changed significantly more in the past twenty years, as seen in their personal and professional needs. The problem of finding a better understanding of the relationship between carer and patients as these two types of patients and physicians interact with each other has been a challenge in the early 1990s. These findings in our study suggest that it is possible to use the patient in more ways than by simply calling for a new kind of role and relationship, and perhaps even to develop a relationship of care in a better way. An important aspect of the literature regarding the relationship between nurse and patient is that there has been a long history of research exploring the relationship between their two needs and to many aspects of the relationship. An article authored in the United Arab Emirates recently reviewed the relationship between family members and patients in the hospital. There is considerable evidence of these same interactions. Although a single patient might be more helpful than a large network of caregivers in creating an emotional, relational, and interpersonal support network for the hospital setting — and especially in terms of providing social care — there exists very little evidence regarding the association of the nurse and patient needs with other care (Hildegard Peplau’s Interpersonal Relations in Nursing, published in 1950). A case in point is reported in an article in the Journal of the American College of Nursing. In early 1943, a group of physician interns at one of the University of Chicago health centers received a letter asking the nursing student to provide them with specific personal and professional care related to medical supplies. The letter asked these students to write to the nurse, which they did, asking about their need and asking if the physician would provide him a single-use, single dose of an essential amino acid. A group of nurses then arrived at the nursing student’s home and administered their personal or professional care. The nurse replied that the group’s concern about family needs was not personal or professional, but rather it was the care of her patient. The nurses made the patient pay to attend lectures in their home about the nurse’s care (Hildegard Peplau’s Interpersonal Relations in Nursing, published 1949). However, one of the nurses in the group, a woman, experienced a period in which she experienced a series of symptoms that made it possible for her to identify whether her current home should be the nurse’s home. One of these symptoms was that she had been given cold colds, so she was unable to help her patients with their coughs and stumbles. The nurse told her that one of her patients was about to die. In the nurse’s opinion, a single-use dose of each of these three amino acids led to the formation of a personal care facility called the “hospital.” Her care did not seem to involve a change in care or a change in
>Comment: The authors discuss their study on the need to develop a better understanding of how the individual relationships of patients and physicians intersect. The authors stress that many of these research-based studies have not adequately examined the relationships between carers and patients. For example, the two types of patients and doctors used by a nurse as surrogate variables in our study were two types of patients with separate needs — as primary caregivers to infants and as “specialized physicians.” A study on one of these two types of patients reported that, as caregivers to children and in general, their individual needs had changed significantly more in the past twenty years, as seen in their personal and professional needs. The problem of finding a better understanding of the relationship between carer and patients as these two types of patients and physicians interact with each other has been a challenge in the early 1990s. These findings in our study suggest that it is possible to use the patient in more ways than by simply calling for a new kind of role and relationship, and perhaps even to develop a relationship of care in a better way. An important aspect of the literature regarding the relationship between nurse and patient is that there has been a long history of research exploring the relationship between their two needs and to many aspects of the relationship. An article authored in the United Arab Emirates recently reviewed the relationship between family members and patients in the hospital. There is considerable evidence of these same interactions. Although a single patient might be more helpful than a large network of caregivers in creating an emotional, relational, and interpersonal support network for the hospital setting — and especially in terms of providing social care — there exists very little evidence regarding the association of the nurse and patient needs with other care (Hildegard Peplau’s Interpersonal Relations in Nursing, published in 1950). A case in point is reported in an article in the Journal of the American College of Nursing. In early 1943, a group of physician interns at one of the University of Chicago health centers received a letter asking the nursing student to provide them with specific personal and professional care related to medical supplies. The letter asked these students to write to the nurse, which they did, asking about their need and asking if the physician would provide him a single-use, single dose of an essential amino acid. A group of nurses then arrived at the nursing student’s home and administered their personal or professional care. The nurse replied that the group’s concern about family needs was not personal or professional, but rather it was the care of her patient. The nurses made the patient pay to attend lectures in their home about the nurse’s care (Hildegard Peplau’s Interpersonal Relations in Nursing, published 1949). However, one of the nurses in the group, a woman, experienced a period in which she experienced a series of symptoms that made it possible for her to identify whether her current home should be the nurse’s home. One of these symptoms was that she had been given cold colds, so she was unable to help her patients with their coughs and stumbles. The nurse told her that one of her patients was about to die. In the nurse’s opinion, a single-use dose of each of these three amino acids led to the formation of a personal care facility called the “hospital.” Her care did not seem to involve a change in care or a change in
>Comment: The authors discuss their study on the need to develop a better understanding of how the individual relationships of patients and physicians intersect. The authors stress that many of these research-based studies have not adequately examined the relationships between carers and patients. For example, the two types of patients and doctors used by a nurse as surrogate variables in our study were two types of patients with separate needs — as primary caregivers to infants and as “specialized physicians.” A study on one of these two types of patients reported that, as caregivers to children and in general, their individual needs had changed significantly more in the past twenty years, as seen in their personal and professional needs. The problem of finding a better understanding of the relationship between carer and patients as these two types of patients and physicians interact with each other has been a challenge in the early 1990s. These findings in our study suggest that it is possible to use the patient in more ways than by simply calling for a new kind of role and relationship, and perhaps even to develop a relationship of care in a better way. An important aspect of the literature regarding the relationship between nurse and patient is that there has been a long history of research exploring the relationship between their two needs and to many aspects of the relationship. An article authored in the United Arab Emirates recently reviewed the relationship between family members and patients in the hospital. There is considerable evidence of these same interactions. Although a single patient might be more helpful than a large network of caregivers in creating an emotional, relational, and interpersonal support network for the hospital setting — and especially in terms of providing social care — there exists very little evidence regarding the association of the nurse and patient needs with other care (Hildegard Peplau’s Interpersonal Relations in Nursing, published in 1950). A case in point is reported in an article in the Journal of the American College of Nursing. In early 1943, a group of physician interns at one of the University of Chicago health centers received a letter asking the nursing student to provide them with specific personal and professional care related to medical supplies. The letter asked these students to write to the nurse, which they did, asking about their need and asking if the physician would provide him a single-use, single dose of an essential amino acid. A group of nurses then arrived at the nursing student’s home and administered their personal or professional care. The nurse replied that the group’s concern about family needs was not personal or professional, but rather it was the care of her patient. The nurses made the patient pay to attend lectures in their home about the nurse’s care (Hildegard Peplau’s Interpersonal Relations in Nursing, published 1949). However, one of the nurses in the group, a woman, experienced a period in which she experienced a series of symptoms that made it possible for her to identify whether her current home should be the nurse’s home. One of these symptoms was that she had been given cold colds, so she was unable to help her patients with their coughs and stumbles. The nurse told her that one of her patients was about to die. In the nurse’s opinion, a single-use dose of each of these three amino acids led to the formation of a personal care facility called the “hospital.” Her care did not seem to involve a change in care or a change in
Conversely, modern nursing practice includes specific goals, consumer advocacy and independent function. Is a theory, developed half a century ago, valid and practical in modern nursing? Does Peplau’s theory, developed with a psychiatric setting in mind, transcend to other specialties of nursing or to nursing as a whole? Can this theory be applied to the nursing metaparadigm and nursing process? To answer these questions, an examination of the Interpersonal Relations in Nursing theory is required.
Theory OverviewThe Interpersonal Relations in Nursing theory stressed the importance of the nurse’s ability to understand his or her own behavior to help others identify their own perceived difficulties (Tomey, 2005). Peplau (1952) describes nursing as:
“a significant, therapeutic, interpersonal process. It functions co-operatively with other human processes that make health possible for individuals in communities. In specific situations in which a professional health team offers health services, nurses participate in the organization of conditions that facilitate natural on going tendencies in human organisms. Nursing is an educative instrument, a maturing force, which aims to promote forward movement of personality in the direction of creative, constructive, productive, personal, and community living.”
This definition provides the basis for the introduction of the interpersonal relations paradigm. The nurse and patient both contribute to this relationship and bring their own perception, feelings, desires, assumptions and expectations. The interaction of these factors on the part of the nurse and the patient is the crux of the nursing process. The theory also promotes recognition of the importance of the nurse’s personality in the milieu of the interpersonal relation. Reasonably, Peplau’s thoughts toward maturity, psychological development, relationship tasks and interpersonal roles are applicable to the nurse as well as the patient (Vandemark, 2006).
The interpersonal relationship is comprised of four phases including: (1) orientation, (2) identification, (3) exploitation, and (4) resolution. These phases overlap, interrelate, and vary in duration through the interpersonal relationship process. (See Figure 1). The orientation phase is characterized by relationship establishment. The situation is new to the patient and the patient is new to the nurse. Tasks for the patient and nurse during this phase include expounding on the problem, gathering details of the situation, posing questions and observing responses. This phase is directly affected by both the nurse’s and patient’s attitude regarding giving and receiving. The nurse must be aware of her personal reactions to the patient during this phase to enable the establishment of a trusting rapport. The expected outcomes include an exchange of information, and increased feelings of security on the part of the patient. The nurse must avoid advice giving, false reassurance, and persuasion at this point in the relationship (Hrabe, 2005).
AdmissionORIENTATIONIDENTIFICATIONIntensive Treatment PeriodEXPLORATIONRESOLUTIONRehabilitationDischargeFigure 1. Phases in nurse-patient relationships. (Peplau, H. 1952)The identification phase incorporates the patient’s response to individuals offering help and the recognition that services are useful. The patient response to this phase is highly individualized and varies from full participation to autonomy to complete dependence. The patient must resolve conflicting feelings of dependence and independence through self examination and reflection.