Discussion and Practical Application of Interpersonal Relations in Nursing Theory
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Discussion and Practical Application of Interpersonal Relations in Nursing Theory
Hildegard 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).
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 Overview
The 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).
Admission
ORIENTATION
IDENTIFICATION
Intensive Treatment Period
EXPLORATION
RESOLUTION
Rehabilitation
Discharge
Figure 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. Tasks for the nurse include offering new experiences enabling the patient’s creativity and productivity. Preferred outcomes in the identification phase include clarification of the patient’s expectation of the nurse and nursing, clarifying the nurse’s expectations of the patient and his or her skills and learning,
and allowing the patient to develop feelings of strength and personal power. Negative consequences include the patient expecting the nurse to meet his or her needs with nothing reciprocated in return (Hrabe, 2005).
The exploitation phase is characterized by the patient taking full advantage of services offered. The patient task is balancing dependence and independence by extracting help from the available means. The nurse must understand and contemplate what causes shifts in the patient’s behavior. This phase also demands consistent maintenance of the therapeutic relationship to sustain the nurse-patient rapport already established. A patient that is comfortable with utilizing services and exploring all available possibilities is the desired outcome of this phase. In contrast, patients who exploit to dominate and or use attention seeking techniques are potential barriers to this phase (Hrabe, 2005).
The final phase is the resolution phase. This stage demands that all other phases must be completed prior to occurrence of this stage. Resolution incorporates a freeing process of self-sufficiency. Patient tasks include expending self to achieve new goals. The nurse must meet the patient’s need of dependency and recognize growth cues. The patient therefore develops a strengthened ability to function independently. This requires the dissolution of the dependency relationship as the patient drifts away from the nurse. The psychological impact of the situation may persist creating a dependency issue