Theory of Interpersonal Relations / Hildegard Peplau - Research Paper Example

Theory of Interpersonal Relations / Hildegard Peplau Major Concepts of the Theory Hildegard Peplau came up with the Interpersonal Relations Nursing Theory in 1948. The theory was revolutionary in that it described nursing in terms of psychological and interpersonal procedures. The theory is a middle range descriptive theory, which was also influenced by other theorists such as Percival Symonds and Elger Miller. The theory is sometimes described as psychodynamic nursing, which is usually geared towards the comprehension of behavior. Peplau divided the nursing processes into phases. The model also divided the function of the nurse into five functionalities (McNaughton, 2005). This essay will analyze the nurse patient relationship from the perspective of the interpersonal theory of nursing. This study will establish that the nurse patient relationship is the most significant element in the determination of successful outcomes in therapy especially with regard to victims of rape. The nurse according to Peplau’s theory had six roles in the nursing process: stranger, teacher, resource person, counselor, surrogate, and leader. The nurse is a strange personality in that the meeting of the patient and nurse is usually not preceded by prior contact and hence a relationship has to be established starting form this perspective. The nurse is a teacher in that he offers information to the patient that will answer their need or interest. The role of the teacher and nurse also doubles up as a resource person in helping the patient understand current or developing situations. The nurse is a counselor in that it is upon the ethical nurse to assist the patient in understanding an integrating changing and current circumstances through the provision of support and direction (Peplau, 1989). The nurse acts as a surrogate in that they help the patient to identify their areas of dependence, independence, and interdependence so that they may be assisted. The nurse who then acts as a leader assists the patient in attaining responsibility in the achieving of particular objectives. The theory then divides the nursing process into four phases; orientation, identification, exploitation and resolution. During the orientation phase, the nurse and the patient get to know each other and weigh up roles. This is the phase in which the patient gauges what amount of help is to be expected from the nurse. During this phase, the nurse attempts to establish a connection with the patient. After establishment of a connection, the nurse will then attempt to identify the problems of the patient and make the patient realize the level of responsibility expected from him. After identification of the problem follows the exploitation phase, in which the nurse then makes use of the information obtained in order to assist the patient in a professional manner. After the identification, orientation and exploitation, there comes the final phase of resolution of the problems and finally the breaking of relations in which the patient leaves the institution. Victims of Rape in the Theory Victims of rape are more suited to treatment based on the interpersonal relations theory of nursing more than other models of nursing theories. Victims of rape are usually no free about talking about their experiences, which would make the work of helping them to be particularly difficult. In the treatment of rape victims, it is important that the nurse take into account the physical trauma that the patient has undergone. The nurse will therefore have to follow the nursing theory in a systematic formation of the patient ids to be helped. The nurse will have to try to establish through an orientation in the first meeting (Mcnaughton, 2005). In the orientation phase, the nurse will try to establish a level of integrity with the patient in order to get the patient to gain trust and confidence in him. After the nurse has established the connection, there is then the development to the identification of the problem of the problem. It is important that the orientation is conducted in such a manner that the identification of the problem and responsibility of the patient easier to determine. Since many rape patients have a high level of dependence, it is important that the nurse establishes the level of dependence and responsibility that the patient may have in order that confidence between him and the patient is maintained (Gastmans, 2008). It is crucial that the nurse be professional in the exploitation stage by using the various tools of nursing theory available in trying to solve the issue at hand. A systematic application of the interpersonal theory will be beneficial to rape victims since it creates an atmosphere of confidence and trust in the patient. Such an approach to nursing of rape victims will make it more probable that victims of rape will visit the medical center. Studies Conducted There have been a variety of studies which have been conducted in which prove the importance of the interpersonal relationship theory propounded by Peplau. Peplau (1989) established the concept of trust is of particular importance in the building of a therapeutic relationship. Trust is significant in that one it is established, it allows for the development of the relationship to other modes such as identification and exploitation. The study by Obrien found that trust was the determinant factor of the success of the therapeutic relationship. O’Brien established that patients who approached medical centers had many problems since they had to first develop a level of trust towards the nurse. If patients are able to find a genuine, warm, and empathetic nurse, then the therapeutic relationship is more likely to be successful. A study conducted by Yamashita, Cheryl, and Bronwyn (2005) found that the element of empathy is also crucial in the forging of the therapeutic relationship. An absence or the unskillful utilization of empathy in the relationship may destroy the relationship and lead to a total failure of the medical objectives. In instances in which the nurses did not recognize the patient’s needs, the relationship was in most instances damaged irreparably since the patient experienced feelings of rejection, culpability, and aggravation for their illness. The study further alludes that patients deemed the most crucial aspect of therapy had lot to do with having an empathetic therapist. Clients in the study asserted that such a therapist was able to get into their feelings and emotions drawing them out and was thus able to be of more help. Research conducted by Orlando (2001) aimed at finding out the effect of the forging of special relationships. According to the study, genuineness in the therapist was a very important factor that led to the success of therapy. The patients in both their verbal and non-verbal cues, which were then used to gauge whether the patient would like to cooperate, evaluated the genuineness of the therapist or not. The study established that the patients were receptive to non-verbal communication such as encouragement, open communication, and respect as having a positive effect on therapy. Genuineness may be looked at from the perspective of the nurse having empathy on the patients in such a manner that he will respect the client and thus offer the patient autonomy. Listening is a factor that contributes to effectiveness in the therapy process. A practitioner who listens to what the patient has to say and has a genuine interest is more likely to develop a connection with the client, which will lead to effective therapy. Through the practitioner asking of their clients, concerning their feelings and attitudes and getting feedback feelings of mutuality were created in the nurse patient relationship. It is important that the practitioner take into consideration not only his knowledge, ideas and values but also the unique circumstances of the client, which are obtained from active listening. According to the study the therapeutic relationship benefits when the practitioner get an understanding of the patient that is more than what is expected in ordinary work (Gastmans, 2008). A study conducted by (Travelbee, 2009) identified empowerment as a critical influence in the therapy process. Empowerment is said to be impacted and enhanced by continuity of care and communication. The study found that successful therapy sessions recorded a higher level of empowerment of patients through the exchange of information between the practitioner and the patient. Therapy sessions, which stressed upon the letting of patients take control of their illness, were more effective. Some interventions employed by medical practitioners such as institutionalization negatively affect the therapeutic process since they led to a loss of responsibility and autonomy of the patient. Issue such as stigma were recognized as negative on the empowerment process and as such the role of the nurse was an empowerment of the patient through making them understand their illness and respond to it in a positive and responsible manner. Barker & Reynolds, (2005) analyzed the role of the nurse in the facilitation of the life of the patient post nursing care. The nurse may employ a variety of professional skills such as an analysis and depiction of the patient’s illness in a manner that would make the client look upon the problems in a positive way in order to increase patient autonomy. The study goes on further to explore the relationship of autonomy between the practitioner and the patient. The study established that autonomy was successful if performed in the perspective of acceptance and permissiveness. Assistance by the practitioner in the attainment of skills to battle illness is an important factor in patient recovery. The aspect of advocacy has two facets according to a research conducted by (Smith & Glass, 2007). The first is the need for a development of a connection between the practitioner and the patient. The second facet is the requirement that medication and therapy be done in consultation with the patient. Advocacy entails the practitioner making use of other professionals and agencies in assisting the patient solve his illness problems. The nurse’s duty in advocacy also involves the obtaining of knowledge about the patient and then transmitting it to the doctors in a manner that would be most beneficial to the patient. Baldwin, (2003) asserts the need for continuity in the nursing therapeutic relationship by asserting that the absence of continuity in therapy would cause a negative impact on the therapeutic relationship. The lack of continuity in therapy results in patient frustration as the study showed that many of the clients did not like to repeat their histories and felt that the institution did not care enough about their welfare. The study established that continuity in medical therapy gave clients a feeling of security in knowing that somebody was aware of their illnesses in a personal capacity. According to a study done by (Arnold & Boggs, 2003), the aspect of time is important in the therapeutic relationship. It is important for the health practitioner to take time to get to know the patient. Patients were established to experience a better therapeutic relationship in instances where the nurse was more involved in their welfare. The element of time is also crucial in that it offers patients an opportunity to express their illnesses and circumstances. The study reported that the time of acting was important in that the nurse and he practitioner need to be in tandem when taking action concerning the affliction of the patient. The above studies were conducted on different populations with varied number of participants taking part in the study. All of the studies except for the last two were conducted on a random sample of patients that were drawn from different hospitals in the New York Area. All of the studies are of the middle range theory studied in interpersonal relations in nursing theory developed by Peplau. Addition to the Body of Knowledge The various studies analyzed in this analysis with regard to the various application of the interpersonal theory developed by Peplau offer vital new aspects of the nursing patient theory which may be used to develop the theory further. A research study conducted in order to ascertain the effectiveness of therapy interventions in nursing would be particularly helpful. My hypothesis established the concept of trust as being crucial in the therapeutic sessions. Peplau identified the stages of identification and exploitation in her model of interpersonal relationship. In the identification, process it is of utmost significance that there is developed a certain amount of trust between the nurse and the patient. Identification involves the process in which the patient and the nurse meet for the first time, which call for a need to create rapport between the nurse and the patient. The issue of the development of trust may be used to make identification be more practical in the therapy for rape victims. The issue of trust is of utmost importance in making the exploitation process even more successful. The exploitation phase acquires a deeper meaning when looked at from the perspective of obtaining the trust of the patient. The study conducted has shown that trust leads to a better therapy since it enables the patient to be more open with the nurse, which enables him to exploit the information obtained in order to help the client professionally. While Peplau’s theory focused on being professional, the study conducted on rape patients showed that by developing trust between the practitioner and the patient. The study also investigated aspects of orientation that may be useful in developing the interpersonal relationship theory. Peplau put forward the resolution phase in which she asserted that there was a development of continuity in the relationship between the nurse and the patient. Of crucial importance in the resolution phase is the making of the patient responsible for his health after therapy and during therapy. The study conducted established empowerment as a critical element in the resolution phase of the nurse patient relationship. While many practitioners consider their work to be done after the patient leaves the medical institution, the study has established that empowerment of the patient through the identification of the responsibility level is also important in making the therapy session effective. Empowerment is a notion that may be very useful in enhancing the interpersonal relations theory in that, while the notion of orientation and resolution of the therapeutic relationship is given by Peplau in theoretical terms, empowerment as shown by the study would make the theory to be more practical. The study proving the effectiveness of empowerment is important in the development of the entire process of the interpersonal relations theory in that empowerment in itself improves the nurse patient relationship. Empowerment would make the interpersonal theory even better in that it improves the aspects of orientation, identification and resolution, which were identified by Peplau, by improving communication. References Arnold, E., Boggs, K. (2003) Interpersonal Relationships: Professional Communication Skills for Nurses, 14 (6) 43-50. Baldwin, M. (2003). “Patient Advocacy: A Concept Analysis.” Nursing Standard, 17(21) 33-39. Barker, P. & Reynolds, B. (2005). Rediscovering the proper focus of nursing: a critique of Gournay's position on nursing theory and models.” J Psychiatr Ment Health Nurs; 3:76–80. Gastmans, C. (2008) “Interpersonal Relations in Nursing: A Philosophical-Ethical Analysis of the Work of Hildegard E. Peplau.” Journal of Advanced Nursing, 28(6) 1312-1319. McNaughton, B. (2005). "A Naturalistic Test of Peplau's Theory in Home Visiting." Public Health Nursing, 22: 429–438. Orlando, J. (2001). The dynamic nurse-patient relationship: Function, process, and principles. New York: Putnam. Peplau, H. (1989). Interpersonal Relations in Nursing. New York: G.P. Putnam's Sons. Smith, M. & Glass, V. (2007) “Meta-analysis of psychotherapy outcome studies.” Am Psychol; 32:752–60. Travelbee J. (2009). Intervention in psychiatric nursing: process in the one-to-one relationship. Philadelphia: Davis. Yamashita, M., Cheryl F., & Bronwyn, M. (2005). "Nurse Case Management: Negotiating Care Together Within a Developing Relationship." Perspectives in Psychiatric Care 41 (2): 62–7. Read More