Theories in nursing provide an avenue where the perspectives of nurse are described and explored in clinical phenomena. The perspectives include the definition ’what’ of nursing, ’who’ of nursing and when nursing services are needed. The goals and boundaries of a nurse are identified in a theory. Theories are composed of concepts, propositions, frameworks and assumptions which they are based on. Since this paper looks at the accepted theory and how it affects nursing care of patients, Peplau’s theory of interpersonal communication will be discussed. Hildegard Peplau theory is based on the psychodynamic nursing. The relationship between the nurse and the patient is described in this theory. Many clinical phenomena involve the interaction between the nurse and the client. This theory gives the stages in which a patient and the nurse interact with each other.
A theory is a set of concepts and propositions that give an organized way of viewing a given phenomenon . In nursing, theories are developed to describe the process, occurrence or event which is referred to as nursing as phenomena. The main purpose of nursing theory is to bring out a desired practice from the nursing care by predicting, explaining or describing these outcomes. A concept or model is a framework that brings all concepts together and links them in a unified structure. Concepts are labels which are constructed in a social perspective which may represent one or more phenomena. A proposition is a structural element of a theory. It is a statement that suggests a relationship between concepts. Theories in scientific fields are used as a guide in research where existing knowledge is enhanced, or new knowledge is developed. Therefore, theories are particularly beneficial in nursing since they help us in how to organize ideas and thoughts. Theories also provide a direction or a procedure on how to use given knowledge. For one to believe in theory, they must believe in the assumptions of the theory as true.
This paper will look at Hildegard Peplau theory. It is an interpersonal relations model which is based on the psychodynamic nursing. According to Peplaus (1952), there are two assumptions;
Nurses make a substantial difference their clients during the treatment process. This impact is realized by the client during the illness period.
Fostering personality development in the direction of maturity is the function of nursing and nursing education; it requires the use of principles and methods that permit and guide the process of grappling with everyday interpersonal problems or difficulties? .
Concepts of the theory
The theory focuses on the relationship that develops between the nurse and the client based on the interpersonal and therapeutic relationships. The theory is based on the principles of human relations. The concepts defined in this theory include:
1. Person-is an individual, an organism which tried to reduce anxiety resulted by needs. The person lives in unstable equilibrium.
2. Nursing -is an educative element, therapeutic, an important force that ensures health is possible.
3. Health - This is a "forward movement of personality and other on-going human processes in the direction of creative and constructive personal and community living"(Peplau, 1952a).
The Peplaus’s theory focuses on interpersonal relationship, where nurses are required to attend to the interpersonal relational process, emanate between the nurse and the client. It focuses on the nurse’s Self-reflection although the theory does not focus on individuals but the interpersonal process and relationships. The interpersonal processes in focus include; nurse-client relationship, communication, pattern integration and the roles of the nurse.
The nurse client relationship according to the theory is at a crux for nursing which is described as therapeutic nurse-client relationship. This relationship grows in overlapping phases that can be identified. The phases include Orientation, working, and resolution. Orientation as the first phase varies between few minutes to months. The client and the nurse know each other as persons where the client starts to trust the nurse. The second phase is the working phase, the client shares out areas that need to be worked on. The nurse helps the client to explore various options available in solving given issues. The second phase has subphases which include identification where the client begins to identify the problems to be worked in the work relationship stage. The problems facing clients can be as wide as the scope of nursing practices. Exploitation is another sub-phase in the second phase. The client in this phase, utilizes the available services of the nurse. The last phase is the resolution phase which occurs between the time when the problem is solved and the termination of the relationship between the nurse and the client .
Verbal and non-verbal communications are the two types of communication commonly used. Verbal communication is where language while non-verbal is expressed through gestures, postures and patterns. Clients use verbal communication to express what they feel or their pain status. Nurse-client relationship with the theory takes verbal communication as a vital component. Nonverbal communication is equally valuable since they convey a clearer message compared to language.
Peplau identifies four patterns of integrations which include; complementary, mutual, antagonistic and mixed. Complementary patterns are those that are different,, but fit together. Mutual integration occurs when two individuals display similar patterns. Antagonistic pattern are those patterns combined which are different and they do not fit well together. This pattern motivates the individuals to strive and change. These patterns are extremely valuable in the theory since the interpersonal communication and the resultant nurse-client relationship depends on this pattern.
Role of the nurse
The roles of a nurse vary depending on the needs of the client and the creativity of the nurse. The role is also influenced by where the nurse is working and the position of that nurse. A community based nurse may have more roles that a nurse in a hospital who works in shifts. Peplau’s (1952a) book indicates the role of a nurse as: stranger, resource person, researcher, technical expert, teacher, leader, counselor and change-agent. In her later books, she insists that nurses should play a role of being a counselor as the primary role. The nurse - client relationship should be developed based on the role of a nurse as a counselor.
Major concepts of a theory provide a guide to the nursing process.
Peplau’s theory state that there are three phases in interpersonal process including; Orientation, working, and resolution. Both nursing and Peplau’s theory are sequences where the client and nurse meet as strangers. The process of assessment in nursing is parallel to the orientation in the theory. Verbal and nonverbal communications are used in both cases.
Nursing process Palau’s theory
Nursing diagnosis Identification
The main focus of Peplau’s theory is about interpersonal process. It is indispensable to consider an interpersonal process for the client and the nurse. Intrapersonal process is the process that occurs within an individual. Anxiety, learning, thinking, and competence are some of the elements of intrapersonal process that are in the interpersonal process of Peplau’s theory. Anxiety is energy which is generated as a response to a perceived threat. The threat can either be physical or mental. According to Peplau, anxiety is developed in stages starting from the point where developing of expectations, then the expectations are not met the person feels discomfort relief behavior is then used, and the final stage is where relief behavior is justified.
According to Peplau, nurses are advised to be aware of the patterns with clinical phenomena. Patterns of development and resolution of specific clinical issues should be observed in order to apply this knowledge in other clinical situations. Although each situation is different and the clients are unique, experience of one situation can be used in other cases since the larger patterns are the same. Peplau explores loneliness and hallucinations clinical concepts. Concepts are defined and operationalized by identification of critical attributes. This includes observable characteristics of clients.
Theories may address similar situations in a given discipline but the extent to which each of them explores the situation varies. This is referred to as the scope of a theory. The Scope is the boundaries of the theory, it specify what the theory will cover.
There are three categories that relate to the scope of theories which include; grand theories, middle-range theories and Micros-range theories. Peplau’s theory is in middle-range descriptive classification theory. This category has theories that are meant to explore more specific and more restricted phenomena compared to grand theories. Middle-raged theories are aimed at providing explanations to situations in nursing field. However, this group of theories do not explore a wider perspective of the clinical situations in nursing or any other applicable discipline. The interpersonal relations are an example of this theory where the theory explores a multifaceted environment and give guidelines for mitigation of the situation.
Theories from nursing and other behavioral science are used by professional nurses in collecting organizing, and classifying patient data that helps in analyzing, interpreting, and understanding patient health situations. Concepts from theories guide every nursing phase in nurse processing they include; planning, implementing and evaluating nursing care. The rationale of selecting this theory is to see if the nursing practices in care are reflected as explored in the theory. The real nursing cases or situations can be handled by the theory which provides concepts in tackling the cases.
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