APPLICATION OF INTERPERSONAL THEORY
IN NURSING PRACTICE
This page was
last updated on
16-03-09
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Outline
Peplau’s theory focuses on the
interpersonal processes and therapeutic
relationship that develops between the nurse and
client. The interpersonal focus of Peplau’s theory
requires that the nurse attend to the
interpersonal processes that occur between the
nurse and client. Interpersonal process is
maturing force for personality. Interpersonal
processes include the nurse- client relationship,
communication, pattern integration and the roles
of the nurse. Psychodynamic nursing is being able
to understand one’s own behavior to help others
identify felt difficulties and to apply principles
of human relations to the problems that arise at
all levels of experience. This theory stressed the
importance of nurses’ ability to understand own
behavior to help others identify perceived
difficulties.
The four phases of nurse-patient relationships
are:
1.
Orientation:
During this phase, the
individual has a felt need and seeks
professional assistance. The nurse helps the
individual to recognize and understand his/ her
problem and determine the need for help.
2.
Identification
The patient identifies
with those who can help him/ her. The nurse
permits exploration of feelings to aid the patient
in undergoing illness as an experience that
reorients feelings and strengthens positive forces
in the personality and provides needed
satisfaction.
3.
Exploitation
During this phase, the patient attempts to derive
full value from what he/ she are offered through
the relationship. The nurse can project new goals
to be achieved through personal effort and power
shifts from the nurse to the patient as the
patient delays gratification to achieve the newly
formed goals.
4.
Resolution
The patient gradually puts aside
old goals and adopts new goals. This is a process
in which the patient frees himself from
identification with the nurse.
Overlapping phases in nurse- patient relationship
Peplau’s theory and nursing process:
Peplau defines Nursing Process as a
deliberate intellectual activity that guides the
professional practice of nursing in providing care
in an orderly, systematic manner.
Peplau explains
4 phases such as:
-
Orientation: Nurse and
patient come together as strangers; meeting
initiated by patient who expresses a “felt need”;
work together to recognize, clarify and define
facts related to need.
-
Identification:
Patient participates in goal setting; has feeling
of belonging and selectively responds to those who
can meet his or her needs.
-
Exploitation:
Patient actively seeks and draws knowledge and
expertise of those who can help.
-
Resolution:
Occurs after
other phases are completed successfully. This
leads to termination of the relationship.
In Nursing
Process, the orientation phase parallels with
assessment phase where both the patient and nurse
are strangers; meeting initiated by patient who
expresses a felt need. Conjointly, the nurse and
patient work together, clarifies and gathers
important information. Based on this assessment
the nursing diagnoses are formulated, outcome and
goal set. The interventions are planned, carried
out and evaluation done based on mutually
established expected behaviours.
Peplau’s theory application nursing process:
The nursing
process for Mrs. JL based on Peplau’s theory is as
follows:
Mrs. JL
27 years
Diagnosis: Inter vertebral disc
prolapse
|
Assessment
(Orientation phase) |
Nursing
diagnosis |
Planning
(Identification phase) |
Implementation
(Exploitation phase) |
Evaluation
(Resolution phase) |
|
Mrs. JL is on pelvic traction and she is
restricted to bed.
The need for bed rest and restriction was
discussed. |
Impaired physical mobility related to the
presence of pelvic traction.
|
Goal setting was done along with patient
Patient will have improved physical mobility
as evidenced by participating in self care
within the limits.
Provide active and passive exercises to
all the extremities to improve the muscle tone
and strength.
Make the patient to perform the
breathing exercises which will strengthen the
respiratory muscle.
Massage the upper and lower extremities which
help to improve the circulation.
Provide articles near to the patient and
encourage doing activities within limits.
Provide positive reinforcement for even a
small improvement to increase the frequency of
the desired activity.
|
Carried out plans mutually agreed upon.
Provided active and passive exercises
to all the extremities
Made the patient to perform breathing
exercises
Massaged the upper and lower extremities
Provided article within the reach of the
patient
Provided positive reinforcement to the patient |
Mrs. JL was free to express problems regarding
difficulty in mobilizing.
She expressed satisfaction when able to move
without difficulty. |
|
Assessment
(Orientation phase) |
Nursing
diagnosis |
Planning
(Identification phase) |
Implementation
(Exploitation phase) |
Evaluation
(Resolution phase) |
|
Mrs. JL expresses pain in the low back region.
|
Pain related to the degenerative changes in
the lumbar region. |
Goal setting was done along with patient
Mrs. JL will have reduction in pain as
evidenced by her verbalisation of reduction in
pain responses.
Provide
non-pharmacological measures for pain relief
such as diversional activity which diverts the
patients mind.
Give the client a neutral position
Always use back support while turning the
patient that reduces the strain on the back.
Support the areas with extra pillow to allow
the normal alignment and to prevent strain.
Administer analgesics as prescribed by the
physician.
Provide pelvic traction to the patient |
Provided non
pharmacological measures like diversion,
massaging, and pelvic traction.
Provided supine
position to the client
Supported the
back during position change
Used pillows to
support the back.
Administered
Tab. Hifenac P and Cap.
Myoril 4mg as prescribed.
Given pelvic traction and explained the need
for traction
|
Expressed that she got slight relief from
pain. |
|
Assessment
(Orientation phase) |
Nursing
diagnosis |
Planning (Identification phase) |
Implementation
(Exploitation phase) |
Evaluation
(Resolution phase) |
|
Mrs. JL
expresses that she need assistance to get down
from bed.
Regarding self
care discussion was done and discussed
regarding the measures to solve the problems. |
Self care deficit related to
the presence of pelvic traction. |
Goal setting was
done along with patient
Client will
achieve and maintain self care activities with
assistance of caregiver or within her limits.
Keep all the
articles within the reach of the patient.
Provide a call
bell to the patient to call in any emergency
Frequently visit
the patient and enquire for any needs.
Assist the
patient in doing her self care activities.
Remove the
weight of the traction as needed by the
patient.
|
Kept the
articles within t he reach of the client
Frequently
visited the patient and enquired for any needs
Assisted the
client in doing her self care activities
Removed the
weight as and when needed. |
She used to call
for the needs and all her needs were met
appropriately
She achieved and
maintained self care activities within her
limits |
|
Assessment
(Orientation phase) |
Nursing
diagnosis |
Planning (Identification phase) |
Implementation
(Exploitation phase) |
Evaluation
(Resolution phase) |
|
Mrs. JL is
enquiring about the disease condition, its
outcome and need for surgery
Discussed with
the client regarding the disease process and
the findings in the client |
Anxiety related
to hospital admission as evidenced by
verbalisation and client & family appearing
withdrawn |
Goal setting was
done along with patient
Client will have
reduced feeling of anxiety as evidenced by
asking fewer
questions
Teach the family
and client regarding the disease process.
Explain in
simple understandable language of the client.
Allow and
encourage the client and family to ask
questions. Allow the client and family to
verbalize anxiety.
Stress that
frequent assessment are routine and do not
necessarily imply a deteriorating condition.
Allow the family
members to visit the client frequently
|
Taught the
family regarding the disease process in simple
Kannada
Allowed the
client and family members to ask questions
She and her
husband expressed their anxiety
Allowed the
family members to frequently visit the client |
She asked her
doubts regarding the illness and the
diagnostic procedures
She verbalized
that her anxiety has reduced to some extent. |
|
Assessment
(Orientation phase) |
Nursing
diagnosis |
Planning
(Identification phase) |
Implementation
(Exploitation phase) |
Evaluation
(Resolution phase) |
|
Mrs. JL is enquiring about the disease
condition, its outcome and need for surgery
Discussed with the client regarding the
disease process and the need for follow up |
Deficient knowledge related to the treatment
measures to be continued even after the
discharge. |
Goal setting was done along with patient
Patient will acquire adequate knowledge
regarding the treatment and home care.
Explain the treatment measures to the patient
and their benefits
|
Explained
treatment measures and the need for follow up
Explained
regarding the signs of aggravation of disease
Used simple and
understandable terms for explaining
Clarified her
doubts
Repeated the
information
|
She expressed
acquisition of knowledge regarding the disease
and the signs of aggravation of illness |
Summary:
1.
Orientation phase
-
Client is initially
reluctant to talk due to pain.
-
Client is expressing
that while standing she is having much pain.
-
Client expressed
without movement and supine position gave her
relief from pain.
2.
Identification
-
-
Expresses the need for measure to
get relief from pain
-
Expresses need for improving the
mobility
-
Expresses need to know more about
prognosis, discharge and home care and follow up.
3.
Exploitation
4.
Resolution
Evaluation of the theory of interpersonal
relations by Peplau
With the help of the theory of
interpersonal relations, the client's needs could
be assessed. It helped her to achieve them within
her limits. This theory application helped in
providing comprehensive care to the client.
References:
1.
Chinn P L, and Kramer M K.
Theory and nursing- a systemic approach. 3rd
edition. Philadelphia: Mosby year book;1991
2.
George J B. Nursing theories. 5th
edition. New Jersey: Prentice hall; 2002
3.
Alligood M R, Tomey A M. Nursing
theory- utilization and application. 3rd
edition. Missouri: Mosby Elsevier; 2006
4.
Craven R F, Hirnle C J.
Fundamentals of nursing – human health and
function. 5th edition. Philadelphia:
Lippincott Williams and Wilkins; 2007
5.
McQuiston C M and Webb A A.
Foundations of nursing theory- Contributions of 12
key theorists. New Delhi: Sage Publications; 1995
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