Philosophy, theory, concept, models, conceptual framework, proposition, domain, process, paradigm, and metaparadigm.

Abstract

Keywords

Philosophy, theory, concept, models, conceptual framework, proposition, domain, process, paradigm, and metaparadigm.

Introduction

Nursing theories are bodies of knowledge that define nursing, nurses’ roles, and nursing objectives. One can say that nursing theories provide a way that defines the nursing profession as unique compared to other disciplines such as medicine. It is a framework involving concepts and purposes intended to guide Nursing Practice (NP) at a more concrete level. As a profession, nursing recognizes its own unparalleled body of knowledge crucial to NP. For nurses to distinguish this foundation of knowledge, they must identify, develop, and understand concepts and theories in line with the profession.

There exist multiple theorists with theories that emphasized the need for nursing education. For instance, Nightingale, in her environmental theory, defined nursing as the act of utilizing patients’ environment with the objective of assisting them until their recovery. Peplau’s theory on interpersonal relations emphasizes a need for a client-nurse relationship as a nursing practice foundation. Faye Abdellah helped shift the focus of nursing from a disease-centered approach to patient-centered care. Neuman’s theory recognizes the existence of multiple needs, which can disrupt client balance and stability.therefore. She emphasized stress reduction as the goal of the system model of the nursing profession. Lastly, Watson came up with the philosophy of caring and highlighted nursing humanistic aspects as they intertwine with scientific knowledge and NP. This paper will utilize Peplau’s theory of interpersonal relations.

Selection of theory

Peplau’s middle-range theory on interpersonal relations in nursing was selected as a suitable nursing approach for this research as Peplau frequently acknowledged the significance of patients’ experiences of nursing care.

There exist four major concepts that are frequently interrelated and essential to nursing theories. These include person, environment, health, and nursing. These four concepts are collectively referred to as the metaparadigm of nursing. A person defines the recipient of nursing care and can involve individuals, families, societies, groups, and patients. Environment refers to internal or external surroundings, including all negative and favorable conditions that impact the patient. Health is the degree of a patient’s wellbeing. The term health may entail varying meanings for each patient, health setting, and care providers. Nursing can refer to attributes, characteristics, and actions of the professional providing health care on behalf of the patient.

These four concepts are defined differently throughout different nursing theories. Each theorist’s definition varies according to their orientation, experience, and aspects that affect their view on nursing. The person is the major focus, but how each theorist defines the nursing metaparadigm gives unique takes specific to a particular theory. Peplau defines a person as an organism that strives in its ways to mitigate tension generated by needs. According to Peplau, Health is a word symbol that implies a forward movement of personality and other ongoing processes in the direction of personal, constructive, creative, productive, and community living. This theorist also considered nursing to be a significant therapeutic interpersonal process. Lastly, although Peplau fails to address society, she encourages nurses to consider patients’ cultures and a need to help a patient adjust to the hospital routine.

For a theory to function, it has to contain a set of concepts, statements, assumptions, relational statements, and definitions explaining a phenomenon. It must also explain how the components are related. Phenomenon is a term used to describe ideas concerning events or a group of events that can be temporary or permanent. Therefore, nursing theories focus on the phenomena of nursing. Concepts are used to describe a phenomenon. They can be defined as words that define and establish structure and boundaries for ideas generated about a specific phenomenon. Definitions help convey the general meaning of the theory’s concepts, and they can be classified as theoretical and operational definitions. Relational statements refer to the association between two or more concepts. Furthermore, assumptions are accepted truths based on values and beliefs. Such statements explain the nature of concepts, definitions, purpose, associations, and structures of theories.

Peplau’s nursing process is utilized to assess needs and implement nursing interventions. She defines the Nursing Process as a deliberate intellectual activity that guides nurses in the provision of care in a systematic manner. During the orientation phase, nurses and clients come together as strangers with a meeting initiated by the client. Together, they recognize, clarify, and define facts associated with the patient’s needs. During the identification phase, patients participate in the setting of healthcare goals, have a feeling of belonging, and select those who can meet their health needs. During the exploitation phase, patients actively seek and gain the knowledge & expertise of nurses. Lastly, the resolution phase leads to the termination of the process. Based on this evaluation, nursing diagnoses are formulated, outcomes, and goals. Also, interventions are planned, carried out, and assessment done based on mutually established terms.

Strength of theory for nursing practice

As seen, Peplau’s theoretical approach provides a systematic view of nursing situations. The four discussed phases in the nurse-client relationship are clear while key concepts are clearly defined, consistent, and well understood, providing simplicity concerning the progression of the nurse-client relationship leading to adaptability in any nurse-patient interaction. Hence, providing generalizability.

The strength of this approach is its focus on the nurse-patient relationship, which acts as a foundation of nursing practice. This theory emphasizes on the give and take of nurse-patient relationships. Peplau emphasizes a need for nurse-patient partnership as opposed to the client passively receiving care and the nurse’s passively conducting a doctor’s orders. According to D’Antonio et al. (2015), an interpersonal relationship focuses on clients’ needs, problems, ideas, and feelings. Another study by Adams (2017) shows that the incorporation of effective care has brought about patient wellness, which has led to the consideration of Peplau’s theory in clinical events.

This theory can be applied to the concepts of human beings, health, environment, and nursing. Also, the theory provides a logical, systematic manner of viewing nursing situations. For instance, key concepts such as anxiety goals and tension are indicated with explicit associations and progressive phases. In addition, Peplau’s theory has helped later theorists and clinicians to develop more effective interventions regarding the roles that reveal dynamic character typical in nursing. For instance, it has led to the development of roles such as counselors, technical experts, leaders, mediators, safety agents, and health teachers.

Theory contribution to the development of nursing knowledge

Peplau’s work began the development, basis, and revolution of nursing knowledge for general nursing and for psychiatric mental health nursing (Adams, 2017). The theorists’ underlying philosophical assumptions and theory not only emphasize the science of nursing that was dominant at the time, but she explained how nursing as an art contributes to nursing knowledge, practice, and research that is evident in modern times. As a nursing pioneer, Peplau has helped bridge the gap between theory and practice that continues to build on nursing’s knowledge base today.

As discussed, the orientation phase is initiated by a patient’s perceived problem who then seeks clinical help with it. The nurse-patient relationship then occurs in the working phase whereby the patient begins to understand the reaction to their ill-health. During the working phase, the patient can concentrate on their response to the disease and develops an understanding of what their existing condition requires of them. Focusing on the nurse-patient relation directs the nurse from a disease-focused approach towards a more inclusive view regarding the experiences of the illness of a client, family, and the health system in which patients can express themselves. After the narration, a nurse must explore their feelings and beliefs to ensure that they form trustful relations. This is because there can arise conflicts in regards to a patient culture that may not go hand in hand with modern views on medicine. Whereby patients may feel that their beliefs are not respected, and in turn, fail to consider care. A nurse can then listen to the patient with empathy facilitating trust in their relationship. From such a dialogue, both the nurse and patient can then agree and define the patient’s problem.

An example of theory contribution to nursing knowledge development involves a case study of an adolescent patient with a history of delinquency (Arabaci et al., 2019). During his care period, the attending nurse applied Peplau’s theory of interpersonal relations, which helped develop knowledge regarding the management of the condition. The clinical decision involved undergoing specialist and therapy training while also undergoing routine care by other service nurses. The patient went through an orientation phase where the necessary information was obtained. The next phase involved identification, where a trust-based relationship was established while the patient’s existing issue was defined. During the exploitation phase, the nursing interventions for the identified issue were applied and evaluated. During the resolution phase, the patient was motivated to participate in his care, which improved his clinical outcome. Through such a study, today’s nurses can then utilize Peplau’s theory to make critical health decisions to enhance care.

In addition, the incorporation of Peplau’s theory on interpersonal relations has helped to gain knowledge in the management of substance-induced psychosis. This condition is a form of psychosis that develops from the use of alcohol and other drugs. Although the issue can be managed with continued use of medication, Peplau’s theory can also be used as a framework to assist nurses in understanding and managing patients with such a condition. In this case, the process involved a therapeutic process that involved both the nurse and the client (Ogoncho et al., 2017). Through the process of orientation, working, and resolution, the nurse, was able to realize the issue affecting the patient and come up with a clinical decision that ultimately led to positive outcomes.

How theory is utilized for wellness

Problems regarding labor dissatisfaction among nurses characterize healthcare settings. Part of the problem arises from a labor organization in a facility’s units in regards to how issues are managed. Dissatisfaction is also due to relationship problems and the lack of adequate communication, which involves active listening, empathy, and authenticity. Such skills help express issues effectively, improving the working relationship between patients and nurses, in conjunction with good interpersonal relationships between nurses and co-workers.

Patient experiences in hospitals are crucial indicators of the quality of healthcare services. Patient experiences are measured by surveys such as Consumer Assessment of Healthcare Providers and Systems–Hospital (HCAHPS). Such a survey was developed to facilitate public reporting of data regarding patient experiences to compare hospital scores that will lead to informed choices. Also, such surveys are done so that hospitals can measure their strengths and weaknesses in regard to patient experiences. Out of 32 items, four of the HCAHPS reflect nurses’ work and highlight patients’ answers on nurses’ contributions to patient care. It is hypothesized that a latent structure reflecting a middle-range theory, such as Peplau’s theory on interpersonal relations, would provide a comparably fit for the data, given the vast role that nurses play in patients’ experiences. As seen, Peplau emphasized patient hospital experiences and the impact that nurse-client relationships have on the experiences. An HCAHPS survey done from 2,429 hospitals reflected that patients who rated their experiences as most positive were more likely to have had a higher number of nurses per client days (Hagerty et al., 2017). In addition, the HCAHPS items reflecting the communication with nurses’ aspects were also found to correspond positively with patients’ perceptions about their experiences in hospitals. Such an empirical study is crucial to healthcare decision-making. As a result, health workers can incorporate interpersonal relations in their care to help improve patient outcomes. Systematic searches conducted of PubMed and Psy-cINFO were used to construct search strategies using terms sucPsycINFOent relations and nurse-patient relations (Kornhaber et al., 2016). The data revealed that patient centered care was a fundamental aspect of clinical care. An interview comprising 11 nurses working with suicidal patients was also conducted. The nurses reported that therapeutic engagement facilitated a reduction in feelings of isolation, loss of control, and distress. It was through acts of compassion, genuineness, and trust that led to patients’ wellness.

Clinical scenario

Critical analysis

Peplau’s theory demonstrates clear sets of nurses’ roles that can be utilized by nurses. The theory implies that a nurse’s duty is not just to care but also encompasses activities that may impact patient care. The concepts can highly apply to the care of psychiatric patients considering Peplau’s background. Nevertheless, it is not limited to just psychiatric patients as it can be applied to capable people and has the will to communicate. The interpersonal relations theory phases are highly comparable to the nursing process, which makes it highly applicable. Evaluation coincides with the orientation phase while nursing diagnosis & planning coincides with the identification phase. In addition, implementation coincides with the exploitation phase, and lastly, evaluation coincides with the resolution phase.

Summary

Hildegard E. Peplau based her approach on interpersonal relations primarily on the work of Harry Stack Sullivan. Her approach was the first conceptualization of nursing to emphasize interpersonal relations between the nurse and the client & to focus on assessing the interpersonal processes central to the interaction (Barker, 2017). The theorist observed that the fundamental elements in nursing events involved the nurse, the patient, and their interaction. This interactional or interpersonal point of view was in sharp contrast to the prevailing idea that a pathological issue resided within the client. The nurse’s role was to help the physician treat that condition without consideration of the interpersonal aspects. Therefore, Peplau directed nursing’s attention to the need to develop a theory concerning what the nurse and patient did together. Her theory also provided the knowledge to transform the nursing profession into autonomous practice when nursing was dominated by medicine. In turn, the theory has contributed to the development of nursing knowledge in today’s healthcare scene. For instance, nurses can now manage conditions such as substance-induced psychosis and delinquency, among other health issues.

Conclusion

In conclusion, nursing theories define nursing, what nurses do, and why they do it. Nursing is a profession committed to recognizing its own body of knowledge crucial to NP. Hence, to distinguish this foundation of knowledge, nurses need to identify, develop, and understand concepts and theories in line with nursing practice. The first nursing theories were discovered in the earlier ages when a strong emphasis was placed on nursing education. Theorists such as Nightingale, Abdellah, Neuman, Watson, and Peplau were among the foundational theorists who helped develop theories that prioritized the meta paradigms earlier discussed in this discussion, which has led to improved patient care. This discussion focused on Peplau’s theory on interpersonal relations as it was found to focus on the nurse-patient relationship, which, according to numerous studies, leads to positive patient outcomes. Also, Peplau’s theory on interpersonal relations has proved to be of significant use to clinicians and other theorists as it has helped develop more sophisticated and therapeutic nursing interventions showing the dynamic character roles typical in healthcare. In addition, The four discussed phases in the nurse-client relationship are clear. At the same time, key concepts are clearly defined, consistent, and well understood, providing simplicity concerning the nurse-client relationship’s progression leading to adaptability in any nurse-patient interaction. Hence, providing generalizability. Studying Peplau’s theory can be of high significance, especially for students aspiring to join the profession. It can help them learn skills that will ultimately speed along with the treatment and recovery of patients with various health conditions.

References

Adams, L. Y. (2017). Peplau’s contributions to psychiatric and nursing knowledge. Journal of Mental Health and Addiction Nursing, 1(1), e10-e18.

Arabacı, L. B., & Taş, G. (2019). Effect of Using Peplau’s Interpersonal Relations Nursing Model in the care of a juvenile delinquent. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 10(3).

Barker, P. (2017). Psychiatric and mental health nursing: The craft of caring. CRC Press.

D’Antonio, P., Beeber, L., Sills, G., & Naegle, M. (2014). The future in the past: H ildegard P Peplau and interpersonal relations in nursing. Nursing Inquiry, 21(4), 311-317.

Hagerty, T. A., Samuels, W., Norcini-Pala, A., & Gigliotti, E. (2017). Peplau’s Theory of Interpersonal Relations: An Alternate Factor Structure for Patient Experience Data?. Nursing science quarterly, 30(2), 160-167.

Kornhaber, R., Walsh, K., Duff, J., & Walker, K. (2016). Enhancing adult therapeutic interpersonal relationships in the acute health care setting: An integrative review. Journal of multidisciplinary healthcare, 9, 537.

Ogoncho, I. M., Sanga, P., & Halake, D. G. (2017). Case Management of Substance-Induced Psychosis Using Peplau’s Theory of Interpersonal Relations.