Nursing Concepts

Peplau’s Intrapersonal relationship plays an important role as being a nurse. Her theory sets the foundation on how to approach the patient when first encountering him or her. She specifically identified four phases in interpersonal relationships: (1) orientation, (2) identification, (3) exploitation, and (4) resolution. Each of these phases’ overlaps, interrelates, and varies in duration as the process evolves toward a solution. (George, 2011) Peplau later wrote that the nurse-patient relationship consists of three phases, orientation phase, working phase and termination phase. Here she combined her earlier phases together depending on various nursing roles. Peplau broadly described it as follows: (1) Teacher: one who imparts knowledge concerning a need or interest, (2) Resource: one who provides specific, needed information that aids in understanding a problem or a new situation, (3) Counselor: One who, through the use of certain skills and attitudes, aids another in recognizing, facing and accepting, and resolving problems that are interfering with the other person’s ability to live happily and effectively, (4) Leader: one who carries out the process of initiation and maintenance of group goals through interaction, (5) Technical expert: one who provides care by displaying clinical skills and operating equipment in this care (6) Surrogate: one who takes the place of another. (George, 2011)

Idea Jean Orlando was another theorist who felt that after observing nurse and patient interaction, felt she could only label a “good” or “bad” nurse. It then occurred to her that the role of the nurse is to meet the patient’s immediate need for help. (Orlando, 1961) Orlando realizing this, in 1961 developed, The dynamic nurse-patient relationship: Function, process and principles. Orlando’s paradigm believed that key concepts such as: Patient Behavior, Nurse Reaction, Nurse Action are dependent on a positive patient outcome. Patient behavior is the beginning of the nurse-patient relationship. Orlando states that this time is important in evaluating the patient behavior to achieve positive feedback from the patient. The steps include the nurse accessing the patients’ behavior, including verbal and non-verbal communication. If not accessed properly by the nurse than a major problem in providing care would lead to a nurse-patient relationship failure. The patients’ behavior stimulates a nurse reaction where Orlando believes is the beginning of the nurse-patient relationship. Evaluating a patients behavior correctly is important and are as followed: (1) use of senses to perceive behavior, (2) perception leads to automatic thought, (3) thought produces an automatic feeling, (4) the nurse shares reactions with the patient to ascertain whether perceptions are accurate or inaccurate, (5) the nurse consciously deliberates about personal reactions and patient input in order to produce professional deliberative actions based on mindful assessment rather than automatic reactions. (Orlando, 1972) The nurse must provide care either automatic or deliberative. Orlando defines automatic reactions as a stem from nursing behaviors that are performed to satisfy a directive other than the patient’s need for help. Deliberative reaction is defined as a disciplined professional response. (Orlando’s Nursing Process Theory, 2012)

Peplau and Orlando both have theories that are nurse-patient relationship focused. Having a good relationship with your patient allows for clearer communication and understanding of your patients’ needs. Orlando defined nursing as a distinct profession “Providing direct assistance to individuals in whatever setting they are found for the purpose of avoiding, relieving, diminishing or curing the individual’s sense of helplessness” (Orlando, 1972, p.22) Using Orlando’s theory in the ICU setting for a post operative coronary artery bypass graft a nurse would realize the patients excruciating pain from the sternotomy and administer pain medications as needed for severe pain. Observing the patient’s behavior of being in pain and then re-evaluating the patients response to pain medication would inform the nurse if the patient’s needs are met or are not met. If not met the patient can potentially be in distress. This action by the nurse would be defined as a deliberate actions The nurse calming the patient down with deep breathing exercises and splinting the incisional wound with a pillow would be an automatic response according to Orlando. Peplau’s theory would have the nurse gather data and analysis the patients need not necessary be a felt need here. The nurse using Peplau’s theory may assess the patients level of pain and administer medication and provide splinting as a goal to have the
patient out of pain on the basis of mutually expected behaviors. If the patients goal is achieved a new plan may be initiated or if the goal is not achieved the nurse might terminate previous plan. In Peplau’s theory, the nurse-patient relationship is quickly terminated once the patient’s goal is met where as it seems in Orlando’s theory, there is a constant on re-evaluation of the patients needs.

Peplau’s interpersonal relationship theory and Orlando’s nurse-patient relationship theory both are sequential and focus on therapeutic communication and relationship. Both theories involve problem solving techniques for the nurse and patient to work on, which provide an end product of meeting the patient’s needs. Finally, both theories use observation communication and nurses’ notes as basic tools to be utilized by the nurse. (Application of Interpersonal Theory in Nursing Practice, 2012).

Ida Orlando and Peplau were both ahead of their time in developing nursing theories. They both knew that the patient was the focus and priority for the nurse to obtain their full health. They both took Florence Nightingales vision of patient orientated goals to achieve the best outcome. In developing these theories, neither Orlando nor Peplau knew how influential they would be in nursing care years later.

George, J.B. (2011). Chapter 4: Interpersonal relations in nursing: Hildegard E. Peplau, Nursing Theories. The Base for Professional Nursing Practice, Sixth Edition. Pearson Education. Nursing Theories a companion to nursing theories and models Application of Interpersonal Theory in Nursing Practice (2012). Retrieved from Nursing Theories a companion to nursing theories and models Orlando’s Nursing Process Theory (2012). Retrieved from Orlando, I. J. (1972). The discipline and teaching of nursing process: An evaluative study. New York: G. P. Putnam.

Vandemark L.M. Awareness of self & expanding consciousness: using Nursing theories to prepare nurse –therapists Ment Health Nurse. 2006 Jul; 27(6) : 605-15

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