Interpersonal Relations

1. Interpersonal Relations Middle Range Nursing Theory

2. Interpersonal Relations • Background • Created by Hildegard Peplau in early 20th century • Interpersonal Relations Theory • Basic Elements • Definitions • Guiding Assumptions • Evaluation of Theory

3. Hildegard Peplau • Born in 1909 • In Reading, PA to German immigrant parents • Raised by paternalistic parents in a paternalistic society • First nursing theorist since Florence Nightingale • Her time was one where nursing was more art than science

4. Hildegard Peplau • Primary clinical background was psychology • Wanted to bring humane treatment, dignity & respect, and healing & discussion to her patients. • Witnessing injustices in her life pushed Peplau on a quest for social justice • She created the nursing theory of Interpersonal Relations (also known as psychodynamic nursing) to focus on the nurse-patient relationship

5. The Birth of a Theory • Director Of Advanced Program in Psychiatric Nursing at Teacher’s College • Created nursing curriculum • Studied nurse-patient interactions through “process recordings” • Analyzed interactions of students with patients • Interpersonal Relations in Nursing, 1948 • Publishing took additional 4 years; at the time it was groundbreaking for nurse to contribute a scholarly work without a coauthoring physician.

6. Goals of Theory • Peplau’s original intent was to • “convey to the nursing profession ideas she thought were important to improve practice.” • Focus on quality of nurse-patient interactions and nursing education • Ultimately, she wound up revolutionizing the scholarly work of nurses and contributing to mental health laws and reform

7. Interpersonal Relations TheoryBasic Elements • Patient • Nurse • Interaction between the two

8. Interpersonal Relations TheoryDefinitions • Client/Patient • Person, couple, group, community, etc. deserving of humane care with dignity, privacy and ethics • Environment • Physiological, psychological, and social fluidity that may be illness-maintaining or health-promoting • Health • Forward movement of personality and other ongoing human processes in the direction of creative, constructive, personal, and community living

9. Definitions Continued • Interpersonal • Phenomena that occurs between persons • Nurse • The medium of the art of nursing: a maturing force. “The unique blend of ideals, values, integrity, and commitment to the well-being other others…” • Nursing Roles • Assiting a patient starting as stranger, then technical expert, resource person, surrogate, counselor, teacher and others.

10. Guiding Assumptions of Theory • Two Original • (1)Kind of nurse one becomes makes a substantial difference in what each patient will learn • (2)Fostering personality development in the direction of maturity is a function of nursing and nursing education • Requires use of principles and methods that permit and guide the process of grappling with every day interpersonal problems or difficulties. • Two added later by Peplau • (3)Nursing can uniquely focus on the reactions of clients to the circumstances of their health problems • (4)Since illness provides opportunity for learning and growth, nursing can assist patients in gaining intellectual and interpersonal competencies • Such competencies evolve through nurse-patient interactions

11. Guiding Assumptions of TheoryInferred From Peplau’s Writing • (5)Psychodynamic nursing crosses all specialty areas • Not just psych nursing • (6)Difficulty in interpersonal relations reoccurs in varying intensities throughout everyone’s life • (7) The need to harness energy derived from tension and anxiety to positive means for addressing the problem at hand is universal • (8)All human behavior is purposeful and goal-seeking in terms of feelings of satisfaction and/or security • (9)The interaction of nurse and patient is fruitful when a method of communication that identified and uses common meanings is at work in the situation

12. Guiding Assumptions of TheoryInferred From Peplau’s Writing • (10)The meaning of behavior to the client is the only relevant basis on which nurses can determine needs to be met • (11)Each person will behave, during any crisis, in a way that has worked in relation to crisis in the past • (12) Function of personality is to grow and develop • (13) Because illness is an event that is experienced along with feelings that derive from older experiences, the nurse-patient relationship is an opportunity for nurses to help patients to complete unfinished psychological tasks of childhood.

13. Nurse Patient Relationship4 Phases • (1) Orientation • Get acquainted • Work through preconceptions • Establish parameters • Develop trust • Begin to understand roles

14. Nurse Patient Relationship4 Phases • (2) Identification • Patient identifies problems to be worked on in relationship • Goal of nurse: • Help patient recognize their own role and promote responsibility for self

15. Nurse Patient Relationship4 Phases • (3) Exploitation • Patient’s trust of nurse at full potential • Patient makes full use of nursing services • Immediate problems are solved • Identifying and orienting self to discharge goals

16. Nurse Patient Relationship4 Phases • (4) Resolution • Final phase of nurse-patient relationship • Sense of security is found as patient has less reliance upon nurse helper • Patient has increased self-reliance to deal with their problems

17. Interpersonal Relations TheoryNurses Assists by Fulfilling Roles • Interlocking functions to assist patient • Specific roles variable; imagination of nurse is the only limitation • Historically, nurses acted as surrogate parents • With Interpersonal Relations Theory, focus is on autonomy and growth • Rather than feeding someone, teach them to fish

18. Interpersonal Processes • Nursing Process Methods • Observation • Understanding observations essential for making judgements and designing experiences with patients that aid them in problem resolution • Communication • Verbal and nonverbal • Nurse must recognize and understand meanings • Process Recordings • Analyze • Evaluate • Used as educational tools • Nurse self-scrutiny

19. Nurse Patient Relationship

20. Theory Insights • Nurse gains competencies of higher understanding of self, concepts, roles and processes to help patient toward growth and healing • Peplau warns against “social talk” with patients • Nurse’s own emotional needs should not get in the way • Can assist nurse to • Observe more intelligently • Interene more sensitively

21. Comparison of IPV Screening • Without Using Theory • New patient to be screened for IPV • Nurse senses fear/tension and tries to ‘lighten mood’ through distraction • Nurse uses closed-ended questions during screening • Continued reliance upon nurse throughout process • Using Theory • New patient to be screened for IPV • Nurse recognizes anxieties about IPV, as well as patient’s anxieties • Nurse uses open-ended questions during screening • Assists patient directly at first, then patient to become more independent in use of resources

22. Interpersonal RelationsEvaluation • Clarity / Parsimony • Clear and logical • Definitions straightforward • Concepts abstract, but can be learned with practice and utility

23. Interpersonal RelationsEvaluation • Significance & Internal Consistency • Metaparadigm concepts addressed and explained explicitly • Concepts and ideas are unchanged through time • Based on philosophical foundations • All elements of theory congruent • Has been widely implemented in the United States and abroad • Logical Development • Inductively and deductively based • Uses many psychological theorists’ work • Nursing role promotes patient’s movement through steps of nursing process

24. Interpersonal RelationsEvaluation • Testability • Theory can easily be tested by following the established guidelines • Results are heavily dependent on the goals of the patient and the critical thinking skills of the nurse • Complexity • At its core, theory is simple • Reality convergence • Basic tenents are reality-based • Real-life application • Requires time and practice to master

25. Interpersonal RelationsEvaluation • Pragmatic Adequacy • Contributes to nursing process • Consistent with nursing’s values and mission • Applicable to a multitude of clinical problems • Can be used in any nursing specialty • Holistic in nature • Consistent with legal and ethical requirements of nursing practice • Research has found positive correlation between the theory and patient satisfaction, nurse satisfaction, quality of life, and cost • Empirical Adequacy • Multiple research studies found that the nursing stages described by Peplau are observable in nurse-patient encounters

26. Interpersonal RelationsEvaluation • Utility • Beyond task-oriented nursing • Directly affects interventions dealing with communication • Scope • Very useful in settings of nursing education where focus is on nurse-patient relationship and communication • Can be implemented in many areas of nursing • Health education • Palliative care • AIDS care • Oncology

27. Limitations • Patients with overwhelming physiological needs not good candidates • Usefulness limited in patients with impaired communication, such as the sedated, comatose, demented, and neonates

28. References Beeber, L. S., & Bourbonniere, M. (1998). The concept of interpersonal pattern in Peplau’s theory of nursing Journal of Psychiatric and Mental Health Nursing, 5(3), 187-192. doi: 10.1046/j.1365-2850.1998.00124.x Callaway, B.J. (2002). Hildegard Peplau: Psychiatric nurse of the century. New York, NY: Springer Publishing Company, Inc. Current Nursing (2012). Application Peplau's interpersonal theory. Retrieved November 21, 2014, from http:// currentnursing.com/nursing_theory/application_Peplau's_interpersonal_theory.html Fawcett, J., & DeSanto-Madeya, S. (2012). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed.). Philadelphia, PA: F.A. Davis. Forchuk, C. (1993). Hildegarde E. Peplau: Interpersonal nursing theory. Newbury Park, CA: Sage Publications. Forchuk, C., Westwell, J., Martin, M., Bamber-Azzapardi, W., Kosterewa-Tolman, D., & Hux, M. (2000). The Developing Nurse-Client Relationship: Nurses' Perspectives. Journal of the American Psychiatric Nurses Association,6(1), 3-10. doi: 10.1177/107839030000600102 Peterson, S. J., & Bredow, T. S. (2013). Middle range theories: Application to nursing research (3rd ed.). Philadelphia, PA: Lippincott Williams & Wilkins.