Running Head: A THEORETICAL APPROACH TO PSTCHIATRIC NURSING

A Theoretical Approach to Psychiatric Nursing Peplaus Interpersonal Relations Theory Student Name: Dermot Connolly Stenberg College

A THEORETICAL APPROACH TO PSTCHIATRIC NURSING A Theoretical Approach to Psychiatric Nursing Peplaus Interpersonal Relations Theory Like most professions, the growth and survival of psychiatric nursing is dependant on its ability to adapt with the changes in its profession. The development of theoretical approaches in the field of psychiatric nursing is a reflection of the recognition that the field can no longer be classified alongside traditional medical theories. Over the years theoretical approaches to psychiatric nursing have being established with the common goal of attempting to identify and bridge the gap between the physical and holistic treatment of the psychiatric patient. In 1952 the first of these theories was published, it was called interpersonal relations in nursing and it was written by Hildegard Peplau a woman later be regarded as the founder of psychiatric nursing. The first of its kind to be written without the input of a physician, Peplau attempted to have her book published four years earlier but was unsuccessful as it was considered too groundbreaking

and it was feared it would not gain the recognition it deserved. Her interpersonal relations theory introduced the importance of education and interpersonal relations in the field of psychiatric nursing, but more importantly, it also highlighted the need for other theoretical approaches to be created and adopted into the psychiatric nursing sector. Peplau built her interpersonal relations theory on two interchangeable beliefs; 1) nursing education and 2) therapeutic approach to nursing. Scribd (2012). In terms of nursing education, Peplau long held the view that psychiatric nursing needed to have professional accountability, that to be a psychiatric nurse involved having the courage and conviction to stand over and justify ones actions. She held the belief that all psychiatric nurses have a responsibility to keep up to date with the changes in their field, to increase their knowledge base and develop their ability to think critically so as to challenge standard nursing practice and theories. Pearson, A., &Vaughan, B. (1989). Peplau also recognized the role the school played in the role of psychiatric

A THEORETICAL APPROACH TO PSTCHIATRIC NURSING

nursing education. Nursing educators must train the student to develop an understanding of their own values, beliefs and culture through a process of self awareness. Only through heightened self awareness techniques can a student reflect on their own reactions to real life clinical situations and hone their reactions so as not to cause discomfort or embarrassment to the patient. Peplau saw the role of education as interchangeable with the role of the therapeutic approach to nursing. She viewed nursing as the development of a professional relationship between the patient and the nurse with the view of helping the patient develop an understanding of their illness and learn from their exposure to it. Pearson, A., &Vaughan, B. (1989). This approach to nursing had far reaching affects as it moved away from the more traditional approach where the patient was treated for their physical symptoms only. Over the years, other theorists developed similar models whose fundamentals were steeped in Peplaus concept of therapeutic nursing care. Barker for example described the process of therapeutic relationships as the cornerstone of nursing practice with people who are experiencing threats to their health. Barker, P. (2009). He would later establish his own theoretical approach to psychiatric nursing to develop a therapeutic model called the Tidal Model. Peplaus interpersonal theory was developed from the belief that nurses spend much more time with the patient than the patients physician. This gave the nurse the ability to help the patient become more aware of their illness while helping them develop the foresight to understand the true root cause and prevent a relapse. This placed the nurse into the realm of preventative nursing. Pearson, A.,&Vaughan, B. (1989).With the emphasis of therapeutic care being heavily dependant on the nurse / patient relationship, Peplaus interpersonal theory calls for the role of the psychiatric nurse to develop into one where nurses are actively involved in the planning and role out of psychiatric health care

A THEORETICAL APPROACH TO PSTCHIATRIC NURSING programs. She takes it a step further and calls for all psychiatric nurses to use their unique positions of exposure to mental illness to influence social policy. Through her interpersonal theory, Peplaus indentified four phases that she believed mapped out every patients road to recovery. These phases are; 1) The orientation phase assessment of the patient, 2) The Identification phase intervention planning, 3) The exploitation phase plan execution and 4) The resolution phase evaluation and assessment of the plan. Pearson, A., &Vaughan, B. (1989). The orientation phase marks the phase when the

patient or their family has recognized that psychiatric assistance is needed. It is during this period of time that the patient and the nurse meet and get acquainted. In order for the orientation phase to be successful, both the nurse and the patient must work collaboratively to recognize, identify and resolve the patients problems. This is an important step as only through mutual agreement and recognition can the patient actively resolve their problems. Self awareness is also important during the orientation phase as factors such as race, values and culture will all play an important role in the reactions displayed by both the psychiatric nurse and the patient. By the end of the orientation phase the goal is for the nurse and the patient to be working together towards a shared common goal indentified and agreed on by both parties. Scribd (2012). The next phase in the Peplaus treatment process is the identification phase. During this phase, the patient plays a more active role in their treatment, helping to eliminate their feelings of helplessness and bolster their confidence and independence. This phase is marked by the execution of the treatment plan agreed in the orientation phase. Peplau recognized that upon occasion, differences will arise between the patient and the nurse regarding the specific goals of the treatment. Successful resolution of these differences plays an important part of the success of the identification phase. Pearson, A., &Vaughan, B. (1989). The third phase in Peplaus interpersonal theory is the

A THEORETICAL APPROACH TO PSTCHIATRIC NURSING exploitation phase. During this phase, the full extent of the services available to the patient are exploited and the patient starts to take a commanding role of their treatment and recovery. The role of the psychiatric nurse also changes, to one where she becomes the provider of resources and counseling skills to the patient which enables the patient to make a full recovery. Pearson, A., &Vaughan, B. (1989). As the patient progresses through the exploitation phase, they start to develop a sense of self belief and attainment. As they near the end of the exploitation phase the patient will be in a position to generate their own goals and strive to meet them. Scribd (2012). The final phase in Peplaus interpersonal theory is the resolution phase, where the patient has met the agreed predetermined goals as laid out in the orientation phase. A successful resolution

phase sees the patient as completely independent from the nurse and vice versa. The execution of the resolution phase can sometimes be difficult for both the patient and the nurse as both may have developed a psychological bond making the dissolution of the relationship difficult. The use of terminology also plays an important role in nursing theory. Global terms or metaparadigms attempt to encompass broad nursing views in an effort to increase the users vantage point on the subject. While several different metaparadigms have being put forward by different scholars, there is widespread agreement that nursing theory can be divided into the following; human beings, health, environment, and nursing. Peplau incorporated each of these metaparadigms into her interpersonal model. She defined the needs of human beings as a necessity of life, to enable them to maintain a state of equilibrium. Health is described as the ability of the individual to evolve and grow allowing them to reintegrate into the community. While Peplau did not address environment directly, she did stress the importance of being aware of not only the patients culture, beliefs and home environment, but also the role adjusting to the hospital environment can have on the patient. The final metaparadigm of nursing is of particular

A THEORETICAL APPROACH TO PSTCHIATRIC NURSING importance to Peplau interpersonal theory as it emphasizes the importance of providing quality nursing care to the patient in the form of therapeutic relationship. The development of this relationship is of particular importance as it provides the foundation upon which the goals and objectives of the patients treatment is built. In terms of tracking the patients progress, Peplaus theory does not specify a particular

method to track and measure performance. It is however still important to document the patients journey towards recovery and one of the most common methods used to record this information is a process depicted by the acronym SOAPIER. This acronym is utilized to enable the nurse to track and record the patients progress where each letter stands for an important step in the recovery process. S applies to the subjective experience of the illness, O is the objective observations made by the nurse, A stands for the nurses formal assessment of the patient, P is the treatment plan agreed by both the patient and the nurse, I is the implementation of this plan, E is the evaluation of the plan after it has being implemented and finally R defines the need to reassess the plan based on the lessons learned from the plans implementation. Pearson, A., &Vaughan, B. (1989). The benefits of a standard approach to note recording ensures that each patient is assessed against a template that allows for their progress to be tracked easily as well as having the ability to see trends in behavior from one patient to the next. While we have discussed each of the phases in Peplaus interpersonal theory, its important to note that each of the four phases are comparable to the nursing process. This is highly beneficial to the nursing sector as Peplaus theory allows for it to be easily incorporated into nursing practice. Both Peplaus theory and the nursing practice are deeply focused on the development of a therapeutic relationship between the nurse and the patient. However while many similarities exist, there are also some significant differences in the application of Peplaus

A THEORETICAL APPROACH TO PSTCHIATRIC NURSING theory into nursing practice. When Peplaus published her book in 1952, she considered the role of the doctor to be the diagnosis of the patients condition while the primary role of the nurse was to carry out the instructions documented by the doctor as well as recording other symptoms displayed by the patient during the treatment process. This assertion is in stark contrast to the role of a psychiatric nurse today where the role of the nurse has expanded to allow for greater responsibility and accountability. Psychiatric nurses today play a much greater role in the therapeutic care of their patients. Some of these additional responsibilities include aiding the patient in socioeconomic issues such as financial support, social services and family support.

This expanded role extends beyond those considered by Peplau when she published her findings in 1952. Scribd (2012). Peplaus interpersonal theory and its importance in the establishment of other nursing theories cannot be understated. It has helped to redefine the role of the psychiatric nurse from a time when the nursing sector was heavily dependant of the contributions of the licensed physicians. Through its introduction, the very basis of psychiatric nursing practice has being established, helping to provide a set of guidelines to help drive the psychiatric nursing practice forward. While the role of the psychiatric nurse has evolved since the introduction of Peplaus interpersonal theory in 1952, many of its teachings are valid today. The importance of nursing education and therapeutic relationships for example are as respected today as they were in 1952. Peplaus interpersonal theory highlighted the need for additional research to be conducted into the field of psychiatric nursing and over the years more and more theories have being developed. Upon closer examination of these theories, one can see that they all share a common pitfall, a single set of paradigms to help define each theory and due to the diversity of the nursing sector; this is unlikely to change. Colley, S. (2003). While the benefits of nursing theory are far

A THEORETICAL APPROACH TO PSTCHIATRIC NURSING reaching, one of its biggest challenges inhibiting its successful introduction is the language and

terminology used to write them. Many nurses spend the majority of time trying to understand and interpret new nursing concepts and as a result fail to see the benefits to their practice. Therefore if nursing theory is to survive, it must first gain acceptance and understanding from its intended users. Colley, S. (2003).

References:

A THEORETICAL APPROACH TO PSTCHIATRIC NURSING

Barker, P. (2009). Psychiatric and Mental Health Nursing The craft of caring (2nd ed.). London: Hodder Arnold. Colley, S. (2003). Nursing theory: its importance to practice. Nursing standard. 17 (46). 33-37. Nursing Theories (2012).A Companion to nursing theories and models. Retrieved from: http://currentnursing.com/nursing_theory/interpersonal_theory.html Parker, M.E. & Smith, M.C. Chapter 3.Choosing, evaluating and implementing nursing theories for practice. Retrieved from: http://stenbergcollege.mrooms3.net/file.php/320/Choosing_Evaluating_and_Implementin g_Nursing_Theories.pdf Pearson, A.,&Vaughan, B. (1989). Nursing models for practice. Heinemann Nursing. (141-154) Peplau, H. E. (1994). Psychiatric mental health nursing: challenge and change. Journal of Psychiatric and mental health nursing. (1). 3-7. Scribd (2012). Hilegard Peplau. Retrieved from: http://www.scribd.com/doc/39045632/Hildegard-Peplau