Learning Activity Sheet Number 1

Hildegard E. Peplau (September 1, 1909 – March 17, 1999)

" Somewhere, somehow, at some time in the past, courageous nurses determined skills, learned them, fought for the
right to use them. All nurses have an obligation to remember that part of nursing’s past, and to keep their own skills in
pace with new opportunities for nursing into the next century." H. Peplau 1989.

• Born on September 1, 1909 and was raised in Reading Pennsylvania by parents of German descent Gustav and
Otyllie Peplau
• She was the only American nurse who served as Executive Director and later as President of American Nurses
Association (ANA).
• The first nursing theorist since Florence Nightingale.
• Known as the “Mother of Psychiatric Nursing and Nurse of the Century”.
• A professor emeritus and member of the College of Nursing faculty at Rutgers University from 1954 until 1974.
• She received nursing highest honor the “ Christiane Reimann Prize” in 1997
• Honored as “Living legend” by the American Academy of Nursing in 1996.
• Published a book “Interpersonal Relations in Nursing” in 1952 her theoretical work and teachings help catapult
nursing from an occupation to a profession.
• In 1918 she observed the disturbing flu epidemic and influenced her understanding on the significance of illness
and death on families.

DEFINITIONS:

• Person: A developing organism that tries to reduce anxiety caused by needs.

• Environment: Existing forces outside the organism and in the context of culture
• Health: A word symbol that implies forward movement of personality and other ongoing human processes in the
direction of creative, constructive, productive, personal and community living.
• Nursing: A significant therapeutic interpersonal process. It functions cooperatively with other human process
that make health possible for individuals in communities.
o Nursing is therapeutic and interpersonal process.
o It is a human relationship between an individual who is sick or in need of health services, and a nurse
especially educated to recognize and to respond to the need for help (Peplau, 1952).
o Described nursing as an "enabling, empowering, or transforming art (Peplau, 1988)

Peplau’s Theoretical Model

• It derives from the perspective of a critical philosophy that integrates both the science and practice of nursing in
theory development. Also, it was based upon her study, observation, and analysis of nurses and patients as
influenced by Harry Stack Sullivan and others psychodynamic viewpoint.
Interpersonal Relationship

• The nurse-patient relationship is fundamental to providing nursing care and derives from the human need for
connectedness that is still essential in the 21st century (Peplau, 1997).
• Nurses assess and assist people to achieve healthy levels of anxiety intrapersonally and facilitate healthy pattern
integrations interpersonally, with the overall goal of fostering well-being, health, and development.
• This also provides the context for the nurse to develop, apply, and evaluate theory-based knowledge for nursing
care.

Phases of Interpersonal theory

• ORIENTATION PHASE
o Problem defining phase
o Starts when client meets nurse as stranger
o Defining problem and deciding type of service needed
o Client seeks assistance, conveys needs, asks questions, shares preconceptions and expectations of past
experiences
o Nurse responds, explains roles to client, helps to identify problems and to use available resources and
services

Values
Culture race
Beliefs Nurse-patient
Past experiences
relationship
Expectations
Preconceived ideas

• Identification Phase
o Selection of the appropriate assistance by a professional.
o The patient begins to feel as if he or she belongs, and feels capable of dealing with the problem which
decreases the feeling of helplessness and hopelessness
o The identification phase is the development of a nursing care plan based on the patient’s situation and
goals.
• Exploitation Phase
o Uses professional assistance for problem-solving alternatives.
o The advantages of the professional services used are based on the needs and interests of the patients.
o the patient feels like an integral part of the helping environment, and may make minor requests or use
attention-getting techniques.
o Therapeutic communication is essential to explore, understand, and adequately deal with the underlying
problem for patient’s independence is likely to fluctuate. The nurse assists the patient in utilizing all
avenues of help in progressing towards the final phase.
o It is the implementation of the nursing plan, taking actions toward meeting the goals set in the
identification phase.
• Resolution Phase
o The nurse and patient evaluate the situation based on the goals set and whether or not they were met.
o Emotional balance is achieved and both become mature individuals.
o It is the termination of the professional relationship since the patient’s needs have been met through
the collaboration of patient and nurse.

Role of Nurses

• Stranger: the nurse receive patient in the same way patient meets a stranger in other life situations (creation of
accepting climate that builds trust).
• Teacher: who imparts knowledge in reference to a need or interest.
 • Resource Person: one who provides a specific needed information that aids in the understanding of a problem or
new situation.
• Counselors: helps to understand and integrate the meaning of current life circumstances, provides guidance and
encouragement to make changes
• Surrogate: helps to clarify domains of dependence interdependence and independence and acts on client’s
behalf as an advocate.
• Leader: helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way.

Strengths:

• It is relevant but not limited to psychiatric patients and capable individuals who has the motivation to
communicate.
• Phases of therapeutic nurse-client are similar to nursing process. Orientation phase concurs with nursing
assessment, identification phase is with nursing diagnosis and planning, exploitation phase so as implementation
and resolution phase with evaluation.
• It supports future nursing theorist and clinician in developing further therapeutic interventions that can be
applied in clinical nursing.
• Stages of therapeutic nurse-client is simple leading to adaptive progression of any nurse-patient collaboration.

Weaknesses:

• Inappropriate for withdrawn patients, clients with communication problem, unconscious and paralyzed patients.
• Less emphasis on health promotion and maintenance.
• Few considerations on personal space and community service.

Questions:

1. Give an actual scenario or example of the Phases of Interpersonal theory.

2. Give an actual scenario or example where a nurse become a client’s advocate.
Learning Activity Sheet Number 2

IDA JEAN ORLANDO

BIOGRAPHY

• was an internationally known psychiatric health nurse, theorist, and researcher.

• developed the “Deliberative Nursing Process Theory.”
• Her theory allows nurses to create an effective nursing care plan that can also be easily adapted when and if any
complications arise with the patient.
• In 1947, she received a nursing diploma from the Flower Fifth Avenue Hospital School of Nursing in New York.
• In 1951, she received a Bachelor of Science degree in public health nursing from St. John’s University in Brooklyn,
New York.
• And in 1954, Orlando received her Master of Arts degree in mental health consultation from Teachers College,
Columbia University.
• While studying, she also worked as a staff nurse in OB, MS, ER, as a general hospital supervisor, and as an
assistant director and a teacher of several courses.
• Associate Professor Of Mental Health And Psychiatric Nursing
o After receiving her master’s degree on 1954
o 8 years
o Yale University School of Nursing
• Research Associate and the principal project investigator of “Integration of Mental Health Concepts in a Basic
Curriculum”
o National Institute of Mental health Institute of the United States Public Health Service
• Associate Professor And The Director Of The Graduate Program In Mental Health And Psychiatric Nursing
o 1958-1961
o Yale University
• Clinical Nurse Consultant
o 1962 – 1972
o Mclean Hospital in Belmont, Massachusetts
o the interactions of nurses with clients, other nurses, and other staff members and how these
interactions affected the nurse’s help to clients.
• Educator
o Boston Univeristy School of Nursing
o 1981
• Administrative Positions
o Metropolitan State Hospital In Waltham, Massachusetts.
o 1984 To 1987
• Assistant Director of Nursing for Education and Research
o September 1987
o Metropolitan State Hospital In Waltham, Massachusetts.
• Project Consultant for the Mental Health Project for Associate Degree Faculties created by the New England
Board of Higher Education.
• In 1992, Orlando retired and received the Nursing Living Legend award from the Massachusetts Registered
Nurse Association.
• “The Dynamic Nurse-Patient Relationship: Function, Process, and Principles” 1961
• “The Discipline and Teaching of Nursing Process” 1972

Deliberative Nursing Process Theory

ORIGIN OF THEORY

• Orlando developed her theory from a study conducted at the Yale University School of Nursing, integrating
mental health concepts into a basic nursing curriculum.
• For 3 years, she recorded 2000 observations between a nurse and patient interactions.
• She then examined the content of these 2,000 nurse-patient records and only was able to categorize them into
two mutually exclusive sets that she labeled “good nursing” and “bad nursing”.
• From these observations, she formulated the ”Deliberative Nursing Process” which was published in 1961.
 • Conducted research at McLean Hospital through continuous tape recording of nurses with patients and other
health care members.
• Based on this research, her formulations were validated, thus she extended her theory to include the entire
nursing practice system which then evolved as “Nursing Process Discipline”

Assumptions

1. When patients cannot cope with their needs on their own, they become distressed by feelings of helplessness.
2. In its professional character, nursing adds to the distress of the patient.
3. Patients are unique and individual in how they respond.
4. Nursing offers mothering and nursing analogous to an adult who mothers and nurtures a child.
5. The practice of nursing deals with people, the environment, and health.
6. Patients need help communicating their needs; they are uncomfortable and ambivalent about their dependency
needs.
7. People can be secretive or explicit about their needs, perceptions, thoughts, and feelings.
8. The nurse-patient situation is dynamic; actions and reactions are influenced by both the nurse and the patient.
9. People attach meanings to situations and actions that aren’t apparent to others.
10. Patients enter into nursing care through medicine.
11. The patient cannot state the nature and meaning of his or her distress without the nurse’s help or him or her first
having established a helpful relationship with the patient.
12. Any observation shared and observed with the patient is immediately helpful in ascertaining and meeting his or
her need or finding out that he or she is not in need at that time.
13. Nurses are concerned with the needs that the patient is unable to meet on his or her own.

METAPARADIGM OF THE THEORY

Human Being

• “a person who becomes distressed, when without help, he cannot meet his needs”
• Orlando uses the concept of human as she emphasizes individuality and the dynamic nature of the nurse-patient
relationship. For her, humans in need are the focus of nursing practice.

Nursing

• Orlando speaks of nursing as unique and independent in its concerns for an individual’s need for help in an
immediate situation. The efforts to meet the individual’s need for help are carried out in an interactive situation
and in a disciplined manner that requires proper training.

Health

• health is replaced by a sense of helplessness as the initiator of a necessity for nursing. She stated that nursing
deals with individuals who require help.

Environment

• Orlando completely disregarded the environment in her theory, only focusing on the patient’s immediate need,
chiefly the relationship and actions between the nurse and the patient (only an individual in her theory; no
families or groups were mentioned). The effect that the environment could have on the patient was never
mentioned in Orlando’s theory.

Five Major Interrelated Concepts:

1. the function of professional nursing

2. presenting behavior
3. immediate reaction
4. nursing process discipline
5. improvement
Professional Nursing Function

• Organizing principle
• She envisions the nursing function as’ ‘finding out and meeting the patient’s immediate need for help’’.
• If the patient is in need and the need for help is met by the nurse, the professional function has been fulfilled.

THE PATIENT’S PRESENTING BEHAVIOR

• Problematic situation
• “The presenting behavior of the patient, regardless of the form in which it appears, may represent a plea for
help’’
• Patient’s behavior can be manifested in the following forms:
o Verbal: such as asking a question or making a statement to the nurse;
o Vocal: such as coughing, moaning, crying, wheezing, shouting
o Non-verbal: such as Tears in the eyes, skin color, reddened face, clenched fist, or physiological
manifestations like Papules (Orlando 1961).

IMMEDIATE REACTION/RESPONSE

• Internal response

• Automatic Nursing Actions - are nursing actions decided upon for reasons other than the patient’s immediate
need.
• Deliberative Nursing Actions - are actions decided upon after ascertaining a need and then meeting this need
NURSING PROCESS DISCIPLINE

• Investigation
• Deliberative nursing process formulations reflect the nurse- patient situation as a dynamic whole; the patient’s
behavior affects the nurse and the nurse’s behavior (action) affects the patient.
• The use of a deliberative nursing action requires a shared communication process between the nurse and the
patient in order to determine:
• The meaning of the patient’s behavior,
• The help required by the patient, and
• Whether the patient was helped by the nurse’s action

IMPROVEMENT

• Resolution
• This refers to improvement in the patient’s behavior
• According to Orlando, If the nurse’s activity meets the patient’s immediate needs for help, the patient’s behavior
improves.
• If behavior of the patient doesn’t change, the nursing function has not been met.

5 STAGES OF THE DELIBERATIVE NURSING PROCESS

• Orlando's theory remains one the of the most effective practice theories available.
• Many theory scholars utilized her concept as basis for their further studies.
• Her work has been translated into different languages and was contained in the international section.

APPLICATION TO NURSING PRACTICE

1. It provides a framework to guide nurses’ actions.

2. It focuses on nurse’s-mind set.
3. Can easily understand and use everyday practice.

Use in Clinical Practice:

• Nursing care plan

• Case studies
• Progressive patient care settings
Application to Education:

• Orlando nursing process theory was recommended for:

• teaching BSN students and
• conceptualize BSN curriculums

STRENGTHS

• Prevent inaccurate diagnosis or in effective plan.

• The patient will be treated as individuals and they will participate into their own care.
• Assertion of nursing’s independence as a profession based on a sound theoretical frame work.
• Guides the nurse to evaluate their care in terms of observable patient outcome.

WEAKNESSES

• The lack of the operational definitions of society or environment which limits the development of research
hypothesis.
• Orlando’s work focuses on short term care, particularly aware and conscious individuals
• Absence of reference group or family members.

CONCLUSION TO THEORY

• Orlando's Deliberative Nursing Process Theory focuses on the interaction between the nurse and patient,
perception validation, and the use of the nursing process to produce positive outcomes or patient improvement.
Orlando's key focus was to define the function of nursing. (Faust C., 2002)
• Orlando's theory remains one the of the most effective practice theories available.
• The use of her theory keeps the nurse's focus on the patient.
• The strength of the theory is that it is clear, concise, and easy to use.
• While providing the overall framework for nursing, the use of her theory does not exclude nurses from using
other theories while caring for the patient.

Questions:

1. What do you think is the importance of family members or support group in a nursing intervention?
2. What do you think why Orlando did not included environment on her theory?
Question’s instructions:

1. Write your name at the top of the document.

2. Times new roman 12 font size
3. Justified
4. Double spacing
5. Answers must be minimum of 5 sentences.
6. Question must be in red color, answer in black.
7. File should be in PDF.
8. Filename is your surname plus initial (JFDelaCruz).
9. Submission is until 6pm, November 3, 2023.
10. https://drive.google.com/drive/folders/1LSnU4sjje6JWKjvADf8X4WT7OpxE53-4?usp=sharing
a. Upload your answers here and use FCPC gmail account.