Session

• #8:
Hildegard Peplau's Theory of
Interpersonal Relationship

• Ida Jean Orlando's Theory of Deliberative

Nursing Process
 Learning
Targets:
• Acknowledge the background and credentials of these nursing theorists;
• Identify the major concepts with their definitions as utilized in their respective
theory;
• List down their specific theoretical assertions or assumptions;
• Highlight their major contributions in the nursing field;
• Enumerate the major assumptions enclosed within their theory;
• Describe each of these theories in view of the four metaparadigms;
• Apply the significance of these theories in the nursing education, research, and
practice ; and,
• Recognize the application of these theories in nursing today and in the clinical
setting.
 Hildegard Peplau's Theory
of Interpersonal Relationship

"Nursing is the interpersonal therapeutic

process of functioning cooperatively
with other human processes that make
health possible for individuals in
communities through education that
aims to promote forward movement of
personality."
 Credentials & Background of the
Theorist:
She is considered as the "Mother of Psychiatric
Mental Health Nursing" and "Nurse of the
Century.

She served as Executive Director and President

of the American Nurse Association (ANA).

Peplau taught the first classes for graduate psychiatric nursing students at
Teachers College, Columbia University.
 Credentials & Background of the
Theorist:
Contributed to the advancement of the nursing
profession was more than what she gave for this
special area of clinical nursing.

Her seminal book is recognized as the first

nursing theory textbook since Nightingale's work
in the 1850s.
Peplau is credited for the following in the nursing profession:

• Promotion of professional standards and regulation through

credentialing
• Introduced the concept of advanced nursing practice
• Stressed the importance of psychodynamics in nursing
practice
• The proponent of the nurse's unique ability to understand
his or her behavior to help others identify their perceived
difficulties.
She discussed four psychobiological experiences that
compel destructive or constructive patient responses,
these are:
 Needs
 Frustrations
 Conflicts
 Anxieties
4 PHASES OF THE
NURSE-PATIENT
RELATIONSHIP
• Orientation- the phase in the nurse-patient interaction where the client
seeks help and the nurse assists the client to understand the problem
and the extent of the help.

• Identification- characterized by the client who assumes a posture of dependence,

interdependence, or independence in relation to the nurse's focus is to assure the
person that the nurse understands the interpersonal meaning of the client's
situation.

• Exploitation- the client derives full value from what the nurse offers through the
relationship; the client uses available services based on self-interest needs; power
shifts from the nurse to the client.

• Resolution- old needs and goals are set aside and new ones are adopted; once older
needs are resolved, newer and more mature ones become evident.
6 PROPOSED
NURSING
ROLES:
1. Stranger Role- is exemplified by the nurse receiving the client in the same way one meets a
stranger in other life situations. The nurse provides an accepting climate that builds trust.

2. Resource Role- the nurse answers questions, interprets clinical treatment data, and
gives information.

3. Teaching Role- the nurse gives instructions and provides training. She also involves
analysis and synthesis of the learner's experience.

4. Counseling Role- the nurse helps clients understand and integrate the meaning of
current life circumstances and provides guidance and encouragement to make changes.

5. Surrogate Role- the nurse helps the client clarify domains of dependence, interdependence,
and independence and acts on the client's behalf as an advocate.

6. Active Leadership Role- the nurse helps the client assume maximum responsibility for
meeting treatment goals in a mutually satisfying way.
 Theoretical
Assertions:
 Nurse and the patient can interact.

 Peplau emphasized that both the patient and nurse mature as the
result of the therapeutic interaction.

 Communication and Interviewing skills remain fundamental nursing

tools.

 Peplau believed that nurses must clearly understand themselves to

promote their client's growth and avoid limiting their choices to
those that nurses value.
Theory in View
of
Metaparadigms:
 Nursing
Hildegard Peplau considers nursing to be a "significant,
therapeutic, interpersonal process." She defines it as a "human
relationship between an individual who is sick, or in need of health
services, and a nurse specially educated to recognize and to respond
to the need for help."
 Person
Peplau defines man as
an organism that "strives in its own way to reduce tension
generated by needs." The client is an individual with a
felt need.
 Health
Health is defined as " a word symbol that implies the
forward movement of personality and other ongoing human
processes in the direction of creative, constructive, productive,
personal, and community living."
 Environme
nt
Although Peplau does not directly address
society/environment, she does encourage the nurse
to consider the patient's culture and mores when the
patient adjusts to the hospital routine.
 Ida Jean's Theory of IDA JEAN
Deliberative Nursing
ORLANDO
Process
Deliberative
"Nursing is a profession that Nursing
seeks to find out and meet the Process
Theory
patient's immediate need for
help."
 Credentials & Background of the
Theorist:
 Developed her theory from a study conducted at
the Yale University School of Nursing, integrated
mental health concepts into the basic nursing
curriculum.

 She was one of the first nursing leaders to identify and

emphasize the elements of the nursing process and the critical importance of

the patient's participation in the nursing process.

 Orlando's theory focuses on how to produce improvement in the patient's
behavior. Evidence of relieving the patient's distress is seen as positive
changes in the patient's observable behavior.
 Credentials & Background of the
Theorist:
 Orlando analyzed the content of 2000 nurse-
patient contacts and created her theory based on
the analysis of these data.

 She was one of the early thinkers in nursing who proposed that patients
have their own meanings and interpretations of situations and therefore
nurses must validate their interferences and analyses with patients before
drawing conclusions.
 Theory
Description
 Ida Jean Orlando's theory developed observations she recorded between a nurse
and patient. Orlando's nursing theory stresses the reciprocal relationship between
patient and nurse. What the nurse and the patient say and do affects them both.

 According to Orlando, persons become patients who require nursing care when
they have needs for help that cannot be met independently because they have
physical limitations have negative reactions to an environment, or have an
experience that prevents them from communicating their needs.

 Patients experience distress or feelings of helplessness as the result of unmet needs

for help. (Orlando, 1961)

 Orlando proposed a positive correlation between the length of time the patient
experiences unmet needs and the degree of distress. Therefore, immediacy is
emphasized throughout her theory.
 In Orlando's view, when individuals are able to meet their own needs,
they do not feel distressed and do not require care from a professional
nurse.

 Orlando emphasizes that it is crucial for nurses to share their perceptions,

thoughts, and feelings so they can determine whether their interferences are
congruent with the patient's needs. (Schmieding, 2006)

 Abraham (2011) used Orlando's theory to help nurses achieve more

successful patient outcomes such as fall reduction. Orlando's theory remains
a most effective practice theory that is especially helpful to new nurses as they
begin their practice.
Nursing Process Theory

The nursing process is an interaction of three

basic elements.
• The behavior of the patient
• The reaction of the nurse
• The nursing actions which are designed for the patient's
benefit.

• The role of the nurse is to find out and meet the patient's immediate
need for help.
• The nursing process helps the nurse find out the nature of the distress
and what helps the patient
• The use of this theory keeps the nurse's focus on the patient
• The strength of the theory is that it is clear, concise, and easy to use.
 Major Concepts &
Definitions
 The nurse's responsibility is composed of whatever help the
patient may require for his needs to be met.

 The nurse may either give this need for help directly herself or
indirectly employing the aid of other members of the health
care team.
 Neat- is a situationally defined requirement of the patient which
relieves or diminishes his immediate distress if this is supplied.

Presenting behavior of patient- any observable verbal and

nonverbal behavior of the patient.

Immediate reactions- the nurse's and patient's individual perceptions,

thoughts, and feelings.
Nursing Process Discipline
-includes the nurse communicating to the patient his or her own immediate reaction
-made in order to ask for validation, clarification, or correction from the patient
-once referred to as the "deliberative nursing process"

Automatic nursing actions

- nursing activities that are decided upon for reasons other than the
patient's immediate need.

Deliberative nursing actions

-those decided upon after ascertaining a need and then meeting this
need.
 Theory

Assumption
• When patients cannot cope with their needs on their own, they become distressed
by feelings of helplessness.

• In its professional character, nursing adds to the distress of the patient.

• Patients are unique and individual in how they respond.

• Nursing offers mothering and nursing analogous to an adult who mothers and
nurtures a child.

• The practice of nursing deals with people, the environment, and health.

• Patients need help to communicate their needs; they are uncomfortable and
ambivalent about their dependency needs.

• People can be secretive or explicit about their needs, perceptions,

thoughts, and feelings.
• The nurse-patient situation is dynamic; actions and reactions are influenced by
both the nurse and the patient.

• People attach meanings to situations and actions that aren't apparent to others.

• Patients enter into nursing care through medicine.

• The patient cannot state the nature and meaning of his or her distress without the
nurse's help or his or her first having established a helpful relationship with the
patient.

• 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.

• Nurses are concerned with the needs the patient is unable to meet his or her own.
Theory in View of
Metaparadigms:
 Nursin
g
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.
 Perso
n
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.
 Healt
h
In Orlando's theory, 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.
 Environme
nt
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.
APPLICATION OF
THE THEORY:
  Since the premise of Orlando's theory is the immediacy of help needed by
patients, this framework will be important for nurses who are assigned in
special clinical areas that require quick decision-making and critical thinking
skills. Such areas are the OR, ER, and ICU/ Critical Care Unit.

 Orlando's theory stresses the reciprocal relationship

between patient and nurse remains a most effective practice theory that
is especially helpful to new nurses as they
begin their practice
Thank
you
for