Reconstructing a Nursing Theory Based on Advanced Nursing Roles

The integration of nursing theories is a guiding light in the field of advanced nursing practice, guiding the path to the best patient care and professional advancement. Nursing theories are often rooted in diverse philosophical frameworks that offer an understanding of the nature of the profession and its application in healthcare (Fletcher, 2023). The nursing theorist selected for this discussion is Hildegard Peplau who described the theory of interpersonal relations. I selected this theory because it deals with the foundations of nursing practice, especially the nurse-client relationship. Peplau’s theory views nursing as an interpersonal process that entails interaction between two people with a common goal (Vogelsang, 2022). Peplau revolutionized the profession’s approach to patient care, shifting the focus from task-oriented routines to holistic, patient-centered practices. This discussion focuses on the development of Peplau’s theory using the phases of theorizing, syntax, testing, and evaluation.

Theory Development: Theorizing

My theory of interpersonal relations emerges from the key areas of personal experiences, professional insights, and scholarly pursuits. Behind the development of this theory is the knowledge and experiences I gained from my nursing education. After I graduated from Pennsylvania, I became a school nurse and met with key figures in nursing. During my early days in the war, I witnessed the vulnerability and unspoken pleas of people suffering from the adversities of the war. At this time I questioned the distinct roles that nurses played in caring for patients. What was the nature of the relationships between the victims of war and the nurses? This was a key question that sparked the road to my theory.

BUILDING A HEALTH HISTORY Discussion Case – Adolescent white male without health insurance seeking medical care for STI

Apart from this instance, a pivotal turning point was when I worked in Phipps Clinic Baltimore under Dr. Moreno, a pioneer in group psychotherapy. During this interaction, I observed the nature of relationships between providers and patients. How does understanding the unique experiences of patients impact their health? I asked this question as I observed Dr. Moreno interact with psychiatric patients. Upon these observations, I theorized that nursing is about therapeutic relationship building. Nursing involves empowering patients to participate in their care where they collaborate with patients, acknowledging their expertise and autonomy in decision-making processes (Wasaya et al., 2021). In addition, I observed that collaborating with patients and acknowledging their expertise and autonomy in decision-making processes is a nursing responsibility. Nursing is not solely about performing clinical tasks and procedures and should encompass interpersonal connections. Nursing is not paternalistic where providers make decisions for patients, but a profession in which nurses and patients collaborate (Fletcher, 2023). Lastly, I believe nursing is not practiced in isolation from social and cultural concepts.

Theory Development: Syntax

My theory of interpersonal relations has been influenced by the prevailing social and intellectual milieu of the mid-20th century, marked by significant advancements in psychology, psychiatry, and nursing. The nurse-patient relationship is a dynamic entity characterized by mutual influence and reciprocity. Based on these arguments, I believe there are four concepts or phases that each nurse-patient relationship experiences. These phases include orientation, identification, exploitation, and resolution (Vogelsang, 2022). When utilizing these phases, the ultimate goal of the nurse is to understand the needs and frustrations of the patient and help in facilitating growth.

Orientation is the first phase of a nurse-client relationship that provides a guide to uncharted territory (Clark, 2023). The nurse is a stranger to the patient at this point and the client is just a mere individual seeking assistance. To effectively care for patients, the nurse ought to help the patient become oriented to their problem and understand their sources of anxiety or fear. The nurse must be an active listener and focus on the needs of the patient, not that of the nurse to effectively orient the patient to the situations surrounding care delivery. The second concept that precedes orientation is identification which is merely a bridge of shared understanding (Hagerty et al, 2017). The patient begins to understand their situation and identify sources of help at this stage. The nurse should promote constructive learning by ensuring the patient develops skills that can enable an independent response to the nurse.

Another key concept in the theory is exploitation which is defined by the patient drawing resources from the nurse’s expertise (Vogelsang, 2022). The client makes full sense of the help offered and the advantages of the services. The nurse should aid the patient in exploring avenues of help and progress toward meeting the set goals. The last phase of interpersonal relationships is resolution where the patient no longer needs the services of the nurse. The nurse part ways with the patient and dissolves the bond that was established. After several years of observing the nurse-patient relationship, the four concepts have been narrowed down to three phases including the orientation, working, and termination phases (Fletcher, 2023). I used these changes to ensure simplicity, making it easier for nurses to apply the theory in their practice.

 Theory Testing

Clinical research and observations have been used to evaluate the concepts of Peplau’s theory and its applicability to nursing research. One of the quantitative research that I can relate to testing of this theory involves an investigation of Peplau’s theory’s impact on patient experiences (Hagerty et al., 2017). In this example, the interpersonal relations theory was used as a conceptual framework to determine the impact of the theory on HCAHPS data. The study sample consisted of 15,814 patients hospitalized in medical-surgical and maternity units. The three phases of Peplau’s model were utilized during patient care delivery and patients were assessed on their level of satisfaction. The findings indicated increased patient satisfaction scores where patients reported experiencing respect and careful listening by nurses (Hagerty et al., 2017). It was observed that patient experiences were directly related to the nature of nurse-patient relationships and high-quality patient care can be realized by utilizing the elements of Peplau’s theory.

A second article that demonstrates testing of this theory is a qualitative research conducted to determine the role of therapeutic interaction and communication in the case of a child delinquent. During this research, two nurses followed the four phases of the interpersonal relations model to care for a child diagnosed with delinquent behavior (Arabaci & Tas, 2019). From the interaction, the effects of communication between the patient and the nurse using Peplau’s theory were observed. Aspects like anger and aggression were observed to be reduced by utilizing the phases of the theory (Arabaci & Tas, 2019). The theory served as a guide to care for the patient and it was observed to offer a simple way to establish an effective relationship with the patient. After undergoing treatment, the application of Peplau’s model allowed the child to be discharged with a commitment to take responsibility for his life.

Theory Evaluation

The interpersonal relations theory can be evaluated using key questions that focus on key elements of theories such as clarity, consistency, and application. Is the theory articulated and easy to understand? The theory is clear because it highlights four phases of interpersonal relations and the role of the nurse in each phase. Are the concepts and propositions within the theory logically consistent with one another? Certainly, the concepts of Pelplau’s theory are logical and consistent because the phases progress from the beginning of the nurse-patient relationship to the termination phase. Does the theory have practical relevance and applicability to nursing practice? This theory applies to nursing practice, especially in the areas of psychiatry and community health nursing (Wasaya et al., 2021). The theory’s emphasis on therapeutic relationships, promoting patient autonomy, and facilitating communication resonates with contemporary nursing values and principles.

Theory Evaluation: Use in Practice

The theory of interpersonal relations has been widely utilized in nursing practice to enhance patient care, improve therapeutic communication, and promote positive health outcomes. In the field of psychiatry, the theory has been used to help nurses establish rapport, and trust, and engage patients in meaningful dialogue (Clark, 2023). In the field of oncology, the theory guides nurses in supporting patients and their families through the emotional and physical challenges of cancer diagnosis, treatment, and survivorship. A randomized trial among patients with prostate cancer revealed that Peplau’s interpersonal relations theory was effective in minimizing issues like urinary incontinence and restoration of other physiologic symptoms (Yang et al., 2022). Peplau’s theory has also been used to improve practice in aesthetic nursing by encouraging communication between providers and patients. The concepts of the theory are found to be effective in patients who choose to undergo elective cosmetic procedures by ensuring articulation of the patient’s bothersome traits (Fletcher, 2023).

In conclusion, nurses play multiple roles when caring for patients and the formation of relationships is key. Hildegard Peplau’s theory of interpersonal relationships has been used to provide a framework for how nurses can deepen their relationships with patients. The key concepts of this theory include orientation, identification, exploitation, and resolution (Hagerty et al., 2017). Peplau’s theory has been used to improve practice in many areas including psychiatry, oncology, and aesthetic nursing. This theory supports interaction with patients and the delivery of patient-centered care by dictating how nurses should approach their practice.

References

Arabacı, L. B., & Taş, G. (2019). Effect of Using Peplau’s Interpersonal Relation Nursing Model in the care of a juvenile delinquent. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 10(3).

https://www.journalagent.com/phd/pdfs/PHD_10_3_218_226%5BA%5D.pdf

Clark, G. (2023). A history of the concept of interpersonal relations in nursing based on the psychiatric nursing textbook literature. Issues in Mental Health Nursing, 44(1), 48-54. https://doi.org/10.1080/01612840.2022.2108948

Fletcher, L. (2023). Peplau’s theory of interpersonal relations and its applications in aesthetic nursing. Journal of Aesthetic Nursing, 12(3), 145-148. https://doi.org/10.12968/joan.2023.12.3.145

Hagerty, T. A., Samuels, W., Norcini-Pala, A., & Gigliotti, E. (2017). Peplau’s Theory of Interpersonal Relations: An Alternate Factor Structure for Patient Experience Data?. Nursing science quarterly, 30(2), 160–167. https://doi.org/10.1177/0894318417693286

Vogelsang, L. (2022). Peplau’s Theory of Interpersonal Relations: Application to asynchronous nursing education. Canadian Journal of Nursing Informatics, 17(3-4).  https://cjni.net/journal/?p=10464

Wasaya, F., Shah, Q., Shaheen, A., & Carroll, K. (2021). Peplau’s theory of interpersonal relations: A case study. Nursing Science Quarterly, 34(4), 368–371. https://doi.org/10.1177/08943184211031573

Yang, X. H., Wu, L. F., Yan, X. Y., Zhou, Y., & Liu, X. (2022). Peplau’s interpersonal relationship theory combined with bladder function training on patients with prostate cancer. World journal of clinical cases, 10(9), 2792–2800. https://doi.org/10.12998/wjcc.v10.i9.2792