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Application of Interpersonal Theory in Nursing Practice



Introduction
  • Peplau’s theory focuses on the interpersonal processes and therapeutic relationship that develops between the nurse and client.
  • The interpersonal focus of Peplau’s theory requires that the nurse attend to the interpersonal processes that occur between the nurse and client.
  • Interpersonal process is maturing force for personality. Interpersonal processes include the nurse- client relationship, communication, pattern integration and the roles of the nurse.
  • Psychodynamic nursing is being able to understand one’s own behavior to help others identify felt difficulties and to apply principles of human relations to the problems that arise at all levels of experience.
  • This theory stressed the importance of nurses’ ability to understand own behavior to help others identify perceived difficulties.
The four phases of nurse-patient relationships are:
1. Orientation:
  • During this phase, the individual has a felt need and seeks professional assistance.
  • The nurse helps the individual to recognize and understand his/ her problem and determine the need for help.
2. Identification
  • The patient identifies with those who can help him/ her.
  • The nurse permits exploration of feelings to aid the patient in undergoing illness as an experience that reorients feelings and strengthens positive forces in the personality and provides needed satisfaction.
3. Exploitation
  • During this phase, the patient attempts to derive full value from what he/ she are offered through the relationship.
  • The nurse can project new goals to be achieved through personal effort and power shifts from the nurse to the patient as the patient delays gratification to achieve the newly formed goals.
4. Resolution
  • The patient gradually puts aside old goals and adopts new goals. This is a process in which the patient frees himself from identification with the nurse.
Peplau’s theory and nursing process
Peplau defines Nursing Process as a deliberate intellectual activity that guides the professional practice of nursing in providing care in an orderly, systematic manner.
Peplau explains 4 phases such as:
  • Orientation: Nurse and patient come together as strangers; meeting initiated by patient who expresses a “felt need”; work together to recognize, clarify and define facts related to need.
  • Identification: Patient participates in goal setting; has feeling of belonging and selectively responds to those who can meet his or her needs.
  • Exploitation: Patient actively seeks and draws knowledge and expertise of those who can help.
  • Resolution: Occurs after other phases are completed successfully. This leads to termination of the relationship.
In Nursing Process, the orientation phase parallels with assessment phase where both the patient and nurse are strangers; meeting initiated by patient who expresses a felt need.
Conjointly, the nurse and patient work together, clarifies and gathers important information.
Based on this assessment the nursing diagnoses are formulated, outcome and goal set.
The interventions are planned, carried out and evaluation done based on mutually established expected behaviours.
Peplau’s theory application nursing process:
The nursing process for Mrs. JL based on Peplau’s theory is as follows: 
  • Mrs. JL
  • 27 years
  • Diagnosis: Inter vertebral disc prolapse 
Assessment (Orientation phase)
Nursing diagnosis
Planning (Identification phase)
Implementation (Exploitation phase)
Evaluation                (Resolution
phase)
Mrs. JL is on pelvic traction and she is restricted to bed.
The need for bed rest and restriction was discussed.
Impaired physical mobility related to the presence of pelvic traction. Goal setting was done along with patient

Patient will have improved physical mobility as evidenced by participating in self care within the limits.
Provide active and passive exercises to all the extremities to improve the muscle tone and strength.
Make the patient to perform the breathing exercises which will strengthen the respiratory muscle.
Massage the upper and lower extremities which help to improve the circulation.
Provide articles near to the patient and encourage doing activities within limits.
Provide positive reinforcement for even a small improvement to increase the frequency of the desired activity. 
Carried out plans mutually agreed upon.
 
 
Provided active and passive exercises to all the extremities
 
Made the patient to perform breathing exercises
 
Massaged the upper and lower extremities
Provided article within the reach of the patient
 
Provided positive reinforcement to the patient
Mrs. JL was free to express problems regarding difficulty in mobilizing.

She expressed satisfaction when able to move without difficulty.

Assessment (Orientation phase) Nursing diagnosis Planning (Identification phase) Implementation (Exploitation phase) Evaluation                (Resolution phase)
Mrs. JL expresses pain in the low back region.
 
Regarding pain, discussion was made to assess the severity and the type and duration of pain. Also the measures to reduce pain were discussed.
Pain related to the degenerative changes in the lumbar region. Goal setting was done along with patient
Mrs. JL will have reduction in pain as evidenced by her verbalisation of reduction in pain responses.
Provide non-pharmacological measures for pain relief such as diversional activity which diverts the patients mind.
Give  the client  a neutral position
Always use back support while turning the patient that reduces the strain on the back.
Support the areas with extra pillow to allow the normal alignment and to prevent strain.
Administer analgesics as prescribed by the physician.
Provide pelvic traction to the patient
Carried out plans mutually agreed upon.


Provided non pharmacological measures like diversion, massaging, and pelvic traction.
Provided supine position to the client
Supported the back during position change
Used pillows to support the back.
Administered Tab. Hifenac P and Cap. Myoril 4mg as prescribed.
Given pelvic traction and explained the need for traction
Mrs. JL was free to express problems of pain.

 
Expressed that she got slight relief from pain.


Assessment (Orientation phase) Nursing diagnosis Planning (Identification phase) Implementation (Exploitation phase) Evaluation                (Resolution phase)
Mrs. JL expresses that she need assistance to get down from bed.
Regarding self care discussion was done and discussed regarding the measures to solve the problems.
Self care deficit related to the presence of pelvic traction. Goal setting was done along with patient
Client will achieve and maintain self care activities with assistance of caregiver or within her limits.
Keep all the articles within the reach of the patient.
Provide a call bell to the patient to call in any emergency
Frequently visit the patient and enquire for any needs.
Assist the patient in doing her self care activities.
Remove the weight of the traction as needed by the patient. 
Carried out plans mutually agreed upon.



Kept the articles within t he reach of the client


Frequently visited the patient and enquired for any needs
Assisted the client in doing her self care activities
Removed the weight as and when needed.
Mrs. JL was free to express problems of self care.
She used to call for the needs and all her needs were met appropriately
She achieved and maintained self care activities within her limits

Assessment (Orientation phase) Nursing diagnosis Planning (Identification phase) Implementation (Exploitation phase) Evaluation                (Resolution phase)
Mrs. JL is enquiring about the disease condition, its outcome and need for surgery
Discussed with the client regarding the disease process and the findings in the client
Anxiety related to hospital admission as evidenced by verbalisation and client & family appearing withdrawn Goal setting was done along with patient
Client will have reduced feeling of anxiety as evidenced by
asking fewer questions
Teach the family and client regarding the disease process.
Explain in simple understandable language of the client.
Allow and encourage the client and family to ask questions. Allow the client and family to verbalize anxiety.
Stress that frequent assessment are routine and do not necessarily imply a deteriorating condition.
Allow the family members to visit the client frequently
Carried out plans mutually agreed upon.


Taught the family regarding the disease process in simple Kannada

Allowed the client and family members to ask questions
She and her husband expressed their anxiety


Allowed the family members to frequently visit the client
Mrs. JL was free to express problems of self care.
She asked her doubts regarding the illness and the diagnostic procedures
She verbalized that her anxiety has reduced to some extent.


Assessment (Orientation phase) Nursing diagnosis Planning (Identification phase) Implementation (Exploitation phase) Evaluation                (Resolution phase)
Mrs. JL is enquiring about the disease condition, its outcome and need for surgery
Discussed with the client regarding the disease process and the need for follow up
Deficient knowledge related to the treatment measures to be continued even after the discharge. Goal setting was done along with patient
Patient will acquire adequate knowledge regarding the treatment and home care.
Explain the treatment measures to the patient and their benefits
Explain to the client the signs of aggravation of illness
Use simple and understandable terms
Clarify all the doubts of the patient of importance.
Repeat the information whenever necessary to reinforce learning.
Carried out plans mutually agreed upon.


Explained treatment measures and the need for follow up
Explained regarding the signs of aggravation of disease
Used simple and understandable terms for explaining
Clarified her doubts

Repeated the information
Mrs. JL was free to express problems of self care.
She expressed acquisition of knowledge regarding the disease and the signs of aggravation of illness
Summary
1. Orientation phase
  • Client is initially reluctant to talk due to pain.
  • Client is expressing that while standing she is having much pain.
  • Client expressed without movement and supine position gave her relief from pain. 
2. Identification
  • The client participates and interdependent with the nurse
  • Expresses the need for measure to get relief from pain
  • Expresses need for improving the mobility
  • Expresses need to know more about prognosis, discharge and home care and follow up.
3. Exploitation
  • Client explains that she gets relief of pain when lying down supine.
  • Cooperates and participates actively in performing exercises.
  • Client mobilizes changes position and cooperates during position changes.
4. Resolution
  • Client expressed that pain has reduced a lot and she is able to tolerate it now
  • She has agreed upon to continue the exercises at home
  • She also expressed that she would come for regular follow up after discharge.
Evaluation of the theory of interpersonal relations by Peplau
  • With the help of the theory of interpersonal relations, the client's needs could be assessed.
  • It helped her to achieve them within her limits. This theory application helped in providing comprehensive care to the client.
References
  1. Chinn PL, and Kramer MK. Theory and nursing- a systemic approach. 3rd edition. Philadelphia:  Mosby year book;1991.
  2. George JB. Nursing theories. 5th edition. New Jersey: Prentice hall; 2002.
  3. Alligood MR, Tomey AM. Nursing theory- utilization and application. 3rd edition. Missouri: Mosby Elsevier; 2006.
  4. Craven RF, Hirnle CJ. Fundamentals of nursing – human health and function. 5th edition. Philadelphia: Lippincott Williams and Wilkins; 2007.
  5. McQuiston CM and Webb AA. Foundations of nursing theory- Contributions of 12 key theorists. New Delhi: Sage Publications; 1995.
Description: Application of Interpersonal Theory in Nursing Practice
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