peplau' theory
Post on 27-Apr-2015
1.123 Views
Preview:
DESCRIPTION
TRANSCRIPT
INTERPERSONALRELATIONS
Hildegard E. PeplauA Middle-Range Nursing Theory Analysis
By
Argi Virgona, S.Kp. M.Kep
“A Light in the Darkness”
GOALS OF THE THEORY
She wanted “only to convey to the nursing profession ideas [she] thought were important to improve practice”
Fokus Peplau adalah kualitas interaksi nurse-patient dan nursing education
(O’Toole, 1989; Forchuk, 1993, p. 3)
Hilda in 1951
INTERPERSONAL RELATIONS THEORY
BASIC ELEMENTS: the patient the nurse the interaction between them
DEFINITIONS: CLIENT/PATIENT – orang,
pasangan, kelompok, komunitas layak mendapatkan asuhan manusiawi dengan dignity, privacy, ethics
ENVIRONMENT - Physiological, psychological & social yang mempengaruhi sakit & sehat
HEALTH – Forward movement of personality & human processes in the direction of creative, constructive, personal, and community living
INTERPERSONAL – Phenomena that occur between persons
NURSE – The medium of the art of nursing; a maturing force. “The unique blend of ideals, values, integrity, and commitment to the well-being of others…”
NURSING ROLES - to assist client starting as stranger, then technical expert, resource person, surrogate, counselor, teacher and others
(Forchuk, 1993; Peterson, 2009)
RELATIONSHIPS HAVE FOUR PHASES
ORIENTATION PHASE Preconceptions Parameter dibangun &
diidentifikasi Tahapan awal trust
dikembangkan Peran mulai dipahami
IDENTIFICATION PHASE Klien mulai mengidentifikasi
masalah Tujuan perawat : membantu
pasien mengenali his/her own interdependent/participation role & meningkatkan responsibility for self
(Belcher, 2002; Peterson, 2009)
RELATIONSHIP PHASES (CONT’D)
EXPLOITATION PHASE Klien mempercayai perawat
mampu mengeksplorasi seluruh potensialnya
Klien mengoptimalkan manfaat dari asuhan keperawatan
Memecahkan masalah dengan segera
Mengidentifikasi & mengorientasikan diri untuk pencapaian tujuan
RESOLUTION PHASE Fase terakhir dari nurse-patient
relationship Rasa aman klien terpenuhi Klien meningkatkan
kemampuannya untuk mengatasi masalahnya
(Belcher, 2002; Peterson, 2009)
THE NURSE ASSISTS THROUGH ROLES ROLES of NURSE:
Stranger (Orientation phase) Technical Expert & Authority
Figure Surrogate for significant
others Resource Person Change-Agent Researcher Counselor Teacher & More
Specific roles bervariasi pada setiap situasi nurse-client situation, terbatas hanya pada imajinasi & keterampilan perawat
Helping PatientsHelp Themselves- - Rather than feeding them,
Teaching them “to fish” --
INFLUENCED PSYCHOBIOLOGICAL EXPERIENCES
Setiap orang memiliki kebutuhan, frustrasi, konflik, & kecemasan yang saling mempengaruhi
Setiap orang memiliki basic needs & harapan dalam setiap hubungan
Nurse’s own self-understanding merespon tensions & coping mechanisms
Nurse memandu pasien utk pulih; tension and anxiety are converted into purposeful action as the result of the therapeutic relationship
(Peterson, 2009)
VISUAL MODEL OF MAJOR CONCEPTS
Peplau’s framework: Major Concepts and their Interrelationships(Forchuk, 1993, p. 8)
THEORY INSIGHTS - PROFESSIONALISM
Nurse memperoleh kompetensi dengan memahami > lanjut ttg self, concepts, roles & proses utk membantu pasien tumbuh & pulih
Peplau memperingatkan: danger of ‘social talk’ with patients – Perawat tdk diperbolehkan utk berbicara dgn cra yg sama pada px, kelg, atau kelompk. Harus mengarah pada efek therapeutic – promoting long-term well-being
Kebutuhan emosional perawat tidak boleh mempengaruhi pemberian askep
Interpersonal Relations theory membantu pasien untuk :
Observe more intelligently Intervene more sensitively
(O’Toole, 1989)
Check your emotional baggage
at the door of patient care
EVALUATION OF THEORY ADEQUACY:
Contributes to the nursing process
Clearly consistent with nursing’s values and mission
Limited in groups of people
Fairly narrow set of cultural assumptions
(Meiers & Sheran, 2009)
I disagree that it’s limited in groups - Lego demonstrates it has potential for group work
(Lego, 1998)
It can be used in any specialty area of nursing with patient contact
It is holistic in nature
CLARITY: Clear and logical fashion Definitions are readily
understandable Though concepts are at a
high level of abstraction, they can be learned with practice
EVALUATION OF THEORY
CONSISTENCY: Concepts and ideas
are parsimonious Worldview is
phenomenological in nature and remains consistent throughout the theory
(Meiers & Sheran, 2009)
LOGICAL DEVELOPMENT: Logically inductively
and deductively based
Many psychological theorists’ works integrated into development
Nursing role promotes the patient’s movement through the steps of the nursing process (Meiers & Sheran, 2009)
EVALUATION OF THEORY LEVEL OF
DEVELOPMENT: Remains at the
descriptive level Focusing on phases of
relationships and interactional/inter- and intrapersonal phenomena
Not changed significantly since Peplau’s original writings were published over 50 years ago
DISCRIMINATION: Peplau is clear about
making distinctions between the nursing and the medical profession
But theory can be used by all helping professions in practically all areas of the relationship arena
(Meiers & Sheran, 2009)
The patients who have overwhelming physiological needs (or unconscious) are not good candidates for this theory application (Belcher, 2002)
Use with family members would be appropriate
EVALUATION OF THEORY COMPLEXITY:
Theory has breadth, life and fluidity
The basic core of the theory is simple, but certain aspects of the psychology in communication make it more complex
(Meiers & Sheran, 2009)
The concepts are at a fairly high level of abstraction
Both inductive and deductive reasoning ability are part of this theory
Both quantitative and qualitative research can take place
REALITY CONVERGENCE: The basic tenants reality based,
particularly in nursing situations requiring healing nurse-patient communication
Real life Application: Nurses should be treating patients in a holistic fashion, no matter the context - It should be utilized more than it is, for the patient’s sake
It requires time & practice to master – start with the basics: a continual process improvement
Considering the economy & managed care, Jones reports (1996) “…the need to provide cost-effective quantifiable care may negate the value of Peplau’s theory”
I disagree - This theory is valuable as part of human development, maturity and individual healing in many contexts
EVALUATION OF THEORY PRAGMATIC UTILITY:
Nurses’ critical thinking, therapeutic-intervention/communication - beyond task oriented nursing
Requires self-scrutiny of motives and expectations by the nurse (maturity)
(Belcher, 2002) Requires understanding of
inductive reasoning skills It is the basis of higher levels of
caring Directly affects interventions
dealing with communication The interactions with the patient
spawn deeper thinking in both the patient and the nurse towards positive healthcare outcomes
(Meiers & Sheran, 2009) Utility based on individual use by
nurse to invest energy and vision into relationship understanding & healing
SCOPE: Used in practice domains where
interpersonal or intrapersonal difficulties are taking place – [all (?)]
Uses are broad; not confined to only psychiatric nursing, but other areas of nursing as well
(Meiers & Sheran, 2009) Limited in realm of
physiological/medical issues – but helpful to patients with concerns or “issues” –most pts have these to some degree
Very useful in settings of nursing education where focus on nurse-patient relationship and communication are discussed
EVALUATION OF THEORY
SIGNIFICANCE/CONTAGIOUS/CONTEMPORARY USE:
Criterion for significance has been met for the nursing discipline
(Meiers & Sheran, 2009)
Continued references to the theory in contemporary research and literature attests to continued utility
Many elements of the theory have become public domain and integrated into nursing practice without Peplau being credited
Theory has stood the test of time, though only moderate and variable use for formal research has occurred
(Belcher, 2002; Meiers & Sheran, 2009)
Used internationally in Australia
and New Zealand, Belgium, Canada, the UK, Ireland and the United States
Translated into multiple languages
Use of the theory by psychiatric nurses and advanced practice nurses is not uncommon
Documented as useful in many other areas of nursing: health education, palliative care, oncology, AIDS care, quality of life and many others (Belcher, 2002)
PREVIOUS APPLICATION TO PRACTICE Used widely around the
world – nursing education Often integrated into
policies without credit to Peplau – Public Domain
Patient health education, palliative care, oncology, AIDS care, quality of life, private practice, nurse practitioners, home care & of course, psychiatric nursing
Nurse counseling of individuals and groups
(Belcher, 2002; Lego, 1998; McNaughton, 2005; Beeber, 2001)
RECOMMENDED FOR NURSING PRACTICE ROUTINE
INTEGRATION into daily practice within any area of clinical nursing, with multi-faceted effects
Nurses in private counseling practice would increase
Theory requires the mature nurse to look deeply at own behavior, attitudes, motives, & actions during daily practice & in relationships – self-scrutiny
(Belcher, 2002)
Invites the nurse to be less self-gratifying, and more in tune to the needs of the patient (and support systems), as well as filtering into peer and professional relationships
RESULTS: All interactions within practice would be more mature and healing in a context of caring, potentially improving peer relations as well
Near elimination of disrespect between staff members with improved focus on the welfare of the patient – better focused care plans
RECOMMENDED FOR NURSING PRACTICE Patients would
perceive being better understood Would comprehend
instruction with less anxiety Would give higher scores in
levels of satisfaction regarding their nursing care
Re-admissions would decrease Increased comprehension
of teaching in patients Patient and staff increased
sense of responsibility for selves
Empowerment of both patients & staff
Improved health outcomes
Success stories and patient comments could be shared in staff meetings and newsletters to reinforce the new staff behaviors
Role modeling by nursing & management would give the atmosphere of healing and caring – less stressful environment
RECOMMENDED FUTURE RESEARCH
Quantitative & qualitative research demonstrating positive health-care outcomes needs to take place (Jones, 1996)
Focus on quantitative research would verify the theory’s contemporary value, even with today’s financial constraints It might require a blended effort of
Psychology and Nursing scholars
Specifically, quantitative studies needed to support the efficacy of the theory in relation to patient outcomes Improved mental and physical health
status Positive patient education results Favorable patient satisfaction
UPCOMINGNURSING RESEARCH
HAVE ANY QUESTIONS ???
top related