Orientation phase of a therapeutic nurse patient relationship

Theories in Nursing Jadiam Lopez Aspen N491 Professor Anny Dionne 07/29/2020

Part 1: Nurse-Patient Interaction

Peplau theory focuses on the interpersonal processes and therapeutic relationship that develops between the nurse and the client. It requires that the nurses attend to the interpersonal processes that occur between the client and the nurse. The processes include; communication, nurse-patient relationships, roles of the nurse and lastly, pattern integration. The theory stresses on the importance of nurses’ ability to understand their own behaviors in order to help others identify perceived difficulties.

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The phases of the Nurse-Patient relationship as defined by Peplau

Peplau theorized that nurse-patient relationships must pass though four phases in order to be considered successful;

Orientation.

Identification.

Exploitation.

Resolution.

In Peplau’s theory, nursing is identified as an interpersonal, therapeutic process that happens when professionals, especially nurses participate in therapeutic relationships with people who are in need of health services (George, 2011).

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Orientation Phase

During this orientation phase that is also brief, patients who are hospitalized realize that they need help and hence attempt to adjust their current experiences.

According to Peplau, nurses interact with patients and gain important information about them as people with unique needs and priorities. The first role during this phase is that of the stranger. Previously, nurses were advised to greet patients with the respect and positive interest accorded to the stranger. Patients and nurses quickly pas this phase and hence courtesy and respect should be displayed by the nurses throughout the three phases (Hagerty, Samuels, Norcini-Pala, & Gigliotti, 2017).

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The Identification Phase

The patients identifies with those that can help them.

This phase accounts for majority of the nurses'’ time with the patients.

Nurses assess patients and use the collected data to teach and contribute to the interdisciplinary plan of care.

The role of the nurses becomes more familiar with the patients.

The patients begin to see nurses as resource persons, health educators, care providers and counselors. Using the stated therapeutic form of communication, nurses offer reflection and feedback without judging the patients to help them clarify their thoughts.

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The exploitation Phase

During this phase, the attempts to come out with the full value obtained through their interactions with nurses.

The patient actively seeks an draws knowledge and expertise of those who can help.

The nurse has the responsibility of projecting 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 set goals.

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The Resolution Phase

It is the final phase and is commonly thought of as discharge planning.

The patients free themselves from identification with the nurse.

The success of this phase depends on how well the nurses and the patients navigate the previously mentioned phases (Orientation and Working phases).

An important factor that occurs during the termination phase is when nurses teach patients about symptom management and recovery at home. With this said, it can be observed that nurses contribute enormously to the patients’ experiments.

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Current practice supporting the use of Peplau's theory

Peplau’s theory of interpersonal relations can be incooperated to promote holistic communication between adults at old age and nursing students.

An increase in life expectancy has seen older adults interacting more with healthcare workers. Holistic communication is used to help nursing student meet the clinical requirements of their programs. In order to function as licensed practitioners, they need to develop appropriate knowledge to take care of older adults. Peplau’s theory provides the nurses with a useful set of four interlocking and overlapping working phases for nurses’ interaction with patients in the form of the nurse- patient relationship. This theory therefore teaches the students on holistically communicating with the older adults.

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Part 2: Orem’s Self-Care Deficit Theory

Orem’s Self-Care Deficit Theory suggests that patients are better able to recover when they maintain some independence over their own self-care (Queirós et al., 2014). Dorothea Elizabeth Orem defined nursing as “The act of assisting others in the provision and management of self-care to maintain and improve human functions at home level of effectiveness.”

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The three related parts in Orem’s Theory

The self-care Deficit theory of Nursing Is composed of three interrelated theories;

The theory of nursing systems

The theory of self-care

The self-care deficit theory

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The theory of nursing systems

It is the product of a series of relations between the legitimate nurse and the legitimate client.

It is activated when the when a client’s therapeutic self-care demand exceeds the available self-care agency, leading to the need for nursing.

There are three theories under the nursing systems namely; wholly compensatory nursing system, partial compensatory nursing system, and supportive-educative system. Examples of these practices include;

Care of a newborn baby

Care of client recovering from surgery in a post-anesthesia care unit

A nurse bringing a meal tray for client who can feed himself

Nurse guiding a mother on how to breastfeed her baby

Concealing a pshycatric patient on more adaptive coping strategies.

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The theory of self-care

This theory focuses on the performance of and practices of the projects initiated by individuals that they perform on their own behalf to maintain life, health and well-being.

It is represented in three categories; universal self-care requisites that are associated with life processes and maintenance of the integrity of human structure and functioning; developmental self care requisites that are specialized expressions of universal self-care requisites focused for developmental purposes; and health deviation self-care requisites that are required in conditions of illness, injury or disease resulting from medical measures required to diagnose and correct the condition.

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The theory of Self-care Deficit

It delineates when nursing is needed.

Nursing is a requirement when a patient is limited in the provision of continuous effective self-care.

Orem clearly identified the five methods of helping patients and they include;

Teaching another

Guiding others

Supporting another

Acting for and doing for others

Providing an environment that promotes personal development regarding future demands.

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The major concepts of Orem’s Theory

Person

Environment

Health

Nursing

Major Assumptions

All patients wish to care for themselves.

Humans are capable of and willing to engage in self-care ad care for dependent members of the family.

Self-care and dependent care are learned behaviors through human communication and interaction with each other.

Nursing is a deliberate helping actions performed by nurses for the benefits of others over a certain period of time.

Application of Orem Self Care Deficit Theory on Psychiatric Patient

Different strategies are applied like offering concealing and teaching sessions that motivate the patient to think differently.

Orem’s theory encourages group therapy as is the case when providing support for a psychiatric patient.

Moreover, ludo and physiotherapy sessions can be arranged which overall will help the patient improve his condition.

Orem’s theory is highly applicable in the clinical setting and helps nurses improve the patients health by making them independent (Seed, & Torkelson, 2012). A nurse can assist in the speedy recovery of the patient by incorporating theoretical concepts into the practice.

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References

Deane, W. H., & Fain, J. A. (2016). Incorporating Peplau’s theory of interpersonal relations to promote holistic communication between older adults and nursing students. Journal of Holistic Nursing, 34(1), 35-41.

George, J. B. (2011). Nursing Theories: The Base for Professional Nursing Practice, 6/e. Pearson Education India.

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.

Queirós, P. J. P., Vidinha, T. S., & Almeida Filho, A. J. (2014). Self-care: Orems theoretical contribution to the nursing discipline and profession. Revista de Enfermagem [internet], 4(3), 157-63.

Seed, M. S., & Torkelson, D. J. (2012). Beginning the recovery journey in acute psychiatric care: Using concepts from Orem's self-care deficit nursing theory. Issues in mental health nursing, 33(6), 394-398.