NURSING GRAND THEORIES: PEPLAU • ORLANDO • TRAVELBEE

Hildegard E. Peplau

Theory of Interpersonal Relations. Known as the “Mother of Psychiatric Nursing” and “Nurse of the Century.” She was the first nursing theorist to publish a major nursing theory after Florence Nightingale.

Peplau’s definition of Person

An organism that “strives in its own way to reduce tension generated by needs”

Peplau’s definition of Health

Defined as “a word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living.”

Peplau’s definition of Environment

Encourages nurses to consider the patient’s “culture” and “mores” when the patient adjusts to the hospital routine. Existing forces outside the organism and in the context of culture.

Peplau’s definition of Nursing

A therapeutic and healing art. A “significant therapeutic, interpersonal process” that functions cooperatively with others to make health possible.

ORIENTATION PHASE

The nurse and patient meet as two strangers • The individual has a “felt need” and seeks professional assistance • The nurse helps the individual to recognize and understand their problem and determine the need for help.

IDENTIFICATION PHASE

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

EXPLOITATION PHASE

Patient attempts to derive full value from what he/she is offered through the relationship • Patient may make minor requests or display attention-getting techniques • 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.

RESOLUTION PHASE

Termination of the professional relationship. Patient gradually puts aside old goals and adopts new goals • Patient frees himself from identification with the nurse

Stranger

Greets the patient with respect and acceptance, building a foundation of trust

Resource Person

Provides clear, relevant information to help the patient understand their condition and care.

Teacher

Guides learning about health, treatment, and self-management.

Leader

Encourages participation, decision-making, and cooperation in the care process.

Surrogate

Acts as a substitute figure (e.g., parent, sibling, or confidant) to meet emotional needs temporarily.

Counselor

Listens, supports, and helps the patient explore feelings to promote self-awareness and coping.

Ida Jean Orlando

Deliberative Nursing Process Theory. Authored The Dynamic Nurse-Patient Relationship: Function, Process and Principles of Professional Nursing Practice (1961).

Orlando’s definition of Person

Considers the person as a “human being” – a unique individual behaving verbally and non-verbally. Humans in need are the focus of nursing practice

Orlando’s definition of Health

A person experiences this when their needs are met and they are free from discomfort. An unmet need creates a deficit in this (helplessness), which serves as the exact initiator that necessitates nursing intervention.

Orlando’s definition of Environment

did not define this in her theory. She did not evaluate how physical surroundings, cultural settings, families, or broader community groups impact the patient. She only focused on the patient’s immediate need, chiefly the relationship and actions between the nurse and the patient

Orlando’s definition of Nursing

It must be carried out through a disciplined, interactive process where the nurse validates perceptions with the patient before taking action. A unique, independent profession separate from medicine

Deliberative Nursing Process

nurse helps patients meet perceived needs that the patient cannot meet for themselves. identifying client behaviors, nurse’s reactions, and nursing actions to take.

Presenting Behavior

This is the patient’s problematic situation. • Considered the stimulus, causes an automatic internal response in the nurse, which in turn causes a response in the patient.

Distress

When the patient experiences a need that cannot be resolved, a sense of helplessness occurs.

Immediate Reaction

Perceptions stimulate automatic thought, and each thought stimulates an automatic feeling, causing the patient to act. • The immediate reaction reflects how the nurse experiences their participation in the nurse-patient relationship

Nurse’s Reaction

The patient’s behavior stimulated a nurse’s reaction, which marks the beginning of the nursing process

Nurse’s Action

When the nurse acts, an action process transpires.

nursing process

This action process by the nurse in a nurse-patient contact. The nurse decides on appropriate action to resolve the need in cooperation with the patient. This action is evaluated after it is carried out.

Automatic Nursing Actions

These are nursing actions decided upon for reasons other than the patient’s immediate need.

Deliberative Nursing Actions

These are actions decided upon after ascertaining a need and then meeting this need.

Assessment

The nurse uses a nursing framework to collect both subjective and objective data about the patient. The nurse completes a holistic assessment of the patient’s needs

Diagnosis

This stage uses the nurse’s clinical judgment about health problems. can then be confirmed using links to defining characteristics, related factors, and risk factors found in the patient’s assessment.

Planning

Each problem is given a specific goal or outcome, and each goal or outcome is given nursing interventions to help achieve the goal. Addresses each of the problems identified in the diagnosis.

Implementation

This is the stage wherein the nurse begins utilizing the nursing care plan to carry out essential nursing interventions.

Evaluation

The nurse looks at the patient’s progress toward the goals set in the nursing care plan. Changes can be made to the nursing care plan based on how well (or poorly) the patient is progressing toward the goals.

Joyce Travelbee

Human-to-Human Relationship Model

Travelbee’s definition of Person

A unique irreplaceable individual – a one-time being in this world – like yet unlike any person who has ever lived or ever will live. a unique, irreplaceable individual who is in continuous process of becoming, evolving and changing

Subjective Health

an individually defined state of well being in accord with self-appraisal of physical-emotional-spiritual status

Objective Health

absence of discernible disease, disability or defect as measured by physical examination, laboratory tests and assessment by spiritual director or psychological counselor

Travelbee’s definition of Environment

Defined human conditions and life experiences encountered by all men as suffering, hope, pain, and illness.

Illness

a category and classification

Subjective criteria

refer to the way in which a human being perceives himself or herself as ill

Objective criteria

are determined by the outward effects of illness on the individual

Travelbee’s definition of Nursing

An interpersonal process whereby the professional nurse practitioner assists an individual, family, or community to prevent or cope with the experience of illness and suffering, and if necessary, to find meaning in these experiences

Nurse-Patient Interaction

Refers to any contact between a nurse and an ill person

Therapeutic Use of Self

Ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing intervention

Original Encounter

First impressions. The nurse and patient see each other in stereotyped or traditional roles

Emerging Identities

Involves perceiving each other’s uniqueness. The link of the relationship begins to form

Empathy

Refers to the ability to share in the person’s experience (feeling with someone).

Sympathy

When the nurse wants to lessen the cause of the patient’s suffering (feeling for someone).

Rapport

Described as nursing interventions that lessen the patient’s sufferinga harmonious, trusting connection built between a nurse and a patient through mutual respect, empathy, acceptance, and active communication.