TFN MIDTERMS WEEK 4

HILDEGARD PEPLAU

-        Peplau was an American nurse and theorist who is often called the “Mother of Psychiatric Nursing” because of her pioneering work in mental health nursing.

-        She was born on September 1, 1909, in Pennsylvania, USA.

-        She died on March 17, 1999.

-        She developed the Interpersonal Relations Theory in the 1950s.

-        She also received numerous honors, including being named one of the most influential nurses of the 20th century.

THEORY OF INTERPERSONAL RELATIONSHIP

-        Emphasized the nurse-client relationship as the foundation of nursing practice.

-        Emphasizes the need for a partnership between nurse and client as opposed to the client passively receiving treatment (and the nurse passively acting out the doctor's orders).

STRANGER
TEACHER
RESOURCE PERSON
COUNSELOR
SURROGATE
LEADER

DIFFERENT ROLES OF A NURSE ACCORDING TO HILDEGARD PEPLAU

STRANGER

Receives the client the same way one meets a _____ in other life situations; provides an accepting climate that builds trust.

“Hi. I’m Nurse Duday. I’ll be caring for you today. How are you feeling?”

TEACHER

Imparts knowledge about a need or interest, emphasizes self-care, and helps the patient understand the teaching plan.

Demonstrating how to use an inhaler to a patient with asthma and letting them practice.

RESOURCE PERSON

Provides specific needed information that aids in the understanding of a problem or new situation.

The nurse explains what a CT scan is and what the patient should expect before the procedure.

COUNSELOR

Helps the patient understand and integrate the meaning of current life circumstances; provides guidance and encouragement to make changes.

Helping a patient process their emotions and plan the next steps.

SURROGATE

Temporary caregiver/motherly role; acts on the client’s behalf as an advocate.

A teenage patient sees the nurse as an older sister figure; the nurse uses this trust to encourage positive behaviors.

LEADER

Acts on behalf of the patient but also enables them to make decisions through cooperation and active participation.

During a group therapy session, the nurse guides the discussion so each patient gets a turn to share.

ORIENTATION
IDENTIFICATION
EXPLOITATION
RESOLUTION

4 SEQUENTIAL PHASES IN THE INTERPERSONAL RELATIONSHIP

ORIENTATION

-        Initial interaction between the nurse and the patient wherein the latter has a felt need and expresses the desire for professional help.

-        Problem-defining phase.

-        Starts when a client meets the nurse as a stranger.

-        Early levels of trust are developed.

-        Roles begin to be understood.

CATEGORY	DETAILS
Scenario	A patient newly admitted with major depressive disorder sits quietly, avoiding eye contact. The nurse introduces herself, explains confidentiality, and assures the patient they are in a safe space to talk.
Purpose	Builds trust and reduces initial anxiety.

IDENTIFICATION

-        Patient and nurse explore the experience & the needs of the patient, which leads to relatedness.

-        Selection of appropriate professional assistance.

-        Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness.

CATEGORY	DETAILS
Scenario	The patient begins to open up about feelings of hopelessness and difficulty sleeping. The nurse helps the patient recognize triggers for these emotions and works with them to set goals, such as attending one group therapy session.
Purpose	Patient identifies the nurse as someone who understands and can help.

EXPLOITATION

-        The patient derives the full value of the relationship as he moves on from a dependent role to an independent one.

-        Patient may fluctuate in Independence.

-        Client’s trust of nurse reached full potential.

-        Client making full use of nursing services.

-        Solving immediate problems.

-        Identifying and orienting self to goals.

CATEGORY	DETAILS
Scenario	The patient actively participates in art therapy, attends medication education classes, and seeks out the nurse to discuss coping strategies for when suicidal thoughts arise.
Purpose	Patient uses available therapeutic resources.

RESOLUTION

-        Patient earns independence over his care.

-        Termination of professional relationship.

-        The patient’s needs have already been met by the collaborative effect of patient and nurse.

-        Mutual termination of relationship.

-        A sense of security is formed.

-        Patient is less reliant on nurse.

-        Increased self-reliance to deal with own problems.

CATEGORY	DETAILS
Scenario	The patient shows improved mood, shares plans for outpatient follow-up, and thanks the nurse for helping them regain hope. The nurse reviews coping skills and prepares the patient for discharge.
Purpose	Ends the therapeutic relationship appropriately, promoting independence.

STRENGTHS

Useful in helping psychiatric patients become receptive to therapy

Based on reality and can be tested/observed through pure observation

Used in every aspect of the nursing profession, especially in patient care

WEAKNESSES

Limited or impossible to use with senile, comatose, or newborn patients

Can only be applied when communication occurs between the nurse and the patient

IDA JEAN ORLANDO

-        was a prominent American nurse, psychiatric nurse specialist, theorist, educator, and researcher.

-        She was born on August 12, 1926, and passed away on November 28, 2007.

-        She is best known for developing the Deliberative Nursing Process Theory.

DELIBERATIVE NURSING PROCESS THEORY

-        The theory proposes a flexible, patient-centered approach to nursing care. It centers on the idea that:

o   All patient behaviors–verbal or nonverbal–are meaningful expressions of needs or distress.

o   Nurses should deliberately interpret these behaviors, validate their understanding with patients, and plan care collaboratively–not merely follow routines or orders.

ASSESSMENT
NURSING DIAGNOSIS
PLANNING
IMPLEMENTATION
EVALUATION

5 COMPONENTS OF THE NURSING PROCESS

ASSESSMENT

-         GOAL: establish a database about the client’s response to health concerns or illness.

STEP	DESCRIPTION
Collecting data	The process of gathering information.
Organizing data	The process of categorizing data systematically.
Validating data	The act of “double-checking” or verifying data to confirm that it is accurate and factual.
Documenting data	Recording the collected, organized, and validated information.

SUBJECTIVE DATA
OBJECTIVE DATA

2 CLASSIFICATIONS OF ASSESSMENT

SUBJECTIVE DATA

Symptoms or Covert Data

Apparent only to the person affected

Can be described only by the person affected

Includes sensations, feelings, values, beliefs, attitudes, and perceptions of personal health status and life situations

OBJECTIVE DATA

Signs or Overt Data

Detectable by an observer

Can be measured or tested against an accepted standard

Can be seen, heard, felt, or smelled

PRIMARY SOURCE
SECONDARY SOURCE

SOURCES OF DATA

PRIMARY SOURCE

The Client

SECONDARY SOURCE

All other sources of data. Should be Validated, If possible.

OBSERVING
INTERVIEWING
EXAMINING

METHODS OF DATA COLLECTION

OBSERVING

Gathering data using the senses: - Skin color (vision) - Body or breath odors (smell) - Lung or heart sounds (hearing) - Skin temperature (touch)

INTERVIEWING

Planned communication or conversation with a purpose: - Identify problems or mutual concern - Evaluate change - Teach - Provide support - Provide counseling or therapy

EXAMINING (PHYSICAL EXAMINATION)

Systematic data-collection method: - Uses observation and inspection, auscultation, palpation, percussion - Blood pressure - Pulses - Hear and lung sounds - Skin temperature and moisture - Muscle strength

NURSING DIAGNOSIS

-        Analyzing and synthesizing data.

-        GOALS:

o   Identify client strengths.

o   Identify health problems that can be prevented or resolved.

o   Develop a list of nursing and collaborative problems.

ACTUAL DIAGNOSIS

- Problem is currently present at the time of assessment. - There are associated signs and symptoms confirming the problem.

- Hyperthermia - Acute Pain  - Ineffective Breathing Pattern - Impaired Gas Exchange - Ineffective Airway Clearance

RISK DIAGNOSIS

- Problem does not exist yet, but there are risk factors that make it likely to develop. - Focus is on prevention through early intervention.

- Risk for Infection - Risk for Bleeding - Risk for Ineffective Airway Clearance

NURSING DIAGNOSIS

Ineffective Airway Clearance

Disturbed Body Image

Risk for Unstable Blood Glucose

MEDICAL DIAGNOSIS

Pneumonia

Amputation

Type 2 Diabetes Mellitus

PROBLEM
ETIOLOGY
SIGNS AND SYMPTOMS

COMPONENTS OF NURSING DIAGNOSIS

PROBLEM

Describes the client’s health problem or the diagnostic label.

Ineffective Airway Clearance

ETIOLOGY

The cause or origin of the problem; explains why the problem exists.

Excessive mucus production due to respiratory infection

SIGNS AND SYMPTOMS

Observable or reported evidence of the problem; supports the diagnosis.

Wheezing, coughing, shortness of breath

PLANNING

-        identified priority client problems.

-        GOALS:

o   Develop an individualized care plan that specifies client goals/ desired outcomes.

o   Related nursing interventions.

-        Setting Priorities:

SMART	EXPLANATION
Specific	Clearly defines what the nurse wants to achieve. Avoid vague goals.
Measurable	The goal can be measured or observed to track progress.
Achievable	The goal is realistic and attainable for the patient.
Relevant	The goal is meaningful and directly related to the patient’s problem.
Time-bound	The goal has a specific timeframe for achievement.

-        Establishing a preferential sequence for addressing nursing diagnoses and interventions.

o   High priority (life-threatening)

o   Medium-priority (health-threatening)

Low priority (developmental needs)

HIGH PRIORITY

LIFE THREATENING

MEDIUM PRIORITY

HEALTH THREATENING

LOW PRIORITY

DEVELOPMENTAL NEEDS

IMPLEMENTATION

-        Carrying out (or delegating) and documenting planned nursing interventions.

-        GOALS:

o   Assist the client to meet desired goals/outcomes

o   Promote wellness

o   Prevent illness and disease

o   Restore health

o   Facilitate coping with altered functioning

-        Types of Nursing Intervention:

INDEPENDENT INTERVENTIONS	DEPENDENT INTERVENTIONS
Activities that nurses are licensed to initiate based on their knowledge and skills	Activities carried out under a doctor’s orders or supervision
Example: Performing TSB (Temperature, Skin, Breath assessment)	Example: Administering ordered medications

INDEPENDENT INTEVENTIONS
DEPENDENT INTERVENTIONS

TYPES OF NURSING INTERVENTIONS

INDEPENDENT INTERVENTIONS

Activities that nurses are licensed to initiate based on their knowledge and skills

Example: Performing TSB (Temperature, Skin, Breath assessment)

DEPENDENT INTERVENTIONS

Activities carried out under a doctor’s orders or supervision

Example: Administering ordered medications

EVALUATION

-        Measuring the degree to which goals/outcomes have been achieved.

-        Identifying factors that positively or negatively influence goal achievement.

-        GOAL:

o   Determine whether to continue, modify, or terminate the plan of care.

-        Evaluation Composition:

o   Goal Met

o   Partially Met

o   Not Met

JOYCE TRAVELBEE

-        She was an American psychiatric nurse, educator, and author, best known for revolutionizing nursing theory with her Human-to-Human Relationship model.

-        She was born in 1927 and died in 1973.

HUMAN TO HUMAN RELATIONSHIP MODEL

-        Travelbee emphasized that nursing is not merely about treating disease – it is about connecting human beings, a genuine human connection between the nurse and the person receiving care.

-        Nursing is an interpersonal process where one human helps another cope with illness and suffering.

ORIGINAL ENCOUNTER
EMERGING IDENTITIES
EMPATHY
SYMPATHY
RAPPORT

5 STAGES OF RELATIONSHIP ACCORDING TO JOYCE TRAVELBEE

ORIGINAL ENCOUNTER

The very first meeting; first impressions and initial communication.

Nurse in ER meets newly admitted patient with severe abdominal pain; introduces herself, explains triage, notes patient’s anxiety and pallor.

EMERGING IDENTITIES

Both recognize each other as unique individuals; bond begins forming.

During second vital signs, nurse learns patient is a chef; they share brief conversation about cooking. Relationship shifts from “nurse–patient” to “person–person.”

EMPATHY

Nurse truly understands and feels the patient’s emotional state.

Post-operative mastectomy patient cries; nurse acknowledges emotional and physical overwhelm and shares understanding.

SYMPATHY

Nurse desires to help and takes action to relieve suffering.

Nurse connects mastectomy patient with support group and arranges counselor visit.

RAPPORT

Mutual trust, respect, and emotional closeness are established.

Dialysis patient greets nurse with smile, updates her on labs, shares fears, trusts guidance.