NURSING GRAND THEORIES (Peplau, Orlando, Travelbee)

Hildegard E. Peplau

Born on September 1, 1909, in Reading, Pennsylvania, USA; died on March 17, 1999

Hildegard E. Peplau

Known as the “Mother of Psychiatric Nursing” and “Nurse of the Century”.

Hildegard E. Peplau

She was the first nursing theorist to publish a major nursing theory after Florence Nightingale

Hildegard E. Peplau

Educational Background (Nursing Diploma in Pottstown Hospital School of Nursing in 1931, BA in Interpersonal Psychology from Bennington College in 1943, MA in Psychiatric Nursing in 1947, an EdD in Curriculum Development in 1953 from Teachers College, Columbia University)

Hildegard E. Peplau

Worked as a staff nurse in Pennsylvania and New York before becoming a school nurse at Bennington College, where she pursued her studies in interpersonal psychology

Hildegard E. Peplau

Served in the Army Nurse Corps from 1943 to 1945 at the 312th Field Station Hospital in England, where she collaborated with prominent figures in psychiatry

Hildegard E. Peplau

Extended Harry Stack Sullivan’s interpersonal theory to nursing practice and contributed to the advancement of mental health care in the United States during the postwar period, including developments surrounding the National Mental Health Act of 1946.

Person (Peplau)

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

Person (Peplau)

For her, the client is an individual with a felt need

Person (Peplau)

Lives in unstable equilibrium

Person (Peplau)

Viewed as unique biological-psychological-spiritual structure

Health (Peplau)

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

Health (Peplau)

Consists of interacting physiologic and interpersonal conditions

Environment (Peplau)

Existing forces outside the organism and in the context of culture

Environment (Peplau)

Encourages nurse to consider the patient’s “culture” and “mores” when the patient adjusts to the hospital routine

Nursing (Peplau)

a therapeutic and healing art

Nursing (Peplau)

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

Nursing (Peplau)

To educate and be a maturing force so that the patient (person) gets a new view of himself, given the need that he has presented

Orientation, Identification, Exploitation, Resolution

in chronological order, what are the phases of the nurse-patient relationship?

Orientation

The nurse and patient meet as two strangers

Orientation

The individual has a “felt need” and seeks professional assistance

Orientation

The nurse helps the individual to recognize and understand their problem and determine the need for help

Identification

Patient identifies with those who can help him/her

Identification

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

Patient attempts to derive full value from what he/she is offered through the relationship

Exploitation

Patient may make minor requests or display attention-getting techniques

Exploitation

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

Patient gradually puts aside old goals and adopts new goals

Resolution

Patient frees himself from identification with the nurse

Resolution

Termination of the professional relationship

Stranger, Resource Person, Teacher, Leader, Surrogate, Counselor

What are the 6 Nursing Roles According to Peplau

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

was an American nursing theorist born in 1926

Ida Jean Orlando

Earned her nursing diploma from New York Medical College School of Nursing in 1947, BS in Public Health Nursing from St. John’s University in 1951, and MA in Mental Health Consultation from Teachers College, Columbia University, in 1954

Ida Jean Orlando

Worked as a nurse, researcher, educator, and consultant, focusing on psychiatric nursing and the nursing process

Ida Jean Orlando

Developed the Deliberative Nursing Process Theory, emphasizing the identification and validation of patients’ immediate needs for help

Ida Jean Orlando

Believed that nurses should validate their interpretations of parents’ behaviors directly with them rather than making assumptions about their needs

Ida Jean Orlando

Authored The Dynamic Nurse-Patient Relationship

Person (Orlando)

Considers the person as a “human being” - a unique individual behaving verbally and non-verbally

Person (Orlando)

Individuals are able to meet their own needs and at times unable to do so

Person (Orlando)

Humans in need are the focus of nursing practice

Health (Orlando)

A person experiences “health” when their needs are met and they are free from discomfort

Health (Orlando)

An unmet need creates a deficit in health (helplessness), which serves as the exact initiator that necessitates nursing intervention

Environment (Orlando)

She did not define this in her theory. She did not evaluate how physical surroundings, cultural settings, families, or broader community groups impact the patient

Environment (Orlando)

She only focused on the patient’s immediate need, chiefly the relationship and actions between the nurse and the patient

Nursing (Orlando)

A unique, independent profession separate from medicine

Nursing (Orlando)

The function of professional nursing is to discover and meet an individual’s immediate need for help

Nursing (Orlando)

It must be carried out through a disciplined, interactive process where the nurse validates perceptions with the patient before taking action

Deliberative Nursing Process Theory

Orlando believed that the nurse helps patients meet perceived needs that the patient cannot meet for themselves

Deliberative Nursing Process Theory

Involves interacting with clients to meet immediate needs by identifying client behaviors, nurse’s reactions, and nursing actions to take

Deliberative Nursing Process Theory

Allows nurses to formulate an effective nursing care plan that can also be easily adapted when and if any complexity comes up with the patient

Deliberative Nursing Process Theory

Patients have their own meanings and interpretations of situations and therefore nurses must validate their inferences and analyses with patients before concluding

Presenting Behavior

This is the patient’s problematic situation

Presenting Behavior

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

Immediate Reaction

reflects how the nurse experiences their participation in the nurse-patient relationship

Nurse’s Reaction

The patient’s behavior stimulated ________, which marks the beginning of the nursing process

Nurse’s Action

When the nurse acts, an action process transpires

Nursing Process

The action process by the nurse in a nurse-patient contact

Automatic Nursing Process

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

The Nursing Process

The nurse decides on appropriate action to resolve the need in cooperation with the patient; This action is evaluated after it is carried out

The Nursing Process

If the patient’s behavior improves. The action was successful, and the process is completed

The Nursing Process

If there is no change or the behavior gets worse, the process recycles with new efforts to clarify the patient’s behavior or the appropriate nursing action

Assessment, Diagnosis, Planning, Implementation, Evaluation

In chronological order, What are the Stages of the Nursing Process?

Assessment

The nurse completes a holistic assessment of the patient’s needs

Assessment

The nurse uses a nursing framework to collect both subjective and objective data about the patient

Diagnosis

This stages uses the nurse’s clinical judgment about health problems

Diagnosis

It can then be confirmed using links to defining characteristics, related factors, and risk factors found in the patient’s assessment

Planning

Addresses each of the problems identified in the diagnosis

Planning

Each problem is given a specific goal or outcome, and each goal or outcome is given nursing interventions to help achieve the goal

Implementation

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

Implementation

Each intervention should be rational and evidence-based

Evaluation

The nurse looks at the patient’s progress toward the goals set in the nursing care plan

Evaluation

Changes can be made to the nursing care plan based on how well (or poorly) the patient is progressing toward the goals

Evaluation

If any new problems are identified in this stage, they can be addressed, and the process starts over again for those specific problems

Joyce Travelbee

was an American psychiatric nurse theorist born in 1926

Joyce Travelbee

Earned her nursing education at a hospital-based nursing school and later pursued a Bachelor of Science in Nursing and a Master of Science in Nursing

Joyce Travelbee

Worked as a psychiatric nurse, nursing educator, and instructor at various educational institutions

Joyce Travelbee

Developed the Human-to-Human Relationship Model emphasizing the nurse’s role in helping individuals and families cope with illness, suffering, and loss

Joyce Travelbee

Believed that nursing is an interpersonal process in which the nurse and patient relate to each other as unique human beings rather than merely as professional and patient

Joyce Travelbee

Authored Interpersonal Aspects of Nursing (1966; second edition, 1971)

Joyce Travelbee

died in 1973, leaving a lasting contribution to psychiatric nursing and the importance of human connection in nursing care

Person (Travelbee)

A unique irreplaceable individual - a one-time being in this world - like yet unlike any person who has ever lived or ever will live

Person (Travelbee)

a unique, irreplaceable individual who is in continuous process of becoming evolving, and changing

Person (Travelbee)

Patients are individual human beings in need of care, services, and assistance from other human beings who can provided the necessary support

Health (Travelbee)

Measured by subjective and objective health

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

Environment (Travelbee)

Defined human conditions and life experiences encountered by all men as suffering, hope, pain, and illness. These conditions are associated to the???

Illness (Travelbee)

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

Suffering, Pain, and Hope

What are the Human Conditions or Life Experiences according to Travelbee?