In the last post I applied Orem’s Self-Care Theory to correctional nursing practice. It fit well in a sick call situation but doesn’t give much attention to the emotional/psychological needs of the patient. So, I have been on the search for a practical theory that might help in that sphere. Thus, I happened upon the classic nursing theory of Interpersonal Relations developed by Hildegard Peplau.
What is attractive about Peplau’s theory of nursing practice is that it focuses on the dynamics of the nurse-patient relationship and sees the nurse’s role as a therapeutic force in that relationship. She also emphasizes the importance of communication and interviewing skills in nursing practice and that nurse-patient interactions promote growth for both the patient and the nurse. Correctional nurses must often quickly develop relationship in brief patient encounters in order to determine the health concern and needed interventions so Peplau’s theory holds promise for application in the criminal justice system. Here are the high points.
The Theory of Interpersonal Relations provides a number of roles the nurse plays in a patient relationship depending on immediate needs. These roles can change overtime as the patient progresses through various stages in their health or illness. Here are a few of the common nursing roles identified in the theory.
- Stranger – Start the relationship with an accepting attitude that will build trust
- Teacher – Provide information related to the patient’s need or interest
- Resource Person – Provide information that will assist in better understanding a situation or problem
- Counselor – Assist the patient to integrate the meaning of the current situation along with guidance and encouragement to adapt to new situations
- Surrogate – Act on the patient’s behalf as an advocate, when needed
- Leader – Encourage the patient to take on the responsibility for meeting health care needs
Phases of the Nurse-Patient Relationship
Besides various roles, there are also natural phases that a nurse-patient relationship moves through.
- Orientation: During this phase of the relationship the nurse identifies the health care problem of concern and moves from a stranger to one or more of the other roles depending on what is discovered.
- Identification: Here the nurse determines the appropriate professional assistance to provide to the patient. The patient, in turn, begins to feel supported and has decreased feelings of helplessness and hopelessness.
- Exploitation: In this phase assistance is provided and the nurse supports the patient in ‘exploiting’ all the avenues of help.
- Resolution: In this final phase the patient leaves the relationship in a healthier emotional balance, no longer needing professional nursing services. The relationship ends.
Applying Peplau’s Theory to Correctional Practice
Will Peplau’s theory work in a correctional nursing interaction? Let’s apply it in this intake screening encounter.
A 34 year old husband and father of 2 is booking in to a small county jail on a 30 day sentence for possession and sale of a controlled substance. A nurse is performing the receiving screening and preparing to place a TST when he states, “I just want to get this over with. I figure if I mind my own business I can stay out of trouble and get on with it. They’ll leave me alone, won’t they?” He looks stiff and nervous.
How might Peplau’s Theory of Personal Interaction help in this patient situation? Let’s walk through the phases of the nurse-patient relationship.
Orientation: Using an accepting tone of voice and open body language the nurse responds, “It’s tough going to jail. Tell me about your concerns. Maybe I have some information for you.”
Identification: The patient is slow to respond but finally shares with the nurse that he has never been in jail before and he is anxious about gangs, violence, and sexual assault. He says he has seen a lot of things on television. The nurse determines that she can take on the role of teacher, resource person, and counselor to this patient.
Exploitation: The nurse acknowledges his anxiety, instructs him on how to access health care and some of the other support services available, including chaplain services. She explains that, fortunately, there is little gang activity or sexual assault in this small jail and counsels him on how to report any sexual advances.
Resolution: The patient is visibly more relaxed after this information is shared and proceeds through the rest of the health screening. At the conclusion of the encounter, the nurse makes direct eye contact with the patient and states, “You can do this. It may be one of the toughest things you have ever done, but you can make it through.” The patient nods and seems to be pondering those words as he heads back out to the booking room.
So, what do you think? Would Peplau’s Theory of Interpersonal Relations work in your setting? Share your thoughts in the comments section of this post.
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