In the theory of interpersonal relations in nursing, Peplau emphasized .. The orientation phase was described by Peplau () as a time for . in nursing: A philosophical-ethical analysis of the work of Hildegard E. Peplau. In , Hildegard Peplau, a legendary nurse theorist, introduced a theory of The roles have also been described in relation to nursing care for specific clinical . Adams () explains the start of the nurse-client relationship (as per this theory ) is at 'orientation'. This is when the client exposes the issue.
The stranger role occurs when the nurse and the client first meet and become acquainted.
They begin the relationship as strangers, each with preconceived expectations for the first encounter. The goal of the nurse is to establish the relationship and build trust with the client. Peplau believed that compassionate verbal and nonverbal communication, a respectful approach, and nonjudgmental behavior are essential to this role.
Successful implementation of the stranger role is the foundation for development of a therapeutic relationship and a necessary condition for the establishment of the other roles. Assisting the client to attain knowledge to improve health is the primary goal of the teacher role Forchuk et al. This process may be formal, such as providing detailed instructions for individuals or conducting training sessions for groups to teach a health-related behavior, or the process may be informal, such as modeling patterns of health and wellness in the therapeutic relationship Lego, The leadership role involves collaboration between the nurse and the client to meet desired treatment goals.
The goal of the nurse is to help the client accept increased responsibility for the plan of care Peplau, In the surrogate role, the nurse functions as an advocate or a substitute for another human being who is well known to the client, such as a parent, sibling, other relative, friend, or teacher Lego, Through this process a client may unconsciously transfer behaviors or emotions that are connected to a significant other onto the nurse. The nurse addresses this reaction and assists clients to recognize the differences as well as similarities between themselves and the other.
In the counselor role, the nurse encourages the client to explore his or her current situation or presenting problem. The nurse must be aware that such exploration often engenders anxiety and, therefore, must facilitate an atmosphere that is conducive for the client to safely express his or her concerns Peplau, To successfully implement the counseling role, the nurse must demonstrate active listening skills, apply therapeutic communication techniques, provide guidance and support in the process of self-discovery, and maintain professional boundaries and self-awareness Gastmans, Although Peplau did not include the technical expert role in her original work, it is now considered to be one of the primary helping roles of the nurse-client relationship Peplau, As a technical expert, the nurse demonstrates technical skills to perform nursing care.
The technical expert role includes physical assessment and interventions and the use of equipment, such as intravenous pumps, blood pressure cuffs, and ventilators. The implementation of the helping roles Peplau, has been described in a number of settings, including psychiatric and mental health Doncliff, ; Feely, ; Forchuk et al. The research questions were as follows: After providing informed consent, the men and women participated in minimally structured interviews conducted in their communities by advanced practice nurses.
Initially, participants were asked broad, open-ended questions to encourage them to describe their experiences of sexual violence, the context in which it occurred, and how they responded to it. Because one of the aims of the parent project is to develop a sexual violence assessment guide to be used by nurses in their daily practices, a series of more structured questions regarding healthcare experiences were asked at the end of the interview.
Have you had contact with any agencies, such as healthcare, police, court, rape crisis? What were those experiences like? Based on your experiences, what advice would you give to healthcare professionals who encounter women or men who have experienced sexual violence or other types of abuse?
The interviews were audiotaped, transcribed, and entered in the N6 computer software program QSR, Healthcare professionals are considered to be any individuals who provide services to promote the physical and mental well-being of others and to care for those who are ill or injured.
Because most participants spontaneously discussed receiving healthcare in the early part of the interviews, and all responded to the more structured questions regarding healthcare at the end of the interviews, the researchers determined that ample data regarding encounters with healthcare professionals were provided by 60 participants.
Healthcare professionals described by these participants included nurses, physicians, psychologists, social workers, counselors, and therapists. They independently read the transcripts, highlighted content related to healthcare, and divided this content into text units i.
The raters then compared their selected text units and agreed on which units should be included in the analysis. At this point, it was evident that the participants had positive or negative, rather than neutral, recollections of their encounters with healthcare professionals. Without being prompted by the interviewer, they spontaneously indicated for each encounter whether the healthcare professional had been helpful or hurtful.
Peplau’s Theory – A Nurse/Patient Collaboration
On the coding sheets, which contained definitions of the helping roles, the raters independently coded the text units to one of the roles and indicated whether the role had been performed in a way that was helpful done correctly or hurtful done incorrectly.
After the raters coded 10 transcripts, they gave their coding sheets to the project director, who calculated an intercoder reliability index, that is, the number of agreements text units coded to the same role by both coders divided by the number of agreements and disagreements.
To achieve an index above. After all 60 transcripts were coded, the inter-coder reliability index was. The co-investigator of the parent study the second author then met with the raters to review the 34 text units that were coded to different roles by the raters or placed in the Other category.
The goal of this meeting was to determine the best disposition of these units without forcing data to the theory. For 14 of the text units, the group determined that disagreement was attributable to how the raters interpreted the definition of counselor. References to healthcare encounters in which the professional had used therapeutic communication skills e.
- Hildegard Peplau
- Peplau’s Contributions to Psychiatric and Nursing Knowledge
- Hildegard Peplau’s Theory and the Healthcare Encounters of Survivors of Sexual Violence
The group determined, therefore, that text units about professionals using therapeutic communication skills to provide healthcare should be coded as technical expert unless the professional was assisting the client to explore their life situations, in which case it should be coded as counselor. The text units were recoded accordingly.
For 9 of the text units, the group decided that disagreement occurred because the text was not about actual healthcare encounters and should be eliminated from the coding.
These units were also eliminated. On examination, however, the group noted that these text units were similar in that they were all examples of encounters in which a healthcare professional was present with a participant in a social situation in a way that felt supportive to the participant.
The group agreed that these text units constituted a new category that they labeled social support and coded them as such. The group then reviewed the units deemed codable to ensure that they were coded accurately. Results The Sample The sample included 30 women and 30 men who ranged in age from 18 to 62 years.
Hildegard Peplau’s Theory and the Healthcare Encounters of Survivors of Sexual Violence
Other ethnic groups and biracial participants were represented in smaller numbers. The participants had experienced a wide range of types of sexual violence, from sexual abuse of long duration to onetime sexual assaults. Text Units Coded to the Helping Roles Of the text units coded, female participants provided and male participants provided The number of text units coded to different types of professionals were therapists, 13; counselors 63; physicians, 31; psychiatrists, 23; social workers, 7; nurses, 6; and psychologists, 3.
In addition, 43 text units were coded to healthcare professionals because the participants did not specify which specific discipline the professional practiced.
The findings answered the four research questions: The number of text units coded to each role were counselor, 79; technical expert, 78; stranger, 13; resource person, 2; teacher, 4; leadership 6; and surrogate, 0.
Sarah, a year-old Caucasian female who had experienced multiple events of sexual abuse by family members, described the role of social support: One hundred and forty-seven of the text units were coded as helpful interactions. Of these, 57 were coded to the counselor role and 66 to technical expert role.
The numbers of text units coded to the remaining roles were stranger, 6; resource person, 2; teacher, 3; leadership, 6; and social support, 7. Ella, a year-old African- American female who experienced a rape by an acquaintance, said of her experience with a counselor: I can come in and I can see you….
Um, I guess basically I meet with my counselor and we talk and we just set different little goals and she explained some stuff that happened to her and I explain stuff that happened to me and I feel real open to express how I feel.
Melvin, a year-old African American who had experienced childhood sexual abuse CSAdescribed how his psychiatrist facilitated insight: Specifically, participants felt helped if a healthcare professional listened attentively and provided empathic responses when they talked about the violence. I was very paranoid. I was locking all the doors, locking all the windows, [closing] all the blinds, [closing] all the curtains, you know. I felt like they felt sorry for me…. When Melanie, a year-old biracial woman who had experienced a lifetime of sexual violence, asked a healthcare professional what she should do with her children who were exhibiting problematic behavior.
They give you literature like on gonorrhea and I think syphilis. She [the therapist] suggested that I write him [the perpetrator] a letter. Negative experiences with professionals performing the counselor role often involved therapists who did not believe the participant when he or she revealed the sexual violence, who minimized the importance of the violence, failed to provide in-depth mental health care, or violated professional boundaries.
Alvin, a year-old Caucasian male who had been raped while in the military, described a series of hurtful encounters with a therapist: I decided on the third day that I saw that guy [a therapist] I was going to say, if I had to take three issues that I want to deal with over the next five months, this is issue number 1 [hits the table], which was the assault.
And this is issue number three, and that was to deal with my marital problems. But, in that order. Hurtful encounters with healthcare professionals in the technical expert role often occurred when they had poor communication skills or provided physical care in an insensitive or unskillful manner.
Sally, a year-old African American female who survived intimate partner violence in adulthood, talked about a social worker who showed lack of respect by not coming to a scheduled appointment. The IOM's framework is one that emphasizes patient-centered care and places patient dignity at the forefront.
Peplau theorized that nurse-patient relationships must pass through three phases in order to be successful: During the brief orientation phase, hospitalized patients realize they need help and attempt to adjust to their current and often new experiences.
Hildegard Peplau - Wikipedia
Simultaneously, nurses meet patients and gain essential information about them as people with unique needs and priorities Peplau, Among the many roles that nurses assume in their interactions with patients, the first role during the orientation phase is that of stranger.
Patients and nurses quickly pass through this phase and nurses must continue to display courtesy and respect throughout the three phases. Given that characteristics of the orientation phase are continued in the other two phases; in the current study, the orientation phase was not initially hypothesized to be a latent factor.
The next phase is the working phase, which accounts for the majority of nurses' time with patients. During the working phase, the roles of nurses become more familiar to patients; they begin to accept nurses as health educators, resource persons, counselors, and care providers.
Using this therapeutic form of communication, nurses provide reflective and nonjudgmental feedback to patients for the sake of helping them clarify their thoughts.