Introduction
The nursing theory involves an extensive and creative artistic development of ideas for a systematic view of an event or situation (Taylor & Renpenning, 2011). The most recognized types of nursing theories include grand nursing theories, mid-range nursing theories, and micro-range theories. This paper seeks to evaluate the mid-range theories to determine how they apply to nurse practice.
Mid-range nursing theories tend to address more precise phenomenon than grand theories. Besides, mid-range theories provide an efficient connection between nursing practice and other nursing theories. Thus, mid-range theories provide explanations, predictions, and concepts that are intended to answer queries concerning nursing practice.
In this light, this paper will explore the development and application of the mid-range theory. The most applied mid-range theories include Peplau’s theory that relates to interpersonal relations, Watson’s theory of human caring, and Orlando’s theory of a deliberate nursing process. Mid-range theories offer a perspective from which to examine difficult situations and a plan for mitigation (Sagar, 2014). This paper will use Peplau’s theory of interpersonal relations to help in describing, evaluating, and discussing the application of theories to the nursing phenomenon. Theorist Hildegard Peplau was born in Reading, Pennsylvania in 1909 and lived up to 1999.
Theory background
A philosopher known as Florence Nightingale introduced professional nursing during the early 20th Century. During the 20th Century, Nightingale envisioned and spearheaded nursing practices, and she served as a guide to the growth of the nursing practices in the United States (Senn, 2012). In the late 20th Century, other philosophers such as Hildegard Peplau emerged and started to link theories of nursing into research.
Even though the majority of these theories were categorized as grand theories, Peplau’s interpersonal theory emerged as a mid-range theory. This conceptual model by Peplau provided a means of comprehending elements that structure the nursing theory. Peplau defined these elements as concepts and propositions. The exploration of the concepts of Peplau’s theory reflects the four nursing paradigms including the persons, health, nursing, and the environment.
Peplau played a critical role in influencing and stressing the development of professional training and the significance of practice standards in the nursing field. Peplau made a tremendous contribution to the nursing field by emphasizing the model of interpersonal relations. This mid-range theory has and continues to influence the significance with which the nurse-patient relationship is regarded today.
The vital nature of the nurse-patient relations and its prominence as a therapeutic approach validates Peplau’s theory and explains both the art and science of nursing practice. This theory challenges nurses to strive and thrive in all stages of practice through consistent devotion to the essence of the nurse-patient relationship, involvement in evidence-based strategies, and delivery of leadership in transforming the health care paradigm to patient-centered (Penckofer, Byrn, Mumby, & Ferrans, 2011).
Peplau sought to address various issues using the interpersonal theory. Peplau observed nursing practice as a therapeutic interpersonal process since it entails interaction between people with a shared objective. In nursing practice, this shared goal creates an incentive for the nursing process to take a course in which the nurse engages in respectful relations with the patient (Senn, 2012). The two parties can learn and appreciate through interactions. This theory suggests that the role of the nurse is to assist patients to realize their felt problems through interactions. Consequently, nurses should employ principles of human relations to issues that emanate at all stages of practice.
This theory explores the stages of interactions beginning with orientation, identification, exploitation to resolution. This theory seeks to explain roles in nursing practice and ways for learning to nurse as an interpersonal course. This theory seeks to reveal that nursing is therapeutic in that it helps heal a person who is unwell or who requires medical attention. This theory further shows that the attainment of treatment goals entails a chain of stages and patterns. Peplau seeks to show that the success of a nurse or a patient relies on the ability to work together through the healing process (Senn, 2012).
Theory description
Mid-range nursing theories can be advanced through inductive or deductive strategies. In the deductive approach, the quantitative methodology is applied in developing the theory by adopting ideas from other sources (Sagar, 2014). The inductive approach in advancing a theory is used if the information is available. The inductive approach utilizes observations in many scenarios. Peplau employed both inductive and deductive approaches in her theory development. Peplau employed both inductive and deductive approaches in advancing her theory.
Deductively, Peplau successfully incorporates ideas from other theories to build her interpersonal relations theory. For instance, she was motivated by the work of Sigmund Freud when seeking information on unconscious motivation. When researching about the nurse-patient relationship, Peplau relied on Harry Sullivan’s theory of interpersonal relations. Besides, Peplau integrated ideas of the humanistic theorists such as Abraham Maslow and Carl Rodgers.
Inductively, Peplau used direct observations and conversations with participants to gather information. For instance, during her study, she conducted a study by sitting nursing students with a patient and observed what happened (Senn, 2012). These observations led to the introduction of psychotherapy by nurses. Patients coping with certain sickness strive to become aware of their conditions. The interpersonal relations theory helps nurses to assess the patients’ needs and further to commence health care interventions. Peplau offers an explicit explanation regarding the theoretical concepts. For instance, minor concepts including tension, anxiety, goals, and stress are determined with explicit interlink within them and interlinking phases.
There are various propositions that Peplau seeks to explain in her interpersonal theory. Propositional phrases in a study reflect the theorist’s view regarding how concepts influence each other. Peplau’s theory provides nurses with the knowledge to gather, plan, and categorize patient data and to comprehend patients’ health status. Theoretical concepts and theories link all stages of the nursing practice, including organizing, executing, and explaining nursing care, while also exploring and defining desired feedback and product of care.
The concepts act as classifications to the nurse in establishing the important data that should be gathered to enable assessments and to implement nursing diagnoses (Cowling, 2007). The concepts also present the forms of nursing care and patient development goals to be indicated in the care plan.
Theory evaluation
Peplau’s theory builds on two main assumptions. The first assumption emphasizes the kind of nurse each person is capable of becoming. She suggests that the kind of nurse one becomes determines what every client will learn through the nursing process. Second, Peplau believed that the patient and nurse thrive because of therapeutic relations. In other words, she sought to imply that communication and interacting skills are critical elements in nursing practice. Besides, nurses must clearly understand their strengths to facilitate their patient’s wellbeing.
Peplau identifies four nursing meta-paradigm that influences interpersonal relation in nursing practice. She offers both theoretical and operational meaning to these concepts including nursing, persons who include the nurse and the patient, health, and environment. The definition of these concepts is very critical in comprehending the theory of interpersonal relations. She defines nursing as a restorative process involving a sick individual or a person in search of health services and a nurse who has adequate training to offer assistance.
Persons are defined as organisms that exist in unstable circumstances and rely on a nurse to gravitate towards equilibrium (Basavanthappa, 2007). The nurse should have the capacity to determine the patient’s problems and be able to forge relationships that will nurture their interpersonal skills as well as improve the wellbeing of the patient.
The patient is defined as an individual worthy of respect, autonomy, privacy, and ethical concerns (Cowling, 2007). Health is a sign to imply the positive development of personality and stability. There are various indicators of health such as emotional, physical, and social wellbeing. The environment entails the area where therapy occurs. The environment includes structured components such as the ward and unstructured components. The unstructured components are often neglected though vital for patient recovery.
The unstructured components include patient-patient, staff-patient, and staff-staff relationships (Basavanthappa, 2007). Besides, Peplau urges the nurse to address issues of diversity such as culture and mores. Peplau remains consistent in the way she deploys these concepts to explain the complex theory of interpersonal relations.
In a bid to reinforce the interpersonal relations, Peplau identifies four phases that are essential in guiding the nurse-patient relationship. The phases include orientation, identification, exploitation, and resolution. Every stage is seen as dependent on each other and requiring mutual understanding as nurses and patients learn to collaborate in problem resolution. The nurse adopts various roles during these stages.
The roles include leadership, surrogate role, teacher, resource person, and accepting the patient objectively. During the orientation stage, the nurse and the client meet as strangers and start by knowing each other (Penckofer et al., 2011). Ideally, this phase involves rapport and trust-building, identifies the major problem, and designs a model of interacting.
During the identification phase, the goal of the interactions is to establish clarity regarding patient’s presumptions and anticipation of nurses and nursing practice. Such clarity helps improve acceptance, rapport, identify feelings and establish people who can assist in the treatment process (Taylor & Renpenning, 2011). If the nurse and the patient agree to a specific care approach, it is time to transition to the exploitation phase.
This phase is a critical stage where the care plan is implemented and explored for its effectiveness. The patient can benefit from the available resources to facilitate quality health care and wellbeing. The nurse should act as a leader to guide and ensure that the patient develops the ability to take charge of his/her situation. During this learning phase, patients become more responsible and autonomous.
When the problem is addressed, it is important to shift to the resolution phase. Resolution is the last phase that entails gradual termination of the professional relationship. The patient’s needs have been addressed adequately through a collaborative effort of the nurse and the patient. The patient enjoys increased emotional and physical balance, and the nurse manifests a higher level of professionalism (Sagar, 2014).
Peplau’s work manifests a high level of consistency in the way she analyses nurse-patient relations and the phases of their relationships. Peplau’s work is relevant in other nursing situations such as in the relationship between staff.
Besides, her findings are highly supported by the scholarly work of other theorists such as Sullivan and Maslow. Peplau’s theoretical ideas continue to be important in health care not only in psychiatric mental health practice but also in areas where patients are faced with interpersonal or intrapersonal challenges. Furthermore, this theory offers a logical perspective on understanding nursing practice (Sagar, 2014). As indicated earlier, this theory is consistent with various validated studies, laws, and ethical considerations but is open to criticism and further development.
Theory application
The principle aim of Peplau’s theory is to motivate nurses, philosophers, practitioners, and academicians in designing and facilitating the practice of nursing. Additionally, the mid-range theories have fulfilled the crucial functions of distinguishing nursing from other health professions. This theory has also contributed to the nurse’s understanding of the patient’s situation, issuing diagnoses, and possible approaches for its proficiency.
Interpersonal relations theory is a contemporary nursing model that expresses the patient’s wellbeing. A relationship is nurtured upon realizing an individual’s health. Interpersonal relations are built by providing the physical, mental, and emotional health care of a patient. These relations promote the standards of life of a patient and that of his or her loved ones. According to Penckofer et al. (2011), nursing entails assisting an individual through challenging times.
These concepts are highly applicable in my area of practice, education, and administration. For instance, providing care to psychiatric patients and emotionally challenged people requires the nurse and patient to work together.
This theory requires nurses to serve as a resource person by offering answers to patient’s questions and needs. The nurse should also serve as a teacher. The nurse should probe to understand what the patient knows to create a basis for learning through experience. As a leader, this theory assists nurses to embrace teamwork in setting goals. The patient is allowed to be an active participant rather than a passive consumer of nursing plans. When the nurse engages in dialogue and observations to gather evidence, the nurse improves problem-solving skills (Cowling, 2007).
In nursing education and research, Peplau’s theory offers a framework for curriculum design. This theory guides decision-making. Besides, the theory provides a platform for creating knowledge and new conclusions. Theories help to close gaps in nursing education, offer a chronological approach to interpreting results, and validate new ideas (Basavanthappa, 2007). However, its application is limited to the conscious and needy patients. This assertion holds is because theory cannot be applied to patients who have withdrawn since they lack a felt need. Similarly, unconscious patients are excluded since they cannot engage in interpersonal relations.
Conclusion
This paper highly recommends the use of Peplau’s interpersonal theory in nursing practice. As indicated earlier, her theory is consistent, clear, and adaptable. This theory would encourage and facilitate communication with patients, leading to increased satisfaction concerning the nursing process. Ideally, increased understanding and cooperation would decrease relapse and readmission to health care facilities as patients will have a better understanding of their conditions.
References
Basavanthappa, B. (2007). Nursing theories. New Delhi, India: Jaypee Brothers.
Cowling, W. (2007). A unitary participatory vision of nursing knowledge. Advances in Nursing Science, 30(1), 61-70.
Penckofer, S., Byrn, M., Mumby, P., & Ferrans, C. (2011). Improving subject recruitment, retention, and participation in research through Peplau’s Theory of Interpersonal Relations. Nursing Science Quarterly, 24(2), 146-151.
Sagar, P. (2014). Transcultural nursing scholars’ corner: Leadership in application and dissemination of concepts, models, and theories. Journal of Transcultural Nursing, 26(2), 209-210.
Senn, J. (2012). Peplau’s Theory of Interpersonal Relations: application in emergency and rural nursing. Nursing Science Quarterly, 26(1), 31-35.
Taylor, S., & Renpenning, K. (2011). Self-care science, nursing theory, and evidence-based practice. New York, NY: Springer Publishers.