Peplau_055104.pptxmammaamamamama? mmamma

.,....

1. Hildegard Peplau Interpersonal R elations Model

2. Interpersonal Relations as a Nursing Process: “Man as an Organism That Exists in an Unstable Equilibrium.” Client experiences insult that renders them incapable of moving forward because of stressful environmental thereby causing anxiety and stress.

3. Hildegard E. Peplau was an American nurse and the first published nursing theorist since Florence Nightingale and created the middle-range nursing theory of interpersonal relations, which helped to revolutionize the scholarly work of nurses .

4. Theory Description: Interpersonal relations model explores: Interpersonal relationship of the nurse and the client. Identifies the clients feelings as a predictor of positive outcomes related to health and wellness.

5. Phases of the Nurse-Patient Relationship : a. Orientation Phase: The nurse and patient first meet. The nurse assesses the patient's needs and establishes trust and rapport. b. Identification Phase: T he patient begins to identify with the nurse, and the relationship deepens. The patient may start to share feelings and concerns more openly . c. Exploitation Phase: The patient derives full value from the relationship, and the nurse assists the patient in achieving their goals, such as improved health . d. Resolution Phase: This phase occurs as the patient's health improves, and the relationship comes to an end. The nurse and patient separate, and the patient can move forward with improved health and independence.

6. Factors Affecting the Nurse-Patient Relationship : a . Personal Values b. Race and Culture c. Personal Beliefs d. Past Experiences e. Expectations f. Pre-conceived Ideas

7. Six Nursing Roles: a . Stranger- Receives client/patient in same way one meets a stranger and provides a climate that builds trust b. Teacher- Who imparts knowledge in reference to a need or interest c. Resource Person- One who provides specific information for problem solving d. Counselor- One who provides guidance and encouragement to make changes e. Surrogate- One who helps to clarify domains of dependence, interdependence , and independency, and acts on client’s behalf as an advocate f. Leader- One who helps client assume maximum responsibility for meeting goals

8. Collaboration and Communication: Effective communication and collaboration are essential in building and maintaining the nurse-patient relationship. Nurses are encouraged to use therapeutic communication techniques to understand the patient's needs and provide appropriate care.

9. Nursing as a Helping Profession: Peplau emphasized that nursing is fundamentally a helping profession, and the nurse's role is to facilitate the patient's growth, independence, and recovery .

10. Application to Psychiatric Nursing: While Peplau's theory has been applied to various nursing settings, it is particularly relevant in psychiatric nursing, where the nurse-patient relationship plays a crucial role in helping individuals with mental health issues.

11. Person: Developing organism that tries to reduce anxiety caused by needs. Environment: Existing forces outside the organism AND in the context of culture (any unpleasant atmosphere causing stress/anxiety) Health: Implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living. ( optimal physical and emotional wellness and resolution of any obstacles to well-being) Nursing: A significant therapeutic interpersonal process. It functions cooperatively with other human process that make health possible for individuals in communities.

12. Limitations: Personal space considerations and community social service resources are considered less. Health promotion and maintenance were less emphasized Cannot be used in a patient who doesn’t have a felt need eg . Withdrawn patients, unconscious patients  Some areas are not specific enough to generate hypothesis 

13. Virginia Henderson 14 Nursing Needs Theory

14. Virginia Henderson was born November 30, 1897, in Kansas City, Missouri. In 1901, she and her family relocated to Virginia . Her first teaching position was at Teachers College, Columbia University in 1934. In 1939, her revision of Bertha Harmer’s Textbook of the Principles and Practice of Nursing was published. Virginia Henderson directed the Nursing Index Studies Project from 1959-1971, which led to her publication of the four volume Nursing Index Studies. Henderson was named research associate emeritus at Yale at age 75. Virginia Henderson for 70 years made remarkable contributions to nursing. She paid as an advocate for humane and holistic care for patients, promoter for nursing research, and author to widely used nursing texts. Henderson died March 19, 1996. 4 HISTORY AND LIFE

15. Two events influenced the development of her definition of nursing and her theory. Her participation in the revision of “The Textbook of the Principles and Practice of Nursing” written by Bertha Harmer. Following this, Henderson realized the need to be very clear about the role and functions of the nurse . She grew concerned that many states had no provisions for nursing licensure. She felt it was important to establish the idea of what truly makes a nurse in order to ensure safe and competent care for patients. She examined the earlier statements of nursing functions set forth by the American Nurses Association and viewed these statements as non specific, unclear, and unsatisfactory.

16. Virginia Henderson’s goal was not to develop a theory in nursing, but a unique focus on the nursing concept . Need Theory suggests that nurses should be caring for the patient, but at the same time helping the patient gain independence so that once they are discharged they are able to take care of themselves . This theory presents the patient as a sum of parts with biophysical needs rather than as a type of client or consumer.

17. There are fourteen components based on human needs that make up nursing activities. These components are:

18. Henderson described the nurse's role as substitutive (doing for the person), supplementary (helping the person), or complementary (working with the person), with the goal of helping the person become as independent as possible. Henderson wanted to work to rehabilitate patients in order to make them more independent for themselves . Nurses need to stress promotion of health and prevention and cure of disease. Each nurse would want the 14 concepts for themselves and should strive for their patients to heal in the same environment .

19. Dorothea Orem Self-Care Deficit Theory

20. Born in Baltimore, MD in 1914 Began Nursing Career in Providence Hospital in Washington DC, received her nursing diploma. Completed BSN in 1939 and her MSN in 1946 at Catholic University of America. Held Directorship of nursing school and nursing department at Providence Hospital in Detroit from 1940-1949 Moved to Indiana and worked for the Indiana State Board of Health HISTORY AND LIFE

21. Moved to Washington DC in 1957 at the US Department of Health as a curriculum consultant to upgrade nursing training Became Assistant Professor at Catholic University of America in 1959 Developed her concepts of nursing and self care at Catholic University of America Began consulting firm in 1970 and published first book in 1971 “Nursing: Concepts of Practice” Honorary Doctorates Died in 2007 HISTORY AND LIFE

22. Developed theory to improve quality of nursing and patient ability to meets demands of care Three components of theory: Self-care Self-care deficit Nursing System Self-care deficit is core of Orem’s theory because determines when nursing is needed. The main purpose for theory is for patients and families to maintain control of health by actively performing for self

23. Orem's theory revolves around the concept of self-care, which refers to the actions that individuals take to meet their own needs for maintaining life, health, and well-being. Self-care includes activities such as eating, grooming, and managing one's health. A. SELF-CARE

24. Self-care agency is an individual's ability to perform self-care activities. It encompasses an individual's knowledge, motivation, and physical and psychological abilities to engage in self-care. B . SELF-CARE AGENCY

25. Orem identified three categories of self-care requisites: Universal Self-Care Requisites: These are basic self-care activities that every individual needs, such as air, water, food, and rest. Developmental Self-Care Requisites: These are self-care activities necessary for an individual's growth and development, such as education, socialization, and work. Health Deviation Self-Care Requisites: These are self-care activities needed when an individual's health is compromised or when they are dealing with illness or injury. This category focuses on the specific healthcare needs of the individual. C. SELF-CARE REQUISITES

26. Orem proposed that when an individual is unable to meet their self-care needs independently, a self-care deficit exists. This deficit can be due to limitations in self-care agency or an increased demand for self-care, such as during illness, injury, or other health challenges. D . SELF-CARE DEFICIT

27. The nursing system involves the role of nurses in helping individuals meet their self-care needs. Nurses can provide support in the form of wholly compensatory care (performing all self-care activities for the patient), partially compensatory care (assisting the patient with some self-care activities), or supportive-educative care (teaching and encouraging the patient to perform self-care activities independently). E. NURSING SYSTEM

28. Ida Jean Orlando Nursing Process Theory

29. The nursing process is based on a nursing theory developed by Ida Jean Orlando. She developed this theory in the late 1950's as she observed nurses in action. She saw "good" nursing and "bad" nursing. From her observations she learned that the patient must be the central character. Nursing care needs to be directed at improving outcomes for the patient, and not about nursing goals. The nursing process is an essential part of the nursing care plan.

30. Assessing collecting , validating, and communicating of patient data Diagnosing analyzing patient data to identify patient strengths and problems Planning specifying patient outcomes and related nursing interventions Implementing carrying out the plan of care Evaluating measuring extent to which patient achieved outcomes

31. OBJECTIVE DATA Observable and measurable data that can be seen, heard, or felt by someone other than the person experiencing them For example, elevated temperature, skin moisture, vomiting SUBJECTIVE DATA Information perceived only by the affected person For example, pain experience, feeling dizzy, feeling anxious

32. Types of Nursing Diagnosis: Actual Risk Possible Wellness Syndrome

33. Defining characteristics—identifies the subjective and objective data that signal the existence of a problem Problem—identifies what is unhealthy about patient Etiology—identifies factors maintaining the unhealthy state

34. COMMON SOURCES OF ERROR: Premature diagnoses based on incomplete database Erroneous diagnoses resulting from inaccurate or faulty database Routine diagnoses resulting from failure to tailor data to patient Errors of omission

35. Elements of Planning: Initial Ongoing Discharge

36. INITIAL PLANNING Developed by the nurse who performs the nursing history and physical assessment Addresses each problem listed in the prioritized nursing diagnoses Identifies appropriate patient goals and related nursing care

37. ON-GOING PLANNING Carried out by any nurse who interacts with patient Keeps the plan up to date States nursing diagnoses more clearly Develops new diagnoses Makes outcomes more realistic and develops new outcomes as needed Identifies nursing interventions to accomplish patient goals

38. DISCHARGE PLANNING Carried out by the nurse who worked most closely with the patient Begins when the patient is admitted for treatment Uses teaching and counseling skills effectively to ensure home care behaviors are performed competently

39. Independent N ursing A ctions Nurse-initiated interventions Protocols Standing orders Collaborative Nursing A ctions Physician-initiated interventions Collaborative interventions