Hildegard E Peplau Nursing Theory: A Summary PDF

**INTRODUCTION** **TOPIC** **SUB-TOPIC** **HILDEGARD E PEPLAU: PSYCHODYNAMIC NURSING THEORY** **BACKGROUND** Name: Hildegard Elizabeth Peplau  Nickname: Hilda  Birthday: September 1, 1909  Died: March 17, 1999 in Sherman Oaks, California Birthplace: Reading, Pennsylvania **Career Timeline*...

**INTRODUCTION** **TOPIC** **SUB-TOPIC** **HILDEGARD E PEPLAU: PSYCHODYNAMIC NURSING THEORY** **BACKGROUND** Name: Hildegard Elizabeth Peplau  Nickname: Hilda  Birthday: September 1, 1909  Died: March 17, 1999 in Sherman Oaks, California Birthplace: Reading, Pennsylvania **Career Timeline** 1931 - Diploma program in Pottstown, Pennsylvania  1943 - BA in interpersonal psychology - Bennington College  1947 MA in psychiatric nursing from Colombia University, New York  1952 - Published Interpersonal Relations in Nursing  1968 - interpersonal techniques - the crux of psychiatric Nursing     Worked as executive director and president of ANA      Worked with WHO and NIMH **INTRODUCTION TO THEORY BY PEPLAU** The nurse and patient work together so that both become mature and knowledgeable in the process.  It is psychodynamic in nature and it facilitates  -Understanding of one\'s own behavior  -Helping others identify felt needs or difficulties  -Therapeutic Nurse  Patient relationship  -Application of human relations to problem-solving at all levels of experience. **PEPLAU\'S SEVEN ROLES OF A NURSE** **Stranger**: offering the client the same acceptance and courtesy that the nurse would respond to any stranger **Resource** person: providing specific answers to questions within a larger context **Teacher**: helping the client to learn formally or informally Leader: offering direction to the client or group **Surrogate**: serving as a substitute for another such as a parent or a sibling **Counselor**: promoting experiences leading to health for the client such as expression of feelings **Technical Expert**: providing physical care for the patient and operates equipment **Additional roles include:** Technical expert Consultant Health teacher Tutor Socializing agent Safety agent Manager of environment Mediator Administrator Recorder observer Researcher **Four Phases of the Therapeutic Nurse-Patient Relationship** **1. Orientation Phase**: This initial phase involves the nurse and patient coming together. The nurse establishes rapport, assesses the patient's needs, and clarifies the purpose and goals of the relationship. During this phase, trust is built, and boundaries are set. **2. Identification Phase:** In this phase, the patient begins to identify with the nurse and feels comfortable sharing thoughts and feelings. The patient recognizes their needs and seeks help. The nurse supports this exploration, helping the patient articulate their concerns and goals. **3. Exploitation Phase:** This is the working phase where the patient utilizes the resources provided by the nurse. The patient engages in various therapeutic activities, explores feelings, and works on problem-solving. The nurse acts as a facilitator, guiding the patient through challenges and promoting personal growth. **4. Resolution Phase:** The final phase occurs when the therapeutic relationship ends. The nurse and patient review the progress made, discuss feelings about the termination, and reinforce the patient's newfound skills and insights. The focus is on ensuring the patient can apply what they\'ve learned independently in the future. CONCLUSION Peplau\'s theory explains the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process. Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care. Ida Jean Orlando's Deliberative Nursing Process Theory **BACKGROUND** - Born in 1926. - Wrote about THE NURSING PROCESS. - Nursing Diploma - New York Medical College - BS in public health nursing - St. John\'s\ University, NY, - MA in mental health nursing - Columbia\ University, New York. - Associate Professor at Yale School of Nursing and Director of the Graduate Program in Mental Health Psychiatric Nursing. **MAJOR CONCEPTS AND DEFINITIONS** **Definitions** **Distress** is the experience of a patient whose need has not been met.  **Nursing role** is to discover and meet the patient\'s immediate need for help.  -Patient\'s behavior may not represent the true need.  -The nurse validates his/her understanding of the need with the patient. **Nursing actions** directly or indirectly provide for the patient\'s immediate need.  An **outcome** is a change in the behavior of the patient indicating either a relief from distress or an unmet need.  -Observable verbally and nonverbally. ** Nursing client** - patients who are under medical care and who cannot deal with their needs or who cannot carry out medical treatment alone  ** Nursing problem** - distress due to unmet needs due to physical limitations, adverse reactions to the setting or experiences which prevent the patient from communicating his needs  ** Nursing process** - the interaction of 1) the behavior of the patient, 2) the reaction of the nurse and 3) the nursing actions which are assigned for the patients benefit  ** Nurse - patient relations** - central in theory and not differentiated from nursing therapeutics or nursing process **Nursing therapeutics ** Direct function-initiates a process of helping the patient express the specific meaning of his behavior in order to ascertain his distress and helps the patient explore the distress in order to ascertain the help he requires so that his distress may be relieved.  Indirect function - calling for help of others, whatever help the patient may require for his need to be met  ** Automatic activities** - perception by five senses, automatic thoughts, automatic feeling, action CONCEPTS **Function of professional nursing** - organizing principle  **Presenting behavior** - problematic situation  **Immediate reaction** - internal response  **Nursing process discipline**- investigation  **Improvement** - resolution **Function of professional nursing** **organizing principle** Finding out and meeting the patient immediate needs for help  \"Nursing\....is responsive to individuals who suffer or anticipate a sense of helplessness, it is focused on the process of care in an immediate experience, it is concerned with providing direct assistance to individuals in whatever setting they are found for the purpose of avoiding, relieving, diminishing or curing the individuals sense of helplessness.\" - Orlando **Presenting Behavior - Problematic Situation**  To find out the immediate need for help the nurse must first recognize the situation as problematic  The presenting behavior of the patient, regardless of the form in which it appears, may represent a plea for help  The presenting behavior of the patient, the stimulus, causes an automatic internal response in the nurse, and the nurses behavior causes a response in the patient **Immediate Reaction-Internal Response** Person perceives with any one of his five sense organs an object or objects The perceptions stimulate automatic thought  Each thought stimulates an automatic feeling  Then the person acts  The first three items taken together are defined as the person\'s immediate reaction **Nursing Process Discipline - Investigation** Any observation shared and explored with the patient is immediately useful in ascertaining and meeting his need or finding out that he is not in need at that time. The nurse does not assume that any aspect of her reaction to the patient is correct, helpful or appropriate until she checks the validity of it in exploration with the patient. The nurse initiates a process of exploration to ascertain how the patient is affected by what she says or does. When the nurse does not explore with the patient her reaction it seems reasonably certain that clear communication between them stops. **Improvement - Resolution** It is not the nurse\'s activity that is evaluated but rather its result: whether the activity serves to help the patient communicate her or his need for help and how it is met.  Each contact the nurse repeats a process of learning how to help the individual patient. **5 Stages of the Deliberative ** Nursing Process The Deliberative Nursing Process has five stages: *assessment, diagnosis, planning, implementation, and evaluation.* **Assessment** In the assessment stage, the nurse completes a holistic assessment of the patient's needs. This is done without taking the reason for the encounter into consideration. The nurse uses a nursing framework to collect both subjective and objective data about the patient. **Diagnosis** The diagnosis stage uses the nurse's clinical judgement about health problems. The diagnosis can then be confirmed using links to defining characteristics, related factors, and risk factors found in the patient's assessment. **Planning** The planning stage addresses each of the problems identified in the diagnosis. Each problem is given a specific goal or outcome, and each goal or outcome is given nursing intervention to help achieve the goal. By the end of this stage, the nurse will have a nursing care plan. **Implementation** In the implementation stage, the nurse begins using the nursing care plan.  **Evaluation** Finally, in the evaluation stage, the nurse looks at the patient's progress toward the goals set in the nursing care plan. Changes can be made to the nursing care plan based on how well (or poorly) the patient is progressing toward the goals. If any new problems are identified in the evaluation stage, they can be addressed, and the process starts over again for those specific problems. **ACCEPTANCE BY THE NURSING COMMUNITY** **PRACTICE** Clearly applicable to nursing practice.  Basis of practice in hospitals.  Used at the patient care level, managerial level, and nursing division level. **EDUCATION** Orlando\'s process recording has made a significant contribution to nursing education.  Process recording - a tool to facilitate self- evaluation of whether or not the process discipline was used. **RESEARCH** Enjoyed considerable acceptance by the nursing profession in the area of research and has been applied to a variety of research settings. **HENDERSON\'S NEED THEORY** **BACKGROUND** INTRODUCTION ABOUT VIRGINIA HENDERSON  "The Night of Modern Nursing" "Modern-Day Mother of Nursing " "The 20th century Florence Nightingale" Born in Kansas City, Missouri, in Nov 30th. 1897. Diploma in Nursing from the Army School of Nursing at Walter Reed Hospital, Washington, D.C. in 1921.  Worked at the Henry Street Visiting Nurse Service for 2 years after graduation.  In 1923, started teaching nursing at the Norfolk Protestant Hospital in Virginia  In 1929, entered Teachers College at Columbia University for Bachelor\'s Degree in 1932, Master\'s Degree in 1934. Died: March 19, 1996 In 1939, she revised: Harmer\'s classic textbook of nursing for its 4th edition, and later wrote the 5th; edition, incorporating her personal definition of nursing (Henderson, 1991) **DEFINITION OF NURSING** Her definition of NURSING was: \"The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge. And to do this in such a way as to help him gain independence as rapidly as possible\" (Henderson, 1966). **14 COMPONENTS OF HENDERSON\'S THEORY** THE 14 COMPONENTS  1\. Breathe normally.  2\. Eat and drink adequately.  3\. Eliminate body wastes.  4\. Move and maintain desirable postures.  5\. Sleep and rest.  6\. Select suitable clothes-dress and undress.  7\. Maintain body temperature within normal range by adjusting clothing and modifying environment  8\. Keep the body clean and well groomed and protect the integument  9\. Avoid dangers in the environment and avoid injuring others.  10\. Communicate with others in expressing emotions, needs, fears, or opinions.  11\. Worship according to one\'s faith.  12\. Work in such a way that there is a sense of accomplishment.  13\. Play or participate in various forms of recreation.  14\. Learn, discover, or satisfy the curiosity that leads to normal development and health and use the available health facilities. The **first 9 components are physiological. ** The **10th and 14th are psychological aspects of communicating and learning, ** The **11th component is spiritual and moral ** The **12th and 13th components are sociologically oriented to occupation and recreation.** **ACCORDING TO HENDERSON (1990), AN EXCELLENT NURSE CAN BE MEASURED IN THE FOLLOWING** Decreased mortality rates among those she serves. Decrease in symptoms of nursing neglect such as pressure sores or incontinence.  Decrease in psychological withdrawal symptoms, negativism, or mutism.  Decrease in dependency with respect to daily activities or the degree of rehabilitation achieved.  Favorable opinions of care given by the nurse as expressed by the patient, his family, other nurses, or associated medical personnel. PURPOSES OF NURSING THEORIES **In Practice** Assist nurses to describe, explain, and predict everyday experiences.  Serve to guide assessment, interventions, and evaluation of nursing care.  Provide a rationale for collecting reliable and valid data about the health status of clients, which are essential for effective decision making and implementation.  Help to describe criteria to measure the quality of nursing care.  Help build a common nursing terminology to use in communicating with other health professionals.  Ideas are developed and words are defined.  Enhance autonomy (independence and self-governance) of nursing through defining its own independent functions. **In Education: ** Provide a general focus for curriculum design  Guide curricular decision making.    **In Research: ** Offer a framework for generating knowledge and new ideas.  Assist in discovering knowledge gaps in the specific field of study.  Offer a systematic approach to identify questions for study; select variables, interpret findings, and validate nursing interventions. **CONCLUSION**  In conclusion, Henderson\'s work is considered a nursing theory because it contains a definition of nursing and basic needs of nursing care. She focuses on patient care to help patients reach a level of independence which include nursing care and education. By exploring Henderson\'s nursing theory and understanding its origins and key features, and how it relates to personal values and beliefs I am able to apply her theory to clinical situations. **Abdellah\'s 21 Nursing Problems Theory** **BACKGROUND** **Faye Glenn Abdellah** (March 13, 1919-Febuary 24, 2017) \*   She is a nursing research pioneer who developed the\ \"Twenty- One Nursing Problems.\" \*   She was born in New York to a father of Algerian heritage and a Scottish mother. Her family subsequently moved to New Jersey, where she attended high school. \*   She was the first nurse officer to rank a two-star rear admiral, the first nurse, and the first woman to serve as a Deputy Surgeon General. \*   In 1942, she earned a nursing diploma from Fitkin Memorial Hospital\'s School of Nursing, now known as Ann May School of Nursing. **21 Nursing Problems Theory** **Description of the Theory ** Abdellah\'s typology of 21 nursing problems is a conceptual model mainly concerned with patient\'s needs and nurses\' role in problem identification using a problem analysis approach. **The 21 Nursing Problems fall into three categories: ** 1.Physical sociological and emotional needs of clients  2\. Types of interpersonal relationships between the nurse and patient  3\. Common elements of client care  She used Henderson\'s 14 basic human needs and nursing research to establish the classification of nursing problems.    **Problem Solving ** Is a process involves identifying the problem, selecting pertinent data, formulating hypothesis, testing hypothesis through the collection of data, and revising hypothesis where necessary on the basis of conclusions obtained from the data. **Classification of the 21 Nursing Problems **  1.Basic to all Patients  2\. Sustenal Care Needs  3\. Remedial Care Needs  4\. Restorative Care Needs **Basic to all Patients ** 1\. To maintain good hygiene and physical comfort.  2\. To promote optimal activity; exercise, rest, sleep.  3\. To promote safety through prevention of accident, injury or other trauma, and through prevention of the spread of infection.  4\. To maintain good body mechanics and prevent and correct deformity. **Sustenal Care Needs ** 5\. To facilitate the maintenance of a supply of oxygen to all body cells.  6\. To facilitate the maintenance of nutrition for all body cells.  7\. To facilitate the maintenance of elimination.  8\. To facilitate the maintenance of fluid and electrolyte balance. 9\. To recognize the physiological responses of the body to disease conditions- pathological, physiology, and compensatory.  10\. To facilitate the maintenance of regulatory mechanisms and functions.  11\. To facilitate the maintenance of sensory function. ** Remedial Care Needs ** 12\. To identify and accept positive and negative expressions, feelings, and reactions.  13\. To identify and accept interrelatedness of emotions and organic illness.  14\. To facilitate the maintenance of effective verbal and nonverbal communication.  15\. To promote the development of productive interpersonal relationships.  16\. To facilitate progress toward achievement and personal spiritual relationships.  17\. To create or maintain a therapeutic environment. 18\. To facilitate awareness of self as an individual with varying physical, emotional, developmental needs. **Restorative Care Needs ** 19\. To accept the optimum possible goals in the light of limitations, physical and emotional.  20\. To use community resources as an aid in resolving problems that arise from illness.  21\. To understand the role of social problems as influencing factors in the cause of illness. **Application Nursing Practice** Abdellah\'s main goal is the improvement of nursing education  The most important impact of Abdellah\'s theory to nursing practice is that, it helped transform the focus of the profession from being \"disease-centered\" to \"patient-centered\". **Conclusion** Abdellah\'s theory provides basis for determining and organizing nursing care. The problems also provide a basis for organizing appropriate nursing strategies.  As a whole, the theory is intended to guide care not just in the hospital setting, but can also be applied to community nursing as well.  This theory is mainly focused on the clients and nurse\'s role in identification and solving these problems.  Her theory has changed the entire nursing focus from disease to patient centered approach.