What theories do you use in your current practice?Provide an example. Our management team works sohard to improve our practice of care and to teach nurses about good healingrelationships between the patient and the nurses. Our hospital opened in 2013,and at the beginning we had a lot of challenges with new staff because most ofthe nurses had no experience working with mentally ill patients, making itdifficult for patients and nurses. Most of our nurses were experienced in the nursinghome area, not in an acute psych unit.
This lack of experience makes it really difficultfor nurses and patients. During this time, our psch unit had high rate ofpatient fighting and violence, and most of the patients received seclusionand/or physical or mechanical restraint. This caused frustration among themanagement team, staff, patients and family members. The hospital riskmanagement team started looking at each incident to find out the main cause ofthis high incidence rate.
Poor communication between our psych patients andstaff was the main reason. For this reason, the management team started givingtraining for staff regarding how to reduce the incidents of aggression/assaultto others and how staff can communicate effectively with our mentally illpatinets and their family members. The hospital created tools to assess eachpatient’s risk. This assessment regarding the patient’s behavior is done dailyand during each admission. This tool helps our staff to be able to predict theaggression level of the patient and mange it accordingly before the incidenthappens.
This tool improves the capacity of our nurses to able to identify andrespond effectively for the future aggression and assault from patients.However, this was not effective enough to reduce the aggression and assault to others. As a result, themanagement team decided to train staff to follow the Hildegard Peplau theory. Peplau defined four phases of the nursingrelationship: orientation, identification, exploitation, and resolution(“Theory of Interpersonal Relations,” 2010). As a nurse, I try toconnect each different step of the Peplau theory to of our daily nursingassessment, diagnostic, implementation, and evaluation. After I trained, I have been using thistheory in my everyday practice.
This theory is very helpful for me and othernurses to build healthy, trusting relationships with my patients and theirfamilies. As psychiatric nurse in the psych unit, I use this process to care for mypatient on daily basis. The first part is the assessment phase, whichparallelsorientation.
During this orientation phase, I gather and analyze the patientdata. I assument myself stranger to my patient and family members. I will ask my patient about his or her need,and if my patient can’t able to express his need, then I will help him toidentify his problem.
I define my role in the relationship. The orintationphase usually built some level of trust between myself and my patients . Thenext phase is nursing diagnostic, which is similar to identification. Duringthis phase, my patient and I agree on common goals. Then my patient begins tobuild better trust about my care.
Thenext step is implementation, which is similar to the exploitation phase of Peplau’stheory. Base on diagnostic, the treatment is implemented. I help my patientunderstand all aspects of care and give other options, which is necessary tostrengthen our relationship. The last step is evaluation, which is compared toresolution.
During this phase, the goals are often met with collaborative relationshipswith other health care providers. This is the end of the interpersonal relationshipbetween me and my patient, which can be difficult sometime especially whenworking with mentally ill patients.Also, Peplauidentified roles of nursing such as counselor, resource, teacher, technicalexpert, surrogate, and leader (Chitty & Black, 2007). After this training,I understood that I have different roles as a nurse for my patient. I will act asresource person, by giving satisfactory information that helps my patientunderstand more about his illness, care and plan. I can act as a counselor byproviding important advice on how to deal with triggers for violent behavior. Iwill act as leader by making sure each patient agrees to maximum engagement toachieve treatment goals.
As a conclusion, Peplau’s theory helps me to understand my patients’ need andhelp them according to their need by building trust between my patinets and me.This theory helps me to listen to my patients very careful and involve them in theircare. As result, my patients and I enjoy the outcome of this theory