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EVOLUTION OF NURSING THEORIES

ACTIVITY 2: A MINI CASE STUDY ON NURSE-CLIENT RELATIONSHIP

Submitted by: CODILLA, Christel Jirah D. and SINADJAN, Farrah Mae (BSN 1-B)

PEPLAU’S NURSE-PATIENT RELATIONSHIP

Peplau’s Nurse-Patient Relationship Theory acknowledges that nursing should apply principles of
human relations to the problems at all experience levels, and that the attainment of a nursing goal is based
on series of steps following a pattern.

Given that the patient knows the presence of her trust issues and is willing to overcome them,
development of her interpersonal relations is totally possible. This is important since the theory states that
the person is a developing organism that tries to reduce anxiety caused by needs and that health is a forward
movement of personality in the direction of creative, constructive, productive, personal and community living.
The response to the patient’s need must therefore be done in a sequential manner, as Peplau stated in her
theory.

There are three phases of interpersonal relationship according to Peplau. The Orientation Phase
was basically the interview in the outpatient office, because at that point, the patient already recognized her
felt need and request for help.

The Identification and Exploitation Phase for this particular patient is the most crucial parts of the
relationship, because it is where the nurse explains to her, as a teacher, counselor and leader, the importance
of interpersonal communication in order to achieve her goal. She must explain to the patient that she is there
to help her resolve her issues, and is willing to go through a slow but sure process to ensure that she gets
well. The use of a helping relationship must also be mentioned to the patient so she can properly participate
and cooperate in the process.

The patient, however, will clearly find it difficult initially, therefore, undergoing the Identification and
Exploitation Phase is vital. This is where the nurse can fully explore the patient’s feelings through efficient
observation and communication, and in return, give the patient an experience that reorients her feelings. The
nurse will be able to provide a strong and positive foundation in the relationship that will effectively create a
connection between the two, so the patient can be provided with the initial satisfaction for care.

By the time the nurse proceeds to the Exploitation Phase, efficient orientation of the problem and
definition of the service and goals have been applied, and the patient will be ready by then to participate in
it.

The Exploitation Phase is where the patient attempts to bring value to the communication that was
done and the relationship that was established. Therefore, the nurse can now develop new goals that can be

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achieved through mutual and personal efforts. This, in return, allows the patient to actively seek and receive
knowledge of those who can help her, and not necessarily from the healthcare field. The patient can identify
her lapses and where she starts to produce a protective barrier against those around her, which the nurse
and patient worked together to figure out, and then reform this in the future with the help and recommendation
of her nurse.

The Resolution Phase is the time where the patient terminates her relationship with the nurse, but
with satisfaction of care. When this happens, she is free to express her takeaways from the relationship and
the plans she has for self-care.

In the entire sequence, Peplau’s definition for nursing is achieved, as a therapeutic interpersonal and
sequential process was done between the nurse and patient, which consequently led the patient to achieve
the “forward movement of personality” to restore her health need.

JOYCE TRAVELBEE’S HUMAN-TO-HUMAN RELATIONSHIP MODEL

Joyce Travelbee’s Relationship Model is a fitting resolution to the client as he requires a genuine,
interpersonal relationship with someone to alleviate the distress of his unmet need of belongingness and self-
esteem. The model, in essence, highlights the responsibility of the nurse in assisting him to cope up with
those needs, so that he may achieve optimum health. This is also conjunctive to the existentialist basis of
the theory, in which man is responsible for his personal development according to his free will, therefore
when he is distressed, there is a need to resolve this so that his development will not be delayed or ceased.

From the patient’s statement itself, it is evident that he lacks one of the theory’s basic concepts which
is meaning, or the reason one attributes to himself. This is due to his negative filial history. Moreover, he is
suffering both physically and emotionally, so if the need stays unmet, he is at risk of potentially more
dangerous situations due to a longer stay in the young blood organization. The nurse, according to the theory,
is able to “help man find meaning in the experience of illness and suffering”, which can be done through the
establishment of a genuine relationship conceived only through the interactional process.

Both the patient and the nurse are human beings, and are capable of empathizing, sympathizing,
and giving hope, all three of which are basic concepts of Travelbee’s theory. In essence, the patient, as a
human being, can feel pain, but the nurse can provide care to alleviate this.

In the situation, the gunshot wound, in relation to objective health or the absence of discernable
disease, was already resolved, but an anomaly in the patient’s subjective health, or his individually defined
state of well-being, during their original encounter (the first phase of the relationship model) urged the nurse
to establish an interpersonal relationship to help him. The theory states that the nurse can provide efficient
communication using a targeted intellectual approach to bring out the patient’s self-awareness and self-
understanding for complete rehabilitation.

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Following the original encounter phase, further communication and strategic questioning can lead to
the second phase which is the visibility of emerging identities. The phases of empathy, sympathy, and
establishment of mutual understanding and contact are subsequent, and will ideally happen in order for the
patient’s need to be resolved.

If all these are satisfied, the nurse-patient relationship can give meaning to the patient’s experience
and suffering, not just stopping there, but proceeding to a point where the nurse gives hope to the patient
(one extremely vital concept of Travelbee’s theory), and ultimately attain rapport in the end.

In conclusion, Travelbee’s theory all involve concepts and processes that are all ideal in the
resolution of the patient’s conflict since in essence, an interpersonal relationship is what he needs for his
emotional and personal difficulties. The relationship model of this theory is centered on identity, self-esteem,
self-awareness, and self-understanding, all of which perfectly meet the patient’s condition. The five phases
of the model were a systematic, intellectual approach—done by accompanying and communicating with the
client to allow his identity to emerge, his history to be recalled, and his behavior to be understood—to appease
the patient’s unconscious emotional suffering, and consequently satisfy his subjective health’s unmet need.

IDA JEAN ORLANDO’S THEORY OF THE DYNAMIC NURSE-PATIENT RELATIONSHIP

Orlando’s Theory highlights the responsibility of the nurse to find out and meet the patient’s need for
help, and there are several terms involved in this theory that relates to the situation of the client. Distress is
the experience where a need has not been met, but is resolvable through nursing actions and roles, which
will ideally produce a change in behavior of the patient, labelled as the outcome.

This scenario emphasizes an immense emotional distress from the client, a person who has an
immediate need and requires careful supervision of her behavior. This distress was identified by the nurse,
a highly responsive and critical being. The nurse, in return, can apply the nursing process to systematically
address this distress.

There are five concepts to this theory, and written below are the actions required for each concept.
The first one is the function of professional nursing, where the nurse is expected to identify and meet the
need for help of the patient through observation of the her presented behavior. The nurse in this scenario
was able to do this because of her conscious observations on her patient.

The second, presenting behavior, was illustrated in the scenario as the point where the nurse
acknowledged the possibility that the patient may be a victim of domestic abuse due to unconscious hints
given by the patient.

The third one is the immediate reaction, which was impressively done by the nurse through her
critical observations and logical interrelating of vital information from the patient, coming from her efficient
use of her senses and perception. In this case, the was able to point out, based on the client’s behavioral
patterns, her false claim for her physical injury, her emotional instability, frequent denials, and subliminal

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inquiries on overdose of medication that she was indeed a suspected victim of domestic abuse, and that a
helping relationship is required for her.

The fourth one is the nursing process discipline. Assessment, diagnosis, planning, nursing
intervention and evaluation (the five steps of the nursing process) can be done by the nurse to address and
resolve the patient’s need. To expound, the assessment is where complete and critical observation was done
by the nurse to identify the patient’s immediate need. Diagnosis is where the nurse was able to come to a
conclusion, with the interconnection of evidence, that aside from physical rehabilitation, the patient was in
need of a relief for her emotional distress. Planning can help meet this need by a composing a strategic and
therapeutic proposal for the nursing intervention. In this phase of the process, the nurse can think of the
integration of other nursing theories, even psychotherapeutic or psychiatric practices, to help the patient.

The nursing intervention then is the application of those formed plans to come to the final concept of
the theory which is improvement. This is where the result is evaluated.

In conclusion, Orlando’s theory can be used in this situation because it specifically relates to one
assumption where patients need help communicating their needs and are able to be secretive about them.
The patient in this scenario exhibited just this, but the nurse was able to function according to theory, where
the nurse’s role is to meet and ascertain the patient’s need by providing critical observations that can
immediately help make sense of his/her distress. The nursing process can then be followed to systematically
produce a positive outcome and improvement in the patient’s wellbeing.