Theoretical Foundations in Nursing

STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR

Session # 8

LESSON TITLE: Materials:

▪ HILDEGARD PEPLAU’S THEORY OF Pen and notebook
INTERPERSONAL RELATIONSHIP
▪ IDA JEAN ORLANDO’S THEORY OF
DELIBERATIVE NURSING PROCESS

LEARNING TARGETS:
Upon completion of this lesson, you can:
▪ Acknowledge the background and credentials of these
nursing theorists;
▪ Identify the major concepts with their definitions as
utilized in their respective theory;
▪ List down their specific theoretical assertions or
assumptions;
▪ Highlight their major contributions in the nursing field;
▪ Enumerate the major assumptions enclosed within
their theory;
▪ Describe each of these theories in view of the four
metaparadigms;
▪ Apply the significance of these theories in the nursing Reference:
education, research, and practice; and, Alligood, M. (2018). Nursing theories and their
▪ Recognize the application of these theories in nursing work (9th ed.). Singapore: Elsevier.
today and in the clinical setting.

LESSON REVIEW/PREVIEW
Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the
space provided. You may use the back page of this sheet, if necessary. Have fun!

Instruction: Enumerate and site examples of the following behavioral systems that you have studied from the previous
lesson.
1. ___________________________________________________________________________
2. ___________________________________________________________________________
3. ___________________________________________________________________________
4. ___________________________________________________________________________
5. ___________________________________________________________________________
6. ___________________________________________________________________________
7. ___________________________________________________________________________

MAIN LESSON
You will study and read their book, if available, about this lesson.

HILDEGARD PEPLAU’S THEORY OF INTERPERSONAL RELATIONSHIP

“Nursing is the interpersonal therapeutic process of functioning cooperatively with other human processes that make
health possible for individuals in communities through education that aims to promote forward movement of personality.”

Credentials & Background of the Theorist:

✔ She is considered as the “Mother of Psychiatric Mental Health Nursing” and “Nurse of the Century”.
✔ She served as Executive Director and President of the American Nurses Association (ANA).

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 ✔ Peplau taught the first classes for graduate psychiatric nursing students at
Teachers College, Columbia University.
✔ Contributed to the advancement of the nursing profession was more than what she
gave for this special area of clinical nursing.
✔ Her seminal book is recognized as the first nursing theory textbook since
Nightingale’s work in the 1850s. Peplau is credited for the following in nursing
profession:
o promotion of professional standards and regulation through credentialing
o introduced the concept of advanced nursing practice
o stressed the importance of psychodynamics in nursing practice
o proponent of the nurse’s unique ability to understand his or her own
behavior in order to help others identify their perceived difficulties
✔ She discussed four psychobiological experiences that compel destructive or
constructive patient responses, as follows: needs, frustrations, conflicts, and
anxieties.

4 Phases of the Nurse-Patient Relationship (which Peplau identified):

▪ Orientation – the phase in the nurse-patient interaction where the client seeks help and the nurse assists the
client to understand the problem and the extent of the help
▪ Identification – characterized by the client who assumes a posture of dependence, interdependence, or
independence in relation to the nurse; the nurse’s focus is to assure the person that the nurse understands the
interpersonal meaning of the client’s situation
▪ Exploitation – the client derives full value from what the nurse offers through the relationship; client uses
available services based on self- interest and needs; power shifts from the nurse to the client
▪ Resolution – old needs and goals are set aside and new ones are adopted; once older needs are resolved,
newer and more mature one become evident.

6 Proposed Nursing Roles:

1. Stranger Role – is exemplified by the nurse receiving the client in the same way one meets a stranger in other
life situations. The nurse provides an accepting climate that builds trust.
2. Resource Role – the nurse answers questions, interprets clinical treatment data, and gives information.
3. Teaching Role – the nurse gives instructions and provides training. She also involves analysis and synthesis of
the learner’s experience.
4. Counseling Role – the nurse helps clients understand and integrate the meaning of current life circumstances
and provides guidance and encouragement to make changes.
5. Surrogate Role – the nurse helps clients clarify domains of dependence, interdependence, and independence
and acts on client’s behalf as advocate.
6. Active Leadership Role – the nurse helps the client assume maximum responsibility for meeting treatment goals
in a mutually satisfying way.

Theoretical Assertions:
✔ Nurse and the patient can interact.
✔ Peplau emphasized that both the patient and nurse mature as the result of the therapeutic interaction.
✔ Communication and interviewing skills remain fundamental nursing tools.
✔ Peplau believed that nurses must clearly understand themselves to promote their client’s growth and avoid limiting
their choices to those that nurses value.

Theory in View of Metaparadigms:

Hildegard Peplau considers nursing to be a “significant, therapeutic, interpersonal process.” She
Nursing defines it as a “human relationship between an individual who is sick, or in need of health services,
and a nurse specially educated to recognize and to respond to the need for help.”
Peplau defines man as an organism that “strives in its own way to reduce tension generated by
Person
needs.” The client is an individual with a felt need.
Health is defined as “a word symbol that implies forward movement of personality and other ongoing
Health human processes in the direction of creative, constructive, productive, personal, and community
living.”

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 Although Peplau does not directly address society/environment, she does encourage the nurse to
Environment consider the patient’s culture and mores when the patient adjusts to the hospital routine.

IDA JEAN ORLANDO’S THEORY OF DELIBERATIVE NURSING PROCESS

“Nursing is a profession that seeks to find out and meet the patient’s immediate need for
help.”

Credentials & Background of the Theorist:

✔ Developed her theory from a study conducted at the Yale University School of
Nursing, integrating mental health concepts into basic nursing curriculum.
✔ She was one of the first nursing leaders to identify and emphasize the elements of
the nursing process and the critical importance of the patient’s participation in the
nursing process.
✔ Orlando’s theory focuses on how to produce improvement in the patient’s
behavior. Evidence of relieving the patient’s distress is seen as positive changes in
the patient’s observable behavior.
✔ Orlando analyzed the content of 2000 nurse-patient contacts and created her
theory based on analysis of these data.
✔ She was one of the early thinkers in nursing who proposed that patients have their
own meanings and interpretations of situations and therefore nurses must validate
their inferences and analyses with patients before drawing conclusions.

Theory Description:
✔ Ida Jean Orlando’s theory developed observations she recorded between a nurse and patient. Orlando’s nursing
theory stresses the reciprocal relationship between patient and nurse. What the nurse and the patient say and do
affects them both.
✔ According to Orlando (1961), persons become patients who require nursing care when they have needs for help
that cannot be met independently because they have physical limitations, have negative reactions to an
environment, or have an experience that prevents them from communicating their needs.
✔ Patients experience distress or feelings of helplessness as the result of unmet needs for help (Orlando, 1961).
✔ Orlando proposed a positive correlation between the length of time the patient experiences unmet needs and the
degree of distress. Therefore, immediacy is emphasized throughout her theory.

✔ In Orlando’s view, when individuals are able to meet their own needs, they do not feel distress and do not require
care from a professional nurse.
✔ Orlando emphasizes that it is crucial for nurses to share their perceptions, thoughts, and feelings so they can
determine whether their inferences are congruent with the patient’s need (Schmieding, 2006).
✔ Abraham (2011) used Orlando’s theory to help nurses achieve more successful patient outcomes such as fall
reduction. Orlando’s theory remains a most effective practice theory that is especially helpful to new nurses as
they begin their practice.

Nursing Process Theory: the nursing process is an interaction of three basic elements.
1. The behavior of the patient
2. The reaction of the nurse
3. The nursing actions which are designed for the patient’s benefit.

▪ The role of the nurse is to find out and meet the patient’s immediate need for help.
▪ Nursing process helps the nurse find out the nature of the distress and what helps the patient.
▪ The use of this theory keeps the nurse’s focus on the patient.
▪ The strength of the theory is that it is clear, concise and easy to use.

Major Concepts & Definitions:

Nurse’s responsibility is composed of whatever help the patient may require for his needs to be met. The nurse may either
give this need for help directly herself or indirectly employing the aid of other members of the healthcare team.

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 ▪ Need
→ is a situationally defined requirement of the patient which relieves or diminishes his immediate distress if
this is supplied

▪ Presenting behavior of patient

→ any observable verbal and nonverbal behavior of the patient
▪ Immediate reactions
→ the nurse’s and patient’s individual perceptions, thoughts, and feelings

▪ Nursing process discipline

→ includes the nurse communicating to the patient his or her own immediate reaction
→ made in order to ask for validation, clarification, or correction from the patient
→ once referred to as the “deliberative nursing process”

▪ Automatic nursing actions

→ nursing activities that are decided upon for reasons other than the patient’s immediate need

▪ Deliberative nursing actions

→ those decided upon after ascertaining a need and then meeting this need

Theory Assumptions:
✔ When patients cannot cope with their needs on their own, they become distressed by feelings of helplessness.
✔ In its professional character, nursing adds to the distress of the patient.
✔ Patients are unique and individual in how they respond.
✔ Nursing offers mothering and nursing analogous to an adult who mothers and nurtures a child.
✔ The practice of nursing deals with people, the environment, and health.
✔ Patients need help communicating their needs; they are uncomfortable and ambivalent about their dependency
needs.
✔ People can be secretive or explicit about their needs, perceptions, thoughts, and feelings.
✔ The nurse-patient situation is dynamic; actions and reactions are influenced by both the nurse and the patient.
✔ People attach meanings to situations and actions that aren’t apparent to others.
✔ Patients enter into nursing care through medicine.
✔ The patient cannot state the nature and meaning of his or her distress without the nurse’s help or him or her first
having established a helpful relationship with the patient.
✔ Any observation shared and observed with the patient is immediately helpful in ascertaining and meeting his or
her need or finding out that he or she is not in need at that time.
✔ Nurses are concerned with the needs the patient is unable to meet on his or her own.

Theory in View of Metaparadigms:

Orlando speaks of nursing as unique and independent in its concerns for an individual’s need for help
Nursing in an immediate situation. The efforts to meet the individual’s need for help are carried out in an
interactive situation and in a disciplined manner that requires proper training.
Orlando uses the concept of human as she emphasizes individuality and the dynamic nature of the
Person
nurse-patient relationship. For her, humans in need are the focus of nursing practice.
In Orlando’s theory, health is replaced by a sense of helplessness as the initiator of a necessity for
Health
nursing. She stated that nursing deals with individuals who require help.
Orlando completely disregarded the environment in her theory, only focusing on the patient’s
immediate need, chiefly the relationship and actions between the nurse and the patient (only an
Environment
individual in her theory; no families or groups were mentioned). The effect that the environment could
have on the patient was never mentioned in Orlando’s theory.

Application of the Theory:

✔ Since the premise of Orlando’s theory is in the immediacy of help needed by patients, this framework will be
important for nurses who are assigned in special clinical areas that require quick decision making and critical
thinking skills. Such areas are the OR, ER, and ICU/Critical Care Unit.
✔ Orlando's theory stresses the reciprocal relationship between patient and nurse remains a most effective
practice theory that is especially helpful to new nurses as they begin their practice.

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CHECK FOR UNDERSTANDING
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the
correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not
allowed.

1. Nursing Process Theory was conceptualized by:

a. Margaret Newman
b. Hildegard Peplau
c. Ida Jean Orlando
d. Virginia Henderson
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

2. The nursing process is an interaction of three basic elements. The following are the three basic elements, except:
a. Patient’s behavior
b. Nursing analysis
c. Nursing action
d. Nurse’s reaction
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

3. Nursing Care Plan is:

a. Nurse centered
b. Patient centered
c. A & B
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

4. There are 4 phases of nurse - patient relationship. Which of the following is not included?
a. Orientation
b. Identification
c. Recreation
d. Exploitation
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

5. There are six roles of a nurse stated by Peplau, one of which describes how the nurse helps clients clarify domains of
dependence, interdependence, and independence and acts on client’s behalf as advocate.
a. Stranger
b. Surrogate
c. Teaching
d. Resource
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

6. She is considered as the mother of Psychiatric Mental Health Nursing:

a. Dorothy Johnson
b. Ida Jean Orlando

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 c. Hildegard Peplau
d. Betty Neuman
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

7. “Nursing is a profession that seeks to find out and meet the patient’s immediate need for help” is defined by?
a. Dorothy Johnson
b. Ida Jean Orlando Pelletier
c. Hildegard Peplau
d. Betty Neuman
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

8. The theory of Orlando emphasizes immediate nursing action to address the patient’s need. This can be mostly
applied in areas such as Operating Room, Intensive Care Unit and Emergency Area.
a. the first statement is correct; the second statement is incorrect
b. the first statement is correct, the second statement is correct
c. the first statement is incorrect; the second statement is incorrect
d. the first statement is incorrect, the second statement is correct
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

9. Includes the nurse communicating to the patient his or her own immediate reaction is defined as:
a. Need
b. Nursing process discipline
c. Immediate nurse’s reaction
d. Automatic nursing actions
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

10. Ida Jean Orlando’s theory developed observations she recorded between a nurse and patient. This statement is:
a. true
b. false
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

RATIONALIZATION ACTIVITY
The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:________________________________________________________________________________________
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2. ANSWER: ________
RATIO:________________________________________________________________________________________
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3. ANSWER: ________
RATIO:________________________________________________________________________________________
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4. ANSWER: ________
RATIO:________________________________________________________________________________________
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5. ANSWER: ________
RATIO:________________________________________________________________________________________
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6. ANSWER: ________
RATIO:________________________________________________________________________________________
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7. ANSWER: ________
RATIO:________________________________________________________________________________________
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8. ANSWER: ________
RATIO:________________________________________________________________________________________
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9. ANSWER: ________
RATIO:________________________________________________________________________________________
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10. ANSWER: ________
RATIO:________________________________________________________________________________________
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LESSON WRAP-UP

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: LEARNING SHEETS

This technique will help you engage by providing a question sheet that guides & stimulates the learning. You will answer
the questions per column, as fast as you can. It will be great to time yourself as you answer on the space provided.

FIND-OUT QUESTIONS:
1. The ________________ phase is characterized by the client who assumes a posture of dependence,
interdependence, or independence in relation to the nurse.
2.  In the _____________ role of nurses, the nurse answers questions, interprets clinical treatment data, and
gives information.
3. ______________ is a situationally defined requirement of the patient which relieves or diminishes his
immediate distress if this is supplied.

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LARGER QUESTIONS: (These can only be answered if the FIND-OUT QUESTIONS are completed.)

1. What are the six Nursing roles according to Peplau?

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

2. What are the credentials of Hildegard Peplau and Orlando?

________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

3. What are the three basic elements of interaction of nurse and patient?
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

CHALLENGE QUESTION:
1. What is the importance of having an effective relation and interaction to your patient?

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