THEORETICAL FOUNDATIONS OF NURSING

Ns. Heni Dwi Windarwati, M.Kep., SpKepJ

HILDEGARD PEPLAU’S

INTERPERSONAL RELATIONS

THEORY

HILDEGARD PEPLAU Born on September 1, 1909 @

Reading, Pennsylvania 1931- Graduated from Pottstown,

Pennsylvania Hospital School of Nursing

Worked as an Operating Room Supervisor@ Pottstown Hospital

1943- received Bachelor of Arts in Interpersonal Psychology- Bennington College, Vermont

HILDEGARD PEPLAU

1947- Received a Master of Arts in Psychiatric Nursing- Teacher’s College, Columbia, New York

1953- received a Doctor of Education in Curriculum Development @ Columbia

Became a member of the Army Nurse Corps & worked in a neuropsychiatric hospital in London, UK- WORLD WAR II

HILDEGARD PEPLAU

Worked with psychiatrists Freida Fromm-Riechman and Harry Stack Sullivan.

March 7, 1999- she died @ her home in Sherman Oaks, California @ the age of 89.

MAJOR INFLUENCES- She had her first exposure on

INTERPERSONAL THEORY @ Bennington

- She attended lectures on INTERPERSONAL RELATIONS by Harold Stack Sullivan

- She was influenced by the Sullivanian theory (psychoanalysis) and she aimed to bring this to the patients.

MAJOR CONCEPTS:

1. PERSON: man is an organism that lives in an unstable balance of a given system

2. HEALTH: movement of the personality & other ongoing human processes that directs the person towards creative, constructive. Productive and community living.- needs must also be met (physiologic demands & interpersonal process)

3. ENV’T: forces outside the organism & in the context of the socially- approved way of living- social processes (norms. Customs, beliefs)

4. NURSING: significant, therapeutic interpersonal process

KEY AND SUB-CONCEPTSA. PSYCHODYNAMIC

NURSING:- Being able to understand

one’s own behavior to help others identify felt difficulties & to apply principles of human relations to the problem

B. NURSE- PATIENT RELATIONSHIP

* PHASES *1. ORIENTATION- Initial interaction

between the nurse and the patient wherein the latter has a felt need and expresses the desire for professional help.

2. IDENTIFICATION- patient and nurse explore the experience & the needs of the patient- leads to relatedness

3. EXPLOITATION- patient derives the full value of the relationship as he moves on from dependent role- independent one.

4. RESOLUTION- patient earns independence over his care.

C. NURSING ROLESNurse assumes several roles w/c are used in empowering in meeting the needs of the patient.

1. ROLE OF THE STRANGERNurse must treat the patient with outmost courtesy- accepts the patient and respects the patient’s individuality

2. ROLE OF THE RESOURCE PERSON(Pt is in dependent role)- nurse

provides answers to pt’s queries- providing health information, advices, and simple explanation of the course of care.

either straightforward answers or providing counseling

3. TEACHING ROLEGives importance to self- care

Helping patient understand the teaching plan

develop discussions around the interest of the patient

4. LEADERSHIP ROLEActs in behalf of the patient but also enables pt to make decisions (achieved through cooperation and active participation)

5. SURROGATE ROLEAlso known as temporary care

giver role- motherly role

6. COUNSELING ROLE It has the greatest

importance and emphasis in nursing

STRENGTHS OF THE THEORY

1. Useful in helping psychiatric pts become receptive for therapy

2. This theory is based on reality and it can be tested and observed using pure observation

3. It is used in every aspect of the nursing profession especially in dealing with patients.

LIMITATION OF THE THEORY

1. The use of this model/ theory is limited or impossible in working with senile, comatose or newborn patients.

2. Can only be used wherein a communication occurs between the nurse and the patient.

APPLICATION TO NURSING PRACTICE

In psychiatric nursing, Peplau’s interpersonal model is used in counselling women undergoing depression. Because of the strengthened nurse-pt relationship, women are able to describe patterns that resulted to negative thinking & independently found strategies to manage them.

Provides clear design for the practice of psychiatric nursing

Emphasized the development of interpersonal relationship between the patient and the nurse

APPLICATION TO NURSING EDUCATION

Peplau’s book, INTERPERSONAL RELATIONS IN NURSING, is being used as a manual to help graduate nurses and nursing students alike in creating a significant nurse- patient relationship.

Formulated effective psychotherapeutic methods.

APPLICATION TO RESEARCH

Formulated concepts of anxiety as a means to constructively resolve angry feelings through experiential learning within the nurse- patient relationship.

Florence

Nightingale

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Florence and the Patient

Nightingale believed that caring for the sick was a component of Christianity

Cures were not limited to medical acts but also acts of God

Patient’s needs should be prioritized according to Maslow’s Hierarchy

Florence and the Patient

Health Promotion occurred through providing a sanitary environment, adequate nutrition, patient comfort, and conservation of the patient’s energy

Considered a client to have the capability to be healthy, however, he/she did not have the power to control their unsanitary environment or poor access to essential nutrients

Florence’s Theory and Health

Although Florence Nightingale was bedridden, she continued to campaign toimprove the heath standards, publishing 200 books, reports and pamphlets.

She believed that infection arose spontaneously in dirty and poorly ventilated places

Her belief led to improvements in hygiene and healthier living and working environments

Florence Nightingale’s vision of health care included professional nursing for the sick and the poor

Florence’s Theory and Health

One of the first people to examine data on occupational health and safety

Systemic approach to health care with a major role for prevention, clean air, clean water, decent housing and good infant care

Promoted uniform hospital statistics so that results could be compared by country, institution and type of treatment

Florence and the Environment

Mother’s responsibility to teach her children cleanliness in mind, body, and spiritThis included waste management and

tidiness in and around the home

Bad smells were to be considered a sign of danger

Florence and the Environment

In order for healing to occur, all environmental and sanitary conditions must improve

Ventilation/ Clean Air and light were considered key factors in hygiene

Florence and Nursing Florence Nightingale is the reason why

nursing is considered a profession today and recognized that educated nurses would be viewed by the public as professional.

First nursing school at St. Thomas Hospital in London

She believed that God called her to be a nurse and that He had natural laws that were to be followed

Florence and Nursing

According to Nightingale, the aim of nursing education was to train women to become nurses in order to serve society for the alleviation of the suffering of the sick, for the amendment of the living conditions of the poor, and for the improvement of the health of the population (Nightingale 1859).

The Effect on Nursing Practice Stressed the importance of hygiene and

believed that it aided in the prevention of disease spreading

Focused on a holistic caring perspective Aseptic practices Nursing is a continuous learning process

because new and better practices are always being developed

What it is, or what it should be?

BOTH! Maintaining a clean environment within

the healthcare setting is essential to prevent nonsocomial infectionsGloves and other PPE, bed linens,

handwashingKeeping a clear path for fire safety

What it is, or what it should be?

However, not everyone always follows the rules:Carts, etc. obstructing the hallwaysNot everyone wears gloves when they

are supposed toHandwashing

Florence Nightingale’s Theory is one that every nurse should strive to achieve by maintaining a healthy environments not only for their patients, but also for themselves.

CULTURAL CARE DIVERSITY AND UNIVERSALITY THEORY 

MADELEINE M. LEININGER

MADELEINELEININGER

Born in Sutton, Nebraska July 13, 1925

Received her Basic Nursing Education from St. Anthony’s School of Nursing in 1948

Received her Bachelor of Science from Mount St. Scholastica College in 1950

Received her Master of Science in Psychiatric-Mental Health Nursing from The Catholic University of America in 1954

Received her Ph.D. in Cultural and Social Anthropology from the University of Washington in 1965

MADELEINELEININGER

Dr. Leininger is the founder of Transcultural Nursing

She is a fellow in the American Academy of Nursing

She was named a “Living Legend” by the American Academy of Nursing in 1998

She is Professor Emeritus in the College of Nursing, Wayne State University and Adjunct Professor at the University of Nebraska Medical Center, College of Nursing, Omaha

A substantive area of study and practice focused on comparative cultural care (caring) values, beliefs and practices of individuals or groups of similar or different cultures with the goal of providing culture-specific and universal nursing care practices in promoting health or well-being or to help people to face unfavorable human conditions, illness or death in culturally meaningful ways.

DEFINITION OF TRANSCULTURAL NURSING

The study of nursing care beliefs, values and practices as cognitively perceived and known by a designated culture through their direct experience, beliefs and value system.

DEFINITION OF ETHNONURSING

The term Transcultural Nursing is used today to refer to the evolving knowledge and practices related to this new field of study and practice.

Leininger stresses the importance of knowledge gained from direct experience or directly from those who have experienced and labels such knowledge as emic or people-centered. This is in contrast with etic knowledge or professional perspective.

TRANSCULTURAL NURSING

Leininger contends that emically derived care knowledge is essential to establish nursing’s epistemological (the branch of philosophy that studies the nature of knowledge, in particular its foundations, scope, and validity)and ontological (the most general branch of metaphysics, concerned with the nature of being)base for practice.

TRANSCULTURAL NURSING

Leininger built her theory of transcultural nursing on the premise that the peoples of each culture can not only know and define the ways in which they experience and perceive their nursing care world but also relate these experiences and perceptions to their general health beliefs and practices.

TRANSCULTURAL NURSING

MODEL KEPERAWATAN LEINEGER

Care. ”Caring”, Kebudayaan Perawatan kultural Cultural care

diversity (perbedaan perawatan kultural)

Cultural care universality (Kesatuan perawatan kultural)

Keperawatan Pandangan dunia Dimensi struktur

sosial dan budaya Lingkungan ”Etnohistory ” Sistem perawatan

profesional Sistem perawatan

pada masyarakat tradisional

CARING

5 ASPEK CARING1. MERUPAKAN SIFAT MANUSIA (HUMAN

TRAIT)2. PERILAKU CARING BERDASAR

MORAL IMPERATIVE3. DITUNJUKKAN DENGAN PENUH

PERASAAN (AFFECT)4. HUBUNGAN INTERPERSONAL

PERAWAT-KLIEN5. INTERVENSI TERAPEUTIK DALAM

ASUHAN KEPERAWATAN

MODEL KEPERAWATAN Jean Watson

10 sifat dan karakter perawat profesional

Membentuk Sistem nilai humanistik-altruistik

Menanamkan keyakinan dan harapan

Meningkatkan kepekaan terhadap diri sendiri dan orang lain

Membina hubungan saling percaya

Mengembangkan dan menerima ekspresi perasaan positif dan negatif.

Mengunakan metode ilmiah dalam penyelesaian masalah .

Meningkatkan proses pembelajaran interpersonal untuk menumbuhkan tanggung jawab kesehatan klien .

Menciptakan suasana supportif, korektif dan protektif terhadap mental, fisik, sosiokultural dan spiritual.

Membantu memenuhi kebutuhan dasar manusia.

Menghargai kekuatan eksternal yang ada dalam kehidupan .

SHARING JURNAL

Tujuan : memberikan kesempatan kepada mahasiswa untuk memahami

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Meleis, Ibrahim.A. (1997). Theoritical nursing : development and progress. (3rd

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Tomey, Ann Marriner. (1994). Nursing theorist and their work. (3rd ed). St.Louis:

Mosby