Knowledge for Nursing Essay

This essay will explore Peplau’s concept of a nurse-patient relationship and how it narrates to the experience I had whilst on placement practice. My aim is to demonstrate my gained understanding of the nursing process, the domains of nursing, the nature of nursing models and their relationship to practice and Peplau’s model of nursing. The reason why the student has chosen this concept is because nursing is an interpersonal process which involves interaction between two or more people with a mutual goal, (George 2003). The essay will start by defining the word concept then describe the incident that I observed in placement practice. The essay will analyze how theories can be used to justify nursing interventions in practice. The conclusion summarises the main points of the essay and reflect on my learning experience. (Meleis 1991) defined concept as â€Å"a label used to describe a phenomenon or a group of phenomena† (McKenna 1997). (McKenna 1997) concludes that concepts are identified when a name is put to a phenomenon. â€Å"Therefore, a concept is a tool and not a real entity – it merely facilitates observation of a real phenomenon,† (McKenna 1997 p8). Chinn and Kramer (2008); Hage (1972); Reynolds (1971) were cited that concepts can be theoretical or tangible. Theoretical concepts are created mentally independent of a particular or interval location, whereas tangible concepts are experienced directly and relate to a specific interval or location (Alligood and Tomey, 2010). â€Å"Nursing is a significant, therapeutic, interpersonal process. It functions co-operatively with other human processes that make health possible for individuals in communities. In specific situations in which a professional health team offers health services, nurses participate in the organisation of conditions that facilitate natural on going tendencies in human organisations. Nursing is an educative instrument, a maturing force that aims to promote forward movement of personality in the direction of creative, constructive, productive, personal, and community living. † (Peplau 1988, p16) Peplau (1952) defined phases in the nurse-patient relationships that overlap and transpire during the relationship interval. George (2002) cited the three phases defined by Peplau are as follows; orientation, identification, working, and termination. Whilst on Placement I had the prospect to put theory into practice with the supervision of my mentor when Mrs. Ahmed aged 85 was admitted into the ward after having had a fall (false name and age due to confidentiality, Nursing and Midwifery Council 2003). During handover it was reported that Mrs. Ahmed was at times unresponsive and seemed uninterested when addressed to by the nurse on duty upon admission, leaving the nurse to rely on the information obtained from the ambulance crew as she was unaccompanied. Upon arrival Mrs. Ahmed had not been able to get up from the stretcher as she was not weight bearing after the fall and appeared to be confused with the new environment. It was hoped that more information would be obtained in the morning when she awoke. Orientation stage My mentor gave me an opportunity to work with Mrs. Ahmed whilst under her supervision and it was obvious that the information we had was not complete. To get further information we went to her bedside which was in a mixed ward were we were introduced to the new patient. The orientation phase is initiated when a health problem occurs thus resulting in a felt â€Å"felt need, and professional assistance is sought. † Peplau (1952, p. 8) Peplau (1952) further states that the nurse and patient meet as two strangers, by clarifying and defining the problem in the orienting stage the patient can direct the accumulated energy from her anxiety about unmet needs and begin working with the presenting problem. The nurse patient rapport is established and continues to be strengthened while concerns are being identified. The nurse assumes a roles as described by Peplau in the overlapping phases of the nurse client relationship. Lebby and Pepper (1998) sees the nurse in the role of a stranger therefore acceptance of the patient as an emotionally able person is required. It is at this early stage I noticed that Mrs. Ahmed was unresponsive and seemed distant when my mentor asked for her consent to be assisted by a trainee nurse under her supervision (Nursing and Midwifery Council Code 2008). After asking her more than once she eventually responded and accepted the request. xxxxx When my mentor spoke to Mrs. Ahmed was clear and slow, and asked closed questions. Ashworth et al (1981) suggest that the quality and quantity of nurse-patient communication in geriatrics is affected by the nurse as well s the patient although some of the traditional attitudes by nurses toward elderly patients posed barriers to communication. Orem (1991) viewed the relationship between a nurse and patient as being complementary and therefore a nurse has to understand the basis of her own behavior. I noticed that the patient had some hearing aids on her bedside and I then considered that she might be having hearing impairment and was either not keen on using her hearing aids or needed assistance putting them on. I asked her if she was happy putting the hearing aids on her own. She attempted to put them on but seemed unsteady with her hands. I gestured that I could help and she extended them to me. I then helped her to put them on. George (2002) sees the working phase as a time when the patient starts to respond selectively to individuals who can meet their needs. Peplau (1952/1988) identified three types of responses from patients; the patient may participate and be interdependent, or be autonomous and independent from the nurse or be passive and dependent on the nurse (George 2002). Peplau (1952/1988) states the patient utilises the relationship fully by making full use of the nurse (Leddy and Pepper 1998). Peplau (1952) describes six nursing roles within the phases of the nurse patient relationship which are; stranger, resource person, teacher, leader, surrogate and counseling. She further described four psychobiological experiences, in her book which are; needs, frustration, conflict and anxiety. Peplau (1952) saw these experiences as energy providers transforming into action and provides a basis for goal formation and nursing interventions. Mrs. Ahmed showed she was becoming more relaxed and became more trusting and cooperative. Arnold and Underman Boggs (1999) suggested that the dynamic nursing approach Peplau advocated is not that of passive observer but participant observers, nurses actively engaging with their clients. I initiated further verbal dialogue and realised that although she could hear me she was struggling to understand what I was saying to her. Her replies where brief and at times not relevant to the questions posed. It became obvious that since English was not her first language she was struggling to understand me and her conversational English skills were basic. I then slowed my rate of speech and emphasised with gestures where appropriate. That way she seemed to comprehend what I was saying better. Forchuk (1993) mentions two types of communication, verbal and non-verbal communication, verbal communication conveyed by words and non-verbal communication conveyed through empathic links, postures, gestures, and patterns (Forchuck 1993). Peplau (1952/1988) considers the use of verbal communication to be an essential component of the nurse-client relationship (Forchuk 1993). The general principle is that anything clients act out with nurses will most probably not be talked about, and that which is not discussed cannot be understood. † Peplau (1989a p. 197). Forchuk (1993) suggest that discussing issues and concerns presents the patient an option to work them out. Thus nursing knowledge enables nurses to justify actions or stop unsafe or poor practices (Nursing and Midwifery 2003, The Code). Mrs. Ahmed was reluctant to have me assist her with personal hygiene although it was obvious that she needed it and it was also documented in her notes that she was not independent in this respect. She said something about being used to doing things for herself and how it was expected in her culture to clean one’s own body, she then suggested to wash herself and would ask for help when in difficulty. After washing herself, I took the opportunity of getting more information about Mrs. Ahmed, her family and health Data collection is constant throughout Peplau’s phases. George (2002) state that in the nursing process, primary collection of data is the nursing assessment, and further collection of data becomes an integral part of reassessment. The need for Mrs. Ahmed ‘s relations to be present compliments George (2002) statement that the nurse, patient and relatives need to work together in order to simplify and explain the problem at hand. Peplau (1995) discusses the need for the nurse to not only support but health educate the patient’s relations thus decreasing the tension and anxiety connected with the felt need and fear of the unknown thus the avoidance of future problems arising from unresolved significant events(George 2002). Peplau (1952/1988) states the importance of clarity on both parties in the relationship as their past experiences will influence their expectations in this progression. I also made her aware of her condition and situation whilst being conscious not to give advice, but rather asking her questions which we needed answers for, to help resolve her care needs. Peplau (1988) stated that the exploitation phase is where the nurse assists the patient to seek out other health care services and personal strengths in resolving the issues for which the client initially sought treatment. She thanked me for having explained everything she needed to know and for my patience during my interaction with her on that day. Peplau (1952/1988) saw the termination phase as a liberating process wherein the client’s wishes for psychological dependency and maintaining relationships have been worked through to support the ability to mutually end the relationship with the nurse (Leddy and Pepper 1998). Peplau views this phase as problematic for nurses as the progression of letting go is focused upon (Simpson1991).