Introduction
Nursing theories are at the core of nurses’ work and essential to building patient relationships. Nursing theorists such as Virginia Henderson, Lydia Hall, Hildegard Peplau, and Dorothea E. Orem developed key principles of practice in their theories and sought to conceptualize nursing work. Nursing theories help to better communicate with patients, build trusting relationships with them, and, as a result, contribute to nursing outcomes. Therefore, this paper will analyze Peplau’s theory of the nurse-patient relationship and Orem’s self-care deficit theory.
Peplau’s Nursing Theory
Patient-Nursing Relationships
Hildegard Peplau’s theory of interpersonal relationships is one of the best-known and widely used theories in nursing. Peplau was a psychiatric nurse, so her idea is based on the relationship between nurse and patient (Smith & Parker, 2020). To achieve maximum positive outcomes in treatment, healthcare providers and patients must work collectively towards a common goal. However, nurses have a key role in building these effective relationships. They must be able to establish communication with the patient and help maintain this relationship.
In these relationships, nurses play several vital roles for the patient. These roles and functions include stranger, resource, teacher, leader, surrogate, and counselor (Wasaya et al., 2021). These roles change and develop depending on the phase in the relationship between the health worker and the patient. Nurses must have professional expertise and “possess extensive knowledge about the potential problems that emerge during a nurse–patient interaction” (Smith & Parker, 2020, p. 69).
The competence of the healthcare provider is the foundation of an effective patient relationship as it contributes to achieving positive outcomes for the individual. The nurse is used as a resource that a person with a disease needs for effective treatment. In addition, the healthcare provider plays an educational role for the individual as a key source of knowledge about diseases and treatment options (Smith & Parker, 2020). Nurses contribute to informing patients and raising public health by educating the public about existing threats and ways to prevent diseases. However, healthcare providers must also constantly educate themselves and improve their skills in response to emerging challenges.
Moreover, nurses must have certain characteristics to build an effective relationship with a patient. Peplau defined that “the nurse must possess intellectual, interpersonal, and social skills” (Smith & Parker, 2020, p. 69). These skills help healthcare providers meet patients’ needs related to their disease and personal needs. In addition, they help analyze not only the current state of a person’s health but also potential risks and possible deterioration based on the patient’s life context and social determinants of health.
Peplau’s theory is based on health professionals’ understanding of the patient’s point of view and considering their personal values and beliefs when developing a treatment plan. Therefore, this theory is based on an individual approach to each person, where the professional knowledge of the nurse is the basis. The theoretical knowledge of health professionals must be adapted to the needs of each patient to contribute to the personal development of the person (Smith & Parker, 2020). This implies both an improvement in patients’ physical and psychological condition and an increase in their awareness and provision of social support.
Phases of Nurse-Patient Relationship
According to Peplau, there are four phases in the nurse-patient relationship. Relationship building begins with the orientation phase, which “sets the stage for the development of the relationship” (Smith & Parker, 2020, p. 70). At this stage, the nurse and patient are strangers, so both parties must learn key information about each other. This includes the nurse’s assessment of the patient’s health status and identifying limitations that may arise in communication.
For example, a case study by Wasaya et al. (2021) demonstrates that language and cultural and religious beliefs can be significant barriers to working with patients. Determining these aspects of the patient helps the nurse understand the primary purpose of the interaction and provides key information to consider when making treatment decisions. Moreover, this phase lays the foundation for a trusting relationship between the patient and the nurse.
After getting to know the patient and identifying their needs, the nurse can move on to the subsequent phases in the relationship. The stages of identification and exploitation are often combined into a working phase (Smith & Parker, 2020). In these phases of the relationship, the patient is the central component.
During the identification phase, the patient identifies the nurse as the source of care, while the healthcare provider determines the level of intervention needed to achieve the client’s recovery. The patient may function independently or interdependently depending on their condition (Smith & Parker, 2020). In addition, at this stage, the client’s progress in achieving the set goals is assessed, and the healthcare provider can adjust the course of treatment depending on the person’s changing needs.
During the exploitation phase, the patient uses the resources provided to them to obtain the maximum benefit for their health. In addition, at this stage, the client “begins to develop responsibility and independence” (Smith & Parker, 2020, p. 71). However, for the patient to be able to take care of their health in the future, the nurse must provide them with the necessary information and knowledge. At this stage, the healthcare provider can be a resource and teacher (Wasaya et al., 2021). This includes informing the client about self-care practices and the possibilities of their implementation in daily life.
The final phase of the nurse-patient relationship is a resolution when the initial treatment goals are achieved. At this relationship stage, based on treatment outcomes, the client and healthcare provider set new goals for future collaboration (Smith & Parker, 2020). These goals may include maintaining the results or setting new treatment goals if the initial ones cannot be achieved. In the resolution phase, the patient can independently provide self-care, and intervention from the nurse is no longer necessary. In addition, both sides of the relationship must evaluate the results of their interaction and bring the relationship to its logical conclusion.
Orem’s Self-Care Deficit Theory
Orem’s Self-Care Deficit theory focuses on the importance of self-care for patients and nurses to achieve the best nursing outcomes. The approach is based on three main concepts: self-care, self-care deficit, and nursing systems (Smith & Parker, 2020). The basis of the theory is the nurse’s understanding of the patient’s needs and ability to meet them. When clients cannot take care of themselves, they need the help of another person with the appropriate competencies.
Self-care is inherent in everyone, and they use it to maintain their physical, emotional, and social well-being. These actions are voluntary and conscious, represent a particular stereotype, and are performed in a specific sequence (Yip, 2021). It includes basic activities like hygiene, nutrition, exercise, and rest. In addition, for proper self-care, it is necessary to assess the situation and determine what actions must be taken. Most often, people manage to meet their basic needs on their own; however, in some cases, there is a need for dependent care when people need additional help.
A self-care deficit occurs when people cannot care for themselves due to physical or psychological limitations. This includes self-care capacity, limited self-care, and non-self-care (Smith & Parker, 2020). If the client, due to certain limitations, cannot take care of himself, the intervention of a nurse is necessary. According to Orem, the self-care deficit is the rationale for nursing care and nursing in general (Smith & Parker, 2020). This approach is based on the patient’s perception that the party needs help, and the nurse provides the necessary assistance.
The nursing system results from interactions between the patient and the healthcare provider. There are wholly compensatory, partially compensatory, and supportive-educative nursing systems (Smith & Parker, 2020, p. 108). Under wholly compensatory, the nurse assumes full responsibility for meeting a specific aspect of care that the patient cannot perform independently. Partially compensatory systems of nursing care involve the joint actions of the nurse and the patient. Supportive-educative systems are needed to teach the patient some actions to satisfy his need for therapeutic self-care.
Orem’s Self-Care Deficit theory can be applied to caring for children because they cannot meet their needs independently. Different nursing systems can be used depending on the child’s age and health. For example, healthcare providers may engage children in self-care practices as an educational function (Isik & Fredland, 2023). Early education of children in self-care practices contributes to improving children’s self-care, increasing public health, and preventing the development of various diseases in children.
Conclusion
In conclusion, nursing theories help nurses understand the patient’s needs and are the basis of professional practice. Moreover, they allow healthcare providers to develop treatment plans and make decisions based on patients’ needs and interests. Peplau’s and Orem’s nursing theories are necessary to understand the patient’s needs and the nurse’s role in meeting them. Moreover, these theories focus on improving the effectiveness of medical care and achieving positive nursing outcomes.
References
Isik, E., & Fredland, N. M. (2023). Orem’s self-care deficit nursing theory to improve children’s self-care: An integrative review. The Journal of School Nursing, 39(1), 6-17. Web.
Smith, M. C., & Parker, M. E. (2020). Nursing theories and nursing practice (5th ed.). F.A. Davis.
Wasaya, F., Shah, Q., Shaheen, A., & Carroll, K. (2021). Peplau’s theory of interpersonal relations: A case study. Nursing Science Quarterly, 34(4), 368-371. Web.
Yip, J. Y. C. (2021). Theory-based advanced nursing practice: A practice update on the application of Orem’s self-care deficit nursing theory.SAGE Open Nursing, 7, 1-7. Web.