Personal Reflection on Communicating Nursing Theory to patients

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Nursing theory is a conceptualization of some aspect of discovered or invented realities that relates to nursing. The concept is expressed for the purpose of describing, explaining, predicting or prescribing nursing care (Chinn & Kramer, 1990). This definition adds the important of communicating nursing theory and the purpose of prescription of nursing care. Nursing theory is a framework in which to plan nursing care and organise nursing knowledge. Nursing theory helps to provide the principles that underpin nursing practice and will increase nursing knowledge (Hood & Leddy, 2006). A well defined body of theory in nursing helps the nurses to understand their purpose and role in the health care setting. Nursing theories have four elements; they are person, environment, health and nursing (Forchuk, 1993). In this essay I will describe an incident from my nursing practice and I will also discuss Peplau's theory and its contribution to nursing knowledge and nursing practice. Moreover I will explain the changed outcomes resulting from the use of Peplau's theory in that situation. I will also clarify the advantages and disadvantages of applying theory to my personal practice.

I would like to discuss an incident that happened in my practical area, when I was working as a staff nurse at reputed Hospital in India during my practice. One male patient was admitted to my ward after a road traffic accident with a traumatic foot injury. He was a 30 year old healthy unmarried man. He was posted for skin grafting. After all the blood investigations he was diagnosed as having non insulin dependent diabetic mellitus (NIDDM). He was very depressed at becoming a diabetic patient at his age. On the day of admission I gave him orientation about the unit facilities. I did not have more time to share with the client because of the busy shift .I collected his history from the medical history record sheet. I gave all cares according to the medical orders. He underwent the surgery and he was on antibiotics and hypoglycaemic agent. After two weeks he was discharged. I had given him the discharge advice and the health education leaflet and broucher on the day previous to the discharge. The health education sheet contained information about all the cares for a diabetic person and the foot care. After three weeks of discharge he was again admitted to same ward with high blood sugar levels and a gangrenous toe. He had not followed the discharge advice about NIDDM and foot care. Unfortunately he had surgery to amputate the gangrenous toe. This may have been because of the ignorance of the importance of the follow-up care and lack of awareness of the consequences of this.

The theory of Inter Personal Relations first taught to nursing student in 1948 and published by Hilgeard Peplau by 1952. Peplau published Interpersonal relation in nursing referring to her book as a "partial theory for the practice of nursing" (Chinn & Kramer, 1990). It has great importance in the nursing field, especially in psychiatric nursing. She focused on the use of a therapeutic relationship between the nurse and the client to intervene optimum health outcomes (Marchese, 2006). Peplau used the term "psychodynamic nursing" to describe the dynamic relationship between a nurse and a patient (Hood & Leddy, 2006). As a theorist she defines the Meta paradigm of nursing as consisting of the patient (individual), environment and health. Nursing is viewed as a significant therapeutic interpersonal process. The Inter- personal process is a maturing force and educative instrument for both nurse and patient. The individual is viewed as an organism who strives in its own way to reduce tension generated by needs. Each individual is viewed as a unique person. Environment is viewed as culture and mores and as factors to consider in dealing with the individual. Health is defined as a forward movement of the personality and other ongoing human processes in the direction of creative, constructive and productive, community, living. Peplau describes the four phases of this relationship and the six major roles of the nurse. The four phases are orientation, identification, exploitation and resolution (Hood & Leddy, 2006). During the first phase, the nurse and client meet as two strangers. But later on client begins to trust the nurse. The nurse helps the person to identify the person's problem and gives orientation in the use of services. In the identification phase, the person identifies with the nurse and is thereby accepting help (Alligood & Tomey, 2006). The nurse gives encouragement for the client to express his feelings and strengthens the positive forces. In the exploitation phase, the person makes use of the nurse's help and the utilizing of the services available. This phase is the working stage of the therapeutic relationship (Alligood & Tomey, 2006). Finally, in the resolution phase, the actual problems are resolved and the person accepts new goals and frees her or himself from the relationship (Hood & Leddy, 2006) The six different nursing roles that emerge in the various phases of the nurse patient relationship are stranger, resource person, leader, teacher and counsellor (Alligood & Tomey, 2006).The roles depend on the needs of the client and the skills and creativity of the nurse.

I selected this theory because in nursing interpersonal relationship is the most important aspect of my personal philosophy. I have read many nursing theories but Peplau's theory has helped me to know more about different phases of the interpersonal relationship. Its application to my practical area boosts my way of dealing with the clients. This theory also helps me to identify my six major roles as a nurse. The contribution of Peplau's theory to nursing knowledge and practice is vast. Her influence in the psychiatric nursing speciality had a profound effect on the nursing profession; nursing science and nursing practice through the development of inter personal relations theory. The interpersonal relationship is the central concept of nursing care (Alligood & Tomey, 2006). Peplau's theory provides a basis for both the art and science of nursing practice. Analysis of Peplau's works illuminates a scholarship of nursing practice that is relevant today (Gregg, 1999). Peplau emphasised the need for nursing practice-based theory, as well as nursing theory-based practice (Gregg, 1999). Her theory of Interpersonal Relations complements the other elements of practice knowledge that the nurse uses to assist patients. Peplau's theory is helpful in group practice like organized clinical programmes, case management services and counselling services to individuals who are mentally ill (Forchuk, 1993). The theory has also been used to evaluate the overall effectiveness of a public health programme. Peplau's theory can also be used as a guide for both qualitative and quantitative research. Research conducted on the basis of Peplau's theory over a two year period shown that nurses were able to reduce the length of hospitalization through using therapeutic relationship (Forchuk, 1993).

In the situation, which I have discussed with you, if I had used Peplau's theory, I would have a better outcome. As per Peplau's theory, in the orientation period, along with the orientation to the use of services, a productive exploitation of anxiety and tension by talking and sharing with the client should be done. A thorough would have changed from stranger to a resource person and counsellor. This reduces fear and anxiety. In the second phase where the patient assumes a feeling of interdependence or trustworthiness in relation to the nurse I could assist the patient to consider and select the services needed. The patient history helps the nurse to identify the specific problems and needs of the patient. The nurse may be able to develop a care plan for him. From this time onwards I should give health education about diabetic diet, exercise, medication, personal hygiene especially, foot care since he has a traumatic foot injury. I should make him understand the need for prevention of infection, the interrelation between infection and high sugar levels. The nurse can identify psychobiological experiences like frustration, conflicts and anxieties due to changes in physique. I should give psychological support to him because he is a young person with newly detected diabetic mellitus. In the phase of exploitation, I should allow him to make use of the available recourses and to utilize the services for a better outcome. I should implement the care as per the care plan and treatment protocols. This may include medication, wound care, demonstration of rehabilitative plans and meet needs as they emerge. I should help him to contact to the local diabetic association and clarify all the doubts and give psychological support. In the resolution phase, all the old needs are resolved. He may be able to take care of himself at home. His view towards the disease may have changed due to the therapeutic, educational and interpersonal process of nursing. If I had cared for him according to Peplau's interpersonal theory, he may have been able to take care of himself. His blood sugar level may have been within normal limits and he may have prevented secondary infection to the toe. He could perhaps have avoided the second hospital admission and amputation.

There are many benefits of using theory in nursing practice. Nursing theory helps in explaining and describing the phenomena of nursing. The theory provides the basis of the nurses' knowledge and doing in nursing framework which also develop the skills of critical thinking and decision making in practice (Alligood & Tomey, 2006). The nursing theory also helps in forming the foundations of nursing practice and also helps nurses in analysing what they know and what they have to do. The theories give an appropriate approach for the understanding of the nursing matters, observing the situations and guidance for research and practice (Alligood & Tomey, 2006). By applying theories of different theorist in clinical practice, a nurse can provide the better patient-care. The theory also helps in generating the future knowledge and development in nursing. The theory promotes professional standards by the use of the psychodynamic approach in nursing (Hood & Leddy, 2006).

However though, theory contributed a lot to the nursing field it has some disadvantages too. The main draw-back of the application of the theory is that some theories are only adaptable to only nursing settings (Forchuk, 1993). Those theories could not apply to all kinds of patients like unconscious patients. This theory is not applicable in case of emergency settings and treatments too like CPR and defibrillation (Forchuk, 1993). The theory cannot work if the nurse can not understand the patient's language; so a language barrier is a difficult in the development of the good inter personal relationship. Moreover, many nurses have not had the training or experience to deal with the abstract concepts presented by nursing theory. This makes it difficult for the majority of nurses to understand and apply theory to practice (Johnson & Webber, 2010).

In conclusion, theory in nursing helps the nurses to understand their purpose and role in the health care setting. It helps to increase the knowledge and skills of the nurses to implement nursing care. The contribution of Peplau's theory to nursing knowledge and practice is enormous. Peplau's theory can also be used as a guide for both qualitative and quantitative research. The application of Peplau's theory in my practical situation helped me to understand my major roles as a nurse. The different phases in this interpersonal theory help to improve my interpersonal relationship with my patients. There are many benefits in my practical area of using the concepts of nursing theory. However, there is a need for nurses to understand the proper utilisation of the theory in practice to maintain high standards of practice.