Hildegard peplau

S
Sheena Marie CorderoClinical Instructor um Riverside
Prayer
Hildegard Peplau
Life and Works
Who was Hildegard Peplau?
Early life
Name: Hildegard Elizabeth Peplau
Nickname: Hilda
Birthday: September 1, 1909
Died: March 17, 1999 in Sherman Oaks, California
Birthplace: Reading, Pennsylvania
Parents: immigrants of German descent
Father: Gustav Peplau (illiterate but hard-working)
Mother: Otyllie Peplau (oppressive and perfectionist)
Birth Order: She was the second daughter born of six
children
Characteristics
• strong-willed
• strong motivation
• has a vision to grow beyond traditional women’s
roles
• wanted more out of life
Why Nursing?
Nursing was one of few career choices for
women in her day. As a child, she
witnessed the devastating flu epidemic of
1918, a personal experience that greatly
influenced her understanding of the
impact of illness and death on families.
Career Timeline
1931 - Diploma program in Pottstown, Pennsylvania
1943 - BA in interpersonal psychology - Bennington
College
1947 - MA in psychiatric nursing from Colombia
University, New York
1952 - Published Interpersonal Relations in Nursing
1953 - EdD in curriculum development in 1953
Professor emeritus from Rutgers university
Started first post baccalaureate program in
psychiatric nursing
1968 - interpersonal techniques - the crux of psychiatric
nursing
• Worked as executive director for ANA
• President of ANA from 1970-1972
• Vice-President of ANA from 1972-1974
• Worked with W.H.O., NIMH and Nurse Corps.
• She was the first published nursing theorist
since Florence Nightingale
• created the middle-range nursing theory of
interpersonal relations, which helped to
revolutionize the scholarly work of nurses
• Staff Nurse in Pennsylvania and New York City
• School Nurse at Bennington College, VT
Affiliations and Achievements
• Certified in Psychoanalysis at the William Alanson
White Institute of New York City
• Faculty of the College of Nursing at Rutgers University
• Created first graduate level program for the
preparation of clinical specialists in Psychiatric Nursing
• Therapeutic Care vs Custodial Care in mental hospitals
• Strong advocate for graduate education and research
in nursing
• She is the primary contributor to mental health law
reform, leading the way towards humane treatment
of patients with behavior and personality disorders
Interpersonal Theory
• Interpersonal Relations Model
• Psychodynamic Nursing
In a nutshell:
• Using an understanding of one’s own
behavior to help others identify their
difficulties
• Applies principles of human relations
• Patient has a felt need
What is Interpersonal Relations Theory?
• Emphasized the nurse-client relationship as the
foundation of nursing practice
• The interpersonal model emphasizes the need
for a partnership between nurse and client as
opposed to the client passively receiving
treatment (and the nurse passively acting out
doctor's orders).
• shared experience - Nurses could facilitate this
through
observation, description, formulation, interpretat
ion, validation, and intervention
Major Concepts
• The theory explains the purpose of nursing is to help
others identify their felt difficulties.
• Nurses should apply principles of human relations to
the problems that arise at all levels of experience.
• Peplau's theory explains the phases of interpersonal
process, roles in nursing situations and methods for
studying nursing as an interpersonal process.
• Nursing is therapeutic in that it is a healing
art, assisting an individual who is sick or in need of
health care.
Major Concepts
• Nursing is an interpersonal process because it
involves interaction between two or more
individuals with a common goal.
• The attainment of goal is achieved through the
use of a series of steps following a series of
pattern.
• The nurse and patient work together so both
become mature and knowledgeable in the
process.
• Theory of interpersonal relations is a middle
range descriptive classification theory
• The theory was influenced by Harry Stack
Sullivan's theory of inter personal relations
(1953)
• The theorist was also influenced by Percival
Symonds, Abraham Maslow's and Neal Elger
Miller
• Peplau's theory is also referred
as psychodynamic nursing, which is the
understanding of ones own behavior
Metaparadigm
Person:
• An individual
• A developing organism that tries to reduce
anxiety caused by needs.
• Lives in stable equilibrium
Environment:
• Existing forces outside the organism and in the
context of culture
Metaparadigm
Health:
• A word symbol that implies forward movement of
personality and other ongoing human processes in
the direction of
creative, constructive, productive, personal and
community living
Nursing:
• A significant therapeutic interpersonal process.
• It functions cooperatively with other human process
that make health possible for individuals in
communities.
• Involves problem-solving
Peplau’s Seven Roles of a Nurse
• Stranger: receives the client in the same way one
meets a stranger in other life situations provides an
accepting climate that builds trust.
• Teacher: who imparts knowledge in reference to a
need or interest
• Resource Person : one who provides a specific
needed information that aids in the understanding
of a problem or new situation
• Counselor : helps to understand and integrate the
meaning of current life circumstances, provides
guidance and encouragement to make changes
Peplau’s Seven Roles of a Nurse
• Surrogate: helps to clarify domains of
dependence interdependence and
independence and acts on clients behalf as an
advocate.
• Leader : helps client assume maximum
responsibility for meeting treatment goals in a
mutually satisfying way
• Technical Expert: provides physical care by
displaying clinical skills and operates equipment
Additional Roles
1. Consultant
2. Health teacher
3. Tutor
4. Socializing agent
5. Safety agent
6. Manager of environment
7. Mediator
8. Administrator
8. Recorder observer
10. Researcher
Four Sequential Phases in the
Interpersonal Relationship
1. Orientation
2. Identification
3. Exploitation
4. Resolution
Orientation Phase
• Problem defining phase
• Starts when client meets nurse as stranger
• Defining problem and deciding type of service
needed
• Client seeks assistance, conveys needs, asks
questions, shares preconceptions and
expectations of past experiences
• Nurse responds, explains roles to client, helps to
identify problems and to use available resources
and services
Orientation Phase
• Get acquainted phase of the nurse-patient
relationship.
• Preconceptions are worked through
• Parameters are established and met
• Early levels of trust are developed
• Roles begin to be understood
Factors Affecting the Orientation Phase
Identification Phase
• Selection of appropriate professional assistance
• Patient begins to have a feeling of belonging and
a capability of dealing with the problem which
decreases the feeling of helplessness and
hopelessness
• The client begins to identify problems to be
worked on within relationship
• The goal of the nurse: help the patient to
recognize his/her own
interdependent/participation role and promote
responsibility for self
Exploitation Phase
• Use of professional assistance for problem
solving alternatives
• Advantages of services are used is based on the
needs and interests of the patients
• Individual feels as an integral part of the helping
environment
• They may make minor requests or attention
getting techniques
• The principles of interview techniques must be
used in order to explore, understand and
adequately deal with the underlying problem
Exploitation Phase
• Patient may fluctuates on independence
• Nurse must be aware about the various phases
of communication
• Nurse aids the patient in exploiting all avenues of
help and progress is made towards the final step
• Client’s trust of nurse reached full potential
• Client making full use of nursing services
• Solving immediate problems
• Identifying and orienting self to [discharge] goals
Resolution Phase
• Termination of professional relationship
• The patients needs have already been met by the
collaborative effect of patient and nurse
• Now they need to terminate their therapeutic
relationship and dissolve the links between them.
• Sometimes may be difficult for both as
psychological dependence persists
• Patient drifts away and breaks bond with nurse and
healthier emotional balance is demonstrated and
both becomes mature individuals
Resolution Phase
• Client met needs
• Mutual termination of relationship
• Sense of security is formed
• Patient is less reliant on nurse
• Increased self reliance to deal with own
problems.
• The patient gradually puts aside old goals and
adopts new goals. This is a process in which the
patient frees himself from identification with the
nurse.
Interpersonal Theory and Nursing Process
• Both are sequential and focus on therapeutic
relationship
• Both use problem solving techniques for the
nurse and patient to collaborate on, with the
end purpose of meeting the patients needs
• Both use observation communication and
recording as basic tools utilized by nursing
Assessment
Data collection and analysis
[continuous]
May not be a felt need
Orientation
Non continuous data collection
Felt need
Define needs
Nursing diagnosis
Planning
Mutually set goals
Identification
Interdependent goal setting
Implementation
Plans initiated towards
achievement of mutually set
goals
May be accomplished by
patient, nurse or family
Exploitation
Patient actively seeking and
drawing help
Patient initiated
Evaluation
Based on mutually expected
behaviors
May led to termination and
initiation of new plans
Resolution
Occurs after other phases are
completed successfully
Leads to termination a
Application of Theory to Areas in Nursing
Nursing Education
• Has an impact on the Psychiatric Nursing
especially in the baccalaureate program in
nursing teaching CARE OF CLIENTS WITH
MALADAPTIVE PATTERNS OF BEHAVIOR
(NCM 105) composed of 72 hours lecture
and 102 hours RLE
Application of Theory to Areas in Nursing
Practice
• Focuses on the interpersonal processes and therapeutic
relationship that develops between the nurse & client.
• It requires that the nurse attends to the interpersonal
processes that occur between the nurse and client.
• Interpersonal process is maturing force for personality.
It includes the nurse- client
relationship, communication, pattern integration and
the roles of the nurse.
• Psychodynamic nursing is understanding one’s own
behavior to help others identify felt and perceived
difficulties and to apply principles of human relations to
the problems that arise at all levels of experience.
Application of Theory to Areas in Nursing
Research Based on Peplau’s Theory
• Hays, D. (1961). Phases and steps of experimental
teaching to patients of a concept of anxiety:
Findings revealed that when taught by the
experimental method, the patients were able to
apply the concept of anxiety after the group was
terminated.
• Burd, S.F. Develop and test a nursing intervention
framework for working with anxious patients:
Students developed competency in beginning
interpersonal relationship.
Vignette
The nursing process for Mrs. JL based on
Peplau’s theory is as follows:
• Mrs. JL
• 27 years
• Diagnosis: Inter vertebral disc prolapse
Assessment
(Orientation)
Nursing
diagnosis
Planning
(Identification)
Implementation
(Exploitation phase)
Evaluation
(Resolution)
Mrs. JL is on
pelvic traction
and she is
restricted to
bed.
The need for
bed rest and
restriction was
discussed.
Impaired
physical
mobility
related to
the
presence
of pelvic
traction.
Goal setting was
done along with
patient
Provide active and
passive exercises
to all the
extremities to
improve the
muscle tone and
strength.
Provide articles near
to the patient and
encourage doing
activities within
limits.
Carried out plans
mutually agreed
upon.
Provided active and
passive exercises to
all the extremities
Provided article within
the reach of the patient
Mrs. JL was free
to express
problems
regarding
difficulty in
mobilizing.
She expressed
satisfaction
when able to
move without
difficulty.
Assessment
(Orientation)
Nursing
diagnosis
Planning
(Identification)
Implementation
(Exploitation)
Evaluation
(Resolution)
Mrs. JL
expresses pain
in the low back
region.
Regarding pain,
discussion was
made to assess
the severity and
the type and
duration of pain.
Also the
measures
to reduce pain
were discussed.
Pain related
to the
degenerativ
e changes in
the lumbar
region.
Goal setting was
done along with
patient
Mrs. JL will have
reduction in pain
as evidenced by
her verbalisation
of reduction in
pain responses.
Administer
analgesics as
prescribed by the
physician.
Provide pelvic
traction to the
patient
Carried out plans
mutually agreed
upon.
Provided non
pharmacological
measures like
diversion,
massaging, and
pelvic traction.
Administered Tab.
Hifenac P; Cap.
Myoril 4mg as
prescribed.
Given and
explained need
for pelvic traction
Mrs. JL was free
to express
problems of pain.
Expressed that
she got slight
relief from pain.
Assessment
(Orientation)
Nursing
diagnosis
Planning
(Identification)
Implementation
(Exploitation)
Evaluation
(Resolution)
Mrs. JL
expresses that
she needs
assistance to
get down from
bed.
Self care
discussion was
done and
discussed
measures to
solve the
problems.
Self care
deficit
related to
presence of
pelvic
traction.
Goal setting was
done along with
patient
Client will achieve
and maintain self
care activities with
assistance of
caregiver or within
her limits.
Keep all the articles
within the reach of
the patient.
Assist the patient in
doing her self care
activities.
Carried out plans
mutually agreed
upon.
Kept the articles
within the reach
of the client
Assisted the
client in doing her
self care activities
Mrs. JL was free to
express problems
of self care.
She used to call for
the needs and all
her needs were
met appropriately
She achieved and
maintained self
care activities
within her limits
Assessment
(Orientation)
Nursing
diagnosis
Planning
(Identification)
Implementation
(Exploitation)
Evaluation
(Resolution)
Mrs. JL is
enquiring
about the
disease
condition, its
outcome and
need for
surgery
Discussed
with the
client
regarding the
disease
process and
the findings
in the client
Anxiety
related to
hospital
admission as
evidenced by
verbalisation
and client &
family
appearing
withdrawn
Goal setting was done
along with patient
Client will have reduced
feeling of anxiety as
evidenced by
asking fewer questions
Teach the family and
client regarding the
disease process.
Stress that frequent
assessment are routine
and do not necessarily
imply a deteriorating
condition.
Carried out plans
mutually agreed
upon.
Taught the family
regarding the
disease process in
layman’s terms
Allowed the
family members
to verbalize
anxiety
Mrs. JL was
free to
express
problems of
self care.
She asked her
doubts
regarding the
illness and the
diagnostic
procedures
She verbalized
that her
anxiety has
reduced to
some extent.
Assessment
(Orientation)
Nursing
diagnosis
Planning
(Identification)
Implementation
(Exploitation)
Evaluation
(Resolution)
Mrs. JL is
enquiring
about the
disease
condition, its
outcome and
need for
surgery
Discussed
with the
client
regarding the
disease
process and
the need for
follow up
Deficient
knowledge
related to the
treatment
measures to
be continued
even after
the discharge.
Goal setting was
done along with
patient
Patient will acquire
adequate knowledge
regarding the
treatment and home
care.
Explain the
treatment measures
to the patient and
their benefits
Use simple and
understandable
terms
Carried out plans
mutually agreed
upon.
Explained
treatment
measures and the
need for follow up
Used simple and
understandable
terms for
explaining
Mrs. JL was
free to express
problems of
self care.
She expressed
acquisition of
knowledge
regarding the
disease and
the signs of
aggravation of
illness
Evaluation of the application of the theory
of interpersonal relations by Peplau
• With the help of the theory of interpersonal
relations, the client's needs could be assessed.
• It helped her to achieve them within her limits.
This theory application helped in providing
comprehensive care to the client.
Summary of Application
1. Orientation phase
• Client is initially reluctant to talk due to pain.
• Client is expressing that while standing she is having much
pain.
• Client expressed without movement and supine position
gave her relief from pain.
2. Identification
• The client participates and interdependent with the nurse
• Expresses the need for measure to get relief from pain
• Expresses need for improving the mobility
• Expresses need to know more about prognosis, discharge
and home care and follow up.
Summary
3. Exploitation
• Client explains that she gets relief of pain when lying down
supine.
• Cooperates and participates actively in performing
exercises.
• Client mobilizes changes position and cooperates during
position changes.
4. Resolution
• Client expressed that pain has reduced a lot and she is
able to tolerate it now
• She has agreed upon to continue the exercises at home
• She also expressed that she would come for regular follow
up after discharge.
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Hildegard peplau

  • 3. Who was Hildegard Peplau? Early life Name: Hildegard Elizabeth Peplau Nickname: Hilda Birthday: September 1, 1909 Died: March 17, 1999 in Sherman Oaks, California Birthplace: Reading, Pennsylvania Parents: immigrants of German descent Father: Gustav Peplau (illiterate but hard-working) Mother: Otyllie Peplau (oppressive and perfectionist) Birth Order: She was the second daughter born of six children
  • 4. Characteristics • strong-willed • strong motivation • has a vision to grow beyond traditional women’s roles • wanted more out of life
  • 5. Why Nursing? Nursing was one of few career choices for women in her day. As a child, she witnessed the devastating flu epidemic of 1918, a personal experience that greatly influenced her understanding of the impact of illness and death on families.
  • 6. Career Timeline 1931 - Diploma program in Pottstown, Pennsylvania 1943 - BA in interpersonal psychology - Bennington College 1947 - MA in psychiatric nursing from Colombia University, New York 1952 - Published Interpersonal Relations in Nursing 1953 - EdD in curriculum development in 1953 Professor emeritus from Rutgers university Started first post baccalaureate program in psychiatric nursing 1968 - interpersonal techniques - the crux of psychiatric nursing
  • 7. • Worked as executive director for ANA • President of ANA from 1970-1972 • Vice-President of ANA from 1972-1974 • Worked with W.H.O., NIMH and Nurse Corps. • She was the first published nursing theorist since Florence Nightingale • created the middle-range nursing theory of interpersonal relations, which helped to revolutionize the scholarly work of nurses • Staff Nurse in Pennsylvania and New York City • School Nurse at Bennington College, VT Affiliations and Achievements
  • 8. • Certified in Psychoanalysis at the William Alanson White Institute of New York City • Faculty of the College of Nursing at Rutgers University • Created first graduate level program for the preparation of clinical specialists in Psychiatric Nursing • Therapeutic Care vs Custodial Care in mental hospitals • Strong advocate for graduate education and research in nursing • She is the primary contributor to mental health law reform, leading the way towards humane treatment of patients with behavior and personality disorders
  • 9. Interpersonal Theory • Interpersonal Relations Model • Psychodynamic Nursing In a nutshell: • Using an understanding of one’s own behavior to help others identify their difficulties • Applies principles of human relations • Patient has a felt need
  • 10. What is Interpersonal Relations Theory? • Emphasized the nurse-client relationship as the foundation of nursing practice • The interpersonal model emphasizes the need for a partnership between nurse and client as opposed to the client passively receiving treatment (and the nurse passively acting out doctor's orders). • shared experience - Nurses could facilitate this through observation, description, formulation, interpretat ion, validation, and intervention
  • 11. Major Concepts • The theory explains the purpose of nursing is to help others identify their felt difficulties. • Nurses should apply principles of human relations to the problems that arise at all levels of experience. • Peplau's theory explains the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process. • Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care.
  • 12. Major Concepts • Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal. • The attainment of goal is achieved through the use of a series of steps following a series of pattern. • The nurse and patient work together so both become mature and knowledgeable in the process.
  • 13. • Theory of interpersonal relations is a middle range descriptive classification theory • The theory was influenced by Harry Stack Sullivan's theory of inter personal relations (1953) • The theorist was also influenced by Percival Symonds, Abraham Maslow's and Neal Elger Miller • Peplau's theory is also referred as psychodynamic nursing, which is the understanding of ones own behavior
  • 14. Metaparadigm Person: • An individual • A developing organism that tries to reduce anxiety caused by needs. • Lives in stable equilibrium Environment: • Existing forces outside the organism and in the context of culture
  • 15. Metaparadigm Health: • A word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal and community living Nursing: • A significant therapeutic interpersonal process. • It functions cooperatively with other human process that make health possible for individuals in communities. • Involves problem-solving
  • 16. Peplau’s Seven Roles of a Nurse • Stranger: receives the client in the same way one meets a stranger in other life situations provides an accepting climate that builds trust. • Teacher: who imparts knowledge in reference to a need or interest • Resource Person : one who provides a specific needed information that aids in the understanding of a problem or new situation • Counselor : helps to understand and integrate the meaning of current life circumstances, provides guidance and encouragement to make changes
  • 17. Peplau’s Seven Roles of a Nurse • Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate. • Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way • Technical Expert: provides physical care by displaying clinical skills and operates equipment
  • 18. Additional Roles 1. Consultant 2. Health teacher 3. Tutor 4. Socializing agent 5. Safety agent 6. Manager of environment 7. Mediator 8. Administrator 8. Recorder observer 10. Researcher
  • 19. Four Sequential Phases in the Interpersonal Relationship 1. Orientation 2. Identification 3. Exploitation 4. Resolution
  • 20. Orientation Phase • Problem defining phase • Starts when client meets nurse as stranger • Defining problem and deciding type of service needed • Client seeks assistance, conveys needs, asks questions, shares preconceptions and expectations of past experiences • Nurse responds, explains roles to client, helps to identify problems and to use available resources and services
  • 21. Orientation Phase • Get acquainted phase of the nurse-patient relationship. • Preconceptions are worked through • Parameters are established and met • Early levels of trust are developed • Roles begin to be understood
  • 22. Factors Affecting the Orientation Phase
  • 23. Identification Phase • Selection of appropriate professional assistance • Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness • The client begins to identify problems to be worked on within relationship • The goal of the nurse: help the patient to recognize his/her own interdependent/participation role and promote responsibility for self
  • 24. Exploitation Phase • Use of professional assistance for problem solving alternatives • Advantages of services are used is based on the needs and interests of the patients • Individual feels as an integral part of the helping environment • They may make minor requests or attention getting techniques • The principles of interview techniques must be used in order to explore, understand and adequately deal with the underlying problem
  • 25. Exploitation Phase • Patient may fluctuates on independence • Nurse must be aware about the various phases of communication • Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step • Client’s trust of nurse reached full potential • Client making full use of nursing services • Solving immediate problems • Identifying and orienting self to [discharge] goals
  • 26. Resolution Phase • Termination of professional relationship • The patients needs have already been met by the collaborative effect of patient and nurse • Now they need to terminate their therapeutic relationship and dissolve the links between them. • Sometimes may be difficult for both as psychological dependence persists • Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals
  • 27. Resolution Phase • Client met needs • Mutual termination of relationship • Sense of security is formed • Patient is less reliant on nurse • Increased self reliance to deal with own problems. • The patient gradually puts aside old goals and adopts new goals. This is a process in which the patient frees himself from identification with the nurse.
  • 28. Interpersonal Theory and Nursing Process • Both are sequential and focus on therapeutic relationship • Both use problem solving techniques for the nurse and patient to collaborate on, with the end purpose of meeting the patients needs • Both use observation communication and recording as basic tools utilized by nursing
  • 29. Assessment Data collection and analysis [continuous] May not be a felt need Orientation Non continuous data collection Felt need Define needs Nursing diagnosis Planning Mutually set goals Identification Interdependent goal setting Implementation Plans initiated towards achievement of mutually set goals May be accomplished by patient, nurse or family Exploitation Patient actively seeking and drawing help Patient initiated Evaluation Based on mutually expected behaviors May led to termination and initiation of new plans Resolution Occurs after other phases are completed successfully Leads to termination a
  • 30. Application of Theory to Areas in Nursing Nursing Education • Has an impact on the Psychiatric Nursing especially in the baccalaureate program in nursing teaching CARE OF CLIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR (NCM 105) composed of 72 hours lecture and 102 hours RLE
  • 31. Application of Theory to Areas in Nursing Practice • Focuses on the interpersonal processes and therapeutic relationship that develops between the nurse & client. • It requires that the nurse attends to the interpersonal processes that occur between the nurse and client. • Interpersonal process is maturing force for personality. It includes the nurse- client relationship, communication, pattern integration and the roles of the nurse. • Psychodynamic nursing is understanding one’s own behavior to help others identify felt and perceived difficulties and to apply principles of human relations to the problems that arise at all levels of experience.
  • 32. Application of Theory to Areas in Nursing Research Based on Peplau’s Theory • Hays, D. (1961). Phases and steps of experimental teaching to patients of a concept of anxiety: Findings revealed that when taught by the experimental method, the patients were able to apply the concept of anxiety after the group was terminated. • Burd, S.F. Develop and test a nursing intervention framework for working with anxious patients: Students developed competency in beginning interpersonal relationship.
  • 33. Vignette The nursing process for Mrs. JL based on Peplau’s theory is as follows: • Mrs. JL • 27 years • Diagnosis: Inter vertebral disc prolapse
  • 34. Assessment (Orientation) Nursing diagnosis Planning (Identification) Implementation (Exploitation phase) Evaluation (Resolution) Mrs. JL is on pelvic traction and she is restricted to bed. The need for bed rest and restriction was discussed. Impaired physical mobility related to the presence of pelvic traction. Goal setting was done along with patient Provide active and passive exercises to all the extremities to improve the muscle tone and strength. Provide articles near to the patient and encourage doing activities within limits. Carried out plans mutually agreed upon. Provided active and passive exercises to all the extremities Provided article within the reach of the patient Mrs. JL was free to express problems regarding difficulty in mobilizing. She expressed satisfaction when able to move without difficulty.
  • 35. Assessment (Orientation) Nursing diagnosis Planning (Identification) Implementation (Exploitation) Evaluation (Resolution) Mrs. JL expresses pain in the low back region. Regarding pain, discussion was made to assess the severity and the type and duration of pain. Also the measures to reduce pain were discussed. Pain related to the degenerativ e changes in the lumbar region. Goal setting was done along with patient Mrs. JL will have reduction in pain as evidenced by her verbalisation of reduction in pain responses. Administer analgesics as prescribed by the physician. Provide pelvic traction to the patient Carried out plans mutually agreed upon. Provided non pharmacological measures like diversion, massaging, and pelvic traction. Administered Tab. Hifenac P; Cap. Myoril 4mg as prescribed. Given and explained need for pelvic traction Mrs. JL was free to express problems of pain. Expressed that she got slight relief from pain.
  • 36. Assessment (Orientation) Nursing diagnosis Planning (Identification) Implementation (Exploitation) Evaluation (Resolution) Mrs. JL expresses that she needs assistance to get down from bed. Self care discussion was done and discussed measures to solve the problems. Self care deficit related to presence of pelvic traction. Goal setting was done along with patient Client will achieve and maintain self care activities with assistance of caregiver or within her limits. Keep all the articles within the reach of the patient. Assist the patient in doing her self care activities. Carried out plans mutually agreed upon. Kept the articles within the reach of the client Assisted the client in doing her self care activities Mrs. JL was free to express problems of self care. She used to call for the needs and all her needs were met appropriately She achieved and maintained self care activities within her limits
  • 37. Assessment (Orientation) Nursing diagnosis Planning (Identification) Implementation (Exploitation) Evaluation (Resolution) Mrs. JL is enquiring about the disease condition, its outcome and need for surgery Discussed with the client regarding the disease process and the findings in the client Anxiety related to hospital admission as evidenced by verbalisation and client & family appearing withdrawn Goal setting was done along with patient Client will have reduced feeling of anxiety as evidenced by asking fewer questions Teach the family and client regarding the disease process. Stress that frequent assessment are routine and do not necessarily imply a deteriorating condition. Carried out plans mutually agreed upon. Taught the family regarding the disease process in layman’s terms Allowed the family members to verbalize anxiety Mrs. JL was free to express problems of self care. She asked her doubts regarding the illness and the diagnostic procedures She verbalized that her anxiety has reduced to some extent.
  • 38. Assessment (Orientation) Nursing diagnosis Planning (Identification) Implementation (Exploitation) Evaluation (Resolution) Mrs. JL is enquiring about the disease condition, its outcome and need for surgery Discussed with the client regarding the disease process and the need for follow up Deficient knowledge related to the treatment measures to be continued even after the discharge. Goal setting was done along with patient Patient will acquire adequate knowledge regarding the treatment and home care. Explain the treatment measures to the patient and their benefits Use simple and understandable terms Carried out plans mutually agreed upon. Explained treatment measures and the need for follow up Used simple and understandable terms for explaining Mrs. JL was free to express problems of self care. She expressed acquisition of knowledge regarding the disease and the signs of aggravation of illness
  • 39. Evaluation of the application of the theory of interpersonal relations by Peplau • With the help of the theory of interpersonal relations, the client's needs could be assessed. • It helped her to achieve them within her limits. This theory application helped in providing comprehensive care to the client.
  • 40. Summary of Application 1. Orientation phase • Client is initially reluctant to talk due to pain. • Client is expressing that while standing she is having much pain. • Client expressed without movement and supine position gave her relief from pain. 2. Identification • The client participates and interdependent with the nurse • Expresses the need for measure to get relief from pain • Expresses need for improving the mobility • Expresses need to know more about prognosis, discharge and home care and follow up.
  • 41. Summary 3. Exploitation • Client explains that she gets relief of pain when lying down supine. • Cooperates and participates actively in performing exercises. • Client mobilizes changes position and cooperates during position changes. 4. Resolution • Client expressed that pain has reduced a lot and she is able to tolerate it now • She has agreed upon to continue the exercises at home • She also expressed that she would come for regular follow up after discharge.