This essay, will draw upon my own personal experiences of building a therapeutic relationship using case study of a service user in practice. This will then be analysed and discussed to show the importance of such a relationship using Peplau theoretical framework. It could be argued that therapeutic relationship is at the heart of nursing due to interpersonal approach. This relationship is defined by Peplau (1988, pp9-11) as
“one in which two persons come to know one another well enough to face the problem at hand in a co-operative way. The relationship of nurse to patient can be represented on a continuum; at one end are two individuals with separate goals and interests; at the other end are two persons working together to solve a
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When first admitted n Ann presents as grossly psychotic, with chaotic thinking and very agitated. She was also detained under section 2 of the Mental Health Act (MHA).
Orientation is the first phase of Peplau theoretical framework. This is where the nurse starts to engage the SU in treatment, answer questions and offer explanations. Peplau (1988) also states at this stage we are strangers. Therefore, it is needed to build a rapport before any sort therapeutic relationship can be formed. Doing this will encourage trust and warmth in the relationship, discussing non health related issues can help at this point as this displays warmth and genuine interest in person rather than them merely just being a ‘patient’ (Townsend, 2013). Upon meeting Ann, she displayed low self-esteem often apologizing for herself. At this point to help build rapport it is important to remember Carl Rodgers (1951) principle of unconditional positive regard. Showing Ann positive regard can be done by simply calling her by her name, spending enough and allowing sufficient time for her ask and receive answers to any questions or concerns she may have. Doing this can help the nurse convey respect and dignity towards client and reassure that she will be cared for and helped (Raskin, Rogers, & Witty, 2011). At this stage it often useful to set boundaries, as well as explain the roles and what Ann could expect from nursing staff. Setting boundaries
Peplau defines nursing as the therapeutic interpersonal, serial, goal- oriented process. A health-focused human relationship( Meleis, p 165, 2012)
A therapeutic relationship is a professional, inter-personal alliance in which the nurse and client join together for a defined period to achieve health-related treatment goals (Chauhan & Long, 2000), which may only last for a short period of time but
A therapeutic relationship is a key component in the nursing profession. Without therapeutic relationships, the best possible care can never be provided. The foundation in which trust is built upon is created from the nurse’s ability to truly listen and respond appropriately. Listening creates the base in developing a strong, trusting relationship. Sometimes it is simply hearing what a patient says that makes all the difference, empowering them to open up and become more comfortable with the nurse (Hawkins-Walsh, 2000).
There are many ways of forming a relationship and gaining the trust and respect of the patient and I had to work out the different things that make a good therapeutic relationship. According to Hinchliff et al (2003) there are a number of important elements that make a good therapeutic relationship, but it is important to make clear that a therapeutic relationship is a formal relationship between a medical professional and patient. The Nursing and Midwifery Council (2008) maintains that at all times nursing staff must maintain appropriate professional boundaries in the relationships they have with patients and clients.
As a healthcare professional a therapeutic relationship is fundamental in providing quality patient care. The Nursing and Midwifery Board of Australia (NMBA) National Competency Standards for a Registered Nurse (2006) emphasises Collaborative and Therapeutic relationships as one of the four main domains which make up the standards. The assignment will explore one specific quality on establishing, maintaining and appropriately concluding a therapeutic relationship in relation to a Horizon Hospital and Health Service client, in this case Mary Young. The specific attribute chosen is ‘establishes rapport with individuals/groups that enhances they ability to express feelings, fosters an appropriate context for expression of feeling.’ This attribute is crucial in having the guiding principals for a safe professional practice.
By giving nurses a sense of identity, nursing theory can help patients, managers and other healthcare professionals to recognize the unique contribution that nurses make to the healthcare service (Draper 1990).Hildegard Peplau, one of the role model of nursing theorist, established a theory of interpersonal relationships in nursing. Her reason is the goal of the nurse-client relationship is to give a quality nursing care moving forward to health promotion and maintenance. The purpose of this paper is to conduct a basic assessment of her theory.
This is the way nurses come together with healthcare consumer, family, and others in the conduct of nursing practices. Collaboration is professional healthcare partnership grounded in a reciprocal and respectful recognition and acceptance of: each partner’s unique expertise, power, and sphere of influence and responsibilities; the commonality of goals; the mutual safeguarding of the legitimate interest of each party; and the advantages of such a relationship. (Spring, 2010). Nursing students should be ready to collaborate with their patients and their families at times in every situation in order to come out with a positive outcome while helping the patients. This is attained by sharing the knowledge we have learned in class combined with what the patient says (subjectives) orthe situation you are. When nurses collaborate together and understand one another it will be easier for them to take care of the patients and they will manage to offer a high quality care possible.
Hildegard Peplau’s middle-range theory, Interpersonal Relations, established in 1948 and highlighted the nurse-patient relationship as the groundwork of nursing practice. Peplau supports each role individually, the nurse and the patient, by ensuring that equal participation is implemented to reach a mutual goal. For example, the role of the patient reflects vulnerability and the expectation to be open to the health care providers throughout care and treatment plan. Subsequently, the nurse is supposed to facilitate a reciprocated relationship by noting the client’s behavior, defining the client’s illness, creating the most proper care for the client, understanding the physician’s treatment plan and confirming it, and intervening when required (Sue Penckofer, 2013).
Effective nursing practice is in need of on an effective therapeutic relationship between the nurse and the client. This instruction addresses the qualities and capacities of an effective therapeutic relationship, the state of knowledge, and the information needed to be effective. To implement a therapeutic relationship effectively, hospitals characteristics must be supportive. The therapeutic relationship is also known as the helping alliance and it refers to the bond between a healthcare professional and a client. It is the means of professional hopes to involve with, so as to change the outcome result of the client. This relationship is significant to the client’s orientation
The building of a positive relationship is described as showing warmth, respect and empathy however to provide effective communication between nurse and patient the nurse needs to be aware of and identify the patient’s physical, social and psychological barriers. A nurse can use these tools to build trust, mutual respect and confidence with the patient as these are needed for
Peplau utilized both deductive and inductive reasoning in her theory development work (Reed & Shearer, 2011). The deductive reasoning methods used were that Peplau integrated ideas from a number of theories into her theory of interpersonal relations. Influenced by works of Sigmund Freud, particularly his interest in unconscious motivation as well as Harry S. Sullivan’s theory of interpersonal relations all contributed to her development of the theory of interpersonal processes in nursing, For example she refers to Sullivan’s concepts of anxiety, self-system and modes of experiencing. (Peterson & Bredow, 2017). She also incorporated into her theory some elements from developmental psychology and learning theory (Armstrong & Kelly, 1995) and some ideas of the humanistic psychologists, Abraham Maslow, Rollo May and Carl Rogers. (Peterson & Bredow, 2017). For example, Peplau’s systematic approach to establishment of nurse-patient relationship and therapeutic intervention are ideas that resonated with Martha Rogers' theoretical assumptions about human pattern and organization. (Armstrong & Kelly, 1995).
Peplau’s work is well-known and several publications have used her interpersonal relations in nursing theory in various settings and contexts. Various research applications of Peplau’s interpersonal relations theory include application in emergency and rural nursing (Senn, 2013), patients with long-term serious mental illness (Kim & Kim, 2007), psychiatric workforce development (Armstrong & Kelly, 2007), adolescents with mental health problems (Davies & Huws-Thomas, (2007), and healthcare professionals and ethnopharmacology (Warren, 2008).
The three main components of this phase are to open the relationship, clarify the problem, and structuring and formulating the contract (Brammer, 1988; Koizer and Erb, 2016). Other tasks that naturally occur in the initiation phase include getting to know each other to develop a trust, as well as to ease the patient into the progressing relationship with the nurse. The introductory phase also leaves open opportunities to find resistive behaviour within the patients as they may find it difficult in acknowledging their need for help, or have discomfort involved in changing the problem (Koizer and Erb, Vol 2, 2016) but by conveying a caring attitude and a genuine interest in the patient, the patient can then foster trust in the
In this essay, I am going to give a structured reflective account on the development of a therapeutic relationship with a client on one of my clinical placements as part of my training as a student nurse. I will be using a reflective model which explores the processes involved in developing and maintaining such relationships bearing in mind theoretical knowledge and how it applies to this clinical experience. Jasper (2003) describes reflective practice as one of the ways that professionals learn from experience in order to understand and develop their practice. As a trainee health care professional, I have learnt the importance of reflection in
Not all patients are capable of independently identifying and articulate their care needs, so the nurse also adapts the role as an advocate. Clarity and continuity in a trusting environment enables good communication. Progressive identification of needs takes place as nurse and patient communicate with one another in the interpersonal relationship (Peplau 1988, p. 84). Being considerate to the needs and vulnerability of patients is a moral attribute, as nurses are accountable for the care they deliver.