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Nursing Theory in Practice

Maybe I am just quirky. I love nursing theory. I mean, I enjoy other theories as well, but nursing theories in particular give me warm fuzzy feelings. (I can hear some nurses making gagging noises as I speak). Someone said to me recently that nursing theories aren’t truly applicable to reality of practice. I have to disagree. They are applicable – they provide a framework to build practice upon. They provide different ways of thinking and experiencing the nurse-client relationship. Now I will admit, some theories I do find interesting but I don’t feel inspired to build my practice on their foundations. But usually I am able to dig out some kernals of goodness that I can bring into my practice. The more theories I learn, the more adaptable I am to the individual client experience in the ways that I am able to think, feel, experience and provide care. Now there are some theories that make my blood sing…and I think “Now that is how I want to provide care, that is the lens which I want to filter my practice through!” Some of those theories have links in my sidebar.

Perhaps this love of theory comes from my particular personality.Perhaps it is because I am a psychiatric nurse and these theories are perfect for my practice (really I think I could apply some nursing theory to any practice, so that is not it)  I love philosophy and anthropology and all things (well most things) spiritual. I love a good theory that ties those three things together in the context of thinking feeling and doing. I love a theory that makes me look at instances in my practice and think “if I had approached that problem from this perspective, or if I had acted in this way – then that situation would have been better. Not only for the client, but also improvement in the kind of care that I am capable of providing. Because I do want to continually improve.

So I digress from my intended purpose for these ramblings (which if you have read this blog at all, you will discover that to be typical). 

A nursing theory that I have been learning to practice of late is Peplau’s Interpersonal theory. Now this is not one of those that initially made my blood sing. Truly it seemed rather rudimentary and simple. This is the one theory that curriculum lead by the accrediting agency wants me to teach.  Since I do want my students to pass the NCLEX, I will teach it, but first I have to feel some passion about it (I am afraid that was a little lacking last semester when I taught it for the first time). I do hope that as I get more comfortable in this teaching role that I will add in some Watson or Parse…but I digress again. Peplau.

So her theory is all about the interpersonal. That applies of course. What I am discovering is that in its very simplicity is where its beauty lies. I love that it outlines phases of the nurse-client relationship and does so in such a way that allows for a building of trust and a clear direction for movement towards health. When that first report is received the nurse has time to reflect on her/his own values, beliefs, judgments about the client’s situation. If the nurse indeed goes through this process, she will be able to deal with any emotional flux and remove them from the professional relationship before it ever begings. This will hopefully avoid the damaging effects of countertransference that often occurs when the nurse is unaware and the emotions bleed into the nurse-client relationship. Peplau also acknowledges that the nurse and client come together as strangers, and must very quickly advance from strangers to a deeper place of trust and sharing that will allow for identification and then resolution of problems. In the medical world of bustle, flurry and the dictates of  insurance, there is little time for this to be accomplished and if that trust is not developed, information vital to the problem resolution can be overlooked or withheld and opportunities for healing lost.

Another important piece of Peplau’s theory is the identification of different nursing roles in the nurse-client relationship and how these roles can help the client achieve resolution or rather movement through unfulfilled stages of development. These roles include the common sense ones – that every nurse knows to be a part of her/his  job description: teacher, technical expert and resource person. ALso included are other roles that may be more challenging: arbitrator, change agent, counselor, surrogate. Last semester when I mentioned the role of surrogate I saw the face of several students twist in obvious disapproval. “I don’t want to pretend to be anyone’s mommy”, one said, “that doesn’t seem healthy”. Yet we can model healthy behaviors and be a source of support that is motherly, sisterly etc., that perhaps that person never had. It does not mean that we become like a mother to that person and that we continue in that role. No, that would not be healthy for either of us. I am reminded of a female patient who shared with me her self-hatred and her confusing feelings toward her own mother who had not helped her, who had closed her eyes when the client as a teen told her mother that she was being molested by her step-father. In my role as a nurse, there was no way for me to go back in time and make that situation any better for her. What I could and did do is what Peplau’s theory lays out for me. I became a surrogate mother for a few moments in time. I heard the clients pain and anger and mirrored it to her. I offered her positive affirmation of her worth and that she did not deserve what happened to her, that what happened to her was not okay. I created a safe container for the client to express her feelings, and offered her comfort, acceptance and love.  Then we moved on. In my next encounter with her, I was likely (I don’t recall exactly) in another role – that of teacher, or technical expert.  Peplau’s theory not only tells us it is okay and appropriate to move from role to role, but also how determine the appropriate role depending on the client’s needs. 

Enough for today…the house will not clean itself!


2 Responses

  1. hi was wondering if you had any other good references on introducing change into clinical placement following lewin and lippits theory

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