Community and Behaviour in Nursing

Communication is among the most critical elements in nursing, and nurses strive to perfect their communication in order to interact and understand patients comprehensively to attain quality care. However, not all interactions between nurses and their patients are straightforward, and most of them involve intricacies of language barriers or a plethora of factors that may end up affecting the smooth flow of communication and thus t heir interactions. Hargerty et al. (2018) contend that the experiences of patients in hospitals are crucial indicators of the hospital’s quality of care. This is indicative of the necessity to utilize conceptual models or theories in order to enhance the process of nursing practice. According to Meleis (1985), a theory is “an articulated and communicated conceptualization of invented or discovered reality (central phenomenon and relationships) in or pertaining to nursing for the purpose of describing, explaining, predicting or prescribing nursing care” (29). Via the analyses of theories, nurses are capable of gaining power via knowledge and comprehend the phenomena which depict the nursing condition. This process of enhancing the nursing practice via the adoption of critical nursing theories and evidence from research is seconded by Melnyk (1989). This paper entails the application of Peplau’s theory in nursing practice. 

Description of the Nursing Interaction 

         In one of the instances during my shift , a 25-year-old came to the hospital to seek medical care. He had a healthy and athletic body with the right body mass index as well as weight. I was in charge of checking the vitals of patients, and as he entered the room, he looked to be in distress as he was restless and shaking. He was also twitching and could not rest his legs as he was fidgeting when he sat down to take his vitals and measurements. Similarly, he was taking heavy breaths, and it seemed as if he was trying to calm himself down. When I took his vitals, his temperatures were normal. I put the digital sphygmomanometer on his left hand in order to take his blood pressure as well as pulse rate, and while doing so, I also measure d his respiration rate. While I tried to establish communication with the patient, he seemed to be nervous and anxious and could not articulate words correctly as he was shaking and seemed to be in distress. Unsurprisingly, his breathing rate was higher than average as it was above 25 breaths per minute which is considered to be abnormal (Cleveland Clinic, 2020). After I check ed his blood pressure and pulse rate on the digital sphygmomanometer, his blood pressure and rate were higher than normal, which should typically be less than 120/80 mm Hg, and between 60-80 bpm, respectively. The young man was clearly showing signs of anxiety, and to gain insight into it, I started to tell him that his vitals were not normal and that he needed to calm down so that I can get accurate readings that are not false positives. This did not help as the second test came back worse. I tried to seek help from my workmate, but the situation was still the same, and thus I knew that I had to find a solution to be able to communicate and interact with the patient . I had to apply Peplau’s theory of interpersonal relationship in order to get a resolution to the process and help the patient. 

Application of Peplau’s Theory of Interpersonal Relationship 

         Peplau had published her Theory of Interpersonal relations, which formed the foundation for interpersonal techniques that formed the crux of psychiatric nursing. The theory primarily consists of the phases of orientation, working, and termination (Peplau, 1997). However, this model was later influenced by Sullivan, Symonds, Maslow, and Miller to expound on the model and include the different contexts (Peplau’s Theory of Interpersonal Relations, 2020). In the orientation phase, the nurse is required to define the problem. This phase usually commences when the nurse encounters the patient. After the definition of the issue, the phase of orientation identifies the service type required by the patient. The patient usually seeks for assistance from the nurse in this stage, and communicates with the nurse in regards to what they need, share preconceptions, ask questions, as well as expectations on the basis of previous outcomes. This stage is essentially the assessment of the nurse in regards to the patient’s situation and health (Senn, 201 3 ). The identification phase entails the selection of the right assistance by a professional. In this stage, the patient starts to feel as if they belong and have the capacity to deal with the issue, which leads to the decline of hopelessness as well as helplessness. The identification stage is the development of the nursing care plan on the basis of the needs and goals of the patient. 

The exploitation stage utilizes professional assistance for finding alternative solutions to the problem. In this phase, the patient perceives themselves as an integral part of the helping environment and may make some requests or use techniques to get attention. When making interactions with the patient at this stage, the nurse ought to be conscious of the various stages of communication since the independence of the patient might fluctuate. The nurse should also aid the patient to exploit the different sources of help as things progress towards the final phase. This phase entails the implementation of the nursing plan, which is typified by taking actions towards attaining the goals that were set in the identification phase. The concluding phase is the resolution phase, which is typified by the termination of the professional relationship as the needs of the patients have been met via the collaboration of nurse and patient. They ought to server their link and eliminate any ties that exist between them. Each party attains emotional equilibrium, and both attain maturity. This marks the evaluation process where both the nurse and patient evaluate the instance on the basis of whether the set goals were attained or not. 

The following entails the analysis of my situation using Peplau’s Theory of Interpersonal Relations: 

Orientation Phase 

The phase entailed a on e -way contact where I initially identified myself by name as well as professional status and stated the purpose, time, and nature of our interaction (Deane and Fain, 2015) . This interaction was strictly professional and followed the rules stipulated in the nursing conduct . I sought for essential information from the patient via interview, history taking, evaluation, and the basic data that were needed by the clinicians. Beyond obtaining this information, my main aims were to set the tone for further interactions and to showcase professional interest as well as receptivity to the patient. 

Identification Phase 

In this phase, I provided appropriate professional assistance by engaging the patient in a conversation in order to make them feel less nervous. I understood that the patient was in distress and that his situation was a typical manifestation of anxiety, which is very common in young individuals. The patient later admitted to having anxieties, especially around the hospital setting, because he was afraid that he would get bad news on his health whenever he visits the hospital . He was receptive, with time , and wanted to solve his anxiety issues around hospitals, and I was ready to help by offering my professional expertise . Therefore, in this stage, we both set the goal of catering towards the problem that the patient had. Although anxiety was not the issue he was seeking medical attention for, it was still affecting his well being, and in the long-term, it might have detrimental impacts on him. I established a genuine professional relationship between the patient and me at this stage (Arabaci and Tas., 2019) to be able to find a holistic solution. 

Exploitation Phase 

During this phase, I helped the patient in utilizing health services. For instance, I helped the patient by taking him through the different sections of the hospital like the lab, to the clinician, and even during the checkout in order to give him a sense of comfort about the insecurities he had with the healthcare environment. This process was also to make the patient feel like he was an integral part of the environment, and he admitted to having less anxiety as a result of our interaction and the manner in which I handled the situation. I had advised him to relay the issue of anxiety to the clinician so that they may find a comprehensive solution and delve deeper into whether it might be due to his genetics or not. 

Resolution Phase 

In this stage, the patient was no longer having anxiety issues and was comfortable in his environment. This outcome showcases that the needs of the patient have been met and satisfied. However, this was a short-term relationship, but if that particular patient revisits the hospital and recognizes the role I played in decreasing his anxiety around hospitals, it would develop into a long-term one. At that juncture, however, we terminated our professional relationship and thus the termination phase. 

Termination 

The termination phase was marked by the independence of the patient as well as the subsequent detachment from each other’s company. After the patient had left the hospital, I reviewed and examined the achievements of the goals that I had set forth in the prior stages. I undertook this by utilizing summarization skills to evaluate the intervention’s progress towards the goal. This brought about a sense of accomplishment, as we had both attained our goal. 

What I did not do Right in Fulfilling the Phase 

Orientation  

In this phase, one of the things I did not do right was to have the right introduction to the patient as I approached him as I would a typical patient and did not initially anticipate his mental condition. Usually, a handshake can be an appro priate introduction, but I failed to have a proper introduction to the patient to establish a good rapport immediately. 

Identification 

In this stage, nurses are expected to help patients to explore feelings about their conditions, and I initially failed in this regard as instead of sitting down with the patient and trying to calm them down, I asked for assistance from another nurse. Although this is not bad in itself, it was not appropriate for that situation as it increased the patient’s anxiety. Also, I did not initially explore the possibility of using therapeutic communication to engage with the patient which is recommended by Zarea et al., (2014). Therapeutic communication to patients has been showcased to have significant positive impacts on their wellbeing and recovery. 

Exploitation 

In this stage, I failed to conform to the various levels of communication as the patient became more independent. I should have eased off a little as the patient became more comfortable, but I got accustomed to helping him even though he did not need it. For instance, I escorted him to the exit and kept on advising him even though he did not necessarily require it . 

Resolution 

In this phase, although it was expected that we terminate our professional relationship, I was still looking forward to meeting him again, and this is some form of attachment that I had gotten accustomed to as a result of helping the patient and feeling the need to help them more so that I can get a sense of fulfillment. 

Termination  

In this phase, I failed to properly terminate the professional relationship as I continued to help the patient until he left the hospital . Similarly, I had some lingering memories of the encounter, and this should not be the ideal case. 

What I Could Have Changed 

To improve interaction and communication with the patient, I would have (Adams, 2020): 

Improve my verbal and non-verbal communication cues (Riley, 2020)- this process can significantly improve one’s communication process as the combination of both verbal and non-verbal communication can put across messages effectively. 

Become more observant and a better listener - this element is crucial for great communication as one can get a lot of information via observation and listening. 

Exercise d more patience with the patient - the process of exercising patience with patients enables one to come into terms with patients as they see one as more understanding and caring. 

Maintained an attitude that is positive - positive attitude is always important as it easily transferrable to the patient, which is always a good foundation for recovery. 

Kept my emotions in check - this goes in line with being patient and it ensures that I always maintain a professional and humane act towards patients and workmates. 

References 

Adams, G. (2020). How to Improve Your Communication Skills as a Nurse . Retrieved 13 December 2020, from https://www.ultimatemedical.edu/blog/how-to-improve-your-communication-skills-as-a-nurse/ 

Arabacı, L. B., & Taş, G. (2019). Effect of Using Peplau’s Interpersonal Relation Nursing Model in the care of a juvenile delinquent. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri Dernegi, 10(3). 

Cleveland Clinic. (2020). Vital Signs. Retrieved 13 December 2020, from https://my.clevelandclinic.org/health/articles/10881-vital-signs#:~:text=A%20respiration%20rate%20under%2012,of%20narcotics%20or%20drug%20overdose. 

Deane, W. H., & Fain, J. A. (2016). Incorporating Peplau’s theory of interpersonal relations to promote holistic communication between older adults and nursing students.  Journal of Holistic Nursing ,  34 (1), 35-41. 

Hagerty, T. A., Samuels, W., Norcini-Pala, A., & Gigliotti, E. (201 8 ). Peplau’s Theory of Interpersonal Relations: An Alternate Factor Structure for Patient Experience Data? Nursing science quarterly, 30(2), 160-167. 

Meleis, A. (1985). Theoretical nursing: Development and progress. Philadelphia: J. B. Lippincott 

Melnyk, K. (1989). The process of theory analysis: An examination of the nursing theory of Dorothy E. Orem. Nursing Research, 32, 170-174. 

Peplau, H. E. (1997). Peplau’s theory of interpersonal relations.  Nursing science quarterly ,  10 (4), 162-167. 

Riley, B., J. (2020). Communication in Nursing. Elsevier. ISBN: 9780323625487 

Senn, J. F. (2013). Peplau’s theory of interpersonal relations: application in emergency and rural nursing.  Nursing science quarterly ,  26 (1), 31-35. 

Zarea, K., Maghsoudi, S., Dashtebozorgi, B., Hghighizadeh, M. H., & Javadi, M. (2014). The impact of peplau’s therapeutic communication model on anxiety and depression in patients candidate for coronary artery bypass.  Clinical practice and epidemiology in mental health: CP & EMH ,  10 , 159.