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Peplau’s Theory of Interpersonal Relations Research with Patients Experiencing Traumatic Events

Peplau’s Theory of Interpersonal Relations Research with Patients Experiencing Traumatic Events. Presented by Group 3: Kimberly Hargrove, Donna Johnson, Debra Lenhart, Sheila Lucas Ferris State University. Brief overview of Peplau’s Theory of Interpersonal Relations….

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Peplau’s Theory of Interpersonal Relations Research with Patients Experiencing Traumatic Events

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  1. Peplau’s Theory of Interpersonal Relations Research with Patients Experiencing Traumatic Events Presented by Group 3: Kimberly Hargrove, Donna Johnson, Debra Lenhart, Sheila Lucas Ferris State University

  2. Brief overview of Peplau’s Theory of Interpersonal Relations…

  3. Theory focuses on interpersonal communication: First model to suggest that… • Nurse and patient act as PARTNERS to initiate change rather than patient passively receiving treatment and nurse simply acting on orders from physician.

  4. Effective communication causes nurse to take on numerous roles: • Stranger • Resource • Teacher • Leader • Surrogate • Counselor • Technical Expert Courey, T J, Martsolf, D S, Draucker, C B, & Strickland, K B (April-May 2008). Hildegard Peplau's Theory and the Health Care Encounters of Survivors of Sexual Violence.  Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p. 137

  5. Continuum showing changing nurse-patient relationships: Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed., p. 55). St. Louis, MO: Mosby Elsevier.

  6. Four phases of nurse-patient relationship: • Orientation • Identification • Exploitation (or working) • Termination

  7. Phases and changing roles in nurse-patient relationship: Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed., p. 55). St. Louis, MO: Mosby Elsevier.

  8. Theory is based upon psychological models. • Influences include Freud, Maslow, and Sullivan Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed., p. 55). St. Louis, MO: Mosby Elsevier.

  9. Peplau’s interpersonal theory stated: • Psychobiological experiences lead to constructive or destructive responses. Four experiences include: • Needs • Frustrations • Conflicts • Anxieties Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed., p. 55). St. Louis, MO: Mosby Elsevier.

  10. Due to the psychobiological components, this model is effective to study effects of and assist nurses in dealing with patients that have experienced traumatic events.

  11. Rationale for use in Nursing Practice Opens individuals eyes to the hidden hurt of trauma Educates nurses not to pre-judge patient’s who have been victims of traumatic events Reminds us that we are all vulnerable to traumatic events Articles give us tools to assist those in need Identifies coping mechanisms, strategies and communication techniques Seeks to understand the underlying mental anguish to multiple vague physical complaints Reasons to believe that there can be an ending to the hidden hurt of trauma

  12. Studies Researched • Peplau’s Theory of Interpersonal Relations not only a nursing theory but also has roots in the psychiatry. Most of the studies that include this theory are based on psychiatric nursing

  13. In light of Peplau’s theory, we are looking at studies done on counseling AIDS patients, victims of sexual violence, the value of psychoeducation for PTSD patients, and the effectiveness of counseling and medication on patients experiencing depression

  14. Hildegard Peplau's Theory and the Health Care Encounters of Survivors of Sexual Violence • Tamra J. Tourey • Donna S. Martsolf • Claire B. Draucker • Karen B. Strickland. 

  15. Objective • According to Courey, “The purpose of this study was to use Hildegard Peplau’s (1952) conceptualization of nurses helping roles (i. e., stranger, resource person, teacher, leadership, surrogate, counselor, technical expert) in nurse client interactions to explore how survivors of sexual violence perceive their encounters with health care professionals.” Courey, T J, Martsolf, D S, Draucker, C B, & Strickland, K B (April-May 2008). Hildegard Peplau's Theory and the Health Care Encounters of Survivors of Sexual Violence.  Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu Peplau, H. (1992). Interpersonal relations: A theoretical framework for application in nursing practice. Nursing Science Quarterly, 5, 12-18.

  16. First… Lets review nursing roles according to Peplau’s theory

  17. Peplau’s Theoretical Framework Courey, T J, Martsolf, D S, Draucker, C B, & Strickland, K B (April-May 2008). Hildegard Peplau's Theory and the Health Care Encounters of Survivors of Sexual Violence.  Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p. 137 Gastmans, C. (1998). Interpersonal relations in nursing: A philosophical-ethical analysis of the work of Hildegard E. Peplau. Journal of Advanced Nursing, 28, 1312-1319 Leadership Role The nurse and patient work together to meet the same result of the condition, the main objective of leadership role is to “help the patient accept increased responsibility for the plan of care.” Surrogate Role Nurses provide a substitute for another who is close to the patient. For example if the Patient’s family is unavailable, nurses would demonstrate a surrogate role. Counselor role Nurses must provides secure, safe environment and to be thriving must exhibit active listening, guidance, and support in this process of self discovery, all the while the nurse must maintain professional boundaries (Gastmans 1998 as found in Courey 2008).

  18. Peplau’s Theoretical Framework • Technical expert role Nurse demonstrates competency in technical skills (such as IV pumps or blood pressure cuffs). This helps in building trust, hope, and confidence in the patient-nurse relationship. • Resource Person Role “Provides professional knowledge, the ability to deliver information in a sensitive manner, and critical thinking skills needed to process the client’s questions and offer a therapeutic response.” • Stranger Role “Goal is to provide trust to build a solid patient-nurse relationship with non-verbal and verbal communication.” • Teacher Role Assisting client to obtain information and develop health and well being in a healing relationship. Courey, T J, Martsolf, D S, Draucker, C B, & Strickland, K B (April-May 2008). Hildegard Peplau's Theory and the Health Care Encounters of Survivors of Sexual Violence.  Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p.137

  19. Selection Process • 30 men and 30 women were recruited in the parent study Ages ranged from 18-62 • Large diversity of participants: • 50% African Americans • 35% Caucasians • 15% smaller biracial ethnic participants • 58% single • 12% married • 8% divorced • 5% separated • 1 engaged • “All Participants lived in the greater Akron, Ohio, metropolitan area who had experienced sexual violence at some point in their lives, recruited via fliers placed in their communities, referrals from community leaders, and snowball sampling” Courey, T J, Martsolf, D S, Draucker, C B, & Strickland, K B (April-May 2008). Hildegard Peplau's Theory and the Health Care Encounters of Survivors of Sexual Violence.  Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p. 138

  20. Critique of Research • Assessed by two advanced practice psychiatric/mental health nurses • Assessor rated each participants encounter with healthcare providers • “When survivors of sexual violence describe their encounters with health care professionals, do they describe roles performed by professionals that are consistent with one or more of the Peplau's helping roles?” • “When survivors of sexual violence describe their encounters with health care professionals, do they describe roles performed by professionals that are not consistent with one or more of the Peplau's helping roles?” • “When survivors of sexual violence describe their encounters with health care professionals who perform one of Peplau's roles, what about these encounters do they perceive as helpful?” • “When survivors of sexual violence describe their encounters with health care professionals who perform one of Peplau’s roles, what about these encounters do they perceive as hurtful?” Courey, T J, Martsolf, D S, Draucker, C B, & Strickland, K B (April-May 2008). Hildegard Peplau's Theory and the Health Care Encounters of Survivors of Sexual Violence.  Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p.140-141

  21. Results • Participants had either a positive or negative encounter with their healthcare providers • Described encounters with health care professionals according to Peplau’s helping roles as follows: • 79-counselor • 78- technical support • 13-stranger • 2-resource person • 4-teacher • 0-surrogate • Research revealed that the roles of counselor and technical support were most important to the survivor of sexual violence. Courey, T J, Martsolf, D S, Draucker, C B, & Strickland, K B (April-May 2008). Hildegard Peplau's Theory and the Health Care Encounters of Survivors of Sexual Violence.  Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu

  22. Implications for Practice Nurses who facilitate insight by therapeutic communication have helpful encounters with victims of sexual violence. “Hurtful encounters were most likely to occur when health care professionals were insensitive or dismissed the suffering caused by the violence. Although the need for sensitive, compassionate care is probably universal to all those who seek health care, it seems to be Particularly important to survivors of sexual violence” Courey, T J, Martsolf, D S, Draucker, C B, & Strickland, K B (April-May 2008). Hildegard Peplau's Theory and the Health Care Encounters of Survivors of Sexual Violence.  Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p.142

  23. Implications for personal practice Courey, T J, Martsolf, D S, Draucker, C B, & Strickland, K B (April-May 2008). Hildegard Peplau's Theory and the Health Care Encounters of Survivors of Sexual Violence.  Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu • As found in Courey, Physical complaints of survivors of sexual violence include: • Headaches (Golding, 1999). • Pelvic pain (McCauley et al., 1997). • Gastrointestinal upset (Heitkemper et al., 2001). • Chronic malignant pain (Golberg & Goldstein, 2000). • Mental health complaints of survivors of sexual violence include: • Depression • Anxiety disorders • Post traumatic stress disorder • Substance abuse (Elliott, Mok, & Briere 2004; Koss, Figueredo, & Prince, 2002; Saunders, Kilpatrick, Hanson, Resnick, & Walker, 1999).

  24. Critical Reflection • Only two of Peplau’s helping roles were most helpful during this difficult time for patients who were victims of sexual violence. • Counselor role–helps the victim understand the violence and gain insight into their life situations. • Technical support role- therapeutic communication which helped manage symptoms related to the violence. • Nurses who take care of victims and use Peplau’s theory and research of counselor roles and technical support roles to help victims play a significant role in the healing process • Nurses help their patients to • Explore the depth of the violence • Grow and learn how to help others • Recover faster • Avoid post traumatic stress disorder

  25. Effectiveness of psychoeducation intervention on post-traumatic disorder and coping styles of earthquake survivors • Fahriye Oflaz, PhD, Asst. Prof. Chief of Psychiatric Nursing Dept. • Sevgi Hatipoglu, PhD, Dean of School of Nursing • Hamdullah Aydin, MD, Former Chief of Psychiatric Dept. Gulhame Military Medical Academy Etlik, Ankara, Turkey

  26. Peplau’s theory and PTSD Research conducted in Turkey following 1999 earthquakes measuring 7.4 and 7.2 on the Richter scale less than 3 months apart

  27. Objective Study to show the effect of psychoeducation interventions on PTSD symptoms and associated coping skills of earthquake survivors.

  28. Conducted from January to December 2000 at the Gulhane Military Medical Academy in Ankara, Turkey.

  29. Selection process: • Participants voluntarily requested treatment at the medical center due to symptoms of PTSD. • 169 patients were diagnosed with PTSD, only 68 fit the criteria to participate in the study. • Of the 68 initially selected, 17 refused to be involved in the research.

  30. In the end, 51 survivors of the Marmara earthquake were used as the sample in the research.

  31. Characteristics of Participants: Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  32. Assignment to intervention groups • Assessed by psychiatrists • Diagnosis with PTSD and medications determined • Consent for participation • Administration of questionnaires and group assignment Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  33. Three study groups formed: • Psychoeducaton and medications (21 participants, 41.2%) • Medication only (16 participants, 31.3%) • Psycoeducation only (14 participants, 27.5%) Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  34. Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  35. Psychoeducation Intervention: Six separate sessions 60-90 minutes in length & one week apart. • First interview - opinions and feelings about traumatic experience and significance to patient discussed • Second interview – information given to patients regarding PTSD symptoms and treatment. Patients questions were also answered during session. • Third interview – provided information about stress and coping techniques. Discussed coping methods prior to trauma as well as current methods. Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  36. Psychoeducation continues: • Fourth interview – summarized previous session. Patient ranked current problems and target goals were set regarding perceived problems. • Fifth interview – goals studied in-depth. Time to achieve goals and implementation stressed. Alternative goals were discussed. • Final interview – evaluation of results. General review and patient opinion. Post-test regarding coping strategies given. Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  37. Interviews and Peplau’s model Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  38. Final Results: • While the post-test scores of all three participant groups showed significantly lower scores in post-traumatic stress and depression than the pre-test scores, there was no difference among the groups regarding coping strategies. Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  39. Psychoeducation with Medications Increased problem solving Decreased depression Increased social-support seeking Decreased avoidance Medication Only Increasedpost-traumatic stressscores Increased social-support seeking Decreased avoidance Individual Group Findings: Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  40. Psychoeducation only group No significant differences were found in the coping strategies of this group in comparison with the previous groups. This is most likely due to the benefits of combined therapy to decrease anxiety and enhance learning simultaneously. Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  41. Research limitations: • Small sample group (only 51 participants) • All sample participants were military personnel, and their immediate family members • Sample participants had to be literate in Turkish • Results were based upon patient self-report

  42. Peplau’s theory and how it pertains to this research study: • Peplau believed that a patient’s good health is directly correlated to a reduction in anxiety. The focus of PTSD treatment is also a reduction in anxiety to enhance coping skills. • Peplau’s model focuses on the nurse-patient relationship and the different roles undertaken by the nurse. All of these were utilized within this research program. • Peplau’s interaction process in the nurse-patient relationship comprised four distinct phases. These phases were specifically used during the psychoeducation sessions of this study. Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  43. Final ThoughtsRegarding Peplau’s Model & PTSD Treatment • Overall, the results of the study show that Peplau’s theory is appropriate for use by nurses treating patients experiencing anxiety and depression Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  44. Final ThoughtsRegarding Peplau’s Model & PTSD Treatment • Combined treatment including medications and counseling as well as focusing on the patients’ needs contribute to more positive outcomes when treating PTSD. • Active listening and a positive nurse-patient relationship are key to successful treatment of trauma victims suffering from PTSD. Oflaz, F., Hatipoglu, S., & Aydin, H. (2008). Effectiveness of psychoeducation intervention on post-traumatic stress disorder and coping styles of earthquake survivors. Journal of Clinical Nursing, 17, 677-687. doi:10.1111/j.1365-2702.2007.02047.x

  45. Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS • Paul-Andre Guathier, RN, TCC, CNS, DMD, MN

  46. Objective • “The Purposes of this research were to provide an example of the development of a nursing approach by the use of Peplau’s interpersonal relations model and to gain a greater understanding of life-and-death issues raised by men and women with HIV and AIDS.” Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. Journal of the American Psychiatric Nurses Association. 6 (4) p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p.119

  47. Study Design • “A qualitative analysis of a man with AIDS was completed by use of Peplau’s model.” • Patient studied was a male in his early 30’s with diagnosis of AIDS • Study was conducted during multiple encounters with the patient and nurse Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. Journal of the American Psychiatric Nurses Association. 6 (4) p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p.119

  48. Results • “A question, such as "What are your concerns regarding your situation or your disease?" can greatly encourage clients facing a terminal illness to discuss their concerns. • Nurses can assist clients in discussing their concerns regarding death. • Nurses can create trusting relationships with clients and understand various issues facing the clients and the interaction process involved. • Greater knowledge and understanding of these issues are gained when looking at three categories of concern: care and disease, life and death, and stereotypes and prejudices.” Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. Journal of the American Psychiatric Nurses Association. 6 (4) p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p. 119

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