Peplau's Theory: A Nurse/Patient Collaboration

A study in 2017 by Fernandes and Naidu (2017) interestingly found that Peplau’s Theory is able to encourage client engagement with self-care diabetes management.

Pre-intervention, the participants’ average fasting blood glucose levels (BGLs) were 124.5 mg/dl. Post-intervention, the average BGLs were 115.8 mg/dl.

So, What Exactly is ‘Peplau’s Theory’?

Peplau’s Theory relates to modern concepts such as motivational interviewing, client self-management, making informed decisions, and client engagement (D’Antionio, Beeber, Sills & Naegle, 2014).

The theory involves the healthcare professional working to understand their own behaviour, as well as that of their clients (Adams 2017).

Adams (2017) explains that the start of the nurse-client relationship (as per this theory) is at 'orientation', which is when the client exposes the issue that they are seeking the nurse’s support with.

'Identification', the next stage of the nurse-client relationship in this theory, involves the nurse educating the client. This stage of the relationship sees a focus on building respect and working towards meeting the needs of the client (Adams 2017).

The third phase of the nurse-client relationship is called ‘exploitation’. This stage is where the nurse encourages the client to modify their behaviour. Ideally, the client’s behavioural changes will help them to meet their needs, and the nurse will not be depended upon as heavily.

The final stage is ‘termination’. As the name suggests, this stage involves the client being able to self-manage their initial issue of concern. The nurse may then release the client from their care (Adams 2017).

How to Use Peplau's Theory in Practice

1. Identify what the client is asking for help with. This means actively listening to their concerns and exploring their experience and behaviours.
2. Be aware of your own behaviours. It will be essential to act professionally, ethically, emotionally intelligently and without judgment. Trust and respect need to be built.
3. Educate the client about the issues that are concerning and affecting them. Ensure you utilise evidence-based education approaches. Be person-centred in your teaching approach and ask the client how they learn best.
4. Behaviour modification may involve applying evidence-based coaching and behaviourist education styles. You may want to consider investigating what the client’s triggers are for their behaviours of concern (e.g. ask ‘Can you list the events that led to this behaviour?’). You may also wish to consider client goal-setting and positive reinforcement (e.g. positive verbal praise such as ‘Good work meeting the goal that you set in a healthy manner’).
5. In the termination phase, you may need to ensure that the client has the skills and knowledge for self-management. For example, you may wish to observe the client’s demonstration of the desirable behaviour. Or, as a different example, this may mean having the client describe or paraphrase their plans for self-management. It is important, as with any nursing discharge process, that there is a realistic contingency plan in place. Where will the client seek help and support from once discharged? When will their progress be reviewed next? When is the follow-up meeting going to take place?
6. Ensure that thorough documentation occurs throughout the entire relationship/process.

Note that self-care and interpersonal collaboration techniques such as Peplau's Theory should always be used in addition to best practice care.

References

• D’Antionio, P, Beeber, L, Sills, G & Naegle, M 2014, 'The Future in the Past: Hildegard Peplau and Interpersonal Relations in Nursing', Nursing Inquiry, vol. 21, no. 4, https://onlinelibrary.wiley.com/doi/full/10.1111/nin.12056
• Fernandes, S & Naidu, S 2017, 'Promoting Participation in Self Care Management Among Patients with Diabetes Mellitus: An Application of Peplau&'s Theory of Interpersonal Relationships', International Journal of Nursing Education, vol. 9, no. 4, pp. 129-34, viewed 15 May 2018, http://web.a.ebscohost.com/abstract…9349%26AN%3d127723889