Peplau's Theory - A Nurse/Patient Collaboration

It may be alarming to hear that diabetes mellitus is now recognised ‘as one of the fastest growing threats to public health in almost all countries of the world’ (Fernandes & Naidu 2017).

Fernandes and Naidu (2017) interestingly found in their study that Peplau’s Theory was 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’?

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

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

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

‘Identification’ is the next stage of the nurse-client relationship in this theory, and it 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 in this theory is called ‘exploitation’. This stage is where the nurse aims for behaviour modification for the client. Ideally, the client’s behaviour change will help to meet their needs and the nurse will not be depended upon as heavily.

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

Using Peplau’s Theory

1. Identify what the client is asking for help with. This means actively listening to their concerns and exploring their experience and behaviours.
2. The nurse evidently needs to be aware of their own behaviours. It will be essential to act professionally, ethically, emotionally intelligent, and without judgment. Trust and respect need to be built.
3. Educate the client regarding the issues that are concerning them, and affecting them. Ensure to utilise evidence-based education approaches. Be person-centred in your teaching approach and ask the client how they learn best. This may help you to modify the client’s education program to be more person-centred and effective.
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. ‘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 for diabetes.

The American Diabetes Association highlight the following activities to improve the care of people with diabetes:

• Patient-centred communication that incorporates ‘patient preferences, assesses literacy and numeracy, and addresses cultural barriers’
• Follow the ‘Chronic Care Model’ (CCM) framework for improving chronic illness care
• Coordinate care across the patient’s lifespan (e.g. pregnancy, childhood, older age)
• Further planning to prevent cardiovascular disease risk factors

(2015)

The Australian Diabetes Educators Association promote the following for self-management of diabetes:

• Facilitate an understanding of the patient’s condition and the risks and benefits of their lifestyle choices
• Offer support to encourage informed choices
• Offer problem solving assistance
• Active collaboration with other members of the multidisciplinary healthcare team
• ‘Supporting implementation, maintenance and change of health behaviours as required.’

(ADEA n.d.)

And, the Royal Australian College of General Practitioners recommends that:

• All people with type 2 diabetes should be referred for structured, personalised diabetes education

(RACGP n.d.)

References

• Australian Diabetes Educators Association 2018, ‘Diabetes self-management education and credentialed diabetes educators’, ADEA, viewed 15 May 2018, https://www.adea.com.au/about-us/our-people/diabetes-self-management-education-and-credentialled-diabetes-educators/
• American Diabetes Association 2015, ‘Standards of Medical Care in Diabetes—2015 Abridged for Primary Care Providers’, Clinical Diabetes : A Publication of the American Diabetes Association, vol. 33, no. 2, pp. 97–111, viewed 16 May 2018, http://clinical.diabetesjournals.org/content/33/2/97
• D’Antionio, P, Beeber, L, Sills, G & Naegle, M 2014, ‘The future in the past: Hildegard Peplau and interpersonal relations in nursing’, 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
• RACGP and Diabetes Australia 2016, ‘5.3. patient education and self management’, General Pratice Management of Type 2 Diabetes, viewed 16 May 2018, https://www.racgp.org.au/your-practice/guidelines/diabetes/5-structured-care-and-patient-education/53-patient-education-and-self-management/