Peplaus Theory of Interpersonal Relations Research with Patients

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…

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

Effective communication causes nurse to take on numerous roles: n Stranger n Resource n Teacher n Leader n Surrogate n Counselor n 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 Courey, T J, Martsolf Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p. 136(8). Retrieved November 14, 2009, from Academic One. File via Gale: http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name =lom_ferrissu p. 137 http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name= lom_ferrissu p. 137

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

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

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

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

Peplau’s interpersonal theory stated: n 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 (6 th ed. , p. 55). St. Louis, MO: Mosby Elsevier. Tomey, A. M. , & Alligood (6 th ed. , p. 55). St. Louis, MO: Mosby Elsevier.

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.

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

Studies Researched n 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

n 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

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

Objective n 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 Courey, T J, Martsolf Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p. 136(8). Retrieved November 14, 2009, from Academic One. File via Gale: http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name=lom_ferrissu

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

Peplau’s Theoretical Framework 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. ” n 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. n 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). n 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 Courey, T J, Martsolf Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p. 136(8). Retrieved November 14, 2009, from Academic One. File via Gale: http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name=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

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. n Resource Person Role “Provides professional knowledge, the ability to deliver information in “Provides professional knowledge, a sensitive manner, and critical thinking skills needed to process the client’s questions and offer a therapeutic response. ” n Stranger Role “Goal is to provide trust to build a solid patient-nurse relationship with non-verbal and verbal communication. ” n Teacher Role Assisting client to obtain information and develop health and well being in a healing relationship. n 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 Courey, T J, Martsolf Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p. 136(8). Retrieved November 14, 2009, from Academic One. File via Gale: http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name=lom_ferrissu p. 137

Selection Process 30 men and 30 women were recruited in the parent study Ages ranged from 18 -62 n Large diversity of participants: – 50% African Americans – 35% Caucasians – 15% smaller biracial ethnic participants – 58% single – 12% married – 8% divorced – 5% separated – 1 engaged n “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” n 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 Courey, T J, Martsolf Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p. 136(8). Retrieved November 14, 2009, from Academic One. File via Gale: http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name=lom_ferrissu p. 138

Critique of Research n n 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 Courey, T J, Martsolf Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p. 136(8). Retrieved November 14, 2009, from Academic One. File via Gale: http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name=lom_ferrissu p. 140 -141

Results Participants had either a positive or negative encounter with their healthcare providers n Described encounters with health care professionals according to Peplau’s helping roles as follows: n – – – n 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 Courey, T J, Martsolf Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p. 136(8). Retrieved November 14, 2009, from Academic One. File via Gale: http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name =lom_ferrissu http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name=

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 Courey, T J, Martsolf Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p. 136(8). Retrieved November 14, 2009, from Academic One. File via Gale: http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name =lom_ferrissu p. 142 http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name= lom_ferrissu p. 142

Implications for personal practice n – – – – As found in Courey, Physical complaints of survivors of sexual violence include: Headaches (Golding, 1999). Pelvic pain (Mc. Cauley 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). 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 Courey, T J, Martsolf Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p. 136(8). Retrieved November 14, 2009, from Academic One. File via Gale: http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name =lom_ferrissu http: //0 -find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id=AONE&user. Group. Name=

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. n 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 n 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 n

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

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

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

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

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

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

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

Assignment to intervention groups Assessed by psychiatrists n Diagnosis with PTSD and medications determined n Consent for participation n Administration of questionnaires and group assignment n 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

Three study groups formed: n n n 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

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

Psychoeducation Intervention: Six separate sessions 60 -90 minutes in length & one week apart. n First interview - opinions and feelings about traumatic experience and significance to patient discussed n Second interview – information given to patients regarding PTSD symptoms and treatment. Patients questions were also answered during session. n 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

Psychoeducation continues: n Fourth interview – summarized previous session. Patient ranked current problems and target goals were set regarding perceived problems. n Fifth interview – goals studied in-depth. Time to achieve goals and implementation stressed. Alternative goals were discussed. n 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

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

Final Results: n While the post-test scores of all three participant groups showed significantly lower scores in posttraumatic stress and depression than the pretest 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

Individual Group Findings: Psychoeducation with Medications n n n Medication Only Increased post-traumatic stress scores Increased problem solving Decreased depression n Increased social-support seeking n Decreased avoidance 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

n 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

Research limitations: n n 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

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. n 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. n 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. n 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

Final Thoughts Regarding Peplau’s Model & PTSD Treatment n 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

Final Thoughts Regarding 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. n Active listening and a positive nurse-patient relationship are key to successful treatment of trauma victims suffering from PTSD. n 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

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

Objective n “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-anddeath 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) Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. p. 119 -125. Retrieved November 14 from http: //0 -jap. sagepub. com. libcat. ferris. edu/cgi/reprint/6/4/119 p. 119

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

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. n Nurses can assist clients in discussing their concerns regarding death. n Nurses can create trusting relationships with clients and understand various issues facing the clients and the interaction process involved. n 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. ” n 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) Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. p. 119 -125. Retrieved November 14 from http: //0 -jap. sagepub. com. libcat. ferris. edu/cgi/reprint/6/4/119 p. 119

How Peplau’s theory framed Research n “Peplau’s model is useful because it places emphasis on the relationship to be developed and provides an interpersonal process that facilitates the establishment of meaningful interaction with clients. ” 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) Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. p. 119 -125. Retrieved November 14 from http: //0 -jap. sagepub. com. libcat. ferris. edu/cgi/reprint/6/4/119 p. 124

Peplau’s phases that guide Nurses Orientation Phase– As stated in Gauthier, “During the first phase, nurses explain Gauthier, their role and expectations. Clients express “felt needs” and they look for assistance. Nurses assist clients in recognizing and understanding their problems and determining their need for help (Carey, Noll, Rasmussen, Searcy, & Stark, 1989). ” n Identification Phase– “Nurses directly or indirectly express acceptance without judging the clients. By helping clients express their needs and concerns, nurses assist clients in solving their problems and decreasing their anxiety and stress. Clients play an active role in identifying their concerns so nurses understand those concerns from the client’s perspective. ” n Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. Journal of the American Psychiatric Nurses Association. Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. 6 (4) p. 119 -125. Retrieved November 14 from http: //0 -jap. sagepub. com. libcat. ferris. edu/cgi/reprint/6/4/119 p. 120

Peplau’s phases that guide Nurses Working Phase– “Nurses continue to discuss clients’ concerns and try to assist them in achieving their goals…the reduction of anxiety is of prime importance, particularly when anxiety is related to the fear of dying. Feely (1997) indicated that nurses can help clients recognize the source of their tension and their reaction to it. Then nurses can assist them in learning to deal with it positively. – Peplau (1952/1988) wrote, ‘When a nurse permits patients to express what they feel, and still get all of the nursing that is needed, then patients can undergo illness as an experience that orients feelings and strengthens positive forces in personality. ’ (p. 31) – Nurses become guides who facilitate therapeutic process. ” n Termination Phase– “Nurses summarize the work that has been done and terminate the nurse-client interaction. By reaching this phase, nurses have provided the assistance required by the clients. ” n 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) Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. p. 119 -125. Retrieved November 14 from http: //0 -jap. sagepub. com. libcat. ferris. edu/cgi/reprint/6/4/119 p. 120

Limitations of Study n Only one patient used in study – Large margin for error n No direct input from patient on how study effected him – All input was from nursing point of view and observation

Implications for Practice n n n “Peplau’s model is useful because it provides an interpersonal process that facilitates the establishment of meaningful interactions with clients. ” “Persons affected by AIDS need a guide and facilitator to help them move toward a more meaningful life. ” “Frank discussions connected to client concerns are always relevant. ” “Nurses can help clients face their problems, explore their options and determine possible solutions” As stated in Gauthier, Peplau (1952/1988) explains that “exploring goals and making plans together helps clients strengthen their relationships with others and thus keep their anxiety to a minimum” Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. Journal of the American Psychiatric Nurses. Association 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. 124

Critical Reflections n Peplau’s Theory of Interpersonal Relations can be used to create a trusting, therapeutic working relationship with all patients regardless of their diagnosis. n Nurses can help patients create an anxiety free atmosphere which is essential to having positive outcomes

Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study n Linda S. Beeber – Syracuse University College of Nursing, Syracuse, NY, USA n Melissa L. Charlie – University of Pennsylvania School of Nursing, Philadelphia, PA, USA

n According to Beeber, Peplau said, “depressive symptoms are the result of changes in the self and relations developed to manage anxiety” Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Nursing. 12(5), Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. p. 247 -254. Retrieved November 14, 2009 from http: //0 -web. ebscohost. com. libcat. ferris. edu/ehost/detail? vid=6&hid=106&sid=078477 e 6 -efc 7 -4604 -944 c- 16 ea 140134 ea%40 sessionmgr 110&bdata=Jn. Npd. GU 9 ZWhvc 3 Qtb. Gl 2 ZQ%3 d%3 d#db=cin 20&AN=1999001459 doi: 10. 1016/S 0883 -9417(98)800034 -4

Objectives Discover if women with depressive symptoms could be identified n Determine if women would participate in a theoretically driven intervention delivered by a Psychiatric Mental Health Advanced Practice Nurse (PMH-APN) n Establish whether measures of the concepts in theory were sensitive to outcomes proposed to occur as a result of the intervention n The intervention focused on women because women are twice as vulnerable as men to depression n Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Nursing. 12(5), p. Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 247 -254. Retrieved November 14, 2009 from http: //0 -web. ebscohost. com. libcat. ferris. edu/ehost/detail? vid=6&hid=106&sid=078477 e 6 -efc 7 -4604 -944 c- 16 ea 140134 ea%40 sessionmgr 110&bdata=Jn. Npd. GU 9 ZWhvc 3 Qtb. Gl 2 ZQ%3 d%3 d#db=cin 20&AN=1999001459 doi: 10. 1016/S 0883 -9417(98)800034 -4 p. 248

Selection n 33 women were chosen for the study n Screened and referred by primary care nurses, nurse practitioners, and physicians n The women were then screened for depressive symptoms with the Beck Depression Inventory (BDI) (Beck, Steer, & Garbin, 1988). Women scoring 10 or higher on the BDI were offered the intervention. Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Nursing. 12(5), p. Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 247 -254. Retrieved November 14, 2009 from http: //0 -web. ebscohost. com. libcat. ferris. edu/ehost/detail? vid=6&hid=106&sid=078477 e 6 -efc 7 -4604 -944 c- 16 ea 140134 ea%40 sessionmgr 110&bdata=Jn. Npd. GU 9 ZWhvc 3 Qtb. Gl 2 ZQ%3 d%3 d#db=cin 20&AN=1999001459 doi: 10. 1016/S 0883 -9417(98)800034 -4 p. 249

Method n The participants were diagnosed with depression and met with a PMH-APN who provided interventions based on Peplau’s Theory of Interpersonal Relations. Some of these interventions included: – – – – Establish a therapeutic relationship Assess life transitions Investigate the role of depressive symptoms in the management of anxiety Understand depressive symptoms in the context of self and relations Help patient to manage anxiety differently Assist patient to take charge of the sources of anxiety Help patient to improve health practices Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Nursing. 12(5), p. Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 247 -254. Retrieved November 14, 2009 from http: //0 -web. ebscohost. com. libcat. ferris. edu/ehost/detail? vid=6&hid=106&sid=078477 e 6 -efc 7 -4604 -944 c- 16 ea 140134 ea%40 sessionmgr 110&bdata=Jn. Npd. GU 9 ZWhvc 3 Qtb. Gl 2 ZQ%3 d%3 d#db=cin 20&AN=1999001459 doi: 10. 1016/S 0883 -9417(98)800034 -4

Results n n It was found that depressive symptoms significantly decreased following intervention, but only when performance self esteem levels increased. Social self esteem and satisfaction in interpersonal relations did not significantly increase. The results seem to indicate that the coping skills learned by the participants have boosted their performance self esteem and decreased their depressive symptoms. It was also determined that patients are receptive to depression screening and interventions performed by a PMH-APN. “Their exit interviews indicated a high degree of satisfaction” Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Nursing. 12(5), p. Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 247 -254. Retrieved November 14, 2009 from http: //0 -web. ebscohost. com. libcat. ferris. edu/ehost/detail? vid=6&hid=106&sid=078477 e 6 -efc 7 -4604 -944 c- 16 ea 140134 ea%40 sessionmgr 110&bdata=Jn. Npd. GU 9 ZWhvc 3 Qtb. Gl 2 ZQ%3 d%3 d#db=cin 20&AN=1999001459 doi: 10. 1016/S 0883 -9417(98)800034 -4

Critique of the Research n Research Strength – Acceptance of PMH-APN by Health Care Team & patients – Use of Peplau’s Theory of Interpersonal Relations – Interventions based on 2 previous studies – Multi-cultural group – Decrease in depression symptoms and physical symptoms in most participants Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Nursing. 12(5), p. Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 247 -254. Retrieved November 14, 2009 from http: //0 -web. ebscohost. com. libcat. ferris. edu/ehost/detail? vid=6&hid=106&sid=078477 e 6 -efc 7 -4604 -944 c- 16 ea 140134 ea%40 sessionmgr 110&bdata=Jn. Npd. GU 9 ZWhvc 3 Qtb. Gl 2 ZQ%3 d%3 d#db=cin 20&AN=1999001459 doi: 10. 1016/S 0883 -9417(98)800034 -4

Critique of the Research n Research Weakness – Only women (18 to 35 years of age) – No control – No randomization – Small group (33 participants) – Some measurement tools used showed insufficient sensitivity Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Nursing. 12(5), p. Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 247 -254. Retrieved November 14, 2009 from http: //0 -web. ebscohost. com. libcat. ferris. edu/ehost/detail? vid=6&hid=106&sid=078477 e 6 -efc 7 -4604 -944 c- 16 ea 140134 ea%40 sessionmgr 110&bdata=Jn. Npd. GU 9 ZWhvc 3 Qtb. Gl 2 ZQ%3 d%3 d#db=cin 20&AN=1999001459 doi: 10. 1016/S 0883 -9417(98)800034 -4

Implications for Practice The consultant role of the PMH-APN in a primary health setting would result in early intervention for patients with depressive symptoms. These patients often seek care for vague physical symptoms that require numerous, costly visits and testing to determine the cause. When depressive symptoms are addressed at an early stage, it results in considerable cost savings. This study verified the value of advance practice nursing. n When establishing a therapeutic relationship with patients, it is important to look for depressive symptoms and share that information with other members of their health care team. Many individuals suffer from untreated depression. It often isn’t discovered and acted on until they come to a primary health setting with a physical complaint. n This study supplied useful information for the discovery and treatment of depressive symptoms. n Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Nursing. 12(5), p. Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 247 -254. Retrieved November 14, 2009 from http: //0 -web. ebscohost. com. libcat. ferris. edu/ehost/detail? vid=6&hid=106&sid=078477 e 6 -efc 7 -4604 -944 c- 16 ea 140134 ea%40 sessionmgr 110&bdata=Jn. Npd. GU 9 ZWhvc 3 Qtb. Gl 2 ZQ%3 d%3 d#db=cin 20&AN=1999001459 doi: 10. 1016/S 0883 -9417(98)800034 -4

Final Thought n As nurses, we strive to provide care that is evidence based and constantly improving. Nursing education and practice are based on theories that have proven successful. An unproven theory will find no support until it has been proved to be true through numerous research studies. Nurses need to always look for ways to improve patient care. To determine if a new way of performing nursing duties is safe and effective, it must be researched. A good nurse is always aware of theory behind work performed and evaluating the result.

References Beeber, L S. , Charlie, M L. , (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 12(5), p. 247 -254. Retrieved November 14, 2009 from http: //0 - web. ebscohost. com. libcat. ferris. edu/ehost/detail? vid=6&hid=106&sid=0784 77 e 6 -efc 7 -4604 -944 c 16 ea 140134 ea%40 sessionmgr 110&bdata=Jn. Npd. GU 9 ZWhvc 3 Qtb. Gl 2 ZQ%3 d %3 d#db=cin 20&AN=1999001459 doi: 10. 1016/S 0883 -9417(98)800034 -4 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 -143. Retrieved November 14, 2009, from Academic One. File via Gale: http: //0 find. galegroup. com. libcat. ferris. edu/gtx/start. do? prod. Id= AONE&user. Group Name=lom_ferrissu DOI: 10. 1177/1078390308315613 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 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

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