What is the most important information the nurse should share with the patient during the orientation phase group of answer choices?

Peplau published her Theory of Interpersonal Relations in 1952, and in 1968, interpersonal techniques became the crux of psychiatric nursing. The Theory of Interpersonal Relations is a middle-range descriptive classification theory. It was influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elger Miller.

The four components of the theory are: person, which is a developing organism that tries to reduce anxiety caused by needs; environment, which consists of existing forces outside of the person, and put in the context of culture; health, which is a word symbol that implies forward movement of personality and other other human processes toward creative, constructive, productive, personal, and community living.

The nursing model identifies four sequential phases in the interpersonal relationship: orientation, identification, exploitation, and resolution.

The orientation phase defines the problem. It starts when the nurse meets the patient, and the two are strangers. After defining the problem, the orientation phase identifies the type of service needed by the patient. The patient seeks assistance, tells the nurse what he or she needs, asks questions, and shares preconceptions and expectations based on past experiences. Essentially, the orientation phase is the nurse’s assessment of the patient’s health and situation.

The identification phase includes the selection of the appropriate assistance by a professional. In this phase, the patient begins to feel as if he or she belongs, and feels capable of dealing with the problem which decreases the feeling of helplessness and hopelessness. The identification phase is the development of a nursing care plan based on the patient’s situation and goals.

The exploitation phase uses professional assistance for problem-solving alternatives. The advantages of the professional services used are based on the needs and interests of the patients. In the exploitation phase, the patient feels like an integral part of the helping environment, and may make minor requests or use attention-getting techniques. When communicating with the patient, the nurse should use interview techniques to explore, understand, and adequately deal with the underlying problem. The nurse must also be aware of the various phases of communication since the patient’s independence is likely to fluctuate. The nurse should help the patient exploit all avenues of help as progress is made toward the final phase. This phase is the implementation of the nursing plan, taking actions toward meeting the goals set in the identification phase.

The final phase is the resolution phase. It is the termination of the professional relationship since the patient’s needs have been met through the collaboration of patient and nurse. They must sever their relationship and dissolve any ties between them. This can be difficult for both if psychological dependence still exists. The patient drifts away from the nurse and breaks the bond between them. A healthier emotional balance is achieved and both become mature individuals. This is the evaluation of the nursing process. The nurse and patient evaluate the situation based on the goals set and whether or not they were met.

The goal of psychodynamic nursing is to help understand one’s own behavior, help others identify felt difficulties, and apply principles of human relations to the problems that come up at all experience levels. Peplau explains that nursing is therapeutic because it is a healing art, assisting a patient who is sick or in need of health care. It is also an interpersonal process because of the interaction between two or more individuals who have a common goal. The nurse and patient work together so both become mature and knowledgeable in the care process.

The nurse has a variety of roles in Hildegard Peplau’s nursing theory. The six main roles are: stranger, teacher, resource person, counselor, surrogate, and leader.

As a stranger, the nurse receives the patient in the same way the patient meets a stranger in other life situations. The nurse should create an environment that builds trust. As a teacher, the nurse imparts knowledge in reference to the needs or interests of the patient. In this way, the nurse is also a resource person, providing specific information needed by the patient that helps the patient understand a problem or situation. The nurse’s role as a counselor helps the patient understand and integrate the meaning of current life situations, as well as provide guidance and encouragement in order to make changes. As a surrogate, the nurse helps the patient clarify the domains of dependence, interdependence, and independence, and acts as an advocate for the patient. As a leader, the nurse helps the patient take on maximum responsibility for meeting his or her treatment goals. Additional roles of a nurse include technical expert, consultant, tutor, socializing and safety agent, environment manager, mediator, administrator, record observer, and researcher.

Some limitations of Peplau’s theory include the lack of emphasis on health promotion and maintenance; that intra-family dynamics, personal space considerations, and community social service resources are less considered; it can’t be used on a patient who is unable to express a need; and some areas are not specific enough to generate a hypothesis.

1. Carper B. Fundamental patterns of knowing in nursing. Adv in Nurs Sci. 1978;1:13–23. [PubMed] [Google Scholar]

2. Watson J. Nursing: The philosophy and science of caring 1979. Liittle Brown; Boston, MA: 1985. Reprinted. Colorado Associated. [Google Scholar]

3. Swanson KM. Empirical development of a middle range theory of caring. Nurs Res. 1991;40(3):161–166. [PubMed] [Google Scholar]

4. Tanner CA, Benner P, Chesla C, Gordon DR. The phenomenology of knowing the patient. J Nurs Scholarsh. 1993;25(4):273–280. [PubMed] [Google Scholar]

5. Benner P, Tanner C. Clinical judgment: How expert nurses use intuition. Am J Nurs. 1987;87(1):23–31. [PubMed] [Google Scholar]

6. Bundgaard K, Nielsen KB, Delmar C, Sorensen EE. What to know and how to get to know? A fieldwork study outlining the understanding of knowing the patient in facilities for short-term stay. J Adv Nurs. 2011;68(10):2280–2288. [PubMed] [Google Scholar]

7. Jenny J, Logan J. Knowing the patient: One aspect of clinical knowledge. J Nurs Scholarsh. 1992;24(4):254–258. [PubMed] [Google Scholar]

8. Radwin LE. Knowing the patient: A process model for individual interventions. Nurs Res. 1995;44(6):364–370. [PubMed] [Google Scholar]

9. Radwin LE. Empirically generated attributes of experience in nursing. J Adv Nurs 1998. 1998;27:590–595. [PubMed] [Google Scholar]

10. Takemura Y, Kanda K. How Japanese nurses provide care: a practice base on continuously knowing the patient. J Adv Nurs. 2003;42(3):252–259. [PubMed] [Google Scholar]

11. Luker KA, Austin L, Caress A, Hallett CE. The importance of 'knowing the patient': Community nurses' constructions of quality in providing palliative care. J Adv Nurs. 2000;31(4):775–782. [PubMed] [Google Scholar]

12. Whittemore R. Consequences of not “knowing the patient” Clin Nurse Spec. 2000;14(2):75–81. [PubMed] [Google Scholar]

13. Speed S, Luker KA. Changes in patterns of knowing the patient: The case of British district nurses. Int J Nurs Std. 2004;41:921–931. [PubMed] [Google Scholar]

14. Blythe J, Royle J. Brief communications: Assessing nurses’ information needs. Bull Med Libr Assoc. 1993;81(4):433–435. [PMC free article] [PubMed] [Google Scholar]

15. Corcoran-Perry S, Graves J. Supplemental-information-seeking behavior of cardiovascular nurses. Res in Nurs Health. 1990;13(2):119–127. [PubMed] [Google Scholar]

16. Ekman I, Segesten K. Deputed power of medical control: The hidden message in the ritual of oral shift reports. J Adv Nurs. 1995;22:1006–1011. [PubMed] [Google Scholar]

17. Lange L. Information seeking by nurses during beginning-of-shift activities. Proceedings from the Annual Symposium Computers Applied Medical Care. 1992:317–321. [PMC free article] [PubMed] [Google Scholar]

18. McKnight M. The information seeking of on-duty critical care nurses. J Med Libr Assoc. 2006;94(2):145–151. [PMC free article] [PubMed] [Google Scholar]

19. Zhou X, Ackerman M, Zheng K. I just don’t know why it’s gone: maintaining informal information use in inpatient care. Proceedings from CHI. 2009 [Google Scholar]

20. Ammenwerth E, Mansmann U, Uler C, Eichstadter R. Fcators affecting and affected by user acceptance of computer-based nursing documentation: Results of a two-year study. JAMIA. 2003;10(1):69–84. [PMC free article] [PubMed] [Google Scholar]

21. U.S. Congress. [Accessed on June 20, 2013.];American recovery and reinvestment act of 2009. Available from: http://www.gpo.gov/fdsys/pkg/BILLS-111hr1eh/pdf/BILLS-111hr1eh.pdf.

22. Kelley TF, Brandon D, Docherty S. Electronic nursing documentation as a strategy to improve the quality of patient care. J Nurs Scholarsh. 2011;43(2):154–162. [PubMed] [Google Scholar]

23. Staggers N, Jennings BM. The content and context of change of shift report on medical and surgical units. J Nurs Adm. 2009;39(9):393–398. [PubMed] [Google Scholar]

24. Kelley TF. Dissertation. Durham: NC: Duke University; 2012. Information use with paper and electronic nursing documentation by nurses caring for pediatric patients. [Google Scholar]

25. Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA. 2001;285(16):2114–2120. [PubMed] [Google Scholar]

26. Lannon CM, Coven BJ, Lane France F, Hickson GB, Miles PV, Swanson JT, et al. Principles of patient safety in pediatrics. Pediatrics 2001. 2001;107(6):1473–1475. [PubMed] [Google Scholar]

27. Miller MR, Elixhauser A, Zhan C. Patient safety events during pediatric hospitalizations. Pediatrics. 2003;111(6 Pt 1):1358–1366. [PubMed] [Google Scholar]

28. Mangione-Smith R, DeCristofaro AH, Setodji CM, Keesey J, Klein DJ, Adams JL, et al. The quality of ambulatory care delivered to children in the United States. N Engl J Med. 2007;357(15):1515–1523. [PubMed] [Google Scholar]

29. Miles PV, Miller M, Payne DM, Perelman R, Saffer M, Zimmerman E. Alliance for pediatric quality: creating a community of practice to improve health care for America's children. Pediatrics. 2009;123(Suppl 2):S64–66. [PubMed] [Google Scholar]

30. Lin C, Hsieh K. Pediatric critical care–A new frontier. Pediatric Neonatalogy. 2009;50(5):184–189. [PubMed] [Google Scholar]

31. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–1288. [PubMed] [Google Scholar]

32. Miles MB, Huberman AM, Saldana J. Qualitative data analysis: An expanded Sourcebook. 2. Thousand Oaks: Sage; 2013. [Google Scholar]

33. U.S. Department of Health and Human Services. [Accessed on June 8, 2010.];Electronic health records and meaningful use. Available from: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1325&parentname=CommunityPage&parented=1&mode=2.