The Advancing Role of the Psychiatric Nurse
The scope of psychiatric nursing has undergone changes over the recent decades, shifting its focus to psychosocial interventions. Consequently, the roles, responsibilities, and training of nurses have advanced in response to this change. As Hem & Heggen (2003) claim, theoretical principles of psychiatric nursing are characterized by contradictions as they revolve around the idea of nurses being “therapeutic instruments” (p. 101). As Delaney et al. (2017) state, staff’s engagement with patients is crucial in a psychiatric clinical setting. However, the principle of equilibrium between intimacy and distance appears narrow.
The nurse’s role is not limited to balancing professional and human behavior. Instead, the interpersonal relationship suggests interactions of thoughts, actions, feelings, and beliefs in exploiting avenues of help for the patient. Furthermore, work in the practice setting involves communication with individuals, groups, families, and communities. According to Delaney et al. (2017), recognizing the nurse’s roles in inpatient therapeutic relationships can be beneficial for ensuring interpersonal engagement and improving the quality of services and patient outcomes. The responsibilities of psychiatric staff members are complex, which identifies the need for a comprehensive theoretical framework to be applied to nursing care.
Peplau’s Interpersonal Relations Theory’s Relevance to Psychiatric Nursing
One of the first prominent nursing theorists, Peplau, made a significant contribution to the development of nursing knowledge by establishing theoretical baselines for contemporary methods. Her interpersonal relations theory emphasizes the importance of interpersonal techniques in psychiatric nursing. Gastmans’ (1998) analysis of the philosophical-ethical background of Peplau’s work determined that the model is based on the concept of an ethical relationship of care between the nurse and the patient. Acknowledging personal, social, and cultural aspects of nursing care is detrimental to the advancement of the clinical practice.
The emphasis on cooperation for promoting health and well-being redefines the role of the nurse in the broader context. Peplau referred to nursing as a therapeutic process and “an educative instrument, a maturing force, that aims to promote forward movement of personality in the direction of creative, constructive, productive, personal and community living” (as cited in Gastmans, 1998, p. 1315). Such a definition shifts focus to the paradigm of the interpersonal relations in care and helps fill the gap between the theory and practice in general and psychiatric nursing.
Peplau’s interpersonal relations model is based on the transformative idea of nursing. It incorporates key elements, such as the person as a developing organism, the environment with cultural context and forces outside of the person’s control, health as the progressive movement of personality, and nursing as a therapeutic interpersonal process. The theory suggests four phases present in the interpersonal relationship: orientation, identification, exploitation, and resolution (Hagerty et al., 2017).
Thus, the role of the nurse expands and implies a broader range of responsibilities, among which stranger, teacher, resource person, counselor, surrogate, leader, as well as other subsidiary roles (Hagerty et al., 2017). Peplau’s detailed explanation of the theory provides grounds for integrating science and art of nursing to build on the theoretical knowledge to be applied in the practice setting (Adams, 2017). Hence, the unique contribution of the interpersonal relations model demonstrates how nursing care evolves.
To identify the relevance of Peplau’s theory to psychiatric nursing, it is crucial to discuss the sequential phases and associated influencing factors. The orientation phase suggests that the nurse meets the patient as a stranger and helps them define the problem and the service required to resolve it (Adams, 2017). During the identification phase, appropriate assistance is chosen, and the patient’s feeling of helplessness is expected to be replaced by the sense of belonging. The exploitation phase focuses on using professional assistance and services based on the patient’s needs. The nurse utilizes interviewing techniques to explore the underlying issues, with a degree of independence for the patient.
The resolution phase implies the termination of the therapeutic relationship as the patient’s needs are met due to the cooperation between the nurse and the client. During this time, difficulties may occur in the dissolution of the psychological link (Adams, 2017). Peplau emphasized applying the human relation values to resolve the issues and work towards meeting the identified goals (Hagerty et al., 2017). The desired outcome of the cooperation between the patient and the nurse is a healthier emotional balance in the client.
Peplau’s theory is essential to the advancement of the professional practice in psychiatric nursing. Beeber and Bourbonniere (1998) studied the so-called interpersonal patterns that derive from such sources as biological needs, socio-cultural aims, and behaviors controlling anxiety. The assessment of the patient’s interpersonal relations will help the nurse identify dominant patterns determined by their theme that reveals a common need. As per Beeber and Bourbonniere (1998), the observation of such patterns and the identification of themes is pivotal for obtaining clinical data used for further investigation and change.
Furthermore, recognizing the dominant interpersonal behaviors allows for placing them in the context and evaluating causes and consequences of the client’s actions. Peplau noted that patterns tend to form “processes” with predictable components (as cited in Beeber & Bourbonniere, 1998, p. 189). Some examples of the said processes include chronic disease management, grieving, life cycle transitions, and so forth (Beeber & Bourbonniere, 1998). With that being said, observations during inpatient care acquire particular importance.
The Application of Peplau’s Interpersonal Relations Theory in Future Research
In the context of the research study focusing on the experiences of clients under close observation during inpatient care, Peplau’s interpersonal relations theory, with its emphasis on therapeutic engagement, is of particular interest. As Insua‐Summerhays et al. (2018) argue, previous research mentioned counter-therapeutic interactions between the nurse and the patient. In particular, Veale et al. (2020) report adverse effects of nursing observations during the night time for the patients.
Holyoake (2013) reevaluates the view of observing in the psychiatric nursing setting as a tool, emphasizing the role of the psychiatric culture being both the patient and the caregiver. In turn, Adams (2017) emphasizes that nursing situations provide a field of observations and an opportunity to derive nursing concepts and enhance theoretical knowledge. As a result, many researchers conducted studies and developed theories in various psychiatric contexts based on Peplau’s ideas of therapeutic relationships and interpersonal patterns.
Considering previous research findings is essential to identifying the relevance of Peplau’s theory to studying lived experiences of clients with the utilization of an interpretative phenomenological analysis. In this regard, Sun et al. (2006) developed a theory for the nursing care of patients at risk of suicide which suggests special observations of patients and requires facilitated room for closer monitoring. An observer-as-participant strategy was applied to collect data, and the relationships between psychiatric nurses and patients were identified as crucial for the client’s perception and therapeutic effects (Sun et al., 2006).
Another study, carried out by MacKay et al. (2005), focuses on identifying the impact of constant or special observations of patients presenting a risk of aggression or violence. MacKay et al. (2005) defined the term observation as a “caring and interactive” process, emphasizing Peplau’s concept of interpersonal relations (p. 469). Furthermore, the researchers noted the need to shift from formal observation to providing care and including both proactive and reactive elements of prevention (MacKay et al., 2005). Another important finding is the need for adequate training in nurses to ensure the effectiveness of the observational process.
Peplau’s model is based on psychodynamic nursing, which suggests understanding one’s behavior and helping others in identifying felt difficulties. The utilization of observations consistent with the theory’s principles aims to provide therapeutic effects for the patient. According to Forchuk et al. (2005), the demand for quality services in the area of mental health continues to grow. Arabacı & Taş (2019) suggest that Peplau’s theory of interpersonal relations can be used for solving the communication-based problem. In this regard, integrated behavioral health care emerges as a field that considers behavior factors in medical conditions affecting the patient’s health (Caldwell et al., 2021).
Alongside with Peplau’s theory, the application of the interpretive phenomenological analysis (IPA) in psychiatric care research can provide a framework for a comprehensive description of findings. Peat et al. (2019) argue that adopting the IPA method can help researchers “construct insightful interpretative accounts of experiences,” thus, shedding light on subjects that require further investigation. In turn, Hauenstein (2020) acknowledges the changing role of nurses in the implementation of health care reforms in the changing environment. Therefore, Peplau’s theory can be applied in psychiatric nursing practice under the condition of providing staff with appropriate knowledge regarding observations and associated challenges.
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Veale, D., Ali, S., Papageorgiou, A., & Gournay, K. (2020). The psychiatric ward environment and nursing observations at night: a qualitative study. Journal of psychiatric and mental health nursing, 27(4), 342-351. Web.