The value of Peplau's theory for mental health nursing.

Jones A.

Abstract

Recent changes in mental health care have necessitated reevaluation of Peplau's nursing
theory. There is an expanding body of nursing knowledge and a debate is taking place
regarding the difference between models and theories. Peplau's theory considers nursing
as an interpersonal process between nurse and patient. The theory lacks empirical
investigation and is not yet tested regarding the multidisciplinary team approach, which is
largely based on the medical model. For the theory to gain credibility within the dynamics
of the multidisciplinary team, it must be tested within a framework of robust research
design involving various diagnostic groups and practice settings. Until such time, the
theory's utility must seriously be questioned within contemporary mental health practice.

https://www.ncbi.nlm.nih.gov/pubmed/8718356
Chapter 1 Psychiatric and mental health nursing:

theory and practice w. REYNOLDS and D. CORMACK Contemporary psychiatric

nursing has its recent history in the custodial model of care which caused
the mentally ill to be isolated, frequently under lock and key, from the
rest of the population. Such people were housed in psychiatric
institutions, and provided with clothing, heat, food and other physical
requirements. The main purpose of medical intervention was to separate
patients from the rest of the community, to keep them in reasonably good
physical health, and to provide physically based psychiatric treatment.
Medical intervention was, for the most part, confined to making
psychiatric diagnoses, the prescription of a small range of
tranquillizers, and to other forms of physical treatment. For the most
part, psychiatric nurses functioned in support of this isolate and
tranquillize philosophy. Up until the 1940s and 1950s, one of the main
attributes of a psychiatric nurse was adequate physical stature and
strength. The main purpose of psychiatric nursing was to contain patients,
keep them in reasonable physical health, and prevent patients from harming
themselves, other patients, and staff. The custodial role of the nurse
in these areas was of paramount importance, with the psychiatrist being
the sole source of decision making, determining the type and focus of
nursing care, and generally being responsible for all aspects of patient
treatment. This relationship between doctor and nurse, with the former
being responsible for and directing the activities of nursing staff, was
little changed from that existing 100 years earlier when Connelly (1856,
p. 37) wrote: ' ... all his [the physician's] plans, all his care, all
his personal labour, must be counteracted, if he has attendants [nurses]
who will not observe his rules, when he is not in the ward, as
conscientiously as when he is present.' Thus, the period which emphasized
custodial care began and ended with a psychiatric nursing role which
included little more than a caretaking custodial function. The primary
function of the nurse, therefore, was to maintain the safety and physical
health of patients under the close W. Reynolds et al., Psychiatric and
Mental Health Nursing © Springer Science+Business Media Dordrecht 1990
4 Psychiatric and mental health nursing: theory and practice direction
and supervision of medical staff, and to carry out the treatments
prescribed by them. That view contrasts with that of Reynolds (1988a) who
stated that the primary function of the psychiatric nurse is to formulate
and deliver his or her own treatment strategies, rather than to focus
exclusively on giving assistance to other professionals. During the 1950s,
when an array of psychopharmacological treatments became available, the
custodial approach began to be extended to include a range of more
sophisticated and selective treatments. At that stage, the role of the
psychiatric nurse was extended to include the administration of a much
wider range of medical prescriptions, and to monitoring the effects and
side-effects of these. As a consequence of the use of these
pharmacological agents, many patients became considerably more
accessible to nursing staff, leading to the formation of a variety of
nurse- patient relationships. Although these nurse-patient relationships
were relatively unsophisticated, frequently unplanned, and not designed
to fulfil any specific goals, they undoubtedly had the potential for
enabling nursing staff to positively influence the health status of
patients. Indeed, there followed some debate regarding the extent to which
psychopharmacology influenced patient behaviour, and the extent to which
nurse-patient interactions and relationships produced change. McGhie
(1957, p. xiii), in a discussion of the role of the psychiatric nurse,
stated: ' ... psychiatrists, while not doubting the efficacy of these
[medical] treatments to many psychiatric conditions, have referred to the
difficulty in differentiating between the therapeutic value of the
treatment itself and the interpersonal influences which are an integral
part of any treatment situation'. Increased nurse-patient contact,
frequently resulting in the formation of informal relationships, added
a new dimension to the role of the psychiatric nurse. Nursing staff were
now able to influence the mental health status of patients, although this
was almost certainly done in an unstructured, unsystematic and random way
which had no theoretical underpinning. Indeed, it might be argued that
nurses used their new access to patients in order to encourage/motivate
patients to continue to accept that which was offered in terms of the
custodial model of care, and to accept those specific (medical) treatments
which were provided by psychiatrists. Nurses were perceived as being those
who facilitated the work of others, primarily that of medical staff.
Johnson and Martin (1958), in a sociological comment on the psychiatric
nurses' role suggested that they might have a specialist function in terms
of maintaining the equilibrium of the patient! carer sphere, and in
facilitating success of patient care within the medical model. In
discussing these aspects of the psychiatric nurses' role Johnson and
Martin (1958, p. 373) stated: 'We call actions which are directly related
to moving the system towards its goal instrumental, and actions which are
related to maintaining motivational equilibrium in the individuals
composing the group expressive'.

https://link.springer.com/chapter/10.1007/978-1-4899-3011-8_1

Stuart Stress Adaptation Model

Last updated on March 9, 2012

Introduction
  Stuart Stress Adaptation Model is a model of of psychiatric nursing care, which
integrates biological, psychological, sociocultural, environmental, and legal-ethical
aspects of patient care into a unified framework for practice.
 The Stuart Stress Adaptation Model of health and wellness provides a consistent
nursing-oriented framework (Stuart, 2009).

Assumptions

 "Nature is ordered as a social hierarchy from the simplest unit to the most complex
and the individual is a part of family, group, community, society, and the larger
biosphere."
 "Nursing care is provided within a biological, psychological, sociocultural,
environmental, and legal-ethical context."
 Health/illness and adaptation/maladaptation (nursing world view) are two distinct
continuums.
 The model includes the primary, secondary, and tertiary levels of prevention by
describing four discrete stages of psychiatric treatment: crisis, acute, maintenance,
and health promotion.
 Nursing care is based on the use of the nursing process and the standards of care and
professional performance for psychiatric nurses.

Concepts

 Biopsychosocial approach - a holistic perspective that integrates biological,

psychological, and sociocultural aspects of care.
 Predisposing factors -risk factors such as genetic background.
 Precipitating stressors - stimuli that the person perceives as challenging such as life
events.
 Appraisal of stressor - an evaluation of the significance of a stressor.
 Coping resources - options or strategies that help determine what can be done as well
as what is at stake.
 Adaptation/maladaptation -
 Levels of Prevention

o Primary
o Secondary
o Tertiary
 Four stages of psychiatric treatment & nursing care

o Crisis stage
o Acute stage
o Maintenance stage
o Health promotion stage

Conclusion
  Stuart Stress Adaptation Model can be used across psychiatric settings.
 This model is based on standards of psychiatric nursing care and professional
performance.

References

1. Stuart GW. (2009). Principles and Practice of Psychiatric Nursing, 10th Edition Stuart -
Mosby Elsevier, Missouri.
2. Theorist's page

http://currentnursing.com/theory/Stuart_Stress_Adaptation_Model.html
Hildegard E. Peplau: The
psychiatric nursing legacy of a
legend
Author links open overlay panelJudithHaberPhD(APRN, CS, FAAN)1
Show more

https://doi.org/10.1016/S1078-3903(00)90021-1Get rights and content

Hildegard Peplau is remembered by nurses worldwide as the “mother
of psychiatric nursing.” Her scope of influence transcended her
psychiatric nursing specialty and had a profound effect on the nursing
profession, nursing science, and nursing practice. Peplau played a
leadership role by influencing and emphasizing the advancement of
professional, educational, and practice standards, and the importance
of professional self-regulation through credentialing. She made a
major contribution to nursing science, professional nursing, and, of
course, to the psychiatric nursing specialty through development of
the Interpersonal Relations paradigm, a mid-range theory that has
influenced the importance with which the nurse-patient relationship
is regarded. The essential nature of the nurse-patient relationship and
its significance as a therapeutic modality operationalizes Peplau's
scholarship and provides the basis for both the art and science of
nursing practice. Peplau would challenge psychiatric nurses to thrive
in the new millennium through continued commitment to the
importance of the nurse-patient relationship, engagement in
evidence-based practice, support of competence in information
technology, and provision of leadership in influencing the health care
paradigm shift to community-based health care delivery.
https://www.sciencedirect.com/science/article/abs/pii/S10783903009002
11

Human Becoming Theory

Rosemarie Rizzo Parse
This page was last updated on October 27, 2011

INTRODUCTION

The Parse theory of human becoming guides nurses In their practice to

focus on quality of life as it is described and lived (Karen & Melnechenko,
1995).




The human becoming theory of nursing presents an alternative to both

the conventional bio-medical approach and the
bio-psycho-social-spiritual (but still normative) approach of most other
theories of nursing.(ICPS)




The human becoming theory posits quality of life from each person's own
perspective as the goal of nursing practice.(ICPS)




Rosemarie Rizzo Parse first published the theory in 1981 as the

"Man-living-health" theory (ICPS)


 

The name was officially changed to "the human becoming theory" in

1992 to remove the term "man," after the change in the dictionary
definition of the word from its former meaning of "humankind."

ABOUT THE THEORIST

 Educated at Duquesne University, Pittsburgh

 MSN and Ph.D. from University of Pittsburgh
 Published her theory of nursing, Man-Living-Health in 1981
 Name changed to Theory of Human Becoming in 1992
 Editor and Founder, Nursing Science Quarterly
 Has published eight books and hundreds of articles about Human
Becoming Theory
 Professor and Niehoff Chair at Loyola University, Chicago

THEORY DEVELOPMENT

The human becoming theory was developed as a human science nursing

theory in the tradition of Dilthey, Heidegger, Sartre, Merleau-Ponty, and
Gadamer and Science of Unitary Human Beings by Martha Rogers .




The assumptions underpinning the theory were synthesized from works

by the European philosophers, Heidegger, Sartre, and Merleau-Ponty,
along with works by the pioneer American nurse theorist, Martha Rogers.




The theory is structured around three abiding themes: meaning,

rhythmicity, and transcendence.

ASSUMPTIONS

About man

 The human is coexisting while coconstituting rhythmical patterns with the

 universe.
 The human is open, freely choosing meaning in situation, bearing
responsibility for decisions.
 The human is unitary, continuously coconstituting patterns of relating.
 The human is transcending multidimensionally with the possibles

About Becoming

 Becoming is unitary human-living-health.

 Becoming is a rhythmically coconstituting human-universe process.
 Becoming is the human’s patterns of relating value priorities.
 Becoming is an intersubjective process of transcending with the
possibles.
 Becoming is unitary human’s emerging

Three Major Assumptions of Human Becoming

 Meaning

o Human Becoming is freely choosing personal meaning in

situations in the intersubjective process of living value
priorities.
o Man’s reality is given meaning through lived experiences
o Man and environment cocreate
 Rhythmicity

o Human Becoming is cocreating rhythmical patterns of relating

in mutual process with the universe.
o Man and environment cocreate ( imaging, valuing, languaging)
in rhythmical patterns
 Transcendence

o Human Becoming is cotranscending multidimensionally with

emerging possibles.
o Refers to reaching out and beyond the limits that a person sets
o One constantly transforms

SUMM ARY OF THE THEORY

Human Becoming Theory includes Totality Paradigm

o
 Man is a combination of biological, psychological, sociological
and spiritual factors

o
 Simultaneity Paradigm

o Man is a unitary being in continuous, mutual interaction with

environment
 Originally Man-Living-Health Theory

NURSING P ARADIGMS AND P ARSE'S THEORY

 Person

o Open being who is more than and different from the sum of the
parts
 Environment

o Everything in the person and his experiences

o Inseparable, complimentary to and evolving with
 Health
o Open process of being and becoming. Involves synthesis of
values
 Nursing

o A human science and art that uses an abstract body of

knowledge to serve people

SYMBOL OF HUM AN BECOMING THEORY

Black and white = opposite paradox significant to ontology of human

becoming and green is hope




Center joined =co created mutual human universe process at the

ontological level & nurse-person process


  Green and black swirls intertwining = human-universe co creation as an
ongoing process of becoming

STRENGTH AND WEAKNESSES

Strengths

 Differentiates nursing from other disciplines

 Practice - Provides guidelines of care and useful administration
 Useful in Education
 Provides research methodologies
 Provides framework to guide inquiry of other theories (grief, hope,
laughter, etc.)

Weaknesses

 Research considered to be in a “closed circle”

 Rarely quantifiable results - Difficult to compare to other research studies,
no control group, standardized questions, etc.
 Does not utilized the nursing process/diagnoses
 Negates the idea that each person engages in a unique lived experience
 Not accessible to the novice nurse
 Not applicable to acute, emergent care

APPLICATION OF THE THEORY

Nursing Practice

 A transformative approach to all levels of nursing

 Differs from the traditional nursing process, particularly in that it does not
seek to “fix” problems
 Ability to see patients perspective allows nurse to “be with” patient and
guide them toward desired health outcomes
 Nurse-person relationship cocreates changing health patterns

Research

 Enhances understanding of human lived experience, health, quality of life

and quality of nursing practice
 Expands the theory of human becoming
 Builds new nursing knowledge about universal lived experiences which
may ultimately contribute to health and quality of life

CRITIQUE

 Congruence with personal values

 o Nurse must subscribe to this world view to truly use it
 Congruence with other professional values

o Complements and competes with other health care

professionals’ values
o Exoteric foundations
o Esoteric utility
 Congruence with social values

o Fulfills society’s expectations of nursing role

 Social Significance

o Makes a substantial difference in the lives of clients and nurses

http://currentnursing.com/nursing_theory/Rosemary_Pars_Human_Becoming
_Theory.html