Peplau’s Theory of Interpersonal Relations Research with Patients Experiencing Traumatic Events...

Peplau’s Theory of Peplau’s Theory of Interpersonal Relations Interpersonal Relations Research with Patients Research with Patients Experiencing Traumatic Experiencing Traumatic

EventsEventsPresented by Group 3: Kimberly Presented by Group 3: Kimberly Hargrove, Donna Johnson, Debra Hargrove, Donna Johnson, Debra

Lenhart, Sheila LucasLenhart, Sheila LucasFerris State UniversityFerris State University

Brief overview of Peplau’s Brief overview of Peplau’s Theory of Interpersonal Theory of Interpersonal

Relations…Relations…

Theory focuses on Theory focuses on interpersonal communication:interpersonal communication:

First model to suggest that…First model to suggest that… Nurse and patient act as PARTNERS Nurse and patient act as PARTNERS

to initiate change rather than patient to initiate change rather than patient passively receiving treatment and passively receiving treatment and nurse simply acting on orders from nurse simply acting on orders from physician.physician.

Effective communication causes Effective communication causes nurse to take on numerous roles:nurse to take on numerous roles:

StrangerStranger ResourceResource TeacherTeacher LeaderLeader Surrogate Surrogate CounselorCounselor Technical Expert 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 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. Survivors of Sexual Violence. Journal of the American Psychiatric Nurses Association (JAPNA)Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p. 137 p. 137

Continuum showing changing Continuum showing changing nurse-patient relationships:nurse-patient relationships:

Tomey, A. M., & Alligood, M. R. (2006). Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their workNursing theorists and their work (6th ed., p. 55). St. Louis, MO: Mosby Elsevier. (6th ed., p. 55). St. Louis, MO: Mosby Elsevier.

Four phases of nurse-patient Four phases of nurse-patient relationship:relationship:

Orientation Orientation IdentificationIdentification Exploitation (or working)Exploitation (or working) TerminationTermination

Phases and changing roles in Phases and changing roles in nurse-patient relationship:nurse-patient relationship:


Theory is based Theory is based upon psychological upon psychological models. models.

Influences include Influences include Freud, Maslow, and Freud, Maslow, and SullivanSullivan


Peplau’s interpersonal Peplau’s interpersonal theory stated:theory stated:

Psychobiological experiences lead to Psychobiological experiences lead to constructive or destructive responses. constructive or destructive responses. Four experiences include:Four experiences include:

NeedsNeeds FrustrationsFrustrations ConflictsConflicts AnxietiesAnxieties


Due to the psychobiological components, Due to the psychobiological components, this model is effective to study effects of this model is effective to study effects of and assist nurses in dealing with patients and assist nurses in dealing with patients that have experienced traumatic events.that have experienced traumatic events.

Rationale for use in Nursing Rationale for use in Nursing PracticePractice

Opens individuals eyes to the hidden hurt of traumaOpens individuals eyes to the hidden hurt of trauma Educates nurses not to pre-judge patient’s who Educates nurses not to pre-judge patient’s who

have been victims of traumatic eventshave been victims of traumatic events Reminds us that we are all vulnerable to traumatic Reminds us that we are all vulnerable to traumatic

eventsevents Articles give us tools to assist those in needArticles give us tools to assist those in need Identifies coping mechanisms, strategies and Identifies coping mechanisms, strategies and

communication techniquescommunication techniques Seeks to understand the underlying mental anguish Seeks to understand the underlying mental anguish

to multiple vague physical complaintsto multiple vague physical complaints Reasons to believe that there can be an ending to Reasons to believe that there can be an ending to

the hidden hurt of traumathe hidden hurt of trauma

Studies Researched Studies Researched

Peplau’s Theory of Interpersonal Peplau’s Theory of Interpersonal Relations not only a nursing theory Relations not only a nursing theory but also has roots in the psychiatry. but also has roots in the psychiatry. Most of the studies that include this Most of the studies that include this theory are based on psychiatric theory are based on psychiatric nursingnursing

In light of Peplau’s theory, we are In light of Peplau’s theory, we are looking at studies done on counseling looking at studies done on counseling AIDS patients, victims of sexual AIDS patients, victims of sexual violence, the value of violence, the value of psychoeducation for PTSD patients, psychoeducation for PTSD patients, and the effectiveness of counseling and the effectiveness of counseling and medication on patients and medication on patients experiencing depressionexperiencing depression

Hildegard Peplau's Theory and Hildegard Peplau's Theory and the Health Care Encounters of the Health Care Encounters of Survivors of Sexual ViolenceSurvivors of Sexual Violence

Tamra J. ToureyTamra J. Tourey Donna S. MartsolfDonna S. Martsolf Claire B. DrauckerClaire B. Draucker Karen B. Karen B.

Strickland. Strickland.

ObjectiveObjective According to Courey, “The purpose of this study According to Courey, “The purpose of this study

was to use Hildegard Peplau’s (1952) was to use Hildegard Peplau’s (1952) conceptualization of nurses helping roles (i. e., conceptualization of nurses helping roles (i. e., stranger, resource person, teacher, leadership, stranger, resource person, teacher, leadership, surrogate, counselor, technical expert) in nurse surrogate, counselor, technical expert) in nurse client interactions to explore how survivors of client interactions to explore how survivors of sexual violence perceive their encounters with sexual violence perceive their encounters with health care professionals.”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 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. Survivors of Sexual Violence. Journal of the American Psychiatric Nurses Association (JAPNA)Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissuPeplau, H. (1992). Interpersonal relations: A theoretical framework for application in nursing practice. Nursing Science Quarterly, 5, 12-18.

First…First… Lets review nursing roles Lets review nursing roles

according to Peplau’s according to Peplau’s theory theory

Peplau’s Theoretical Framework Leadership RoleLeadership Role

The The nurse and patient work together to meet the same result of nurse and patient work together to meet the same result of the condition, the main objective of leadership role is to “help the condition, the main objective of leadership role is to “help the patient accept increased responsibility for the plan of the patient accept increased responsibility for the plan of care.”care.”

Surrogate RoleSurrogate Role Nurses provide a substitute for another who is close to the Nurses provide a substitute for another who is close to the

patient. For example if the Patient’s family is unavailable, patient. For example if the Patient’s family is unavailable, nurses would demonstrate a surrogate role.nurses would demonstrate a surrogate role.

Counselor roleCounselor roleNurses must provides secure, safe environment and to be Nurses must provides secure, safe environment and to be thriving must exhibit active listening, guidance, and support in thriving must exhibit active listening, guidance, and support in this process of self discovery, all the while the nurse must this process of self discovery, all the while the nurse must maintain professional boundaries (Gastmans 1998 as found in maintain professional boundaries (Gastmans 1998 as found in Courey 2008).Courey 2008).

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 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. Survivors of Sexual Violence. Journal of the American Psychiatric Nurses Association (JAPNA)Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p. 137 p. 137Gastmans, C. (1998). Interpersonal relations in nursing: A philosophical-ethical analysis of the work of Hildegard E. Peplau. Journal of Advanced Nursing, 28, 1312-1319

Technical expert roleTechnical expert role Nurse demonstrates competency in technical skills (such as Nurse demonstrates competency in technical skills (such as

IV pumps or blood pressure cuffs). This helps in building IV pumps or blood pressure cuffs). This helps in building trust, hope, and confidence in the patient-nurse relationship.trust, hope, and confidence in the patient-nurse relationship.

Resource Person RoleResource Person Role““Provides professional knowledge,Provides professional knowledge, the ability to deliver information in a sensitive manner, and critical thinking skills and critical thinking skills needed to process the client’s questions and offer a needed to process the client’s questions and offer a therapeutic response.”therapeutic response.”

Stranger RoleStranger Role““Goal is to provide trust to build a solid patient-nurse Goal is to provide trust to build a solid patient-nurse relationship with non-verbal and verbal communication.”relationship with non-verbal and verbal communication.”

Teacher RoleTeacher RoleAssisting client to obtain information and develop health Assisting client to obtain information and develop health and well being in a healing relationship.and well being in a healing relationship.

Peplau’s Theoretical Framework

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 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. Survivors of Sexual Violence. Journal of the American Psychiatric Nurses Association (JAPNA)Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p.137 p.137

Selection ProcessSelection Process 30 men and 30 women were recruited in the parent study 30 men and 30 women were recruited in the parent study

Ages ranged from 18-62Ages ranged from 18-62 Large diversity of participants:Large diversity of participants:

– 50% African Americans50% African Americans– 35% Caucasians35% Caucasians– 15% smaller biracial ethnic participants15% smaller biracial ethnic participants– 58% single58% single– 12% married12% married– 8% divorced8% divorced– 5% separated5% separated– 1 engaged1 engaged

““All Participants lived in the greater Akron, Ohio, All Participants lived in the greater Akron, Ohio, metropolitan area who had experienced sexual violence at metropolitan area who had experienced sexual violence at some point in their lives, recruited via fliers placed in their some point in their lives, recruited via fliers placed in their communities, referrals from community leaders, and communities, referrals from community leaders, and snowball sampling”snowball sampling”

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 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. Survivors of Sexual Violence. Journal of the American Psychiatric Nurses Association (JAPNA)Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p. 138 p. 138

Critique of ResearchCritique of Research Assessed by two advanced practice psychiatric/mental health Assessed by two advanced practice psychiatric/mental health

nursesnurses Assessor rated each participants encounter with healthcare Assessor rated each participants encounter with healthcare

providersproviders– ““When survivors of sexual violence describe their encounters When survivors of sexual violence describe their encounters

with health care professionals, do they describe roles performed with health care professionals, do they describe roles performed by professionals that are consistent with one or more of the by professionals that are consistent with one or more of the Peplau's helping roles?” Peplau's helping roles?”

– ““When survivors of sexual violence describe their encounters When survivors of sexual violence describe their encounters with health care professionals, do they describe roles performed with health care professionals, do they describe roles performed by professionals that are by professionals that are notnot consistent with one or more of the consistent with one or more of the Peplau's helping roles?”Peplau's helping roles?”

– ““When survivors of sexual violence describe their encounters When survivors of sexual violence describe their encounters with health care professionals who perform one of Peplau's with health care professionals who perform one of Peplau's roles, what about these encounters do they perceive as roles, what about these encounters do they perceive as helpful?”helpful?”

– ““When survivors of sexual violence describe their encounters When survivors of sexual violence describe their encounters with health care professionals who perform one of Peplau’s with health care professionals who perform one of Peplau’s roles, what about these encounters do they perceive as hurtful?”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 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. Survivors of Sexual Violence. Journal of the American Psychiatric Nurses Association (JAPNA)Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p.140-141 p.140-141

ResultsResults Participants had either a positive or negative encounter with Participants had either a positive or negative encounter with

their healthcare providerstheir healthcare providers Described encounters with health care professionals Described encounters with health care professionals

according to Peplau’s helping roles as follows:according to Peplau’s helping roles as follows:– 79-counselor79-counselor– 78- technical support78- technical support– 13-stranger13-stranger– 2-resource person2-resource person– 4-teacher4-teacher– 0-surrogate0-surrogate

Research revealed that the roles of counselor and technical Research revealed that the roles of counselor and technical support were most important to the survivor of sexual support were most important to the survivor of sexual violence.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 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. Survivors of Sexual Violence. Journal of the American Psychiatric Nurses Association (JAPNA)Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissuhttp://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu

Implications for PracticeImplications for Practice Nurses who facilitate insight by therapeutic Nurses who facilitate insight by therapeutic

communication have helpful encounters with communication have helpful encounters with victims of sexual violence. victims of sexual violence. “Hurtful encounters were most likely “Hurtful encounters were most likely to occur when health care professionals were to occur when health care professionals were insensitive or dismissed the suffering caused by insensitive or dismissed the suffering caused by the violence. Although the need for sensitive, the violence. Although the need for sensitive, compassionate care is probably universal to all compassionate care is probably universal to all those who seek health care, it seems to be those who seek health care, it seems to be Particularly important to survivors of sexual Particularly important to survivors of sexual violence”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 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. Survivors of Sexual Violence. Journal of the American Psychiatric Nurses Association (JAPNA)Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p.142 p.142

Implications for personal Implications for personal practicepractice

As found in Courey, Physical complaints of survivors of As found in Courey, Physical complaints of survivors of sexual violence include:sexual violence include:– Headaches (Golding, 1999).Headaches (Golding, 1999).– Pelvic pain (McCauley et al., 1997).Pelvic pain (McCauley et al., 1997).– Gastrointestinal upset (Heitkemper et al., 2001).Gastrointestinal upset (Heitkemper et al., 2001).– Chronic malignant pain (Golberg & Goldstein, 2000).Chronic malignant pain (Golberg & Goldstein, 2000).

Mental health complaints of survivors of sexual Mental health complaints of survivors of sexual violence include:violence include:– DepressionDepression– Anxiety disordersAnxiety disorders– Post traumatic stress disorderPost traumatic stress disorder– Substance abuse (Elliott, Mok, & Briere 2004; Koss, Substance abuse (Elliott, Mok, & Briere 2004; Koss,

Figueredo, & Prince, 2002; Saunders, Kilpatrick, Hanson, Figueredo, & Prince, 2002; Saunders, Kilpatrick, Hanson, Resnick, & Walker, 1999).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 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. Survivors of Sexual Violence. Journal of the American Psychiatric Nurses Association (JAPNA)Journal of the American Psychiatric Nurses Association (JAPNA), 14, 2. p.136(8). Retrieved November 14, , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:2009, from Academic OneFile via Gale:http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu

Critical ReflectionCritical Reflection Only two of Peplau’s helping roles were most helpful Only two of Peplau’s helping roles were most helpful

during this difficult time for patients who were victims of during this difficult time for patients who were victims of sexual violence.sexual violence.

– Counselor role–helps the victim understand the Counselor role–helps the victim understand the violence and gain insight into their life situations. violence and gain insight into their life situations.

– Technical support role- therapeutic communication Technical support role- therapeutic communication which helped manage symptoms related to the which helped manage symptoms related to the violence.violence.

Nurses who take care of victims and use Peplau’s theory Nurses who take care of victims and use Peplau’s theory and research of counselor roles and technical support and research of counselor roles and technical support roles to help victims play a significant role in the healing roles to help victims play a significant role in the healing processprocess

Nurses help their patients to Nurses help their patients to – Explore the depth of the violenceExplore the depth of the violence– Grow and learn how to help othersGrow and learn how to help others– Recover fasterRecover faster– Avoid post traumatic stress disorderAvoid post traumatic stress disorder

Effectiveness of psychoeducation intervention on post-traumatic disorder and coping styles of

earthquake survivors

Fahriye Oflaz, PhD, Fahriye Oflaz, PhD, Asst. Asst. Prof. Chief of Psychiatric Prof. Chief of Psychiatric Nursing Dept.Nursing Dept.

Sevgi Hatipoglu, PhD, Sevgi Hatipoglu, PhD, Dean Dean of School of Nursingof School of Nursing

Hamdullah Aydin, MD, Hamdullah Aydin, MD, Former ChiefFormer Chief of Psychiatric of Psychiatric Dept.Dept.

Gulhame Military Medical Gulhame Military Medical AcademyAcademy

Etlik, Ankara, TurkeyEtlik, Ankara, Turkey

Peplau’s theory and PTSDPeplau’s theory and PTSD

Research conducted Research conducted in Turkey following in Turkey following 1999 earthquakes 1999 earthquakes measuring 7.4 and measuring 7.4 and 7.2 on the Richter 7.2 on the Richter scale less than 3 scale less than 3

months apartmonths apart

ObjectiveObjective

Study to show the Study to show the effect of effect of

psychoeducation psychoeducation interventions on interventions on PTSD symptoms PTSD symptoms and associated and associated coping skills of coping skills of

earthquake earthquake survivors.survivors.

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

Selection process:Selection process: Participants voluntarily requested treatment at Participants voluntarily requested treatment at

the medical center due to symptoms of PTSD.the medical center due to symptoms of PTSD.

169 patients were diagnosed with PTSD, only 68 169 patients were diagnosed with PTSD, only 68 fit the criteria to participate in the study.fit the criteria to participate in the study.

Of the 68 initially selected, 17 refused to be Of the 68 initially selected, 17 refused to be involved in the research.involved in the research.

In the end, 51 survivors of the In the end, 51 survivors of the Marmara earthquake were used as the Marmara earthquake were used as the

sample in the research.sample in the research.

Characteristics of Characteristics of Participants: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 Assignment to intervention groupsgroups

Assessed by psychiatristsAssessed by psychiatrists Diagnosis with PTSD and medications Diagnosis with PTSD and medications

determineddetermined Consent for participationConsent for participation Administration of questionnaires and Administration of questionnaires and

group assignmentgroup assignment


Three study groups formed:Three study groups formed: Psychoeducaton and medications (21 Psychoeducaton and medications (21

participants, 41.2%)participants, 41.2%)

Medication only (16 participants, 31.3%)Medication only (16 participants, 31.3%)

Psycoeducation only (14 participants, Psycoeducation only (14 participants, 27.5%)27.5%)


Psychoeducation Psychoeducation Intervention:Intervention:

Six separate sessions 60-90 minutes in Six separate sessions 60-90 minutes in length & one week apart.length & one week apart.

First interview -First interview - opinions and feelings about traumatic opinions and feelings about traumatic experience and significance to patient discussedexperience and significance to patient discussed

Second interview –Second interview – information given to patients information given to patients regarding PTSD symptoms and treatment. Patients regarding PTSD symptoms and treatment. Patients questions were also answered during session.questions were also answered during session.

Third interview –Third interview – provided information about stress and provided information about stress and coping techniques. Discussed coping methods prior to coping techniques. Discussed coping methods prior to trauma as well as current methods.trauma as well as current methods.


Psychoeducation continues:Psychoeducation continues:

Fourth interview –Fourth interview – summarized previous session. Patient summarized previous session. Patient ranked current problems and target goals were set ranked current problems and target goals were set regarding perceived problems.regarding perceived problems.

Fifth interview –Fifth interview – goals studied in-depth. Time to achieve goals studied in-depth. Time to achieve goals and implementation stressed. Alternative goals were goals and implementation stressed. Alternative goals were discussed.discussed.

Final interview –Final interview – evaluation of results. General review and evaluation of results. General review and patient opinion. Post-test regarding coping strategies patient opinion. Post-test regarding coping strategies given.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 Interviews and Peplau’s modelmodel


Final Results:Final Results: While the post-test scores of all three While the post-test scores of all three

participant groups showed significantly participant groups showed significantly lower scores in post-traumatic stress and lower scores in post-traumatic stress and depression than the pre-test scores, there depression than the pre-test scores, there was no difference among the groups was no difference among the groups regarding coping strategies. regarding coping strategies.


Individual Group Findings:Individual Group Findings:Psychoeducation Psychoeducation with Medicationswith Medications

Increased problem Increased problem solvingsolving

Decreased depressionDecreased depression Increased social-Increased social-

support seekingsupport seeking Decreased avoidanceDecreased avoidance

Medication OnlyMedication Only IncreasedIncreased post-post-

traumatic stresstraumatic stress scoresscores

Increased social-Increased social-support seekingsupport seeking

Decreased avoidanceDecreased avoidance


Psychoeducation only groupPsychoeducation only groupNo significant differences were found in the coping No significant differences were found in the coping

strategies of this group in comparison with the strategies of this group in comparison with the previous groups. This is most likely due to the previous groups. This is most likely due to the

benefits of combined therapy to decrease anxiety benefits of combined therapy to decrease anxiety and enhance learning simultaneously.and enhance learning simultaneously.


Research limitations:Research limitations: Small sample group (only 51 participants)Small sample group (only 51 participants) All sample participants were military All sample participants were military

personnel, and their immediate family personnel, and their immediate family membersmembers

Sample participants had to be literate in Sample participants had to be literate in TurkishTurkish

Results were based upon patient self-Results were based upon patient self-reportreport

Peplau’s theory and how it pertains to Peplau’s theory and how it pertains to this research study:this research study:

Peplau believed that a patient’s good health is Peplau believed that a patient’s good health is directly correlated to a reduction in anxiety. The directly correlated to a reduction in anxiety. The focus of PTSD treatment is also a reduction in focus of PTSD treatment is also a reduction in anxiety to enhance coping skills.anxiety to enhance coping skills.

Peplau’s model focuses on the nurse-patient Peplau’s model focuses on the nurse-patient relationship and the different roles undertaken by relationship and the different roles undertaken by the nurse. All of these were utilized within this the nurse. All of these were utilized within this research program.research program.

Peplau’s interaction process in the nurse-patient Peplau’s interaction process in the nurse-patient relationship comprised four distinct phases. relationship comprised four distinct phases. These phases were specifically used during the These phases were specifically used during the psychoeducation sessions of this study.psychoeducation sessions of this study.



Final ThoughtsFinal Thoughts Regarding Regarding Peplau’s Model & PTSD TreatmentPeplau’s Model & PTSD Treatment

Overall, the results of the study show Overall, the results of the study show that Peplau’s theory is appropriate that Peplau’s theory is appropriate for use by nurses treating patients for use by nurses treating patients experiencing anxiety and depressionexperiencing anxiety and depression



Final ThoughtsFinal Thoughts Regarding Regarding Peplau’s Model & PTSD TreatmentPeplau’s Model & PTSD Treatment

Combined treatment including medications and Combined treatment including medications and counseling as well as focusing on the patients’ counseling as well as focusing on the patients’ needs contribute to more positive outcomes when needs contribute to more positive outcomes when treating PTSD.treating PTSD.

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



Use of Peplau’s Use of Peplau’s Interpersonal Relations Interpersonal Relations

Model to Counsel People Model to Counsel People with AIDSwith AIDS

Paul-Andre Paul-Andre Guathier, RN, TCC, Guathier, RN, TCC, CNS, DMD, MNCNS, DMD, MN

ObjectiveObjective ““The Purposes of this The Purposes of this

research were to research were to provide an example of provide an example of the development of a the development of a nursing approach by nursing approach by the use of Peplau’s the use of Peplau’s interpersonal relations interpersonal relations model and to gain a model and to gain a greater understanding greater understanding of life-and-death issues of life-and-death issues raised by men and raised by men and women with HIV and women with HIV and AIDS.”AIDS.”

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

Study Design Study Design

““A qualitative analysis of a man with A qualitative analysis of a man with AIDS was completed by use of AIDS was completed by use of Peplau’s model.”Peplau’s model.”

Patient studied was a male in his Patient studied was a male in his early 30’s with diagnosis of AIDSearly 30’s with diagnosis of AIDS

Study was conducted during multiple Study was conducted during multiple encounters with the patient and encounters with the patient and nursenurse


ResultsResults “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.

Nurses can assist clients in discussing their concerns regarding death.

Nurses can create trusting relationships with clients and understand various issues facing the clients and the interaction process involved.

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.”

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

How Peplau’s theory framed How Peplau’s theory framed ResearchResearch

“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. Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. Journal of the American Psychiatric Nurses Journal of the American Psychiatric Nurses AssociationAssociation. 6 (4) p.119-125. Retrieved November 14 from . 6 (4) p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p. 124 p. 124

Peplau’s phases that guide Peplau’s phases that guide NursesNurses

Orientation Phase-Orientation Phase-– As stated in Gauthier, Gauthier, “During the first phase, nurses

explain 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).”

Identification Phase-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.”

Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. Journal of the American Psychiatric Journal of the American Psychiatric Nurses AssociationNurses Association. 6 (4) p.119-125. Retrieved November 14 from . 6 (4) p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p. 120 p. 120

Peplau’s phases that guide Peplau’s phases that guide NursesNurses

Working Phase-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 the therapeutic process.”

Termination Phase-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.”


Limitations of StudyLimitations of Study

Only one patient used in studyOnly one patient used in study– Large margin for errorLarge margin for error

No direct input from patient on how No direct input from patient on how study effected himstudy effected him– All input was from nursing point of view All input was from nursing point of view

and observationand observation

Implications for Practice Implications for Practice ““Peplau’s model is useful because it provides an Peplau’s model is useful because it provides an

interpersonal process that facilitates the interpersonal process that facilitates the establishment of meaningful interactions with establishment of meaningful interactions with clients.”clients.”

““Persons affected by AIDS need a guide and Persons affected by AIDS need a guide and facilitator to help them move toward a more facilitator to help them move toward a more meaningful life.” meaningful life.”

““Frank discussions connected to client concerns are Frank discussions connected to client concerns are always relevant.”always relevant.”

““Nurses can help clients face their problems, explore Nurses can help clients face their problems, explore their options and determine possible solutions”their options and determine possible solutions”

As stated in Gauthier, Peplau (1952/1988) explains As stated in Gauthier, Peplau (1952/1988) explains that “exploring goals and making plans together that “exploring goals and making plans together helps clients strengthen their relationships with helps clients strengthen their relationships with others and thus keep their anxiety to a minimum”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. Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. Journal of the American Psychiatric Journal of the American Psychiatric NursesAssociationNursesAssociation. 6 (4) p.119-125. Retrieved November 14 from . 6 (4) p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p. 124 p. 124

Critical ReflectionsCritical Reflections

Peplau’s Theory of Interpersonal Peplau’s Theory of Interpersonal Relations can be used to create a Relations can be used to create a trusting, therapeutic working trusting, therapeutic working relationship with all patients relationship with all patients regardless of their diagnosis. regardless of their diagnosis.

Nurses can help patients create an Nurses can help patients create an anxiety free atmosphere which is anxiety free atmosphere which is essential to having positive essential to having positive outcomes outcomes

Depressive Symptom Depressive Symptom ReversalReversal

for Women in a Primary for Women in a Primary Care Setting:Care Setting:A Pilot StudyA Pilot Study Linda S. BeeberLinda S. Beeber

– Syracuse University Syracuse University College of Nursing, College of Nursing, Syracuse, NY, USA Syracuse, NY, USA

Melissa L. CharlieMelissa L. Charlie– University of University of

Pennsylvania School Pennsylvania School of Nursing, of Nursing, Philadelphia, PA, Philadelphia, PA, USA USA

According to According to Beeber, Peplau Beeber, Peplau said, “depressive said, “depressive symptoms are the symptoms are the result of changes in result of changes in the self and the self and relations relations developed to developed to manage anxiety”manage anxiety”

Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Archives of Psychatric Nursing.Psychatric Nursing. 12(5), p. 247-254. Retrieved November 14, 2009 from 12(5), p. 247-254. Retrieved November 14, 2009 from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail? http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=6&hid=106&sid=078477e6-efc7-4604-944c-16ea140134ea%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3dvid=6&hid=106&sid=078477e6-efc7-4604-944c-16ea140134ea%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=cin20&AN=1999001459 doi:10.1016/S0883-9417(98)800034-4 %3d#db=cin20&AN=1999001459 doi:10.1016/S0883-9417(98)800034-4

ObjectivesObjectives Discover if women with depressive Discover if women with depressive

symptoms could be identifiedsymptoms could be identified Determine if women would participate in a Determine if women would participate in a

theoretically driven intervention delivered theoretically driven intervention delivered by a Psychiatric Mental Health Advanced by a Psychiatric Mental Health Advanced Practice Nurse (PMH-APN)Practice Nurse (PMH-APN)

Establish whether measures of the concepts Establish whether measures of the concepts in the theory were sensitive to outcomes in the theory were sensitive to outcomes proposed to occur as a result of the proposed to occur as a result of the interventionintervention

The intervention focused on women The intervention focused on women because women are twice as vulnerable as because women are twice as vulnerable as men to depressionmen to depression

Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Archives of Psychatric Nursing.Nursing. 12(5), p. 247-254. Retrieved November 14, 2009 from 12(5), p. 247-254. Retrieved November 14, 2009 from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail? http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=6&hid=106&sid=078477e6-efc7-4604-944c-16ea140134ea%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3dvid=6&hid=106&sid=078477e6-efc7-4604-944c-16ea140134ea%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=cin20&AN=1999001459 doi:10.1016/S0883-9417(98)800034-4 p.248%3d#db=cin20&AN=1999001459 doi:10.1016/S0883-9417(98)800034-4 p.248

SelectionSelection

33 women were chosen for the study33 women were chosen for the study Screened and referred by primary Screened and referred by primary

care nurses, nurse practitioners, and care nurses, nurse practitioners, and physiciansphysicians

The women were then screened for The women were then screened for depressive symptoms with the Beck depressive symptoms with the Beck Depression Inventory (BDI) (Beck, Depression Inventory (BDI) (Beck, Steer, & Garbin, 1988). Women Steer, & Garbin, 1988). Women scoring 10 or higher on the BDI were scoring 10 or higher on the BDI were offered the intervention.offered the intervention.

Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Archives of Psychatric Nursing.Nursing. 12(5), p. 247-254. Retrieved November 14, 2009 from 12(5), p. 247-254. Retrieved November 14, 2009 from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail? http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=6&hid=106&sid=078477e6-efc7-4604-944c-16ea140134ea%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3dvid=6&hid=106&sid=078477e6-efc7-4604-944c-16ea140134ea%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=cin20&AN=1999001459 doi:10.1016/S0883-9417(98)800034-4 p. 249%3d#db=cin20&AN=1999001459 doi:10.1016/S0883-9417(98)800034-4 p. 249

MethodMethod The participants were diagnosed with depression The participants were diagnosed with depression

and met with a PMH-APN who provided and met with a PMH-APN who provided interventions based on Peplau’s Theory of interventions based on Peplau’s Theory of Interpersonal Relations. Some of these Interpersonal Relations. Some of these interventions included:interventions included:– Establish a therapeutic relationshipEstablish a therapeutic relationship– Assess life transitionsAssess life transitions– Investigate the role of depressive symptoms in the Investigate the role of depressive symptoms in the

management of anxietymanagement of anxiety– Understand depressive symptoms in the context of self Understand depressive symptoms in the context of self

and relationsand relations– Help patient to manage anxiety differentlyHelp patient to manage anxiety differently– Assist patient to take charge of the sources of anxietyAssist patient to take charge of the sources of anxiety– Help patient to improve health practicesHelp 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. Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Archives of Psychatric Nursing.Nursing. 12(5), p. 247-254. Retrieved November 14, 2009 from 12(5), p. 247-254. Retrieved November 14, 2009 from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail? http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=6&hid=106&sid=078477e6-efc7-4604-944c-16ea140134ea%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3dvid=6&hid=106&sid=078477e6-efc7-4604-944c-16ea140134ea%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=cin20&AN=1999001459 doi:10.1016/S0883-9417(98)800034-4 %3d#db=cin20&AN=1999001459 doi:10.1016/S0883-9417(98)800034-4

ResultsResults It was found that depressive symptoms It was found that depressive symptoms

significantly decreased following intervention, but significantly decreased following intervention, but only when performance self esteem levels only when performance self esteem levels increased.increased.

Social self esteem and satisfaction in interpersonal Social self esteem and satisfaction in interpersonal relations did not significantly increase.relations did not significantly increase.

The results seem to indicate that the coping skills The results seem to indicate that the coping skills learned by the participants have boosted their learned by the participants have boosted their performance self esteem and decreased their performance self esteem and decreased their depressive symptoms.depressive symptoms.

It was also determined that patients are receptive It was also determined that patients are receptive to depression screening and interventions to depression screening and interventions performed by a PMH-APN. “Their exit interviews performed by a PMH-APN. “Their exit interviews indicated a high degree of satisfaction”indicated a high degree of satisfaction”


Critique of the ResearchCritique of the Research

Research StrengthResearch Strength– Acceptance of PMH-APN Acceptance of PMH-APN

by Health Care Team & by Health Care Team & patientspatients

– Use of Peplau’s Theory Use of Peplau’s Theory of Interpersonal of Interpersonal RelationsRelations

– Interventions based on 2 Interventions based on 2 previous studiesprevious studies

– Multi-cultural groupMulti-cultural group– Decrease in depression Decrease in depression

symptoms and physical symptoms and physical symptoms in most symptoms in most participantsparticipants


Critique of the ResearchCritique of the Research

Research WeaknessResearch Weakness– Only women (18 to Only women (18 to

35 years of age)35 years of age)– No controlNo control– No randomizationNo randomization– Small group (33 Small group (33

participants)participants)– Some measurement Some measurement

tools used showed tools used showed insufficient insufficient sensitivitysensitivity


Implications for PracticeImplications for Practice The consultant role of the PMH-APN in a primary health The consultant role of the PMH-APN in a primary health

setting would result in early intervention for patients with setting would result in early intervention for patients with depressive symptoms. These patients often seek care for depressive symptoms. These patients often seek care for vague physical symptoms that require numerous, costly vague physical symptoms that require numerous, costly visits and testing to determine the cause. When depressive visits and testing to determine the cause. When depressive symptoms are addressed at an early stage, it results in symptoms are addressed at an early stage, it results in considerable cost savings. This study verified the value of considerable cost savings. This study verified the value of advance practice nursing.advance practice nursing.

When establishing a therapeutic relationship with patients, When establishing a therapeutic relationship with patients, it is important to look for depressive symptoms and share it is important to look for depressive symptoms and share that information with other members of their health care that information with other members of their health care team. Many individuals suffer from untreated depression. team. Many individuals suffer from untreated depression. It often isn’t discovered and acted on until they come to a It often isn’t discovered and acted on until they come to a primary health setting with a physical complaint.primary health setting with a physical complaint.

This study supplied useful information for the discovery and This study supplied useful information for the discovery and treatment of depressive symptoms. treatment of depressive symptoms.


Final ThoughtFinal Thought As nurses, we strive to provide care that is evidence based and As nurses, we strive to provide care that is evidence based and

constantly improving. Nursing education and practice are based on constantly improving. Nursing education and practice are based on theories that have proven successful. An unproven theory will find no theories that have proven successful. An unproven theory will find no support until it has been proved to be true through numerous research support until it has been proved to be true through numerous research studies. Nurses need to always look for ways to improve patient care. 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 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 the effective, it must be researched. A good nurse is always aware of the theory behind work performed and evaluating the result.theory behind work performed and evaluating the result.

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a Primary Care Setting: A Pilot Study. a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing.Archives of Psychatric Nursing. 12(5), 12(5), p. 247-254. Retrieved November 14, 2009 from p. 247-254. Retrieved November 14, 2009 from http://0- http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=6&hid=106&sid=078477e6-efc7-4604-944c-16ea140134eavid=6&hid=106&sid=078477e6-efc7-4604-944c-16ea140134ea%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#db=cin20&AN=1999001459 doi:10.1016/S0883-9417(98)800034-4 %3d#db=cin20&AN=1999001459 doi:10.1016/S0883-9417(98)800034-4

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