Chapter 12Theories Focused on Interpersonal

Relationships

Introduction• Interpersonal theory posits that anxiety arises

from relationships with significant others.• Interpersonal theory in health care grew from

psychiatric research that attributed mental illness to social-cultural factors.

• Health-related theories focus on humans as social beings that require support and nurturance from their environment.

Sign of the Times: 1800s to 1970s

• Early nursing theorist concentrated on the difference between nursing knowledge and medical knowledge.

• During the 1950s, conceptual frameworks in nursing were developed base on other areas.

• The psychiatric care movement and psychotropic drug development in the 1960s and 1970s led to nursing theory focused on interpersonal communication.

Peplau: Theory of Interpersonal Relations in Nursing (1 of 2)

• Peplau posited that nurses serve as nurse-therapists and function in a counseling role.

• Focused on the idea that nurse-patient relationships have a starting point, proceed through definable phases, and have an end point.

• Utilized personality development tasks associated with stages of personality described by Freud and Sullivan.

Peplau: Theory of Interpersonal Relations in Nursing (2 of 2)

• Divided relationship development into four phases:– Preorientation– Orientation– Working– Resolution

• Important to nursing because it emphasized the relationship between therapeutic use of self and patient well-being in the treatment milieu.

Orlando: Nursing Process Theory (1 of 2)

• Orlando posited that nursing be governed by patient needs rather than organizational rules.

• Liked effective care to the nurse’s knowledge of patient needs validated by patient response.

• Suggested that nursing practice is circular and reflexive, not linear like the processes taught in nursing education.

Orlando: Nursing Process Theory (2 of 2)

• Proposed three components of nursing:– Patient behavior– Nurse reaction– Nursing action appropriate to patient need

• Delineated automatic (dictated) and deliberative (decision-based) nursing processes.

• Important to nursing because it focused on the whole patient and improved nurses’ decision-making skills.

Travelbee: Human-to-Human Relationship Model (1 of 2)

• Travelbee posited that caring is the basic goal of nursing and involved helping individuals, families, and communities cope with and find meaning in illness.

• Promoted understanding and acknowledgement of the uniqueness of patients.

• Introduced the concept of hope for patients with mental and long-term illnesses.

Travelbee: Human-to-Human Relationship Model (2 of 2)

• Promoted five stages of care relationships:– Original encounter– Emerging identities– Developing feelings of empathy– Developing feelings of sympathy– Rapport

• Important to nursing because it defined areas of concern for mental health nurses and advanced the hospice movement.

Sign of the Times: 1970s to Present

• During the 1970s and 1980s, human interaction in health and wholeness became the focus of nursing theory.

• Change was reflected in education and theory based in modern and postmodern philosophies.

• Postmodern phenomenology added an experiential human element to modern exploration of empirical finding validity.

Paterson and Zderad: Humanistic Nursing Theory (1 of 2)

• Paterson and Zderad posited that understanding how people experience existence facilitates nursing.

• Proposed that nursing is an existential experience enhanced by phenomenological descriptions of experience.

• Coined the term “humanistic nursing” to highlight importance of the nurse’s existential awareness of self and others.

• Described nursing care as a call and response relationship.

• Conceptualized health as a process of becoming whatever is possible for the human being.

• Important to nursing because it focused on the process of interaction and dialogue between nurse and patient.

Paterson and Zderad: Humanistic Nursing Theory (2 of 2)

Watson: Transpersonal Care (1 of 2)

• Watson posited that curing is the domain of medicine and caring is the domain of nursing through the transpersonal care relationship.

• Based on a moral commitment to human dignity, wholeness, caring, and healing.

• Utilized “carative factors” in addition to kindness, concern, love of self and others, and the ecology of the earth.

Watson: Transpersonal Care (2 of 2)

• Promoted four components of care:– Affirmation of patient significance– Connection with the spirit of the patient– Unity with the patient’s state of being– Caring, healing modalities that potentiate comfort

and harmony• Important to nursing because it focuses on both

the physical body and the embodied spirit, both of which must be cared for in order for patients to achieve healing.

Newman: Theory of Health as Expanding Consciousness (1 of 2)

• Newman posited that expanding consciousness is essential for gaining a deeper appreciation of life and having meaningful relationships.

• Proposed that health is a synthesis of being well and being ill, and that these two states together reflect wholeness.

• Focused on the importance of the nurse-patient relationship in helping patients gain meaning from their evolving health patterns.

• Important to nursing because it calls for a shift in the nursing worldview from health and illness to transformation and pattern recognition.

Newman: Theory of Health as Expanding Consciousness (2 of 2)

Parse: Humanbecoming Theory (1 of 2)

• Parse posited that lived experiences and preferences influence healthcare choices.

• Focused on structuring meaning, configuring rhythmical patterns of relating, and cotranscending possibles.

• Proposed three health-related assumptions:– It is freely choosing personal meaning– It is configuring rhythmical patterns of relating– It is cotranscending limits with emerging

possibilities

• Emphasized a non-judgemental approach that reveres a patient’s expertise in knowing what is best for him or her within the nurse-patient relationship.

• Important to nursing because it focuses on quality of life as the articulator of the goal of nursing practice.

Parse: Humanbecoming Theory (2 of 2)

Non-Nursing Theories: Interpersonal Relations Theory

• Posits that personality is defined as behavior observable within interpersonal relationships.

• Socialization occurs throughout developmental stages and failure to proceed lays the foundation for maladaptive behavior.

• Unsatisfactory personal relationships are the primary cause of developmental progression.

• Harry Stack Sullivan was an adherent to the theory.

Humanistic Theory

• Posits that each person is a work in progress.• Focuses on the personal worth of the individual

and the essential role of human values.• Draws on humanistic philosophy and

psychology.• Carl Rogers was an adherent to the theory.

Existentialism and Phenomenology

• Posits that existence takes precedence over essence, that humans are free to act, and are responsible for their acts.

• Focuses on knowledge as the result of decision making.

• Points to creativity, initiative, ad self-fulfillment as important personality factors

• Victor Frankl and Rollo May were adherents to the theory.

Positive Psychology

• Posits that people want more than an end to suffering and seek to lead meaningful lives.

• Aims to move psychology away from the preoccupation with repairing the worst in life toward building positive qualities.

• Proposes that positive experiences, positive individual traits, and positive institutions are the three central concerns for psychology.

Positive Psychology: Seligman

• Posits that happiness could be analyzed into three different elements that one chooses for their own sake: positive emotion, engagement, and meaning.

• Five crucial elements of well-being: PERMA– Positive Emotion– Engagement– Relationships– Meaning– Accomplishment

Transpersonal Psychology

• Posits that spiritual self-development, peak experiences, mystical experiences, systemic trance, and other occult experiences of living help humanity reach its highest potential.

• Stems from psychoanalysis, behaviorism, and humanistic psychology.

• Seeks to describe and integrate mystic experiences with modern psychological theory.

Recovery-Oriented Care Systems (1 of 2)

• Recovery-oriented care has become central to SAMHSA’s and CSAT’s misisons.

• Recovery indicates a normal adaptation process of healing, improvement, or mending, to mention a few meanings.

• Redefined to: a process of personal discovery, of how to live (and to live well) with enduring symptoms and vulnerabilities.

• SAMSHA’s Working Definition of Recovery from Mental Disorders and/or Substance Use Disorders provides a working definition of recovery, and set of recovery principles.

• Elements of Recovery-Oriented Care:– Encourage individuality– Promote accurate portrayals/ fight discrimination– Focus on strengths– Use language of hope– Variety of treatment options– Supports risk taking, even when failure is possible– Actively involve service users and family– Encourage participation– Help develop connections with communities– Help people develop valued social roles/ activities

Recovery-Oriented Care Systems (2 of 2)

Back to the Future

• Nursing has shifted from a focus on medical knowledge to a focus on nurse-patient relationships to a focus on existentialism.

• We have shifted from positivism to postmodernism and increasingly to neomodernism.

• Opportunities for healthcare system growth found in recovery-oriented and trauma-informed care seem poised to foster new directions in nursing care and national wellbeing.

Summary

• Interpersonal theory in nursing has undergone many changes over the years and sought to emphasize the importance of the individual patient in practice.

• Nursing theories build upon theories of other fields and one another to promote patient-focused care.

• Philosophical shifts in the discipline have also played key roles in theoretical change.