The nursing theories of Jean Watson and Hildegarde Peplau.
Concept Synthesis on Nursing Philosophy
Concept Synthesis on Nursing Philosophy
Introduction
In the nursing community, communication is an essential part which should be taken seriously. Nurses are the main medical personnel who interact with patients in hospital. Most patients feel closer and calmer around than any other person including doctors. This, therefore, should be used so as to ensure the comfort and quick recovery of patients. However, how will they ensure this without proper communication skills? This is why the statement below is of much importance. The nurses need to learn effective communication skills so as to ensure the wellbeing of patients.
The nurse theorists who have tried to come up with ways to improve nurse patient relationships by creating theories for nursing are many. In this paper, the focus will be specifically on Jean Watson and Hildegard Peplau. The theories of these two people are mainly focused on communication in nursing which is also the key factor in nursing (Fitzpatrick & Whall, 2005). Although the theories of Watson and Peplau are about the same issue, their explanations are somewhat contradicting. Their definitions of communication are different, and within each of their theories it has a different focus. This contradiction however does not mean that one of them is wrong instead it actually offers more light as one person simply cannot have it all right. If all the best points are picked from each of these theories, a new stronger theory will be developed.
Jean Watson’s Theory of Transpersonal Caring
Jean Watson’s theory of transpersonal caring is also commonly known as the theory of human caring. It was developed in 1979. Over the years, this theory has evolved, however its base remains untouched. This theory basically puts more emphasis on the humanistic aspects of nursing in combination with scientific knowledge. This theorist designed this specific theory so as to bring more meaning to nursing as a distinct health profession. According to Watson, “caring” is considered as an endorsement of the identity of professional nurses. She also believes that caring is the medicines identity. A Florence Nightingale once appeared to agree with Watson in her statement whereby she claimed that a surgeon only saves the patients life, but the nurse helps the patient to live.
The nurse’s role, according to Watson is not to specifically offer drugs in the hospital (Fitzpatrick & Whall, 2005). Instead in a medical setting, the nurse is expected to establish a caring relationship with all her patients. The nurse is supposed to treat each patient as a holistic being, in body, mind and spirit. Some issues should not be discussed with patients, however if a patient brings up a topic, the nurse should engage in a conversation which is positive at all times. They should encourage the patient whenever they talk. Whenever a patient is hospitalized and placed in the care of a nurse, the specific individual is expected to be treated well via display of unconditional acceptance and also in a positive regard. The nurse is not only expected to use her knowledge on drug administration, but also to promote the health of a patient by intervention (Taylor & Carol, 2001). This means that whenever the patient is willing to open up, the nurse should spare time to listen for a little while and offer her opinion as well. During the time spent with the nurse, the patient should be offered caring moments whereby the nurse is not supposed to interrupt such moments.
According to Watson, such “caring moments” can be described in various ways. First, no matter how bad the health condition of the patient is, the nurse should at least make some contact with the patient (Fitzpatrick & Whall, 2005). Second, the moment a nurse enters the patient’s room, a feelings of expectation are created naturally. Through the nurse’s attitude and competence, a patient’s world may become larger or smaller, brighter or dull, threatening or secure. If a nurse portrays an attitude which is not encouraging, for example when they act as if the patient’s situation is hopeless, the patients’ world becomes hopeless too. On the other hand, when a nurse portrays an attitude of hope to her patients, the patient’s spirit is also lifted such that they become hopeful. These feelings are usually influenced by the way a nurse acts towards the patient and also towards life. Patients are usually linked to nurses in a special bond which seems to affect their views of life (Taylor & Carol, 2001). In most cases, the nurse may be the last person a patient asks for so as to deliver their death wish. This is why the patient needs to communicate effectively and positively to patients so as to help them live by enabling them to visualize the world in a totally different way (Fitzpatrick & Whall, 2005). This should not matter even when the patient is suffering from a chronic illness and will pass away soon. The nurse should still continue to support the patient’s view of life by ensuring they stay positive to the last minute.
Hildegard Peplau’s Theory of Interpersonal Relations
The theory of Hildegard Peplau was influenced by Harry Stack Sullivan’s theory of inter personal relations. The theorist on the other hand was influenced by Percival Symonds, Abraham Maslow’s and Neal Elger Miller. Hildegard Peplau’s theory of Interpersonal Relations is also known as psychodynamic nursing, which refers to the understanding of someone’s own behavior. Peplau’s theory states that the main purpose of nursing is to help other people identify their felt difficulties (Wills & McEwen, 2002). At times, patients find themselves in a state of self-pity or self-denial which often results to depression and poor state of health. Once a nurse has enabled the patient to identify the difficulties, proper help may be sort. However in most cases, simple communication is the key. According to Peplau, a nurse should apply principles of human relations to the difficulties identified at any time (Wills & McEwen, 2002). This means that the nurse should act as a fellow human and practically relate to the patients situation before giving any opinions as what the nurse communicates to the patient may make a difference if the patient will get better or worse (Meleis, 1997). Peplau’s theory explains the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process. Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care (Wills & McEwen, 2002).
Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal. The attainment of goal is achieved through the use of a series of steps following a series of pattern. The nurse and patient work together so both become mature and knowledgeable in the process (Meleis, 1997).
The interpersonal process occurs in three phases: orientation, working, and termination (Meleis, 1997). In the orientation phase, the client seeks help, and the nurse assists the client to understand the problem and the extent of the need for help. In the identification phase, the client assumes a posture of dependence, interdependence, or independence in relation to the nurse. In the exploitation phase, the client derives full value from what the nurse offers through the relationship (Wills & McEwen, 2002). The client uses available services on the basis of self-interest and needs. Power shifts from the nurse to the client. To utilize this theory in the nursing practice, the nurse recognizes that the client move from one phase of dependence to independence during the nurse-patient interaction for the provision of health care.
Communication is central to the nursing theories developed by Jean Watson and Hildegard Peplau, however, communication is defined differently and has a different focus within each theory (Meleis, 1997). According to Peplau “Clear and supportive communication is a key tool in nursing…Language is attributed major importance in Peplau’s theory because it influences the person’s thinking, which influences actions. Therapeutic talking with patients helps them to learn from their dysfunctional thinking patterns and develop cognitive perspectives that influence productive behaviors”, (Fitzpatrick, & Whall, 2005).
Peplau focuses more on the verbal aspects of communication in the relationship between nurse and patient, using the nurse as a moving force, as a mode to help the patient heal and overcome illness or negative patterns of behavior. Communication in Peplau’s view, assists in the creation of a therapeutic environment with a focus on the patient who is having psychiatric problems (Taylor & Carol, 2001).
Jean Watson describes communication and language between the nurse and patient as phenomenon that occurs on a more spiritual level versus just a verbal occurrence or commonplace event (Fitzpatrick, & Whall, 2005). Spiritual connectivity as a mode of communicating is not focused on any specific group of patients as Peplau’s theory is. The communication that occurs beyond the physical realm allows the patient to feel supported and to take the lead in the relationship between the nurse and the patient. “The moment of coming together presents them with the opportunity to decide how to be in the moment, in the relationship—what to do with and in the moment If the caring moment is transpersonal, each feels a connection with the other at the spirit level, thus it transcends time and space, opening up new possibilities for healing and human connection at a deeper level than physical interaction”, (Fitzpatrick, & Whall, 2005).The patient and nurse both allow themselves to be present, spiritually, to one another which is a direct link to the therapeutic environment that helps the patient to heal.
Peplau and Watson also have different perspectives on the definition of what nursing is. Peplau discusses a more practical definition of nursing via the use of the scientific method, research, as well as nursing assessment as a means of helping a patient to heal. Watson’s approach is one that uses the concept of “care” at the center of her definition of nursing and nursing care, placing the nurse in a position of being central to the patient’s care team. The concept of caring, is what guides the nurse in helping a patient to heal. “The nurse in essence becomes a “sacred architect” who is critical to the healing process”, (Fitzpatrick, & Whall, 2005).
Jean Watson and Hildegard Peplau present differing views on nursing and the use of specific forms of communication within the interactions that take place between nurse and patient (Potter & Perry, 1992). A common thread exists in that each theorist provides easy ways to incorporate communication into the development of the patient environment as a way to promote the healing process.
Both are sequential and focus on therapeutic relationship. Both use problem solving techniques for the nurse and patient to collaborate on, with the end purpose of meeting the patient’s needs (Potter & Perry, 1992). Both use observation communication and recording as basic tools utilized by nursing. Communication in nursing profession can be a complicated process, and the possibility of sending or receiving incorrect messages frequently exists. It is essential that we know the key components of the communication process, how to improve our skills, and the potential problems that exist with errors in communication (Potter & Perry, 1992).
Successful communication has three major components: a sender, a receiver, and a message (Özkan, Okumus, Buldukoglu & Watson, 2013). In nursing practice, we frequently have a great deal of information to send to others in a short period of time. To do this effectively, we need to know that there are factors which could influence how our message is interpreted. We must consider the setting in which the communication occurs, the past experiences and personal perceptions of both the sender and receiver, the timing of the message. Breakdown in communication can cause negative outcomes. We all know how important it is to give a thorough patient report to the oncoming nurse at shift change. In situations where this does not occur and important information is not conveyed, treatments, medications, may be missed.
The importance of communication in health care hit the headlines recently at the British Medical Association’s annual consultants’ conference earlier this month. Jargon, said the doctors, could harm patients’ care (Özkan, Okumus, Buldukoglu & Watson, 2013).
The following anecdote from my own experience illustrates the dangers of poor communication:
John*, a man in his 30s, is in bed on a coronary surgery ward. Older men occupy the other beds. It is Christmas Day. The nurses are having a party; their office door opens in snaps of laughter. The man in the bed next to him has no visitors. John wonders if he’d like to play cards, but the nurses have not offered to play. John’s mouth has been fixed in a tight line since his family came bearing presents; he cannot smile for fear of crying. He holds a morphine pump in one hand, and the phone in the other. The nurse in charge has not succeeded in persuading the doctor to come, so John is trying himself. The man opposite is calling out, but the nurses avoid him, and when John points out that he wants someone, nurse replies: ‘He’s just demented.’
Ineffective handoff communication presents a critical threat to patient safety. An estimated 80% of serious medical errors involve miscommunication during handoffs and transfers. These errors can lead to patient harm and increased costs. To help prevent such problems, The Joint Commission Center for Transforming Healthcare has released a new handoff communications tool.
The Targeted Solutions Tool™ (TST™) measures the effectiveness of handoffs conducted either from one department to another within the same facility or from one facility to another. More importantly, the tool provides proven solutions. During the Handoff Communications Project that developed the tool, organizations that used TST™ reaped many benefits (Özkan, Okumus, Buldukoglu & Watson, 2013). They reported:
• increased satisfaction for patients, families, and staff members
• a reduction of 52.3% in problematic handoffs
• reduced patient readmissions by up to 50%
• reduced time to move patients from the emergency department to the inpatient unit.
Interestingly, the organizations that used the TST™ had to make only minor changes in the roles and responsibilities of existing staff to gain the benefits that the tool offers.
Studying Handoff Problems
The Joint Commission Center for Transforming Healthcare was well aware of the problems that can result from ineffective handoffs, which include:
• delayed or inappropriate treatment
• adverse events
• omission of care
• increased length of hospital stay
• avoidable readmissions
• increased costs
• inefficiency from rework.
To develop the right tool to address these problems, the Center studied patient transfers in 10 hospitals. The study found that expectations related to handoffs differed significantly between senders (caregivers who transmit patient data and transfer care) and receivers (caregivers who accept patient data and care). By using the TST™, senders and receivers had better matched expectations, developed a successful handoff process, and had more effective communications and relationships (Özkan, Okumus, Buldukoglu & Watson, 2013). These organizations found that the TST™:
• aided in examining existing handoff communications from both the sender and receiver viewpoints.
• accurately measured data for improving the existing handoff communications.
• pinpointed areas for improvement, such as the need for different types of information in different handoff settings.
• provided customizable forms for data collection
• offered guidelines for determining the most appropriate, realistic handoff communication process for each type of transfer.
Solving Handoff Problems with SHARE
The Center and the 10 hospitals that participated in the study developed handoff communications solutions based on the acronym SHARE. Each letter in the acronym addresses a specific area that is key to a successful handoff. Here are the SHARE elements with a few examples:
S = Standardize critical content
• Give the receiver details of the patient’s history.
• Emphasize key patient data for the receiver.
• Synthesize patient data from different sources before sharing it.
H = Hardwire within your system
• Develop standardized forms, tools, and methods, such as checklists.
• Work in a quiet space that’s conducive to sharing patient information.
• State expectations about conducting a successful transfer.
• Identify technologies to help make handoffs successful.
A = Allow opportunities to ask questions
• Use critical thinking skills when discussing a patient.
• Share and receive information as an interdisciplinary team.
• Expect to get all key patient data from the sender.
• Exchange contact information in case questions arise later.
• Scrutinize data and question it, if needed.
R = Reinforce quality and measurement
• Demonstrate leadership’s commitment to successful handoffs.
• Hold staff members accountable for managing the patient’s care.
• Monitor compliance with standardized handoff tools and processes.
• Use data in a systematic approach to improvement.
E = Educate and coach
• Teach staff members what makes a successful handoff.
• Standardize training on performing handoffs.
• Give staff members real-time feedback and just-in-time training.
• Make successful handoffs a priority.
Conclusion
In conclusion, communication is an essential part of the human health especially for patients. Coming up with tools to effect communication among patients and nurses is among the ways through which a hospital may enhance communication and improve the health of individuals.
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