Development of Psychiatric Nursing Theories

Nursing Theorists

Nursing has changed drastically over the years from the beginning when Florence Nightingale began the basics of proper care. Nursing theory is the practice of using research and evidence-based practice to improve patient care and the working environment for the modern nurse. Nursing theory has shaped our profession by using practical nursing such as trial and error in an attempt to come up with Evidence Based practice procedures that will help with the quality of patient care.

There can be a gap between practical nursing and the nursing theorist. This can be based upon the verbiage that the nursing theorist used and the practical nurse not understanding the terminology used. There is also the old age adage of that you can’t teach an old dog new tricks. Nurses that have been nurses for years have their own way of doing things that have worked for them. These ways may not always be incorrect and could be seen as having their own evidence-based practice. (Saleh, 2018).

Psychiatric nursing seems to be one the most misunderstood types of nursing. It has been argued throughout history if nurses should even be considered part of mental health care for patients. In Barker’s article he states, “ I received requests, simultaneously, from colleagues in Spain and England to help them argue the case against the removal of nurses from specific mental health care settings (especially for people with ‘chronic mental illness’) and their replacement with ‘generic care workers” (Barker, 1998, p. 214). I chose Hildegard Peplau and Phil Barker as my nursing theorists. Both have made major contributions to the world of psychiatric nursing theory with techniques on understanding the mind and how to connect on a personal level with the patient to render meaningful care.

Hildegard Peplau was considered to be the “mother of psychiatry nursing”(Haber, 2000, p. 56). As time has changed Peplau’s theories of psychiatric nursing have stood the test of time. Many of theories are still in practice today. Peplau stated, “nursing can take as its unique focus the reactions of the patient or client to the circumstances of his illness or health problem” (Haber, 2000, p. 57). Her beliefs have stood the test of time and are still in practice and used by the ANA today. (Haber, 2000). Peplau believe that patients have specific problems and those problems must be identified in order to help with patient care. These problems would later be defined as “nursing diagnosis”(Haber, 2000, p. 57).  She believes that all nurses should further their education to the master levels and beyond to help them with the scope of practice they chose. (Haber, 2000). “Peplau cautioned clinical nurse specialists and nurse practitioners against making statutory or regulatory ‘deals with the devil’ that gave control over nursing practice to other profession.” (Haber, 2000, p. 58). I believe that Peplau was ahead of her time, in modern time we still see how hard it is for a DNP to get their journal published. Nurses have spent years fighting for their voices to be heard with things like evidence-based practice skills. Peplau based her theories on real world views and things she saw in her career. She believed that nurses needed to bond with client in order to understand their mental state and to help them recover. (Haber, 2000).

“Peplau’s contributions with her nursing theories have held fast through her time to modern times. “Peplau’s model for nursing are The seven Nursing roles: the stranger role, in which the nurse receives the patient the way a stranger is met in other situations, and provides an atmosphere to build trust, the resource role, in which the nurse answers questions, interprets data, and gives information; the teaching role, in which the nurse gives instructions and provides training; the counseling role, in which the nurse helps the patient understand the meaning of current circumstances, as well as provides guidance and encouragement in order for change to occur, the surrogate role, in which the nurse acts as an advocate on behalf of the patient; the active leadership role, in which the nurse helps the patient take responsibility for meeting treatment goals; and the technical expert role, in which the nurse provides physical care for the patient and operates equipment. (Nursing Theory, 2016, p. 2). Peplau’s concepts can still be used in modern day nursing as a way to form trust between the nurse and the psychiatric patients. The nurse is able to give the patient the resources they made need such as bipolar resources or referral to psychiatric services. Nurses are always an advocate for a patient but in some cases especially those with psych backgrounds, they may need extra support due to their mental state. Peplau’s concepts are able to survive in modern nursing due to her idea of providing support for the patient and create a rapport with them. As the world changes the nurse must change to stay relevant to and educate herself on the different cultures that are out there to maintain a relationship with the client and family (Haber, 2000).

In Phil Barker’s journal he noted that Peplau stated “…people with schizophrenia Perhaps, of equal significance to her consideration of how nurses might address the human responses associated with schizophrenia, was her assertion that nurses needed to emphasize ‘person hood’ of patients” (Barker, 1998, p. 217). Barker’s Tidal Model has similarities to Peplau’s theory. Barker bases his model on a religious basis stating that patients must be treated as a whole person. Barker believed that patients must be treated based on what their current experiences are. He compared life experiences to that of life being a ship. He believed that people go through calm periods and storms. Barker believed that you must treat each person individually in order to treat their specific problems (Barker, 2001).

“The values of the Tidal Model are revealed in the Ten Commitments:

1. Value the voice. That is, the patient’s story is paramount.

2. Respect the language, which means to let the patient use his or her own language.

3. Develop genuine curiosity or show interest in the patient’s story.

4. Become the apprentice to learn from the person being helped.

5. Reveal personal wisdom. Patients are experts in their own stories.

6. Be transparent. Nurses should model confidence by being transparent and helping                        make sure the patient always knows exactly what’s being done.

7. Use the available toolkit; the patient’s story contains valuable information as to what     what works and what doesn’t.

8. Craft the step beyond. That is, the patient and nurse work together to construct an       appreciation of what needs to be done in that moment.

9. Give the gift of time to foster change.

10. Know that change is constant” (Nursing Theory, 2016, p. 2).

Barker’s Tidal Model is consistent with interviewing the patient and coming up with a plan that suits the patient and fosters an open dialogue between the nurse and the patient which can help facilitate the healing process. “Peplau is proposing that everyone should be treated as individuals, emphasizing how people differ from one another” (Barker, 1998, p. 214). Even though Peplau and Barker were almost a century apart in their life spans and educational backgrounds there theories on psychiatric patient care were similar and to treat the patient as a whole. They both new that nurses were necessary to help with the care of the patient. Both these theorists are still relevant today and I believe their care theories will hold true for several more years to come.

References

• Barker, P. (1998, January 15). The future of the Theory of Interpersonal Relations? A personal reflection on Peplau’s legacy. Journal of Psychiatric and Mental Health Nursing, 5, 173-180. http://dx.doi.org/10.1016/S1078-3903(00)90021-1
• Barker, P. (2001, November 27). The Tidal Model: developing an empowering, person-centered approach to recovery within psychiatric and mental health nursing. Journal of Psychiatric and Mental Health Nursing, 8, 233-240. http://dx.doi.org/10.1046/j.1365-2850.2001.00391.x
• Haber, J. (2000). Hildegard E. Peplau: The Psychiatric Nursing Legacy of a Legend. Journal of the American Psychiatric Nursing Association, 6 No. 2, 56-62. http://dx.doi.org/https://doi.org/10.1016/S1078-3903(00)90021-1
• Nursing Theory. (2016). http://www.nursing-theory.org/nursing-theorists/Hildegard-Peplau.php
• Nursing Theory. (2016). http://www.nursing-theory.org/nursing-theorists/Phil-Barker.php
• Saleh, U. S. (2018, January 7). Theory guided practice in nursing. J Nurs Res Pract , 2(No. 1). Retrieved from https://www.pulsus.com/scholarly-articles/theory-guided-practice-in-nursing.pdf