In Peplau’s (1952/1991/1997) theory, nursing is defined as an interpersonal, therapeutic process that takes place when professionals, specifically educated to be nurses, engage in therapeutic relationships with people who are in need of health services. Peplau theorized that nurse-patient relationships must pass through three phases in order to be successful: (a) orientation, (b) working, and (c) termination. Theory of Interpersonal Relations
During the brief orientation phase, hospitalized patients realize they need help and attempt to adjust to their current (and often new) experiences. Simultaneously, nurses meet patients and gain essential information about them as people with unique needs and priorities (Peplau, 1997). Among the many roles that nurses assume in their interactions with patients, the first role during the orientation phase is that of stranger. Initially, nurses are expected to greet patients with the “respect and positive interest accorded a stranger” (Peplau, 1952/1991, p. 44). Patients and nurses quickly pass through this phase and nurses must continue to display courtesy and respect throughout the three phases. Given that characteristics of the orientation phase are continued in the other two phases; in the current study, the orientation phase was not initially hypothesized to be a latent factor.
The next phase is the working phase, which accounts for the majority of nurses’ time with patients. In this phase, nurses make assessments about patients to use during teaching and when contributing to the interdisciplinary plan of care (Peplau, 1952/1991/1997). During the working phase, the roles of nurses become more familiar to patients; they begin to accept nurses as health educators, resource persons, counselors, and care providers. Nurses practice “nondirective listening” to facilitate patients’ increased awareness of their feelings regarding their changing health (Peplau, 1952/1991, p. 43). Using this therapeutic form of communication, nurses provide reflective and nonjudgmental feedback to patients for the sake of helping them clarify their thoughts. In this study, the working phase was operationalized by measuring the ratings on HCAHPS Items 1, 2, 3, 4, 8, 9, 11, 13, 14, 16, and 17. Theory of Interpersonal Relations
Path Diagram of 16 HCAHPS Items That Correspond to Peplau’s Phases.
The final phase is the termination phase, which is more commonly thought of as discharge planning. The success of the termination phase is dependent on how well patients and nurses navigated the orientation and working phases. A major part of the termination phase occurs when nurses teach patients about symptom management and recovery at home. In this study, the termination phase was operationalized by measuring the ratings on HCAHPS Items 19, 20, 23, 24, and 25. Theory of Interpersonal Relations.
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