Transcript Peplau’s Theory of Interpersonal Relations Research with

Peplau’s Theory of
Interpersonal Relations
Research with Patients
Experiencing Traumatic
Events
Presented by Group 3: Kimberly
Hargrove, Donna Johnson, Debra
Lenhart, Sheila Lucas
Ferris State University
Brief overview of Peplau’s
Theory of Interpersonal
Relations…
Theory focuses on interpersonal
communication:
First model to suggest that…
 Nurse and patient act as PARTNERS to
initiate change rather than patient
passively receiving treatment and nurse
simply acting on orders from physician.
Effective communication causes nurse
to take on numerous roles:
Stranger
 Resource
 Teacher
 Leader
 Surrogate
 Counselor
 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 Survivors of Sexual
Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:
http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p. 137
Continuum showing changing
nurse-patient relationships:
Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed., p. 55). St. Louis, MO: Mosby Elsevier.
Four phases of nurse-patient
relationship:
Orientation
 Identification
 Exploitation (or working)
 Termination

Phases and changing roles in
nurse-patient relationship:
Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed., p. 55). St. Louis, MO: Mosby Elsevier.
Theory is based upon
psychological models.
 Influences include
Freud, Maslow, and
Sullivan

Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed., p. 55). St. Louis, MO: Mosby Elsevier.
Peplau’s interpersonal theory
stated:

Psychobiological experiences lead to constructive
or destructive responses. Four experiences
include:
 Needs
 Frustrations
 Conflicts
 Anxieties
Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their work (6th ed., p. 55). St. Louis, MO: Mosby Elsevier.
Due to the psychobiological components, this
model is effective to study effects of and assist
nurses in dealing with patients that have
experienced traumatic events.
Rationale for use in Nursing
Practice
Opens individuals eyes to the hidden hurt of trauma
 Educates nurses not to pre-judge patient’s who have
been victims of traumatic events
 Reminds us that we are all vulnerable to traumatic events
 Articles give us tools to assist those in need
 Identifies coping mechanisms, strategies and
communication techniques
 Seeks to understand the underlying mental anguish to
multiple vague physical complaints
 Reasons to believe that there can be an ending to the
hidden hurt of trauma

Studies Researched

Peplau’s Theory of Interpersonal Relations
not only a nursing theory but also has
roots in the psychiatry. Most of the studies
that include this theory are based on
psychiatric nursing

In light of Peplau’s theory, we are looking
at studies done on counseling AIDS
patients, victims of sexual violence, the
value of psychoeducation for PTSD
patients, and the effectiveness of
counseling and medication on patients
experiencing depression
Hildegard Peplau's Theory and the
Health Care Encounters of
Survivors of Sexual Violence
Tamra J. Tourey
 Donna S. Martsolf
 Claire B. Draucker
 Karen B. Strickland.

Objective

According to Courey, “The purpose of this study
was to use Hildegard Peplau’s (1952)
conceptualization of nurses helping roles (i. e.,
stranger, resource person, teacher, leadership,
surrogate, counselor, technical expert) in nurse
client interactions to explore how survivors of
sexual violence perceive their encounters with
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 Survivors of Sexual
Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:
http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu
First…
Lets review nursing roles
according to Peplau’s theory
Peplau’s Theoretical Framework



Leadership Role
The nurse and patient work together to meet the same result of the
condition, the main objective of leadership role is to “help the patient
accept increased responsibility for the plan of care.”
Surrogate Role
Nurses provide a substitute for another who is close to the patient.
For example if the Patient’s family is unavailable, nurses would
demonstrate a surrogate role.
Counselor role
Nurses must provides secure, safe environment and to be thriving
must exhibit active listening, guidance, and support in this process of
self discovery, all the while the nurse must maintain professional
boundaries (Gastmans 1998 as found in 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 Survivors of Sexual
Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:
http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p. 137
Gastmans, C. (1998). Interpersonal relations in nursing: A philosophical-ethical analysis of the work of Hildegard E. Peplau. Journal of Advanced Nursing, 28,
1312-1319
Peplau’s Theoretical Framework




Technical expert role
Nurse demonstrates competency in technical skills (such as IV
pumps or blood pressure cuffs). This helps in building trust, hope,
and confidence in the patient-nurse relationship.
Resource Person Role
“Provides professional knowledge, the ability to deliver information in
a sensitive manner, and critical thinking skills needed to process the
client’s questions and offer a therapeutic response.”
Stranger Role
“Goal is to provide trust to build a solid patient-nurse
relationship with non-verbal and verbal communication.”
Teacher Role
Assisting client to obtain information and develop health and well
being in a healing relationship.
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. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:
http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p.137
Selection Process



30 men and 30 women were recruited in the parent study Ages
ranged from 18-62
Large diversity of participants:
– 50% African Americans
– 35% Caucasians
– 15% smaller biracial ethnic participants
– 58% single
– 12% married
– 8% divorced
– 5% separated
– 1 engaged
“All Participants lived in the greater Akron, Ohio, metropolitan area
who had experienced sexual violence at some point in their lives,
recruited via fliers placed in their communities, referrals from
community leaders, and 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 Survivors of Sexual
Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:
http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p. 138
Critique of Research


Assessed by two advanced practice psychiatric/mental health nurses
Assessor rated each participants encounter with healthcare
providers
– “When survivors of sexual violence describe their encounters
with health care professionals, do they describe roles performed
by professionals that are consistent with one or more of the
Peplau's helping roles?”
– “When survivors of sexual violence describe their encounters
with health care professionals, do they describe roles performed
by professionals that are not consistent with one or more of the
Peplau's helping roles?”
– “When survivors of sexual violence describe their encounters
with health care professionals who perform one of Peplau's
roles, what about these encounters do they perceive as helpful?”
– “When survivors of sexual violence describe their encounters
with health care professionals who perform one of Peplau’s
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 Survivors of Sexual
Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p.136(8). Retrieved November 14, 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
Results


Participants had either a positive or negative encounter with their
healthcare providers
Described encounters with health care professionals according to
Peplau’s helping roles as follows:
–
–
–
–
–
–

79-counselor
78- technical support
13-stranger
2-resource person
4-teacher
0-surrogate
Research revealed that the roles of counselor and technical support
were most important to the survivor of sexual 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 Survivors of Sexual
Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:
http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu
Implications for Practice
Nurses who facilitate insight by therapeutic
communication have helpful encounters with victims of
sexual violence.
“Hurtful encounters were most likely to occur when
health care professionals were insensitive or dismissed
the suffering caused by the violence. Although the need
for sensitive, compassionate care is probably universal to
all those who seek health care, it seems to be Particularly
important to survivors of sexual 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 Survivors of Sexual
Violence. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:
http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu p.142
Implications for personal
practice


As found in Courey, Physical complaints of survivors of sexual
violence include:
–
–
–
–
Headaches (Golding, 1999).
Pelvic pain (McCauley et al., 1997).
Gastrointestinal upset (Heitkemper et al., 2001).
Chronic malignant pain (Golberg & Goldstein, 2000).
–
–
–
–
Depression
Anxiety disorders
Post traumatic stress disorder
Substance abuse (Elliott, Mok, & Briere 2004; Koss, Figueredo, &
Prince, 2002; Saunders, Kilpatrick, Hanson, Resnick, & Walker,
1999).
Mental health complaints of survivors of sexual violence
include:
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. Journal of the American Psychiatric Nurses Association (JAPNA) , 14, 2. p.136(8). Retrieved November 14, 2009, from Academic OneFile via Gale:
http://0-find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroupName=lom_ferrissu
Critical Reflection



Only two of Peplau’s helping roles were most helpful during this
difficult time for patients who were victims of sexual violence.
– Counselor role–helps the victim understand the violence
and gain insight into their life situations.
– Technical support role- therapeutic communication which
helped manage symptoms related to the violence.
Nurses who take care of victims and use Peplau’s theory and
research of counselor roles and technical support roles to help
victims play a significant role in the healing process
Nurses help their patients to
– Explore the depth of the violence
– Grow and learn how to help others
– Recover faster
– Avoid post traumatic stress disorder
Effectiveness of psychoeducation
intervention on post-traumatic
disorder and coping styles of
earthquake survivors



Fahriye Oflaz, PhD, Asst. Prof.
Chief of Psychiatric Nursing
Dept.
Sevgi Hatipoglu, PhD, Dean of
School of Nursing
Hamdullah Aydin, MD, Former
Chief of Psychiatric Dept.
Gulhame Military Medical
Academy
Etlik, Ankara, Turkey
Peplau’s theory and PTSD
Research conducted in
Turkey following 1999
earthquakes
measuring 7.4 and 7.2
on the Richter scale
less than 3 months
apart
Objective
Study to show the effect
of psychoeducation
interventions on PTSD
symptoms and
associated coping
skills of earthquake
survivors.
Conducted from January to December 2000
at the Gulhane Military Medical Academy
in Ankara, Turkey.
Selection process:

Participants voluntarily requested treatment at the
medical center due to symptoms of PTSD.

169 patients were diagnosed with PTSD, only 68 fit the
criteria to participate in the study.

Of the 68 initially selected, 17 refused to be involved in
the research.
In the end, 51 survivors of the Marmara
earthquake were used as the sample in the
research.
Characteristics of 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
groups
Assessed by psychiatrists
 Diagnosis with PTSD and medications
determined
 Consent for participation
 Administration of questionnaires and group
assignment

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
Three study groups formed:



Psychoeducaton and medications (21
participants, 41.2%)
Medication only (16 participants, 31.3%)
Psycoeducation only (14 participants, 27.5%)
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
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
Psychoeducation Intervention:
Six separate sessions 60-90 minutes in
length & one week apart.



First interview - opinions and feelings about traumatic experience
and significance to patient discussed
Second interview – information given to patients regarding PTSD
symptoms and treatment. Patients questions were also answered
during session.
Third interview – provided information about stress and coping
techniques. Discussed coping methods prior to trauma as well as
current methods.
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
Psychoeducation continues:



Fourth interview – summarized previous session. Patient ranked
current problems and target goals were set regarding perceived
problems.
Fifth interview – goals studied in-depth. Time to achieve goals
and implementation stressed. Alternative goals were discussed.
Final interview – evaluation of results. General review and patient
opinion. Post-test regarding coping strategies 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 model
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
Final Results:

While the post-test scores of all three participant
groups showed significantly lower scores in posttraumatic stress and depression than the pretest scores, there was no difference among the
groups regarding coping strategies.
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
Individual Group Findings:
Psychoeducation
with Medications
Increased problem
solving
 Decreased depression
 Increased social-support
seeking
 Decreased avoidance
Medication Only




Increased post-traumatic
stress scores
Increased social-support
seeking
Decreased avoidance
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

Psychoeducation only group
No significant differences were found in the coping
strategies of this group in comparison with the previous
groups. This is most likely due to the benefits of
combined therapy to decrease anxiety and enhance
learning simultaneously.
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
Research limitations:
Small sample group (only 51 participants)
 All sample participants were military personnel,
and their immediate family members
 Sample participants had to be literate in Turkish
 Results were based upon patient self-report

Peplau’s theory and how it pertains to this
research study:



Peplau believed that a patient’s good health is directly
correlated to a reduction in anxiety. The focus of PTSD
treatment is also a reduction in anxiety to enhance
coping skills.
Peplau’s model focuses on the nurse-patient relationship
and the different roles undertaken by the nurse. All of
these were utilized within this research program.
Peplau’s interaction process in the nurse-patient
relationship comprised four distinct phases. These
phases were specifically used during the
psychoeducation sessions of this study.
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
Final Thoughts Regarding Peplau’s
Model & PTSD Treatment

Overall, the results of the study show that
Peplau’s theory is appropriate for use by
nurses treating patients experiencing
anxiety and depression
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
Final Thoughts Regarding Peplau’s
Model & PTSD Treatment


Combined treatment including medications and
counseling as well as focusing on the patients’ needs
contribute to more positive outcomes when treating
PTSD.
Active listening and a positive nurse-patient relationship
are key to successful treatment of trauma victims
suffering from PTSD.
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
Use of Peplau’s Interpersonal
Relations Model to Counsel
People with AIDS

Paul-Andre Guathier,
RN, TCC, CNS, DMD,
MN
Objective

“The Purposes of this
research were to provide
an example of the
development of a nursing
approach by the use of
Peplau’s interpersonal
relations model and to
gain a greater
understanding of life-anddeath issues raised by
men and women with
HIV and AIDS.”
Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. Journal of the American Psychiatric Nurses Association. 6 (4)
p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p.119
Study Design
“A qualitative analysis of a man with AIDS
was completed by use of Peplau’s model.”
 Patient studied was a male in his early
30’s with diagnosis of AIDS
 Study was conducted during multiple
encounters with the patient and nurse

Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. Journal of the American Psychiatric Nurses Association. 6 (4)
p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p.119
Results
“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. Journal of the American Psychiatric Nurses Association. 6 (4)
p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p. 119
How Peplau’s theory framed
Research

“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. Journal of the American Psychiatric Nurses Association. 6 (4)
p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p. 124
Peplau’s phases that guide Nurses


Orientation Phase– As stated in 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– “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. Journal of the American Psychiatric Nurses Association.
6 (4) p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p. 120
Peplau’s phases that guide Nurses


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– “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.”
Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel People with AIDS. Journal of the American Psychiatric Nurses Association. 6 (4)
p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p.120
Limitations of Study

Only one patient used in study
– Large margin for error

No direct input from patient on how study
effected him
– All input was from nursing point of view and
observation
Implications for Practice





“Peplau’s model is useful because it provides an
interpersonal process that facilitates the establishment of
meaningful interactions with clients.”
“Persons affected by AIDS need a guide and facilitator to
help them move toward a more meaningful life.”
“Frank discussions connected to client concerns are
always relevant.”
“Nurses can help clients face their problems, explore
their options and determine possible solutions”
As stated in Gauthier, Peplau (1952/1988) explains that
“exploring goals and making plans together helps clients
strengthen their relationships with 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. Journal of the American Psychiatric NursesAssociation. 6 (4)
p.119-125. Retrieved November 14 from http://0-jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119 p. 124
Critical Reflections
Peplau’s Theory of Interpersonal Relations
can be used to create a trusting,
therapeutic working relationship with all
patients regardless of their diagnosis.
 Nurses can help patients create an anxiety
free atmosphere which is essential to
having positive outcomes

Depressive Symptom Reversal
for Women in a Primary Care
Setting:
A Pilot Study

Linda S. Beeber
– Syracuse University
College of Nursing,
Syracuse, NY, USA

Melissa L. Charlie
– University of
Pennsylvania School of
Nursing, Philadelphia,
PA, USA

According to Beeber,
Peplau said,
“depressive
symptoms are the
result of changes in
the self and relations
developed to manage
anxiety”
Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 12(5),
p. 247-254. Retrieved November 14, 2009 from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=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
Objectives
Discover if women with depressive symptoms
could be identified
 Determine if women would participate in a
theoretically driven intervention delivered by a
Psychiatric Mental Health Advanced Practice
Nurse (PMH-APN)
 Establish whether measures of the concepts in
the theory were sensitive to outcomes proposed
to occur as a result of the intervention
 The intervention focused on women because
women are twice as vulnerable as men to
depression

Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 12(5), p.
247-254. Retrieved November 14, 2009 from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=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
Selection
33 women were chosen for the study
 Screened and referred by primary care
nurses, nurse practitioners, and physicians
 The women were then screened for
depressive symptoms with the Beck
Depression Inventory (BDI) (Beck, Steer,
& Garbin, 1988). Women scoring 10 or
higher on the BDI were offered the
intervention.

Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 12(5), p.
247-254. Retrieved November 14, 2009 from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=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
Method

The participants were diagnosed with depression and
met with a PMH-APN who provided interventions based
on Peplau’s Theory of Interpersonal Relations. Some of
these interventions included:
– Establish a therapeutic relationship
– Assess life transitions
– Investigate the role of depressive symptoms in the management
of anxiety
– Understand depressive symptoms in the context of self and
relations
– Help patient to manage anxiety differently
– Assist patient to take charge of the sources of anxiety
– Help 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. Archives of Psychatric Nursing. 12(5), p.
247-254. Retrieved November 14, 2009 from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=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
Results




It was found that depressive symptoms significantly
decreased following intervention, but only when
performance self esteem levels increased.
Social self esteem and satisfaction in interpersonal
relations did not significantly increase.
The results seem to indicate that the coping skills
learned by the participants have boosted their
performance self esteem and decreased their depressive
symptoms.
It was also determined that patients are receptive to
depression screening and interventions performed by a
PMH-APN. “Their exit interviews indicated a high degree
of satisfaction”
Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 12(5), p.
247-254. Retrieved November 14, 2009 from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=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
Critique of the Research

Research Strength
– Acceptance of PMH-APN by
Health Care Team &
patients
– Use of Peplau’s Theory of
Interpersonal Relations
– Interventions based on 2
previous studies
– Multi-cultural group
– Decrease in depression
symptoms and physical
symptoms in most
participants
Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 12(5), p.
247-254. Retrieved November 14, 2009 from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=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
Critique of the Research

Research Weakness
– Only women (18 to 35
years of age)
– No control
– No randomization
– Small group (33
participants)
– Some measurement
tools used showed
insufficient sensitivity
Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 12(5), p.
247-254. Retrieved November 14, 2009 from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=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
Implications for Practice



The consultant role of the PMH-APN in a primary health setting
would result in early intervention for patients with depressive
symptoms. These patients often seek care for vague physical
symptoms that require numerous, costly visits and testing to
determine the cause. When depressive symptoms are addressed at
an early stage, it results in considerable cost savings. This study
verified the value of advance practice nursing.
When establishing a therapeutic relationship with patients, it is
important to look for depressive symptoms and share that
information with other members of their health care team. Many
individuals suffer from untreated depression. It often isn’t
discovered and acted on until they come to a primary health setting
with a physical complaint.
This study supplied useful information for the discovery and
treatment of depressive symptoms.
Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 12(5), p.
247-254. Retrieved November 14, 2009 from http://0-web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=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
Final Thought

As nurses, we strive to provide care that is evidence based and constantly
improving. Nursing education and practice are based on theories that have
proven successful. An unproven theory will find no support until it has been
proved to be true through numerous research 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 effective, it must be researched. A good nurse is
always aware of the theory behind work performed and evaluating the result.
References
Beeber, L S., Charlie, M L., (1998). Depressive Symptom Reversal for Women in
a Primary Care Setting: A Pilot Study. Archives of Psychatric Nursing. 12(5),
p. 247-254. Retrieved November 14, 2009 from http://0-
web.ebscohost.com.libcat.ferris.edu/ehost/detail?vid=6&hid=106&sid=0784
77e6-efc7-4604-944c16ea140134ea%40sessionmgr110&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d
%3d#db=cin20&AN=1999001459 doi:10.1016/S0883-9417(98)800034-4
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. Journal of the American Psychiatric Nurses
Association (JAPNA), 14, 2. p.136-143. Retrieved November 14,
2009, from Academic OneFile via Gale:
http://0find.galegroup.com.libcat.ferris.edu/gtx/start.do?prodId=AONE&userGroup
Name=lom_ferrissu DOI: 10.1177/1078390308315613
Gastmans, C. (1998). Interpersonal relations in nursing: A philosophical-ethical
analysis of the work of Hildegard E. Peplau. Journal of Advanced Nursing,
28, 1312-1319
Gauthier, P A. (2000). Use of Peplau’s Interpersonal Relations Model to Counsel
People with AIDS. Journal of the American Psychiatric NursesAssociation. 6
(4) p.119-125. Retrieved November 14 from http://0jap.sagepub.com.libcat.ferris.edu/cgi/reprint/6/4/119
References
Oflaz, F., Hatipoglu, S., Aydin, H. (February 2008). Effectiveness of
psychoeducation intervention on post-traumatic stress disorder and
coping styles of earthquake survivors. Journal of Clinical Nursing.
14, 5. p. 677-687. Retrieved November 14, 2009, from
http://0www3.interscience.wiley.com.libcat.ferris.edu/journal/120087263/ab
stract?CRETRY=1&SRETRY=0
Peplau, H. E. (1953). Themes in nursing situations. American Journal of
Nursing, 53, 1221-1223.
Peplau, H. E. (1988). Interpersonal relations in nursing. London:
Macmillan Education. (Reprinted from Interpersonal relations in
nursing: A conceptual framework of reference for psychodynamic
nursing, 1952, New York: G. P. Putnam & Sons).
Peplau, H. (1992). Interpersonal relations: A theoretical framework for
application in nursing practice. Nursing Science Quarterly, 5, 12-18.
Tomey, A. M., & Alligood, M. R. (2006). Nursing theorists and their
work (6th ed., p. 55). St. Louis, MO: Mosby Elsevier.