Abstract
This paper explores six published articles containing information about three nursing theories and how to integrate them into improving care and how they will work symbolically to provide better care for the elderly population at home. The three theories will address a patient’s personal home environment, nurse-patient relationship, and the emotional needs of elderly patients, while identifying how the three theories are similar and different. Introduction
Elderly patients are facing challenging obstacles in their home environment such as managing their own health care needs and maintaining safety in the home. Even though these patients want to stay home, they have numerous medical problems which lead to hospitalizations. To keep these patients home and to prevent hospitalizations, home health care is usually ordered to help patients maintain health and safety. The home health nurse is an integral part in helping the patient and his/her caregiver with managing health care needs. Three theories: Rodger’s Theory of Science of Unitary Human Beings, Watson’s Theory of Human Caring, and Peplau’s Theory of Interpersonal Relationship will be defined, the theories will be applied to nursing in the home health environment, and the theories’ similarities and differences will be outlined. Rodger’s Science of Unitary Human Beings
Rodger’s Science of Unitary Human Beings identifies how the patient and environment are integral and create a multidimensional universe of open systems. There is constant interacting between person and their environment, which are constantly changing. Rodger’s stipulates that a patient cannot be separated from his or her environment and nurses need to promote health and wellbeing wherever the patient may be located. (Klemm & Stashinko, 1997) In the home health environment, the nurse treats the patient in his or her home. The nurse must assess the patient’s entire environment and how it affects the patient’s safety and well-being. A part of the home health nurse’s assessment includes how well the patient ambulates in the home, if the patient requires safety devices, if the
patient has accessibility to transportation to get to the physician’s office, if the patient can afford medications, or if the patient needs any special assistance in activities of daily living. Watson’s Theory of Human Caring
Watson’s Theory of Human Caring identifies the nurse-patient relationship as being interpersonal. Effective health care promotes a caring relationship between the nurse and patient. Watson suggests treating patients holistically (mind, body, and spirit), accept the patient without any conditions, and treat with respect. The nurse is suggested to spend time creating caring moments with the patient. At the beginning of the nurse-patient relationship, the nurse establishes a link with one another, depending how the nurse initially approaches the patient. Cara, (2003)
In the home health environment, nurses spend a lot of time with the patient and their caregivers. From the moment that the nurse enters the home, the nurse can affect the mood or the momentum of future visits and if the patient and/or caregiver will be receptive to the nurse’s visits. The patient’s home can be in disarray, especially if the patient has been sick or unable to do house work. There are many problems that exist in the home environment that does not occur in any other health care environment. The home health nurse who treats the patient holistically, not only cares for the body, mind, and spirit; the nurse is caring for financial, caregiver, and environmental needs. Peplau’s Theory of Interpersonal Relationship
Peplau’s Theory of Interpersonal Relationship describes four phases of nurse-patient, interpersonal relationship: 1) Orientation, 2) Identification, 3) Exploitation, and 4) Resolution. Orientation is when the patient seeks help when realizing that help is needed and the nurse helps the patient to identify his or her problem or need. Identification is when the patient identifies his or her self with those who are providing assistance and when the nurse explores feelings about providing care to the patient. Exploitation is when the patient feels valued as a result of the relationship and the nurse establishes new goals by shifting power from the nurse back to the patient. Resolution is when the patient adapts to the new goals and begins to free his or her self from the nurse. (Gastmans, 1998) In the home health environment, the nurse develops the initial interpersonal relationship with the patient. Often, the patient does not feel that he or she needs nursing or home health services.
Therefore, during the orientation phase, the nurse explains what home health is, assesses the patient’s needs, and educates the patient regarding his or her health care needs. In the identification phase, the patient and home health nurse develop an interpersonal relationship by attempting to find a commonality or kinship. A good partnership can be established during this phase if both openly communicate with one another. During the exploitation phase, the patient begins feeling confidence in managing his or her own health care needs and the nurse begins empowering the patient and/or caregiver to be independent with care. The nurse begins to establish new goals for the patient to follow. During the resolution phase, the nurse begins to step back when the patient is independent with care and no longer needs home health care. (Gastmans,1998) Theories’ Similarities
All three theories are based on nurse-patient relationships. The theories identify the importance of nursing interventions to help the patient achieve health care goals. Watson’s and Peplau’s theories are more similar, because these two theories outline interpersonal relationships and communications that promote patient wellness. The different steps and phases in these two theories suggest interventions for nurses to follow and explain how these interventions affect the patient. For example, Watson begins at nurse-patient introduction and the relationship can be positively or negatively affected based on how the nurse approaches the patient. Peplau’s first phase is orientation where the interpersonal relationship is developed based on the patient seeking help and the nurse identifying the patient’s needs. Difference of the Three Theories
Rodgers’ theory is completely different from Watson and Peplau’s. Rodgers’ theory is mostly evolved around the patient and the patient’s environment. Watson and Peplau’s theories are based on nurse-patient relationships. Watson’s theory is based on developing a caring relationship and how their relationships feed-off one another. For example, the patient is experiencing his or health care needs and the nurse is experiencing his or her own need to provide care for the patient. Peplau’s theory is interpersonal and describes how these nurse-patient relationships evolves through different phases, beginning at the time of first contact and ending when the patient is independent with managing his or her own health care needs. (Gastmans,1998) Conclusion
The purpose of this discussion was to define three nursing theories, identify how the theories can be utilized in the home health environment, and define the theories similarities and differences. As discussed, all three theories can be implemented by the home health nurse. Rodger’s Theory of Science of Unitary Human Beings identifies how the patient and his or her environment are integral and can affect one another. (Klemm & Stashinko, 1997) The home health nurse provides care in the home environment and assesses how the environment affects the patient’s wellbeing. Watson’s Theory of Human Caring identifies how the nurse can establish a caring relationship with the patient by first beginning with a trusting relationship. (Cara, 2003) The home health nurse should remember not to judge the patient based on his environment, being negative toward the patient can negatively affect the relationship and prevent a caring relationship from forming. Peplau’s Theory of Interpersonal Relationship helps the home health nurse develop an interpersonal relationship with the patient and lead to the patient being independent with managing health care needs.
References
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