Application of Nursing Theory – Peplau’s Nurse Patient Relationship Theory in Advanced Clinical Practice


Nursing growth and development has highly been influenced by various developed nursing theories. These theories have facilitated evolution of nursing from nightingale period to now. They have highly enhanced the perfection of nursing care time after time. This paper will focus on Peplau’s nurse-patient relationship theory in advanced clinical practice. Based on Peplau nursing is therapeutic since it is an art of healing, helping a person who is need of healthcare or is sick. Nursing can be perceived as an interpersonal process since it involves relations between two or more persons with a common objective. This common goal in nursing offers the therapeutic process incentive where in the patient and nurse respect one another as persons, both of them growing and learning due to interaction. A person learns when he or she selects stimuli in the surrounding and then responds to the stimuli.

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While developing the major concept of this theory, Peplau describes man as an organism which strives in its personal way to lower tension created by needs. In this regard, a client is a person with a felt need. She then describes health as a word symbol that refers to personality forward movement and other continuing human processes in the direction of community, creative, personal, constructive, and productive living (McEwen & Wills, 2014). In Hildegard Peplau views, nursing is an interpersonal, therapeutic, significant process. In this regard, therapeutic nurse-client relationship is referred to as a planned ad professional association between nurses and client which centers on the pattern, needs, problems, and feelings of a client. This relation contains four nursing components that include patient need, professional expertise, two persons that include the patient and nurse, as well as patient relationship. Nursing entails interaction between two or more persons sharing the same goal. This goal is attained via a number of steps that follow a progressive pattern that contains four phases that include resolution phase, identification phase explanation phase, and orientation phase (McEwen & Wills, 2014).

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This paper will review various issues in a number of sections. This includes the description of the actual nursing issues that need to be resolved. The paper in this section discusses the quality of care problem faced by various healthcare organizations in the world. This section evaluates the literature contribution to the issue, and the highly impacted stakeholders. The paper evaluates the application of the selected nursing theory in the resolving of the identified healthcare issue. The paper finally gives a brief summary of the discussion.

Description of Issue or Concern

The main issue to be considered here is quality of care provided to the patients. The overall result to the care provided to the patient highly depend the information the clinical practitioners can get from the patient either through assessment process and also by the feedback obtained from the patients in the course of the care. This highly determines the approach the clinical officer can employ to enhance patient intervention and care. It also plays a great role in increasing patient care outcome in any medical organization and hence in the improvement of care. Improvement of the care quality is a part of the advance clinical practice. Advanced clinical practice involves the improvement of care to ensure more satisfying output. It focuses on constant improvement of patient care quality.

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The nursing profession should care about quality of care since it determines the care efficiency, the organization reputation, and individual nurse job satisfaction. Nurses offer their care services to patients hoping to improve their life, to remove them from dependence stage to ensure that they are able to care for themselves. The chances of accomplishing their care goal highly depend on the quality of care they can be able to provide. This is determined by a number of factors that include the availability of the necessary facilities, individual nurse knowledge, and individual nurse ability to relate with the patient and to obtain all necessary information to enhance care. When a nurse is highly knowledgeable or skilled and works in a well-equipped healthcare, then a nurse has high ability to offer quality care to any patient. However, this can be undermined by the relationship between a nurse and a patient. A nurse has the role to initiate nurse-patient relationship. This relationship plays a great role in enhancing quality patient assessment and also in obtaining the feedback of the provided intervention measures.

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Poor quality of care is a major problem in various healthcare organizations. It is characterized by increase in medical error, molarity rate, readmission for the same reason, increase in hospitalized infection and low patients outcome. According to Keogh (2014), this can be facilitated by a number of issues which include poor patient- nurse communication, nurses’ shortage, lack of enough knowledge among nurses, lack of the required facilities, poor safety measures and poor organization management among other things. According to Dixon-Woods et al. (2012) nurses-patient communication relationship plays a major role in determining the main course of nursing care failure in an organization. Quality of care in Martin (2012) views is determined by how well a healthcare organization will manage its errors. Richard and Tabatha, (2010) classifies the root cause of errors as latent failure which is normally involve poor decision making by the practitioners, active failure that include poor direct contact between medical practitioners and patients, organizational system failure that involve the organization culture and operation systems as well as technical failure that are initiated by external sources of facilities indirect failure. In this regard to have total quality of care, quality of patient nurse relation must be enhanced. This according to Hall et al. (2008) is also enhanced by the nurse-patients ration in a healthcare. The level of relation between nurses and patients goes down when a nurse has so many patients to attend to.  This reduces effective communication between a nurse and a patient, and thus, it will be hard to establish great relationship in any organization. In this regard, the poor care quality associated with poor patient-nurse relationship can highly be recorded in institution experiencing nurses’ shortage. Although there is no accurate statistics on the number of hospital experiencing quality issues, quality improvement is a common initiative in various healthcare organizations and thus, poor quality of care is a common in different healthcare organizations in the world.

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The health care quality issue is a great problem that affects a number of stakeholders which include patients and their families, the healthcare providers, the healthcare organization, the government, the surrounding communities, and the healthcare management. Patients are highly affected since they suffer the greatest negative impact of poor quality of care. This can include magnification of medical problem, introduction of a new medical problem, increase in treatment related expenses or even death. This agony is also experienced by other family members and friends who watch as their loved ones’ condition deteriorate in a place where they anticipated good care and health improvement. This affects their emotions and their finances too. Health providers suffer from low job satisfaction and thus, they are highly involved establishing ways to reduce the consequences of poor quality of care.  They are normally involved in research and establishment of the cause of the problem and probable problem’s solution. The government will be highly impacted especially if the hospital is partially or fully funded by the government. Medical errors and other poor quality consequences are quite expensive to handle and thus, they can easily increase the government spending in a country. The surrounding community will also be affected in that they will lose faith with the nearby healthcare organization and as a result, most of them will try to avoid the most accessible healthcare organization in their surroundings. Healthcare management is responsible for developing the organization policies. In this regard, they will need to develop new policies that can be used to improve quality of care in an organization based on the main problem initiating poor health condition.

Application of the Nursing Policy to the Issue of Concern

The selected nursing theory to be used in this case is Peplau’s nurse-patient relationship theory. The theory enhances quality of care by encouraging a good patient-nurse relationship. This relationship initiates the development of good communication between a patient and a nurse and thus, making it easy to assess a patient and acquire the right diagnosis and thus, giving a nurse a better chance to offer the best intervention measures (Neese, 2015). This good communication assists in gathering information on the patient progress and hence in keeping record on the efficiency of the selected intervention measure. According to Parker and Smith (2010), communication plays a great role in enhancing a chain of success of failure in medical field. Poor communication can result to wrong assessment results which results to wrong diagnosis and hence wrong intervention techniques and eventually resulting to fatal medical error.

According to this theory, interviewing and communication skills remain essential nursing tools that can be used to enhance patient-nurse relationship (Kourkouta & Papathanasiou, 2014). This is very essential when a nurse is obtaining individual medical history and while assessing a patient for current health conditions and symptoms. Good interaction maximizes on the amount of important information that can be obtained regarding patient’s medical condition. This increases chances for positive medical outcome since assessment highly determines the form of care. Good interaction also plays part in restoring patient’s hope and spirituality. It increases patient’s trust to the caregiver and thus making it easy to report any upcoming issue or any unanticipated problem. This assist nurses in understanding patient’s progress, any medical reaction or side effects, any improvement among other essential information. All these result to improved patient’s outcome and patient satisfaction of the provided care.

Patient-nurse relationship can be implemented in patient care using four main steps or phases. These phases include the orientation phase where client is engaged into treatment, offering information and explanations, as well as answering questions. This is the phase the patient and the nurse get to know each other and where the nurse gathers relevant medical information that can enhance patient diagnosis. This is very essential stage particularly in medical conditions where patient’s medical and/or life history is needed. The second phase is the identification phase which starts when the client independently works with the nurse, shows feelings, and starts to feel strong (Kourkouta & Papathanasiou, 2014). This is the phase in which a patient gains nurse’s trust and open up to give more information and also to depend on a nurse for full treatment. The third phase is the explanation phase where the client makes sufficient use of the offered services. In this phase the patient is ready to give feedbacks, to ask questions and to request for advance medical care where necessary. The patient at this stage is determined to recover with the help of a nurse. The last phase is the resolution phase where in the patient no longer requires professional services. In this phase the patient stops the dependency behavior and the relation terminates. The patient at this stage has managed to gather all relevant information regarding his or her condition from a nurse, and has also managed to understand measures he or she can personally employ to enhance and maintain good health (Richard & Tabatha, 2010).

Although Peplau’s nurse-patient relationship theory describes how a good relation between a patient and a nurse can enhance healthcare outcome, it is important to note that this relationship must remain professional. Nurses should always remember their professional duties, policies and code of conduct to ensure that no personal relationships are formed while trying to improve quality of care using this theory. Lack of control while implementing this theory can result to personal relationships which would undermine individual nurse ability to employ his or her professional skills efficiently. This can also increase chances of a nurse to develop psychological conditions such as vicarious trauma in case a nurse is highly attached to the patient’s pain or suffering. In this regard, when not kept under control, this association may go beyond the required professional level creating ethical issues.

Nurse-patient relationship plays a major role in enhancing quality of care in a healthcare organization. However, it is not clearly known to what extent this can improve the quality of care in an organization. There have been a number of researches done to determine how to improve patient care and to enhance quality of care, where patient-nurse relation is featured (Porter-O’Grady & Malloch, 2011). However, there are no researches demonstrating the level in which good patient-nurse relation can solely enhance the level of care or improve quality of care. In this regard, I would recommend a research on how Peplau’s nurse-patient relationship theory can solely be employed to enhance care in a healthcare organization.


Peplau’s nurse-patient relationship theory is one of the theories that can be employed to enhance communication and improve quality of care in a healthcare organization. This theory is implemented via four stages which see a patient through from introduction to termination of nursing care. Although the theory is very effective in improvement of care, it can result to ethical issues if its application goes against nursing code of conducts or professionals. The efficiency of patient-nurse relation has been acknowledged in various researches on quality of care. However, there are no individual information on extend in which this can enhance care on its own. Thus more researches need to be done on this issue to establish the efficiency of the theory in increasing quality of care in an organization. This research has enabled me to realize the power of this theory in the enhancement of advanced clinical services in any healthcare organization.

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