Introduction
Nursing theories represent frameworks that professionals can use in their practice to provide care that shows respect for patients and improves their outcomes. They help distinguish nursing as a distinct discipline that is separate from medicine and other related sciences, assisting nurses in understanding the unique needs of their patients (Mudd et al., 2020). When teaching nurses the core principles of their practice, the understanding of the intersections of nursing, patients, health, and the environment that is embedded within nursing theories allows for simplifying the ever-changing relationship that nurses encounter within their profession.
For the purposes of the current discussion, the focus is placed on Hundergard Peplau’s Environmental Theory and Dorothy Johnson’s Behavioral Theory. The purpose of each of the mentioned theories of nursing is to provide practical recommendations for implementing meaningful actions within the nursing field. The theories can be used separately or in conjunction with one another in cases when the application of only one theory cannot be beneficial. This paper will critically discuss the two theories and assess their application in nursing practice. Besides, it is necessary to reflect on the way in which the theories will affect personal experiences as a nursing professional.
Discussion of Theories
Peplau’s Environmental Theory
The innovations in contemporary nursing and the application of theoretical concepts by other authors, such as Sigmund Freud, Abraham Maslow, Harry Sullivan, and Neil Miller, led Peplau to develop her own theory of psychodynamic care based on interpersonal relationships between patients and nursing professionals. The progress of this theory was based on the study of other important works on human behavior and the functioning of the psyche. In addition, the theorist intertwined them with his personal and professional experience in her field of activity.
Hildegard Peplau’s Environmental Theory, commonly referred to as the Theory of Interpersonal Relations, underlines that nurse-patient relationships must pass through three phases such as orientation, working, and termination. At the orientation stage, patients who have been hospitalized realize that they require assistance to adjust to their current experiences within a new setting. Thus, the role of the nurse is to note the unique needs and priorities of the patients while assuming that they are strangers who should be treated with “the respect and positive interest accorded a stranger” (Hagerty et al., 2017, p. 161). In the next phase of working, nurses spend the most time with patients.
The practitioners are expected to get more familiar with them and should start accepting nurses as health educators, resource persons, counselors, and care providers. Notably, at this point, through the therapeutic form of communication, nurses will provide non-judgmental and reflective feedback to patients for them to clarify their thoughts (Hagerty et al., 2017). The final termination phase, which entails discharge planning, is contingent on how well nurses and patients communicated at the previous stages. Nurses are expected to teach patients how they can effectively handle their symptoms and engage in successful recovery at home.
Dorothy Johnson’s Behavioral Theory
Johnson believed that illness, and lifestyle changes, can unbalance the subsystems of human behavior. Nursing care should be aimed at restoring balance. To determine the direction of the intervention, it is necessary to assess the patient’s condition with respect to each subsystem. This assessment is carried out in two stages: determine whether the behavior of the patient suggests an imbalance in any subsystem; and determine the causes of this violation (organic or functional). According to the author’s definition, the role of a nurse is complementary to the role of a doctor but does not depend on it. The nurse is assigned the role of a specialist who restores the balance of the patient’s behavioral subsystems during a psychological or physical crisis.
The theory advocates for the efficient and effective behavioral functioning of patients for preventing illness. The patient is considered a behavioral system comprised of several subsystems, which include affiliative, dependency, ingestive, eliminative, sexual, aggressive, and achievement (Aşkar and Ovayolu, 2022). The three functional requirements of every of the mentioned subsystems entail protection from harmful influences, the establishment of a nurturing environment, and growth stimulation. If there is an imbalance within the mentioned subsystems of behavior, health care will exist in a disequilibrium. It is the role of a nurse to assist a patient in returning to a state of equilibrium.
When applying Johnson’s theory into practice, nurses set several goals, the first of which is assisting patients whose behavior is proportional to social demands. The second goal entails helping patients who can change their behaviors in ways that support biological imperatives, while the third one is supporting patients who can benefit to the greatest extent from the skills and knowledge of physicians. The final goal is to help patients whose behavior does not include evidence of unnecessary trauma as an implication of illness.
Application in Practice
Both of the discussed theories positively affect the nursing care process because they underline the importance of the personal comfort of patients and the need to adhere to their expectations of care. They allow for informing the nursing practice regarding suitable interventions, advance the strategies of care, as well as focus on improving patient outcomes for a better life. The two theories allowed for shaping the personal perspective on how future practice can be implemented. They underline the impact of various external influences on the behavior and expectations of care among patients who get admitted to the healthcare setting to receive adequate assistance. For instance, Peplau’s theory encourages paying attention to the quality of relationships that a nurse develops with their patients, which helps in making informed choices about the care process (Kaur, 2020). When referring to Johnson’s theory, it teaches to help patients maintain adequate behavioral functioning of patients to maintain their good health after treatment is formulated. In future practice, emphasizing the specific needs of patients and acting upon them within the interactions between patients, nurses, and the process of care will lead to the improvement of health outcomes.
Conclusion
To conclude, the current nursing practice calls for the implementation of numerous theories. The professional scope of nursing practice is both comprehensive and multidimensional, which is why it could play a central part in transforming the systems of health care to become more accessible, high-quality, and value-driven. The most efficient ways of treating a patient must involve a complex approach and a deeper understanding of both nurses and patients. Therefore, both identification and exploration with attention to attitude analysis can be practical tools in treatment processes. Being aware of patients’ environment and condition while also taking into account their behavioral elements are essential parts of modern nursing.
The critical discussion of Hundergard Peplau’s Environmental Theory and Dorothy Johnson’s Behavioral Theory revealed that nurses’ assistance in facilitating the meeting of the therapeutic needs of patients is central to both approaches. The theories show that the interplay between health, nursing, a person, and the environment shapes the therapeutic interpersonal process that functions cooperatively with other processes, making health attainable for all individuals within diverse communities. In both of the theories under analysis, professional and planned relationships between nurses and their patients emphasize clients’ needs, challenges, and ideas, which also shape specific approaches and behaviors. Thus, the attainment of any health goal is reached through a series of steps arranged sequentially, beginning with orientation-related stages and ending with patient education-focused steps. Depending on the specific behavioral patterns inherent to patients or their distinct health needs, nurses will formulate the appropriate approaches to care in a patient-centric manner.
Finally, it is necessary to note that the application of either theory or its combination in a dynamic nursing environment entails having some degree of structure, which is imperative for successful care delivery. Achieving balance is one of the main goals of nurses who are expected to make slight adjustments and adaptations, the blend of which will help achieve the most appropriate strategy for the unique needs of each patient. The interplay between behavioral, social, and psychotherapeutic nursing theories seeks to address the unmet needs of patients primarily with the help of collaboration, followed by the motivation and personal development of professionals. In the modern care environment, there is no longer a need to focus on one theory; instead, professionals have the freedom to use various principles and approaches to care because each patient is unique and cannot be treated through a ‘one-size-fits-all approach.
Reference List
Aşkar, S. E. and Ovayolu, Ö. (2022) ‘Nursing care based on Dorothy Johnson’s behavioral system model in coronary artery disease: a case report,’ Medical Science & Discovery, 9(2). Web.
Hagerty, T. A., Samuels, W., Norcini-Pala, A. and Gigliotti, E. (2017) ‘Peplau’s theory of interpersonal relations: an alternate factor structure for patient experience data?,’ Nursing Science Quarterly, 30(2), pp. 160-167.
Kaur, B. (2020) ‘Interpersonal communications in nursing practice – key to quality health care’, Archives of Nursing Practice and Care, 6(1), pp. 19-22.
Mudd, A., Feo, R., Conroy, T. and Kitson, A. (2020) ‘Where and how does fundamental care fit within seminal nursing theories: a narrative review and synthesis of key nursing concepts’, Journal of Clinical Nursing, 29(19-20), pp. 3652-3666.