Two Theories at the Bedside: Peplau's Nurse-Patient Relationship in Outpatient Hemodialysis and Orem's Self-Care Deficit Theory After a New Urostomy
Student Name
RN to BSN Program, Aspen University
N491: Concepts and Theories in Nursing
Instructor Name
Month Day, Year
Slide 2: Why These Two Theories Belong Together
Peplau: the relationship between nurse and patient is the therapeutic tool
Orem: the goal is the patient's own ability to care for self
Together: a relationship that moves the patient from dependence to self-care
Speaker notes: This presentation has two parts. The first explains Hildegard Peplau's phases of the nurse-patient relationship and applies them to a patient starting outpatient hemodialysis. The second explains Dorothea Orem's self-care deficit theory, its three related theories, and applies it to a patient learning to manage a new urostomy, supported by a randomized trial. I paired them because Peplau describes how the relationship develops and Orem describes what the relationship is for, so each part makes the other easier to use.
Slide 3: Part One, Peplau's Theory of Interpersonal Relations
Nursing is a significant, therapeutic, interpersonal process
Nurse and patient both learn and change through the relationship
Four phases: orientation, identification, exploitation, resolution
Speaker notes: Peplau was the first nursing theorist to put the relationship between nurse and patient at the heart of care. In Interpersonal Relations in Nursing she described nursing as a therapeutic interpersonal process in which the nurse and patient come to know each other, work on the patient's problem together, and grow in the process (Peplau, 1952). She later summarized the theory as a set of overlapping phases through which a professional relationship moves (Peplau, 1997).
Slide 4: The Four Phases
Orientation: the patient seeks help; nurse and patient clarify the problem
Identification: the patient responds to those who can help
Exploitation: the patient makes full use of available services
Resolution: needs are met and the relationship ends
Speaker notes: In orientation, the patient has a felt need and the nurse helps name the problem and what the patient can expect. In identification, the patient begins to relate to the nurse selectively and to express feelings about the illness. In exploitation, the patient uses the help available, asks questions, and takes more control. In resolution, the patient's needs have been met, the patient becomes more independent, and the relationship ends. Peplau emphasized that the phases overlap rather than follow a fixed schedule (Peplau, 1997).
Slide 5: The Nurse's Roles Across the Phases
Stranger, resource person, teacher
Counselor, surrogate, leader
The role shifts as the patient's needs change
Speaker notes: Peplau described roles the nurse takes on during the relationship. At first the nurse is a stranger and should be treated with the courtesy owed to one. Later the nurse becomes a resource person who answers questions, a teacher, a counselor who helps the patient understand what is happening, sometimes a surrogate for another person in the patient's life, and a leader who works with the patient toward goals (Alligood, 2022).
Slide 6: Practice Example, Starting Outpatient Hemodialysis
Composite patient: 58-year-old man, new to in-center hemodialysis
Missed two sessions in his first month, arrives tense and quiet
Same primary nurse assigned for his first eight weeks
Speaker notes: This patient is a composite created for the presentation. He started hemodialysis after years of chronic kidney disease, three sessions a week in an outpatient center. In his first month he missed two sessions, and staff described him as withdrawn. The center assigned him a primary nurse for his first eight weeks, which made it possible to watch Peplau's phases unfold in a setting where relationships last for years.
Slide 7: The Phases in the Dialysis Chair
Orientation: the nurse learns he believes dialysis means he is dying
Identification: he begins asking for the same nurse and admits his fear
Exploitation: he asks about fluid limits, transplant evaluation, work schedule
Resolution: he attends every session and joins his own care planning meetings
Speaker notes: In orientation, the nurse introduced herself as a stranger would and asked what dialysis meant to him. His answer, that it meant he was dying, explained the missed sessions better than any reminder call. In identification, he began asking for the same nurse and talked about his fear and his father's death on dialysis. In exploitation, the nurse acted as teacher and resource person while he asked practical questions about fluid limits and transplant evaluation. In resolution, he attended every session and began speaking for himself in care planning meetings. The relationship with the unit continues, but the dependence on one nurse resolved, which is the outcome Peplau described.
Slide 8: Evidence for Peplau in Current Practice
12,436 hospitalized patients' survey responses analyzed
Factor models based on Peplau's theory fit the data well
Supports using the theory to show nursing's contribution to patient experience
Speaker notes: A study that analyzed responses from 12,436 patients to items on the national hospital patient experience survey tested whether the data could be organized according to Peplau's theory. Models based on her phases fit the data well, although not as well as the survey's original structure, and the authors concluded that the theory can be used to show nursing's large contribution to hospitalized patients' experiences (Hagerty et al., 2017). The finding suggests that what patients report about their care reflects the relationship Peplau described.
Slide 9: Part Two, Orem's Self-Care Deficit Theory
Self-care: actions people take for themselves to maintain life and health
Nursing is needed when demands exceed the person's ability
A general theory built from three related theories
Speaker notes: Dorothea Orem defined self-care as the activities that people initiate and perform on their own behalf to maintain life, health, and well-being. Nursing becomes necessary when a person's ability to perform self-care is less than what the situation demands. Orem organized her work as a general theory made up of three related theories, named for self-care, for the self-care deficit, and for nursing systems (Orem, 2001).
Slide 10: The Three Related Theories
Self-care: what people must do (universal, developmental, health deviation requisites)
Self-care deficit: when and why nursing is needed
Nursing systems: how nursing responds
Speaker notes: The first of these describes the requisites people must meet: universal requisites such as air, water, food, and elimination; developmental requisites tied to stages of life; and health deviation requisites created by illness or treatment. The deficit theory explains that nursing is needed when the demand for self-care exceeds the person's capability, called self-care agency. The nursing systems theory then describes how the nurse responds (Orem, 2001).
Slide 11: Three Nursing Systems
Wholly compensatory: the nurse performs self-care for the patient
Partly compensatory: nurse and patient share the care
Supportive-educative: the patient performs care with teaching and support
Speaker notes: The nursing system is chosen according to the size of the deficit. In a wholly compensatory system the patient cannot perform self-care, and the nurse acts for them. In a partly compensatory system the nurse and patient each perform some of the care. In a supportive-educative system the patient can perform the care but needs knowledge, guidance, or support to do it well (Alligood, 2022). A single patient often moves through all three during one episode of care.
Slide 12: Practice Example, a New Urostomy
Composite patient: 67-year-old woman after radical cystectomy with ileal conduit
Health deviation requisite: managing a urostomy appliance at home
Goal: independent appliance change before discharge
Speaker notes: This patient is also a composite. She had a radical cystectomy for bladder cancer and now has a urostomy, which creates a new health deviation requisite: emptying the pouch, changing the appliance, protecting the skin, and recognizing complications. Her self-care agency is strong in general, she has managed her own household and medications for decades, but on the first postoperative days her deficit for this particular requisite is complete.
Slide 13: Moving Through the Nursing Systems
Day of surgery: wholly compensatory, the nurse manages the stoma entirely
Days 2 to 4: partly compensatory, she empties the pouch while the nurse changes the wafer
Days 5 to discharge: supportive-educative, she changes the appliance with coaching
After discharge: wound, ostomy, and continence nurse follow-up
Speaker notes: The nursing system changes as her agency grows. On the day of surgery the nurse performs all stoma care. Over the next days she empties the pouch while the nurse changes the wafer and teaches. Before discharge she performs a full appliance change with the nurse only coaching and checking the skin seal. After discharge, a wound, ostomy, and continence nurse continues the supportive-educative system by telephone and in clinic. Orem's theory gives the team a shared language for where she is and what comes next.
Slide 14: Evidence Supporting the Example
Randomized trial, 107 patients undergoing radical cystectomy
Standardized preoperative stoma education versus usual care
Better stoma self-care scores at 35, 120, and 365 days
Speaker notes: The evidence for starting the supportive-educative system even before surgery comes from a randomized trial of 107 patients undergoing radical cystectomy. Patients who received a standardized preoperative stoma education program had significantly better scores on a urostomy self-care scale at 35, 120, and 365 days after surgery than those who received standard care (Jensen et al., 2017). In Orem's terms, teaching before the deficit appeared built the self-care agency the patient would need later.
Slide 15: Comparing the Two Theories
Peplau explains the process of the relationship; Orem explains its purpose
Both aim at the patient's growing independence
Both are usable today in settings their authors never saw
Speaker notes: Peplau and Orem wrote from different starting points, psychiatric nursing and nursing practice more broadly, yet their theories complement each other. Peplau's resolution phase and Orem's supportive-educative system describe the same endpoint from two angles: a patient who needs the nurse less because the relationship and the teaching worked. Both theories were applied here to outpatient dialysis and urologic oncology, settings their authors did not write about, which is good evidence that they remain useful.
Slide 16: Conclusion
Peplau: build the relationship deliberately, phase by phase
Orem: match the nursing system to the size of the deficit
Both: measure success by the patient's independence
Speaker notes: The practical lessons are simple. From Peplau, nurses can treat the relationship as a tool that is built deliberately, starting with the first conversation, which in the dialysis example revealed why the patient was missing treatment. From Orem, nurses can match the level of help to the size of the self-care deficit and plan the move from doing for the patient to teaching the patient. In both cases, the best evidence of good nursing is a patient who needs the nurse less over time.
References
Alligood, M. R. (2022). Nursing theorists and their work (10th ed.). Elsevier.
Hagerty, T. A., Samuels, W., Norcini-Pala, A., & Gigliotti, E. (2017). Peplau's theory of interpersonal relations: An alternate factor structure for patient experience data? Nursing Science Quarterly, 30(2), 160-167. https://doi.org/10.1177/0894318417693286
Jensen, B. T., Kiesbye, B., Soendergaard, I., Jensen, J. B., & Kristensen, S. A. (2017). Efficacy of preoperative uro-stoma education on self-efficacy after radical cystectomy; secondary outcome of a prospective randomized controlled trial. European Journal of Oncology Nursing, 28, 41-46. https://doi.org/10.1016/j.ejon.2017.03.001
Orem, D. E. (2001). Nursing: Concepts of practice (6th ed.). Mosby.
Peplau, H. E. (1952). Interpersonal relations in nursing. G. P. Putnam's Sons.
Peplau, H. E. (1997). Peplau's theory of interpersonal relations. Nursing Science Quarterly, 10(4), 162-167. https://doi.org/10.1177/089431849701000407
How this N 491 Module 2 example is structured
N491 Module 2 typically asks for a two-part PowerPoint of about 14 to 20 slides: Peplau's phases of the nurse-patient relationship aligned with a current practice example, then Orem's self-care deficit theory with its three related parts, a practice example and at least one evidence-based article, with title and reference slides and outside sources plus the textbook. Aspen revises courses, so your classroom's instructions govern. This example keeps each slide to a few lines and puts the explanation in the speaker notes, explains each theory before applying it, maps each example to the theory step by step, and closes with a comparison that shows how the two parts fit together.
N491 Module 2 questions, answered
What does N491 Module 2 usually ask for?
Commonly a two-part PowerPoint of 14 to 20 slides: Peplau's phases of the nurse-patient relationship with a current practice example, and Orem's self-care deficit theory with its three related parts, a practice example and at least one evidence-based research article. Title and reference slides are included, with outside sources plus the textbook.
What are the three related parts of Orem's theory?
Orem described her general theory as three related theories: the theory of self-care, the theory of self-care deficit and the theory of nursing systems. The nursing systems themselves come in three types, wholly compensatory, partly compensatory and supportive-educative, and the sample explains both sets.
Where should the detail go in a graded presentation?
In the speaker notes. Slides with a few short lines are easier to read, and the notes carry the explanation, the citations and the reasoning a grader needs. The sample cites sources inside the notes at the point where each claim is made.
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