Hildegard peplau
Counselor – Helps the patient express feelings
4 Phases of the Nurse-Patient Relationship and thoughts; provides emotional support.
Orientation Phase Teacher – Educates the patient about their
What happens: The patient seeks help and the condition, medications, or procedures.
nurse starts to build trust.
Goal: Define the problem and establish a Leader – Guides the patient in taking
connection. responsibility for their care; promotes
Example: A patient is admitted with anxiety, and participation.
the nurse introduces herself, explains her role,
and starts to gather basic information. Technical Expert – Uses clinical skills and
knowledge to provide physical care.
Identification Phase Surrogate – Acts as a substitute figure (e.g.,
What happens: The patient begins to respond to family, guardian) when the patient transfers
the nurse and identifies with those who can help. emotions or expectations onto the nurse.
Goal: The patient begins to trust the nurse and
accept help. 4 Levels of Anxiety
Example: The patient opens up about personal
struggles and agrees to a care plan. Mild Anxiety
Effect: Heightened awareness and alertness;
Exploitation Phase can enhance learning.
What happens: The patient fully uses the nurse’s Example: A student feeling slightly nervous
services and begins working toward recovery. before an exam but able to concentrate.
Goal: Maximize the benefits of the nurse-patient
relationship. Moderate Anxiety
Example: The patient follows through with Effect: Narrowed focus; the person may need
treatment, asks questions, and actively assistance concentrating.
participates in care. Example: A patient waiting for test results, able
to talk but distracted.
Resolution Phase
What happens: The patient’s needs have been
met, and they no longer need the nurse's help.
Goal: End the nurse-patient relationship Severe Anxiety
professionally. Effect: Focus is extremely limited; difficult to
Example: The patient is discharged and thanks think clearly or make decisions.
the nurse, feeling confident in continuing their Example: A patient facing surgery who is
care independently. overwhelmed and can't follow instructions.
7 Nursing Roles (Peplau’s Roles of the
Nurse) Panic
Effect: Loss of control, disorganized behavior,
Stranger – First contact; the nurse treats the possibly unable to communicate.
patient with respect and acceptance like any Example: A patient in the ER during a heart
other person. attack who is screaming and not responding to
questions.
Resource Person – Provides specific
information needed to understand a condition or
treatment.
Ida Jean Orlando 4. Nurse’s Reaction & Action
Ida Jean Orlando's Theory of the Nursing Orlando emphasizes that nurses should not
Process Discipline is a middle-range nursing act solely on their immediate reactions.
theory that emphasizes the nurse-patient Instead, they must:
interaction and the importance of individualized
care. Her theory provides a framework for ● Validate their perceptions with the
understanding how nurses deliver care through patient (ask and clarify),
observing patient behavior and responding
appropriately. ● Engage the patient to determine the
real need,
Here’s an explanation of the theory using the
terms you listed: ● Respond with a deliberate action that
is relevant to the patient’s expressed
1. Organizing Principle need.
The central organizing principle of Orlando’s 5. Deliberative & Automatic Nursing Actions
theory is that the nurse’s role is to find out
and meet the patient’s immediate need for ● Deliberative Actions: Purposeful,
help. Care should not be based only on what patient-centered, and validated with the
the nurse thinks or assumes, but on what the patient. These actions are grounded in
patient actually needs, as expressed verbally or the nursing process and aim to meet the
nonverbally. patient’s immediate need for help.
2. Presenting Behavior ● Automatic Actions: Routine or habitual
actions not based on patient-specific
This refers to the patient's initial behavior cues (e.g., checking vitals without
(verbal or nonverbal), which is a call for help. It relating it to current distress). Orlando
may be obvious (e.g., pain, crying, complaining) cautions against relying too heavily on
or subtle (e.g., silence, tension, withdrawal). these without patient input.
Nurses must recognize these behaviors as
expressions of distress. 6. ADPIE (Assessment, Diagnosis, Planning,
Implementation, Evaluation)
3. Immediate Reaction
Although Orlando didn’t label the nursing
The nurse’s immediate reaction is the internal process as ADPIE, her theory laid the
response (thoughts, feelings, and perceptions) foundation for it:
to the patient’s presenting behavior. This
includes: ● Assessment: Observing and validating
the patient’s presenting behavior.
● Perception of the behavior,
● Diagnosis: Identifying the patient’s
● Thoughts about what it might mean, need based on shared understanding.
● Feelings in response to it (e.g., ● Planning: Creating a plan of care based
concern, confusion). on the validated need.
● Implementation: Carrying out individuals, not just as roles.
deliberative nursing actions.
● There is a growing recognition and
● Evaluation: Assessing the patient’s appreciation of each other’s personal
response to ensure the need was met. qualities.
Summary: ● This is a critical step in building trust and
beginning meaningful interaction.
Ida Jean Orlando’s theory reminds nurses that
real help begins when the nurse and patient 3. Empathy
interact to clarify the patient’s need. Her
model highlights the importance of ● Empathy is the ability to understand
individualized care, critical thinking, and another person’s feelings and
nurse-patient communication to ensure experiences from their perspective.
actions are truly helpful and appropriate.
● The nurse enters the patient’s world
Joyce Travelbee emotionally and intellectually.
● Travelbee believed empathy is essential
Joyce Travelbee’s Human-to-Human for effective nursing because it leads to
Relationship Model is a nursing theory that insight and appropriate responses.
emphasizes the importance of interpersonal
relationships in providing effective and 4. Sympathy
meaningful care. She believed that nursing is
an interpersonal process whereby the nurse ● Sympathy goes a step further than
helps an individual find meaning in their illness empathy—it is a desire to alleviate the
or suffering. The relationship develops through a patient’s suffering after understanding
series of phases, which you listed: it.
1. Original Encounter ● It’s not just about understanding, but
caring and wanting to help.
● This is the first impression between
the nurse and the patient. ● Sympathy motivates the nurse to take
compassionate and appropriate
● At this stage, both see each other in a actions.
limited, stereotypical way (e.g., "just a
nurse" or "just a patient"). 5. Rapport
● It is usually superficial and based on ● This is the final and ideal stage of the
roles, not individual personalities or relationship.
experiences.
● It is a mutual understanding, trust,
● The goal is to move beyond this to and respect between nurse and patient.
establish a genuine human connection.
● At this point, a genuine
2. Emerging Identities human-to-human connection has
been formed, allowing for meaningful
● In this phase, both nurse and patient care and healing.
begin to see each other as unique
● Travelbee described rapport as a ● Care based on knowledge learned in
compassionate bond that enables the nursing school.
nurse to truly help the patient find
meaning in their experience of illness. ● It includes using skills to help, support,
and improve a person’s health,
Summary: including caring for the sick or dying.
Joyce Travelbee’s phases show the progression 4. Cultural and Social Structural Dimension
of a nurse-patient relationship from initial
contact to a deep, therapeutic connection. ● This looks at important parts of a
These phases encourage nurses to go beyond culture that affect people’s behavior
routine care and develop genuine human and health.
connections with their patients to promote
healing and emotional support. ● These include: religion, family, politics,
money, education, technology, history,
and cultural values.
5. Traditional Concept of Health and Disease
Madeleine leininger ● In many cultures, people may not
believe that illness comes from inside
Here is a simple explanation of the concepts the body, so they may not trust or use
related to Transcultural Nursing and Western medicine.
Leininger's theory, based on what you
provided: ● Their beliefs shape how they
understand and treat illness.
1. Transcultural Nursing
6. Care
● A special area of nursing that studies
and compares different cultures to ● Any action that helps, supports, or
understand their health beliefs, values, makes someone feel better.
and practices.
● Care is essential for survival and
● Goal: To give care that fits the patient's coping with life’s problems.
culture and is effective for their healing
and well-being. 7. Cultural Care
2. Ethnonursing ● The beliefs and values in a culture
that guide how people give and receive
● The study of how people from a care.
certain culture view and experience
care. ● Helps people stay healthy, feel better,
or face challenges like death or
● It focuses on the beliefs and values disability.
about care that are learned from their
culture. 8. World View
3. Professional Nursing Care
● A person’s general way of looking at Leininger’s theory teaches that to give the best
life or the world. nursing care, nurses must understand and
respect different cultures. People’s beliefs
● It is shaped by their culture and life about health, illness, care, and healing are
experiences. shaped by their culture, history, and life
experiences. By learning these, nurses can
provide meaningful, safe, and respectful care
to every individual.
9. Folk Health or Well-Being System Madeleine Leininger’s Theory of Culture Care
Diversity and Universality is foundational in
● Health practices or healing methods that transcultural nursing. Her goal was to help
come from the culture or tradition, not nurses provide culturally congruent care,
from doctors or hospitals. meaning care that fits the patient’s cultural
values, beliefs, and practices.
● Example: using herbs, rituals, or
traditional healers. She identified three modes of nursing care
actions that guide how nurses should approach
10. Traditional Concepts of Illness and care when working with people from diverse
Causality cultural backgrounds:
● Many cultures have their own names for
illnesses (e.g., “evil eye,” “cold wind”).
1. Cultural Preservation (or Maintenance)
● These cultures also have their own
ideas about what causes illness, how ● This involves supporting or helping
to prevent it, and how to treat it. patients retain and use meaningful
cultural practices that are beneficial to
11. Concept of Culture their health.
● Culture is something that is learned ● The nurse respects and encourages
from one generation to another. the patient’s traditional health practices
as long as they are not harmful.
● It’s taught through life experiences,
family, and community. ● Example: Allowing a patient to continue
using herbal remedies alongside
12. Cultural Awareness prescribed medications, as long as there
are no contraindications.
● Being aware of your own background
and culture.
● Recognizing your own biases or
judgments, so you can better 2. Cultural Accommodation (or Negotiation)
understand and respect other cultures.
● This refers to adapting or negotiating
care to help patients meet health needs
in a way that is compatible with their
cultural values.
Summary:
● The nurse works with the patient to Nola Pender's theory focuses on encouraging
find a safe compromise between people to take positive actions toward
traditional practices and necessary improving their health and well-being. The
model is based on the idea that people will
medical care.
engage in health-promoting behaviors if they
feel motivated, confident, and supported.
● Example: Adjusting hospital meal times
so a Muslim patient can fast during
🔹 1. Health Promotion
Ramadan and still receive proper
nutrition and medication.
● These are positive activities people
choose to do to stay well and live a
better life—not just to avoid illness.
3. Cultural Repatterning (or Restructuring) ● Example: Eating healthy, exercising,
managing stress, getting enough sleep.
● This involves helping patients change
harmful cultural practices while
respecting their cultural values.
🔹 2. Health Protection and Illness
Prevention
● The nurse collaborates with the patient ● These are actions taken to avoid
to modify or restructure behaviors to disease or injury.
achieve better health outcomes without
● These may include preventive
completely abandoning their culture. behaviors like:
● Example: Educating a patient about the ○ Wearing a helmet
dangers of high-sodium traditional foods
and working together to find healthier ○ Getting vaccinated
alternatives that still align with cultural
○ Avoiding risky behaviors
tastes.
● Focuses on reducing health risks
before a problem starts.
Summary:
🔹 3. Prior Related Factors (Prior Related
Behavior and Personal Factors)
Leininger’s care strategies help nurses provide These are the background experiences and
holistic, respectful, and effective care by characteristics that influence how likely
recognizing that health beliefs and practices are someone is to adopt a healthy behavior.
shaped by culture. The three
a. Past Behaviors
modes—preservation, accommodation, and
repatterning—guide nurses in tailoring care to ● If someone did a behavior before and
honor culture while promoting health and felt good about it, they’re more likely to
safety. do it again.
● Example: If you used to enjoy jogging,
you’re likely to try jogging again.
🌿 Nola Pender’s Health Promotion Model
(HPM) – Simplified Explanation b. Personal Factors
Includes: e. Interpersonal Influences
● Biological: Age, gender, body type. ● Impact of family, friends, and social
norms.
● Psychological: Self-esteem, motivation,
body image.
“My friends eat healthy, so I want to
● Sociocultural: Cultural background, too.”
education, support system.
These shape how a person thinks and feels f. Situational Influences
about health-related decisions.
🔹
● The environment or setting that helps or
4. Behavior-Specific Cognitions and hinders the behavior.
Affect
These are the thoughts, feelings, and beliefs “Having a park nearby makes it easier
that influence a person's decision to take action. for me to walk daily.”
a. Perceived Benefits of Action 🔹 5. Behavioral Outcomes
● Belief that doing the behavior will have This is the end result—whether or not the
positive results. person actually engages in the health-promoting
behavior.
“If I exercise, I’ll feel more energetic.” a. Commitment to a Plan of Action
● The person makes a decision and
plan to take action.
b. Perceived Barriers to Action
● Belief that there are obstacles to doing “I’ll do 20 minutes of walking after lunch
the behavior. every day.”
“I don’t have time to work out.” b. Immediate Competing Demands and
Preferences
c. Perceived Self-Efficacy
● Things that get in the way of the plan,
● Confidence in your ability to do the like distractions or other responsibilities.
behavior.
“I planned to walk, but I got too busy
“I know I can quit smoking.” with work.”
d. Activity-Related Affect c. Health-Promoting Behavior
● How someone feels about the ● The final healthy action taken. This is
behavior—positive or negative. the goal of the model.
“Despite being tired, I still walked for 20
“I feel happy after yoga, so I’ll keep minutes.”
doing it.”
✅ Summary: How It All Flows
1. Past behaviors and personal traits
influence...
2. Beliefs and feelings about a health
behavior, which influence...
3. A person’s commitment and
follow-through, leading to...
4. Health-promoting actions that improve
well-being.
