makalah peplau

8/17/2019 MAKALAH PEPLAU

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MAKALAH

KRITIKAL REVIEW JURNAL SAINS

“Hildegard Peplau”

Tugas Kelompok 6Mata Kuliah Sains Keperaatan

DISUSUN OLEH:

METTY ASTUTI 14213122

SUNA!TI S"ASTIKA!INI 14213122#

!IKA NO$A!I%A 142131242

ANDIKA &AESA! 1421312'(

MA)ISTE! KEPE!A"ATAN

*AKULTAS ILMU KEPE!A"ATAN

UNI$E!SITAS ANDALAS



214KATA PEN)ANTA!

S!ukur Alham"ulillah kelompok u#apkan Keha"iran Allah SWT$ !ang telah mem%erikanrahmat$ hi"a!ah$ serta karunia&N!a sehingga kelompok "apat men!elesaikan tugas SainKeperaatan tentang Kritikal Jurnal teori 'Hildegard Peplau”

"engan %aik( Shalaat "ansalam kelompok mohonkan kepa"a Allah SWT semoga "isampaikan kepa"a Na%iMuhamma" SAW !ang telah mem%erikan #ontoh "an suri taula"an %agi manusia untuk keselamatan "i "unia "an "i akhirat(

)alam penulisan Makalah ini kelompok telah %erusaha semaksimal mungkin "enganmen#urahkan segenap kemampuan$ aktu$ "an tenaga untuk men!elesaikann!a( Namun"emikian kelompok men!a"ari Makalah ini masih *auh "ari kesempurnaan$ hal ini"ise%a%kan oleh keter%atasan kemampuan "an pengalaman kelompok( Untuk itu "iharapkana"an!a saran "an kritikan !ang %ersi+at mem%angun "ari pem%a#a "emi kesempurnaanMakalah ini(

Makalahini "ia*ukan "alam rangka memenuhi s!arat "alam perkuliahan SainsKeperaatan( )alam men!elesaikan Makalah ini kelompok %an!ak men"apatkan masukan$ %antuan$ "ukungan$ %im%ingan "an arahan "ari %er%agai pihak$ untuk itu "engan segalakeren"ahan hati "an penuh penghargaan kelompok mengu#apkan terima kasih(

Akhir kata semoga makalah ini le%ih sempurna$ "apat "iterima "an %erman+aat %agikita semua(

,a"ang$ Septem%er -./0

Kelompok 6



+A+ I

PENDAHULUAN

A. La,ar +ela-a.g

Sains keperaatan merupakan ilmu !ang terus %erkem%ang sesuai "engan

perkem%angan respon manusia terha"ap lingkungann!a( ,erkem%angan sains

keperaatan "i"asari oleh +alsa+ah$ +iloso+i "an para"igma keperaatan se%agai

kerangka ilmu untuk meningkatkan pela!anan keperaatan se#ara holistik( Sains

keperaatan memiliki +alsa+ah %erupa ke!akinan "an kerangka %erpikir se#ara

sistematis "an ilmiah !ang men"asari suatu gam%aran !ang %er"asarkan pa"a realitas

"an logika sehingga men*a"i pan"uan peraat untuk mem%erikan pela!anan asuhan

keperaatan se#ara pro+esional( Ilmu keperaatan *uga memiliki para"igma

keperaatan se%agai kerangka ilmu untuk %er+okus pa"a pelaksanaan praktek pela!anan keperaatan !ang ter"iri "ari manusia$ lingkungan$ sehat$ "an

keperaatan(

Teori a"alah sekelompok konsep !ang mem%entuk se%uah pola !ang n!ata atau

suatu pern!ataan !ang men*elaskan suatu proses$ peristia atau ke*a"ian !ang

"i"asari +akta&+akta !ang telah "i o%ser1asi tetapi kurang a%solute atau %ukti se#ara

langsung( Teori keperaatan a"alah usaha&usaha untuk menguraikan atau

men*elaskan +enomena mengenai keperaatan( Teori keperaatan "igunakan se%agai

"asar "alam men!usun suatu mo"el konsep "alam keperaatan !ang "igunakan"alam menentukan mo"el praktek keperaatan(

Teori selain "ipergunakan "alam men!usun se%uah mo"el$ *uga memiliki

karakteristik$ "iantaran!a teori mampu mengi"enti+ikasi "an men*a%arkan konsep

khusus !ang %erhu%ungan "engan hal&hal n!ata !ang a"a "i alam$ teori %er"asarkan

alasan&alasan !ang sesuai "engan ken!ataan !ang a"a$ teori harus %ersi+at konsisten

se%agai "asar&"asar "alam mengem%angkan suatu mo"el konsep$ teori mampu

menun*ang terha"ap aplikasi$ teori harus se"erhana "an si+atn!a umum sehingga

"apat "igunakan pa"a kon"isi apapun "alam praktik$ serta teori "apat "ipergunakan

"alam pe"oman praktik(

Untuk men*alankan tugas keperaatan$ %an!ak teori keperaatan !ang

"igunakan$ salah satun!a a"alah 2il"egar" E( ,eplau( Mo"el konsep "an teori

keperaatan !ang "i*elaskan oleh ,eplau men*elaskan tentang kemampuan "alam

memahami "iri sen"iri "an orang lain !ang menggunakan "asar hu%ungan antar

manusia !ang men#akup 0 komponen sentral !aitu klien$ peraat$ masalah ke#emasan

!ang ter*a"i aki%at sakit 3sum%erkesulitan4 "an proses interpersonal(

,ela!anan keperaatan pro+esional merupakan area !ang "apat memun#ulkan

%er%agai perkem%angan ilmu "an teori keperaatan( 2asil "ari pem%erian pela!anan



keperaatan pro+esional "engan pen"ekatan sains keperaatan "apat men*a"i solusi

"ari +enomena keperaatan sehingga "apat meningkatkan kualitas peraatan se%agai

%agian "ari pela!anan kesehatan( 5leh se%a% itu$ pengem%angan sains keperaatan

memiliki hu%ungan interakti+ antara pen"i"ikan$ pela!ananpraktik$ "an riset

keperaatan se%agai ilmu terapan !ang memiliki otonomi pro+esional(

Melalui makalah ini$ kelompok tertarik untuk mem%ahas tentang pengem%angan

sains keperaatan "ari 7iloso+i$ +alsa+ah "an para"igma "engan hu%ungann!a antara

keperaatan "alam pengem%angan sain keperaatan(

B. Tu/ua.

1. Tu/ua. u0u0

Mampu memahami "an menganalisa *urnal sesuai konsep teori 2il"egar" E(

,eplau(

2. Tu/ua. -uu

a. Mampu memahami mo"el konsep teori 2il"egar" E( ,eplau(

b. Mampu menganalisa *urnal sesuai teori 2il"egar" E( ,eplau(

C. Ma.aa,

Man+aat "ari pen!usunan makalah ini "iharapkan mahasisa mampu mengetahui$

menganalisis$ "an menerapkan pengem%angan sains keperaatan "i pen"i"ikan$

pela!anan$ "an riset keperaatan se%agai %agian "ari pela!anan keperaatan pro+esional(

+A+ II

TINAUAN TEO!ITIS

A. Te5ri

Teori a"alah kumpulan konsep&konsep$ "e+inisi&"e+inisi "ari suatu +enomena !ang

"ihu%ungkan atau "ikaitkan sehingga "ihasilkan sesuatu hal !ang mu"ah "ipahami$ %isa



%erupa pern!ataan kata&kata$ pen*elasan$ penggam%aran$ perkiraan terha"ap suatu

+enomena( Ke%era"aan teori sangat %erman+aat "alam pengem%angan ilmu pengetahuan$

khususn!a peren#anaan proses penelitian( Teori selain "ipergunakan "alam men!usun

se%uah mo"el$ *uga memiliki karakteristik$ "iantaran!a teori mampu mengi"enti+ikasi

"an men*a%arkan konsep khusus !ang %erhu%ungan "engan hal&hal n!ata !ang a"a "i

alam$ teori %er"asarkan alasan&alasan !ang sesuai "engan ken!ataan !ang a"a$ teori

harus %ersi+at konsisten se%agai "asar&"asar "alam mengem%angkan suatu mo"el konsep$

teori mampu menun*ang terha"ap aplikasi$ teori harus se"erhana "an si+atn!a umum

sehingga "apat "igunakan pa"a kon"isi apapun "alam praktik$ serta teori "apat

"ipergunakan "alam pe"oman praktik(

Teori&teori "iklasi+ikasikan %er"asarkan pa"a %e%erapa komponen$ !aitu8 3/4

%aha konsep "ii"enti+ikasi "an "i"e+inisikan$ 3-4 %aha klari+ikasi asumsi&asumsimen"asari suatu ke%enaran !ang mana "an "arimana alasan teori&teori "ihasilkan$ 394

"arimana konteks tempat teori$ "an 304 telah teri"enti+ikasi hu%ungan antara "an "iantara

konsep&konsep 3:hin ; Kramer$/<<<= 2iggins ; Moore$-..94(

Teori&teori "i%e"akan %er"asarkan tu*uan$ sum%er$ tingkat kepentingan$ le1el "an

#akupan( ,er%e"aan > per%e"aan terse%ut "igunakan untuk mengklasi+ikasikan( )asar

tu*uan "ari teori a"alah "eskripsi$ pen*elasan$ pre"iksi "an atau #ontrol( Sum%er > sum%er

"alam teori keperaatan meliputi perkem%angan ilmu keperaatan itu sen"iri "an "ari

"isiplin ilmu lain !ang "igunakan "alam keperaatan( )engan "emikian a"a terminologi

!ang "igunakan untuk men#irikan antara "ua sum%er terse%ut !aitu teori keperaatan

"an teori "alam keperaatan(

A"a %e%erapa pen"apat "alam mengklasi+ikasikan tingkatan teori keperaatan(

Teori se#ara luas 3the broad-scope theories4 "ise%ut se%agai macro, holistic, molar,

general, situasional "an grand ( Teori !ang le%ih sempit 3narrow-scope theories4 "ise%ut

middle range, circumscribed atau situational/factor ( Teori !ang paling sempit 3theories

narrowest 4 "ise%ut micro, molecular, atomistic, narrow-range, phenomena, prescriptive,

factor, situation-specific atau practice 3?a%%ie$ /<<@= eorge$ /<<@= ,arker$ -../=

Rinehart$/<BC4( ,en!e%utan se#ara umum tingkatan teori men!e%ut Meta-theory$ Grand

theory, middle range theory, micro theory atau practice theory(

?erikut ini akan "i*elaskan tingkatan %er+ikir se#ara teoritis "alam keperaatan(

Masing > masing tingkatan teori akan "i*elaskan %er"asarkan pen*elasan a%strak "an

#akupan$ kemampuan se#ara umum$ tipe "an peran 3kegunaan4 "ari teori=



a. Meta-theory

Meta-theory a"alah tingkatan !ang paling a%strak "ari semua le1el teori( Isu "ari

teori ini %erhu%ungan "engan mengarahkan pa"a pen#arian *aa%an "ari se%uah

pertan!aan ilmiah 32iggins; Moore$ -..04( Meta&theor! %erhu%ungan "engan isu >

isu ilmiah "an "i kenal "engan +ilsa+at ilmu$ !ang men+okuskan pa"a penggu*ian "ari

se%uah ilmu$ prosesn!a "an pro"uk( Teori ini menghasilkan "asar "ari ilmu

pengetahuan(

Teori ini mempun!ai man+aat %agi ilmuan "an praktisi keperaatan( Teori ini

*uga "igunakan untuk men*aa% pertan!aann !ang ti"ak "apat "i*aa% oleh ilmu

pengetahuan( :ontohn!a$ pa"a kasus&kasus men*elang a*al "an kematian$ stu"i ilmiah

akan men#ari *aa%an tentang peru%ahan > peru%ahan +isiologi !ang ter*a"i pa"a

kematian( Akan tetapi$ stu"i ilmiah "iperlukan untuk men*aa% pertan!aan$DApakah

kematian itu a"alah se%uah proses atau se%uah hasil D( Se%agai teori !ang paling

kuatkokoh "iantara semua le1el teori$ Meta-theory "alam ilmu keperaatan %er+ungsi

mengungkapkan se%agian "ari isu&isu !ang "itu*ukan melalui proses 8

1) Klari+ikasi hu%ungan antara ilmu keperaatan "an praktek(

2) Men"e+inisikan$ mengem%angkan$ "an mengu*i teori(

3) Men#iptakan "asar ilmu "ari keperaatan$ "an

4) Memeriksa "an menginterpretasikan pan"angan "asar +iloso+i "an

hu%ungann!a "engan keperaatan(

b. Grand theory

Teori keperaatan gran" theor! a"alah para"igma umum tentang ilmu

keperaatan 3 2iggins ; Moore$-..04( Teori ini %ersi+at +ormal$ merupakan s!stem

teori !ang %ersi+at a%strak "ari kerangka "isiplin keilmuan( Konsep "an propositions

3asumsi&asumsi4n!a mele%ihi kon"isi !ang spesi+ik "an populasi pasien(

Grand theory memerlukan spesi+ikasi le%ih lan*ut "alam %an!ak kasus$ serta

pemisahan pern!ataan&pern!ataan teoritisn!a supa!a %isa "iu*i "an "i%uktikan se#arateoritis( ,ara ahli grand theory men!atakan rumusan&rumusan teoritis mereka pa"a



tingkat a%straksi !ang sangat umum$ "an sering "i*umpai kesulitan&kesulitan

mengaitkan rumusan&rumusan itu "engan realitas( Si+at a%strakn!a ini mengaki%atkan$

grand theory terka"ang sulit "ipahami oleh sisa %aru peraat "an orang !ang aam(

Menurut 2iggins ; Moore 3-..04$ grand theory mempun!ai kontri%usi !ang

signi+ikan "alam keperaatan$ antara lain !aitu8

1) Mem%erikan %atasan > %atasan sehingga keperaatan "apat mempun!ai i"entitas

"alam ke%era"aann!a(

2) Selain itu$ gran" theor! *uga mempun!ai kontri%usi untuk mem%erikan perspekti+

se*arah keperaatan$ kea"aan aktu itu$

3) Mem%erikan gam%aran %agaimana para pen#ipta mengem%angkan teori$ *uga

+iloso+i mereka men"asari ilmu keperaatan$ pen"i"ikan mereka serta prespekti+

terha"ap praktek keperaatan(

:ontoh "ari ilmuan !ang menemukan grand theory a"alah 7loren#e Nightingale$

"an temuann!a merupakan grand theory pertama !ang tertulis "alam perkem%angan

ilmu keperaatan(

c. Middle range theory

Menurut 2iggins ; Moore 3-..04 se*arah perkem%angan "ari middle theory

termasuk %aru "alam ilmu keperaatan( Sama haln!a "engan grand theory$ middle-

range theory men*elaskan mengenai "unia empiris "alam keperaatan$ tetapi hal itu

le%ih spesi+ik "an se"ikit +ormal "i%an"ing grand teory !ang le%ih a%strak( Middle

range theory mem%utuhkan "iskusi tentang “what it is” "an “what comes before and

after in its range”(

Middle range theory memiliki kriteria$ lingkup$ tingkat a%straksi$ "an kesta%ilan

penerimaan se#ara luas( )alam lingkup "an tingkatan a%strak$ middle range theory

#ukup spesi+ik untuk mem%erikan petun*uk riset "an praktek$ #ukup umum pa"a

#ampuran populasi klinik "an men#akup +enomena !ang sama( Se%agai petun*uk riset

"an praktek$ middle range theory le%ih %an!ak "igunakan "ari pa"a grand theory,

middle grand theory "apat "iu*i "alam pemikiran empiris(



d. Micro theory (practice theory)

Micro range theory merupakan tingkatan teori !ang ti"ak +ormal "an %ersi+at

sementara "i%an"ingkan tingkatan teori lainn!a( "an sangat ter%atas "alam hal aktu

"an lingkup aplikasin!a 32iggins ; Moore -..04( Meskipun %iasan!a menggunakan

pen"ekatan penilaian$ para ilmuan "an praktisi selalu mem%erikan gam%aran$

mengorganisir "an melakukan test terha"ap i"e&i"e mereka( Micro range theory

memiliki "ua tingkatan$ !aitu higher level "an lower level.

Micro range theory pa"a higher level sangat "ekat hu%ungann!a "engan middle

range theory, tetapi ter"iri "ari satu atau "ua konsep&konsep utama "an +rekuensi

aplikasin!a "i%atasi "engan se%uah ke*a"ian( :ontohn!a teori !ang a"a hu%ungann!a

"engan peraatan luka "eku%itus atau peraatan kateter(

Micro range theory pa"a lower level "i"e+inisikan se%agai satu set hipotesa ker*a

atau proposisi. ,ara ilmuan "an praktisi menggunakan proposisi kera se#ara sementara$

men*elaskan atau melakukan test hipotesa ker*a !ang a"a kaitann!a "engan kesehatan

se%agai hasil interaksi antara manusia "an lingkungan(

B. A.alii pe.erapa. ,e5ri pada /ur.al a0pai aa, i.i

2il"egra" ,eplau mener%itkan %ukun!a hu%ungan antar&pri%a"i 3interpersonal4 "alam

keperaatan$ sehu%ungan "engan %ukun!a 'teori parsial untuk praktek keperaatanD

,eplau mem%ahas mengenai tahap&tahap proses hu%ungan antar&pri%a"i$ peran "alam

ker*a keperaatan$ "an meto"e&meto"e "alam mempela*ari keperaatan se%agai satu

proses interpersonal(

Menurut ,eplau$ keperaatan a"alah terapeutik !aitu satu seni men!em%uhkan$

menolong in"i1i"u !ang sakit atau mem%utuhkan pela!anan kesehatan( Keperaatan

"apat "ipan"ang se%agai satu proses interpersonal karena meli%atkan interaksi antara "ua

atau le%ih in"i1i"u "engan tu*uan !ang sama( )alam keperaatan tu*uan %ersama ini

akan men"orong kearah proses terapeutik "imana peraat "an pasien saling

menghormati satu "engan !ang lain se%agai in"i1i"u$ ke"ua&"uan!a mereka %ela*ar "an

%erkem%ang se%agai hasil "ari interaksi( ?ela*ar menempatkan "iri saat in"i1i"u



se#ara pro+essional akan meningkat se#ara e+ekti+( Setiap permasalahan akan

mempengaruhi kepri%a"ian peraat "an meningkatkan pro+essionalisme( Inilah #irri "iri

peraat !ang memiliki peru%ahan langsung "alam terapeutik$ hu%ungan interpersonal(

,eplau mengi"enti+ikasi empat tahapan hu%ungan interpersonal !ang saling %erkaitan

!aitu8 3/4 orientasi$ 3-4 i"enti+ikasi$ 394 eksplorasi$ 304 resolusi 3peme#ahan

masalah4( Setiap tahap saling melengkapi "an %erhu%ungan se%agai satu proses untuk

pen!elesaian masalah(

?e%erapa penelitian telah "ilakukan terkait "engan konsep 2il"egar" E( ,eplau(

Ju"ul 8 !eplau"s #heoretical Model

,enulisan 8 Ree"$ ,amela = Shearer$ Nelma ?(

Fork8 Springer ,u%lishing :ompan!$ -..6(

Analisis 8 Jurnal ini mem%ahas tentang perkem%angan teori ,eplau( 2il"egar"

,eplau merumuskan i"e&i"e teoritis n!a tentang proses terapi

keperaatan pa"a /<0.&an "an "iter%itkan "alam %uku pa"a tahun

/<@- tentang 2u%ungan Interpersonal "alam Keperaatan(

2u%ungan interpersonal !ang ,eplau *uga merupakan proses "imana

pengetahuan keperaatan "apat "ikem%angkan "an "i1ali"asi 3Ree"$

/<<6%4( ,eplau 3/<CC4 Keperaatan a"alah hu%ungan manusia antarain"i1i"u !ang sakit atau mem%utuhkan pela!anan kesehatan$ "an

peraat terutama "i"i"ik untuk mengenali "an merespon ke%utuhan

%antuan( )an ,eplau 3/<@-4 Kesehatan merupakan sim%ol kata !ang

men!iratkan gerak ma*u kepri%a"ian "an proses manusia lainn!a

!ang se"ang %erlangsung ke arah kreati+$ konstrukti+$ pro"ukti+$ hi"up

pri%a"i "an komunitas( 2u%ungan peraat&pasien sangat penting

untuk mem%erikan asuhan keperaatan "an %ersum%er "ari

ke%utuhan manusia akan keterhu%ungan !ang masih penting "alam

a%a" ke&-/ 3,eplau$ /<<B4( Struktur hu%ungan interpersonal !angaaln!a "igam%arkan "alam empat +ase8 orientasi$ i"enti+ikasi$

eksploitasi$ "an resolusi 3,eplau$ /<@-4( 7or#huk 3/<</4$ "engan

"ukungan "ari ,eplau$ men*elaskan struktur se%agai ter"iri "ari tiga

tahap utama8 orientasi$ %eker*a 3!ang "imasukkan i"enti+ikasi "an

eksploitasi4$ "an terminasi( )alam pu%likasi tahun /<<B$ ,eplau

men"ukung ini tampilan tiga +asa "an men*elaskan %aha +ase !ang

tumpang tin"ih$ masing&masing memiliki karakteristik !ang unik(

Mo"el teoritis ,eplau "apat "ikategorikan se%agai middle range

theory( 2al ini sempit "alam lingkup "ari mo"el konseptual atau

grand theory "an alamat se*umlah *elas konsep terukur 3misaln!a$

hu%ungan terapeutik$ ke#emasan4( Teori ini memiliki +okus khusus

http://search.proquest.com/indexinglinkhandler/sng/au/Reed,+Pamela+G/$N?accountid=38628

http://search.proquest.com/indexinglinkhandler/sng/au/Shearer,+Nelma+B/$N?accountid=38628





pa"a karakteristik "an proses hu%ungan terapeutik se%agai meto"e

keperaatan untuk mem%antu mengelola ke#emasan "an men"orong

perkem%angan !ang sehat( )engan "emikian$ mo"el ini langsung

%erlaku untuk penelitian "an praktek( Mo"el ,eplau a"alah historis

signi+ikan untuk praktek "alam hal itu men"orong keperaatan psikiatri "ari peraatan kusto"ian %er%asis antarpri%a"i hu%ungan

%er%asis teori peraatan( ,eplau "ianggap se%agai pen"iri pro+esional

psikiatri keperaatan kesehatan mental "an a"alah !ang pertama

untuk memulai suatu "aerah praktik keperaatan #anggih( Aplikasi

mo"el "itemukan "alam psikoterapi in"i1i"u$ peraatan pen!akit

terminal$ "an kelompok "an terapi keluarga( ,raktek %er"asarkan

,eplau teori %erkisar "ari rumah sakit kepa"a mas!arakat "an

keluarga( ,eker*aan teoritis ,eplau *uga telah mempromosikan

Gpara"igma pro+esionalisasiG "an pem%er"a!aan untuk men"i"ik

peraat untuk a%a" ke&-/ 3Sills$ /<<C4( Se#ara internasional$ peraat

mengakui arisan ,eplau "an rele1ansi a%a"i teorin!a untuk

keperaatan "i milenium %aru 3misaln!a$ ?arker -...4( Ke%angkitan

keperaatan oleh i"e&i"e ,eplau "i tahun /<@.&an %erlan*ut hari ini

melalui eksplorasi$ stu"i$ "an penggunaan praktek s#ien#e%ase" teori

hu%ungan interpersonal( ?ee%er 3/<<C4 penelitian "an pengem%angan

teori telah "iperpan*ang Mo"el ,eplau "alam #ara !ang penting$

menggunakan estetika mengetahui untuk menguraikan konsep pola

interpersonal "an meresmikan ,eplau 3/<<B4 gagasan transisi "alam

teori praktek "epresi( Tulisan metateoretis "ari ,e"en 3/<<C4 "anRee" 3/<<6a4$ terinspirasi oleh strategi pra#ti#e%ase" ,eplau

pem%angunan teori$ meramalkan +iloso+i mun#ul ilmu keperaatan

%aha sanksi "okter serta peneliti tra"isional pengetahuan&

pem%angun(

Ju"ul 8 $%amining peplau"s pattern integrations in long-term care

,enulis 8 S#ha+er$ ,enn!= Mi""leton$ Joan( !ea6ili,a,i5. Nuri.g -6(@

3Sep5#t -.//48 /<-&B(

Analisis 8 Jurnal ini memperlihatkan %agimana ter*a"i perkem%angan "ari teori

peplau !ang se%elumn!a peplau ter"iri "ari ,eplau mengi"enti+ikasi

empat +ase hu%ungan terapeutik8 3a4 orientasi$ 3%4 i"enti+ikasi$ 3#4

eksploitasi$ "an 3"4 resolusi( Tugas utama "ari +ase orientasi a"alah

untuk mengi"enti+ikasi masalah "an ke%utuhan !ang memoti1asi pasien untuk men#ari %antuan( Selama +ase i"enti+ikasi$ peraat "an

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pasien terus mengklari+ikasi masalah "an pasien menilai kemampuan

peraat untuk mem%antu( ,asien mengi"enti+ikasi "engan peraat

%er"asarkan ke%utuhan mereka untuk %antuan "an kemampuan

peraat untuk mem%antu( Tahap eksploitasi ter*a"i ketika pasien$ atas

"asar kepentingan pri%a"i atau ke%utuhan$ mem%uat penuh

penggunaan la!anan !ang terse"ia( 7ase resolusi "itan"ai "engan

persepsi pasien ke%utuhan %aru se%agai ke%utuhan asli terpenuhi(

Meskipun potensi peraat untuk %erkem%ang se#ara pro+esional

melekat "alam hu%ungan terapeutik peraat&pasien$ itu a"alah

ke%utuhan pasien !ang tetap merupakan %agian terpenting hu%ungan

itu( Ketika ke%utuhan "asar pasien terpenuhi$ ke%utuhan !ang le%ih

kompleks lainn!a mun#ul( Sa!angn!a$ ketika ke%utuhan peraat

ti"ak "iakui$ mereka men*a"i prioritas utama atau n!a "an

mengharuskan +okus peraat tentang #ara&#ara "i mana pasien a"alah

memenuhi ke%utuhan ini %ukan pa"a ke%utuhan pasien 3,eplau$

/<@-4( ,eraat$ kurang men!a"ari apa !ang se%enarn!a ter*a"i$ ti"ak

#ukup siap untuk menggunakan hu%ungan interpersonal untuk

meningkatkan pertum%uhan kepri%a"ian pasien "an terka"ang ti"ak

senga*a terli%at "alam pola %erinteraksi pro"uk itu atau meniru

patologi "aripa"a meningkatkan pertum%uhan 3,eplau$ /<C<a4(

,eplau 3/<C<%4 mengi"enti+ikasi empat konsep %aha peraat harusmemahami "an gunakan untuk memastikan %aha mereka terli%at

"alam Ginterpersonal aman praktik keperaatanG8 ke#emasan$

interaksi pola$ man"iri$ "an #ara mengalami( Interaksi Nee"&pola

!ang "ipertim%angkan "i sini( integrasi pola Analisis terpisah

kemungkinan ter%aik selesai "alam lingkungan "i mana

peraatn!aman men"iskusikan reaksi pri%a"i$ "an harapan mereka$

arga( )engan "emikian$ hu%ungan !ang men"ukung "engan rekan&

rekan$ "aripa"a pen!e"iaan peraatan$ men*a"i sarana %agi sta+ untuk

mere"akan ke#emasan !ang terkait "engan %eker*a sama "engan

pen"u"uk mu"a( Meningkatkan sum%er "a!a pri%a"i "an pro+esional

peraat "apat se#ara e+ekti+ "apat "i#apai "engan mem%erikan

pelatihan khusus "alam komunikasi "an interaksi pola( Namun$ %ia!a

pelatihan semua peraat"apat mele%ihi sum%er "a!a keuangan "an

+asilitas peraatan *angka pan*ang( Alternati+ akan mem%uat posisi

pa"a setiap lingkungan untuk in"i1i"u terlatih khusus$ seperti peraat

psikiatri$ untuk menilai interaksi pola "an mempromosikan peluang

untuk pertum%uhan melalui interaksi !ang sehat arga "an pengasuh(



)engan "emikian$ pergeseran penekanan "ari kualitas pela!anan

terha"ap kualitas hi"up "an lingkungan ker*a$ akan ter#apai(

Mempromosikan suasana "i mana peraat%e%as untuk memeriksa

reaksi mereka kepa"a pen"u"uk$ "an "i"ukung "alam mem%uat

peru%ahan !ang "iperlukan "alam perilaku mereka$ "apat mengurangi

kemungkinan reaksi pri%a"i men*a"i %ahan %akar patologi

mempro"uksi$ ke%utuhan&pola integrasi( Se%agai ,eplau 3/<C<a4

menegaskan$ #ara ter%aik untuk men#egah men*a"i tanpa "isa"ari

terli%at "alam sehat mem%utuhkan&pola integrasi a"alah untuk

peraat men!a"ari harapan mereka pegang arga(

C. Pe06aaa. ur.al

)ari ke"ua *urnal "iatas "apat "ilihat perkem%angan "ari teori ,eplau( )imulai pa"a

tahun /<0.&an ,eplau merumuskan i"e&i"e teoritis n!a tentang proses terapi keperaatan

"an pa"a tahun /<@- ,eplau mener%itkann!a "alam %uku tentang 2u%ungan

Interpersonal "alam Keperaatan( Menurut ,eplau struktur hu%ungan interpersonal

!ang aaln!a "igam%arkan "alam empat +ase8 orientasi$ i"enti+ikasi$ eksploitasi$ "an

resolusi 3,eplau$ /<@-4( ,a"a tahun /<</ "engan "ukungan "ari ,eplau$ 7or#huk

men*elaskan struktur hu%ungan interpersonal ter"iri "ari tiga tahap utama8 orientasi$

%eker*a 3!ang "imasukkan i"enti+ikasi "an eksploitasi4$ "an terminasi( )alam pu%likasi

tahun /<<B$ ,eplau men"ukung ini tampilan tiga +asa "an men*elaskan %aha +ase !ang

tumpang tin"ih$ masing&masing memiliki karakteristik !ang unik( ,a"a tahun /<<B *uga

,eplau mengatakan %aha '2u%ungan peraat&pasien sangat penting untuk mem%erikan

asuhan keperaatan "an %ersum%er "ari ke%utuhan manusia akan keterhu%ungan !ang

masih penting "alam a%a" ke&-/D( ,a"a tahun /<<C Sills men!atakan %aha teori ,eplau

telah mempromosikan Gpara"igma pro+esionalisasiG "an pem%er"a!aan untuk men"i"ik

peraat untuk a%a" ke&-/( ?ee%er 3/<<C4 penelitian "an pengem%angan teori telah

"iperpan*ang Mo"el ,eplau "alam #ara !ang penting$ menggunakan estetika untuk

menguraikan konsep pola interpersonal !ang "iresmikan oleh ,eplau pa"a tahun/<<B

!ang merupakan gagasan transisi "alam teori praktek keperaatan terha"ap "epresi(

Ke%angkitan keperaatan oleh i"e&i"e ,eplau "i tahun /<@.&an %erlan*ut hari ini melalui

eksplorasi$ stu"i$ "an penggunaan praktek sciencebased teori hu%ungan interpersonal(

Tulisan metateoretis "ari ,e"en 3/<<C4 "an Ree" 3/<<6a4$ terinspirasi oleh strategi

practicebased ,eplau pem%angunan teori$ meramalkan +iloso+i mun#ul ilmu keperaatan

%aha sanksi "okter serta peneliti tra"isional pengetahuan&pem%angun( Se#ara



internasional$ peraat mengakui arisan ,eplau "an rele1ansi a%a"i teorin!a untuk

keperaatan "i milenium %aru 3misaln!a$ ?arker -...4( 2al "iatas "apat mem%uktikan

%aha pengem%angan empiris tentang mo"el konseptual "ari teori ,eplau( Mo"el teoritis

,eplau "apat "ikategorikan se%agai middle range theory( 2al ini sempit "alam lingkup

"ari mo"el konseptual atau grand theory "an alamat se*umlah *elas konsep terukur

3misaln!a$ hu%ungan terapeutik$ ke#emasan4( ,eplau men"e+inisikan Manusia se%agai

suatu organism !ang %er*uang "engan #aran!a sen"iri untuk mengurangi ketegangan

!ang "ise%a%kan oleh ke%utuhan( Lingkungan %u"a!a "an a"at istia"at merupakan +a#tor

!ang perlu "ipertim%angkan "alam mengha"api kehi"upan( Kesehatan merupakan

sim%ol kata !ang men!iratkan gerak ma*u kepri%a"ian "an proses manusia lainn!a !ang

se"ang %erlangsung ke arah kreati+$ konstrukti+$ pro"ukti+$ hi"up pri%a"i "an komunitas(

Keperaatan a"alah hu%ungan manusia antara in"i1i"u !ang sakit atau mem%utuhkan

pela!anan kesehatan$ "an peraat terutama "i"i"ik untuk mengenali "an merespon

ke%utuhan %antuan(

D. Ke-ua,a. da. -ele0aa. dala0 apli-ai 0ai.g70ai.g pe0i.a,a.

1. Kele%ihan(

a( )apat meningkatkan ke*iaan pasien untuk le%ih %aik(

%( )apat menurunkan ke#emasan klien "alam teori keperaatan(

#( )apat mem%erikan asuhan keperaatan !ang le%ih %aik(

"( )apat me"orong pasien untuk le%ih man"iri(

2. Kelemahan

a. ?er+okus pa"a ke*iaan pasien "alam pen!em%uhann!a(



+A+ III

PENUTUP

A. Kei0pula.

,a"a tahun /<0.&an ,eplau merumuskan i"e&i"e teoritis n!a tentang proses terapi

keperaatan "an pa"a tahun /<@- ,eplau mener%itkann!a "alam %uku tentang

2u%ungan Interpersonal "alam Keperaatan( Menurut ,eplau struktur hu%ungan

interpersonal !ang aaln!a "igam%arkan "alam empat +ase8 orientasi$ i"enti+ikasi$

eksploitasi$ "an resolusi 3,eplau$ /<@-4( ,a"a tahun /<</ "engan "ukungan "ari ,eplau$

7or#huk men*elaskan struktur hu%ungan interpersonal ter"iri "ari tiga tahap utama8

orientasi$ %eker*a 3!ang "imasukkan i"enti+ikasi "an eksploitasi4$ "an terminasi( )alam

pu%likasi tahun /<<B$ ,eplau men"ukung ini tampilan tiga +asa "an men*elaskan %aha

+ase !ang tumpang tin"ih$ masing&masing memiliki karakteristik !ang unik( Mo"el

teoritis ,eplau "apat "ikategorikan se%agai middle range theory( 2al ini sempit "alam

lingkup "ari mo"el konseptual atau grand theory "an alamat se*umlah *elas konsep

terukur 3misaln!a$ hu%ungan terapeutik$ ke#emasan4(



La0pira.

Peplau8 Te5re,i9al M5delRee"$ ,amela = Shearer$ Nelma ? ( Ne Fork8 Springer ,u%lishing :ompan!$ -..6(Turn on hit highlighting +or speaking %rosers %! sele#ting the Enter %utton2i"e highlighting

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2il"egar" ,eplau 3/<.<&/<<<4 +ormulate" her theoreti#al i"eas a%out the therapeuti# pro#ess

o+ nursing in the /<0.s an" pu%lishe" them in the no&#lassi# /<@- %ook$ InterpersonalRelations in Nursing$ a+ter a length! "ispute ith pu%lishers a%out the a%ilit! o+ a nurse toauthor a %ook( At a time hen nurses ere G"oersG +or patients an" G+olloersG o+ ph!si#iansor"ers$ ,eplaus theoreti#al ork an" tea#hings helpe" #atapult nursing +rom an o##upation toa pro+ession( ,eplaus i"eas pro1i"e" a +oun"ation +or nurses to un"erstan" health +rom anursing theoreti#al perspe#ti1e an" to esta%lish interpersonal relationships ith patients as thesigni+i#ant #ontet in hi#h nurses +a#ilitate patients ell&%eing(

Through ,eplaus therapeuti# relationship$ the patient "e1elops inner resour#es +or health! %eha1iors %! a#ti1el! parti#ipating ith the nurse in a "e1elopmental pro#ess o+ #hange(,eplaus interpersonal relationship is also a pro#ess through hi#h nursing knole"ge is"e1elope" an" 1ali"ate" 3Ree"$ /<<6%4( ,eplau 3/<<-4 purpose+ull! linke" her theor! to

pra#ti#e an" resear#h$ as e1i"en#e" in her %asi# assumption that Ghat goes on %eteen people #an %e noti#e"$ stu"ie"$ eplaine"$ un"erstoo"$ an"$ i+ "etrimental$ #hange"G 3p( /04(



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,eplaus theoreti#al mo"el "eri1es +rom the perspe#ti1e o+ a #riti#al philosoph! that integrates %oth the s#ien#e an" pra#ti#e o+ nursing in theor! "e1elopment( ,eplaus theoreti#al mo"elas %ase" upon her stu"!$ o%ser1ation$ an" anal!ses o+ nurses an" patients an" asin+luen#e" %! 2arr! Sta#k Sulli1an an" others ps!#ho"!nami# perspe#ti1es( ,eplaus 3/<@-4#lassi# "es#riptions o+ nursing epress the nature an" goals o+ the interpersonal pro#ess8

GNursing is a human relationship %eteen an in"i1i"ual ho is si#k or in nee" o+ healthser1i#es$ an" a nurse espe#iall! e"u#ate" to re#ognie an" to respon" to the nee" +or helpG3pp( @&64( Nursing is an Ge"u#ati1e instrument$ a maturing +or#e$ that aims to promote+orar" mo1ement o+ personalit! in the "ire#tion o+ #reati1e$ #onstru#ti1e$ pro"u#ti1e$

personal$ an" #ommunit! li1ingG 3p( /64( ,eplau 3/<CC4 +urther "es#ri%e" nursing as anGena%ling$ empoering$ or trans+orming artG 3p( <4( 2ealth$ a##or"ing to ,eplau 3/<@-4$ is aGor" s!m%ol that implies +orar" mo1ement o+ personalit! an" other ongoing human

pro#esses in the "ire#tion o+ #reati1e$ #onstru#ti1e$ pro"u#ti1e$ personal an" #ommunit!li1ingG 3p( /-4( Illness +or#es a Gsto#ktaking %! the si#k person$ hi#h nurses #an use to

promote learning$ groth an" impro1e" #ompeten#ies +or li1ingG 3,eplau$ /<<-$ p( /94(2ealth an" illness are #losel! linke" to su##ess+ul management o+ aniet!$ hi#h ranges +rom

pure euphoria to pure aniet!( An optimal le1el lies %eteen these aniet! etremes$ as"etermine" %! nurse an" patient(

Through the therapeuti# relationship$ the nurse uses a #omple set o+ strategies to assist the patient in using energ! pro1i"e" %! the aniet! to i"enti+! an" gro +rom a pro%lemati#situation 35Toole S# Welt$ /<C<= Ree"$ -..@4( The nurse&patient relationship is +un"amentalto pro1i"ing nursing #are an" "eri1es +rom the human nee" +or #onne#te"ness that is stillessential in the -/st #entur! 3,eplau$ /<<B4( Through this interpersonal relationship$ nursesassess an" assist people to8 3a4 a#hie1e health! le1els o+ aniet! intrapersonall! an" 3%4+a#ilitate health! pattern integrations interpersonall!$ ith the o1erall goal o+ +ostering ell&

%eing$ health$ an" "e1elopment( This relationship also pro1i"es the #ontet +or the nurse to

"e1elop$ appl!$ an" e1aluate theor!&%ase" knole"ge +or nursing #are( Nurse interpersonal#ompeten#ies$ in1estigati1e skill$ an" theoreti#al knole"ge as ell as patient #hara#teristi#san" nee"s are all important "imensions in the pro#ess an" out#omes o+ the relationship3,eplau4(

The stru#ture o+ the interpersonal relationship as originall! "es#ri%e" in terms o+ +our phases8 orientation$ i"enti+i#ation$ eploitation$ an" resolution 3,eplau$ /<@-4( 7or#huk 3/<</4$ ith the support o+ ,eplau$ #lari+ie" the stru#ture as #onsisting o+ three main phases8orientation$ orking 3hi#h in#orporate" i"enti+i#ation an" eploitation4$ an" termination( Ina /<<B pu%li#ation$ ,eplau en"orse" this three&phase 1ie an" eplaine" that the phases ereo1erlapping$ ea#h ha1ing uniHue #hara#teristi#s( Throughout these phases the nurse +un#tions#ooperati1el! ith the patient in the nursing roles o+ stranger$ resour#e person$ #ounselor$lea"er$ surrogate$ an" tea#her( The nurses range o+ +o#us in#lu"es the patient in relationshipith the +amil!$ other health #are pro1i"ers$ an" #ommunit! 3,eplau$ /<@-$ /<<B4(

The orientation phase marks a +irst step in the personal groth o+ the patient an" is initiate"hen the patient has a G+elt nee"G an" seeks pro+essional assistan#e 3,eplau$ /<@-$ p( /C4( Thenurse +o#uses on Gknoing the patient as a personG an" un#o1ering erroneous pre#on#eptions$as ell as gathering in+ormation a%out the patients mental health pro%lem 3,eplau$ /<<B4(The nurse an" patient #olla%orate on a plan$ ith #onsi"eration o+ the patients e"u#ati1enee"s( Throughout the pro#ess$ the nurse re#ognies that the poer to a##omplish the tasks athan" resi"es ithin the patient an" is +a#ilitate" through the orkings o+ therapeuti#relationship(

The +o#us o+ the orking phase is on8 3a4 the patients e++orts to a#Huire an" emplo!knole"ge a%out the illness$ a1aila%le resour#es$ an" personal strengths$ an" 3%4 the nurses



ena#tment o+ the roles o+ resour#e person$ #ounselor$ surrogate$ an" tea#her in +a#ilitating the patients "e1elopment toar" ell&%eing 3,eplau$ /<@-$ /<<B4( The relationship is +lei%leenough +or the patient to +un#tion "epen"entl!$ in"epen"entl!$ or inter"epen"entl! ith thenurse$ %ase" on the patients "e1elopmental #apa#it!$ le1el o+ aniet!$ sel+&aareness$ an"nee"s(

Termination is the +inal phase in the pro#ess o+ the therapeuti# interpersonal relationship(,atients mo1e %e!on" the initial i"enti+i#ation ith the nurse an" engage their on strengthsto +oster health outsi"e the therapeuti# relationship 3,eplau$ /<@-$ /<CC4( In a""ition toa""ressing #losure issues$ the nurse an" patient engage in planning +or "is#harge an"

potential nee"s +or transitional #are 3,eplau$ /<<B4(

,eplaus theoreti#al mo"el #an %e #ategorie" as a mi""le&range theor!( It is narroer ins#ope than a #on#eptual mo"el or gran" theor! an" a""resses a #learl! "e+ine" num%er o+ measura%le #on#epts 3e(g($ therapeuti# relationship$ aniet!4( The theor! has a spe#i+i# +o#uson the #hara#teristi#s an" pro#ess o+ the therapeuti# relationship as a nursing metho" to helpmanage aniet! an" +oster health! "e1elopment( As su#h$ the mo"el is "ire#tl! appli#a%le to

resear#h an" pra#ti#e(,eplau as epli#it in promoting resear#h%ase" theor!( Resear#h %ase" on ,eplaustheoreti#al mo"el has a""resse" topi#s relate" to %oth nurse %eha1iors an" patient health#on"itions( Nurse&+o#use" topi#s in#lu"e8 3a4 the pra#ti#es o+ ps!#hiatri# mental&healthnurses$ 3%4 +amil! s!stems nursing$ an" 3#4 the nature o+ the nurse&patient relationship inre+eren#e to roles an" role #hanges o1er the tra*e#tor! o+ a mental illness$ %oun"ar! issues in

pe"iatri# nursing$ an" #on#epts su#h as therapeuti# intima#!( ,atient&+o#use" resear#h hasa""resse" health #on"itions in#lu"ing "epression$ ps!#hosis$ seual a%use$ Alheimers"isease$ an" multiple s#lerosis( A parti#ularl! nota%le ,eplau&%ase" resear#her is 7or#huk 3e(g($ 7or#huk$ /<<0= 7or#huk et al($ /<<C= 7or#hu#k$ Jeell$ Tee"ell$ S# Steinnagel$ -..94

ho$ along ith #olleagues$ has #on"u#te" a program o+ resear#h into appli#ations o+ theinterpersonal relationship pro#ess in ps!#hiatri# mental&health nursing #are(

,eplaus mo"el is histori#all! signi+i#ant +or pra#ti#e in that it propelle" ps!#hiatri# nursing+rom #usto"ial&%ase" #are to interpersonal relationship theor!&%ase" #are( ,eplau is#onsi"ere" the +oun"er o+ pro+essional ps!#hiatri# mental&health nursing an" as the +irst toinitiate an area o+ a"1an#e" pra#ti#e nursing( 2er theoreti#al i"eas #ontinue to %e signi+i#antin #ontemporar! nursing +or their rele1an#e in not onl! ps!#hiatri# mentalhealth nursing

pra#ti#e %ut pra#ti#e an!here a nurse&patient relationship eists( Appli#ations o+ the mo"elare +oun" in in"i1i"ual ps!#hotherap!$ reminis#en#e therap!$ terminal illness #are$ an" groupan" +amil! therap!( ,ra#ti#es %ase" upon ,eplaus theor! range +rom hospital to #ommunit!an" home&%ase"(

,eplaus theor! has pro1i"e" an en"uring e"u#ational +oun"ation +or tea#hing the nurse& patient relationship as a pi1otal nursing pro#ess in all #ontets o+ pra#ti#e( A #ommon philosoph! un"erl!ing all nursing #urri#ula is a %elie+ in the 1alue o+ a therapeuti# nurse& patient relationship that promotes a#ti1e parti#ipation o+ patients in their health #are( ,eplaustheoreti#al ork has also promote" a Gpara"igm o+ pro+essionaliationG an" empoerment+or e"u#ating nurses +or the -/st #entur! 3Sills$ /<<C4(

,eplaus theoreti#al mo"el #ontinues to in+luen#e nursing resear#h$ pra#ti#e$ an" e"u#ation35Toole S# Welt$ /<C<4$ although her original #ontri%utions ha1e %e#ome knole"ge in the

pu%li# "omain an" are not ala!s epli#itl! a#knole"ge"( Internationall!$ nurses arere#ogniing ,eplaus lega#! an" the en"uring rele1an#e o+ her theor! +or nursing in the ne

millennium 3e(g($ ?arker -...4( The #lini#al signi+i#an#e o+ the therapeuti# relationship islikel! to in#rease as health pro%lems shi+t to those relate" to stress&relate" #on"itions$ #hroni#



illness$ aging pro#esses$ an" en" o+ li+e$ here me"i#al&surgi#al approa#hes alone ha1e littlesu##ess in promoting ell&%eing( ,eplaus interpersonal relationship theor! is epe#te" toithstan" the #urrent health #are #risis an" pro1i"e a #ost&e++e#ti1e an" satis+!ing resour#e+or patient ell&%eing a#ross a 1ariet! o+ nursing #ontets(

The reaakening o+ nursing %! ,eplaus i"eas in the /<@.s #ontinues to"a! througheploration$ stu"!$ an" use o+ the s#ien#e%ase" pra#ti#e o+ interpersonal relations theor!(?ee%ers 3/<<C4 resear#h an" theor! "e1elopment ha1e eten"e" ,eplaus mo"el in importanta!s$ using aestheti# knoing to ela%orate on the #on#ept o+ interpersonal pattern an"+ormaliing ,eplaus 3/<<B4 i"ea o+ transitions in a pra#ti#e theor! o+ "epression(Metatheoreti#al ritings o+ ,e"en 3/<<C4 an" Ree" 3/<<6a4$ inspire" %! ,eplaus

pra#ti#e%ase" strateg! o+ theor! "e1elopment$ porten" an emerging philosoph! o+ nursings#ien#e that san#tions #lini#ians as ell as tra"itional resear#hers as knole"ge&%uil"ers(Through the #reati1e s#holarship o+ nurses$ ,eplaus theoreti#al mo"el #an #ontinue to e1ol1ean" inspire "e1elopment o+ nurse&patient pro#esses that meet #ontemporar! health nee"s o+ so#iet!(

,AMELA ( REE) NELMA ?( S2EARER

Au,5rAilia,i5.

,amela ( Ree"$ ,h)$ RN$ 7AAN

,ro+essor

Uni1ersit! o+ Ariona

:ollege o+ Nursing

Tu#son$ AO

,eplaus Theoreti#al Mo"el= Spiritualit!

Nelma ?( Shearer$ ,h)$ RN

Assistant ,ro+essor

:ollege o+ Nursing

Ariona State Uni1ersit!

Tempe$ AO

,eplaus Theoreti#al Mo"el

Wor" #ount8 1'(1

:op!right Springer ,u%lishing :ompan! -..6



Ea0i.i.g peplau8 pa,,er. i.,egra,i5. i. l5.g7,er0 9areSchafer, Penny; Middleton, Joan. Rehabilitation Nursing 26.5 (Sep/Oct 2011)

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:ontrar! to the so#ietal 1ie that onl! the +rail el"erl! resi"e in long&term #are +a#ilities$man! !oung a"ults ho reHuire resi"ential #are to maintain optimal health$ or ho are in areha%ilitation program$ also li1e in these +a#ilities( The relationships %eteen resi"ents an"#aregi1ers in long&term #are +a#ilities ma! "e1elop into relationships that are more t!pi#all!

+amilial than pro+essional( With these emerging +amil!&like relationships$ the interpersonal pattern intera#tions ma! %e health! or unhealth! an" ma! #reate opportunities +or groth or patholog!&pro"u#ing patterns( This arti#le illustrates ho appl!ing ,eplaus #on#ept o+ nee"& pattern integrations in the long&term #are setting has the potential to enhan#e un"erstan"ing$an" su%seHuentl! gui"e intera#tions$ %eteen !ounger resi"ents an" #aregi1ers( The potentialis greatest hen intera#tions are gui"e"(

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interpersonal theor!$ therapeuti# relationships$ poer

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:ontrar! to the so#ietal 1ie that onl! the +rail el"erl! resi"e in long&term #are +a#ilities$man! !oung a"ults ho reHuire resi"ential #are to maintain optimal health$ or ho are in areha%ilitation program$ also li1e in these +a#ilities( The relationships %eteen resi"ents an"#aregi1ers in long&term #are +a#ilities ma! "e1elop into relationships that are more t!pi#all!+amilial than pro+essional( With these emerging +amil!like relationships$ the interpersonal

pattern intera#tions ma! %e health! or unhealth! an" ma! #reate opportunities +or groth or patholog!&pro"u#ing patterns( This arti#le illustrates ho appl!ing ,eplaus #on#ept o+ nee"& pattern integrations in the long&term #are setting has the potential to enhan#e un"erstan"ing$an" su%seHuentl!

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gui"e intera#tions$ %eteen !ounger resi"ents an" #aregi1ers( The potential is greatest henintera#tions are gui"e"(

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,enn! S#ha+er is a group #oor"inator +or the Aggressi1e ?eha1ior :ontrol ,rogram at theRegional ,s!#hiatri# :entre 3,rairies4 in Saskatoon$ SK$ :ana"a( 2er resear#h has eamine"



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therapeuti# relationships an" therapeuti# %oun"ar! maintenan#e( Joan Mi""leton is a #lini#alnurse spe#ialist at ,arkri"ge :entre in Saskatoon( She has orke" in long&term #are an"e"u#ation +or -. !ears( 2er spe#ialt! areas are %eha1ior management an" mental healthnursing( 2er ma*or resear#h is on pain in the #ommuni#ati1el! impaire" el"erl!( A""ress#orrespon"en#e to ,enn! S#ha+er$ 9-B Eastman :o1e$ Saskatoon$ SK SBN 0L/$ :ana"a or e&

mail p(s#ha+erPsk(s!mpati#o(#a(,eplau 3/<C<a4 argue" that pattern integrations as a use+ul #on#ept ith hi#h to assessintera#tion patterns an" to then inter1ene to pro"u#e groth&promoting patterns in aninpatient ps!#hiatri# setting( Although mental illness is not t!pi#all! a +a#tor that pre#ipitatesa"mission to long&term #are$ pattern integrations appear to ha1e utilit! in long&term #are(Using 1ignettes o+ !ounger a"ults ho li1e in long&term #are en1ironments to maintain their optimal health$ or to re#ei1e reha%ilitation ser1i#es$ e illustrate here ho ,eplaus 3/<C<a4nee"&pattern integrations #on#ept has the potential to enhan#e un"erstan"ing %eteen#aregi1ers an" resi"ents an" gui"e their intera#tions( 5n#e gui"e"$ intera#tions promotegroth$ an" the resi"ents ph!si#al an" ps!#hoso#ial nee"s remain #entral to the emerging

relationship(Long&term #are +a#ilities %e#ome the homes o+ those people ho resi"e in them$ an" in li1ingtogether$ as +amil!$ the! share the a1aila%le resour#es( Long&term #are resi"ents are generall!"epen"ent to some "egree on the assistan#e o+ other people( Thus$ the #are the! re#ei1e$ an"those ho pro1i"e that #are$ %e#ome their most 1alua%le resour#es( Un"erstan"a%l!$ theintera#tion %eteen resi"ents an" #aregi1ers ma! "e1elop into relationships that are moret!pi#all! +amilial than pro+essional 3Mi""leton$ Steart$ ; Ri#har"son$ /<<<4( A""itionall!$relationships %eteen resi"ents ma! also a#Huire man! o+ the #hara#teristi#s more t!pi#al o+ those relationships %eteen +amil! mem%ers( :onseHuentl!$ long&term #are +a#ilities %e#omethe areas here %oth #aregi1ers an" resi"ents re#reate the patterns o+ intera#ting that#hara#terie" pre1ious eperien#es( Just as it happens in +amilies$ the emerging interpersonal

pattern intera#tions ma! %e either health! or unhealth!$ ma! #reate groth promotingopportunities or result in patholog!&pro"u#ing pat&( terns 3,eplau$ /<C<a4(

,eplaus interpersonal theor!$ t!pi#all! applie" in ps!#hiatri# nursing 37or#huk$ /<<94$ alsohas appli#ations in long&term #are$ here #aregi1ers ma! unknoingl! parti#ipate in patternsthat "o not +oster groth +or the +a#ilit!s resi"ents( A #omplete re1ie o+ ,eplaus 3/<@-4interpersonal theor! is %e!on" the s#ope o+ this paper( Fet$ a summar! is not likel! to pro1i"ethe "etail ne#essar! +or the rea"er to master the nee"&pattern #on#ept that is applie"etensi1el! here( The +olloing material is a 1er! %rie+ o1er1ie o+ ,eplaus interpersonaltheor!$ an" a s!nopsis o+ the #on#ept nee"&pattern integrations(

,eplaus interpersonal theor! o+ nursing

When the nurse&patient relationship is #entral to the pro1ision o+ #are$ the +o#us shi+ts +rom"oing G+orG patients to "oing GithG patients 37or#huk$ /<<94( ,eplaus 3/<@-4 theor!emphasies the in"i1i"uals personal&so#ial groth$ rather than the pro%lem ne#essitating#are( In pro1i"ing #are an" attempting to resol1e the presenting pro%lem$ the nurseesta%lishes ith the patient a relationship that %e#omes the means through hi#h the patient#an a#hie1e groth in personalit! "e1elopment( ,eplau i"enti+ie" +our phases o+ thetherapeuti# relationship8 3a4 orientation$ 3%4 i"enti+i#ation$ 3#4 eploitation$ an" 3"4 resolution(The primar! task o+ the orientation phase is to i"enti+! the pro%lem an" the nee"s thatmoti1ate" the patient to seek help( )uring the i"enti+i#ation phase$ the nurse an" patient#ontinue to #lari+! the pro%lem an" the patient assesses the nurses a%ilit! to help( ,atients

i"enti+! ith the nurse %ase" on their nee" +or help an" the nurses a%ilit! to help( Theeploitation phase o##urs hen the patient$ on the %asis o+ sel+&interest or nee"$ makes +ull



use o+ ser1i#es a1aila%le( The resolution phase is #hara#terie" %! the patients per#eptions o+ ne nee"s as the original nee"s are met(

Although the potential +or the nurse to gro pro+essionall! is inherent in the nurse&patienttherapeuti# relationship$ it is the patients nee"s that remain #entral to that relationship( Whenthe patients %asi# nee"s are met$ other more #omple nee"s emerge( Un+ortunatel!$ hen thenurses nee"s are not re#ognie"$ the! %e#ome his or her top priorit! an" reHuire that thenurse +o#us on the a!s in hi#h the patient is meeting these nee"s rather than on the

patients nee"s 3,eplau$ /<@-4( The nurse$ less aare o+ hat is a#tuall! o##urring$ is nota"eHuatel! prepare" to use interpersonal relations to promote the patients personalit! grothan" ma! unintentionall! engage in patterns o+ intera#ting that pro"u#e or repli#ate patholog!rather than enhan#e groth 3,eplau$ /<C<a4( ,eplau 3/<C<%4 i"enti+ie" the +our #on#epts thatnurses must un"erstan" an" use to ensure that the! are engaging in Ginterpersonall! sa+enursing pra#ti#eG8 aniet!$ pattern intera#tions$ sel+$ an" mo"es o+ eperien#ing 3Ta%le /4(

Nee"&pattern intera#tions are #onsi"ere" here(

,attern integrations

,eplau 3/<C<a4 "e+ine" a pattern as a G#hara#teristi# mo"e o+ %eha1iorG 3p( /.C4$ ith an aim$intention$ or theme( A pattern ma! %e intrapersonal$ interpersonal$ or a s!stem phenomena(:onseHuentl!$ pattern intera#tions are the intera#tions %eteen to or more patterns$ an"

pattern integration is the merging o+ patterns( In nee"&pattern integration$ there is a +it %eteen the patterns o+ to or more in"i1i"uals so that nee"s o+ all are met( In essen#e$ themerging o+ patterns is ne#essar! +or the hole to +un#tion$ %e#ause a "isruption in the pattern$su#h as hen a person is a"mitte" to long&term #are$ pro1okes pani#$ aniet!$ an" attempts toreinstate the pattern integration( 7or eample$ the in"i1i"ual ho ala!s #arrie" a allet$ an"ha" the poer to pur#hase "esire" items$ upon entering long&term #are su""enl! loses thein"epen"en#e an" poer asso#iate" ith #arr!ing #ash( The +a#ilit!s %usiness o++i#e is no

the keeper o+ the in"i1i"uals #ash$ an" the agen#! potentiall! gains poer o1er thein"i1i"ual( The loss o+ in"epen"en#e an" poer pro1okes aniet! in the in"i1i"ual$ ho ma!then %egin to hoar" items an" %e#ome suspi#ious o+ #aregi1ers an" other resi"ents( Su#h

%eha1ior ma! restore a sense o+ poer an" in"epen"en#e$ an" re"u#e the in"i1i"uals aniet!$ %ut it #reates the potential +or +urther pro%lemati# pattern integrations(

,eplau 3/<C<a4 i"enti+ie" +our t!pes o+ pattern integrations8 mutualities$ #omplementaries$re#ipro#al or alternating$ an" antagonisti#( Mutualities are patterns su#h as mutualith"raal$ "epen"en#!$ or hostilit!( :omplementaries are pattern integrations that +ittogether$ su#h as "omination an" su%mission( Re#ipro#al or alternating patterns o+ integrations are those here the pattern re1erses$ ith the resi"ent %e#oming the helper$ an"the #aregi1er %e#oming the person re#ei1ing help$ or ha1ing personal nee"s met( 7inall!$

antagonisti# pattern integrations o##ur hen the patterns o+ to in"i1i"uals$ groups$ or organiations "o not +it$ !et a relationship is maintaine"&&#onsi"er the interpersonal nee"&

pattern integrations that emerge in a long&term #are setting(

Interpersonal nee"&pattern integrations8 There are "i++erent nee"&pattern integrations apparentto an o%ser1er o+ the intera#tions %eteen long&term #are resi"ents an" #aregi1ers( The most

pro%lemati# patterns appear to %e %eteen resi"ents an" #aregi1ers$ rather than %eteenresi"ents( This is not surprising$ gi1en the #ompleit! o+ the relationships %eteen resi"entsan" #aregi1ers(

?eteen resi"ents( Mutual "epen"en#e +reHuentl! emerges as nee"&pattern integration %eteen resi"ents( )epen"ing upon one another +or support$ so#ialiation$ an" manipulation

o+ their en1ironment ma! enhan#e relationships among resi"ents( :on1ersel!$ the pattern o+ mutual hostilit! that sometimes emerges %eteen to resi"ents$ or %eteen one resi"ent an"



a group o+ resi"ents$ is pro%lemati#( Mutual hostilit! ma! take the +orm o+ 1er%al or ph!si#alatta#ks$ hurt+ul gossip$ an" #omplaints to #aregi1ers( Most o+ten$ the mutual hostilit! appearsto #enter on a #ompetition among resi"ents +or the #aregi1ers time or +a1or$ as resi"ents ma!organie their %eha1ior to gain the #aregi1ers appro1al 3,eplau$ /<C<#4( 7or eample$ aresi"ent ma! ask a #aregi1er$ GWh! "o !ou gi1e all the attention to herG= the response +rom

the other resi"ent$ an" not the #aregi1er$ ma! %e GFoure *ust *ealous #ause she the #aregi1erlikes me %etter(G

:aregi1ers ma! unittingl! perpetuate patterns o+ mutual hostilit! among resi"ents(Em%ra#ing resi"ents #omplaints a%out other resi"ents perpetuates the pattern integration(7urthermore$ resi"ents ma! sele#ti1el! #omplain a%out$ or "ire#t hostilit! at$ resi"ents hothe! per#ei1e #aregi1ers are rea#ting to personall!( ?! "oing so$ a resi"ent ma! +orm anallian#e ith a #aregi1er %! %eing a 1ehi#le +or that #aregi1er to epress +eelings that #annot

%e epresse" "ire#tl!$ an" there%! ensure the resi"ents #ontinue" satis+a#tion o+ personal #arenee"s( :aregi1ers ho are +o#use" solel! on the resi"ents ph!si#al #are nee"s$ an" areunaare o+ the intera#tion patterns emerging$ are unittingl! "ran into these nontherapeuti#

intera#tion patterns(The patterns %eteen resi"ents are not o##urring in isolation( Rather$ the! are a++e#te" %! the#aregi1ers( There+ore$ grothpromoting intera#tions must %e #ontet spe#i+i# an" must stem+rom a thorough assessment an" anal!sis o+ the intera#tions %eteen #aregi1ers an" resi"ents$an" %eteen resi"ents( While it ma! %e the aim o+ the resi"ents to ensure that the! re#ei1ea"eHuate an" eHuita%le #are$ #aregi1ers ma! %e struggling to #ope ith #on+li#ting +eelingstoar" the resi"ents$ espe#iall! i+ the resi"ents are 1er%all! or ph!si#all! aggressi1e(

?eteen resi"ents an" #aregi1ers( There is a multitu"e o+ nee"&pattern integrations that ma!emerge %eteen resi"ents an" #aregi1ers %e#ause o+ the #ompleit! o+ their relationships(:aregi1ers ha1e positions o+ poer o1er resi"ents$ ho are parti#ularl! 1ulnera%le %e#ause o+

their "epen"en#e on them( 7urthermore$ hen resi"ents are una%le to "ire#t their personal#are$ ha1ing those nee"s met ma! #on+li#t ith their nee" +or autonom!( :onseHuentl!$ *ustas "i" the ph!si#all! "isa%le" in Lillestos 3/<<B4 stu"!$ long&term #are resi"ents ma!eperien#e personal #are as a 1iolation$ transgression$ or in+ringement upon them %! thoseho pro1i"e their #are( Fet$ #aregi1ers "o not epe#t that resi"ents ill 1ie the #are as a1iolation( Rather$ the! ma! epe#t that resi"ents ill a##ept$ #ompl! ith$ an" appre#iate the#are( :aregi1ers$ unaare that the! ha1e these epe#tations$ ma! unittingl! aim to ha1ethem +ul+ille" 3,eplau$ /<C<a4( The potentiall! #on+li#ting nee"s o+ the resi"ents$ #ouple"ith the epe#tations an" the poer o+ #aregi1ers$ #reates an en1ironment in hi#h the

potential +or pro%lemati# nee"&pattern integrations ma! %e greater than the potential +or intera#tions that promote autonom! an" in"epen"en#e(

With the intent o+ ha1ing their personal #are nee"s met hile the! maintain a sense o+ autonom!$ long&term #are resi"ents ma! attempt to #ontrol their #are %! asserting poer o1er the #aregi1ers( Aggression an" "eman"ing %eha1ior ma! %e the means use" to assert their

poer an" maintain #ontrol( Joking at their on epense$ #ompartmentaliing the personal#are eperien#e %! 1ieing their %o"ies as pu%li#$ or "a!"reaming hile spe#i+i# #are is

%eing pro1i"e" 3Lillesto$ /<<B4 ma! also %e a!s that resi"ents #ope ith the #on+li#t %eteen maintaining autonom! an" +eeling 1iolate" in re#ei1ing personal #are( 7or eample$a resi"ent ma! enlist the +amil!$ or e1en politi#ians$ to help ensure that their #are nee"s aremet in a manner that is #onsistent ith their ishes(

The resi"ent ho is aggressi1e an" "eman"ing is unlikel! to meet the #aregi1ers

epe#tations( The latter ma! 1ie the resi"ent as "i++i#ult an" unappre#iati1e$ re+le#ting aten"en#! to la%el patients as either goo" or %a"$ %ase" on hether the patients meet the



#aregi1ers epe#tations 3Kell! ; Ma!$ /<C-4( This ma! result in a nee"&pattern integration o+ mutual hostilit!$ here%! the resi"ents intention is to assert autonom! through aggression$an" the #aregi1er respon"s %! setting limits( While this ma! temporaril! enhan#e resi"ent#omplian#e$ an" +ul+ill the #aregi1ers epe#tations$ setting limits ma! also perpetuate the

pattern %! in#reasing the resi"ents 1ulnera%ilit!$ an" threatening his or her sense o+

autonom!( 7eeling 1ulnera%le$ resi"ents %e#ome more aggressi1e in their e++orts to assertautonom!(

:aregi1ers$ in a""ition to epe#ting resi"ents to %e #ompliant$ an" impli#it in their nee" tohelp others$ is their epe#tation that resi"ents ill respon" to the #are that the! re#ei1e( Thisma! %e parti#ularl! true hen the resi"ent "oes not +it the stereot!pi#al image o+ a long&term#are resi"ent( The t!pi#all! so#ietal 1ie o+ su#h resi"ents is that o+ ol"er a"ults 3Mi""leton$/<<04 ho are una%le to li1e in"epen"entl! an" ma! %e alone or ithout +amil! illing to#are +or them( This 1ie is likel! hel" %! #aregi1ers orking in long&term #are(:onseHuentl!$ +e #aregi1ers are prepare" to pro1i"e #are +or !ounger resi"ents( Resi"entsare a"mitte" to long&term #are +or "i++erent reasons( 7or !oung a"ults$ a"mission ma! result

+rom hea" or spinal #or" in*uries$ or the progression o+ a terminal "isease( 7or the !oungresi"ent re#o1ering +rom trauma$ reha%ilitation is the o%*e#ti1e o+ %oth the resi"ent an"#aregi1ers( With !oung a"ults$ #aregi1ers ma! %e una%le to separate their +eelings a%out the#are the! are pro1i"ing +rom their +eelings a%out the #are the! oul" epe#t i+ the!$ or amem%er o+ their +amil!$ ere entering long&term #are(

:onseHuentl!$ the #are the! pro1i"e %e#omes the means use" to relie1e their aniet! o1er interpersonal relationships 3,eplau$ /<C<#4 ith resi"ents ho pro1oke +eelings a%out theun#ertaint! o+ their on +utures( :aregi1ers ma! go out o+ their a! to help the resi"ent$ notto promote the resi"ents in"epen"en#e$ %ut to relie1e their on aniet! an" "espair henthe! pi#ture themsel1es$ or a lo1e" one$ as a long&term #are resi"ent( Foung a"ults in long&term #are ma! learn that the %est a! to help relie1e a #aregi1ers aniet!$ hi#h is

#ommuni#ate" interpersonall! 3,eplau$ /<C<#4$ is to nee" them( :onseHuentl!$ "epen"en#e$rather than in"epen"en#e is en#ourage"$ an" this #on+li#ts ith #aregi1er epe#tations thatthe resi"ents ill impro1e as a result o+ their #are( The metho"s use" to relie1e the aniet! inthe interpersonal situation has$ as ,eplau 3/<@-4 argue"$ inter+ere" ith the "e1elopment o+ agroth&promoting relationship %eteen the resi"ent an" #aregi1er(

As time passes an" the resi"ents progress "oes not meet the #hallenges o+ #ommunit! li1ing$#aregi1ers are le+t ith unmet epe#tations$ an" the! ma! 1ie this as %oth a personal an"

pro+essional +ailure( 7a#ing their on potential to %e#ome a longterm #are resi"ent$#aregi1ers are "isappointe" personall! hen a resi"ent +ails to regain in"epen"en#e(A""itionall!$ #aregi1ers must Huestion the e++e#ti1eness o+ their #are hen resi"ents "o not

progress as epe#te"( As ,eplau 3/<C<a4 stresse"$ the #aregi1ers unmet epe#tations$ an" the pain o+ a#knole"ging the "is#repan#! %eteen the help the! %elie1e the! pro1i"e$ an" theresi"ents progress$ ma! %e epresse" as hostilit! toar"$ or emotional ith"raal +rom$ theresi"ent(

:aregi1ers ma! #omplain a%out the resi"ent ho "oes not progress as the! epe#t( The! ma!see reHuests as "eman"s +or spe#ial attention$ or simpl! hining$ an" "epen"en#e ma!

%e#ome manipulation( What as on#e a #omplementar! nee"&pattern integration o+ "epen"en#e an" aniet! relie+ +or the #aregi1er ma! %e#ome a mutual pattern o+ hostilit! or emotional ith"raal( :aregi1ers ma! respon" to a resi"ents per#ei1e" "eman"s %! settinglimits an" pro1i"ing #are that is less personal than that gi1en hen epe#tations ere %eingmet( :aregi1ers ma! %e relu#tant to respon" to a #all light$ hoping +or a response +romanother #aregi1er( The resi"ent ma! respon" %! monitoring the #are pro1i"e" +or others$ an""eman"ing eHual #are$ hile #omplaining a%out the #are the! "o re#ei1e( Ironi#all!$ in some



#ases$ the resi"ents pattern o+ "epen"en#e that is no per#ei1e" %! the #aregi1er as e1i"en#eo+ +ailure %! %oth resi"ent an" sel+ as$ in +a#t$ perpetuate" %! the #aregi1er( The potential +or intera#tions to repli#ate or pro"u#e patholog! 3,eplau$ /<C<a4 is realie"(

Resi"ents ho #ope ith the potentiall! #on+li#ting nee"s +or personal #are an" autonom! %!ith"raing ma! perpetuate mutual ith"raal patterns( Fet$ as ith aggression an""eman"ing %eha1ior$ ith"raal is not likel! to meet #aregi1er epe#tations$ nor is theemerging pattern o+ mutual ith"raal a groth&promoting pattern( Some resi"ents ma! +ear the ith"raal o+ #are( The! ma! not %e satis+ie" ith the #are the! are re#ei1ing$ !et the! "onot +eel sa+e 1oi#ing #on#erns to their #aregi1ers( :onseHuentl!$ the! a##ept the #are

pro1i"e"$ ithout epe#ting a""itional #are( The! ma! sta! in their rooms$ or lea1e the unitto a1oi" the risk o+ "ispleasing or ha1ing hostile intera#tions ith #aregi1ers(

Man! intera#tions %eteen resi"ents an" #aregi1ers are pu%li#( Resi"ents ma! ha1e seenhostile intera#tions %eteen other resi"ents an" #aregi1ers$ intera#tions that ma! ha1eresulte" in limit setting an" the temporar! ith"raal o+ #are( This ith"raal is threateningto people ho are "epen"ent on #aregi1ers to meet their personal #are nee"s$ regar"less o+

ho temporar! it ma! %e or the e1ents that pre#ipitate" it( 2oe1er$ the temporar!ith"raal o+ #are is a 1er! e++e#ti1e a! to "emonstrate poer an" #ontrol$ an" totemporaril! reesta%lish a nee"&pattern integration o+ su%mission&"omination( Although thisma! %e threatening an" "emoraliing to resi"ents$ it ma! also %e the onl! a! #aregi1ers #an

pre1ent +eeling poerless an" "emoralie"( 7or man!$ resi"ents an" #aregi1ers alike$ mutualith"raal is a pattern pre+era%le to mutual hostilit!$ or the antagonisti# pattern o+ nee"s +or in"epen"en#e$ autonom!$ an" #ontrol %! the resi"ents$ ith the pattern o+ nee"s +or "omination$ #ontrol$ an" poer %! the #aregi1ers(

While mutual hostilit! an" ith"raal are o+ten o%ser1e" in the long&term #are setting$ themost +reHuentl! o%ser1e" nee"&& pattern integration is that o+ the #omplementar! pattern o+

"omination&su%mission 3,eplau$ /<C<a4( The resi"ents "epen"en#e on #aregi1ers to ha1etheir personal #are nee"s met makes them parti#ularl! 1ulnera%le( Some resi"ents areapologeti# +or their "epen"en#e$ an in"i#ation o+ their su%missi1eness 3,eplau$ /<C<a4 an"illingness to #ompl! ith their #aregi1ers epe#tations( 7or as long as the #aregi1er hasnee"s to "ominate$ the pattern that emerges ill %e #omplementar!( 2oe1er$ in long&term#are the nee"&pattern o+ "omination&su%mission ma! not o##ur in isolation( A re#ipro#alnee"&pattern integration$ here%! the resi"ents meet the #aregi1ers nee" to maintain a senseo+ #ontrol o1er their ork$ ma! %e o##urring simultaneousl!( Resi"ents ma! a1oi" makingreHuests hile #ompl!ing ith all epe#tations$ an" ne1er +ail to epress gratitu"e +or the#are the! re#ei1e( In essen#e$ the resi"ents ensure the #ontinue" pro1ision o+ personal #are %!+ul+illing the nee"s o+ #aregi1ers to %e nee"e" an" to %e in #ontrol(

Re#ipro#al nee"&pattern integrations ma! "e1elop %ase" on "i++erent #aregi1er nee"s 3,eplau$/<Q<a4( ,erhaps one o+ the most potentiall! #omple nee"s is the #aregi1ers nee" to 1ali"atehis or her seual attra#ti1eness( 7latter! an" +lirting ma! %e use" %! resi"ents to meet thatnee"( 2oe1er$ the resi"ents also ha1e a nee" to epress their seualit!( :aregi1ers ma! tellseual *okes to resi"ents$ or seualie their relationship ith the resi"ent( i1en that %othresi"ent an" #aregi1er ha1e these nee"s$ oul" the resulting nee"&pattern integrations %e

pro%lemati#

A man ho ha" %een a long&term #are resi"ent %elie1e" that +emale #aregi1ers use" him toepress an" 1ali"ate their seualit! %e#ause the! 1iee" him as sa+e( 2e as not epe#te" toa#t on an! seual +eelings that he ma! ha1e eperien#e" toar" his +emale #aregi1ers( A+ter

all$ he as heel#hair&%oun"$ an" he %elie1e" that others 1iee" him as una%le to a#t on hisseual +eelings( 7urthermore$ to respon" seuall! toar" #aregi1ers oul" ha1e %een



#onsi"ere" inappropriate( Ironi#all!$ he as #hallenge" to a#hie1e a %alan#e %eteen1ali"ating his #aregi1ers seual attra#ti1eness$ hile not %eing o1ertl! seual( The nee"&&

pattern integration that emerge" as re#ipro#al rather than mutual$ ith the resi"ent meetingthe nee"s o+ the #aregi1er(

The highl! stru#ture" a#ti1it! an" treatment s#he"ules o+ man! long&term #are resi"entslea1es little room +or +lei%ilit! or seHuen#ing o+ the "ail! tasks #omplete" %! people hoork as atten"ants to the resi"ents( 7or eample$ this group o+ #aregi1ers ma! %e reHuire" to

prepare patients +or ph!si#al therap! so that the therapists #an make maimum use o+ their time( I+ resi"ents are not prepare" +or the s#he"ule" therap! or a#ti1it!$ it ma! %e #an#ele" or

postpone"$ an" the atten"ants are hel" responsi%le( This #ontri%utes to a "is#repan#! %eteenthe le1els o+ their responsi%ilit! an" their authorit!( In essen#e$ the atten"ants are poerless$e#ept that the! #an assert poer o1er the resi"ents ho "epen" on them +or #are( Resi"entsnee" to maintain a sense o+ #ontrol or autonom! o1er their #are$ !et the people pro1i"ing the#are "o not ha1e the authorit! to %e +lei%le in meeting the resi"ents personal #are nee"s(:onseHuentl!$ the personal #are #hoi#es that atten"ants #an o++er resi"ents are limite"(

Without #hoi#es$ resi"ents ha1e +e options ith hi#h to meet their nee"s +or autonom! an"#ontrol o1er their personal #are( In su#h a #ontet$ patterns o+ "omination&su%mission aremore likel! to %e promote"$ rather than patterns o+ intera#ting in hi#h the #are to %e

pro1i"e" is negotiate" %eteen resi"ent an" #aregi1er(

In a""ition to the "isparit! %eteen the le1els o+ responsi%ilit! an" authorit! o+ atten"ants$sta++ in long&term #are +a#ilities is o+ten en#ourage" to +ul+ill surrogate +amil! roles +or theresi"ents( Sta++ mem%ers ma! %e aske" to go shopping +or resi"ents or to spen" etra time atork "uring holi"a!s to meet the nee"s o+ resi"ents ho "o not ha1e +amilies( Some sta++ mem%ers ma! take resi"ents to their on homes +or some o+ the holi"a! season( When sta++ +ul+ills surrogate +amil! roles$ the line %eteen pro+essional an" personal relationships ma!

%e#ome %lurre"$ an" the potential +or a "ual relationship is in#rease"( )ual relationships$

here%! atten"ants maintain %oth a personal an" pro+essional relationship ith the resi"ents$appear to %e a so#io#ultural epe#tation o+ #aregi1ers in long&term #are( :learl!$ the #onteto+ #are in+luen#es the nee"&pattern integrations that emerge in long&term #are( 2oe1er$ toeamine all possi%le patterns on a s!stem le1el is %e!on" the s#ope o+ this arti#le an" is likel!o+ limite" utilit! to the rea"er$ gi1en the "i1ersit! o+ #are "eli1er! s!stems( Instea"$ eeamine" ho the #on#ept nee"&pattern intera#tion 3,eplau$ /<C<a4 #an gui"e intera#tions

%eteen resi"ents an" #aregi1ers so that intera#tions are not ran"om$ %ut rather are gui"e"an" groth&promoting(

ui"e" intera#tions8 Nee"&pattern integrations that emerge in long&term #are ha1e %eeneamine" here on the interpersonal le1el( Inter1ening on that le1el ma! reHuire in#reasing the

personal an" pro+essional resour#es o+ #aregi1ers( ,eplau 3/<C<a4 maintaine" that the a%ilit!to i"enti+!ing pro%lemati# patterns 1arie" among pro+essionals( 5n#e #aregi1ers ha1e anun"erstan"ing o+ nee"&pattern intera#tions$ appli#ation in1ol1es gathering "ata +rom multiplesour#es$ making a "eta#he" anal!sis to i"enti+! the pattern$ i"enti+!ing the role o+ sta++ in the

pattern$ an" "e#i"ing hat nee"s to #hange 3,eplau$ /<C<a4( The 1ignette in Ta%le -illustrates this pro#ess(

Team meetings or #ase #on+eren#es ma! %e the %est metho" +or gathering "ata +rom multiplesour#es( When pro%lem %eha1iors are i"enti+ie"$ #aregi1ers nee" to %e en#ourage" to "es#ri%ethe %eha1ior$ the sta++s response$ an" su%seHuent resi"ent an" sta++ responses$ i+ rele1ant "atais to %e #olle#te"( :ompleting a "eta#he" anal!sis #an %e parti#ularl! #hallenging henhostilit! an" aggressi1e %eha1iors are in1ol1e" an" hen #aregi1ers are unaare or un#om+orta%le ith their rea#tions to resi"ents( )e1eloping a #he#klist$ or a list o+ Huestionsrelate" to the #ommon pro%lemati# patterns$ ma! enhan#e a "eta#he" anal!sis(



7or eample$ a #he#klist to i"enti+! an" anal!e potential patterns o+ "ominan#e an"su%mission might in#lu"e the +olloing Huestions8 Is the resi"ent apologeti# +or reHuiringassistan#e )oes the resi"ent o++er gi+ts or e#essi1e gratitu"e +or #are re#ei1e" What are theresi"ents nee"s What sel+&image ma! the resi"ent %e attempting to maintain What is therole o+ #aregi1ers What are the #aregi1ers epe#tations o+ this resi"ent Is there a healthier

a! +or the resi"ent to meet this nee" What "oes sta++ nee" to #hangeA "eta#he" anal!sis is likel! %est #omplete" in a setting here #aregi1ers are #om+orta%le"is#ussing personal rea#tions to$ an" their epe#tations o+$ resi"ents( As su#h$ supporti1erelationships ith #olleagues$ rather than the pro1ision o+ #are$ %e#ome a means +or sta++ torelie1e anieties asso#iate" ith orking ith !ounger resi"ents(

In#reasing the personal an" pro+essional resour#es o+ #aregi1ers ma! e++e#ti1el! %e a#hie1e" %! pro1i"ing spe#ialie" training in #ommuni#ations an" pattern intera#tions( 2oe1er$ the#ost o+ training all #aregi1ers ma! e#ee" the +inan#ial resour#es o+ man! longterm #are+a#ilities( An alternati1e oul" %e to #reate a position on ea#h ar" +or a spe#iall!&traine"in"i1i"ual$ su#h as a ps!#hiatri# nurse$ to assess pattern intera#tions an" promote

opportunities +or groth through health! intera#tions o+ resi"ents an" #aregi1ers( Thus$ ashi+t in the emphasis +rom Hualit! o+ #are to Hualit! o+ li+e an" ork en1ironment$ oul" %ea#hie1e"( ,romoting an atmosphere here #aregi1ers are +ree to eamine their rea#tions toresi"ents$ an" are supporte" in making ne#essar! #hanges in their %eha1ior$ #an re"u#e thelikelihoo" o+ personal rea#tions %e#oming the +uel o+ patholog!&pro"u#ing$ nee"&patternintegrations( As ,eplau 3/<C<a4 asserte"$ the %est a! to guar" against %eing unittingl!in1ol1e" in unhealth! nee"&pattern integrations is +or the #aregi1er to %e aare o+ theepe#tations the! hol" o+ resi"ents(

Side6ar

There is a multitu"e o+ nee"&pattern integrations that ma! emerge %eteen resi"ents an"

#aregi1ers %e#ause o+ the #ompleit! o+ their relationships(

Side6ar

The highl! stru#ture" a#ti1it! an" treatment s#he"ules o+ man! long&term #are resi"entslea1es little room +or +lei%ilit! or seHuen#ing o+ the "ail! tasks #omplete" %! people hoork as atten"ants to the resi"ents

!eere.9e

Re+eren#es

!eere.9e

7or#huk$ :( 3/<<94( 2il"egar" E( ,eplau8 Interpersonal nursing theor!( In :( Metger M#uiston ; A(A( We%% 3E"s(4$ Notes on nursing theories$ 3No( /.4( Ne%ur! ,ark$ :A8Sage(

Kell!$ M(R($ ; Ma!$ )( 3/<C-4( oo" an" %a" patients8 A re1ie o+ the literature an" atheoreti#al #ritiHue( Journal o+ A"1an#e" Nursing$ B$ /0B&/@6(

Lillesto$ ?( 3/<<B4( Violation in #aring +or the ph!si#all! "isa%le"( Western Journal o+ Nursing Resear#h$ /<394$ -C-&-<6(

Mi""leton$ J( 3/<<04$ Who %elongs in long&term #are +a#ilities uest e"itorial( :ana"ian Nursing 2ome @3/4$ 0&@(



Mi""leton$ J($ Steart$ N(J($ ; Ri#har"son$ J(S( 3/<<<$ Mar#h4( :aregi1er "istress relate" to"isrupti1e %eha1iors on spe#ial #are units 1ersus tra"itional long&term #are units( Journal o+ erontologi#al Nursing$ --$ //&/<(

,eplau$ 2(E( 3/<@-4( Interpersonal relations in nursing( Ne Fork8 (,( ,utnams Sons(

,eplau$ 2(E( 3/<C<a4( ,attern intera#tions( In A(W( 5Toole ; S(R( Welt 3E"s(4$ Interpersonaltheor! in nursing pra#ti#e8 Sele#te" orks o+ 2il"egar" E( ,eplau 3pp( /.C&//<4( Ne Fork8Springer(

,eplau$ 2(E( 3/<C<%4( Interpersonal relationships8 The purpose an" #hara#teristi#s o+ pro+essional nursing( In A(W( 5Toole$ ; S(R( Welt 3E"s(4$ Interpersonal theor! in nursing pra#ti#e8 Sele#te" orks o+ 2il"egar" E( ,eplau 3pp( 0-&@@4( Ne Fork8 Springer(

,eplau$ 2(E( 3/<C<#4( ,s!#hiatri# nursing8 The nurses role in pre1enting #hroni#it!( In A(W(5Toole$ ; S(R( Welt 3E"s(4$ Interpersonal theor! in nursing pra#ti#e8 Sele#te" orks o+ 2il"egar" E( ,eplau 3pp( C.&<C4( Ne Fork8 Springer(

!eere.9e

This #ontinuing e"u#ation o++ering 3#o"e num%er RN:&/C04 ill pro1i"e I #onta#t hour tothose ho rea" this arti#le an" #omplete the appli#ation +orm on page -.-( This in"epen"entstu"! o++ering is appropriate +or all reha%ilitation nurses(

!eere.9e

?! rea"ing this arti#le$ the learner ill a#hie1e the +olloing o%*e#ti1es8

/( )e+ine ,eplaus #on#ept nee"&pattern integration an" list the +our t!pes o+ nee"&patternintegrations(

-( I"enti+! the #on#epts essential +or interpersonall! sa+e nursing pra#ti#e a##or"ing to

,eplau(9( )es#ri%e the steps use" to inter1ene in non&grothpromoting patterns(

:op!right Asso#iation o+ Reha%ilitation Nurses Sep5#t -.//

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