MN502 Unit 8 theorist comparison example

How Does a Nurse Find Out What a Patient Needs? Peplau and Orlando Compared at the Bedside of a "Demanding" Patient

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Purdue University Global

MN502: Theoretical Foundations of Advanced Practice Nursing

Unit 8 Assignment

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[Date]

The patient is a composite written for this comparison. No real patient or unit is described.

The Question and the Theorists

Every nursing encounter depends on the nurse understanding what the patient needs, yet nurses often act on an assumption about need rather than a confirmed one. Hildegard Peplau and Ida Jean Orlando both wrote about this problem in the 1950s and early 1960s, and both placed the nurse-patient relationship at the center of nursing. Both theories sit at a similar level: each is more specific than a grand theory, focused on the interpersonal process of nursing, and closer to the middle range. They answer the shared question differently, and the difference is mostly one of timescale. Peplau describes how a relationship develops over days and weeks. Orlando describes what happens in a single exchange lasting minutes. Fawcett and DeSanto-Madeya (2013) treat both as nursing theories rather than conceptual models, more concrete than grand frameworks and focused on a defined phenomenon, which supports comparing them on equal terms.

Peplau: Need Discovered Across the Phases of a Relationship

Peplau (1952) described the nurse-patient relationship as moving through four overlapping phases. In orientation, the patient recognizes a felt need and seeks help, and nurse and patient begin to clarify the problem. In identification, the patient identifies with the people who can help and begins to express feelings. In exploitation, the patient makes full use of the services available. In resolution, the patient's needs are met and the relationship ends. Across these phases, the nurse takes on roles such as stranger, resource person, teacher, counselor, surrogate and leader. For Peplau, the nurse comes to know the patient's needs as the relationship develops, through the patient's growing ability to express them and the nurse's growing understanding of the person.

Orlando: Need Discovered in a Single Exchange

Orlando (1961) described a process that takes place within each encounter. The patient's behavior, verbal or nonverbal, is a signal that may indicate a need for help. The nurse's immediate reaction to that behavior has three parts: what she perceives, the thought it stimulates and the feeling it produces. Orlando's key step is deliberative: the nurse shares her perception, thought or feeling with the patient and asks whether it is correct, validating her reaction before acting. An automatic response, acting on the nurse's own assumption without checking, often fails to meet the need. For Orlando, need is known only when the nurse's reaction has been validated with the patient.

Comparison Table

Timescale. Peplau: days to weeks, across the phases of a relationship. Orlando: minutes, within a single exchange.

Unit of analysis. Peplau: the developing relationship between nurse and patient. Orlando: one behavior and the nurse's immediate reaction to it.

What counts as knowing the need. Peplau: the patient's growing ability to express needs as the relationship matures, and the nurse's growing understanding of the person. Orlando: the nurse's perception, shared with the patient and confirmed by the patient.

The Case

A composite 69-year-old man is spending his first night after a partial colectomy on a surgical floor. Between 9 p.m. and midnight he presses the call light eleven times. Each time he asks for something small: water, his blanket straightened, the television volume changed, the bed raised slightly. His pain score is 3 of 10. At handoff, the evening nurse describes him as "demanding."

Through Peplau

Through Peplau's lens, the calls suggest an orientation phase that has not completed. The patient has a felt need he has not yet articulated, and he has not worked out who can help him and how. Each call is an attempt to establish contact. The nurse's task is to act as a resource person and, over the coming days, to help him clarify the problem so that the relationship can move toward identification. Peplau's theory points the nurse toward patience and continuity, perhaps assigning the same nurse for several shifts so the relationship can develop.

Through Orlando

Through Orlando's lens, each call is behavior whose meaning is unknown until the nurse checks it. On the eleventh call, the night nurse sat down and shared her perception: "I notice you've called several times for small things. I'm wondering if something else is worrying you tonight." He answered that he was afraid that if he fell asleep, no one would check on him, because after his last surgery he had waited a long time for help in the night. The need was not water or a blanket but reassurance that he would not be forgotten overnight, and it became known only when the nurse validated her perception with him. She told him when she would return and did so each hour, and his calls stopped.

What Each Theory Misses

Each theory also has a blind spot that the case exposes. Peplau's phases describe how a relationship matures, but they say little about what the nurse should do in the first hour, when the patient is calling repeatedly and the relationship has barely begun. A nurse applying Peplau alone might decide to wait for orientation to progress and accept the calls as part of it. Orlando's process is powerful within a single exchange, but it can make each encounter feel new. A patient whose needs change over a long illness may need a nurse who remembers what he said last week and notices what he has stopped saying, which is the continuity Peplau describes.

Neither theory addresses the label itself. The evening nurse's word, demanding, shaped how the night nurse approached him before she had met him. Orlando's emphasis on validating perceptions offers a way to test that label, but neither theorist wrote about how labels passed between nurses at handoff can shape care. A nurse using either theory would still need to notice and set aside the label to discover the need.

Verdict

For this encounter, Orlando's theory answered the question better. The need was discoverable in one exchange, and it was urgent that night; waiting for a relationship to develop through Peplau's phases would have left him frightened and labeled as demanding for days. The verdict might reverse over a longer stay. If the same patient remained in hospital for weeks, with fears about his recovery and his return home, Peplau's attention to the development of the relationship would better describe how the nurse came to understand needs he could not yet express. Which theory answers the question better depends on the timescale of the need. For nurses on short-stay surgical units, where most needs must be found within a shift, Orlando's process is likely to be the more useful everyday tool.

References

Fawcett, J., & DeSanto-Madeya, S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed.). F. A. Davis.

Orlando, I. J. (1961). The dynamic nurse-patient relationship: Function, process and principles. G. P. Putnam's Sons.

Peplau, H. E. (1952). Interpersonal relations in nursing. G. P. Putnam's Sons.