NU678 Unit 10 Professional Identity Essay, Peplau Example

I Came to Find the Right Medication and Found the Relationship Instead: A Professional Identity Essay for the End of a PMHNP Program, Read Through Peplau's Phases

[Student Name]

Purdue University Global

NU678: PMHNP Diagnosis and Management Across the Lifespan Clinical III

Unit 10 Professional Identity Essay

[Instructor Name]

[Date]

The writer and patients are composite; quotations from the writer's admission essay and program handbook are bracketed placeholders.

What I Said I Would Become

Three years ago, in my admission essay, I wrote: "[I want to become the prescriber who finally finds the right medication for patients who have tried everything.]" I meant it. As a medical-surgical nurse, I had watched patients with depression and schizophrenia cycle through hospital admissions, and I believed that what they lacked was a clinician who knew the drugs well enough to get the choice right.

The program's handbook describes its intended graduate in broader terms. Paraphrased, it expects a practitioner who diagnoses and treats psychiatric conditions across the lifespan using both medication and psychotherapy, who builds therapeutic relationships with patients and families, and who practices safely and independently. The population competencies behind it make the same point, placing psychotherapy and the therapeutic relationship beside prescribing as core psychiatric practice (National Organization of Nurse Practitioner Faculties, 2013). When I read the handbook at the start, I skipped past the relationship and the psychotherapy. I thought of them as what came before the real work.

The Practitioner Who Emerged

I no longer think that. Two moments from my final rotation show why.

The first was a follow-up visit with Ms. [F.], a woman in her fifties with recurrent depression who had been stable on an antidepressant for a year but whose mood had dropped over two months. I went into the room with a plan to increase her dose. In the first few minutes she mentioned that her son had stopped speaking to her after an argument at Thanksgiving. I asked about it, and the rest of the visit was about her son, her guilt and what she wanted to say to him. I left the dose unchanged. At her next visit she had written him a letter, he had called, and her mood had improved. The medication had not changed, and it had not needed to.

The second was a first visit with Mr. [J.], a young man brought by his brother after a fight at work. Within ten minutes he was shouting that he did not need to be there. I felt my own heart rate rise and wanted to end the visit. Instead I sat still, lowered my voice, and said that he could leave but that I would like to hear what had happened first. He stayed. Before we finished, he described three weeks of almost no sleep and racing thoughts. The diagnosis and the medication came later. What made them possible was that he stayed in the room.

Reading the Moments Through Peplau

In Hildegard Peplau's account, a nurse-patient relationship passes through three phases: orientation, in which the patient and nurse come to know each other and identify the problem; a working phase, in which the patient uses the relationship to address it; and resolution, in which the work is complete and the two part (Peplau, 1997). She placed the interpersonal competence of the nurse at the center of helping patients recover.

With Mr. [J.], the whole visit was orientation, and it nearly failed in the first ten minutes. My steadiness was what allowed orientation to happen at all. With Ms. [F.], we had been in the working phase for a year, and the relationship allowed her to bring the real problem into the room. In both cases the relationship was not the preliminary to treatment. It was the treatment, or the condition of any other treatment working.

None of this means medication matters less than I once thought. Mr. [J.] needed a mood stabilizer, and Ms. [F.] would not have been stable for a year without her antidepressant. What changed is where I place the medication in my thinking. I used to see the prescription as the point of the visit and the conversation as the way to reach it. I now see the relationship as the setting in which a prescription is chosen, explained, accepted and taken, or in which it becomes clear that a different change, such as a letter to a son, matters more this month. A prescriber who cannot build that setting will choose well and still see patients stop their medicines.

This is not only a nursing idea. Pooling 295 independent studies, one meta-analysis found a consistent positive association between the therapeutic alliance and treatment outcome across different forms of psychotherapy, measures and perspectives (Flückiger et al., 2018). The association is modest, and a correlation does not show that the alliance causes the improvement. But it is robust, and it matches what I saw.

I came into this program to become an expert in medicines, and I am leaving it as a nurse who prescribes, which is a different thing and, I think, a better one.

Holding Myself to the Program's Outcomes

Against the handbook's outcomes, I think I have met one strongly and one only in part. I can build a therapeutic relationship with adults across a range of conditions, including some who arrive angry or frightened; that outcome is met. The outcome of practicing across the lifespan is met only in part: I have seen few young children, and I am not yet confident assessing a six-year-old or talking with the parents of one.

I also still disagree, gently, with one emphasis in the program. Our psychotherapy courses taught several models in depth, which was valuable, but gave less attention to how a prescriber uses a fifteen-minute follow-up therapeutically, which is where most of my relationships with patients will actually happen. I would suggest that future cohorts get more practice with brief supportive techniques within medication visits.

What Is Unfinished

Two things remain. The first is confidence with young children, which I plan to build by taking pediatric cases with supervision in my first year. The second is fluency in the business of practice: billing, prior authorizations and the time pressure of a full schedule, which threaten the very relationships this essay describes. I have no settled answer yet for protecting time for listening when the schedule is full. That question will define my first years of practice more than any drug choice.

Who I Am Now

I am a psychiatric nurse practitioner who treats people through a relationship first and with medication when it helps. That sentence will change as I do, and I expect to rewrite it in five years.

References

Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316-340. https://doi.org/10.1037/pst0000172

National Organization of Nurse Practitioner Faculties. (2013). Population-focused nurse practitioner competencies.

Peplau, H. E. (1997). Peplau's theory of interpersonal relations. Nursing Science Quarterly, 10(4), 162-167. https://doi.org/10.1177/089431849701000407