Hildegard Peplau viewed the nurse/patient relationship as an evolutionary process that is only realized as the person develop through the processes of interpersonal exposure, education, and the course of therapy. Nurses enter into a personal relationship with the patient when they see the need to do so. The nurse must consider the culture of the patient as they adjust to the treatment routine (Gonzalo, 2011). Peplau saw the therapeutic relationship as progressing through a series of phases. These phases are the orientation phase, the identification phase, the exploitation phase, and the resolution phase (Gonzalo, 2011). The book A Spirit Catches You and You Fall Down by Anne Fadiman is one of the best examples of what can happen when the therapeutic relationship breaks down due to a lack of cultural knowledge and sensitivity.
The book is filled with memorable and thought provoking quotes. The one that grabbed my attention the most was in the end of the book when Lia was on her deathbed. After all these struggles,
“Suddenly, Lia was, as Bill Selvidge once told me dryly, “just the sort of patients nurses like.” she had metamorphosed from a hyperactive child with a frightening seizure disorder and inaccessible veins into an inert, uncomplaining body who would probably never need another IV. Simultaneously, in the eyes of the family practice staff, her parents were miraculously transformed from child abusers to model caregivers,” (Fadiman, pg. 214).
This quote demonstrates how western medicine can quickly slip into a mode where the patient it’s a product, an object. At this point in the process, Lia was just a body, a bill that would be paid. To the nurse, she was no longer a bother, it was easy to find her veins, making her job and shift go a little easier. To me this quote serves as a warning not to allow oneself to fall into this mindset. If the nurse loses the perspective of the humanity of the patient, her family, and her culture, the ability to build a positive therapeutic relationship is lost. This cannot result in the optimum outcome for the patient. This quote demonstrates that the patient can become dehumanized.
The nurse must continually analyze the barriers that may exist in the therapeutic relationship from the perspective of cultural understanding (Bednarz, Schim, & Doorenbos, 2010). This suggests that the nurse must play an active role in the process of developing a functional working therapeutic relationship with the patient. It suggests that the relationship simply does not happen on its, own but that the nurse must work to make certain that it develops. In a Fadiman’s book, one of the key elements of the cultural breakdown was that the nurse and physicians in the western hospital simply followed the standard processes and procedures without consider the consequences of their actions from a cultural perspective.
If one considers this perspective using the lens of Peplau’s theory, one can easily see that the process was halted in the orientation phase. The Western physicians were willing to dismiss and invalidate every aspect of Hmong culture as primitive and inferior to their own. This lack of an attempt to understand the cultural aspects of the Hmong culture stood out as a failure on many levels of the western nurses and physicians in the story. The western physicians never made any attempt to understand Hmong culture or to come to an agreement. The breakdown was in the first phase of the Peplau’s process. As the breakdown occurred in the first phase, it could not develop through the subsequent stages.
The first stage in delivering culturally relevant nursing care is to make an attempt to understand the culture of the patient. This understanding can help uncover points of common ground that could be used to build the therapeutic relationship and to move through the stages of Peplau’s process. This story demonstrates that the therapeutic relationship takes work and it also demonstrates the objectification of the patient that can occur when it does not.