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The clinical nurse specialist (CNS) is in a unique position in inpatient settings. Responsibilities include direct patient care, consultation with staff nurses, research, organizing inservice programs, and managerial tasks. The complexity of responsibilities requires both specialized knowledge in psychiatric-mental health nursing and knowledge of system concepts. The systems of a nursing framework and a system framework: enhances, the likelihood of accomplishing the ultimate goal of quality patient care.
This article offers a model for practice that integrates the conceptual work of Peptaw (1952; 1989; 1962), Bowen (1976), and the nursing process (Yura, 1983). The purpose of the model is to guide complex practice in an inpatient setting. Peplau's (1959) explication of roles in psychiatric nursing, such as mother surrogate, technician, manager, teacher, socializing agent, and counselor, will be discussed as well as the phases of the nurse-patient relationship, which include orientation, identification, exploitation, and resolution.
Bowen's (1976) concepts of differentiation of self, nuclear family emotional system, family projection process, multigenerationaf transmission process, sibling position, triangles, and emotional cut-off will also be described briefly. The steps in the nursing process (Yura, 1983), assessment, diagnosis, planning, implementation, and evaluation will be compared and contrasted with Peplau's (1952) phases of the nurse-patient relationship.
The advantages of Peplau's framework are that it provides a vehicle for sorting nursing functions as well as a method for tracking the development of the nurse-patient relationship. The advantage of Bowen's Theory is that it offers a perspective from which to view the larger context in which nursepatient interaction occurs. The advantage of the nursing process is that it forms a structure for the delivery of nursing care.
Given that the nursing process forms the structure, it can be hypothesized that the integration of system and nursing concepts is more effective than either set of concepts used alone. The exclusive use of Peplau's concepts may preclude consideration of important feetors that influence the nurse-patient relationship. Exclusive use of system concepts precludes direction for nursing care. Therefore, an integrated framework allows for more complex relationships by providing a larger view than either set of concepts alone.
Peplau's Framework
The nursing roles outlined by Peplau (1959) form the parameters of nursing practice and include principles to guide implementation of each specific role. Functioning as a counselor...