Hildegard Peplau

Hildegard Peplau

References

Thank you!

Carper, B. (1978). Practice oriented theory. Fundamental patterns of knowing in nursing... part 1 (2). Advances In Nursing Science, 113-23.

D'Antonio, P., Beeber, L., Sills, G., & Naegle, M. (2014). The future in the past: Hildegard Peplau and interpersonal relations in nursing. Nursing Inquiry, 21(4), 311-317. doi:10.1111/nin.12056

Fawcett, J. (2005). Contemporary nursing knowledge: Analysis and evolution of nursing models and theories (Ed. 2). Philadelphia: F.A. Davis Company

Feely, M. (1997). Using Peplau's theory in nurse-patient relations. International Nursing Review, 44(4), 115-120. Retrieved from http://web.a.ebscohost.com.ezproxy.uwindsor.ca/ehost.

Forchuk, C. (1991). Peplau's theory: concepts and their relations. Nursing Science Quarterly, 4(2), 54-60.

Forchuk, C., Beaton, S., Crawford, L., Ide, L., Voorberg, N., & Bethune, J. (1989). Incorporating peplau's theory and case management. Journal of PsychosocialNursing & Mental Health Services, 27(2), 35-38. Retrieved from http://ezproxy.uwindsor.ca/login?url.

George, J.B. (2002). Nursing theories: The base for professional nursing practice. (Ed. 5). New Jersey: Pearson Education.

Hrabe, D. (2005). Peplau in cyberspace: an analysis of Peplau's Interpersonal Relations : Theory and computer-mediated communication. Issues In Mental Health Nursing, 26(4), 397-414. Retrieved from http://web.a.ebscohost.com.ezproxy.uwindsor.ca/ehost.  

Peden, A.R. (1998). The evolution of an intervention - the use of Peplau's process of practice-based theory development. Journal of Psychiatric & Mental Health Nursing, 5(3), 173-178. doi:10.1046/j.1365-2850.1998.00127.xReynolds, W. (1997).

Peplau, H.E. (1991). Interpersonal Relations in Nursing: A conceptual frame of reference for psychodynamic nursing. New York: Springer Publishing Company

Reynolds, W.J. (1997) Peplau's theory in practice. Nursing Science Quarterly, 10(4), 168-170.

Theory of Interpersonal

Relationships

Limitations

Relational Statements/Propositions

(Hrabe, 2005)

• Does not identify a conceptual model or diagram to illustrate the concepts and relations
• Does not examine the broad range of environmental influences on the person
• Lacks emphasis on health promotion and maintenance
• Cannot apply to a non-participative patient
• No boundaries to interpersonal relations
• Attachments
• Death
• Intra-family dynamics
• Conflicts of interest
• Privacy/Confidentiality

Is a model presented to represent the theory?

• When Peplau’s theory first came out it did not have a visual model to guide her proposed concepts and their interactions. It was not until later publications of her book that other theorists agreed upon making the concepts visually appealing and easier to comprehend. Thus a new conceptual frame model was introduced that represented the theory by showcasing all of its main factors. On one side the nurse with all of his/her constituents, and on the other side the patient and his/her characteristics. In the middle lays their interpersonal therapeutic relationship as a common link for both sides. Both elements surrounded by their environments.

Are the linkages clear?

• Peplau’s theory does an excellent job at guiding the nursing process and linking it to the patient’s agreed outcomes. Through the phases of Orientation, Identification, Exploitation and Resolution, the theory sets specific tasks for the nurse and the patient in order to achieve goals that benefits and solidify the therapeutic relationship.

Understanding the theory

How well did you understand the theory?

• I am able to understand the concepts presented by Peplau and apply them to my nurse-client therapeutic relationship in the clinical area where I work. Her concepts promote and improve communication with patients, resulting in patient's adherence to prescribed treatment with less anxiety and higher satisfaction regarding their nursing care.

Did the author clearly represent the theory?

• Peplau's theory provides a logical systematic view of nursing situations. The four progressive phases in the nurse-patient relationship are clear and logical. Key concepts are clearly defined, consistent and clearly understood. The phases provide simplicity regarding the natural progressing of the nurse patient relationship. The theory has multi-use and can be applied to any nurse-patient relationship except comatose, senile, and infant patients and is easily accessible to all health care practitioners to guide and improve their practice.
• Linear process broken down into 4 phases, definitions are clearly defined
• Ideas are organized in a consistent and logical manner
• Interconnections could be made easily
• 4 phases are easy to identify and relate to one another

Nursing Implications

• How does this theory lead to nursing actions that make important differences in the client/family/community/society health status?
• According to Feely (1997) nurses participate in the organization of conditions that facilitates natural ongoing tendencies in human organisms. As an educative instrument and maturing force within the interpersonal relations theory the nurse can assume different roles. Peplau describes these roles as stranger, resource, teaching, leadership, surrogate and counselor. It is evident in our daily practice that we still rely on these roles to achieve a holistic care that impact the patient, their families, the community and therefore the entire society.

Peplau’s Framework

(Forchuk, 1991)

Credibility of the Nursing Model

Usefulness/External Components

Resolution Phase

(George, 2002)

• Mutual termination of the relationship
• Planning for alternate sources of support, problem prevention, and patient’s integration of illness experiences
• Dissolve links between nurse and patient
• Dependency or self-reliant (independent)
• Both the nurse and the patient become stronger maturing individuals
• Termination occurs only with the successful completion of the previous

phases.

• Does the theory fit with your personal value system and/or the way in which you view nursing?
• This interpersonal relations theory resonates and reflects my values as a nurse, as a professional, and as an individual. I view the nurse-patient relationship as the center of my care, and achieving rapport with patients and their family members is the main goal of it. There is opportunity to learn and grow during these connections that help me take these experiences and utilize them in future circumstances.
• It strengthens the nurse-client relationship, builds trust and understanding, allows for self-reflection and realization, provides a holistic and comprehensive approach to patient’s needs.

Personal Value System

• Nursing roles are explored and shown how it can be implemented.
• Is applicable to any nurse or health care practitioner in any area.
• Guides professional practice of nursing to provide effective and quality care
• Fundamental in identifying patient’s needs

Theory Meaning

Peplau emphasizes the importance of establishing a healthy relationship between the patient and the nurse based on mutual trust with the main goal of the patient reaching self-reliance.

Relevance of theory

Phases of the Nurse Client Relationship

Working Phase

Identification Phase:

• Patient begins to identify with the nurse and the purpose of the nurse-patient encounters.
• Together, the nurse and the patient develop a plan as well as the resources needed to carry out the plan

Exploitation Phase:

• Patient is able to make full use of the services of the nurse
• Plans are fully implemented
• Patient and nurse may identify further issues and revert back to the identification phase or move toward the resolution phase.

(Forchuk, 1991; George, 2002)

Orientation Phase:

• First encounter with the nurse and patient
• Nurse and patient come to know each other as a person, understand the role and expectations of each other
• Nurse gives and meets parameters of their role, nurse must be consistent and clear
• Patient tests parameters to establish if the nurse is trustworthy
• Completed when the patient can begin to identify problems to address with the

nurse

(Forchuk, 1991; George, 2002)

Content of the model

Structural and Functional Concepts

Assumptions - Explicit

Peplau explicitly identified 2 guiding assumptions:

1. The kind of person each nurse becomes makes a substantial difference to what each patient will learn as he is nursed throughout his experience with illness.

2. Fostering personality development in the direction of maturity is a function of nursing and nursing education. It requires the use of principles and methods that permit and guide the process of grappling with everyday interpersonal problems or difficulties

Assumptions - implicit

(Peplau, 1991)

3. Psychodynamic nursing crosses all specialty areas of nursing.

4. The need to harness energy that comes from tension and anxiety into positive means for defining, understanding, and meeting productively the problem at hand is a universal need.

5. All human behaviour is purposeful and goal seeking in terms of feelings of satisfaction and security.

6. The interaction of the nurse and patient is productive when a method of communication that identifies and uses common meaning is at work in the situation.

7. The patient is capable of participating in an interpersonal relationship

Nursing

Metaparadigm

Nursing metaparadigm from Peplau’s perspective:

Nursing: an educative instrument, a maturing force, that aims to promote forward movement of the personality in the direction of creative,

constructive, productive, personal and community living. Nursing involves

the growth of the nurse and the patient. It is an enabling, empowering, and transforming art.

Person: an organism that lives in an unstable equilibrium and life is the

process of striving in the direction of equilibrium.

Health: defined as a word symbol that implies forward movement of

personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living. Health is the

primary goal of nursing.

Environment: includes physiological, psychological and social

fluidity.

Systems in the environment can be potentially illness

maintaining or health promoting, depending on

the interaction of patterns.

Major Concepts

(Forchuk, 1991; Peplau, 1991)

Peplau elucidates that the nurse during the therapeutic relationship process, assumes different roles and as the relationship evolves it progresses through different phases. The relationship usually moves through the phases of Orientation, Working (Identification, Exploitation), and Resolution. Anywhere throughout those phases she outlined that nurses can assume six major roles. Not necessarily in this order the nurse could adopt the capacity of stranger, resource, teacher,

leader, surrogate, and counselor.

(Hrabe, 2005)

Major Concepts

cont.

Peplau is consistent on using these concepts throughout her theory. Some of these concepts are very concrete like the six major roles of the nurse during the interpersonal relationship. Other concepts are very abstract and hard to define like the resolution stage that could have a different meaning to the nurse or the patient.

Sub-Concepts

(Forchuk et al, 1989)

• Interpersonal Relationships: encompasses any process occurring between two or more persons.
• Nurse-Patient Relationship: specific interpersonal relationship that develops between a nurse and a patient. It is educative and therapeutic when the nurse and patient can come to know and respect each other as persons who are alike, and yet different, as persons ho share in the solutions of problems.
• Anxiety: is an energy that is cognitively triggered by any real or imagined, internal or external threats to the security of an individual.
• Frustration: result of any interference, blocking, or a barrier to a need or desired goal before

satisfaction of a goal is felt.

Roles

of the nurse

Stranger Role: initial contact with the patient, separate

goals and interests.

• Avoid stereotyping, positive and respectful communication,

acceptance

Resource Role: patient becomes aware of health issues

• Nurse provides specific answers related to disease process

Teaching Role: Patient demonstrates an understanding of

health issues

• Nurse promotes learning through the patient’s

experience/difficulties

Leadership Role: Patient is able to identify, explore, and lead new

actions in promoting health

• Nurse identifies when the nurse or patient should take the lead

Surrogate Role: Patient learns the similarities/differences among

other individuals

• Accept the patient’s view and identify the difficulty that is

being worked on

Counselor Role: Patient aware of conditions required for optimal

health

• Nurse analyzes the patient’s situation to determine

most therapeutic response

(Hrabe, 2005)

Hildegard Peplau

• Born in Reading, Pennsylvania (1909-1999)
• Education

Diploma of Nursing from Pottstown Pennsylvania (1931)

B.A degree in Interpersonal Psychology from Bennington College (1943).

M.A in Psychiatric Nursing (1947)

Ed.D in Curriculum Development from

Columbia University, NY (1953).

• Nursing Experience

Private and general duty hospital nursing

U.S army Nurse Corps

Nursing research

Private practice in psychiatric nursing

Rutgers University – “Professor Emeritus”

• Published Interpersonal Relations in 1952
• National Mental Health Act (1946), World Health

Organization, National Institute of Mental

Health, American Nurse’s Association

(president)

(George, 2002)

• Known as the “Mother of Psychiatric Nursing”
• First published nursing theory since Florence Nightingale
• First theoretical textbook written by a nurse without having a physician as co-author
• Peplau’s original intent was not theory development, but rather ideas to improve the nursing profession and practice
• Roots derived from behavioural science– psychodynamic nursing

Theoretical Roots:

• Harry S. Sullivan’s (1947): behaviour directly evolves from interpersonal relationships
• Sigmunds Freud’s theory (1936): psychological development is critical in the evolution of a person
• Percival Symonds theory (1940s): idea of self and how an individual reacts to himself in terms of self-perception, self-cognition, self-valuation, and self-maintenance or enhancement
• Abraham Maslow’s theory (1943): Hierarchy of needs,

what motivates individuals to achieve certain needs

Historical evolution

Origins of the model

• Health care was focused on treating an “object”

and not the “person”

• Medical practice view - not holistic
• Lacked humane treatment of patients (psychiatric care)
• Lacked open communication between health care provider and patient
• Nursing as a profession was focused on technical skills and Peplau wanted to shift the focus from medical practice to interpersonal practice through a psychosocial approach to caring for patients
• Burden on the health care system
• Discharge prior to meeting the

needs of the patient

Problems

and concerns

Psychiatric care prior to

the Mental Health Act and

contributions of Peplau’s

Interpersonal relationships.

Relevance of the

Theory

Focus shift from patient as object to patient as a person.

(Fawcett, 2005)

Middle-range descriptive classification theory

• Identified commonalities in groups, individuals, events, or situations (ex. nurse-client relationship)
• Name and classify characteristics of the phenomena
• Stimulates and provides rationale for studies
• Assists practice by facilitating understanding of a client’s behaviour
• Peplau (1991) defined the scope of her theory as middle range, “a partial theory for the practice of nursing as an interpersonal process”.

Type of Theory

• Primarily focused on mental health nursing and the

interpersonal relationship between the nurse and the client.

• The nurse must understand his/her self in order to promote

growth and development of the client

• Worldview: phenomenological approach to develop nursing knowledge
• Source of data: human experience (subjective)
• Carper’s Ways of Knowing: Personal Knowledge
• Emancipatory knowing: ability to notice social injustices and identify changes to correct the structures
• Stages of nurse patient relationship
• Roles of the nurse/patient
• Inductive approach: gathered data from specific

observations (psychiatric nursing) and can be applied

generally across all health care providers

Development of Nursing Knowledge

Purpose

What is Nursing?

• The purpose of nursing is to help others identify their felt difficulties and that nurses should apply principles of human relations to the problems that arise at all levels of experience.
• The purpose of Peplau’s theory of interpersonal relations is to deepen an understanding of interpersonal relations in nursing situations so that health care practitioners can provide more effective and socially orientated care.
• Aid in the development of decision making skills related to effective patient care strategies in the context of professional relationships between the nurse and the patient.

(George, 2002)

“Nursing is a human relationship between an individual who is sick, or in need of health services, and a nurse especially educated to recognize and to respond to the need for help”

“Nursing is a process or a function, its series and goal directed nature demands certain steps, actions, operations, or performances that occur between the individual who does the nursing and the person who is nursed”

What kind of a process?

An interpersonal Process

A Therapeutic Process

An Educative Process

(Peplau, 1991)

A Critique by,

Jelena Lastro

and

Yoan Exposito Gonzalez