Nursing theories are critical to the survival of nursing as a scholarly discipline. The second half of the 20th century brought forth a new wave of nurses as professionals. Hildegard Peplau was an integral part of the shift in nursing from a vocation to a profession. With the 1952 publication of her book, Interpersonal Relations in Nursing, Dr. Peplau single-handedly revolutionized the nurse-patient relationship. Her dedication to theory-based practice was advantageous to the patient because it afforded an orderly, educated structure to the practice of nursing. The purpose of this paper is to introduce Hildegard Peplau and to explore the importance of her interpersonal nursing theory as it relates to the nursing process today.
Summation of the TheoryThe central element of Dr. Peplau’s theory is the nurse’s focus on the interpersonal aspect of the nurse-patient relationship. Interpersonal refers to phenomena that occur between people (Forchuk, 1993, p.44). In Peplau’s innovative theory, the focal point of the nurse’s role changed, making the nurse and patient partners in the care process. In Peplau’s theory, it became important for the nurse to use his or her own behavior as a model for patients to recognize their own perceived struggles (Tomey and Aligood, 2002 p.24). The interpersonal and intrapersonal theories of Sullivan and Freud are the basis of Peplau’s theory (Tomey and Aligood, 2002, p.385).
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The Life of a TheoristHildegard “Hilda” Peplau was born to Polish immigrants on September 1, 1909 in Reading, PA. Hilda’s parents were devout Christians with a solid marriage; they demanded quiet and pious children. Because of this, Hilda found her childhood home to be an isolating and confusing place. She looked forward to entering school. She was ultimately disappointed with the public school system, and felt that she was being prepared for secretarial work. Longing for knowledge, she found solace in the public library as her parents would not allow her to bring books home (Callaway, 2002, p. 18-20).
On September 1, 1928, Hilda left Reading and entered the Pottstown Hospital Training School (PHTS). It was at PHTS that Hilda began to understand that nursing was considered a job, and more specifically, a woman’s job. She worked as a private duty nurse in Pottstown until 1936, and then moved on to New York City’s Mt. Sinai Hospital (Callaway, 2002, p.32-62). One year after arriving in New York, Hilda accepted a position as a health service nurse at Bennington College in Vermont, seeing it as an opportunity to further her education. She earned her B.A. in interpersonal psychology in 1943; that same year she left for the Army Nurse Corps where she spent the next two years at the 312th Military Hospital in England (Callaway, 2002, p. 66, 95). This was an excellent opportunity for Hilda as very few women were being accepted as army nurses (Woloch, 2000, p.474).
After the war, Hilda returned to New York and earned her M.A. in teaching and supervision of psychiatric nursing in 1947 from Teachers College in Columbia. In 1953, she received her Ed.D. from Columbia University. She went on to work at Columbia University until 1954, she then a job at Rutgers University until she retired in 1974. Dr. Peplau published countless chapters and articles, 2 books, and many audiotapes teaching her theory. She served as Executive Director, President and 2nd Vice President of the ANA as well as serving positions with other renowned organizations. Hilda died in her sleep in 1999.
Her Nursing TheoryHer 1952 book, Interpersonal Relations in Nursing, Dr. Peplau outlines her conceptual structure for psychodynamic nursing. This book was the first published nursing theory since Florence Nightingale’s 1860 concept. The basis for her work was her personal and clinical experience. She worked during the great influenza epidemic, which helped her to understand the “influence of illness and death on individuals and families” (Tomay and Alligood, 2002, p.380). Her theory focuses on the interpersonal development and the therapeutic relationship that develops between the nurse and the patient, unlike many theories that put the attention solely on the client. This nurse-client relationship becomes the heart of the nursing process.
Peplau’s secondary focus is the intrapersonal process of nurse as well as client. Intrapersonal refers to phenomena that occur within an individual (Forchuk,1993, p.45). The nurse not only focuses on the client, he or she also reflects on him or herself. Hilda taught psychodynamic nursing, stressing the significance of the nurse’s capacity to understand his or her own behavior in order to help patients recognize their perceived obstacles (Tomey and Alligood, 2002, p.24).
Core ConceptsThe core concepts of nursing include: nursing, person, environment, and health. (Forchuk, 1993, p.7) Peplau further defined these concepts in her theory. She considered nursing to be a tool that seeks to promote health, person as an individual that lives in a variable setting, environment as surroundings that may promote health or maintain illness, and health as the advancement of human development (Forchuk, 1993, p7).
Dr. Peplau’s theory evolves through psychodynamic nursing, which she defined as “being able to understand one’s own behavior to help others identify felt difficulties and to apply principles of human reactions to the problems that arise at all levels of experience” (Tomey & Alligood, 2002, p.382). She breaks up the nurse-patient relationship into phases: orientation, identification, exploitation, and resolution. In the orientation phase, the patient has a need and seeks help. In the identification phase, the patient recognizes those who can be of assistance. In the exploitation phase, the patient makes an effort to take full advantage of what he or she is offered through the connection. During the resolution phase, the patient slowly puts aside old goals and accepts new ones (Tomey & Alligood, 2002, p.382).
From these phases, Peplau saw different nursing roles emerging: that of stranger, resource person, teacher, leader, surrogate, and counselor. In the role of stranger, the nurse treats the patient with common courtesy. As a resource person, the nurse answers questions that the patient may have specific to his or her care. The leadership role includes the democratic process and the surrogate role involves the patient and nurse defining all areas of care. In the counseling role, the nurse responds to the patient’s concerns, and the teaching role combines aspects of each of these functions (Tomey & Alligood, 2002, p.382-383).
Application of Dr. Peplau’s TheoryA nursing theory aids the practicing nurse in organizing, understanding, and analyzing patient information; making decisions regarding nursing implementation; planning patient care; and predicting and evaluating patient outcomes (Tomey & Alligood, 2002, p.17). Dr. Peplau’s theory can be utilized to direct the nurse in the various aspects of practice, including assessment and planned interventions. Many nurse-researchers have used Peplau’s theory for quantitative as well as qualitative methods of research. Peplau believed that nurses could apply these principles to any area of their lives.
During assessment, the nurse and patient discuss the patient’s problems and the nurse explains available services. As the nurse-patient relationship is developed, the nurse and patient collaboratively define problems and solutions. Using Peplau’s theory, nurse and client mutually plan to meet the patient needs (Potter & Perry, 1993, p.10-11) For a nurse to establish the efficacy of planned interventions, the nurse must first be aware of the passage through various stages of the therapeutic relationship.
Peplau’s theory has been used extensively in the mental health arena, however, it is relevant in every aspect of nursing practice, including: geriatric, emergency, nurse-management, public health, and clinical practice. Many hospitals in the country have adopted her model as a basis for patient care. Nursing research in areas such as anxiety and empathy resulted from her model (Potter & Perry, 1993, p.11).
ConclusionIn conclusion, Peplau’s theory was revolutionary in all aspects of the nursing process. Peplau’s focus on the interpersonal dynamics of the nurse-patient relationship allows the nurse to cultivate roles as resource person, counselor and teacher. Dr. Peplau’s pioneering idea that the patient is an individual with a felt need and that nursing is an interactive and curative process is still relevant today as it allows for significant healthful outcomes.
