Hildegard Peplau

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This article does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (September 2009) Hildegard Peplau, Ed.D (September 1, 1909, Reading, Pennsylvania 17 March 1999) was a nursing theorist whose seminal workInterpersonal Relations in Nursing was published in 1952. Dr. Peplau emphasized the nurse-client relationship as the foundation of nursing practice. At the time, her research and emphasis on the give-and-take of nurse-client relationships was seen by many as revolutionary. Peplau went on to form an interpersonal model emphasizing the need for a partnership between nurse and client as opposed to the client passively receiving treatment (and the nurse passively acting out doctor's orders). The essence of Peplau's theories is the creation of a shared experience. Nurses, she thought, could facilitate this through observation, description, formulation, interpretation, validation, and intervention. For example, as the nurse listens to her client she or he develops a general impression of the client's situation. The nurse then validates his or her inferences by checking with the client for accuracy. The result may be experiential learning, improved coping strategies, and personal growth for both parties. Peplau died in 1999, aged 89.
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1 Life 2 Peplau's model 2.1 Peplau's Seven Nursing Roles 2.2 Peplau's Developmental Stages of the Nurse-Client Relationship 3 References

[edit]Life

Hildegard Peplau was born September 1, 1909, in Reading, PA, the second daughter of immigrants Gustav and Ottylie Peplau, and one of six children. As a child, she witnessed the devastating flu epidemic of 1918, a personal experience that greatly influenced her understanding of the impact of illness and death on families. Peplau began her career in nursing in 1931 as a graduate of the Pottstown, PA, School of Nursing. She then worked as a staff nurse in Pennsylvania and New York City. A summer position as nurse for the New York University summer camp led to a recommendation for Peplau to become the school nurse at Bennington College in Vermont. There she earned a bachelors degree in interpersonal psychology in 1943. At Bennington and through field experiences at Chestnut Lodge, a private psychiatric facility, she studied psychological issues with Erich Fromm, Frieda FrommReichmann, and Harry Stack Sullivan. Peplaus life-long work was largely focused on extending Sullivans interpersonal theory for use in nursing practice. From 1943 to 1945 she served in the Army Nurse Corps and was assigned to the 312th Field Station Hospital in England, where the American School of Military Psychiatry was located. Here she met and worked with all the leading figures in British and American psychiatry. After the war, Peplau was at the table with many of these same men as they worked to reshape the mental health system in the United States through the passage of the National Mental Health Act of 1946 and so on. Peplau held masters and doctoral degrees from Teachers College, Columbia University. She was also certified in psychoanalysis at the William Alanson White Institute of New York City. In the early 1950s, Peplau developed and taught the first classes for graduate psychiatric nursing students at Teachers College. Dr. Peplau was a member of the faculty of the College of Nursing at Rutgers University from 1954 to 1974. At Rutgers, Peplau created the first graduate level program for the preparation of clinical specialists in psychiatric nursing. She was a prolific writer and was equally well known for her presentations, speeches, and clinical training workshops. Peplau vigorously advocated that nurses should become further educated so they could provide truly therapeutic care to patients rather than the custodial care that was prevalent in the mental hospitals of that era. During the 1950s and 1960s, she conducted summer workshops for nurses throughout the United States, mostly in state psychiatric hospitals. In these seminars, she taught interpersonal concepts and interviewing techniques, as well as individual, family, and group therapy. Peplau was an advisor to the World Health Organization and was a visiting professor at universities in Africa, Latin America, Belgium, and throughout the United States. A strong advocate for graduate education

and research in nursing, she served as a consultant to the U.S. Surgeon General, the U.S. Air Force, and the National Institutes of Mental Health. She participated in many government policy-making groups. After her retirement from Rutgers, she served as a visiting professor at the University of Leuven in Belgium in 1975 and 1976. There she helped establish the first graduate nursing program in Europe.[citation needed] [edit]Peplau's

model

Peplau's model has proved of great use to later nurse theorists and clinicians in developing more sophisticated and therapeutic nursing interventions [edit]Peplau's

Seven Nursing Roles

Peplau's Seven Nursing Roles illustrate the dynamic character roles typical to clinical nursing. Stranger role: Receives the client the same way one meets a stranger in other life situations; provides an accepting climate that builds trust.
1. 2. 3. 4.

Resource role: Answers questions, interprets clinical treatment data, gives information. Teaching role: Gives instructions and provides training; involves analysis and synthesis of the learner's experience. Counseling role: Helps client understand and integrate the meaning of current life circumstances; provides guidance and encouragement to make changes. Surrogate role: Helps client clarify domains of dependence, interdependence, and independence and acts on clients behalf as advocate.
5. 6. 7.

Active leadership: Helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way. Technical expert role: Provides physical care by displaying clinical skills; Operates equipment [edit]Peplau's

Developmental Stages of the Nurse-Client

Relationship
1. Orientation Phase 2. Working Phase -Identification Phase

-Exploitation Phase 3. Termination / Resolution Phase

Hildegard Peplau
PhD, RN, FAAN (1909 - 1999)

Hildegard E. Peplau, PhD, RN, FAAN, known as the "mother of psychiatric nursing," died at the age of 89 on March 17, 1999. The only nurse to serve the ANA as executive director and later as president, she served two terms on the Board of the International Council of Nurses (ICN). In 1997, she received nursing's highest honor, the Christiane Reimann Prize, at the ICN Quadrennial Congress. In 1996, the American Academy of Nursing honored Peplau as a "Living Legend," and, in 1998, the ANA inducted her into its Hall of Fame. (Extract from the "Peplau leaves legacy of achievement" article below - Nursing World May 1999) Hildegard Peplau's fifty-year career in nursing left an indelible stamp on the profession of nursing, and on the lives of the mentally ill in the United States. She wore many hats - founder of modern psychiatric nursing, innovative educator, advocate for the mentally ill, proponent of advanced education for nurses, Executive Director and then President of the American Nurses Association, and prolific author. Her life was often marked with controversy, which she faced with courage and determination. Interpersonal relations model - Peplau's seminal book, Interpersonal Relations in Nursing, was completed in 1948, but not published for four years because it was then considered too revolutionary for a nurse to publish a book without a physician co-author. (Information from Nursingtheory.net) Peplau leaves legacy of achievement: - Nursing World May 1999 (A Tribute) Hildegard Peplau Nursing Theorist Homepage. - University of Western Ontario School of Nursing.

Theory of Interpersonal Relations

Hildegard. E. Peplau This page was last updated on September 19, 2011

Introduction Born in Reading, Pennsylvania [1909] Graduated from a diploma program in Pottstown, Pennsylvania in 1931. Done BA in interpersonal psychology from Bennington College in 1943. MA in psychiatric nursing from Colombia University New York in 1947. EdD in curriculum development in 1953. Professor emeritus from Rutgers university Started first post baccalaureate program in nursing Published Interpersonal Relations in Nursing in 1952 1968 :interpersonal techniques-the crux of psychiatric nursing Worked as executive director and president of ANA. Worked with W.H.O, NIMH and nurse corps. Died in 1999.

Psychodynamic nursing Understanding of ones own behavior To help others identify felt difficulties To apply principles of human relations to the problems that arise at all levels of experience In her book she discussed the phases of interpersonal

process, roles in nursing situations and methods for studying nursing as an interpersonal process. According to Peplau, nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care. Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal. The attainment of goal is achieved through the use of a series of steps following a series of pattern. The nurse and patient work together so both become mature and knowledgeable in the process. Definitions Person :A developing organism that tries to reduce anxiety caused by needs Environment : Existing forces outside the organism and in the context of culture Health : A word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal andcommu nity living. Nursing: A significant therapeutic interpersonal process. It functions cooperatively with other human process that make health possible for individuals in communities Roles of nurse Stranger: receives the client in the same way one meets a stranger in other life situations provides an accepting climate that builds trust. Teacher: who imparts knowledge in reference to a need or interest Resource Person : one who provides a specific needed

information that aids in the understanding of a problem or new situation Counselors : helps to understand and integrate the meaning of current life circumstances ,provides guidance and encouragement to make changes Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate. Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way Additional Roles include: 1. Technical expert 2. Consultant 3. Health teacher 4. Tutor 5. Socializing agent 6. Safety agent 7. Manager of environment 8. Mediator 9. Administrator 10. Recorder observer 11. Researcher Theory of interpersonal relations Middle range descriptive classification theory Influenced by Harry Stack Sullivan's theory of inter personal relations (1953) Also influenced by Percival Symonds , Abraham Maslow's and Neal Elger Miller Identified four sequential phases in the interpersonal relationship: 1. Orientation

2. 3. 4.

Identification Exploitation Resolution

Orientation phase Problem defining phase Starts when client meets nurse as stranger Defining problem and deciding type of service needed Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations of past experiences Nurse responds, explains roles to client, helps to identify problems and to use available resources and services Factors influencing orientation phase

Identification phase Selection of appropriate professional assistance Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness Exploitation phase Use of professional assistance for problem solving alternatives

Advantages of services are used is based on the needs and interests of the patients Individual feels as an integral part of the helping environment They may make minor requests or attention getting techniques The principles of interview techniques must be used in order to explore, understand and adequately deal with the underlying problem

Patient may fluctuates on independence Nurse must be aware about the various phases of communication Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step

Resolution phase Termination of professional relationship The patients needs have already been met by the collaborative effect of patient and nurse Now they need to terminate their therapeutic relationship and dissolve the links between them. Sometimes may be difficult for both as psychological dependence persists Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals Interpersonal theory and nursing process Both are sequential and focus on therapeutic relationship Both use problem solving techniques for the nurse and patient to collaborate on, with the end purpose of meeting the patients needs Both use observation communication and recording as

basic tools utilized by nursing Assessment Data collection and analysis [continuous] May not be a felt need Orientation Non continuous data collection Felt need Define needs

Nursing diagnosis Planning Mutually set goals

Identification Interdependent goal setting

Implementation Plans initiated towards achievement of mutually set goals May be accomplished by patient , nurse or family

Exploitation Patient actively seeking and drawing help Patient initiated

Evaluation Based on mutually expected behaviors May led to termination and initiation of new plans

Resolution Occurs after other phases are completed successfully Leads to termination a

Peplaus work and characteristics of a theory Theories can interrelate concepts in such a way as to create a different way of looking at a particular phenomenon. Four phases interrelate the different components of each phase. The nurse patient interaction can apply to the concepts of human being, health, environment and nursing. Theories must be logical in nature. This theory provides a logical systematic way of viewing nursing situations Key concepts such as anxiety, tension, goals, and

frustration are indicated with explicit relationships among them and progressive phases Theories should be relatively simple yet generalizable. It provides simplicity in regard to the natural progression of the NP relationship. Leads to adaptability in any nurse patient relationship. The basic nature of nursing still considered an interpersonal process Theories can be the bases for hypothesis that can be tested.Has generated testable hypotheses. Theories contribute to and assist in increasing the general body of knowledge within the discipline through the research implemented to validate them. In 1950s two third of the nursing research concentrated on N-P relation ship. Theories can be utilized by practitioners to guide and improve their practice. Peplaus anxiety continuum is still used in anxiety patients Theories must be consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated. Consistent with various theories Limitations Intra family dynamics, personal space considerations and community social service resources are considered less Health promotion and maintenance were less emphasized Cannot be used in a patient who doesnt have a felt need eg. With drawn patients, unconscious patients some areas are not specific enough to generate hypothesis Research Based on Peplaus Theory

Hays .D. (1961).Phases and steps of experimental teaching to patients of a concept of anxiety: Findings revealed that when taught by the experimental method, the patients were able to apply the concept of anxiety after the group was terminated.

Burd .S.F. Develop and test a nursing intervention framework for working with anxious patients: Students developed competency in beginning interpersonal relationship

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