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DANTONIO P, BEEBER L, SILLS G and NAEGLE M. Nursing Inquiry 2014; 21: 311317
The future in the past: Hildegard Peplau and interpersonal relations in nursing
Researchers, educators and clinicians have long recognized the profound influence of the mid-twentieth century focus on interpersonal relations and relationships on nursing. Today, in nursing, as well as in medicine and other social sciences, neuroanatomy, neurobiology and neurophysiology have replaced interpersonal dynamics as keys to understanding human behavior. Yet
concerns are being raised that the teaching, research and practice of the critical importance of healing relationships have been
overridden by a biological focus on the experiences of health and illness. As a way to move forward, we return to Hildegard
Peplaus seminal ideas about the transformative power of relationships in nursing. We propose that Peplaus formulations and,
in particular, her seminal Interpersonal Relations in Nursing can provide direction. We do not propose that her formulations
or her book be simply transposed from the 1950s to todays classroom and clinic. But we do believe that her ideas and writings
are dynamic documents containing concepts and derived operations that can be brought to life in clinical practice. Finally, we
explore Peplaus transformative idea that nursing is, at its core, an interpersonal process both to acknowledge an idea that has
shaped our past and can guide us into our future.
Key words: history, history of ideas, interpersonal communication, nursepatient relationships, nursing theory, therapeutic relationships.
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and political milieu of the late 1940s and early 1950s. Other
nurses, most notably Helena Willis Render, emphasized the
individuality of patients, the importance of emotional as well
as physical care and the importance of self-awareness in nursing practice (Manfreda 1982). The importance of Interpersonal Relations lay both in Peplaus link of nursing with the
demands of citizenship and in her ability to synthesize, distill, and, finally render concrete, a scaffold of interventions
which would be uniquely within nursings disciplinary
domain from the literature on interpersonal relationships
emerging from both the academy and from clinical practice.
This is seen most clearly in two sections of Interpersonal Relations: that in Part II that identifies the psychobiological experiences that influence the functioning of the personalities of
patients, nurses and patients and nurses in relation to one
another; and that in Part III that then looks to how an illness
experience can reframe the unfinished developmental tasks
of both patients and nurses and strengthen the abilities of
both in the quest for further personality development.
Nowhere is Peplau clearer that the movement toward health
and full citizenship claims demanded as much of the nurse
as it did the patient.
thread running through Peplaus formulations is the placement of anxiety as the transformation of energy that is at the
heart of how the human organism that represents the
patient as well as nurse, moves, changes and grows (132).
She invites nurses not to distance themselves from it but,
rather, to embrace it in the name of their and their patients
growth. In the end, nursing is a process not an outcome as
the nurse and patient work together to find out what each is
seeking in the current relationship (157).
PSYCHOLOGICAL TASKS
This might have been a daunting challenge but for Peplaus
move, in Part III of Interpersonal Relations, from the connections among theories and nursing practice to an ordering of
possible courses of nursing actions that might arise from a
nurses understanding of various situations (1952, 159). It is
here that Peplaus formulation of nursing as a maturing
force in society takes on its most concrete representation.
For both patient and nurse, the guiding principle of living
and practice centers on identifying and meeting developmental needs. In Part III, Peplau teaches nurses to neither
shy from patient needs nor ignore their own. Only by
embracing the idea of needs, she argues, will the mutual and
interactive relations between patient and nurse yield more
than mere data about medical problems (187). It will result
in a unique disciplinary perspective in which the meaning of
a behavior to a patient is the only relevant basis on which to
formulate nursing care (266). This is the essence of the idea
that transformed the discipline in the 1950s. Intersubjectivity, rather than pure rationality, science and objectivity,
becomes the hallmark of professional nursing practice. Peplaus genius lay in the translation of this abstract principle
into concrete interventions by linking it to normal developmental phases of human growth.
It is in Part III that Peplau translates a vast literature on
the theoretical development of personality into interpersonal behaviors recognizable to nursing clinicians. The
infants success in learning to develop trust in self and environment, for example, is expressed, when ill, by an ability
(or inability) to accept that dependency is a necessary component in interpersonal relationships and a confidence (or
lack of confidence) in the belief that others can meet inevitable dependency needs. In the same way, a young childs ability to develop a sense of control and independence most
often met by the developmental milestone of toilet training
becomes reframed as an ability (or inability) to delay satisfaction in light of the realities of certain medical problems.
To Peplaus credit, there is no lock-step quality to her reinterpretation of what she describes as the first two necessary
2014 John Wiley & Sons Ltd
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evidence, consider possible courses of actions, and try out what was
proposed (emphasizing the stages of collaborative problemsolving) in consideration of what was possible within a given
hospital environment (248). Yet Peplau linked this essential
interpersonal nursing obligation to the higher cause of
1950s citizenship. Participation is required by a democratic
society she wrote. When it has not been learned in earlier
experiences nurses have an opportunity to facilitate learning
in the present and thus to aid in the promotion of a democratic society (259). This interpersonal collaboration strikingly resonates with our current reform-driven shift toward
disease self-management and individuals taking responsibility for their own health. But, in Peplaus formulation, it does
more: It links a movement toward greater independence,
collaborative participation and authentic control over health
decisions into a larger domain of citizenship and democracy
a link too often omitted in current debates.
CONCLUSION
The idea of identifying and meeting patients needs has long
informed the discipline. As early as 1922, Bertha Harmer, in
her widely used Principles and Practice of Nursing, wrote of
nursing as rooted in the needs of humanity and founded
on the ideals of service. Over the succeeding decades, Virginia Henderson, Harmers collaborator and, beginning in
1939, co-editor, provided successively more precision to the
identification of the patient needs within nursing domains
(Boschma, Davidson and Bonifacio 2009). The fifth edition
of what is now Harmer and Hendersons Principles and Practice of Nursing, published in 1955, provided a now iconic definition of the work of nurses. The unique function of the
nurse, Henderson wrote, is to assist the individual, sick or
well, in the performance of those activities contributing to
health or its recovery (or to a peaceful death) that he would
perform unaided if he had the necessary strength, will, or
knowledge. And to do this in such a way as to help him gain
independence as rapidly as possible (Harmer and Henderson 1955, 4).
Peplaus Interpersonal Relations and Hendersons Principles
and Practice, published within a few short years of each other,
both grew out of the exciting intellectual milieu that characterized the 1950s, in general, and nursing at Teachers College, Columbia University, in particular. While Peplau spoke
to citizenship and Henderson to independence, they both
spoke to values seen as essential to an empowered and deliberative democracy. Yet, they took fundamentally different
approaches to the relationship between nurses and their
patients. Peplau was fundamentally concerned with what
nurses did with their patients; Henderson with what they did
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