HILDEGARD PEPLAU

o She defined Nursing as “interpersonal process of therapeutic interactions between an

individual who is sick or in need of health services and a nurse especially educated to
recognize, respond to the need for help.”
o 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.
o She described the nurse-patient relationship as a four-phase phenomenon. Each phase
is unique and has distinguished contributions on the outcome of the nurse-patient
interaction.

OVERVIEW OF THE NURSE SCHOLAR

o Hildegard E. Peplau, first published nursing theorist in a century, since Nightingale.

o Created the nursing middle-range theory of Interpersonal Relations.
o Helped revolutionize the scholarly work of nurses
o Contributor to mental health laws/reform

–
o Hildegard E. Peplau -- born September 1, 1909 in Reading, PA to immigrant parents of
German descent
o Illiterate, workaholic father
o Oppressive, perfectionist mother
o Raised in a paternalistic family and a paternalistic society
o Though higher education was never discussed at home, Hilda was strong-willed, with
motivation and vision to grow beyond traditional women’s roles
o She wanted more out of life and knew nursing was one of few career choices for women
in her day
HISTORICAL EVENTS OF HILDA’S YOUTH

o WWI ended in 1918, along with the great flu epidemic the same year
o It was a man’s world in both business and education
o Nursing education of Peplau's time
o The autonomous, nursing- controlled Nightingale era schools came to an end – schools
controlled by hospitals now and formal book learning was discouraged
o Hospitals and physicians saw women in nursing as a source of free or inexpensive labor
o Exploitation was not uncommon of nurse’s employers, physicians and educational
providers
o Nursing practice was controlled by medicine
o Nursing education & military service

PEPLAU PUSHED FORWARD BEATING THE ODDS:

o Graduate Pottstown, PA Hospital School of Nursing in 1931

 o BA Psychology: Bennington College, VT 1943
o World War II: Army Nurse Corps -- worked in a neuropsychiatric hospital in
London,England
o MA Psychiatric Nursing: 1947; Ed.D. Nursing Education: 1953, both graduate degrees
from Teachers’ College, Columbia University
o Certification in Psychoanalysis for Teachers: William Alanson White Institute, New York
City, 1954

FOUNDATION OF PEPLAU’S FRAMEWORK

o Hilda witnessed injustices in life, being determined to push past them for social justice
o First exposure to Interpersonal Theory at Bennington
o Attended lectures by Harold Stack Sullivan on Interpersonal Relations
o She had vision to bring the Sullivanian theory to interactions with her patients – they
needed:
- Humane treatment

- Dignity & respect

-Healing discussion

o …in a time when there was none to be found…

o Teachers’ College: Director of Advanced Program in Psychiatric Nursing

SHE CREATED NURSING CURRICULUM

Included study of nurse-patient interactions through “Process Recordings”

Her book, or conceptual framework, was completed by 1948, entitled Interpersonal Relations
in Nursing

WHAT IS THE PURPOSE?

o Is to improve the interpersonal relationship between the nurses and patients and quality
nursing education

INTERPERSONAL RELATIONS THEORY

o “The kind of person that The nurse becomes makes a substantial difference in what each
patient will learn as he or she receives nursing care.”
o Nurse -patient
o It is important that a nurse must have the ability to understand their own behaviors to help
and understand the patients perceived difficulties.
o Peplau formulated theories on interpersonal relations in nursing (1952) and the art and
science of nursing (1988).
o Imagine yourself working in a hospital-based setting, such as an outpatient department.
The common scenario would be that of a patient coming in because of a felt need
related to his health. You as a nurse will assess the reasons for this consultation. At this
point, the process of nursing begins - it is both an interpersonal and a therapeutic process.
 It is both an art and a science, as you apply the scientific knowledge you have acquired
for the therapeutic component of care.
o Peplau’s theory focuses on the interpersonal processes and therapeutic relationship that
develops between the nurse and client. The interpersonal focus of Peplau’s theory
requires that the nurse attend to the interpersonal processes that occur between the
nurse and client. Interpersonal process is maturing force for personality. Interpersonal
processes include the nurse- client relationship, communication, pattern integration and
the roles of the nurse. Psychodynamic nursing is being able to understand one’s own
behavior to help others identify felt difficulties and to apply principles of human relations
to the problems that arise at all levels of experience. This theory stressed the importance
of nurses’ ability to understand own behavior to help others identify perceived difficulties.
o Peplau believes “the behavior of the nurse-as-a-person interacting with the patient as-a-
person has significant impact on the patient’s well-being and the quality and outcome of
nursing care”.
o Four phases of the nurse-patient relationship are identified
PHASES OF NURSE- PATIENT RELATIONSHIP

[Link] PHASE

o Get acquainted phase of the nurse-patient relationship

o It is important that a professional relationship is established
o Parameters and boundaries are established and met
o Early levels of trust are developed

[Link] PHASE

o The client begins to identify problems to be worked on within relationship

o The goal of the nurse: help the patient to recognize his/her participation role and
promote responsibility for self
[Link] PHASE or Working phase

o Client’s trust of nurse reached full potential

o Client making full use of nursing services
o Solving immediate problems
o nurse and the patient work towards discharge and termination goals.
o Interventions of the problems are done

[Link] PHASE/ TERMINATION PHASE

o Final phase of nurse-patient relationship

o Client met needs
o Mutual termination of relationship
o Client has increased self-reliance to deal with his/her problem
HUMAN BEINGS

o Peplau defines man (used in generic terms) as an organism that “strives its own way to
reduce tension generated by needs”.
o an individual; a developing organism who tries to reduce anxiety caused by needs
o lives in unstable equilibrium
o Each individual may be viewed as a unique biological-psychological-spiritual
structure, one that will not react the same as any other individual.
HEALTH

o Health is 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”.
SOCIETY

o Peplau has a narrow perception of the environment, which is a major limitation of her
theory.
o She does encourage the nurse to consider the patient’s culture and mores when the
patient adjusts to hospital routine.
o TODAY: The nurse reviews the patient’s environment, and examines many more
factors, such as cultural background and home and work environments, rather than
considering only a patient’s adjustments to the hospital.
NURSING

o Peplau considers nursing to be a “significant therapeutic, interpersonal process” that

functions cooperatively with others to make health possible
o Involves problem-solving
o According to Peplau, nursing is therapeutic because it is a healing art, assisting an
individual who is sick or in need of health care.

Purpose of nursing: to educate and be a maturing force so that the patient (person) gets a
new view of himself given the need that he has presented. This is achieved when the nurse
enters into a relationship with the person. The nurse is viewed -as a medium for change. The
relationship brings together two persons with different goals. The idea is for both to develop
or assume congruent goals.

NURSING ROLES

o In the course of the nurse-patient relationship, the nurse assumes several roles which
empower and equip her in meeting the needs of the patient. This illustrates 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.

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 client’s behalf as advocate.

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

ADDITIONAL ROLES INCLUDE:

[Link] expert

[Link]

[Link] teacher

[Link]

[Link] agent

[Link] agent

[Link] of environment

[Link]

[Link]

[Link] observer

[Link]

Factors that affects the N-P relationship

NEEDS

o Needs create tension

o Ex. Need to be loved + not being love == TENSION/ ANXIETY
o Ex. Financially secured=== to feel love
INTERFERENCE

 Are conflicting habits and values

PHYSIOLOGICAL DYSFUNCTION

 Manifests as frustrations and aggressions

3 POSSIBLE RESPONSES TO REPEATED FRUSTRATIONS

o Dependent
o Exaggerated independence
o Deny illness

How can nurses facilitate FRUSTRATION?

o Help patient vary their goals

o Allow communicate their aggression
Opposing Goals

How can you tell?

o Hesitate
o Unable to decide
What would nurse do?

o Your role is to listen to patient

o Your interpretation of the issue
o Will be perceived as a barrier
Unexplained Discomfort

Manifestations?

o Frustrations
o Anxiety
o Needs
 o Conflict
SELF Awareness is necessary to identify the cause of discomfort and plan to achieve the
goals

STRENGHTS

o Applicability
o Essential to a strong nurse- patient relationship
WEAKENESS

o Personal space not considered

o Health promotion not emphasized
o Difficult with patient who does not recognize the “need”