Interpersonal relationships are one of the most significant components in nursing care. In healthcare, relationships exist with co-workers, families, and most importantly patients. Hildegard Peplau was the first individual to revolutionize the nurse-client relationship. She wanted emphasize on the need to build a partnership between the two instead of the typical passive interactions. The Theory of Interpersonal Nursing is a theory that is highly utilized in any nursing practice today. The topics of discussion will include a background history of Hildegard Peplau and how her experiences impacted the theory development. A detailed description, evaluation, and application to personal nursing practice of the theory will also be discussed.
Hildegard Peplau’s Background
Hildegard Peplau was born in 1909 in Reading, Pennsylvania. A childhood experience of the devastating flu epidemic in 1918 greatly influenced and impacted Peplau’s understanding of illness and death (Sills, n.d.). Her nursing career began in 1931, as a graduate from the Pottstown, Pennsylvania School of Nursing, and worked as a staff nurse in New York City and Pennsylvania (Nursing Theory, n.d.). A summer job position as a school nurse at Bennington College in Vermont led Peplau to obtain her Bachelor’s degree in Interpersonal Psychology in 1943. While working at Bennington, she studied psychological issues at a private psychiatric facility called Chestnut Lodge, with Frieda Fromm-Reichmann, Harry Stack Sullivan, and Erich Fromm (Nursing Theory, n.d.).
From 1943-1945, Peplau served in the Army Nurse Corps where she was assigned to the 312th Field Station Hospital in England. The American School of Military Psychiatry was located at this station, where she worked alongside leading figures in American and British psychiatry (Sills, n.d.). Peplau earned a Master’s and Doctoral degree from Teachers College, Columbia University. She gained certification in psychoanalysis by the William Alanson White Institute of New York City (Nursing Theory, n.d.).
In the early 1950s, Peplau developed the first graduate psychiatric nursing students at Teachers College and taught the course as well. From 1954-1974, she was a faculty member at the College of Nursing at Rutgers University, where the first graduate level program was created for clinical specialists in psychiatric nursing (Sills, n.d.). Peplau enjoyed writing, being involved in speaking engagements and teaching clinical training workshops. Peplau was a huge advocate for advancing nursing degrees, so these individuals could provide true therapeutic care (Sills, n.d.). During the summers in the 1950s and 1960s, Peplau conducted seminars where she taught interpersonal concepts, interviewing techniques, and individual, and family group therapy (Sills, n.d.).
Hildegard Peplau served as an advisor with the World Health Organization, and was a visiting professor at many universities with the Unites States and around the world (Nursing Theory, n.d.). She also served as a consultant to the Unites States Air Force, United States Surgeon General, and Nation Institute of Mental Health. Peplau also was a participant in policy-making groups for the United States (Nursing Theory, n.d.). Once Peplau retired, she was a visiting professor from 1975-1976 at the University of Leuven in Belgium, where she helped establish the first graduate nursing program in Europe (Nursing Theory, n.d.).
Peplau’s theoretical and clinical experiences guided her to the development in the field of psychiatric nursing. Her theory is an extension of Harry Sullivan’s interpersonal theory to be used in nursing practice (Nursing Theory, n.d.). There are other theorists that have developed interpersonal theories and each are somewhat interrelated. Interpersonal philosophy is defined as “behavior that can be observed within interpersonal relationships” (Butts & Rich, 2018, p. 288). Her book, Interpersonal Relations in Nursing was published in 1952 but was delayed because it was unacceptable for a nurse to publish a book without a physician co-author (Butts & Rich, 2017, p. 269). Peplau’s book is highly accredited in transforming nursing and emphasized the nurse-client relationship as a foundation in nursing practice. Although, it can be noted that there are limitations within the theory, such as a lack of emphasis on the health promotion and maintenance, personal space consideration, the community social service resources not being emphasized, and the intra-family dynamics. Also, the theory cannot be used on individuals who cannot express their needs, as well as, non-specificity in some areas that inhibit a hypothesis (Nursing Theory, n.d.).
Theory Description
Peplau began her career during a time as she describes as a time when, “we were absolutely not allowed to talk to a patient, because if we did we might say the wrong thing” (Peterson & Bredow, 2017, p. 148; Welch, 1995). In the 1930s Peplau discovered that there was more to nursing than just doing activity and not talking to patients. It was her desire to find a way to be more useful to patients and that is when her theory was developed.
The theory of Interpersonal Nursing is a middle-range theory that was developed during a time when nursing was not independent and nursing theory was not highly utilized (Peterson & Bredow, 2017). Deductive and inductive reasoning were used in her theory. She integrates ideas from multiple theories. Peplau’s work had influence from Sigmund Freud and his interest in unconscious motivation. Harry Sullivan’s concepts of anxiety, self-system, and modes of experiencing also contributed to her theory (Peterson & Bredow, 2017). Also, elements from developmental psychology and learning theory were incorporated (Peterson & Bredow, 2017; Armstrong & Kelly, 1995; Lego, 1980), as well as ideas from humanistic psychologist Carl Rogers, Rollo May, and Abraham Maslow (Peterson & Bredow, 2017; Gastmans, 1998). Inductive research is defined in both general and specific according to Peplau. She describes the inductive process in four steps: observing behaviors, seeking to repeat those behaviors, noting regularities, and naming the phenomena (Peterson & Bredow, 2017). Peplau explained that the inductive research involved student-patient interactions and from these observations interpersonal relationship emerged (Peterson & Bredow, 2017).
Peplau’s major concepts were phases of the nurse-client relationship. This consisted of three phases of orientation, working, and resolution and six roles in nurse-client relationship: stranger, resource, person, teacher, leader, surrogate, and counselor (Butts & Rich, 2107). Peplau had a distinct explanation stating, “the nurse-client relationship has a starting point, proceeds through definable phases, and being time-limited, has an end point” (Butts & Rich, 2017; Peplau, 1952). The work of Peplau can be described as theoretical and her concepts are explicit. Her theory has made a major contribution to the theoretical thinking in nursing and has guided research and focused practice (Butts & Rich, 2017).
The major concepts describe the relationship between the nurse and client. The phases are fulfilled via roles, which are influenced by psychobiological experiences, and require attention to particular psychological tasks (Peterson & Bredow, 2017, p. 150). The four phases are interrelated and overlap, with each phase possessing unique functions, and can be experienced in all nursing situations (Peterson & Bredow, 2017).
Evaluation
There are a total of 13 assumptions developed for the theory of Interpersonal Nursing, although two are from Peplau’s initial theory publication and her very own assumptions. Other theorists have expanded on Peplau’s personal assumptions to illustrate the complexity of her theory. Peplau’s two assumptions are explicit to her theory. They highlight the importance of the nurse’s personal growth in creating caring interpersonal relationships with patients (Peterson & Bredow, 2017).
In the development of Peplau’s theory, the four concepts of the nursing metaparadigm (nurse, person, health, and environment) were not specified, but she did address each of them. The nurse is the professional with definable expertise. The nurse should be able to identify patient problems, utilize their skills to meet needs, and have the ability to development relationships to improve their skill (Peterson & Bredow, 2017). Characteristics of the nurse include ideals, integrity, values, and committed to the well-being of others (Peterson & Bredow, 2017, p. 149; Peplau, 1988). The patient is a person who requires services of a nurse and should be treated with respect, privacy, dignity, ethical care, and confidentiality (Peterson & Bredow, 2017). Health was defined by Peplau as a, “word symbol that implies forward movement of personality and human processes” (Peterson & Bredow, 2017, p. 149). Peplau described a therapeutic environment as a milieu, that is the creations of an atmosphere of recovery (Peterson & Bredow, 2017). The environment is considered structured and unstructured. The unstructured components are the complex relationships between staff, patients, and visitors that are rarely addressed, but are significantly impact patient outcomes (Peterson & Bredow, 2017).
Peplau’s theory is very easily understandable and relatable to the nursing practice. Throughout her theory, Peplau consistently discusses the importance of the therapeutic nurse-client relationship. She also presents with two distinct assumptions that are each clearly stated. Peplau’s theory is one that is still very present and it demonstrates how influential her dedication and theory has made and continues to impact the nursing profession and its practice.
Application
The Theory of Interpersonal Nursing can be applied to any nursing practice issue and many different populations (Nursing Theory, n.d.). Utilizing the interpersonal processes that include observation, communication, and recording, along with the six nurse-patient roles are considered an integral part to the nursing process in implementing interventions and improving patient outcomes (Peterson & Bredow, 2017).
The six roles of the nurse-client can guide nursing actions beginning with the stranger role meaning the nurse and patient meeting; the nurses responsibility is to create an environment that is built with trust. The nurse is the teacher who conveys knowledge that is of patient interest (Nursing Theory, n.d.). Providing resources of information allows the patient to have a better understanding of their issue. The counselor role can be utilized so there is understanding, guidance, and encouragement by the nurse in order for changes to be made by the patient (Nursing Theory, n.d.). The surrogate role is an act of advocacy for the patient, and lastly, the leader role allows the patient to take on full control for meeting treatment goals (Nursing Theory, n.d.).
Interpersonal relationships between the nurse and patient are important to improving patient outcomes. Peplau’s theory is very relatable to clinical practice. In my area of personal nursing utilizing the interpersonal processes, and six nurse-patient roles in practice can build trust, create therapeutic communication, build common treatment goals, and overall provide quality care.
Conclusion
Hildegard Peplau is known as one of the first theorist of the modern era of nursing. Her theory of Interpersonal Nursing has a focus on phases that are experienced, nursing roles that can be utilized in any nursing situation, and the issues that can be addressed involving the nurse-client relationship (Peterson & Bredow, 2017). Within the nursing profession, the nurse-patient relationship is very important. Peplau’s theory is still actively utilized within nursing practice. Her theory is clear, concise, and applicable to any nursing situation, therefore Peplau’s theory is one that can guide changes within patient health care and improve patient outcomes.