Nursing Theory: Hildegard E. Peplau Hildegard E. Peplau was born in Reading, Pennsylvania in 1909. Peplau attended a diploma program in 1931 in Pottstown, Pennsylvania, completed a BA in interpersonal psychology at Bennington College in 1943, and received a MA in psychiatric nursing at Columbia University in New York in 1947. Finally, Peplau earned a Ph.D. In curriculum development in 1953. Hildegard's credentials include professor emeritus at Rutgers University and is known for starting the first post baccalaureate program in nursing. Peplau died at the age of 89 and had 50 years as a practicing nurse and is often acknowledged as the "mother of psychiatric nursing" although her ideas have affected all field of the nursing profession. (Lakeman, nd, p.1)

Peplau completed in 1948 the work entitled "Interpersonal Relations in Nursing" labeled as her "seminal work." (Lakeman, nd, p.1) At the time of the writing of the book, it was considered "too revolutionary for a nurse to publish a book without a medical practitioner as co-author and it was not published until 1952. Peplau's book was published in nine languages. (Lakeman, nd, p.1)

I. Theory of Psychodynamic Nursing

Peplau's theory of psychodynamic nursing involved comprehension of one's own behavior and assist others in difficulties with their identity. The principles of human relations applied to the difficulties that are differentially experienced by the individual are addressed in Peplau's Theory of Dynamic Nursing. Peplau defined nursing as "a significant therapeutic, interpersonal process." (1952, p.16) Nursing was also defined as being an instrument of education, a force that brings maturity and one that has as its objective the promotion of personality "in the direction of creative, constructive, productive, personal and community living." (Lakeman, nd, p.2) There are implicit assumptions in the writings of Peplau including that "the relationship of nurse and patient is influential in the outcome for the patient; People may assume a number of roles and have the capacity for empathy in relationships." (Lakeman, nd, p.2) Peplau held that the individual may "assume a number of roles and have the capacity for empathy in relationships. People tend to behave in ways which have worked in the past when faced with a crisis." (Lakeman, nd, p.2) Peplau held that energy and tension arise from unmet or conflicting needs, and the energy which arises may be harnessed into positive means for defining, understanding, and meeting the problem at hand." (Lakeman, nd, p.2)

II. Nurse-Patient Relationship and Three Overlapping Phases

In addition, Peplau's theory states that the nurse-patient relationship "is characterized by a number of overlapping phases with a number of therapeutic tasks or goals to be accomplished. During each phase the patient expresses needs which find expression and require intervention in unique ways." (Lakeman, nd, p.2) The first of all the phases posited by Peplau is the "Orientation Phase." This is the phase when the patient and nurse meet first and become acquainted and learn the expectations and the roles of one another. The patient should recognize and understand that they need help and that it is part of their role to receive assistance from the professional nurse in the form of services.

Naturally, the patient can be expected to "test limits in order to establish the integrity of the nurse." Stated as tasks in the orientation phase are: (1) building of trust; (2) building of rapport; (3) establishing a therapeutic environment; (4) assessing the strengths of the patient as well as their weaknesses; and (5) establish a mode of communication that is "acceptable to both patient and nurse." (Lakeman, nd, p.2) At the time, the patient is able to identify problems the relationship is reported to progress to the "working phase." (Lakeman, nd, p.3) The second phase or the "Working Phase" is reported to incorporate the "identification and exploitation of sub-phases and the relationship may fluctuate back and forth as new problems are identified. During the identification phase it is reported that trust begins to develop and the patient begins to respond selectively to person who seem to offer help." (Lakeman, nd, p.3)

Peplau...

The task within this phase includes development of the preconceptions in terms of its clarity and what they expect of nurses. This result in feelings of acceptance developing as feelings are explored, problems with identity addressed, and the patient learns to respond to those who can offer assistance.
During the exploitation part of the working phase, the patient is reported to "realistically exploit all of the services available to them on the basis of self-interest and need." (Lakeman, nd, p.3) The nurse provides the patient with help in findings a balance between dependent needs and establishing their own independence. The action plan is applied and then it is assessed. The nurse meets needs in an ongoing manner as they continue to be emergent at this phase.

Resolution is stated as the third phase which is inclusive of the freeing of the identification of the patient to the persons assisting them and this occurs slowly and results in the patient gaining strength in their own abilities and results in the "mutual termination of the relationship." (Lakeman, nd, p.3) The old needs of the patients are left behind as the patient sets new goals and applies problem-solving skills and the new style of communication is assumed as well as is a new level of interaction with others. This phase involves new support resources being identified, prevention of the problem being addressed, and the integration of the experience of illness into the life of the patient.

III. Roles of Nurse are Various and Diverse

According to Peplau, the nurse assumes various roles in their relationship with the patient including those of:

(1) stranger';

(2) teacher; and (3) surrogate roles based on the past relationships of the patient. (Lakeman, nd, p.2 )

The patient will be assisted by the nurse in meeting the "goals of therapy, need satisfaction, and growth." (Lakeman, nd, p.5) Communication is highlighted in the theory posited by Peplau in that the expansion of Peplau on "concepts drawn from development, psychoanalytical, and behavioral therapy so that the nurse could be helped by the expansion of the theory in comprehending behavior. Communication was identified in Peplau (1952) as "an interpersonal process involving the selection of symbols or concepts that go some way towards developing a common understanding." (p.290)

Peplau was a pragmatist primarily "rather than an academic theorist. It captures the essence of what nursing is and can become, lending it a timeless quality. Peplau developed knowledge with practical import on learning, anxiety, hallucinations, interpersonal concepts, individual, family, and group therapy." (Lakeman, nd, p.5) As well, a framework for "partnership and recovery" is that which nursing owes a debt to Peplau for her contribution. Peplau (1989) wrote as follows:

"Somewhere, somehow, at some time in the past, courageous nurses determined these skills, learned them, fought for the right to use them, refined them, and taught them to other nurses. All nurses have an obligation to remember that part of nursing's past and keep their own skills in pace with new opportunities for nursing into the next century." (p.32)

The work of Bercheid and Peplau entitled "The Emerging Science of Relationships" reports that that within the close relationships in the individual's life are key elements including:

(1) interaction;

(2) Emotion;

(3) Power;

(4) Roles and Gender;

(5) Development and Change;

(6) conflict' and (7) Intervention. (2000)

The work of Jones (1996) in the work entitled "The Value of Peplau's Theory for Mental Health Nursing" states that changes that have taken place recently in mental health care have "necessitated reevaluation of Peplau's nursing theory. There is an expanding body of nursing knowledge and a debate is taking place regarding the different between models and theories." (Jones,…