Hildegard Peplau Introduction the Mere

Hildegard Peplau

Introduction the mere mention of the name of Hildegard E. Peplau lights up the image of a nurse who later became a bonafide legend in her own time, incomparable for her passion for change throughout her professional career (Clarke 1999). She was unstoppable in her boundless capacity for work, for overcoming obstacles and solving problems and for communicating her vision to others on the future of nursing. This was Hildegard E. Peplau who was and still is known in the field for her unique professional contributions to psychiatric nursing. She has been referred to as the Nightingale of our time (Lego 1999) in that both Nightingale and Peplau transcended their traditional role as women of their respective times and convinced the men who led them about what they could do. Both great women also surfaced when they were desperately needed to offer service and a precise way of thinking, which would serve the needs of the situations of their time and guide the direction of future generations of nurses and health workers (Lego). Peplau, for her part, recognized the great need for intercommunication at a time when psychiatric nurses confronted frustrations over the few-ness of the outlets for this then developing specialty. From the start, she possessed unique characteristics, which destined her for leadership. She was considered a true visionary in her nursing career. She was endowed with the intellect, the energy, the dynamism, and the tenacity to develop an evolutionary theory of interpersonal relations between the psychiatric nurse and her patient. She taught both the nurse and the patient how to communicate with each other by substituting scientifically proven strategies for ineffective and un-tested intuition. For her distinctive contribution to the field, she has also been fittingly referred to as the Psychiatric Nurse of the Century (Holden 1999).

Historical Background. In the 40s and early 50s, the mentally ill were hospitalized in large mental hospitals when size was an ideal (Nursecom, Inc. 1999).. Psychotropic drugs were introduced and administered in those hospitals and in those days of "Scotch douches," the wet packs, continuous tubs, full sheet restraints, B & C. mix, paraldehyde and leather cuffs. The tone of the day was for the nursing staff to protect patients from committing suicide so that eyeglasses, belts, dentures, toothbrushes, combs, mirrors, silverware and even spoons were carefully counted before meals as a preventive measure. Deep coma insulin treatment and the burning odor of electric shock treatments with no anesthesia were common scenarios. There, too, were the "ice-pick" leucotomies, 30 to 50 accomplished in a single morning, with the nursing staff ready for the visit of neurosurgeons who would habilitate the comatose or vegetative psychiatric patients. Hildegard was born in 1909 in Reading, Pennsylvania to a Dutch bloodline. She finished school at the Pottstown Hospital in Pottstown, Philadelphia. She also attended Bennington College where she worked as a school nurse in order to pay her tuition and boarding expenses. She finished a bachelor's degree in social psychology. While taking the course, she was influenced by thinkers like George Herbert Mead. She was also exposed to Harry Stack Sullivan, Frieda Fromm-Reichman and Erich Fromm, who were later to play important roles in the formation of her Interpersonal Theory of Nursing. Hildegard served as a military nurse in England in the mid-40s during which she worked with psychiatrists who would help shape the Mental Health Act of 1946. She earned a master's degree and a doctorate decree at Teachers College where she stayed to open the first graduate program for psychotherapy for nurses. In order to gain admission, she had to go to a state hospital and convince the medical director that her students then interviewed patients to get a direct feel and experience of the difficult work of a psychiatrist. In 1948, she completed her work, Interpersonal Relations in Psychiatric Nursing: a Conceptual Frame of Reference for Psychodynamic Nursing, which was published only in 1952 because it did not have a psychiatrist as co-author. Nonetheless, it was later translated into many languages and reissued in 1991 by Springer. Hildegard Peplau began the Rutgers University Graduate Program for Advanced Psychiatric Nursing in 1953, which accepted only a few students and the drop out rate was high. She trained future leaders, who later in fact, became leaders of their own time. She then served as President and Executive Director of the American Nurses Association, held positions in national and international committees, got inducted into the ANA Hall of Fame, was named a living legend by the American Academy of Nursing and won the prestigious Christiane Reimann Prize, the Nobel Prize of Nursing (Nursecom, Inc.).

Theory Development. Hildegard wanted to make sense out of a patient's hallucinatory experience through collaborative work. Her theory was to guide nursing practice as tested in the real world of practice. This happened decades before the introduction of accreditation standards for the curriculum in nursing schools (Nursecom, Inc. 1999). The direction she took was accurately described by Kaplan who wrote that the greatest need then more than ever before was an understanding of man and his nature, an understanding of society, and an understanding of our relationship with the world around us. Knowledge was the need of the hour and Hildegard Peplau was bringing it into the real world of the state hospital. The knowledge she brought in helped provide moral aspirations and dimensions to the nursing field and career and this narrowed the gap between the ideal and the real. She shared much knowledge with the ordinary everyday practitioner in those desolate wards of state hospitals throughout the country. She rose as the epitome of what she taught them. She practiced the skills she taught. She encouraged nurses to discover their own competencies in seeking out what was healthy in patients. This continuous experiential, educative process, which may not be very much recognized, but it is among her major contribution to psychiatric nursing (Nursecom, Inc.).

Her book on Interpersonal Relations in Nursing has remained extremely useful and popular even decades later and has embodied her theory (Gregg 1999, Nursecom, Inc. 1999). In it, she posits the patient or client in a relationship with the environment. She frames growth by extension as consisting of a relatively full explanation of a small region, which is carried over to an explanation of adjoining regions. The explication of the construct of anxiety would well illustrate the idea of extension. She taught what needed to be learned about the investigative process, which must examine the extent of available information with gaps in observational data and theoretical concepts to be considered. Then they were set aside for further consideration with the completion or discovery of additional data or new knowledge for examination. This process would help the student juggle a host of problems and concerns within the field while keeping open eventual work for their resolution. Hildegard Peplau used or encouraged the conduct of observations and critical thinking and interpretations (Gregg).

Applications. Hildegard Peplau's career was grounded on a scholarly quest for knowledge and an overwhelming interest in the development of a theory upon which clinical actions could be undertaken (Gregg 1999). Her teaching was based on the acquisition of knowledge of established theory and the systematic development of theoretical concepts and processes from clinical observations, which could lead to the development of a nursing theory. She focused her specialty field on her pursuit of knowledge but was not limited to it. Her basic preoccupation was education. She believed that the total profession would benefit from the specialist's opportunity to push forward the frontiers of knowledge and practice. This was an opportunity to select a narrow focus in the acquisition of relevant information. She would critically examine selected phenomena and seek out explanatory theory, leading to the acquisition of knowledge of other specialists in related fields and disciplines. Her belief, which is evident in her writing, would enable nurses to use concepts from psychiatric nursing into other areas of nursing practice. She wanted to see how individuals would learn concepts and employ these in different levels of practice and in different areas of practice. Furthermore, her willing participation in political responsibilities of her profession throughout her career brought significant impact on the professional lives of people around her. She devoted much thought, time and effort in working at various training committees of the National Institute of Mental Health and the advisory boards of other governmental agencies, which also contributed to the development of policies for funding. Educational conferences in psychiatric and mental health nursing sponsored by nursing organizations afforded opportunities for sharing and collaboration in the shaping of the field. Hildegard always appreciated the importance of viable and strong professional organizations (Gregg).