Hildegard Peplau's theory of interpersonal relations in psychiatric nursing

Hildegard Peplau

the Nightingale of Our Time

Nursing Theorist Hildegard Peplau

Hildegard E. Peplau is an indelibly pioneering image in the field of psychiatric nursing for her valuable contributions to it as a nurse theorist. She was born in Reading, Pennsylvania in 1909. She completed a diploma program in Pottstown, Pennsylvania in 1931 and a Bachelors degree in Interpersonal Psychology from Bennington College in 1943 (Current Nursing, 2012). After Pottstown, Peplau studied psychological issues at Chestnut Lodge with a private class, including Erich Fromm, Frieda Fromm-Reichmann, and Harry Stack Sullivan (Nursing Theory, 2011). This engagement led to her life-long work. From there, she served as Army Corps Nurse at the 312th Field Station Hospital in England, where she had the opportunity to be exposed to the leaders of her field in the country. She created and taught the first classes of graduate nursing students at Teachers College in the early 1950s. She was a member of the faculty at the College of Nursing at Rutgers University from 1954 to 1974. In that span of time, she created the first graduate program for clinical specialists in psychiatric nursing. She also conducted summer workshops for nurses throughout the country with emphasis on interpersonal concepts and interviewing techniques and therapy for individuals, families and groups (Nursing Theory).

She likewise served as an advisor at the World Health Organization, as a visiting professor at university nationwide and around the world (Nursing Theory, 2011). She was furthermore a consultant at the United States Surgeon General, the U.S. Air Force, and the National Institutes of Mental Health. She participated in policy-making groups in her specialty for the U.S. government. When she retired from Rutgers, she assisted in creating the first European graduate nursing program at the University of Leuven in Belgium. She died in 1919 (Nursing Theory).

Major Contribution

The field of psychiatric nursing will always be indebted to Peplau for her Theory of Interpersonal Relations. The Theory echoes the influences of Harry Stack Sullivan's own theory on interpersonal relations, of Percival Symonds, Abraham Maslow and Neal Elger Miller. This Theory is also referred to as psychodynamic nursing, as it involves an understanding of one's own behavior (Current Nursing, 2012). It sets forth 7 nursing roles, which reveal the dynamic character roles nurses typically play in clinical care (Nursing Theory 2011). These are as a stranger, a resource person, a teacher, a counselor, a surrogate, an active leader, and a technical expert. The nurse meets the patient first as a stranger but who constructs an atmosphere of trust for the patient. The nurse performs the role of a resource person who answers his questions, interprets data given or needed, and provides information. She plays the role of a teacher in giving instructions and training. She plays the role of a counselor in leading the patient to understand the meaning of particular circumstances or guides and encourages the patient for an expected or probable change to occur. She plays a surrogate role when she advocates for the patient. She plays the role of an active leader when she helps the patient assume responsibility for treatment goals. And she plays the role of a technical expert when providing physical care or operating equipment. Nurses who study and understand these roles set forth by Peplau's model will be able to apply the roles in different situations. Doing this can assure the best possible care of the patient and the resulting speed in treatment and recovery (Current Nursing).

Additional Roles

Peplau lists the additional roles a nurse plays (Current Nursing, 2012). These are as a consultant, a health teacher, a tutor, a socializing agent, a safety agent, a manager of the environment, a mediator, an administrator, a recorder-observer, and a researcher (Current Nursing).

Major Concepts

The Theory states that the purpose of nursing is to assist the patient identify his felt difficulties (Current Nursing, 2012). A nurse should apply the principles of human relations to every problem that surfaces and at all levels of experience in the task. The Theory lists and explains the phases of interpersonal process, nurse roles and methods for studying nursing as an interpersonal process. It explains that nursing is both therapeutic and an interpersonal process. As therapeutic, it is a healing art, which helps a person who is sick or needing health care. It is an interpersonal process in that two or more persons interact towards a common goal. That goal is achievable or achieved through a series of means, which follows a pattern. The nurse and the patient work together. As a result, both of them become more mature and knowledgeable (Current Nursing).

Phases

In the orientation phase, the nurse and the person meet as strangers for the first time (Young, 2012; Landry, 2009). The major consideration is for the person to establish trust and empowerment within himself. Peplau explains the importance of this phase in the need of the person or patient "to recognize and understand his difficulty" and the extent of his need for help (Peplau, 1992 as qtd in Young and Landry). He must be encouraged and led to fully participate in the task and allow him to actively participate in it. He needs to integrate this illness event into the entire realm of his life experiences. He needs to develop confidence that the nurse will respond to or provide for those needs. When this achieved, the situation can proceed to the next phase (Young & Landry).

In the second phase, the identification phase, the nurse and the client or patient, together identify the problems they must deal with (Young, 2012; Landry, 2009). When he recognizes the nurse as a capable and willing source of help and care for his condition, he also sees that the larger problems can be worked on and solved within their relationship. Both of them clarify their perceptions and expectations at this stage. When this id done, the client sees what he can expect from the relationship. The nurse, for her part, uses her education and training to help the client make full use of the relationship. When these happen, they move to the next phase (Young, Landry).

In the exploitation phase, the client uses all available services to full advantage and according to his needs and interests (Young, 2011; Landry, 2009). He becomes more responsible and independent. He develops courage to face new challenges. The purpose of nursing care is about to be achieved with the restoration of function and confidence in the patient. This leads to the fourth and final phase (Young, Landry).

This is the resolution phase in which all the needs of both the client and the nurse are met (Young, 2012; Landry, 2009). Peplau describes it as the process of "the gradual freeing from "… identification with helping persons and the generation and strengthening of ability to stand more or less alone" (Peplau, as qtd in Young and Lardy).

They now must end their therapeutic relationship and remove the links between them. This does not always happen. At times, one or both parties may continue to have a psychological dependence. But if they can manage to terminate the temporary relationship, they will become more emotionally balanced and mature persons (Young).

Why Choose the Peplau Model

Both its interpersonal theory and nursing process have a concrete sequence of use and focus on the therapeutic relationship (Current Nursing, 2012). Both utilize appropriate problem-solving techniques, which aim in common at filling the client's needs. Both use observation and communication as well as recording as basic tools, which are already used in nursing care. The four phases inter-relate and inter-weave the varying components of each phase. The Theory or model is applicable to endeavors, which follow the concepts of client, health, environment and nursing. It proceeds in a logical and systematic manner in viewing and processing nursing situations. Its generalizability rests in its simplicity in the logical progression of the partnership. It has produced testable hypotheses. It can be used in psychiatric patients. It is consistent with many other theories (Current Nursing).

Its use is, however, limited when personal space or community social service resources are not sufficient (Current Nursing, 2012). The emphasis on health promotion and maintenance is less. And it is not useful on a patient who does not perceive a felt need, as when he is unconscious (Current Nursing). But overall, it enables nurses to better connect with patients therapeutically and fulfill the nursing concept as a healing art as Hildegard Peplau conceived and intended in her practice (Landry, 2009). #