This paper examines the nursing theory of Hildegard E. Peplau, widely regarded as the "mother of psychiatric nursing." It traces Peplau's academic background and her seminal 1952 work, Interpersonal Relations in Nursing, before outlining her Theory of Psychodynamic Nursing. The paper details the three overlapping phases of the nurse-patient relationship — orientation, working, and resolution — along with the diverse roles the nurse assumes throughout each phase. It also draws on scholarly commentary by Jones (1996) and Haber (2000) to assess the enduring relevance of Peplau's interpersonal framework for contemporary psychiatric and mental health nursing practice.
Hildegard E. Peplau was born in Reading, Pennsylvania, in 1909. Peplau attended a diploma nursing program in 1931 in Pottstown, Pennsylvania, completed a BA in interpersonal psychology at Bennington College in 1943, and received an MA in psychiatric nursing in New York in 1947. She later earned a Ph.D. in curriculum development in 1953. Peplau held the title of professor emeritus and is credited with establishing the first post-baccalaureate program in nursing. She died at the age of 89 after fifty years as a practicing nurse and is widely acknowledged as the "mother of psychiatric nursing," although her ideas have influenced all fields of the nursing profession (Lakeman, n.d., p. 1).
Peplau completed her landmark work, Interpersonal Relations in Nursing, in 1948, and it is regarded as her seminal text (Lakeman, n.d., p. 1). At the time of writing, it was considered too unconventional for a nurse to publish a book without a physician as co-author, and the work was not published until 1952. The book was ultimately translated into nine languages (Lakeman, n.d., p. 1).
Peplau's Theory of Psychodynamic Nursing involves an understanding of one's own behavior and an ability to help others who are experiencing difficulties with their identity. The theory addresses the principles of human relations as they apply to the difficulties differentially experienced by individuals. Peplau defined nursing as "a significant therapeutic, interpersonal process" (1952, p. 16). Nursing was also defined as an instrument of education, a force that fosters maturity, and one whose objective is the promotion of personality "in the direction of creative, constructive, productive, personal and community living" (Lakeman, n.d., p. 2).
Several implicit assumptions run through Peplau's writings, including that the nurse-patient relationship is influential in patient outcomes and that people may assume a number of roles while possessing the capacity for empathy in relationships (Lakeman, n.d., p. 2). Peplau further held that people tend to behave in ways that have worked for them in the past when confronted with a crisis. She also maintained that energy and tension arise from unmet or conflicting needs, and that such energy can be channeled into constructive means for defining, understanding, and addressing the problem at hand (Lakeman, n.d., p. 2).
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, n.d., p. 2).
The first phase posited by Peplau is the Orientation Phase. This is the phase in which the patient and nurse first meet, become acquainted, and learn each other's expectations and roles. The patient must recognize and understand that they need help and that it is part of their role to receive assistance from the professional nurse. It is natural for the patient to test limits in order to establish the integrity of the nurse. Tasks identified within the orientation phase include: (1) building trust; (2) building rapport; (3) establishing a therapeutic environment; (4) assessing the patient's strengths and weaknesses; and (5) establishing a mode of communication acceptable to both patient and nurse (Lakeman, n.d., p. 2). Once the patient is able to identify problems, the relationship progresses to the working phase.
The second phase, the Working Phase, incorporates identification and exploitation sub-phases, and the relationship may fluctuate back and forth as new problems are identified. During the identification sub-phase, trust begins to develop and the patient begins to respond selectively to those who appear able to offer help (Lakeman, n.d., p. 3). Peplau (1952) noted that when a nurse allows a patient free expression of feelings and receives the provisions of nursing care that are needed, the patient experiences reoriented positive feelings and renewed strengths at the time of illness. The task within this sub-phase includes clarifying preconceptions and expectations of nurses. This results in feelings of acceptance developing as feelings are explored, problems with identity are addressed, and the patient learns to respond to those who can offer genuine assistance.
During the exploitation sub-phase 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, n.d., p. 3). The nurse helps the patient find a balance between dependent needs and the establishment of personal independence. The action plan is applied and then assessed, and the nurse continues to meet the patient's needs as they emerge throughout this phase.
The Resolution Phase is the third and final phase. It involves a gradual freeing of the patient's identification with those who have been assisting them, resulting in the patient gaining strength in their own abilities and the mutual termination of the therapeutic relationship (Lakeman, n.d., p. 3). Old needs are left behind as the patient sets new goals, applies newly developed problem-solving skills, and adopts a new style of communication and a new level of interaction with others. This phase involves identifying new support resources, addressing problem prevention, and integrating the experience of illness into the patient's broader life.
"Nurse as stranger, teacher, and surrogate"
"Jones and Haber assess Peplau's lasting influence"
"Recap of Peplau's contribution to psychiatric nursing"
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