Hildegard Peplau Nursing Theorist

  

INTERACTIVE THEORIES

Interaction with our client is very important especially in aspects of the nursing profession. The nurse patient-relationship, also called therapeutic relationship, is the professional interaction of the nurses to client directed preferment of wellness and health of the bottommost. The most imperative portion of the nursing care relinquished to the health consumers.

A nurse theorist introduced the therapeutic nurse-patient relationship that marked a change in the nursing profession. Hildegard Peplau highlighted to the vital manifestation of social interaction between the nurse and the patient was regarded little and lacking in replication the health needs of the client. However because of the holistic approach, new nursing leaders seek to give value on the positive results of an effective nurse-patient relationship.

       Hildegard Peplau

   Interpersonal Relationship Theory

“The kind of person that the nurse becomes makes a substantial difference in what each patient will learn as he or she receives nursing care. “

Background

• Respected as the “Psychiatric Nurse of the Century”.
• Born September 1, 1909 at Reading, Pennsylvania
• Graduated from Pottstown, Pennsylvania Hospital School of Nursing in 1931.
• Worked as an operating room supervisor at Pottstown Hospital.
• 1943 received a Bachelor of Arts in Interpersonal Psychology from Bennington College, Columbia, Vermont.
• 1947 received a Master of Arts in Psychiatric Nursing from Teacher’s College, Columbia, New York.
• 1953 received a Doctor of Education in Curriculum Development from Columbia.
• Became a member of the Army Nurse Corps and work in a neuropsychiatric hospital in London, United Kingdom during the World War II.
• 1951-1960 considered as one of the renowned nursing leaders of her time that her writings and research are repeatedly featured at the American Journal of Nursing.
• 1952 published her first book, “Interpersonal Relations in Nursing”.
• Received awards like The Christians Reimann Prize.
• March 7, 1999, Hildegard Peplau died peacefully at her home in Sherman Oaks, California after a brief illness at the age of 89.

Metaparadigm in Nursing

Person

            Person was defined by Peplau as a “man” considered as an organism that lives in an unstable balance of a given system.

Health

            Health was considered by Peplau as a symbol of movement in the personality and other active human processes that direct the person towards creative, constructive, productive and community living. Peplau believes that a man must achieved and maintain the value and perspective for one’s health, it is the factor that he must be met. These needs are called physiological demands and interpersonal conditions.

Environment

            Environment was defined by Peplau as external influences of the organism and in the context of the socially-approved way of living, from which the vital human social processes will derive such norms, customs and beliefs. However, these conditions that lead to health will always include the interpersonal process.

Nursing

            Nursing was described by Peplau as special, therapeutic interpersonal process. This work with the support of human processes that present health as a attainable goal for individuals. In collaboration of the nurses and the health care team, health services offered must be projected in holistic approach in consideration of the socio-economic, spiritual, emotional and physical aspect of every person. The process of interaction with the patient or client in various setting and situation must be always available. Nurses must use the interpersonal model as a way to explore and to identify the needs of the man seeking professional help.

Interpersonal Relations Theory

            Peplau categorized the nurse-patient relationship as a four-phase phenomenon. Nurse-patient interaction is a major component of each phenomenon that exists apart from other things, having its own independent existence. Each phase is unique and has distinguished contributions on the outcome of the nurse-patient interaction.

Psychiatric Nursing or the nursing of the mentally ill introduced by Peplau is very important factor in the practice of this discipline.

Phase of Nurse-Patient Relationship
1. Orientation	The initial interaction between the nurse and the patient wherein the latter has a felt need and expresses the desire for professional assistance. The nurse assists the patient in recognizing and understanding the “patient” experience.
2. Identification	The patient and the nurse explore the experience and the needs of the patient which leads to a feeling of relatedness. It is very important in the relationship that the nurse assist the patient in reorienting his feelings and sustaining a constant positive environment.
3. Exploitation	In this phase, the patient derives the full value of the relationship as he moves on from a dependent role to an independent one. New goals are projected by the nurse, but the power is shifted to the patient as these goals would be achieved through personal or self-effort.
4. Resolution	In its final stages, the patient earns independence over his care as he gradually puts aside old goals and formulates new ones. Even though the patient and the nurse end the relationship, it is very apparent that the experience leaves a lasting impression on the patient since illness and assuming a dependent role is a unique human experience.

 The Interpersonal Therapeutic Process is based on the theory proposed by Peplau and particularly useful in helping psychiatric patients become receptive for therapy. It is often referred by Peplau as “Psychological Mothering,” it includes the following steps:

·        The patient is accepted unconditionally as a participant in a relationship that satisfies his need;

·        There is recognition of and response to the patients readiness for growth, as his initiative; and

·        Power in the relationship shifts to the patient, as the patient is able to delay gratification and to invest in goal achievement.

Interpersonal Roles
Nursing Role	The role of nurse is to undertake such distinctive roles which will empower and equip her in meeting the needs of the patient. It is expected that different nursing situations and phases of Interpersonal Relationship will going to happen.  These roles could overlap one over the other and could be observed as soon as the situation comes up.
Role of the Stranger	The nurse and the patient are strangers to one another. Getting to know the patient better, the nurse must treat him with outmost courtesy, which include acceptance of the patient as a person and due respect over his individually. This role coincides with the Identification Phase.
Role of the Resource Person	Nurse must be supportive and educative as the patient acts dependently. Nurse must provide specific answers to his queries which include health information, advices and a simple explanation of the healthcare team’s course of care it is the responsibility of the nurse to appropriately change her responses to the patient’s level of understanding.
Teaching Role	For the progress of interaction, the nurse take over a teaching role as she gives much importance for self-care and in helping him understand the therapeutic plan. In bearing this role, the nurse must determine how the patient understands the subject at hand. She must develop her discussion around the interest of the patient and his ability of using the information provided.
Leadership Role	The health team over the nurse care, the patient is still considered vital in making choices of care would take. The nurse as a leader must act in behalf of the patient’s best interest and at the same time enable him to make decisions over his own care. This is achieved through cooperation and active participation.
Surrogate Role	The surrogate role is when the patient completely or fully take-over his care to the nurse (temporary care giver) role. It is wherein feelings are reactivated and nurtured. Despite the facts that the patients recognizes  the similarity of the nurse with the person whom he recalls in previous relationship, the nurse must assist the patient to make sure that her surrogate role is differently and only temporary.
Counseling Role	Peplau believes that the counseling role has the greatest important and emphasis in nursing. This role strengthens the nurse-patient relationship as the nurse becomes a listening friend, and understanding family member and someone who gives sound and emphatic advises. The very core of the interpersonal technique is for the patient to remember and to understand the experience and how could it be integrated into his daily life.

Contributions of Nursing Theorists
Hildegard Peplau (Psychodynamic Nursing)	Practice	Education	Research
	Ø  Provides clear design for the practice of psychiatric nursing. Ø  Emphasized the development of interpersonal relationship between the patient and the nurse.	Ø  Author of “Interpersonal Relations in Nursing” which aids nurses. Ø  Formulated effective psycho therapeutic methods.	Ø  Formulated concepts of anxiety as a means to constructively resolve angry feelings through experimental learning the nurse-patient relationship.

                                                                                                                                                                                                                                                                                                             The major focus of Peplau’s theory interpersonal relations, are very easy to comprehend. The theory’s basic assumptions and key concepts were clearly given, explained, broken down and outlined. In turn, she also demonstrated how this model could be used as a process when she introduced the Four Phases of Nurse-Patient Relationship. The different roles of the nurse added further understanding on how nurses could effectively use the Interpersonal Model.

    Hildegard Peplau closely observed relationships of the interpersonal process, nurse, patient and psychobiological experiences. She was able to discover patterns that enabled the nurses and the patient to achieve the full measure of their relationship. Peplau’s theory could be described as the meeting of the quality with simplicity.

  

 Peplau believed that all nurses, regardless of their area or clinical setting, could effectively utilize her model. However, the theory can be used only to situations that communication ca occur between the nurse and the patient. The use of the method is limited or impossible in working with senile, comatose or newborn patients. The function of the nurse is to be educative, therapeutic and maturing force, understanding the meaning of the experience to the patient is very important.