Hildegard Peplau's Theory In Interpersonal Relations Of Nursing

Evaluation of the theory in Interpersonal Relations of Nursing by Hildegard. E. Peplau

Many persons go into the healthcare ground because they want to work with people. For these nurses, it is the nurse-patient relationship that is one of the most significant things. By understanding the nurse-patient relationship, nurses can be better furnished to work with their patients and, eventually, deliver superior care for them. Hildegard Peplau's model of nursing emphases on that nurse-patient relationship and recognizes the diverse roles nurses take on when working with patients.

Biography of Hildegard Peplau

Hildegard Peplau was born in 1909 in Pennsylvania. As a child, she saw the devastating effects of the flu epidemic in 1918, which greatly influenced

how she understood how illness and death impacted families.
She graduated from the Pottstown, Pennsylvania School of Nursing in 1931 and worked as a staff nurse in Pennsylvania and New York City. After a summer position led to Peplau being recommended to work as a school nurse at Bennington College in Vermont, she earned her Bachelor's Degree in Interpersonal Psychology in 1943. She earned her Master's and Doctoral degrees from Teacher's College, Columbia University, and was certified in psychoanalysis at the William Alanson White Institution of New York City.
After earning her Bachelor's Degree, Peplau studied psychological issues at Chestnut Lodge, a private psychiatric facility, with Erich Fromm, Frieda Fromm-Reichmann, and Harry Stack Sullivan. This led to Peplau's life long work, which extended Sullivan's interpersonal theory to be used in the nursing field. From 1943 to 1945 Peplau served as an Army Corps Nurse. Being stationed at the 312th Field Station Hospital in England allowed her the opportunity to work with leading figures in American and British psychiatry.
In the early 1950s, she created and taught the first classes for graduate nursing students at Teachers College. She was a member of the faculty of the College of Nursing at Rutgers University between 1954 and 1974, where she created the first graduate program for clinical specialists in psychiatric nursing. In the 1950s and 1960s, she offered summer workshops for nurses across the United States where she taught interpersonal concepts and interviewing techniques, as well as individual, family, and group therapy.
Peplau worked with the World Health Organization by serving as an advisor, and was a visiting professor at universities throughout the United States and around the world. She served as a consultant to the United States Surgeon General, the United States Air Force, and the National Institutes of Mental Health. She also participated in policy-making groups for the United States government. After retiring from her position at Rutgers, Peplau helped create the first European graduate nursing program at the University of Leuven in Belgium, where she was a visiting professor in 1975 and 1976. Peplau died on March 17, 1999.
Theory of interpersonal relations in nursing.

Peplau published her Theory of Interpersonal Relations in 1952, and in 1968, interpersonal techniques became the crux of psychiatric nursing. The Theory of Interpersonal Relations is a middle-range descriptive classification theory. According to (Senn, 2013, p. 31), middle-range theories focus on a portion of reality or human experience, involving a selected number of concepts. Peplau’s theory was influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elger Miller.

Describes the purpose of nursing is to help others recognize their felt problems. Nurses should apply principles of human relations to the difficulties that arise at all levels of experience. Peplau's theory describes the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process. She defined nursing as the therapeutic relationship between both individuals; therefore, it necessitated that the nurse interact with the patient purposefully (Senn, 2013, p. 32). Nursing is therapeutic in that it is a healing art, helping an individual who is sick or in necessity of health care. Nursing is an interpersonal process because it implicates interaction between two or more individuals with a common goal. The attainment of goal is achieved through the use of a sequence of steps following a series of pattern. The nurse and patient work together so both become mature and knowledgeable in the

process.
The four components of the theory are: person, which is a developing organism that tries to reduce anxiety caused by needs; environment, which consists of existing forces outside of the person, and put in the context of culture; health, which is a word symbol that implies forward movement of personality and other human processes toward creative, constructive, productive, personal, and community living.
The nurse has a multiplicity of roles in Hildegard Peplau's nursing theory. The six main roles are: stranger, teacher, resource person, counselor, surrogate, and leader.

The stranger role, in which the nurse receives the patient the way a stranger is met in other situations, and delivers an atmosphere to build trust; as a teacher, the nurse communicates knowledge in reference to the needs or interests of the patient; the resource role, in which the nurse answers questions, interprets data, and gives information needed by the patient that helps the patient understand a problem or situation; the counseling role, in which the nurse helps the patient understand the meaning of current circumstances, as well as provides guidance and encouragement in order for change to occur; the surrogate role, helps the patient clarify the domains of dependence, interdependence, and independence, and acts as an advocate on behalf of the patient; the active leadership role, in which the nurse helps the patient take responsibility for meeting treatment goals; additional roles of a nurse include technical expert, in which the nurse provides physical care for the patient and operates equipment; consultant, tutor, socializing and safety agent, environment manager, mediator, administrator, record observer, and researcher.
The nursing model identifies four sequential phases in the interpersonal relationship: orientation, identification, exploitation, and resolution.
The orientation phase defines the problem. It starts when the nurse meets the patient, and the two are strangers. After defining the problem, the orientation phase identifies the type of service needed by the patient. The patient seeks assistance, tells the nurse what he or she needs, and asks questions, and shares preconceptions and expectations based on past experiences. It is important for the nurse to establish boundaries and maintain these during all phases of the process (Senn, 2013, p. 32). Essentially, the orientation phase is the nurse's assessment of the patient's health and situation.
The identification phase includes the selection of the appropriate assistance by a professional. In this phase, the patient begins to feel as if he or she belongs, and feels capable of dealing with the problem which decreases the feeling of helplessness and hopelessness. The identification phase is the development of a nursing care plan based on the patient's situation and goals.
The exploitation phase uses professional assistance for problem-solving alternatives. The advantages of the professional services used are based on the needs and interests of the patients. In the exploitation phase, the patient feels like an integral part of the helping environment, and may make minor requests or use attention-getting techniques. When communicating with the patient, the nurse should use interview techniques to explore, understand, and adequately deal with the underlying problem. The nurse must also be aware of the various phases of communication since the patient's independence is likely to fluctuate. The nurse should help the patient exploit all avenues of help as progress is made toward the final phase. This phase is the implementation of the nursing plan, taking actions toward meeting the goals set in the identification phase.
The final phase is the resolution phase. It is the termination of the professional relationship since the patient's needs have been met through the collaboration of patient and nurse. They must break their relationship and dissolve any ties between them. This can be difficult for both if psychological dependence still exists. The patient drifts away from the nurse and breaks the bond between them. A healthier emotional balance is achieved and both become mature individuals. During this time, the nurse summarizes the discharge plan and helps the patient organize actions to progress toward new socially interdependent relationships (Senn, 2013, p. 32). This is the evaluation of the nursing process. The nurse and patient evaluate the situation based on the goals set and whether or not they were met.
According to (Senn, 2013, p. 34). Peplau’s (1952) theory can be used in nursing specialties as the nurse patient relationship is the main dimension. Her theory has been widely tested and evidenced-based practice has evolved through qualitative and quantitative research based on her theory.
Emergency nurses can use the components of Peplau’s (1952) theory particularly when applying the principles of the phases in the nurse-patient relationship. The process used by the triage nurse in an emergency department is similar to the process described in the initial orientation phase of the theory. During the initial meeting the stage is set during the interaction between the nurse and the patient. The type and quality of interaction either facilitates or hinders further communication (Senn, 2013, p. 33).
It is critical that nurses have the ability to skillfully interact with patients in any setting. This fosters trust, mutual goal-setting, therapeutic interventions, and improved learning experiences for the patient and the nurse. More often than not, nurses use a combination of nursing theories and conceptual frameworks in daily nursing practice (Senn, 2013, p. 35).
According to (Feely, 1997, p. 118). All nursing care is given within a valued professional nurse-patient relationship and by its very nature requires that the theoretical constructs of interpersonal relations are understood and used to the benefit of patient care. By applying Peplau’s (1952) theoretical approach properly, quality care is given within the confines of the professional nurse-patient relationship.
For those who become nurses to work with people, studying Hildegard Peplau's model of nursing can be very valuable. By better understanding the six main roles of nursing, they can apply diverse roles in different situations, which will guarantee that their patients achieve the best care possible, and will ultimately speed along treatment and recovery.
Peplau's model for nursing, which helped later nursing theorists and clinicians develop more therapeutic interventions, includes six nursing roles, which show the dynamic character roles typical in clinical nursing.
Some limitations of Peplau's theory include the lack of emphasis on health promotion and maintenance; that intra-family dynamics, personal space considerations, and community social service resources are less considered; it can't be used on a patient who is unable to express a need; and some areas are not specific enough to generate a hypothesis.