Peplau's Interpersonal Theory of Nursing: A Legacy of Professionalism, Study Guides, Projects, Research of Nursing

Download Peplau's Interpersonal Theory of Nursing: A Legacy of Professionalism and more Study Guides, Projects, Research Nursing in PDF only on Docsity! Remembering Hildegard Peplau By Richard Lakeman On the 17 th of March 1999, Hildegard Peplau died at the age of 89, ending a nursing career, which spanned over fifty years. Peplau is often recognised as the ‘mother of psychiatric nursing’ but her ideas have influenced all fields of nursing. In 1948 Peplau completed her seminal work, ‘Interpersonal Relations in Nursing’. However, it wasn’t published until 1952 because at the time it was too revolutionary for a nurse to publish a book without a medical practitioner as a co-author. This work which has been published in nine languages, has perhaps done more to facilitate the development of nursing from an occupation to a profession than any other. Sills (1998, p.171) described Peplau as “… a woman of uncommon intellect, socialized outside the traditional 1940s model of nursing in the United States, who developed a paradigm of professionalism…. that has permeated every aspect of her long and distinguished career.” Even if a nurse has never read any of the hundreds of articles or books, which cite and develop Peplau’s ideas, it is likely that she or he, will still have been influenced by them. Peplau suggested that nurses can and do make a difference to people in the context of interpersonal relationships, which have a discernible pattern, predictable phases and during which the nurse assumes roles such as counsellor, leader or teacher. Some may recognise many of her ideas as being similar to those developed in role theory, cognitive behavioural therapy, symbolic interactionism, or reflecting ‘common sense’. A number of studies suggest that Peplau's theory remains a common frame of reference for most psychiatric nurses (Hirschmann, 1989). Some selected ideas from the works of Peplau Peplau (1952, p16) described nursing as "a significant, therapeutic, interpersonal process. It functions co-operatively with other human processes that make health possible for individuals in communities .... Nursing is an educative instrument, a maturing force, that aims to promote forward movement of personality in the direction of creative, constructive, productive, personal and community living". Lack of growth, for whatever reason, implies impaired health in the individual and basic human needs must be met if a healthy state is to be achieved and maintained (Stuart & Sundeen, 1987, p 46). A number of assumptions are implicit in Peplau's original and latter writings (Forchuk, 1991). For example, the relationship of nurse and patient is influential in the outcome for the patient; People may assume a number of roles and have the capacity for empathy in relationships (Torres, 1986, p 171); People tend to behave in ways which have worked in the past when faced with a crisis (Forchuk, 1991); Anxiety and tension arise from unmet or conflicting needs, and the energy which arises may be harnessed into positive means for defining, understanding and meeting the problem at hand. The nurse patient relationship is characterised 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. Orientation Phase The phase of the relationship, when the nurse and patient first meet is known as the orientation phase. This is a time when the patient and nurse come to know each other as people and each other’s expectations and roles are understood. The patient at this time needs to recognise and understand their difficulty and the need for help, be assisted to plan to use the professional services offered, and harness the energy derived from felt needs (Peplau, 1952, p 19). It may be expected that the patient will test limits in order to establish the integrity of the nurse. The tasks of this phase are to build trust, rapport, establish a therapeutic environment, assess the patients strengths and weakness and establish a mode of communication acceptable to both patient and nurse (Shives, 1994, p 91). When the patient can begin to identify problems the relationship progresses to the working phase. Working Phase The working phase incorporates the identification and exploitation sub-phases and the relationship may fluctuate back and forth as new problems are identified. During the identification phase trust begins to develop and the patient begins to respond selectively to persons who seem to offer help. The patient begins to identify with the nurse and identify problems, which can be worked on. The meaning behind feelings and behaviour of the nurse and patient are explored. Peplau (1952, p31) states that when a nurse permits patients to express what they feel, and still get all of the nursing that is needed, then patients can undergo illness as an experience that reorients feelings and strengthens positive forces in the personality. The tasks of this phase are to develop clarity about the patient's preconceptions and expectations of nurses and nursing, develop acceptance of each other, explore feelings, identify problems and respond to people who can offer help. In particular the nurse assists in the expression of needs and feelings, assists during stress, shows acceptance and provides information. The nurse and patient may make plans for the future but the implementation of the plan signifies the beginning of the exploitation phase of the working relationship. During the exploitation phase the patient realistically exploits all of the services available to them on the basis of self interest and need (Peplau, 1952, p 37). The nurse assists the patient in their efforts to strike a balance between the needs for dependence and independence. The plan of action is implemented and evaluated. The patient may display a change in manner of communicating, as new skills in interpersonal relationships and problem solving are developed (Forchuk & Brown, 1989, p 32). The nurse continues to assess and assists in meeting new needs as they emerge.