Hildegard Peplau's Nursing Theory Analysis

Hildegard Peplau is known for her many contributions to nursing. Although, she has made many strides in furthering psychiatric nursing, she greatly impacted the general field of nursing with her theory that is applicable in nearly all fields of nursing. In this paper, the authors will provide information on Hildegard Peplau's background and her theory. Her theory will be discussed in relationship to the Austin Peay State University's School of Nursing concepts and how it is applied in the clinical setting.

Background of Hildegard Peplau

Hildegard Peplau was born September 1, 1909 in Reading, Pennsylvania. She was the second child born out of five to immigrant parents from Poland but of German descent (Callaway, 2002, p. 2). When Hildegard Peplau was young, she decided to go against the societal norms and pursue an education to move into a career of nursing. This decision was not an easy one to make despite her ambition and drive (Callaway, 2002, p. 2). Peplau had many forces working against her to reach this goal such as economic limitations due to her working-class background of her immigrant family, and the fact that she was a female in a male dominated work force.

Her family culture was much different from a usual physically expressed family of her era (Callaway, 2002, p. 2). Although Peplau's parents loved her and her siblings, physical expression of affection was absent. Hugging and kissing were not engaged, and this created a stressful as well as often confusing childhood for Peplau (Callaway, 2002, p. 3). Her only jobs in her hometown of Reading, Pennsylvania were a store clerk, payroll clerk, and bookkeeper as she went to evening classes to graduate high school as the valedictorian in 1928.

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Her interest in nursing did not come from compassion to care for the sick. What made nursing appealing to Peplau was the promise of "free room and board and a monthly stipend" (Callaway, 2002, p. 3). "She was later recognized by the American Academy of Nursing as a 'Living Legend'" (Callaway, 2002, p. 1). Peplau worked as an active nurse for fifty years before retiring in 1974 from Rutgers University. Peplau first earned her nursing diploma before pursuing her baccalaureate degree, master's degree, and doctoral degree (Callaway, 2002, p. 5).

Peplau began her nursing training on her nineteenth birthday in 1928 at Pottstown Hospital Training School. Peplau did not take the typical route to a hospital after earning her diploma, but instead found herself as part of the staff at Bennington College in Vermont (Callaway, 2002, p. 7). Her intelligence and motivation impressed the college president so greatly, that the admission requirements were suspended and Peplau was admitted as a degree student majoring in Psychology.

While she was studying for the degree, World War II intervened and she decided to take the accelerated course study to graduated early and enlist in the Army Nurse Corps (Callaway, 2002, p. 7). However, she did not want to be on the home front, but instead desired to be in the middle of the battle in Europe. Peplau was assigned to a military psychiatric hospital in London, England where she worked with soldiers who were emotionally scarred from the front line (Callaway, 2002, p. 7). By the completion of the war, Peplau was a single parent, by choice. Once again, she was in a position atypical from societal norms. This was a time when society viewed women must choose between being a mother and having a career, but she was not going to give up either roles (Callaway, 2002, p. 8). She raised her child, traveling locally, nationally, and internationally without any child care help. Hildegard Peplau was not active in the feminist movement and the women's movement, but she was strongly driven in creating and shaping her own destiny in order to achieve personal autonomy in her lifetime (Callaway, 2002, p. 9).

Peplau was awarded at least nine honorary doctorates including the nursing's highest honor, the Christiane Reimann Prize (Callaway, 2002, p. 2). She was also the only nurse to be awarded to one of "Fifty Great Americans" by Marquis' Who's Who in 1977 (Callaway, 2002, p. 2). Her career includes six years of general practice and private duty, seven years as a student and the head nurse of health service at Bennington College, three years in the Army Nurses Corps, five years at Teachers College of Columbia University, one year as Executive director, and two years as President of the American Nurses Association (Callaway, 2002, p. 4). Peplau was the only person to ever serve in both of these final positions. Peplau also created the first graduate program to teach nurses advanced-practiced functions in psychiatric-mental health diagnosis, psychotherapy, and also how to care for patients with complex mental health disorders (Chitty & Black, 2007, p. 279). Peplau died March 17, 1999, at the age of 89, but her theories and ideas still continue on (Callaway, 2002, p. 1).

Peplau's Theory Description and Concept Identification

With Peplau's eagerness and drive to learn about life, and the many processes it presents, she created a theoretical framework in the psychiatric nursing field that can be applied to nursing as a whole. Peplau is known for her many contributions to nursing, but one that sticks out above the rest is her theory of Interpersonal Relations in Nursing. She believed that "nursing is based on the interpersonal process and the nurse-patient relationship" (Chitty & Black, 2007, p. 340). According to Chitty & Black (2007, p. 340), nursing care revolves around not just the patient, but around the nurse, the patient, and the therapeutic relationship they create together. This relationship should produce certain goals that are "twofold: first is the survival of the patient; second is the patient's understanding of his or her health problems and learning from these problems as he or she develops new behavior pattern" (Chitty & Black, 2007, p. 340). This means that not only does the patient learn how to better themselves, but the nurse learns about their patient through personal interactions and through thorough assessments of their health and health history. This theory has and will continue to greatly affect how nurses work in today's health-care system and also student nurses learning how to complete thorough care plans and how to establish a therapeutic relationship.

Peplau's Theory Relationship to the Austin Peay School of Nursing's Concepts

The interpersonal theory of Hildegard Peplau has many different facets that relate to the Austin Peay School of Nursing Philosophy. The Austin Peay School of Nursing states that the aim of the Austin Peay Nursing Program is centered on the four paradigms of nursing: the person, the nurse, the environment, and health. Peplau's theory is based upon "recognizing the importance of nursing rather than continuing to define and delineate nursing" (Pearson, 2005, p. 179). Thus, Peplau's theory of interpersonal relationships is very similar to that of the philosophy students follow and can be applied to many different aspects throughout the nursing career.

Concept of Person

The person is the main focus of both Peplau's theory of interpersonal relationships and the Austin Peay School of Nursing concepts. Peplau believed in the relationship between the nurse and the patient. She "based her entire theory on the relationship between the nurse and the patient" (Forchuck, 1993, p. 7). Before, nursing was based upon completing tasks in order to heal the patient physically, not on developing a therapeutic bond and relationship to provide the best care for the patient. These are represented in both the Austin Peay School of Nursing concepts and Peplau's theories.

Concept of Health and Self-Care

Both good health and self care are intertwined when applied to Peplau's theory of interpersonal relationships. Peplau describes self image as "imagined pictures of oneself, drawn from memory or fantasy, which are projected onto or otherwise conveyed to the outside world" (Peplau, 1989, p. 308). With this definition, both self care and health are both equally represented in the importance of a good self image. Health promotion by a nurse can be as simple as completing daily hygiene for a patient and facilitating opportunities to better the mental health of each patient. However, it can be listening to the past events that may have influenced the way a patient perceives their own self image. Peplau believed that one of three outcomes were available when there was a nurse-patient relationship established. The patient either responds passively by becoming dependent on the nurse; by becoming independent or autonomous from the nurse; or becoming interdependent, in which they communicate and work together (Andrist, 2006, p. 270).

Personal self care is equally as important to a positive self image as health, if not more important. Caring for oneself is more gratifying than having someone care for you; therefore, being able to perform personal hygiene and perform basic activities of daily living can have a profound effect on one's self image because the patient then realizes that they are not dependent upon a caregiver to live. This idea of independence is also associated with living at home versus an assisted care facility because clients enjoy living where they are comfortable instead of an unfamiliar residence. According to the Austin Peay School of Nursing philosophy, each individual has self-worth. This is why Peplau also stresses the idea of self image because like physical interventions, it has a positive effect on the health of the patient.

Concept of Family

In some instances the nurse essentially becomes the family of the patient while the client is under the care of the nurse. According to Peplau, the surrogate relationship furthers "the establishment of trust in the nurse-patient relationship" (Andrist, 2006, p. 269). This helps the patient differentiate between the nurse and a symbolic family figure by moving the relationship forward allowing the patient to move from dependency of the nurse to independency (Andrist, 2006, p. 269). The Austin Peay School of Nursing states the family is an influence that affects each individual (APSU SON philosophy), however, this is not limited to the biological family and could include the nurse because a family is what an individual decides that it is.

Concept of Nursing

The interpersonal relationship between the nurse and the patient is essential for the patient to progress towards better health under the care of the nurse. Peplau describes the nurse as being a "nurse, counselor, teacher, technical expert, surrogate, and leader" (Pearson, 2005, p. 341) which allows the nurse to be an all encompassing resource available for the patient to utilize in a variety of situations. The Austin Peay School of Nursing states the professional nurse generalist role includes leader, manager, teacher/counselor, advocate, and researcher. These roles are similar to those presented in Hildegard Peplau's theory which stresses the importance of the personal nurse-patient relationship in order to achieve individual well being. This view of the interpersonal process has been adopted by the Austin Peay School of Nursing in the fact that the nurse's job has many roles that benefit the patient.

Concept of Community

Also important in Peplau's theory is the prevalence of the positive effect that a patient's community has on the patient's health. She states that the nurse "stimulates continuing relationships between patients and their family members and community contacts" (Peplau, 1989, p. 121). This stresses the importance of maintaining culturally connected while under the care of the nurse. Austin Peay School of Nursing also believes that maintaining in contact with the patient's community is important, because by doing so, the factors of the community and environment "motivate the patient to strive for health" (APSU SON philosophy).

Concept of Teaching/Learning

The interpersonal relationships theory presented by Peplau focuses heavily on the teaching and learning relationship between the nurse and the patient. Peplau's theory consists of two main branches of learning, experiential and instructional. The nurse and the patient both have to learn from the experiences between each other and from the patient's past in order for the nurse to be educated about how to effectively teach the patient. Hildegard Peplau believed that in order to teach a patient, the nurse must "observe, describe, analyze, formulate, validate, test, integrate, and use" (Peplau, 1989, p. 359). By doing so the nurse will fall into the identified six roles of nursing which are identified as counselor, resource, teacher, technical expert, surrogate, and leader. The Austin Peay School of Nursing believes that being an effective nurse and being a teacher/counselor is an integral aspect of providing optimum health for the patient as Peplau stated earlier.

Concept of Ethics

Although the Austin Peay School of Nursing believes that professional nursing education involves the understanding and respect of a patient's ethics, Peplau makes no reference to a patient's ethics. However, Peplau believes that the interpersonal relationship is the most important factor influencing the patient's health rather than the ethics surrounding each client.

Clinical Application of Peplau's Theory of Interpersonal Relations

Peplau identified roles of nursing such as counselor, resource, teacher, technical expert, surrogate, and leader (Chitty & Black, 2007, p. 341). She also defined four phases of the nursing relationship: orientation, identification, exploitation, and resolution ("Theory of Interpersonal Relations," 2010). The author's purpose is to relate these roles and phases with the nursing process: assessment, diagnosing, planning, implementation, and evaluation.

Assessment is the gathering of information (Chitty & Black, 2007, p. 195). This step of the nursing process corresponds to Peplau's orientation phase ("Theory of Interpersonal Relations," 2010). In assessment it is important for a nurse to take the leader role so the direction of the assessment is well organized and the nurse gets the needed information. The nurse must also be a counselor and employ the skills of listening and helping the patient through coping with illness. Assessment is the starting point for the rest of the nursing process; if the assessment is wrong the rest of the process is compromised. Therefore the nurse must also be a technical expert in assessment because it is a learned skill.

The data collected in assessment is then grouped and problems and associated causes can be identified (Chitty & Black, 2007, p. 197). The identification phase of Peplau's theory is associated with this phase ("Theory of Interpersonal Relations," 2010). In this phase of the nursing process a nurse would take the role of resource. The nurse holds the knowledge to identify problems and begin to formulate ideas about how to relieve them. The nurse may also begin to play Peplau's surrogate role in this phase if a patient need is not being met by the nurse's agency.

Planning involves setting goals and outcomes (Chitty & Black, 2007, p. 200). The planning phase of nursing is also related to Peplau's identification phase ("Theory of Interpersonal Relations," 2010). In Peplau's theory it is very important for the nurse and patient to communicate and work together in identifying goals and outcomes ("Theory of Interpersonal Relations," 2010). Peplau proposes that by working together the nurse and the patient grow and learn from the process ("Theory of Interpersonal Relations," 2010). The nurse would be a counselor and teacher at this step. The nurse would need to be sure the patient understood desired outcomes and did not have any further questions. Any anxiety or other emotions related to patient goals would also need to be addressed.

Implementation involves putting the plan into action (Chitty & Black, 2007, p. 204). Peplau's phase of exploitation is comparable to this step ("Theory of Interpersonal Relations," 2010). In this phase a nurse would be a surrogate for the patient by obtaining the resources needed for optimal health. The nurse would be a teacher explaining interventions to the patient and how to complete some of these interventions on their own. Nurse's would counsel patients on behavior changes and help the patient through feelings about these changes. The role of technical expert would be important in this phase because a nurse would need particular skills to perform specific interventions.

Evaluation involves a nurse determining if a goal has been met (Chitty & Black, 2007, p. 204). Peplau's resolution phase mirror's this step ("Theory of Interpersonal Relations," 2010). At this point in the helping relationship a nurse would take on the role of teacher. The nurse would teach a patient how to continue improvement, the importance of compliance, or other behavior changes needed to promote health. A nurse would act as a resource helping a patient obtain resources that may be hindering a patient's progress towards a goal. The role of counselor may become important if this step is also associated with termination of services. The nurse would need to address the patient's feelings about the end of the working relationship.

Conclusion of Nursing Theorist: Hildegard Peplau

Hildegard Peplau produced many accomplishments in her lifetime and her Theory of Interpersonal Relations still influences the field of nursing today. This theory emphasizes the close relationship a nurse and patient must make to have effective nursing care happen. This theory also connects on many levels with the Austin Peay School of Nursing concepts that influence the education of the numerous students attending. Learning about this theory can only positively affect how nursing students will enter into their clinical experience. With this theory in hand, student nurses and licensed nurses can have the opportunity to provide the care and communication needed to create the best nurse-patient relationship.