Hildegard Peplau Nursing Theory

Hildegard Peplau’s theory of interpersonal relations is a middle range theory that focuses on the nurse – patient relationship and how the two work together toward the common goal of wellness. By working through a set of phases in a particular order, the nurse and patient can reach the goal toward wellness together and the patient can continue that journey after the relationship is terminated. This theory is important because the nurse needs to understand the importance of how the nurse-patient relationship can help the patient achieve a better understanding of the importance of their care. Once the patient has a good understanding of his or her care, he can continue to work toward wellness without having the nurse constantly helping.

I chose Hildegard Peplau because I feel that nursing is more than the passing of medications or doing wound care. Educating patients on the why’s and what’s of their treatment can help the patient remain well or maintain their health to the best of their ability. Peplau’s theory teaches the nurse how to interact with his or her patient so that the patient feels more in control of his treatment which can also give him the sense that the treatment can be done without the assistance of the nurse once the patient is discharged from her care.

Hildegard Peplau was a psychiatric nurse who had many accomplishments in life. According to Sills, Peplau, and Reppert (2007), Peplau began her nursing career in 1931. While working as a staff nurse she received her Bachelor’s degree in interpersonal psychology in 1943. She then went on to work in a private psychiatric facility where she worked with Eric and Frieda Reichmann and Harry Stack Sullivan. It was Stack’s interpersonal theory that Peplau based her theory on. Peplau then went on to join the Army Nurse Corp from 1943-1945 working in a military psychiatric hospital. Peplau received her master’s and doctoral degrees from Teacher’s College at Columbia University. It was here that she got her certification in psychoanalysis. From 1954-1974 Dr. Peplau remained on the faculty at Rutgers University College of Nursing. In 1952 Peplau had a book published which she completed in 1948 but could not publish due to the fact that “it was considered too revolutionary for a nurse to publish a book without a physician co-author”. Many awards were received throughout Dr. Peplau’s life such as the Christine Reimman prize which is the highest world of nursing honor. In 1996 she was honored as a living legend, and was inducted into the ANA hall of fame in 1998. Dr. Peplau died at the age of 89 in 1999.

Peplau’s theory of interpersonal relations focuses on the nurse-patient relationship. According to Kearney-Nunnery (2008) there are three phases of this theory. The first phase is the orientation phase. During this phase the nurse identifies herself along with her professional status to the patient and she sets the groundwork down for the nurse-patient relationship. The second phase is the working phase which is broken down into to two sub phases, the identification phase and the exploitation phase. The identification phase is when the patient learns how the nurse-patient relationship will work and the exploitation phase sets the groundwork for what services the patient will use. The third and final phase is the termination phase which is when the completed work for the patient is done and the nurse-patient relationship is terminated. The following web page: http://currentnursing.com/nursing_theory/interpersonal_theory.html discusses the theory in depth and gives the reader a break down of how the theory works with the nursing process. The following table found on the web site shows how the theory and nurse process are related Saleem (2010):

Assessment

Data collection and analysis [continuous]

May not be a felt need

Orientation

Non continuous data collection

Felt need

Define needs

Nursing diagnosis

Planning

Mutually set goals

Identification

Interdependent goal setting

Implementation

Plans initiated towards achievement of mutually set goals

May be accomplished by patient , nurse or family

Exploitation

Patient actively seeking and drawing help

Patient initiated

Evaluation

Based on mutually expected behaviors

May led to termination and initiation of new plans

Resolution

Occurs after other phases are completed successfully

Leads to termination a

This theory seems to be mainly based for the psychiatric community but can be applied to regular nursing as well. By setting the ground work during the orientation phase, the nurse can develop a relationship with her patient and open up the communication necessary for treatment to begin. During the working phase, the nurse and patient can discuss what is necessary for the patient to get well and the nurse can begin her teaching which the patient will need in order to maintain his or her health. Once the patient is able to do all things necessary to maintain their health, the termination phase can proceed. This theory can be applied to the nursing practice but as pointed out on the previous web site Saleem (2010), there are limitations such as:

Intra family dynamics, personal space considerations and community social service

resources are considered less

Health promotion and maintenance were less emphasized

Cannot be used in a patient who doesn’t have a felt need e.g. with drawn patients,

unconscious patients

Some areas are not specific enough to generate hypothesis

Dr. Peplau was able to apply this theory in her practice because of the dynamics of her specialty which was psychiatric nursing. My specialty in nursing is working with heart patients. I tend to see many of the same patients over and over due to the disease process. This theory can be applied to my nursing and may be helpful in slowing down the number of times my patients return. By applying this theory my patients will get the education and the understanding they need to manage their disease at home without the watchful eye of the nurse.

In conclusion, by applying Hildegard Peplau’s nursing theory of interpersonal relations to the nursing practice, the nurse is able to communicate and work with the patient more efficiently toward the common goal of wellness.