Hildegard E. Peplau...authobiography

 Hildegard E. Peplau, first published nursing theorist in a century, since Nightingale  Created the nursing middle-range theory of Interpersonal Relations  Helped revolutionize the scholarly work of nurses  Contributor to mental health laws/reform  Hildegard E. Peplau -- born September 1, 1909 in Reading, PA to immigrant parents of German decent  Illiterate, work-a-holic father  Oppressive, perfectionist mother  Raised in a paternalistic family

and a paternalistic society

 Though higher education was never discussed at home, Hilda was strong-willed, with motivation and vision to grow beyond traditional women’s roles  She wanted more out of life and knew nursing was one of few career choices for women in her day.  WW I ended in 1918, along with the great flu epidemic the same year  Industry expansion & bullish stock market  Women first vote 1920  Roaring 20s & Prohibition  It was a man’s world in both business and education

 The autonomous, nursing- controlled Nightingale era schools came to an end – schools controlled by hospitals now and formal book learning was discouraged  Hospitals and physicians saw women in nursing as a source of free or inexpensive labor  Exploitation was not uncommon of nurse’s employers, physicians and educational providers  Nursing practice was controlled by medicine (Chinn, 2008)  Peplau pushed forward beating the odds:  Graduate Pottstown, PA Hospital School of Nursing in 1931  BA Psychology: Bennington College, VT 1943

 World War II: Army Nurse Corps -- worked in a neuropsychiatric hospital in London, England  MA Psychiatric Nursing: 1947; Ed.D. Nursing Education: 1953, both graduate degrees from Teachers’ College, Columbia University  Certification in Psychoanalysis for Teachers: William Alanson White Institute, New York City, 1954

 Hilda witnessed injustices in life, being determined to push past them for social justice  First exposure to Interpersonal Theory at Bennington  Attended lectures by Harold Stack Sullivan on Interpersonal Relations  Studied with Frieda Fromm-Reichman and Eric Fromm  She had vision to bring the Sullivanian theory to interactions with her patients – they needed:  Humane treatment  Dignity & respect  Healing discussion  …in a time when  there was none to be found…

 Teachers’ College: Director of Advanced Program in Psychiatric Nursing  She created nursing curriculum  Included study of nurse-patient interactions through “Process Recordings”  Peplau analyzed interactions of students with patients, taking her own experience into account 

Reviewed them for recurring themes

 Using clinical data for theory development – empirical evidence Her book, or conceptual framework, was completed by 1948, entitled Interpersonal Relations in Nursing   Publishing her book took four additional years because it was groundbreaking for a nurse to contribute this scholarly work without a coauthoring physician  Peplau’s original intent was not theory development per se

 She wanted “only to convey to the nursing profession ideas [she] thought were important to improve practice”  Peplau’s focus was the quality of nurse-patient interactions and nursing education (O’Toole, 1989; Forchuk, 1993, p. 3)

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 BASIC ELEMENTS: 

the patient



the nurse

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the interaction between them

 DEFINITIONS:  CLIENT/PATIENT – person, couple, group, community, deserving of humane care with dignity, privacy, ethics  ENVIRONMENT - Physiological, psychological and social fluidity that may be illnessmaintaining or health-promoting

 HEALTH – Forward movement of personality and other ongoing human processes in the direction of creative, constructive, personal, and community living

 INTERPERSONAL – Phenomena that occur between persons  NURSE – The medium of the art of nursing; a maturing force. “The unique blend of ideals, values, integrity, and commitment to the well-being of others…”  NURSING ROLES - to assist client starting as stranger, then technical expert, resource person, surrogate, counselor, teacher and others 

(Forchuk, 1993; Peterson, 2009)

 Two original assumptions:  1) The kind of nurse each person becomes makes a substantial difference in what each client will learn as she or he is nursed throughout his or her experience with illness  2) Fostering personality development in the direction of maturity is a function of nursing and nursing education; it requires the use of principles and methods that permit and guide the process of grappling with everyday interpersonal problems or difficulties  Later Peplau added:  3) Nursing can take as its unique focus the reactions of clients to the circumstances of their illnesses or health problems  4) Since illness provides opportunity for learning and growth, nursing can assist clients to gain intellectual and interpersonal competencies, beyond those that they have at the

point of illness, by gearing the nursing practices to evolving such competencies through nurse-client interactions (Forchuk, 1993)

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 5) Psychodynamic nursing crosses all specialty areas of nursing. It is not synonymous with psychiatric nursing since every nurse-client relationship is an interpersonal situation in which recurring difficulties of everyday life arise  6) Difficulties in interpersonal relations recur in varying intensities throughout the life of everyone  7) The need to harness energy that derives from tension and anxiety connected to felt needs to positive means for defining, understanding and meeting productively the problem at hand is a universal need  8) All human behavior is purposeful and goal-seeking in terms of feelings of satisfaction and/or security  9) The interaction of nurse and client is fruitful when a method of communication that identifies and uses common meanings is at work in the situation  10) The meaning of behavior to the client is the only relevant basis on which nurses can determine needs to be met  11) Each person will behave, during any crisis, in a way that has worked in relation to crisis in the past (Forchuk, 1993)

  ORIENTATION PHASE

 Get acquainted phase of the nurse-patient relationship  Preconceptions are worked through  Parameters are established and met  Early levels of trust are developed  Roles begin to be understood  IDENTIFICATION PHASE  The client begins to identify problems to be worked on within relationship  The goal of the nurse: help the patient to recognize his/her own interdependent/participation role and promote responsibility for self

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(Belcher, 2002; Peterson, 2009)

 EXPLOITATION PHASE

 Client’s trust of nurse reached full potential  Client making full use of nursing services  Solving immediate problems  Identifying and orienting self to [discharge] goals  RESOLUTION PHASE  Final phase of nurse-patient relationship  Sense of security is found as patient has less reliance and identification upon nurse helper  Client has increased self-reliance to deal with his/her problem

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(Belcher, 2002; Peterson, 2009)

 ROLES of NURSE: Interlocking functions a nurse undertakes to assist a client  Stranger (Orientation phase)  Technical Expert & Authority Figure  Surrogate for significant others  Resource Person  Change-Agent  Researcher  Counselor  Arbitrator  Teacher  & More  Specific roles variable within each nurse-client situation, being limited only by the imagination and skill of the nurse   ROLES of NURSE: Interlocking functions a nurse undertakes to assist a client  Stranger (Orientation phase)  Technical Expert & Authority Figure  Surrogate for significant others

 Resource Person  Change-Agent  Researcher  Counselor  Arbitrator  Teacher  & More  Specific roles variable within each nurse-client situation, being limited only by the imagination and skill of the nurse

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 Within personalities, there are needs, frustrations, conflicts, and anxieties that are influential

 Every human has basic needs and goals exerting tensions within the relationship  Nurse’s own self-understanding helps nurse to respond to these tensions and coping mechanisms

 Nurse guides patient towards healing; tension and anxiety are converted into purposeful action as the result of the therapeutic relationship (Peterson, 2009)  Psychological tasks of humans learning to live with others require attention  Developmental processes directly influence each person’s expressions of feelings, attitudes and beliefs  They bring about situations in which the nurse can assist the patient  Counting on others  Delaying satisfaction  Identifying oneself  Participating with others (Peterson, 2009)  A wide range of concepts are identified by Peplau having an impact on the practice of the nurse and the evolving nurse-patient relationship

 Intrapersonal factors, interpersonal factors and specific clinical phenomena are assessed  Problems and goals can be identified, then strategies implemented for healing and personal growth to take place (Forchuk, 1993)  Nursing Process Methods  Observation  “Observation and understanding of what is observed are essential operations for making judgments and designing experiences with patients that aid them in the solution of their problems”  Communication  Process Recording – Analyze & Evaluate  Nurse self-scrutiny is required, along with observing and analyzing his/her own behavior  Communication: verbal and nonverbal requires nurse to recognize and understand meanings

 Process recordings – used as tools in the educational development of nurse to gain insights and learning skills associated with healing in the context of the relationship (Peterson, 2009, p. 218)

 Nurse gains competencies of higher understanding of self, concepts, roles and processes to help patient toward growth and healing  Peplau warns: danger of ‘social talk’ with patients – Nurses shouldn’t speak the same way to patient as to family or friends. It should lead to therapeutic effects – promoting long-term well-being  Nurse’s own emotional needs should not get in the way of tending to the needs of the patient  Interpersonal Relations theory assists the nurse to  Observe more intelligently  Intervene more sensitively

 New ostomy patient  Nurse senses tentions and tries to help by lightening the mood through distraction toward other events – pt smiles  Nurse continues to help the patient by caring for the appliance for the patient  Inadequate coping is reinforced  Another day went by with nurse promoting increased patient dependency by staff “helping”  New ostomy patient  Nurse recognizes her own anxieties of ostomy, as well as patient’s anxiety (avoidance of care and involvement)  Nurse assists patient to explore feelings through therapeutics  Nurse openly prompts patient to talk about concerns during care of the appliance  Encourages patient to look at, touch, & care for appliance progressively throughout care  PRAGMATIC UTILITY:

 Nurses’ critical thinking, therapeutic-intervention/communication - beyond task oriented nursing  Requires self-scrutiny of motives and expectations by the nurse (maturity)

 Requires understanding of inductive reasoning skills  It is the basis of higher levels of caring  Directly affects interventions dealing with communication  The interactions with the patient spawn deeper thinking in both the patient and the nurse towards positive healthcare outcomes  Utility based on individual use by nurse to invest energy and vision into relationship understanding & healing

 SCOPE:  Used in practice domains where interpersonal or intrapersonal difficulties are taking place – [all (?)]  Uses are broad; not confined to only psychiatric nursing, but other areas of nursing as well  Limited in realm of physiological/medical issues – but helpful to patients with concerns or “issues” –most pts have these to some degree  Very useful in settings of nursing education where focus on nurse-patient relationship and communication are discussed  ROUTINE INTEGRATION faceted effects

into daily practice within any area of clinical nursing, with multi-

 Nurses in private counseling practice would increase  Theory requires the mature nurse to look deeply at own behavior, attitudes, motives, & actions during daily practice & in relationships – self-scrutiny  Invites the nurse to be less self-gratifying, and more in tune to the needs of the patient (and support systems), as well as filtering into peer and professional relationships  RESULTS: All interactions within practice would be more mature and healing in a context of caring, potentially improving peer relations as well  Near elimination of disrespect between staff members with improved focus on the welfare of the patient – better focused care plans  During her military service, Hilda mothered Letitia Anne Peplau or “Tish,” born January 30, 1945  Hilda remained unmarried in a time when it was clearly socially unacceptable, keeping it a secret from all but her immediate family  She had her brother, Walter, legally adopt Tish, so that Hilda could continue to pursue her scholarly endeavors while legally raising her “niece”

 Hilda was not going to let social prejudices stop her from making further progress in her chosen career of nursing…  She continued and transformed nursing from a “Science of doing” to a “Science of knowing”  Peplau played a role in landmark legislation that established the National Institute of Mental Health in 1946  An ambassador for graduate education in nursing - teacher, mentor, advisor, and sponsor – she inspired generations of students

 Though often disappointed by her profession, her career was always rewarding -- She had powerful vision to move nursing forward as a profession of respect  Even in retirement, Hilda was tenacious for nursing education and continued to write for publications and lecture internationally  Many accomplishments did not “seem” noticed by the nursing profession to Hildegard until after her retirement  Hilda contributed joyously as the nursing profession moved forward with developing higher education programs 

ANA created the Hildegard Peplau Award for contributions to the advancement of nursing through research, and inducted Hilda into the ANA Hall of Fame

 Developed the first graduate nursing program devoted exclusively to the preparation of clinical specialists in psychiatric nursing  Executive Director of the American Nurses’ Association: 1969-70, President from 1970-72, and Second V.P. from 1972-74  Third Vice-President and board member for the International Council of Nurses: 1973-81  She served as World Health Organization (WHO) consultant and visiting professor at the University of Leuvan in Belgium for two periods, 1975 and 1976 to 1977 (O’Toole, 1989)  Fellow: American Academy of Nursing  After retirement she earned nine Honorary Doctorates from Rutgers University (Professor Emerita), Columbia University, Duke University, and others  Pronounced a “Living Legend” By the American Academy of Nursing  Labeled “Mother of Psychiatric Nursing” and “Psychiatric Nurse of the Century”  Received Christiane Reimann Prize, nursing’s highest honor  Hilda passed away, age 89, March 17, 1999 leaving a legacy of dignified and healing relations with patients, as well as healthy roots for nursing education and scholarly pursuits  She made many contributions to nursing and society during a critical time in world history

 Hildegard carried a light and will be remembered as the Nursing”

“Mother of Modern Psychiatric