m ILDEGARD LIZABETH
EPLAU

HE ACKGROUND of
mILDEGARD LIZABETH
EPLAU
HILDEGARD ELIZABETH PEPLAU was born in Reading, Pennsylvania
on September 1, 1909 often regarded by many as the
´|

  

G After graduating from the
Pottstown, Pennsylvania Hospital School of Nursing in 1931 she
worked as an operating room supervisor at Pottstown Hospital
She later received a Bachelor of Arts in interpersonal psychology
from Bennington College, Vermont, in 1943, an Master of Arts in
psychiatric nursing from Teachers College, Columbia, New York, in
1947, and an Doctor of education in curriculum development
from Columbia in 1953

From the beginning of her career in the late 1930·s, she worked
ë
 
   tirelessly to advance nursing education and practice Her efforts
 ë and excellent leadership skills saved the American Nurses
    Association from the point of bankruptcy and moved the nursing
 
profession towards scientific recognition and respectability
During World War II, Hildegard E Peplau was a member of the Army Nurse Corps and
worked in a neuropsychiatric hospital in London, England She also did work at Bellevue
and Chestnut Lodge Psychiatric Facilities and was in contact with renowned
psychiatrists Freida Fromm-Riechman and Harry Stack Sullivan She retired in 1974

Hildegard Peplau had been considered as one of the renowned nursing leaders of her
time that her writings and research are repeatedly featured at the Õ 
 

 from 1951 to 1960

Her first book, ´Interpersonal Relations in NursingG published in 1952, was one of the
first books that stated the need to emphasize importance of the nurse-patient
relationship in providing health care Hildegard Peplau holds numerous awards and
positions like     |at International Council of Nurses
Quadrennial Congress and a fellowship at the Õ Õ
 
 

On March 7, 1999, Hildegard Peplau died peacefully at her home in Sherman Oaks,
California after a brief illness at the age of 89 Hildegard Peplau·s 50-year career in
nursing left a remarkable stamp on the profession, and on the lives of the mentally ill
around the world
ÊÕ   Õ
|Õ  | 
!"#Õ! 

Dr Hildegard Elizabeth Peplau, a nursing educator who played a major role in developing
the theory and practice of psychiatric and mental health nursing, died on March 17 at her
home in Sherman Oaks, Calif She was 89

Dr Peplau wrote a seminal text, ''Interpersonal Relations in Nursing: A Conceptual Frame

of Reference for Psychodynamic Nursing,'' which was completed in 1948 and published in
1952 It was translated into several languages and left an impact in much of the world

She introduced the concept of nurse-patient relationship, an interpersonal approach that

has since been integrated into nursing education and practice With this, she was
considered a force in elevating nursing to a profession

Colleagues regarded Dr Peplau as the ''mother of psychiatric nursing,'' said Dr Grayce M

Sills, professor emeritus at the Ohio State University College of Nursing and a fellow of
the American Academy of Nursing
Referring to the general acceptance of Dr Peplau's interpersonal process, Dr Sills added,
''It has been argued that Dr Peplau's life and work produced the greatest changes in
nursing practice since Florence Nightingale '¶

Dr Peplau's book was also deemed highly unusual at the time because it had been written
by a nurse, without a physician as a co-author Its English version remains in print with a
1991 edition from Springer

Dr Peplau was born in Reading, Pa , and witnessed the deadly influenza epidemic of 1918,
which defined her understanding of the impact of illness and death on families

She graduated from Pottstown Hospital School of Nursing in 1931 and from Bennington
College in 1942 She served in the Army Nurse Corps as a first lieutenant in World War II
and received a master's degree from Columbia University in 1947 and a doctorate in
education in 1953

She studied psychology for a certificate from the William Alanson White Institute (1953),
and that study inspired her to adapt the interpersonal approach for the nursing profession
Dr Peplau directed the graduate program of psychiatric nursing at Columbia Teachers
College from 1948 to 1953 and its counterpart at Rutgers University after that She retired
from Rutgers as a professor emeritus in 1974

She lectured worldwide and wrote articles for many publications She was also executive
director and president of the American Nurses Association, which inducted her into its Hall
of Fame last year, and was a board member of the International Council of Nurses, which
honored her with its highest award, the Christiane Reimann Prize, in 1997

Dr Peplau is survived by a sister, Bertha Reppert, of Mechanicsburg, Pa , and a foster

brother, John D Forster, of Reading
½$$Õ"%#ÊÕ 
*Regarded as ´Mother of Psychiatric Nursing G

*Born in 1909, Reading, Pennsylvania

*Graduated from a diploma program in Pottstown, Pennsylvania in 1931

*Bachelor of Arts in Interpersonal Psychology from Bennington College in 1943

*Master of Arts in Psychiatric Nursing from Colombia University, New York in 1947

*Doctor of Education in curriculum development in 1953

*Professor emeritus from Rutgers University

*Certified Psychoanalysis by William Alanson White Institute of New York City

*Worked as executive director and president of ANA

*Died in 1999
|&Õ ! #Õ||Õ

*Interpersonal Relations in Nursing

*Publishes another book, papers, speeches and journal articles

*First nurse to synthesize nursing theory from other scientific fields

#!Õ  %##"

*1943-45 served in the Army Nurse Corps

*Worked with leading figures in British and American psychiatry

*After war worked to reshape mental health system in U S

Õ Õ % !

*First nursing theory to borrow concepts from other disciplines

*Freud, Maslow, Sullivan·s interpersonal relationship theories and the

psychoanalytical model
 ×AJOR ONCPETSand
ERMINOLOGIES
!"#" Õ$! 
Peplau defines psychodynamic nursing because her model evolves through this type of
nursing Psychodynamic nursing is being able to understand one·s own behavior to help
others identify felt difficulties, and to apply principles of human relations to the problems
that arise at all levels of experience

#Õ!!%!'Õ Õ !#|( |! ÕÕ !#"

Peplau described nurse-patient relationship as a four-phase phenomenon One can view
them as separate entities, but they could overlap with each other over the course of the
nurse-patient interation Each phase is unique and has distinguished contributions on the
outcome of the nurse-patient interaction

 Õ |#Õ!' person and the nurse mutually identify the person's problem

*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 recognize 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

*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

*When the patient can begin to identify problems the relationship progresses to the
working phase

r |#Õ!

 %Õ |#Õ!- person identifies with the nurse, thereby accepting help

*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 behavior of the nurse and patient are explored
Peplau 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

)|Õ |#Õ!- person makes use of the nurse's help

*The patient realistically exploits all of the services available to them on the basis of
self interest and need
*The nurse assists the patient in their efforts to strike a balance between the needs for
dependence and independence

*The nurse continues to assess and assists in meeting new needs as they emerge

*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

! |#Õ!- person accepts new goals and frees herself or himself from the
relationship9

*The resolution phase involves the gradual freeing from identification with helping
persons, and the generation and strengthening of ability to stand alone, eventually leading
to the mutual termination of the relationship

*The patient abandons old needs and aspires to new goals

*She or he continues to apply new problem solving skills and maintains changes in style
of communication and interaction

*Resolution includes planning for alternative sources of support, problem prevention,

and the patient·s integration of the illness experience

† Peplau challenged psychiatric nursing to thrive in the new millennium in 


 :

*The nurse-patient relationship

*Engagement in evidence-based practice

*Competence in information technology

*Leadership in shifting the health care paradigm to community-based delivery

 |! Õ#Õ||!!(|!"#Õ$#  proposed
particularly useful in helping psychiatric patients become receptive for therapy

*The patient is accepted unconditionally as a participant in a relationship that

satisfies his needs

*There is recognition of and in response to the patient·s readiness for growth and his
initiative

*Power in the relationships shifts to the patient as the patient is able to delay
gratification and to invest in goal achievement

! ! nurse assumes several roles which empower and equip her in meeting
the needs of the patient

*!: Receives the client the same way one meets a stranger in other life
situations; provides an accepting climate that builds trust Accepting the patient
objectively

* 
| : Answers questions, interprets clinical treatment data, gives
information Interpreting the medical plan to the patient
*: Gives instructions and provides training; involves analysis and
synthesis of the learner's experience Offering information and helping the patient to
learn

Peplau separates teaching into two categories : Instructional³which consists largely of

giving information and is the form explained in educational literature Experiential³
which is using the experience of the learner as a basis from which learning products are
developed

*
 : Helps client understand and integrate the meaning of current life
circumstances; provides guidance and encouragement to make changes Working with
the patient on current problems

*!
: Helps client clarify domains of dependence, interdependence, and
independence and acts on client·s behalf as advocate Figuratively standing in for a
person in the patient's life

*Õ* +: Helps client assume maximum responsibility for meeting

treatment goals in a mutually satisfying way Working with the patient democratically
 ×AJOR
SSUMPTIONS
g
„URSING
×ÕÕ!!$| !
Peplau identifies two explicit assumptions:

*The kind of person the nurse becomes makes a substantial difference in what each
patient will learn as he receives nursing care

*Fostering personality development toward maturity is a function of nursing and

nursing education Nursing uses principles and methods that guide the process toward
resolution of interpersonal problems

! ×Õ|ÕÕ$
! 
Nursing described as a significant, therapeutic, interpersonal process

|!
Peplau defines person in terms of man who is an organism that lives in an unstable
balance of a given system Man is an organism that lives in an unstable equilibrium
#Õ#
Peplau defines health as a word symbol that implies forward movement of
personality and other ongoing human processes in the direction of creative,
constructive, productive, personal, and community living These needs are
physiological demands and interpersonal conditions

  $ 
Peplau implicitly defines the environment in terms of existing forces outside the
organism and in the context of culture, from which mores, customs, and beliefs are
acquired However, these given conditions that lead to health always include the
interpersonal process

#ÕÕ!!

1 Interpersonal Relations in Nursing

2 Patient-nurse relationship
3 Awareness of feelings
4 Use of experiential learning method

Õ%$!

1 Inductive approach
2 Empirical generalizations
3 Observes empirical events and generalizes from specific to all similar events

CCEPTANC
of the
E „URSING HEORY
Õ
1 Integration of scientific disciplines in formulating paradigm of psychiatric nursing
2 Strengthen nurse-patient relationship
3 The start of psychiatric nursing
4 Used for counseling women undergoing depression

Õ
1 Interpersonal Relations in Nursing³used as a manual of instruction to nursing students
2 Foundation of psychiatric nursing education

!Õ#
1 Different studies on the nursing phenomena
2 Improvement of the social system
3 Stress management program
4 Formation of behavior scale
5 Therapeutic behavior of the nurses
 VALUATION
of the
„URSING
½$|"
1 Simple in nature and can be easily understood
2 Definitions not clearly defined
HEORY
3 Logical systematic way of viewing nursing situations

§ Õ"
1 Applicable to all nurses in any setting
2 Used only in the situations that communication can occur
3 It is impossible in working with senile, comatose or newborn patients (one-sided
relationship)

$|Õ!
1 Based on reality
2 Could be tested and observed using pure observation
3 Theoretical area and empirical data are validated and verified

 Õ&? !, !

1 Widens the perception of nursing profession
2 Broaden the scope of nursing practice
3 Touched the lives of many
m