 Nightingale

 Peplau
 Leininger
 INTERPERSONAL
RELATIONS
THEORY

HILDEGARD
PEPLAU’S
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Florence
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Florence and the Patient
 Nightingale believed
that caring for the sick
was a component of
Christianity
 Cures were not limited
to medical acts but
also acts of God
 Patient’s needs should
be prioritized
according to Maslow’s
Hierarchy
 Florence and the Patient
 Health Promotion occurred through
providing a sanitary environment, adequate
nutrition, patient comfort, and conservation
of the patient’s energy

 Considered a client to have the capability

to be healthy, however, he/she did not
have the power to control their unsanitary
environment or poor access to essential
nutrients
 Florence’s Theory and Health
 Although Florence Nightingale was bedridden,
she continued to campaign to
improve the heath standards, publishing 200
books, reports and pamphlets.

 She believed that infection arose spontaneously

in dirty and poorly ventilated places
 Her belief led to improvements in hygiene and
healthier living and working environments
 Florence Nightingale’s vision of health care
included professional nursing for the sick and
the poor
 Florence’s Theory and Health
 One of the first people to examine data on
occupational health and safety

 Systemic approach to health care with a

major role for prevention, clean air, clean
water, decent housing and good infant care
 Promoted uniform hospital statistics so that
results could be compared by country,
institution and type of treatment
 Florence and the Environment
 Mother’s responsibility to teach her
children cleanliness in mind, body, and
spirit
This included waste management and
tidiness in and around the home

 Bad smells were to be considered a sign

of danger
Florence and the Environment
 In order for healing to
occur, all environmental
and sanitary conditions
must improve

 Ventilation/ Clean Air and

light were considered key
factors in hygiene
 Florence and Nursing
 Florence Nightingale is the reason why
nursing is considered a profession today and
recognized that educated nurses would be
viewed by the public as professional.

 First nursing school at St. Thomas Hospital

in London

 She believed that God called her to be a

nurse and that He had natural laws that were
to be followed
 Florence and Nursing
 According to Nightingale, the aim of
nursing education was to train women to
become nurses in order to serve society
for the alleviation of the suffering of the
sick, for the amendment of the living
conditions of the poor, and for the
improvement of the health of the
population (Nightingale 1859).
The Effect on Nursing Practice
 Stressed the importance of hygiene and
believed that it aided in the prevention of
disease spreading
 Focused on a holistic caring perspective
 Aseptic practices
 Nursing is a continuous learning process
because new and better practices are
always being developed
What it is, or what it should be?
 BOTH!
 Maintaining a clean environment within
the healthcare setting is essential to
prevent nonsocomial infections
Gloves and other PPE, bed linens,
handwashing
Keeping a clear path for fire safety
What it is, or what it should be?
 However, not everyone always
follows the rules:
Carts, etc. obstructing the hallways
Not everyone wears gloves when they
are supposed to
Handwashing
 Florence Nightingale’s Theory is
one that every nurse should strive
to achieve by maintaining a healthy
environments not only for their
patients, but also for themselves.
 HILDEGARD PEPLAU
 Born on September 1, 1909 @
Reading, Pennsylvania
 1931- Graduated from Pottstown,
Pennsylvania Hospital School of Nursing
 Worked as an Operating Room
Supervisor@ Pottstown Hospital
 1943- received Bachelor of Arts in
Interpersonal Psychology- Bennington
College, Vermont
 HILDEGARD PEPLAU
 1947- Received a Master of Arts in
Psychiatric Nursing- Teacher’s
College, Columbia, New York
 1953- received a Doctor of Education
in Curriculum Development @ Columbia
 Became a member of the Army Nurse
Corps & worked in a neuropsychiatric
hospital in London, UK- WORLD WAR
II
 HILDEGARD PEPLAU
 Worked with psychiatrists
Freida Fromm-Riechman
and Harry Stack Sullivan.
 March 7, 1999- she died
@ her home in Sherman
Oaks, California @ the age
of 89.
 MAJOR INFLUENCES
 She had her first exposure on
INTERPERSONAL THEORY @ Bennington

 She attended lectures on

INTERPERSONAL RELATIONS by
Harold Stack Sullivan

 She was influenced by the Sullivanian

theory (psychoanalysis) and she aimed to
bring this to the patients.
 MAJOR CONCEPTS:

1. PERSON: man is an organism that lives

in an unstable balance of a given system

2. HEALTH: movement of the personality

& other ongoing human processes that
directs the person towards creative,
constructive. Productive and community
living.- needs must also be met
(physiologic demands & interpersonal
process)
3. ENV’T: forces outside the
organism & in the context of the
socially- approved way of living-
social processes (norms. Customs,
beliefs)

4. NURSING: significant,
therapeutic interpersonal process
KEY AND SUB-CONCEPTS
A. PSYCHODYNAMIC
NURSING:
 Being able to understand one’s
own behavior to help others
identify felt difficulties & to
apply principles of human
relations to the problem
B. NURSE- PATIENT
RELATIONSHIP

* PHASES *
1. ORIENTATION- Initial interaction
between the nurse and the patient
wherein the latter has a felt need
and expresses the desire for
professional help.
2. IDENTIFICATION- patient and nurse
explore the experience & the needs of
the patient- leads to relatedness

3. EXPLOITATION- patient derives the

full value of the relationship as he
moves on from dependent role-
independent one.

4. RESOLUTION- patient earns

independence over his care.
C. NURSING ROLES
Nurse assumes several
roles w/c are used in
empowering in meeting the
needs of the patient.
1. ROLE OF THE
STRANGER
Nurse must treat the
patient with outmost
courtesy- accepts the
patient and respects the
patient’s individuality
2. ROLE OF THE RESOURCE
PERSON
(Pt is in dependent role)- nurse
provides answers to pt’s queries-
providing health information, advices,
and simple explanation of the course
of care.
 either straightforward answers or
providing counseling
3. TEACHING ROLE
Gives importance to self-
care
Helping patient understand
the teaching plan
 develop discussions around
the interest of the patient
4. LEADERSHIP ROLE
Acts in behalf of the
patient but also enables pt
to make decisions (achieved
through cooperation and
active participation)
5. SURROGATE ROLE
Also known as temporary care
giver role- motherly role

6. COUNSELING ROLE
 It has the greatest importance
and emphasis in nursing
 STRENGTHS OF THE THEORY

1. Useful in helping psychiatric pts become

receptive for therapy

2. This theory is based on reality and it can

be tested and observed using pure
observation

3. It is used in every aspect of the nursing

profession especially in dealing with
patients.
LIMITATION OF THE THEORY

1.The use of this model/ theory

is limited or impossible in
working with senile, comatose
or newborn patients.
2. Can only be used wherein a
communication occurs between
the nurse and the patient.
 APPLICATION TO NURSING
PRACTICE
 In psychiatric nursing, Peplau’s interpersonal
model is used in counselling women undergoing
depression. Because of the strengthened nurse-
pt relationship, women are able to describe
patterns that resulted to negative thinking &
independently found strategies to manage them.

 Provides clear design for the practice of

psychiatric nursing

 Emphasized the development of interpersonal

relationship between the patient and the nurse
APPLICATION TO NURSING
EDUCATION

 Peplau’s book, INTERPERSONAL

RELATIONS IN NURSING, is being
used as a manual to help graduate
nurses and nursing students alike in
creating a significant nurse- patient
relationship.

 Formulated effective
psychotherapeutic methods.
APPLICATION TO RESEARCH

 Formulated concepts of
anxiety as a means to
constructively resolve
angry feelings through
experiential learning within
the nurse- patient
relationship.
CULTURAL CARE DIVERSITY AND UNIVERSALITY
THEORY 
MADELEINE M. LEININGER
MADELEINE  Born in Sutton, Nebraska July
13, 1925
LEININGER  Received her Basic Nursing
Education from St. Anthony’s
School of Nursing in 1948
 Received her Bachelor of
Science from Mount St.
Scholastica College in 1950
 Received her Master of Science
in Psychiatric-Mental Health
Nursing from The Catholic
University of America in 1954
 Received her Ph.D. in Cultural
and Social Anthropology from the
University of Washington in 1965
MADELEINE  Dr. Leininger is the founder of
LEININGER Transcultural Nursing
 She is a fellow in the
American Academy of Nursing
 She was named a “Living
Legend” by the American
Academy of Nursing in 1998
 She is Professor Emeritus in
the College of Nursing, Wayne
State University and Adjunct
Professor at the University of
Nebraska Medical Center,
College of Nursing, Omaha
 DEFINITION OF
TRANSCULTURAL NURSING

 A substantive area of study and practice

focused on comparative cultural care (caring)
values, beliefs and practices of individuals or
groups of similar or different cultures with the
goal of providing culture-specific and universal
nursing care practices in promoting health or
well-being or to help people to face unfavorable
human conditions, illness or death in culturally
meaningful ways.
DEFINITION OF ETHNONURSING

 The study of nursing care beliefs,

values and practices as cognitively
perceived and known by a
designated culture through their
direct experience, beliefs and value
system.
TRANSCULTURAL
NURSING
 The term Transcultural Nursing is used today to
refer to the evolving knowledge and practices
related to this new field of study and practice.

 Leininger stresses the importance of knowledge

gained from direct experience or directly from
those who have experienced and labels such
knowledge as emic or people-centered. This is
in contrast with etic knowledge or professional
perspective.
TRANSCULTURAL
NURSING

 Leininger contends that emically derived care

knowledge is essential to establish nursing’s
epistemological (the branch of philosophy that
studies the nature of knowledge, in particular its
foundations, scope, and validity)and ontological
(the most general branch of metaphysics,
concerned with the nature of being)base for
practice.
TRANSCULTURAL
NURSING
 Leininger built her theory of transcultural
nursing on the premise that the peoples of
each culture can not only know and define
the ways in which they experience and
perceive their nursing care world but also
relate these experiences and perceptions to
their general health beliefs and practices.