Hildegard Peplau ( Interpersonal Relations in Nursing) PDF

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Theoretical Foundations in Nursing - Interpersonal Relationship Theories and Theorists...

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INTERPERSONAL RELATIONSHIP INTERPERSONAL RELATIONS IN NURSING Hildegard Peplau

BIOGRAPHY Born on September 1, 1909, Hildegard Peplau is an American and the first nurse to serve the American Nurses Association (ANA). She is called the “Mother of Psychiatric Nursing,” and “Nurse of the Century,” and was the first nursing theorist since Florence Nightingale. Her Theory of Interpersonal Relations in Nursing is well-known for helping revolutionize scholarly works in the field. Her advocacy of further educating nurses started when she witnessed a devastating flu epidemic in 1918. During her time, nursing was one of the few career choices for women and she understood the impact of illness and death to families affected by the epidemic. For Peplau, expanding the nurses’ knowledge on the practice would allow them to provide therapeutic care to patients, rather than the custodial care that was prevalent in mental hospitals that era. Peplau’s entire career was devoted to nursing education; she even became an advisor of the World Health Organization (WHO). In her retirement, she served as visiting professor

at the University of Leuven in Belgium from 1975 to 1976. Hildegard Peplau helped establish the first graduate nursing program in Europe. She died on March 17, 1999, at the age of 89.

CONCEPTS, RELATIONSHIPS, MODEL AND NURSING PARADIGM Introduction to Interpersonal Relations in Nursing by Hildegard Peplau Published in 1952, Hildegard Peplau’s “Interpersonal Relations in Nursing” or “Psychoanalytic Nursing” deals with understanding a patient’s behaviours and was influenced by the Theory of Interpersonal Relations by Harry Stack Sullivan. Other personalities that influenced Peplau and her theory were: Abraham Maslow, Percival Symonds and Neal Elger Miller. The interpersonal relationship theory highlights the nurse and patient relationship or the need for partnership between the two of them, wherein they both work together to become mature and be knowledgeable in the process. Phases of the interpersonal process and roles in nursing were also discussed in this theory. Peplau’s theory defined nursing as an interpersonal process because it requires an interaction between two or more people with a common goal. Her theory also recognizes nursing to be therapeutic because it is a healing art that assists a patient or a person who is sick or in need of health care. It states that nursing has a variety of rules, and there are six (6) main roles, which are the following: stranger, teacher, resource person, counsellor, surrogate, and a leader.

Six Roles of Nursing in Interpersonal Relations in Nursing 1. Stranger: is the role where the nurse receives the patient like a stranger, and creates an accepting atmosphere that is not judgmental towards the patient to have an environment that could develop trust. 2. Teacher: is the role where the nurse provides necessary knowledge to the patient through their need or interest, and identifies the knowledge that the patient already knows and elaborate on it. 3. Resource Person: is the role where the nurse here provides specific information to patients who are facing a new situation, and to help them understand a problem. 4. Counselors: is the role where the nurse aids the patient to understand and accept their current situation. Nurses provide guidance that helps the patient express their negative feelings, and encourage them to make certain changes. 5. Surrogate: is the role of where the nurse helps the patient differentiate and clarify the domains of dependence, interdependence, and independence, and acts as an advocate for the patient. 6. Leader: is the role where the nurse gives the patient a responsibility to meet their treatment goal by encouraging them to actively participate in their treatment recovery and so they would avoid being dependent on nurses.

Included in the Interpersonal Relations are four sequential phases, each of which connects to each other and evolves toward a solution. The four (4) phases are the following: orientation, identification, exploitation, and resolution. Four Sequential Phases in Interpersonal Relations in Nursing 1. Orientation Phase – is the phase where the patient identifies that he or she is sick or in need of health care. The patient could be anxious hence ask question(s) regarding what they are feeling. This also where a nurse assesses the patient’s health, situation, and defines the problem to be able to choose the type of service the patient would need. 2. Identification Phase – in this phase, the type of professional help to be given is selected, and patients are assured by the nurses and that they can rely on them. Nurses empathize to and remind patients that they are ready to help and ensure their safety. 3. Exploitation Phase – in this phase, the patient is provided all the available assistance/services to acquire optimal health and wellbeing, and is on the way to being discharged. Nurses help the patients developing in them a sense of responsibility. 4. Resolution Phase – in the last phase, the patient is physically well to go home, and is so discharged. However, the psychological needs of the patient are recognized. Since the patient has already recovered through patient-nurse cooperation, it is important to end their professional relationship with each other and drift away to become mature individuals.

Peplau's Theory Relationship to the Austin Peay School of Nursing's Concepts The Interpersonal Theory of Peplau has a different sided that can relate to Austin Peay School of Nursing Philosophy. It is related to the four paradigms of Nursing; the person, the nurse, health and the environment. Peplau's theory of Interpersonal Relationship is somehow related to that, and many Nursing student can use that in many different aspects that can help in their Nursing career. CONCEPT OF A PERSON The main focus of Peplau's Theory of Interpersonal Relationship and Austin Peay School of Nursing are the Person. Peplau believed in the importance of the relationship of a patient and a nurse. Nursing before only focused on their task in order to heal the patient physically but not on developing the therapeutic bond between the patient and a nurse. These are discussed in both theories. CONCEPT OF HEALTH AND SELF CARE Good health and self-care are intertwined in Peplau's theory of Interpersonal Relationship Theory. 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). Meaning, both health and self-care are equally present in order to have a good self-image. One of the health promotions of a nurse is a proper hygiene for a patient and to facilitate better about patient's mental health. It can also be the the actions that a nurse can listen to the patient's past event stories that enables the patient to perceives their own self-image.

The patient can respond passively to the nurse and by that, they can be independent and they can communicate well to each other. CONCEPT OF FAMILY In some instances, Nurse will be the patient's family. According to Peplau, the surrogate relationship furthers "the establishment of trust in the nurse-patient relationship" (Andrist, 2006, p. 269). This can help the patient to differentiate the nurse and their family. In that, the can learn the dependency on the nurse. The Austin Peay School of Nursing is talking about the family influence that affects individual but it's not limited on the biological family, it can also include the nurse, because the family is up to the patient's decision. CONCEPT OF COMMUNITY Also important in the Theory of Interpersonal Relationship of Peplau, is that the patient's community has a effect on patient's health. She also states that "stimulates continuing relationships between patients and their family members and community contacts" (Peplau, 1989, p. 121). Wherein the maintaining the culturally connected while under the care of the nurse. Nursing also believes that mainting contact with the patient is important because of it, the factors of community and environment motivates the patient to strive for their health. CONCEPT OF TEACHING AND LEARNING The Interpersonal Relationship Theory, Peplau focuses on teaching and learning between the nurse and the patient. The Nurse and the patient learned from each other's experience. In order for the nurse to be educated on patient's past, and can teach the patient effectively. 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). Meaning, the nurse will fall into the identified roles in nursing. counselor, resource, teacher, technical expert, surrogate, and leader. In Austin Peay School of Nursing, to be able to be a effective nursing and being a teacher, it is an effective way to provide an optimum health for a patient. CONCEPT OF ETHICS In Austin Peay School of Nursing, believes that the professional nursing education includes understanding and respect of a patient's ethics. Although, Peplau believes that Interpersonal Relationship Theory is more important in the patient's health rather than the ethics.

THE METAPARADIGM OF HILDEGARD PEPLAU’S THEORY Person Peplau described a "person" as someone who strives in its own way to reduce tension generated by needs." According to her, they are patients in need of help from a nurse, and are made up of individual parts: physiological, social, and spiritual (Black, 2014).

Environment "Environment" for Hildegard Peplau refers to the outside pressures in the context of culture from where customs and beliefs are acquired. It may be a hindrance to a person's goal to achieve wellness. Moreover, it consists of the presence of therapeutic relationship between the nurse and its patient that is helpful in coping up with the illness and the present environmental situation. Health According to Peplau, "health implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living." To be specific, it consists of the nurse educating the patient about the disease process, helping them understand it; the nurse, as well as the patient identifying the possible cause(s) of the illness; and the nurse and patient developing a plan for new behaviors to prevent illness and promote well-being. Nursing Hildegard Peplau's Interpersonal Relations specifically talked about the 4 stages of nurse-patient relationship: orientation, identification, exploitation, and resolution. This is her concept of "nursing." More importantly, for Peplau, nursing is a significant, therapeutic, and interpersonal process. It is a relationship between an individual who is sick or in need of health services, and a nurse especially educated to recognize and to respond to the need of help. It involves problem solving.

APPLICATION OF THE THEORY Field of Nursing Practice The Interpersonal Relations theory became significant in all areas of nursing practice and stressed the importance of nurses’ ability to understand their own behavior to help others identify perceived difficulties. It taught the relevance to: (1) critically look at an existing practice in a specific situation; (2) incorporate that theory into practice; and (3) evaluate the outcome. Through this theory and the 4 phases mentioned (orientation, identification, exploitation and resolution), nurses were able to assess clients’ needs and achieve them by providing comprehensive care, even within limits. Field of Research Peplau’s theory was used as a framework in many researches and in developing propositions using concepts related to it. It contributed to the United States and worldwide development of psychiatric nursing practices. Moreover, Peplau's theory was also utilized in the following fields of research:

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Home care Depression Patient education Nature of nurse-patient relation Role expectation; and Psychiatric practice

It also opened opportunities into conducting more quantitative and qualitative researches about the following: ● ● ● ●

Patient satisfaction Efficacy of theory in relation to patient outcomes Nurse and patient interaction and outcome in each phase; and Factors influencing nurse-patient interaction and patient outcome

Field of Academe The Theory of Interpersonal Relations played a part in the field of academe as well--in the system of "teaching and learning" to be exact. Through this theory, teaching communications and learning and practicing interpersonal skills were revamped thus, improving all areas involving interpersonal relationships in the educational setting....