The Evolution of the Psychiatric Clinical Nurse Specialist: An Interview with Hildegard E. Peplau

Lee Spray: I'm interested in your experience in content development in the early days of your work to develop graduate education in psychiatric nursing. Hildegard Peplau: Some were worried you wouldn't get sufficient students to come into these new master's programs that were being developed, and the program directors of the five existing graduate programs went entirely different ways. For instance, at Teachers College (TC) at Columbia University, I had students who were working for a bachelor's and students who were working for a master's; they took the same courses but they got the degree they needed. At the University of Minnesota, the Dean decided they couldn't do it at the master's level, so their graduate program was at the baccalaureate level. Then there were differences in the content. I had graduated from the master's program at Teacher's College, which I took in 1946 and '47, and it was really very, very bad. It was a series of lectures by nurses who came in, and some of them talked about their golf games, some of them spent the time berating us because we had been in WW II and had an easy time of it, in Europe or Asia, while they were at home and overworked. Others just sort of filled in the time with whatever came into their heads. The only really good lecture I had was Laura Fitzsimmons, who was then nurse consultant at the American Psychiatric Association. [In 1948] I was trying to think how to make a really useful program and I hit upon the idea of having every nurse sit down with one patient, for one hour, twice a week, for 16 weeks in the first semester and then 16 more weeks in the second semester, write down verbatim what the nurse said and what the patient said, because we didn't have tape recorders then, then meet with me and go over that data piece by piece. It was out of that particular learning experience that I began to generate some conceptual materials like the concept of anxiety, the concept of need integration--that is, the nurse's need and how it is integrated or connected with the patient's needs--and many others, such as the process of hallucination. All of it came out of that kind of clinical work that students did, the supervisory review of the data I did with them, and then the formulation from that of conceptual material, which eventually became advanced nursing practice. Now it took awhile because in the beginning there were many problems. Some of the students came from hospital schools and had been working in state hospitals and had never opened a book. The problems they had in even talking with the patient had to be dealt with before you could get to something substantial from which you could do this kind of empirical, qualitative sort of research. Catholic University pretty much went the descriptive route. It taught the prevailing descriptive psychiatry with a little refurbishing of what it was the nurse did in relation to that. One of the other programs went the psychoanalytic route and it taught Freud, Jung, Adler, Homey, and all of those. So the five programs ended up as being very, very different. At the same time, I served on the National Mental Health Advisory Council to the National Institute of Mental Health (NIMH), and we were making all kinds of decisions. One piece of that was a nurse training grant committee, which began to do site visits to other universities to persuade them to establish graduate programs. So that today, in 1995, there are more than 100 [programs]. But in 1948, when I first directed the Teachers College program there were only five graduate programs, so you can see we have succeeded at least in terms of numbers. I think that content development now depends on a more substantial kind of nursing research and not so much on empirical research derived from the clinical work of graduate students. More nursing research has to be done. LS: You were focused early on having an original contribution to nursing theory. …