Hildegard Peplau
Hildegard E. Peplau (September 1, 1909 – March 17, 1999) was an American nurse and the first published nursing theorist since Florence Nightingale. She created the middle-range nursing theory of interpersonal relations, which helped to revolutionize the scholarly work of nurses. As a primary contributor to mental health law reform, she led the way towards humane treatment of patients with behavior and personality disorders. Biography. Early life. Hildegard was born in Reading, Pennsylvania to immigrant parents of German descent, Gustav and Otyllie Peplau. She was the second daughter born of six children. Gustav was an illiterate, hard-working  father and Otyllie was an oppressive, perfectionist mother. 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. As a child, she was watcher of people's behaviours. She witnessed the devastating flu epidemic of 1918, a personal experience that greatly influenced her understanding of the impact of illness and death on families. She witnessed people jumping from windows in delirium caused by the flu. In the  early 1900s, the autonomous, nursing-controlled, Nightingale era schools came to an end – schools became controlled by hospitals, 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 by a nurse's employers, physicians, and educational providers. Career. Peplau began her career in nursing in 1931 as a graduate of the Pottstown Hospital School of Nursing in Pottstown, Pennsylvania. She then worked as a staff nurse in Pennsylvania and New York City. A summer position as nurse for the New York University summer camp led  to a recommendation for Peplau to become the school nurse at Bennington College in Vermont. There she earned a bachelor's degree in interpersonal psychology in 1943. At Bennington, and through field experiences at Chestnut Lodge, a private psychiatric facility, she studied psychological issues with Erich Fromm, Frieda Fromm-Reichmann, and Harry Stack Sullivan. Peplau's lifelong work was largely focused on extending Sullivan's interpersonal theory for use in nursing practice. From 1943 to 1945, she served in the Army Nurse Corps, and was assigned to the 312th Field Station Hospital in England, where the American School of Military  Psychiatry was located. Here she met and worked with leading figures in British and American psychiatry. After the war, Peplau was at the table with many of these same men as they worked to reshape the mental health system in the United States through the passage of the National Mental Health Act o 1946. Peplau held master's and doctoral degrees from Teachers College, Columbia University. She was also certified in psychoanalysis by the William Alanson White Institute of New York City. In the early 1950s, Peplau developed and taught the first classes for graduate psychiatric nursing students at Teachers  College. Dr. Peplau was a member of the faculty of the College of Nursing at Rutgers University from 1954 to 1974. At Rutgers, Peplau created the first graduate level program for the preparation of clinical specialists in psychiatric nursing. She was a prolific writer, and was well known for her presentations, speeches, and clinical training workshops. Peplau was a tireless advocate for advanced education for psychiatric nurses. She thought that nurses should provide truly therapeutic care to patients, rather than the custodial care that was prevalent in the mental hospitals of that era. During the 1950s and 1960s, she conducted  summer workshops for nurses throughout the United States, mostly in state psychiatric hospitals. In these seminars, she taught interpersonal concepts and interviewing techniques, as well as individual, family, and group therapy. Peplau was an advisor to the World Health Organization, and was a visiting professor at universities in Africa, Latin America, Belgium, and throughout the United States. A strong advocate for research in nursing, she served as a consultant to the U.S. Surgeon General, the U.S. Air Force, and the National Institute of Mental Health. She participated in many government policy-making groups. She served as president of the American  Nurses Association from 1970 to 1972, and as second vice president from 1972 to 1974. After her retirement from Rutgers, she served as a visiting professor at the University of Leuven in Belgium in 1975 and 1976. Personal life. In 1944 Peplau met an American army psychiatrist who was also briefly stationed at the 312th Field Hospital in England. With the psychiatrist somewhat perturbed by post combat stress, and Peplau herself unsettled by the unexpected death of her mother shortly after the couple met, their relationship got out of hand, leading to a pregnancy. As the psychiatrist was married, Peplau  went on to raise their daughter as a single mother. She rarely talked about the father to others, though she spoke highly of him shortly before her death. Letitia Anne Peplau was born in 1945 - she would later grow up to be a psychology professor at UCLA, and an influential contributor to the scientific literature. After Letitia's birth, Peplau had no more serious romances, dedicating her energies to her daughter and to her career. In 1999, Peplau died peacefully in her sleep at her home in Sherman Oaks, California. Theoretical work. In her interpersonal relationship theory, Dr. Peplau emphasized  the nurse-client "relationship", holding that this relationship was the foundation of nursing practice. Her book, "Interpersonal Relations in Nursing", was completed in 1948. Publication took four additional years, mainly because Peplau had authored a scholarly work without a coauthoring physician, which was unheard of for a nurse in the 1950s. At the time, her research and emphasis on the give-and-take of nurse-client relationships was seen by many as revolutionary. The essence of Peplau's theory was creation of a "shared experience" between nurse and client, as opposed to the client passively receiving treatment (and the nurse  passively acting out doctor's orders). Nurses, she thought, could facilitate this through observation, description, formulation, interpretation, validation, and intervention. For example, as the nurse listens to her client she develops a general impression of the client's situation. The nurse then validates her inferences by checking with the client for accuracy. The result may be experiential learning, improved coping strategies and personal growth for both parties. Peplau's model. Peplau's Six Nursing Roles. Peplau describes the six nursing roles that lead into the different phases: Peplau's Developmental Stages of the Nurse-Client Relationship. Orientation Phase. The orientation  phase is initiated by the nurse. This is the phase during which the nurse and the patient become acquainted, and set the tone for their relationship, which will ultimately be patient centered. During this stage, it is important that a professional relationship is established, as opposed to a social relationship. This includes clarifying that the patient is the center of the relationship, and that all interactions are, and will be centered around helping the patient. This phase is usually progressed through during a highly impressionable phase in the nurse-client relationship, because the orientation phase occurs shortly after admission to  a hospital, when the client is becoming accustomed to a new environment and new people. The nurse begins to know the patient as a unique individual, and the patient should sense that the nurse is genuinely interested in them. Trust begins to develop, and the client begins to understand their role, the nurse's role, and the parameters and boundaries of their relationship. Identification Phase. The client begins to identify problems to be worked on within relationship. The goal of the nurse is to help the patient to recognize his/her own interdependent/participation role and promote responsibility for self . Exploitation Phase / Working Phase. During the Working Phase, the nurse and the patient work to achieve the patient's full potential, and meet their goals for the relationship. A sign that the transition from the orientation phase to the working phase has been made, is if the patient can approach the nurse as a resource, instead of feeling a social obligation to the nurse (Peplau, 1997). The client fully trusts the nurse, and makes full use of the nurse's services and professional abilities. The nurse and the patient work towards discharge and termination goal. Resolution Phase/Termination Phase. The  termination phase of the nurse client relationship occurs after the current goals for the client have been met. The nurse and the client summarize and end their relationship. One of the key aspects of a nurse-client relationship, as opposed to a social relationship, is that it is temporary, and often of short duration (Peplau, 1997). In a more long term relationship, termination can commonly occur when a patient is discharged from a hospital setting, or a patient dies. In more short term relationships, such as a clinic visit, an emergency room visit, or a health bus vaccination visit, the  termination occurs when the patient leaves, and the relationship is usually less complex. However, in most situations, the relationship should terminate once the client has established increased self-reliance to deal with their own problems. External links. Other details Peplau Interpersonal Theory and its application with QSEN Name: Institution: Course Title: Date: Introduction The Peplau Interpersonal Theory was advanced by Hildegard Peplau in 1948. As its proponent, she seeks to define the nurse-patient relationship. She advocates for active participation of both parties in ensuring that the experience is more human. The nurse is expected to initiate the communication process  that leads to treatment. On the other hand, the patient is expected to open up to the nurse during care and treatment. The nurse facilitates this mutual relationship through observing the patient's behavior, describing the patient's illness, formulating the appropriate care for the patient, interpreting the doctor's prescription, validating the treatment, and intervening whenever it is deemed necessary (Peplau, 1991). QSEN Competencies Application Conclusion References De, C. M. (2005). Caring for the vulnerable: Perspectives in nursing theory, practice, and research. Sudbury, MA: Jones and Bartlett. Finkelman, A. W., Kenner, C., Finkelman, A. W., & American Nurses Association. (2012 ). Learning IOM: Implications of the Institute of Medicine reports for nursing education. Silver Spring, MD: Nursesbooks.org, American Nurses Association. In Kelly, P., In Vottero, B., & In Christie-McAuliffe, C. (2014). Introduction to quality and safety education for nurses: Core competencies. New York, NY: Springer Publishing. Peplau, H. E. (1991). Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. New York: Springer Pub. Co.