The Interpersonal Theory of Hildegard Peplau
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Hildegard Peplau was the eminent U.S. nurse and the first nursing theorist after Florence Nightingale, who developed the theory of interpersonal relations. The theory helped to drastically change the scholarly work of nurses. As the foremost contributor to the reformation of mental health laws, Peplau advocated the humane treatment of sick people with personality and behavior disorders (Tomey & Alligood, 2006).
She considered the interpersonal competence of nurses as crucial in assisting patients with regaining their well-being and health. The paper seeks to explore the comprehensive and detailed theory of interpersonal relations developed by Peplau, where the nursing theorist provided examples of the three phases, which take place in the nurse-patient relationship along with the associated issues.
Peplau (1991) describes nursing as a therapeutic and healing art that assists individuals who are sick or in the need for healthcare services. Nursing is also viewed as an interpersonal process that includes the interaction between two or more humans with a common aim (Forchuk, 1993). In nursing, a common objective is an incentive for the effective therapeutic process, in which the patients and nurses respect one another as individuals. Both of them continue to learn and grow as a result of close interaction.
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It is important to mention the main concepts of Peplau’s theory. The nurse defines a human organism as one that strives to diminish tension produced by the needs in its own way. The patients are individuals with felt needs. Peplau defines health as a symbolic word that implies constant human processes including the movement of personality in the direction of community, productive, creative, personal, and constructive living. Even though the nurse does not directly address environmental and social issues, she is encouraged to pay attention to the patients’ morals and culture when adjusting to the hospital routine. As the mother of psychiatric nursing, Peplau mentions nursing as an interpersonal, therapeutic, and vital process based on the human relationship between needy, sick people and health care specialists. Nurses receive special education in order to recognize and respond immediately to the need for assistance (Peplau, 1991).
In her theory, Peplau describes a therapeutic relationship between nurses and clients as planned and professional interaction that emphasizes the ideas, needs, and issues. Any purpose can be achieved through 4 simple steps. Therefore, the nurse developed four phases of the therapeutic relationship between nurses and patients.
- The first phase is orientation guided by the nurse. It involves engaging a patient in treatment, providing the necessary information, explanations and responding to the questions.
- The second identification phase starts when the clients work interdependently with the nurses, express their feelings, and feel stronger.
- In the third exploitation phase, the patients fully use the offered services.
- In the fourth resolution phase, the clients no longer need professional services and refuse from dependent behavior. The interaction ends.
Hildegard Peplau identifies the following main roles of nurses in the therapeutic relationship. The first one is a stranger. The nurse offers courtesy and acceptance to the client as to any other stranger. The second one is a resource person, who provides answers to the specific questions within a large context. The third one is a teacher, who helps the patient to learn informally and formally. The fourth one is a leader, who offers direction to a single client or a group of clients. The fifth one is a surrogate, who serves as a substitute. The sixth one is a counselor, who promotes experience and expresses feelings leading to the patient’s recovery. In addition to the main roles, Peplau points to the role of safety agent, mediator, researcher, administrator, observer, consultant, and tutor.
Hildegard Peplau identifies four levels of anxiety (Peterson & Bredow, 2013).
- The first level is mild anxiety. It is the positive state of sharpened sense and increased awareness that allows a human being to resolve problems and learn new behavior.
- The second level is moderate anxiety that involves a reduced field of perception. There is a focus only on immediate tasks. A man may resolve issues and learn new behavior only with the outside help. Another individual can redirect someone to the task.
- The third level is severe anxiety that includes the feeling of terror and fear. In this case, no one can redirect a person to a certain task. These individuals have physiologic symptoms of chest pain and tachycardia. They pay attention only to the scattered details.
- The fourth level is panic anxiety that includes delusions, physical immobility, numbness, and loss of rational thought. At this level, people may expose themselves to injuries.
Since nurses and patients interact, Peplau underscores that nurses should clearly understand themselves, stimulate their patients’ growth and avoid limiting choices of every client (Videbeck, 2010). The phases developed by the nursing theorist reflect simplicity in the natural progression of the relationship between nurses and patients that leads to adaptability in any interaction and provide generalizability.
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Peplau in her interpersonal theory conceptualized a clear set of roles that every nurse can use in their own practice. The nurse’s duty is not only to provide care. The nursing profession includes a variety of activities that may influence the patient’s care. The idea of interaction between nurses and clients is limited in unconscious individuals, who are unable to communicate. The conception offered by the foremost nurse theorist can be applied when providing care to psychiatric patients. Interaction is not limited to these people. Therefore, the nurse can apply it to any capable client, who can communicate. The therapeutic nurse-client phases can be compared to the nursing process making it applicable. While planning and nursing diagnosis coincide with the identification phase, evaluation is associated with the resolution phase, assessment as to the orientation phase, and implementation coincides with the exploitation phase.