Peplau (1969) suggested that nurses need to become aware of themselves, their personal needs and their personal reactions, in order to help patients to meet their own needs. Nurses must develop the skill of attaining professional closeness, an attribute only learned through professional Some limitations of Peplau’s theory include the lack of emphasis on health promotion and maintenance; that intra-family dynamics, personal space considerations, and community social service resources are less considered; it can’t be used on a patient who is unable to express a need; and some areas are not specific enough to generate a hypothesis.
Her 1952 book, Interpersonal Relations in Nursing, Dr. Peplau outlines her conceptual structure for psychodynamic nursing. This book was the first published nursing theory since Florence Nightingale’s 1860 concept. The basis for her work was her personal and clinical experience. She worked during the great influenza epidemic, which helped her to understand the “influence of illness and death on individuals and families” (Tomay and Alligood, 2002, p. 80). Her theory focuses on the interpersonal development and the therapeutic relationship that develops between the nurse and the patient, unlike many theories that put the attention solely on the client.
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This nurse-client relationship becomes the heart of the nursing process. Peplau’s secondary focus is the intrapersonal process of nurse as well as client. Intrapersonal refers to phenomena that occur within an individual (Forchuk,1993, p. 45).The nurse not only focuses on the client, he or she also reflects on him or herself. Hilda taught psychodynamic nursing, stressing the significance of the nurse’s capacity to understand his or her own behavior in order to help patients recognize their perceived obstacles (Tomey and Alligood, 2002, p. 24).
Core Concepts The core concepts of nursing include: nursing, person, environment, and health. (Forchuk, 1993, p. 7) Peplau further defined these concepts in her theory.She considered nursing to be a tool that seeks to promote health, person as an individual that lives in a variable setting, environment as surroundings that may promote health or maintain illness, and health as the advancement of human development (Forchuk, 1993, p7). Dr. Peplau’s theory evolves through psychodynamic nursing, which she defined as “being able to understand one’s own behavior to help others identify felt difficulties and to apply principles of human reactions to the problems that arise at all levels of experience” (Tomey & Alligood, 2002, p. 82).
She breaks up the nurse-patient relationship into phases: orientation, identification, exploitation, and resolution. In the orientation phase, the patient has a need and seeks help. In the identification phase, the patient recognizes those who can be of assistance. In the exploitation phase, the patient makes an effort to take full advantage of what he or she is offered through the connection. During the resolution phase, the patient slowly puts aside old goals and accepts new ones (Tomey & Alligood, 2002, p. 82). From these phases, Peplau saw different nursing roles emerging: that of stranger, resource person, teacher, leader, surrogate, and counselor.
In the role of stranger, the nurse treats the patient with common courtesy. As a resource person, the nurse answers questions that the patient may have specific to his or her care. The leadership role includes the democratic process and the surrogate role involves the patient and nurse defining all areas of care.In the counseling role, the nurse responds to the patient’s concerns, and the teaching role combines aspects of each of these functions (Tomey & Alligood, 2002, p. 382-383). Application of Dr. Peplau’s Theory A nursing theory aids the practicing nurse in organizing, understanding, and analyzing patient information; making decisions regarding nursing implementation; planning patient care; and predicting and evaluating patient outcomes (Tomey & Alligood, 2002, p.
17). Dr.Peplau’s theory can be utilized to direct the nurse in the various aspects of practice, including assessment and planned interventions. Many nurse-researchers have used Peplau’s theory for quantitative as well as qualitative methods of research. Peplau believed that nurses could apply these principles to any area of their lives. During assessment, the nurse and patient discuss the patient’s problems and the nurse explains available services. As the nurse-patient relationship is developed, the nurse and patient collaboratively define problems and solutions.
Using Peplau’s theory, nurse and client mutually plan to meet the patient needs (Potter & Perry, 1993, p. 10-11) For a nurse to establish the efficacy of planned interventions, the nurse must first be aware of the passage through various stages of the therapeutic relationship. Peplau’s theory has been used extensively in the mental health arena, however, it is relevant in every aspect of nursing practice, including: geriatric, emergency, nurse-management, public health, and clinical practice. Many hospitals in the country have adopted her model as a basis for patient care.Nursing research in areas such as anxiety and empathy resulted from her model (Potter & Perry, 1993, p. 11). Conclusion In conclusion, Peplau’s theory was revolutionary in all aspects of the nursing process.
Peplau’s focus on the interpersonal dynamics of the nurse-patient relationship allows the nurse to cultivate roles as resource person, counselor and teacher. Dr. Peplau’s pioneering idea that the patient is an individual with a felt need and that nursing is an interactive and curative process is still relevant today as it allows for significant healthful outcomes.