Hildegard Peplau Wiki

Andrew Schesser, Kelsi Noeth, Brandy Young, Evan Flanders

Hildegard Peplau
Summary
By: Brandy Young

Education:
Hildegard Peplau began her nursing career in 1931 in Pottstown, Pennsylvania. She gained
knowledge of the nursing practice by working in the operating room, helping in World War II,
and attending college to obtain further degrees. Peplau had a large interest in psychology and
worked alongside some of the well-known psychologists of the time. After getting her Masters
Degree in Psychiatric Nursing as well as a Doctorate in Education, Peplaus began working on
her theory and became known as the Mother of Psychiatric Nursing. (George, 2011).

Nursing Theory:
Peplaus nursing theory focuses on the interpersonal communication and relationships that form
between two or more persons during a healthcare visit (George, 2011). Peplau believed that a
patients optimal health level could best be achieved by developing a therapeutic relationship
between the patient, family, and nurse. Peplaus theory easily can be distinguished into 3 stages:
orientation, working, and termination (George, 2011). The orientation stage refers to the initial
contact between the patient and the nurse, where the patient gains trust and is more willing to
collaborate with the nurse (George, 2011). The second stage, the working stage, occurs when the
patient and the nurse discuss mutual goals and concerns and develop a deeper therapeutic
relationship (George, 2011). The termination stage is the final stage, in which the nurse ends the
relationship with the patient after goals have been met (George, 2011).

Concepts:
Peplaus theory is conceptually based on six different roles that a nurse can take on while
developing a therapeutic relationship with a client. These include: a teacher, leader, counselor,
surrogate, resource, and stranger (Comley, 1994). Her theory focuses on nurse-patient
relationships.
Hildegard Peplau Wiki
Andrew Schesser, Kelsi Noeth, Brandy Young, Evan Flanders


Propositions:
The purpose of Peplaus theory remains to identify psychological factors that influence a
persons growth and healing (George, 2011). However, Peplaus theory cannot be applied to
clients with an abundance of physiological health problems or patients in which adequate
communication cannot be achieved (George, 2011).

Application of Meta-Paradigms:
The meta-paradigms of health, human being, environment, the nursing process are all essential to
developing interpersonal relationships with clients. Peplau focused mainly on environment and
human being in regards to patient health, where a healthy environment (i.e. an open therapeutic
relationship with the nurse) provides the possible chance of healing for the human being.

Theorys implication to nursing practice, education, and research
Peplaus theory continues to be applied to nursing practice, education and research. Nurses
utilize the creation of a therapeutic each time they come into contact with a patient. The 3 phases
of Peplaus theory are clear and concise to allow a strong relationship to build and then cease.
Nursing education, specifically psychiatric nursing, has grown immensely as tools were created
to discuss factors contributing to a healthy nurse-patient relationship (George, 2011). Research
continues to emerge in order to create the highest quality interpersonal relationships and care.

Nursing Theory, Concepts, and Propositions
By: Kelsi Noeth
According to Peplau, the therapeutic art of nursing is viewed as interpersonal due to the
interaction between two or more individuals who are all striving for a common goal (George,
2011). This interpersonal theory, also known as psychodynamic nursing, has a main concept that
focuses on the interaction between the nurse, patient, and family and forms a unique view for
understanding the nurse-patient relationship. It correlates the components of human beings,
health, society/environment, and nursing (George, 2011). In terms of nursing, this brings the
patient the most optimal level of healthcare. However, this theory is not generalizable because
the usefulness remains limited to clients that the nurse is able to interact with in order to create
an educative, therapeutic, and maturing force (Comley, 1994). Peplaus theory is understood
through three consecutive stages. The first stage, orientation, describes the initial interaction
between the nurse and patient. During the orientation stage, it is especially important that the
nurse works collaboratively with both the patient and the family in an effort to define the existing
problem that the patient is facing. This collaboration decreases stress and anxiety that may occur
from having a fear of the unknown of the future. At the end of this phase, the nurse, patient, and
family become more comfortable with each other and, in turn, create more comfort for the
patient in the helping environment (George, 2011). The working phase comes next and
throughout this phase the patient and nurse discuss their expectations. This stage requires a
therapeutic relationship that is more intense and selective. Because of the more in depth
relationship, the patient forms feelings of belonging, and has a greater likelihood of wanting to
deal with the problem (George, 2011). The last phase in the interpersonal process is the
termination phase. In this phase, the collaborative efforts of the patient and nurse have produced
Hildegard Peplau Wiki
Andrew Schesser, Kelsi Noeth, Brandy Young, Evan Flanders

success at meeting the expectations. At this point, the links of the relationship need to be
dissolved (George, 2011).
Peplau also describes six different nursing roles that have a possibility of emerging
during the interpersonal relationship between the patient and nurse: the stranger, resource person,
teacher, leader, surrogate, and counselor (Comley, 1994). Since the theory is so complex, the
likelihood of each role occurring depends on each individual client situation. Peplau stated that
the family therapist initiates change in a family system by engaging each family member in
examining the network of relations and pattern integrations in which each is participated and by
testing out new behaviors (Forchuk & Dorsay, 1994, pg 114).
The proposition, or plan of action, of the interpersonal theory has contributed highly to
the nursings body of knowledge. In applying this theory during the nursing practice, the main
focus is to assist the patient to identify psychological and growth needs (George, 2011). The
proposal of this theory is not recommended for those with an abundance of physiological
needs. The theory can also be used for heart failure patients to provide information about their
health status, expectations, and perceptions that can help plan care (George, 2011). The utility of
this theory in cyberspace has also had a considerable amount of research. The phases of this
theory can be applied to the online communication that could occur between the nurse and
patient. Nurses are still capable of upholding the six roles this way (George, 2011).


Education and Specialty
By Andrew Schesser
In 1931, Hildegard Peplau began her nursing career by graduating from the Pottstown,
Pennsylvania Hospital School of Nursing (Forchuck, 2007). Shortly after, she worked in the
same hospital as an operating room supervisor (Forchuck, 2007). In an effort to increase her
knowledge through education, Peplau attended Bennington College in Bennington, Vermont. It
was here that she attained a B.A. in interpersonal psychology (Forchuck, 2007). During the
second World War from 1943 to 1945, Peplau gained experience by working in several different
psychiatric hospitals. Through this work experience, Peplau worked alongside famous
psychiatrists such as Frieda Fromm-Reichman and Harry Sullivan (Forchuck, 2007). Sullivans
theory, along with Freuds and Maslows on interpersonal relationships, would greatly ,
influence the development of her own theory (George, 2011). Becoming interested in combining
the concepts of nursing and psychology, Peplau went on to the Teachers College in Columbia,
New York and eventually earned an M.A. in psychiatric nursing and an Ed.D in curriculum
development from 1947-1953 (Forchuck, 2007). All of this education and experience eventually
lead to a momentous theory in the world of nursing which would impact how nurses interact with
and treat patients in order to perform optimal care of all patients needs instead of simply
performing health maintenance. Through her theory and her work in the nursing field, Peplaus
Hildegard Peplau Wiki
Andrew Schesser, Kelsi Noeth, Brandy Young, Evan Flanders

specialty was nursing in psychiatric hospitals and she is even known today as the mother of
psychiatric nursing (George, 2011, 65).

Application of Meta-paradigms
By Andrew Schesser
There are several meta-paradigms which can be applied to Peplaus theory of
interpersonal relationships. The meta-paradigm of human being is described in this theory as an
organism which naturally works to reduce any strain or discomfort generated by physiological
and psychological needs (George, 2011). Each patient has their own specific needs which they
can feel as a result of emotions that are produced or abnormalities occurring inside of their body.
Health as a meta-paradigm is defined by Peplau as a symbolic word which stands for a positive
increase in physiological and psychological processes such as creativity, productivity, and
becoming part of a community (George, 2011). One of the central meta-paradigms in Peplaus
theory of interpersonal relationships is the environment. Although it is not specifically defined,
providing an environment which recognizes and respects different cultures is pivotal when
making sure that your patient is comfortable and can form a trusting relationship with their nurse.
The last meta-paradigm which can be applied to Peplaus theory is the meta-paradigm of the
nursing process. Nursing, as described in Peplaus theory, is a relationship involving two people;
one person has specific health needs and the other has a specialized educational background in
nursing in order to assess and respond to any needs the patient may have (George, 2011). This
meta-paradigm is especially important, given that a nurse must be able to critically think in order
to identify different problems and appropriately treat them. With these skills, the nurse can
perform the greatest care and thus create the best interpersonal relationship with their patient.

Theorys implication to nursing practice, education, and research
By Evan Flanders

Peplau laid a framework for a well-organized perspective on nurse-patient relationships. The
relationship can be defined by what specific phase it is in. There are three main phases in which
Peplau has detailed, including the orientation phase, working phase, and the termination phase
(George, 2011). These three phases implicate a well-organized approach for a nurse to use when
going through the nursing process and enhance it. Within each phase, a nurse can analyze and
apply concepts of health, nursing, society and environment, such as the components of strangers,
Hildegard Peplau Wiki
Andrew Schesser, Kelsi Noeth, Brandy Young, Evan Flanders

anxiety and problem in the orientation phase (George, 2011). In a way, the theory simplifies the
nurse-patient relationship process, it progresses from beginning to end in a generalizable way the
majority of times, allowing for easy adaptability of the nurse-patient relationship (George, 2011)
The theory has done much for education and research for nursing, especially in the fields
of psychiatric nursing (George, 2011). Focusing on the nurse-patient relationship theory, there
was an instrument created to measure this relationship. Tools such as these were able to conclude
important factors influencing the nurse-patient relationship, such as preconceptions and how to
effectively move from the orientation phase to the working phase (George, 2011). Through
studying and forming hypotheses around this theory, nurses can improve nurse-client
relationships. This will provide a better standard of care through educating new nurses on what
research has already correlated to success. When there is a higher quality nurse-client
relationship that is formed, there is a higher quality of care that is received. With this theorys
framework in place, research and education will create better nurses, better care, and stronger
relationships.

References
Comley, A. L. (1994, January 26). A comparative analysis of Orem's self-care model
and Peplau's interpersonal theory [Electronic version]. Journal of Advanced
Nursing, 20, 755-760.
Forchuk, C., & Dorsay, J. (1994, April 13). Hildegard Peplau meets family systems
nursing: innovation in theory-based practice [Electronic version]. Journal of
Advanced Nursing, 21, 110-115.

Forchuck, Cheryl. "Hildegard Peplau Nursing Theorist Homepage." 2007.
<http://publish.uwo.ca/~cforchuk/peplau/peplau.html>
George, J. B. (2011). Nursing Theories (6th ed., pp. 64-85). Upper Saddle River, NJ: Pearson.