Nursing Inquiry 2014; 21(4): 311317

Feature

The future in the past: Hildegard

Peplau and interpersonal relations in
nursing
Patricia DAntonio,a Linda Beeber,b Grayce Sillsc and Madeline Naegled
aUniversity of Pennsylvania, Philadelphia, PA, USA, bUniversity of North Carolina, Chapel Hill, NC, USA, cThe Ohio State

University, Columbus, OH, USA, dNew York University, New York, NY, USA

Accepted for publication 7 December 2013

DOI: 10.1111/nin.12056

DANTONIO P, BEEBER L, SILLS G and NAEGLE M. Nursing Inquiry 2014; 21: 311317
The future in the past: Hildegard Peplau and interpersonal relations in nursing
Researchers, educators and clinicians have long recognized the profound influence of the mid-twentieth century focus on inter-
personal relations and relationships on nursing. Today, in nursing, as well as in medicine and other social sciences, neuroanat-
omy, neurobiology and neurophysiology have replaced interpersonal dynamics as keys to understanding human behavior. Yet
concerns are being raised that the teaching, research and practice of the critical importance of healing relationships have been
overridden by a biological focus on the experiences of health and illness. As a way to move forward, we return to Hildegard
Peplaus seminal ideas about the transformative power of relationships in nursing. We propose that Peplaus formulations and,
in particular, her seminal Interpersonal Relations in Nursing can provide direction. We do not propose that her formulations
or her book be simply transposed from the 1950s to todays classroom and clinic. But we do believe that her ideas and writings
are dynamic documents containing concepts and derived operations that can be brought to life in clinical practice. Finally, we
explore Peplaus transformative idea that nursing is, at its core, an interpersonal process both to acknowledge an idea that has
shaped our past and can guide us into our future.

Key words: history, history of ideas, interpersonal communication, nursepatient relationships, nursing theory, therapeutic rela-
tionships.

Hildegard Peplaus story is well known and well told by her
biographer, Barbara Calloway (2002). She was a 1931 gradu-
ate of the Pottstown (Pennsylvania) Hospital Training
School, a 1938 nurse in the infirmary while also an under-
graduate student at Bennington College in Vermont, and, in
the winter of 19411942, prior to her Bennington gradua-
tion, an intern at Marylands Chestnut Lodge, a private psy-
chiatric hospital. Her time at Chestnut Lodge was a
transformative experience. Her work there, with a small
group of neo-Freudian analysts who were moving away from
constructs and treatment techniques that emphasized the
primacy of intrapsychic and psychosexual determinants of
Correspondence: Patricia DAntonio, University of Pennsylvania School of
Nursing 418, Curie Boulevard #407, Philadelphia, PA 19104-4217, USA.
E-mail: <dantonio@nursing.upenn.edu>
mental health and illness, coincided with her solidifying her
professional nursing identity as she completed her bacca-
laureate education. As this group began to articulate a
greater emphasis on social and relational aspects of person-
ality development and interpersonal dynamics, nurses
roles as therapeutic rather than custodial agents were
becoming a reality for her. It was a heady time. Peplau
worked with Frieda Fromm-Reichmann, whose relational
approach to patients was later immortalized in her
patients, I Never Promised You a Rose Garden. She also
attended Henry Stack Sullivans weekly seminars and lis-
tened and learned as he worked out the details of what
would become his seminal book, Interpersonal Relationships
in Psychiatry (Calloway 2002).
Peplau carried these experiences into her military nurs-
ing of shell-shocked soldiers during World War II, her post-

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P DAntonio et al.
war clinical positions, masters degree studies and later
teaching nursing at Teachers College, Columbia University.
She re-connected with the interpersonal theories and treat-
ment techniques of Fromm-Reichmann and Sullivan at the
William Alanson White Institute they established in New
York City, one of the first nurses to matriculate at the Insti-
tute. Most significant were her own late-night writings, which
extended these seminal ideas to initial theoretical concepts
for nursing. By 1952, her book, Interpersonal Relations in Nurs-
ing: Offering a Conceptual Frame of Reference for Psychodynamic
Nursing, was published. Her careful, rigorous and detailed
insistence on interpersonal relationships as the foundational
framework for nurses work quickly became the rhetoric, if
not the reality, of nursing education and practice, in general,
and psychiatric nursing, in particular (Manfreda 1982). Inter-
personal Relations was reissued without revisions through
1996, and it has been translated into six languages (Calloway
2002, 325). It is, we suggest, a true reflection of the author
herself, as a stern intellectual taskmaster in concept develop-
ment and mid-range theoretical premises to support nursing
actions. True to the commitment of nursing as an interper-
sonal relationship of mutuality, Peplau placed as many
demands for reflection and change on the nurse as on the
patient. The nurse had to know her/himself as well as he/
she did the patient. In Peplaus mind (and in her italics), it
was the kind of person each nurse becomes (that) makes a
substantial difference in what each patient will learn as he is
nursed throughout his experience of illness (Peplau 1952,
xii). Self-awareness, personal identity and individuality were
established as dominant, guiding concepts for nursing.
Researchers, educators and clinicians have long recog-
nized the profound influence of the mid-twentieth century
focus on interpersonal relations and relationships on nurs-
ing (Reed 1996; Lego 1999). The work of nursing is now
almost inextricably relationship-centered (Duffy and Ho-
skins 2003). But, as Sills has pointed out, the relational
changes that Peplau set in motion ushered in an even more
fundamental change (Sills 1978). The nursepatient rela-
tionship has become the center of nursing practice, and, as
DAntonio argues, the quality of the nursepatient relation-
ship has become a moral compass by which nurses find their
ways to experiences of satisfaction or distress in their work
(DAntonio 2004). These ideas find renewed relevance
within nursing and health-care as concepts such as patient
centered care, partnering with patients and strengthening toward more inclusive formulations about the experiences
the autonomy of patients and families are emphasized in
healthcare reform standards.
The mid-century context that supported Peplaus work
vanished at the dawn of the 21st century. In nursing, as well
as in medicine and other social sciences, neuroanatomy,
312
neurobiology, genomics and neurophysiology have now
replaced interpersonal dynamics as the royal road (to para-
phrase Sigmund Freud) to understanding human behavior.
The matter of the brain has taken precedence over theoreti-
cal abstractions about the mind. Therapeutic interventions
that target thoughts about self and the world are emphasized
over emotions and relationship issues. Interpersonal therapy
does remain a viable form of psychotherapy. But in response
to valid critiques that the mid-century relationship formula-
tions needed more empirical rigor and research, todays
interpersonal therapies are formally scripted, standardized,
focused and time-limited models that require training and
advanced education and lie within the domain of carefully
trained specialists (Markowitz and Weissman 2012).
How might nursing navigate among the tensions that
exist among our historical legacy in relational based care,
current calls to strengthen the significance of interpersonal
partnerships and the biologically and specialty based impera-
tives that have subsumed the significance of relationships in
our practice? We turn to Peplaus seminal ideas about the
transformative power of relationships in nursing. We pro-
pose that Peplaus formulations and, in particular, her semi-
nal Interpersonal Relations in Nursing can provide some
direction. We do not propose that her formulations or her
book be simply transposed from the 1950s to todays class-
room and clinic. But we do believe that her ideas and writ-
ings are dynamic documents and not simply artifacts of a
time and context. Some formulations such as relationships
have initial, working and terminal phases; that anxiety is a
defining state that nurses must acknowledge and manage
have become so established in education and practice that
they seem timeless truths. Other positions such as the
imperative to develop clinical nursing science not only to
advance the practice of the discipline but also to position it
as a therapeutic, educative and maturing force in society as a
whole (Peplau 1952, 261) have been lost. We explore Pe-
plaus transformative idea that nursing is at its core an
interpersonal process, to acknowledge this idea that has
changed the discipline and as an idea that may guide us
toward future refinement of nursing interventions. Peplau,
we acknowledge, wrote at a particular moment in time and
in a particular North American context. But returning to her
focus on interpersonal relations, we argue, move all nurses
away from reductionist foci on diseases and treatments and
of illness in individuals, families and the health systems in
which they find expression. The structure of those systems
will vary across the globe; the priorities within relationships
may also be quite different. But in the context of the stresses
that we anticipate, all health systems will experience in the
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challenges of the 21st century, Peplaus formulations help all
nurses maintain a steadfast focus on our goals and priorities.
These 21st century initiatives on the structure and func-
tion of the brain are extraordinarily exciting, and emerging
research findings are promising. Concerns are increasingly
being raised; however, in nursing, psychology, social work
and medicine that the teaching, research and practice of
critical importance to the relationship, the vortex for behav-
ioral change, have been overridden by a biological focus on
the experiences of health and illness. While the importance
of the nursepatient relationship is still included in curricula
(Dzopia and Ahern 2009), content specific to the therapeu-
tic use of self so clearly articulated by Peplau has lost ground
to diagnosis and definitive treatment modalities such as
pharmacotherapy and manualized psychotherapeutic inter-
ventions (Perraud et al. 2006). Calls for change are explicit,
and echo Peplau and her colleagues, such as Joyce Travel-
bee, Gwen Tudor and Virginia Henderson, are in need to
operationalize interpersonal relations that can resonate with
todays climates in todays clinical settings (Holmes 2002). In
all, authors argue that we must restore the value of relation-
ships in the processes of behavior change that maximize
health and establish that mutual engagement between clini-
cian and patient is required for such change. Patient cen-
tered care and individually tailored intervention must be
more than rhetoric, and relationships will not efficacious
without provider skills that make them meaningful.
PEPLAU AND INTERPERSONAL RELATIONS AS
THE CORE OF NURSING PRACTICE
Hildegard Peplau was not the first to position the nurse
patient relationship as central to nursings practice and disci-
plinary independence. Throughout the 1920s and 1930s,
leading nursing educators and public health clinicians urged
the discipline to use concepts borrowed from what was then
known as the mental hygiene movement to enhance nurses
acknowledged roles in public health promotion and health
teaching. They urged nurses practicing in communities to
consider the personalities of those receiving their care and
to know the desirable and undesirable traits that might affect
individual lives lived in families and communities. Then
nurses could begin their health teaching (DAntonio 2013).
Leading nurse educators embraced this drive to incorporate
the principles of mental hygiene into nursing practice. In
addition to a change in practice, they believed that the new
knowledge bases of environmental and psychoanalytic the-
ory upon which the mental hygiene movement built would
buttress their claims to specialized knowledge, independent
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The future in the past
practice and a place of more equality in the medical public
health hierarchy (DAntonio in press). But this earlier initia-
tive faltered in the face of diminishing interest in public
health initiatives, increasing interest in acute care interven-
tions and the social and political economy of the Great
Depression of the 1930s where services had to be prioritized
based on the most emergent and life-threatening healthcare
needs.
Peplaus ideas for a broader nursing role, by contrast,
came of age during a time of expansiveness. The National
Mental Health Act of 1946, catalyzed by both concerns about
the mental health of soldiers during World War II and
excitement about new treatment possibilities, made the men-
tal health of the American public a key federal priority. It
built upon the financial support to colleges for baccalaure-
ate education and targeted monies for nurses seeking
advanced psychiatric training (Shalit 1950). The Hospital
Survey and Reconstruction Act, also signed in 1946, provided
substantial federal dollars to underwrite the development
and expansion of hospitals throughout the country provid-
ing both practice arenas and a new emphasis on institutional
care. And, as Lynaugh argues, a new political energy and
public and private coalitions came together determined that
nurses would have collegiate education to meet these new
healthcare demands (Lynaugh 2008). For the first time in
decades, education, rather than, practice, as in the 1920s,
would drive change.
Peplaus Interpersonal Relations in Nursing found both its
voice and its audience in this heady brew of expectations
and resources. It called upon nurses and, as importantly,
nursing students, to use their relationships with patients,
relationships whose examples almost always drew from inpa-
tient not, as in the past, community contexts, as templates
for the deliberations and discussions that would lead to the
maturing forces necessary for full citizenship, a key piece of
the emphasis on normalcy found in the Mental Health Act.
The motif of nursing as a maturing force in society not
just for the discipline runs through Interpersonal Relations
(cf. 1952, 16 and 159). A democratic society requires partici-
pation of all its members, Peplau wrote (1952, 239). And
the development of the skills of participation joined nurses
and patients in applying principles that are presented in any
other interpersonal relationship in any other area of living
(1). In other words, as her publisher pointed out in the book
jacket of the first edition, Peplau presented an enlightened
design for living as well as a modern design for nursing
(emphasis in original) that reflected the concerns of the
postwar period.
The significance of Interpersonal Relations, however, lay
not just in the theoretical framework that captured the social
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and political milieu of the late 1940s and early 1950s. Other
nurses, most notably Helena Willis Render, emphasized the
individuality of patients, the importance of emotional as well
as physical care and the importance of self-awareness in nurs-
ing practice (Manfreda 1982). The importance of Interper-
sonal Relations lay both in Peplaus link of nursing with the
demands of citizenship and in her ability to synthesize, dis-
till, and, finally render concrete, a scaffold of interventions
which would be uniquely within nursings disciplinary
domain from the literature on interpersonal relationships
emerging from both the academy and from clinical practice.
This is seen most clearly in two sections of Interpersonal Rela-
tions: that in Part II that identifies the psychobiological expe-
riences that influence the functioning of the personalities of
patients, nurses and patients and nurses in relation to one
another; and that in Part III that then looks to how an illness
experience can reframe the unfinished developmental tasks
of both patients and nurses and strengthen the abilities of
both in the quest for further personality development.
Nowhere is Peplau clearer that the movement toward health
and full citizenship claims demanded as much of the nurse
as it did the patient.
INFLUENCES IN NURSING SITUATIONS
Given the need of a healthy personality to grow and
develop in ways that ensure, in the mid-century vocabulary,
maximum productivity, Peplau wonders in this section of
Interpersonal Relations: What kinds of basic human needs
seek expression in nursing situations (1952, 73)? Distilling
Sullivans identification of safety and security as overarching
end-states in all interpersonal relations, Peplau presents
two clinical vignettes common in nursing practice. In the
first, a 9-year-old boy forthrightly tackles the anxiety of
upcoming surgical procedures; in the second, a 22-year-old
man seeks escape in a constant stream of complaints. For
both, the end goal is the same: safety and security. For each,
the outcome is unique. The process, however, not the
behaviors, is that to which nurses must attend. The need
for safety and security, Peplau writes, creates tension and
tension creates energy that is transformed into some form
of behavior (1952, 80). The task of nursing is to identify
underlying needs for, in her mind and in her italics, only
when needs are met new and more mature ones emerge
(84). The stakes were high. Paying attention to the needs
of patients, so that personalities can develop further, is a
way of using nursing as a social force to aid people to
identify what they want and to feel free and able to struggle
with others that brings satisfaction and move civilization for-
ward (84).
314
In this section, Peplau asks nurses to not take either their
patients or their own behavior literally. Rather, they are to
see both as purposeful and as meaningful and take upon
themselves the task of interpretation. The grounding of her
ideas in disciplinary practice allows her to anticipate points
of resistance. Patients, she acknowledges, protest inten-
tions that are not indicated in their acts; sometimes, nurses
are unaware of the discrepancies between what they say and
what they do. It is not a simple matter to determine what
purposes and goals direct behavior. She invites her col-
leagues on a journey that extends their practice beyond rote
regulations and medical prescriptions. Nurses can specu-
late, she concludes, and eventually expand their insights
into human behavior (1952, 86).
Peplaus sensitivity to the emotional nuances of clinical
nursing practice also allowed her to reframe two of the most
common, and most disquieting, reactions of nurses toward
their patients: that of frustration and anger. Frustration, she
reminds them, is the result of any interference with, blocking
of, or barrier to a need or desired goal before satisfaction of
those urges has been felt; it is a perceived psychological state
that gives rise to a particular behavior that can be character-
ized as directly or indirectly aggressive (96). But she is at her
strongest when she reconceptualizes nurses puzzlements
with unexplained discomforts as mutually reinforcing anxi-
ety. Peplau moves from Sullivans theorizing about the inter-
personal induction of anxiety in situations in which prestige
and dignity are threatened, to a very real clinical conundrum
in which we are so busy all of the time and the patients who
make so many demands and yet do not seem to know what it
is they want, take up a lot of time needed for other work
(120). Today, this sense of frustration and anxiety, when not
understood and properly interpreted, are often at the heart
of workplace conflict for nurses themselves. The working
conditions of nursing, much discussed today, make this idea
of particular relevance and one that begs development in
nursing education, practice and knowledge generation.
In many respects, understanding the interpersonal pro-
cesses of anxiety stands at the heart of Peplaus seminal con-
tribution to nursing practice. We now take for granted so
many of her original formulations. She calls attention to the
selective inattention that both nurses and patients use to
dissociate uncomfortable events or situations (1952, 126).
She translates the narrowing of perceptual awareness that
accompanies increasing anxiety into situations where it can
either focus energies on productive problem-solving or dete-
riorate into disorganized panic (12832). She connects anxi-
ety with both guilt and doubt lying both inside and outside
levels of awareness (13642) and with coping mechanisms
such as phobias, obsessions and compulsions (14753). The
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thread running through Peplaus formulations is the place-
ment of anxiety as the transformation of energy that is at the
heart of how the human organism that represents the
patient as well as nurse, moves, changes and grows (132).
She invites nurses not to distance themselves from it but,
rather, to embrace it in the name of their and their patients
growth. In the end, nursing is a process not an outcome as
the nurse and patient work together to find out what each is
seeking in the current relationship (157).
PSYCHOLOGICAL TASKS
This might have been a daunting challenge but for Peplaus
move, in Part III of Interpersonal Relations, from the connec-
tions among theories and nursing practice to an ordering of
possible courses of nursing actions that might arise from a
nurses understanding of various situations (1952, 159). It is
here that Peplaus formulation of nursing as a maturing
force in society takes on its most concrete representation.
For both patient and nurse, the guiding principle of living
and practice centers on identifying and meeting develop-
mental needs. In Part III, Peplau teaches nurses to neither
shy from patient needs nor ignore their own. Only by
embracing the idea of needs, she argues, will the mutual and
interactive relations between patient and nurse yield more
than mere data about medical problems (187). It will result
in a unique disciplinary perspective in which the meaning of
a behavior to a patient is the only relevant basis on which to
formulate nursing care (266). This is the essence of the idea
that transformed the discipline in the 1950s. Intersubjectiv-
ity, rather than pure rationality, science and objectivity,
becomes the hallmark of professional nursing practice. Pe-
plaus genius lay in the translation of this abstract principle
into concrete interventions by linking it to normal develop-
mental phases of human growth.
It is in Part III that Peplau translates a vast literature on
the theoretical development of personality into interper-
sonal behaviors recognizable to nursing clinicians. The
infants success in learning to develop trust in self and envi-
ronment, for example, is expressed, when ill, by an ability
(or inability) to accept that dependency is a necessary com-
ponent in interpersonal relationships and a confidence (or
lack of confidence) in the belief that others can meet inevita-
ble dependency needs. In the same way, a young childs abil-
ity to develop a sense of control and independence most
often met by the developmental milestone of toilet training
becomes reframed as an ability (or inability) to delay satis-
faction in light of the realities of certain medical problems.
To Peplaus credit, there is no lock-step quality to her re-
interpretation of what she describes as the first two necessary
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The future in the past
developmental stages. The popular stages, as posited by such
theorists in her time, as Erik Erikson or Jean Piaget, are
sometimes referenced but never mimicked. Rather, Peplau
puts forward two additional stages of psycho-social develop-
ment as germane to nursing practice.
The third of Peplaus subsequent stages, identifying one-
self, or developing a sense of self in relation to others, high-
lights the idea that the self either the patient or the nurse
always responds selectively to experiences (1952, 222). But
the patient and nurse have different interpersonal tasks. The
patient can only and should only see the nurse through the
manner in which she relates to him as a professional not as
an individual who also has a family, or hobbies or profes-
sional interest. The nurse, on the other hand, had to relate
to the patient as a whole and had to position herself to see
his whole personality focused on his problem (223). There
would be mutuality in the interpersonal processes that un-
derpinned professional nursing practice, but it could not be
a reciprocal relationship. The nurse might have her own
opinions about certain issues but in relation to the patients
feelings, Peplau underscored in italics, she is neutral, pro-
viding merely conditions and acting as a sounding board
against which the patient may air his views and give full
expression to his feelings in a non-judgmental relationship
(226). The simultaneity of engagement and dispassion pro-
vided the groundwork for what has become the hallmark
principle of current nursing practice, engagement with the
patient yet containment of personal needs. Again with Pe-
plaus emphasis, the meaning of behavior of the patient to
the patient is the only relevant basis on which nurses can
determine needs to be met (227).
Peplaus fourth and final developmental stage, develop-
ing skills in participation, builds, as do most developmental
theories, upon the successful completion of the three prior
stages. It situates the patient as an active participant in
understanding and solving his problem rather than as a pas-
sive recipient of advice and instruction (1952, 240). While
today, this seems self-evident, it was, in fact, a fundamental
departure from the reification of medical authority and hier-
archical decision-making structures of the 1950s (Starr
1982). Contemporary approaches to maximizing this patient
autonomy still meet with resistance in both medicine and
nursing. To be sure, Peplau differentiated decision-making
arenas that lay in the respective domains of these profes-
sions. A physician, for example, would decide how to set a
broken leg. But it was the nursepatient interpersonal collab-
oration that would tackle solving the problems that would
arise as that same patient sought to resume obligations to
family and community (Peplau 1952, 247). In what would
prove to be prescient, the nurse would help the patient gather
315
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evidence, consider possible courses of actions, and try out what was
proposed (emphasizing the stages of collaborative problem-
solving) in consideration of what was possible within a given
hospital environment (248). Yet Peplau linked this essential
interpersonal nursing obligation to the higher cause of
1950s citizenship. Participation is required by a democratic
society she wrote. When it has not been learned in earlier
experiences nurses have an opportunity to facilitate learning
in the present and thus to aid in the promotion of a demo-
cratic society (259). This interpersonal collaboration strik-
ingly resonates with our current reform-driven shift toward
disease self-management and individuals taking responsibil-
ity for their own health. But, in Peplaus formulation, it does
more: It links a movement toward greater independence,
collaborative participation and authentic control over health
decisions into a larger domain of citizenship and democracy
a link too often omitted in current debates.
CONCLUSION
The idea of identifying and meeting patients needs has long
informed the discipline. As early as 1922, Bertha Harmer, in
her widely used Principles and Practice of Nursing, wrote of
nursing as rooted in the needs of humanity and founded
on the ideals of service. Over the succeeding decades, Vir-
ginia Henderson, Harmers collaborator and, beginning in
1939, co-editor, provided successively more precision to the
identification of the patient needs within nursing domains
(Boschma, Davidson and Bonifacio 2009). The fifth edition
of what is now Harmer and Hendersons Principles and Prac-
tice of Nursing, published in 1955, provided a now iconic defi-
nition of the work of nurses. The unique function of the
nurse, Henderson wrote, is to assist the individual, sick or
well, in the performance of those activities contributing to
health or its recovery (or to a peaceful death) that he would
perform unaided if he had the necessary strength, will, or
knowledge. And to do this in such a way as to help him gain
independence as rapidly as possible (Harmer and Hender-
son 1955, 4).
Peplaus Interpersonal Relations and Hendersons Principles
and Practice, published within a few short years of each other,
both grew out of the exciting intellectual milieu that charac-
terized the 1950s, in general, and nursing at Teachers Col-
lege, Columbia University, in particular. While Peplau spoke
to citizenship and Henderson to independence, they both
spoke to values seen as essential to an empowered and delib-
erative democracy. Yet, they took fundamentally different
approaches to the relationship between nurses and their
patients. Peplau was fundamentally concerned with what
nurses did with their patients; Henderson with what they did
316
to their patients. In the end, they were both scholars in and
of their times. Their ideas of the practice environment were
heavily gendered with nurses being inevitable female and
patients almost always men. Their ideas of normative patient
attitudes, wishes and developmental stages reflected the
same white, middle-class biases as did their peers. While both
acknowledged the performative roles patients had as mem-
bers of families, the development of theories of family func-
tioning had to await a new generation of scholars. And more
recent work on relational ethics call attention to the moral
distress and moral ambiguity nurses confront when their role
and their power are decoupled from the social, political,
material and institutional context of care (Peters and Lias-
chenko 2004).
It would be hard to underestimate Hildegard Peplaus
impact on the discipline. Her ideas of nursing as a collabora-
tive, mutual and interpersonal process changed practice,
education and research. Although Peplau has been credited
with formalizing the role of advanced nursing practice
through the creation of the clinical specialist role in psychiat-
ric nursing, her ideas had an even more substantive effect on
generalist nursing education and practice and on the devel-
opment of programs of nursing research. The post-World
War II availability of federal funding for all levels of nursing
education from that needed for entry into practice to that
which created the first generation of nurse scientists
needed form and structure. Across the United States, schools
of nursing re-imagined the skills and experiences students
required if they were to think of their practice as an interper-
sonal process; scholars tested constructs of anxiety, symptom
expression and psychological dynamics; and practitioners
enthusiastically re-engaged in the care of patients too often
marginalized as hopeless and helpless. As early as 1978, Sills
proposed that Peplaus influence on the nursing culture
amounted to second (or substantive) order change: That it
represented a fundamental change in the fabric of our disci-
plines culture (Sills 1978). The change persists. Over
30 years later, our language is certainly different. We now
speak to the imperatives of patient engagement, self-manage-
ment strategies, informed decision-making and motivational
interviewing to encourage healthier behaviors among our
patients and ourselves. And Peplaus language of interper-
sonal processes still infuses life into these concepts and, as it
did over 50 years ago, positions nurses and nursing as cen-
tral to a reformed healthcare enterprise.
Hildegard Peplau would not stand for a mindless applica-
tion of the principles outlined in Interpersonal Relations in
Nursing to our current disciplinary initiatives and preroga-
tives. In her mind, nursing was both a maturing force in soci-
ety as a whole and a maturing profession in and of itself. As
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she herself reminds us as she closed her seminal book, the
professional nurse who becomes ever more mature recog-
nizes the contribution of great nurses of the past without
being intimidated or dominated by their contribution to the
exclusion of consideration of all the new possibilities in the
light of a changing social situation (1952, 300). Her com-
mand that we continue to grow, mature and serve the society
in which our practice is embedded is her ultimate gift to the
thought traditions that characterize the discipline.
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