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HILDEGARD
PEPLAU
MOTHER OF PSYCHIATRIC NURSING

Subject : TFN Submit by : GROUP 1

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BACKGROUND
Born on September 1,1909 and raised in Reading, Pennsylvania, by her
parents of German descent, Gustav and Otyllie Peplau

Though higher education was never discussed at home, Hilda was strong-
willed, with motivation and vision to grow beyond traditional women’s roles

Wanted more out of life and knew nursing was one of few career choices for
women

In 1918, she witnessed the devastating flu epidemic that greatly influenced
her understanding of the impact of illness and death on families.

March 17, 1999, Peplau died peacefully in her sleep at home in Sherman
Oaks, California
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EDUCATION
Graduate Pottston, Pennsylivania Hospital School of Nursing
1931
BA Interpersonal Psychology: Bennington College, Vermont
1943
During World War II, she served in the Army Nurse Corps and
was assigned to the 312th Field Station Hospital from 1943-1945
in England, where the American School of Military Psychiatry was
located.

MA Psychiatric Nursing: 1947; Ed.D. Nursing Education: 1953,

both graduate degrees from Teachers’ College, Columbia
University
Certification in psychoanalysis for Teachers: William Alanson
White Institute, New York City, 1954
 middle range descriptive classification theory
purpose: to help others identify their felt difficulties
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INTERPERSONAL RELATIONS
THEORY
Nurse-patient
Peplau formulated theories on interpersonal relations in nursing (1952) and the art and science of nursing (1988)
The theory focuses on the interpersonal procesess and therapeutic relationship that develops between the nurse
and client. The interpersonal focus of Peplau’s theory requires that the nurse attend to the interpersonal process
that occur between the nurse and client
interpersonal process: maturing force for personality, include the nurse-client relationship, communication,
pattern integration and the roles of the nurse
Psychodnamic nursing: being able to understand one’s own behavior to help others identify felt difficulties
and to apply principles of human relations to the problems that arise of all levels of experience. This theory
stressed the importance of nurses’ ability to understand own behavior to help others identify perceived difficulties
Peplau believes “The behavior of the nurse-as-a-person interacting with the patient as-a-person has significant
impact on the patient’s well-being and the quality and outcome of nursing care
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PHASES OF NURSE-PATIENT
RELATIONSHIP
1. ORIENTATION PHASE

problem defining phase

when client meets nurse as stranger defining problem and decideng type of service needed
client seeks assistance, conveys needs, ask question, shares preconceptions and expectations of past
experience
nurse responds, explains role to client, helps to identify problems and to use available resources and
services
get acquainted phase
it is important that a professional relationship is established
parameters and boundaries are established and met
early level of trust are developed
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PHASES OF NURSE-PATIENT
RELATIONSHIP

2. IDENTIFICATION PHASE
the nurse permits exploration of feelings to aid the patient in undergoing illness as an experience
that reorients feelings and strengthens positive forces in the personality and provides needed
satisfaction
the goal of the nurse: help the patient to recognize their participation role and promote
responsibility for self
patient responds selectively to people who can meet his needs
patient begins to have a feeling of belonging and a capability of dealing with the problem which
decreases the feeling of helplessness and hopelessness
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PHASES OF NURSE-PATIENT
RELATIONSHIP
3. EXPLOITATION OR WORKING PHASE

patient attempts to drive full value from what he or she is offered through the relationship as he or she
moves on from a dependent to independent one
nurse can project new goals to be achieved through personal effort and power shifts from the nurse to
the patient as the patient delays gratification to achieve the newly formed goals
client’s trust of nurse reached full potential
client making full use of nursing services
solving immediate problems
nurse and patient work towards discharge and termination goals
interventions of the problems are done
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PHASES OF NURSE-PATIENT
RELATIONSHIP

4. RESOLUTION OR TERMINATION PHASE

patient earns independence over his or her care as he or she gradually puts aside old goals and
formulates new one
this s a process that the patient frees himself or herself from identification with the nure
it is very apparent that the experience leaves a lasting imression on the patient since illness and
assuming a dependent role is a unique human experience
final phase of nurse-patient relationship
client met needs
mutual termination of relationship
client has increased self-reliance to deal with their problem
 METAPARADIGM 06

MAN
An organism that “strives in its own way to reduce tension generated by needs.” The client is an individual
with a felt need.

HEALTH
Defined as “a word symbol that implies forward movement of personality and other ongoing human
processes in the direction of creative, constructive, productive, personal, and community living.”

ENVIRONMENT
Although Peplau does not directly address society/environment, she does encourage the nurse to consider
the patient’s culture and mores when the patient adjusts to the hospital routine.

NURSING
“Significant, therapeutic, interpersonal process.” She defines it as a “human relationship between an
individual who is sick, or in need of health services, and a nurse specially educated to recognize and to
respond to the need for help.” | Claudia Alves |
 NURSING ROLE
In the course of the nurse-patient relationship, the nurse assumes several roles which empower and equip
her in meeting the needs of the patient. This illustrates the dynamic character roles typical to clinical nursing.

STRANGER ROLE
RESOURCE ROLE TEACHING ROLE
receives the client the
answers questions, gives instructions and
same way one meets a
interprets clinical provides training;
stranger in other life
treatment data, gives involves analysis and
situations; provides an
information synthesis of the learner’s
accepting climate that
experience
builds trust

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 NURSING ROLE
COUNSELING ROLE SURROGATE ROLE ACTIVE LEADERSHIP TECHNICAL EXPERT
helps client understand ROLE
helps client clarify helps client assume
and integrate the provides physical care
domains of dependence, maximum responsibility
meaning of current life by displaying social
interdependence, and for meeting treatment
circumstances; provides skills; operates
independence and acts goals in a mutually
guidance and equipment
on client’s behalf as satisfying way
encouragement to make
advocate
changes

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 QUOTE

“ Interpersonal process of therapeutic interactions between an individual

who is sick or in need of health services and a nurse especially educated to
recognize, respond to the need for help.”

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 USE TODAY
Peplau’s theory is one of the theory which is being used by all nursing
students in different disciplines. However, it is used most commonly by
students who are doing their metal health nursing specialty, as it is particularly
useful in psychiatric patients become receptive of therapy

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VIEWS, OPINIONS,
QUOTE, SITUATION,
ACTI0N
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APPLICATION
ASSESSMENT (ORIENTATION PHRASE)
Mrs. G, a 27 year old waitress, is on pelvic traction and is restricted to bed. The need for bed rest and restriction
was discussed by her nurse

NURSING DIAGNOSIS
impaired physical mobility related to the presence of pelvic traction

PLANNING (IDENTIFICATION PHRASE)

goal setting was done along with patient
patient will have impaired physical mobility as evidenced by participating in self care within the limits
provide active and passive exercise to all the extremities to improve the muscle tone and strength
make the patient to perform the breathing exercise which will strengthen the respiratory muscle
provide articles near to the patient and encourage doing activities within limits.
Provide positive reinforcement for even a small improvement to increase- the frequency of the desired
activity.
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APPLICATION
IMPLEMENTATION (EXPLOITATION PHRASE)

Carried out plans mutually agreed upon.

Provided active and passive exercises to all the extremities
Made the patient to perform breathing exercises
Massaged the upper and lower extremities
Provided article within the reach of the patient
Provided positive reinforcement to the patient

EVALUATION (RESOLUTION PHRASE)

Mrs. JL was free to express problems regarding difficulty in mobilizing.
She expressed satisfaction when able to move without difficulty
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IDA JEAN
ORLANDO
Subject : TFN Submit by : GROUP 1
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BACKGROUND
Internationally known psychiatric health nurse, theorist, and researcher
who developed the “Deliberative Nursing Process.”

A first-generation Irish American born on August 12, 1926

Nursing diploma- Flower Fifth Avenue Hospital School of Nursing in New

York (1947)
BS in public health nursing - St. John’s University, New York (1951)
MA in mental health nursing - Teachers College Columbia University (1954)

Associate Professor at Yale School of Nursing and Director of the Graduate

Program in Mental Health Psychiatric Nursing
A board member of Harvard Community Health Plan
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DELIBERATIVE NURSING
PROCESS
Orlando believes that the nurse helps patients meet perceived needs that the patient cannot meet
themselves
To interact with clients to meet immediate needs by identifying client behaviors, nurse’s reactions,
and nursing actions to take
From these observations she formulated the deliberative nursing process
Therefore, nurses need to use their perception, thoughts about the perception, or the feeling
engendered from their thoughts to explore with patients the meaning of their behavior
This process helps the nurse find out the nature of the distress and what help the patient needs
Orlando’s theory remains one of the most effective practice theories available. The strength
of the theory is that it is clear, concise, and easy to use. While providing the overall
framework for nursing, the use of her theory does not exclude nurses from using other theories
while caring for the patient
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THEORY DESCRIPTION:
Orlando’s theory developed observations she recorded between a nurse and patient. Orlando’s
nursing theory stresses the reciprocal relationship between patient and nurse. What the nurse and
the patient say and do affects them both.
According to Orlando (1961), people became patients who require nursing care when they have needs
for help that cannot be met independently because they have physical limitations, have negative
reactions to an environment, or have an experience that prevents them from communicating their
needs.
Patients experience distress or feelings of helplessness as the result of unmet needs for help (Orlando
1961).
Orlando proposed a positive correlation between the length of time the patient experiences unmet
needs and the degree of distress. Therefore, immediacy is emphasized throughout her theory.
In Orlando’s view, when individuals are able to meet their own needs, they do not feel distress and do
not require care from professional nurse.
Orlando emphasizes that it is crucial for nurses to share their perceptions, thoughts and feelings so
they can determine whether their inferences are congruent with the patients need (Schmieding, 2006)
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NURSING PROCESS
THEORY:
The nursing process is an interaction of 3 basic elements:

01 THE BEHAVIOR OF THE PATIENT

02 THE REACTION OF THE NURSE

THE NURSINING ACTIONS WHICH ARE DESIGNED FOR THE

03 PATIENT’S BENEFIT
the role of the nurse is to find out and meet the patient’s immediate need for help
nursing process helps the nurse find out the nature of the distress and what helps the patient
the use of this theory keeps the nurse’s focus on the patient
the strength of the theory is that it is clear, concise and easy to use

MAJOR CONCEPT &
DEFINITION
NEED
is a situationally defined requirement of
the patient who relieves or diminishes
his immediate distress if this is supplied
PRESENTING BEHAVIOR OF PATIENT
any observable verbal and nonverbal
behavior of the patient immediate
recation
the nurse’s & patient’s individual
perceptions, thoughts, and feelings
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NURSING PROCESS DISCIPLINE
includes the nurse communicating to the patient his or
her own immediate reaction
made in order to ask for validation, clarification, or
correction from the patient
once referred to as the “deliberate nursing process”
AUTOMATIC NURSING ACTION
nursing activities that are decided upon for
reasons other than the patient’s immediate need
DELIBERATIVE NURSING ACTION
those decided upon after ascertaining a need and
then meeting this need
STAGES OF DELIBERATIVE 19

NURSING PROCESS
1. ASSESSMENT
The nurse completes a holistic assessment of the patient’s needs. This is done without taking the reason for the
encounter into consideration. The nurse uses a nursing framework to collect both subjective and objective
data about the patient.

2. DIAGNOSIS
The diagnosis stage uses the nurse’s clinical judgment about health problems. The diagnosis can then be
confirmed using links to defining characteristics, related factors, and risk factors found in the patient’s
assessment.

3. PLANNING
Addresses each of the problems identified in the diagnosis. Each problem is given a specific goal or
outcome, and each goal or outcome is given nursing interventions to help achieve the goal. By the end of
this stage, the nurse will have a nursing care plan.
STAGES OF DELIBERATIVE 20

NURSING PROCESS

4. IMPLEMENTATION
In the implementation stage, the nurse begins using the nursing care plan

5. EVALUATION
The nurse looks at the patient’s progress toward the goals set in the nursing care plan. Changes can be
made to the nursing care plan based on how well (or poorly) the patient is progressing toward the goals. If
any new problems are identified in the evaluation stage, they can be addressed, and the process starts over
again for those specific problems.
 METAPARADIGM 21

MAN
Orlando uses the concept of human as she emphasizes individuality and the dynamic nature of the
nurse-patient relationship. For her, humans in need are the focus of nursing practice.

HEALTH
Health is replaced by a sense of helplessness as the initiator of a necessity for nursing. She
stated that nursing deals with individuals who require help.

ENVIRONMENT
Orlando completely disregarded the environment in her theory, only focusing on the patient’s
immediate need, chiefly the relationship and actions between the nurse and the patient.

NURSING
Unique and independent in its concerns for an individual’s need for help in an immediate
situation. The efforts to meet the individual’s need for
| Claudia help
Alves | are carried out in an interactive
situation and in a disciplined manner that requires proper training.
 QUOTE

“ The role of the nurse is to find out and meet the patients immediate need
for help. The patient’s presenting behavior maybe a plea for help, however,
the help needed may not be what it appears to be.”

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