Hildegard Peplau: A Nursing Theorist

Hildegard Peplau: a Nursing Theorist Introduction Hildegard Peplau is a nursing theorist who lived between 1909 and 1999. She was born in Reading, Pennsylvania. She attended Pennsylvania Hospital School of Nursing where she graduated from in 1931, and went on to obtain a BA in interpersonal psychology in Bennington College in 1943 and an MA in psychiatric nursing in 1947 from Teacher’s college, New York.

Peplau also earned a doctorate degree in Education, curriculum development from Columbia in 1953 Through her works, Peplau established the mental care aspect of nursing (Sills, 1978).

She greatly impacted nursing as a field and the lives of mental patients, and is known as the founder of modern psychiatric nursing and advocate for the mentally ill. Other major accomplishments of Peplau include serving as the executive director and president of ANA, being distinguished with honors such as the Christiane Reimann Prize in 1997 and being crowned as a “Living Legend” (Sills, 1978, p. 121) by the American Academy of Nursing in 1998.

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Hildegard Peplau Professional Life In her early professional life, Peplau worked as a general nurse and as an operating room supervisor before developing a keen interest in psychiatry. In the 1940s, while on winter field trips, she had an opportunity to research on child care in New York and work on children’s wards at Bellevue Hospital. She also worked in Chestnut Lodge, which was a big psychiatrist hospital in Maryland whereby she had the opportunity of being mentored Harry Stack Sullivan and Frieda Fromm-Reichmann. Harry was a psychiatrist who was then researching on interpersonal theory of psychiatric illness, while Frieda was Peplau’s supervisor. Through these exposures to psychological matters, she proceeded to William Alanson White Institute and obtained a certificate in psychoanalysis, subsequently developing the theory of interpersonal relationships.

In 1954, Peplau joined Rutgers University in New Jersey where she introduced the pioneer graduate program in psychiatric nursing. Peplau also worked as an Army Nurse Corp during the second world, besides working in London in a neuropsychiatric hospital (Sills, 1978).

Peplau’s life and work brought impacted greatly the field of nursing since the times of Florence Nightingale, another major theorist. As a child, she was ever fascinated with people and this passion was so strong to drive her to come up with the theory of interpersonal relations.

The development Peplau’s theory of interpersonal relations was inspired by Harry Stack Sullivan’s theory of interpersonal relations (1953). Others who influenced Peplau in the development of her theory were Percival Symonds, Abraham Maslow’s and Neal Elger miller, all prominent psychologists. Peplau’s interpersonal relations, also commonly referred to as psychodynamic nursing, is a middle range descriptive classification theory argues that the major role of a nurse is to assist the clients identify the problems affecting them (Gregg, 1978).

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The Interpersonal Theory and Transitions in Nursing The nursing profession has witnessed drastic changes and developments to become a field that touches on human beings, environment, and health, in contrast to the initial perceptions as a field concerned with illness only. Peplau recognized that it is through understanding the relationships between man, the environment and health that knowledge necessary for the advancement of the nursing practice can be gained. She portrays illness as an opportunity for personal growth and development. At the time Peplau introduced the theory of nursing-patient relationship, patients were not actively involved in issues affecting their health care. Peplau in her work describes the roles the nurse and the patient play in care process by illustrating the interpersonal processes involved during the interaction of the nurse and the patient (Burd & Marshall, 1963).

There are four sequential stages involved in this theoretical framework: “Orientation, identification, exploitation, and resolution” (Callaway, 2002, p.63). In the orientation phase of the nurse-patient interaction, the two got to know one another and understand each other’s background, including culture and education. In the identification phase, the nurse and the client evaluate and analyze the health problem while in the exploitation phase the problem is worked out by utilizing the resourcefulness of the nurse. The resolution phase involves resolving patient’s health issue through team work. Throughout these phases, the nurse has different roles such as being a foreigner, a trustworthy ally, teacher, a resource manager, substitute, and an advisor. During the first meeting, the nurse is a stranger to the client; hence he or she has to work to close the gap between them. The nurse then takes the role of a teacher and imparts knowledge to the client. As a resource manager, the nurse plans for the available medical resources. The nurse also plays the role of surrogate through counseling and sometimes representing the patient.

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Another major role for the nurse is that of a leader and therefore must make initiatives and set goals for the team (Peplau, 1978).

The nurse-patient relationship depends on dynamic psychological and biological experiences which Hildegard, in her theory emphasizes that nurses ought to be helpful to their clients in completing their psychological maturity if not fully developed thus be able to identify themselves, achieve satisfaction, depend on others, and be able to share (Callaway, 2002). To be effective, however, she proposed that the nurses have to comprehend themselves in order to be able to work with the patient and identify perceived problems. Through interacting with the patient, the level of self-awareness, maturity and knowledge increases hence the perceived problems are best tackled.

It is through Peplau’s relentless efforts that nursing theory was merged with practice. She helped in bringing about theoretical learning in nursing and delineated nursing as an independent profession, hence giving the nurses the space to take initiatives contrary to the primitive attitudes which relegated the profession to subordinate the physicians. She instead advocated for the professionalization of nursing to concentrate on the way the patient reacts to health difficulties (Sills, 1978). Peplau refined nursing by challenging nurses to be at the forefront in assisting their clients regain their health by applying high degree of professionalism and competence (Peplau, 1952).

She thus strived for the independency of nursing profession from medicine by explaining the nurse’s role as not being only confined to carrying out the directives of physicians but also carefully observing and understanding the responses of the patient and providing the right information to the patient. Peplau perceived that by having a looser relationship with the

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physicians, nurses could have opportunities of establishing direct relationships with their clients (Sills, 1978).

Conclusion The contributions of Peplau, both theoretical and clinical, resulted into the evolution of psychiatric nursing as a specialty and changed nursing to be an autonomous body (Sills, 1978).

Peplau campaigned strongly for the nurses to further their education and move from the traditional assumptions of nurses as custodial providers in mental facilities, but instead be actively involved in delivery of therapeutic care. The interpersonal processes have been inducted into the nursing profession and other professions worldwide. Peplau is therefore credited with bringing life to the nursing profession by enhancing and promoting the understanding of the nature of man and incorporating it to the profession.

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Burd, S. S. & Marshall, M. A. (1963). Some clinical approaches to psychiatric nursing. New York: Macmillan.

Callaway, B. J. (2002). Hildegard Peplau: Psychiatric nurse of the century. New York: Springer.

Gregg, D. E. (1978). Hildegard E. Peplau: Her contributions. Perspectives in Psychiatric Care, 16(3), 118-121.

Peplau, H. E. (1952). Interpersonal relations in nursing. New York: Putnam, Peplau, H. E. (1989). ‘The professional dimension.’ In interpersonal theory in nursing practice: Selected works of Hildegard E. Peplau (O'Toole A.W. & Welt S.R. eds). New York: Springer.

Sills, G. M. (1978). Hildegard E. Peplau: Leader, practitioner, academician, scholar and theorist.

Perspectives in Psychiatric Care, 16(3), 122-128.