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Hildegard Peplau

1909 1999
Psychodynamic
Nursing Theory

K. Moreno 2008

Background
Born on September 1,1909 Reading,
Pennsylvania
1931 Nursing in Pottstown, Pennsylvania
1943 B.A. in Interpersonal Psychology in
Bennington College
1947 M.A. in Psychiatric Nursing in
Columbia University
1953 Ed.D in Curriculum Development in
Columbia University
Died on March 17, 1999 in Sherman Oaks,
California

Nursing Experiences
Supervisor of Operating Room in Pottstown
Private and general duty hospital nurse
Two years in US Army nursing research
Taught graduate psychiatric nursing
Retired Professor Emeritus from
Rutgers University
Facilitator of first post
baccalaureate nursing program
in Belgium

Literary Works
1951 Interpersonal Relations in
Nursing
Numerous articles in professional
magazines on topics ranging from
interpersonal concepts to current
issues in Nursing
Basic Principles of Patient
Counseling pamphlet; derived from
her research and workshops

Awards and Titles


The only nurse to serve the ANA as
executive director and later as president
Served two terms on the Board of the
International Council of Nurses (ICN)
1996 Living Legend; American
Academy of Nursing
1997 - Christiane Reimann Prize;
nursings highest honor at the ICN
Quadrennial Congress
1998 - ANA inducted her into its
Hall of Fame

Awards and Titles


Founder of modern psychiatric nursing;
Mother of Psychiatric Nursing
Innovative educator
Advocate for the mentally ill
Proponent of advanced education
for nurses
Executive Director
President of the American Nurses
Association
Prolific author

Peplaus Work and the Characteristics


of a Theory
Interrelated creates a different
perspective of viewing the nurse-patient
interaction and the transaction of health
care.
Logical way of progression from initial
contact through termination.
Simple yet Generalizable natural
progression of nurse-patient relationship
which leads to ease in adaptation, thus
provides generalizability.

Peplaus Work and the Characteristics


of a Theory
Generation of Hypothesis and
Contribution to General
Knowledge through Research

Consistent with Other Theories


Maslows Need Theory and Selyes
Stress Theory.

Peplaus Definition of Four Major Concepts


Man an organism who strives in its own
way to reduce tension generated by needs.
Health 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.

Peplaus Definition of Four Major Concepts


Environment - existing forces
outside the organism and in the
context of culture

Nursing a significant therapeutic,


interpersonal process.
It functions cooperatively with other human
process that make health possible for individuals
in communities.

Peplaus Roles of Nursing


Stranger - receives the client in the same
way one meets a stranger in other life
situations provides an accepting climate
that builds trust.

Teacher - who imparts knowledge in


reference to a need or interest
Resource Person - one who provides a
specific needed information that aids in the
understanding of a problem or new
situation

Peplaus Roles of Nursing


Counselor - helps to understand and
integrate the meaning of current life
circumstances ,provides guidance and
encouragement to make changes.
Surrogate one who takes the place of
another.
Leader - helps client assume maximum
responsibility for meeting treatment goals
in a mutually satisfying way.

Psychodynamic Nursing
Self Awareness - understanding of ones own behavior to
help others identify felt difficulties
She discussed the phases of interpersonal process, roles in
nursing situations and methods for studying nursing as an
interpersonal process.
According to Peplau, nursing is therapeutic in that it is a
healing art, assisting an individual who is sick or in need of
health care.
Nursing is an interpersonal process because it involves
interaction between two or more individuals with a common
goal.
The attainment of goal is achieved through the use of a
series of steps following a series of pattern.
The nurse and patient work together so both become
mature and knowledgeable in the process.

Interpersonal Relationship
Four Sequential Phases:
A. Orientation
B. Identification
C. Exploitation
D. Resolution

Peplaus Phases in Nursing


ORIENTATION

- Starts when client meets the nurse as stranger.


- The patient or family has afelt need, therefore
professional assistance is sought.
- The nurse work collaboratively with the patient
and family to analyze the situation so that they
can recognize, clarify, and define the existing
problem and what type of services needed.

Peplaus Phases in Nursing


ORIENTATION

- Client seeks assistance, conveys needs, asks


questions, shares preconceptions and expectations
of past experiences.
- Rapport is established and continues to be
strengthened while concerns are being identified.
- At the end of orientation phase, they are
currently striving to identify the problem and are
becoming more comfortable with each other.

Factors influencing the blending of the nurse-patient


relationship.

NURSE
Values
Culture race
Beliefs
Past
experiences
Expectations
Preconceived
ideas

PATIENT
NURSEPATIENT
RELATIONSHIP

Values
Culture race
Beliefs
Past experiences
Expectations

Peplaus Phases in Nursing


IDENTIFICATION

- The patient responds selectively two


people who can meet his needs, therefore
requires more intense therapeutic
relationship.
- The response to the nurse is threefold:
a. Interdependent
b. Independent
c. Dependent

Peplaus Phases in Nursing


IDENTIFICATION
- The patient and the nurse must clarify
each others perceptions and expectations.
- The patient now begins to have a feeling
of belonging and a capability of dealing
with the problem, which decreases her
feelings of helplessness and hopelessness.

Peplaus Phases in Nursing


EXPLOITATION
- Use of professional assistance for problem
solving alternatives.
- Advantages of services are used is based on the
needs and interests of the patients.
- Individual feels as an integral part of the helping
environment.
- They may make minor requests or attention
getting techniques.

Peplaus Phases in Nursing


EXPLOITATION
- The principles of interview techniques
must be used in order to explore,
understand and adequately deal with the
underlying problem.
- Nurse must encourage the patient to
recognize and explore feelings, thoughts,
emotions by providing non-judgmental
atmosphere and a therapeutic climate.

Peplaus Phases in Nursing


EXPLOITATION
- Nurse must be aware about the various
phases of communication

- Nurse aids the patient in exploiting all


avenues of help and progress is made
towards the final step.

Peplaus Phases in Nursing


RESOLUTION

- Termination of professional relationship.


- The patients needs have already been
met by the collaborative effect of patient
and nurse. Now they need to terminate
their therapeutic relationship and dissolve
the links between them.
- Sometimes dissolving there links is very
difficult for both of them.

Peplaus Phases in Nursing


RESOLUTION
- Anxiety and tension will increase in the
patients and the nurse if there is
unsuccessful completion of the phase.
- Patient drifts away and breaks bond with
nurse and healthier emotional balance is
demonstrated and both becomes mature
individuals.
- The patients needs are met, and
movement can be made toward new goals.

Peplaus Phases of the NursePatient Relationship


Phase

Focus

Orientation

Problem-defining phase

Identification

Selection of appropriate
professional assistance

Exploitation

Utilization of professional
assistance for problem
solving alternatives

Resolution

Termination of the professional


relationship

Interpersonal Relationship and Nursing


Process
Nursing Process
- a deliberate, intellectual activity
whereby the practice of nursing is
approached in an orderly, systematic
manner.

Interpersonal Relationship and Nursing


Process
Both are sequential and focus on
therapeutic relationship.
Both use problem solving techniques for
the nurse and patient to collaborate on,
with the end purpose of meeting the
patients needs.

Both use observation communication and


recording as basic tools utilized by nursing.

Comparison of Nursing Process and


Peplaus Phases
Nursing Process
Assessment
- Data collection and
analysis [continuous]
- May not be a felt need
Nursing Diagnosis
Summary statement
based on analysis
Planning
- Mutually set goals

Peplaus Phases
Orientation
- Non continuous data
collection
- Felt need
- Define needs
Patient clarifies felt need.

Identification
- Interdependent goal
setting

Comparison of Nursing Process and


Peplaus Phases
Nursing Process
Implementation
- Plans initiated towards
achievement of mutually set
goals
- May be accomplished by

Peplaus Phases
Exploitation
- Patient actively seeking
and drawing help
- Patient initiated

patient , nurse or family


Evaluation
- Based on mutually
expected behaviors
- May led to termination
and initiation of new
plans

Resolution
- Occurs after other
phases are successfully
completed and have been
met
- Leads to termination

END.