Interpersonal relations in nursing: a philosophical-ethical analysis of the work of Hildegard E. Peplau

Interpersonal relations in nursing: a philosophical-ethical analysis of the work of Hildegard E. Peplau ¶ Nursing typically has been viewed as a moral practice, for instance by new developments in the ethics of care. Nevertheless, many philosophical-ethical presuppositions of nursing theories remain to be clarified. This paper presents a philosophical-ethical analysis of the work of Hildegard E. Peplau. Analysis of the philosophical-ethical background of Peplau's works illuminates a view on nursing practice that is relevant today. Three main components are analysed more deeply, i.e. the professionalization of nursing, the philosophical underpinnings of Peplau's view on nursing science, and the nurse–patient relationship as the central event in nursing.     

A patient-oriented perspective in existential issues: a theoretical argument for applying Peplau's interpersonal relation model in healthcare science and practice

Since Hildegard Peplau's interpersonal relation model for psychodynamic nursing, in the 1950s, many theories about humanity have been expanded in the discipline of nursing. For this purpose Rosemarie Rizzo Parse, for example, synthesized principles and concepts from Martha Rogers with existential phenomenology, when she introduced the idea of a simultaneity paradigm as unique for the discipline of nursing in opposition to Peplau's psychodynamic model. The aim of this paper is to discuss borrowed theories in relation to the efforts to find a unique theoretical foundation for healthcare science and practice. It is suggested that Parse's division in a totality vs. a simultaneity paradigm is an artificial distinction. The discussion is concluded with reflections about Peplau's interpersonal relation model, a patient-oriented perspective and psychodynamic theory, as example of a theory, which may help to further understand patients' existential situation.     

The evolution of an intervention — the use of Peplau's process of practice-based theory development

In 1969, at the first Nursing Theory Conference, Hildegard Peplau proposed a research methodology that would guide the development of nursing knowledge. To direct nurses in the development of practice-based theory, Peplau proposed a three-step process that would assist in this pursuit. The purpose of this paper is to describe the use of Peplau's process of practice-based theory development as it has directed a program of research in the area of depression. Peplau's ideas related to practice-based theory development came at a time in nursing when grand theories were being developed and theoretical nursing was highly valued. Peplau, ahead of her time, proposed an approach that valued the development of nursing knowledge in practice, while also combining both qualitative and quantitative methods. This research methodology deserves recognition today, as one that can guide knowledge development in psychiatric nursing.     

Awareness of self and expanding consciousness: using nursing theories to prepare nurse-therapists

Psychotherapy is an accepted role of the advanced practice psychiatric nurse. Nursing theorists, notably Hildegard Peplau and Margaret Newman, offer guidance on the psychological and professional development of the nurse. This paper examines Newman's theory of health as expanding consciousness and the concept of awareness of self in Peplau's theory, and suggests that psychiatric advanced practice nursing programs consider the need for nurses to develop self-knowledge to facilitate the nurse-patient relationship and to improve outcomes of patient care in psychotherapy.     

应用佩普洛人际理论探讨临床心理护理路径

基于为临床心理护理实践拓展理论依据、探讨有效对策之目的,应用佩普洛人际关系理论的核心内容,参照国内外研究现状,提出紧扣佩普洛“4个阶段、6个角色“的理论要点,构筑心理护理的临床路径:充分沟通,护患相长;把握契机,灵活应对;正视角色,合理演绎.     

Transforming Practice Knowledge into Nursing Knowledge—A Revisionist Analysis of Peplau

Nursing practice typically has been viewed as applying knowledge. However, currently, there is increasing awareness that nursing practice is also a process of knowledge development. Still, research and practice are not always connected. Analysis of Peplau's works illuminates a scholarship of nursing practice that is relevant today. This paper focuses on a specific strategy and philosophic perspective, as derived from Peplau, for integrating nursing practice more fully into today's knowledge development. Emphasis is on the need for nursing practice-based theory, as well as nursing theory-based practice.     

Peplau's theory: concepts and their relations

This article focuses on Peplau's major concepts, including nursing, person, health, and environment. The concepts are described and the relations among concepts are specified. The purpose of the specification is to facilitate the use of Peplau's theory in research and practice and to facilitate comparison with other nursing theories.     

A naturalistic test of Peplau's theory in home visiting

Nurse-client relationships have been considered the foundation of successful home-visiting programs for vulnerable families. Even though nurse-client relationships are important when working with multiproblem families, relationship theory has not been used to guide interventions in home visiting. Identification of a fitting theory could provide direction for tailoring interventions to families at a "dose" individualized to meet their needs. This article reports a small study that tested the applicability of Peplau's theory of interpersonal relations in nursing (Peplau, 1952/1991) in the context of home visiting. Five prenatal clients and public health nurses participated in the study. Home visits were observed and audio-recorded beginning with the first prenatal home visit and ending in the early postpartum period. Audiotapes were transcribed and analyzed using a start list of codes based on Peplau's theory. Changes in the percentage of interaction assigned to the relationship phases along with a rating from the Relationship Form were compared over time to determine whether relationships progressed as predicted by Peplau. Findings of this study supported Peplau's theory. Implications for nursing practice and research are discussed.     

Humanistic nursing, interpersonal relations theory, and the empathy-altruism hypothesis

The purpose of this paper is to illuminate the relevance and applicability of theory for nursing research and practice. Following a brief explanation of the four levels of theoretical abstraction recognized by nursing, Paterson and Zderad's humanistic nursing theory and Peplau's theory of interpersonal relations are described. In addition, one social psychology theory, the empathy-altruism hypothesis, is also explained. The value and implications of the three theories for nursing research and practice are discussed, and several research questions are proposed.     

Interpersonal mental health nursing: research issues and challenges

Since Peplau outlined her perceptions of psychiatric/mental health nursing in (1952) interpersonal relationships has been considered by many as the core of practice. In the intervening period of almost a half century many researchers and theorists have endeavoured to develop and integrate Peplau's framework into day-to-day nursing activity. However, more recently, as a result of the fusion between the professional nursing agenda and the wider political agenda, the importance of interpersonal relationships and the individuality of psychiatric/mental health nursing is being questioned. This questioning is represented in the debate about the aetiology of mental illness, the choice of research methods to determine treatment outcomes and by association the role and value of the psychiatric/mental health nurse. This paper will focus on the interpersonal nature of psychiatric/mental health nursing and explore possible research approaches aimed at explicating its core. Attention will be given to the necessity of using pluralistic methodology in order to do so.     

The future of the Theory of Interpersonal Relations? A personal reflection on Peplau's legacy

The work of Hildegard Peplau represents the most significant influence, worldwide, on the development of psychiatric nursing practice. Her use of the Theory of Interpersonal Relations created the basis for defining the potential significance of the psychiatric nurse's role as a therapeutic agent. Forty years later she has indicated the means by which nurses might sharpen their focus on the person often overshadowed by the 'patient' label. Peplau's writings have, over this 40-year period, helped clarify the broad range of roles required of the nurse in general and in particular, within psychotherapeutic nursing.     

The concept of priority as it relates to a community mental health team

This article illustrates how a concept clarification exercise can provide evidence to inform local policy development. Based on the framework developed in Walker and Avant's (1995) concept clarification theory, the concept of priority is examined in the context of a team of community mental health nurses. Themes of risk, multidisciplinary working, resources, and nursing role are identified as key areas for consideration, and the difficulties existing between government policy directives towards the severely mentally ill and health promotion are discussed. The article highlights how nursing theory can integrate the concept analysis of priority in planning client care. This is presented using Peplau's (1952) model as a guide to further enhance meaning of generated priorities to nursing practice.     

The robots are here,but are nurse educators prepared?

BackgroundAs robotics continues to be applied to medical and nursing practice, nurse educators need to be aware of innovations and discuss practice and challenges with students.ObjectivesThis paper provides a literature review of the application of robotics in nursing and the implications for nurse education.Review methodsThe methodology adopted for this review was informed by the definition of service robots. The review focused on how clinical service robotics are being discussed in nursing and was undertaken using the Cochrane Library, ScienceDirect and ProQuest databases, using the truncated search terms: nurs* and robot*, education, students and future. Research articles were limited to those that were published in peer reviewed journals, between 2010 and 2019, since this covers the time when robotic science has been flourishing. The field of robotics is vast, thus the search yielded over 400 articles, but most are not specifically relevant to nursing. Twenty-six relevant papers were included.ResultsThematic review of the literature found four main developments affecting nursing and mixed perceptions and ideas among health care staff and the public across varied themes.ConclusionHealth care and nursing work are being transformed through robotics. New technologies, tasks and technician roles that currently do not exist will soon be part of the health workforce, and the nature of nursing work will inevitably change. In the light of such change, there is a need to redefine the nature and practice of nursing and to re-prioritise caring as fundamental to the nursing profession. These changes have implications for the education of future nursing professionals.     

Fruits without labour: the implications of Friedrich Nietzsche's ideas for the caring professions

Seldom is the work of philosophers invoked by health professionals when examining aspects of care from a philosophical perspective. Instead, students of health care, especially nurses, have been introduced to 'philosophies' which are often superficially examined and poorly understood. This practice fails to develop in students an appreciation of the work of philosophers or to acquire the art of critical thinking. The introduction of models and theories of nursing in the past three decades has alerted nurses to the importance of possessing critical skills in order to identify sound theory and implement good practice. This paper goes beyond mere philosophising and examines aspects of mental health care from the perspectives of one of nineteenth century Europe's most notable philosophers, Friedrich Nietzsche. It argues that understanding his work can enhance one's ability to reflect on nursing practice, as well as bringing a new dimension to how we analyse 'mental health' problems. His work provides many insights into how we can improve our understanding of the effect of mental illness and mental health care on the individual, and how we conceptualise the process of care. This paper provides an overview of his life's work, his impact on the history of ideas and develops some of the more provocative implications of his work for mental health care.     

A comparative analysis of Orem's self-care model and Peplau's interpersonal theory

The process of choosing a nursing model or theory to guide one's clinical practice, curriculum development or theoretical framework for research can be facilitated by analysis of and comparison of existing theories, with each other and then with one's personal philosophies This paper summarizes the major concepts and assumptions of Dorothea Orem's self-care model and Hildegard Peplau's interpersonal theory, and then compares the two for similarities and differences in their origins of theory development, meanings related to nursing metaparadigm concepts, logical adequacy, usefulness and generalizability, parsimony and testability     

Advanced nursing practitioners in primary care settings: an exploration of the developing roles

Recent health care policies have resulted in patients having access to an integrated system of care that is quick and reliable. In concert with these changes, opportunities for professional development in nursing have increased, together with a reduction in the numbers of doctors. Advanced Nurse Practitioners (ANPs) have, therefore, developed to meet the complex demands of health care systems. This paper reports on a study that aimed to explore the current role of ANPs in primary care in the West Midlands region of the UK and how ANPs within three different nursing disciplines in primary care developed their roles over time. The study utilized a qualitative exploratory design incorporating a longitudinal element. Twenty-one ANPs were interviewed during phase one, 15 of whom were interviewed again during phase two, approximately 15 months later. Their managers (where appropriate) were also interviewed during phase one. The findings reveal that the nature and focus of practice varies between disciplines. At the extreme practice end of the practice-strategic continuum, Practice Nurse ANPs' expertise lies in their advanced practical assessment and diagnosis of individual patients, with little opportunity for strategic development. Health Visitor and District Nurse ANPs operate at the strategic end of the practice-strategic continuum, but operate differently at this level. Health Visitors, being community and public health focused are involved in multi-agency work, practice development and policy formulation. District Nurses work with individual patients/carers and the nursing team, thus their involvement in strategic developments tends to focus at the patient care level, such as protocol and practice developments, although their work also involves work in all three other domains. Overall, the findings reveal a unique role for all three with a potential career pathway for ANPs to become Nurse Consultants in the future.     

Primary care nursing role and care coordination: an observational study of nursing work in a community health center

Care coordination is a core element of the Patient-Centered Medical Home and requires an effective, well educated nursing staff. A greater understanding of roles and tasks currently being carried out by nurses in primary care is needed to help practices determine how best to implement care coordination and transform into PCMHs. We conducted an observational study of primary care nursing in a Community Health Center by creating a classification schema for nursing responsibilities, directly observing and tracking nurses' work, and categorizing their activities. Ten nurses in eight different practice sites were observed for a total of 61 hours. The vast majority of nursing time was spent in vaccine and medication administration; telephone work; and charting and paper work, while only 15% of their time was spent in activity that was classified broadly as care coordination. Care coordination work appeared to be subsumed by other daily tasks, many of which could have been accomplished by other, lesser trained members of the health care team. Practices looking to implement care coordination need a detailed look at work flow, task assignments, and a critical assessment of staffing, adhering to the principal of each team member working to the highest level of his or her education and license. Care coordination represents a distinct responsibility that requires dedicated nursing time, separate from the day to day tasks in a busy practice. To fully support these new functions, reimbursement models are needed that support such non visit-based work and provide incentives to coordinate and manage complex cases, achieve improved clinical outcomes and enhance efficiency of the health system. This article describes our study methods, data collection, and analysis, results, and discussion about reorganizing nursing roles to promote care coordination.     

Utilizing Rogers' Theory of Self-Concept in mental health nursing

The work of mental health nurse is interactive in nature, the priority of which is the effective development and maintenance of a therapeutic relationship with clients This field of nursing bases its practice on theories from many schools of thought in order to provide clients with the highest quality of care One such theory is that of Carl Rogers whose practice as a psychotherapist was based on his Theory of Self-Concept This paper examines the development of the Theory of Self-Concept from the works of Cooley, Mead, Allport and Rogers and relates to the therapeutic alliance between a primary nurse and a client who has been medically diagnosed as being 'depressed' The implications for practice are considered and some of the difficulties of utilizing Rogers' theory on an in-patient unit are explored The paper emphasizes the need for nurses to be aware of the use of such theories in order to enrich the care that clients receive It also highlights the need for nurses to be aware of their own 'self when working with clients, a state that can only be achieved if the nurses themselves have adequate clinical supervision and an environment which is supportive of such work     

Setting the climate for evidence-based nursing practice: what is the leader's role?

Nurses are being challenged today to justify their practice. Many clinical and policy decisions in nursing are based upon isolated, ritualistic and unsystematic forms of clinical practice. The growing movement towards establishing evidence-based nursing practice (EBNP) is situated in a systematic appraisal of the best evidence available. Nurse leaders have an obligation to cultivate sound clinical and economic practices leading to quality patient care and positive work life environments for nurses.     

A critical analysis of the potential contribution of Orem's (2001) self-care deficit nursing theory to contemporary coronary care nursing practice.

BACKGROUND: Over the last three decades, nurse theorists have strongly advocated the use of conceptual models of nursing to guide nursing practice. Within coronary care units, conceptual model-based care has had inconsistent application and is currently challenged by contemporary approaches such as pathways of care. AIMS: This paper aims to critically analyze the use of Orem's self-care deficit nursing theory as a modus operandi to effectively meet the needs of hospitalized patients in coronary care. RESULTS: Although complex both in the language and construction, the self-care model , provides a comprehensive and holistic approach to the care of people in coronary care. CONCLUSIONS: This paper highlights the potential contribution the application of the self-care deficit nursing theory to the coronary care setting from a philosophical and practical perspective. Orem's conceptual model of nursing and current practice in coronary care units share certain similarities that render a useful model for use in practice. However, while it is recommended for consideration for use in both practice and educational settings, further empirical work is required in the area, together with realistic and practical application of the theory to practice in a way that embraces contemporary notions.