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.     

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.     

Explorations in body image care: Peplau and practice knowledge

Practitioners in mental health care have long utilized the work of Hildegard Peplau, both for nursing discourse and for practice. At a time when the role of theory in practice is once more being debated, and when theories are being applied in new contexts, this paper examines the contribution that Peplau's work may have to offer altered body image nursing care. A case study is used to highlight concepts in practice, the paper examining the ways in which Peplau's Theory of Interpersonal Relations complement the other elements of practice knowledge that the nurse uses to assist patients and lay carers alike.     

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.     

Effects of Home Visits to Vulnerable Young Families

Purpose: Nurses' home visits to new parents have been replaced in many high-need communities by nonprofessional visits without clear evidence of effectiveness. Previous reviews of home visiting research have combined nurse and non-nurse interventions and have pooled studies from the US, where home visiting is mainly limited to low-income families, with those from nations where home visiting is a universal service. This integrative review was focused on nurse-delivered interventions in the US and Canada to identify the nursing-specific models with the greatest effect in this cultural context. Evaluation of support for social ecology theory was a secondary aim.
Design: The sample consisted of 20 experimental and quasi-experimental studies of home nursing interventions for families of newborn infants who were vulnerable because of poverty, social risks, or prematurity.
Methods: Each report was examined systematically using specific rules of inference and a scoring system for methodological quality. Intervention effects on five outcome domains were described.
Findings: Maternal outcomes, maternal-infant interaction, and parenting were more often influenced than was child development, except in preterm infants. Well-child health care did not improve. Effective programs generally began in pregnancy, included frequent visits for more than a year, had well-educated nurses, and were focused on building a trusting relationship and coaching maternal-infant interaction. Social ecology theory was partially supported.
Conclusions: Future nurse home-visiting research should test a combination of these effective components. Nurses can use this information to seek funding of nurse-delivered interventions for vulnerable families.     

Peplau人际关系理论在护理实践中的应用现状

阐述Peplau人际关系理论的核心内容,综述Peplau人际关系理论在国内外护理实践中的应用现状。     

A synthesis of qualitative home visiting research

Over the past decade, a body of qualitative research has been developed which describes the home visiting practice of public health nurses (PHNs) to maternal-child clients. This article reports a synthesis of these studies. The purpose of the synthesis was to identify common elements and differences between the research reports that would lead to theory development or support of existing theories. Methods were based on Miles and Huberman's (1994) text on qualitative data analysis. Results of the synthesis indicated that building and preserving relationships with the client is the central focus of home visiting and provides a foundation for problem identification and problem solving. Clients control access to their homes as well as the information they are willing to share with the nurse. The goals of home visiting relate to empowering mothers, supporting their independence and decision making. Similarities to Peplau's theory of Interpersonal Relations and Cox's Interaction Model of Client Health Behavior (IMCHB) are noted.     

Peplau in cyberspace: an analysis of Peplau's Interpersonal Relations Theory and computer-mediated communication

This paper explores the applicability of Peplau's Interpersonal Relations Theory to the context of computer-mediated communication. Although Peplau never intended her theory be applied to this mode of communication, research from the fields of communication and social psychology suggest that such application may be possible. After Peplau's theory is briefly summarized, research and theory dealing with computer-mediated communication are explored, and questions for future research endeavors are offered.     

Nurse home visits to maternal-child clients: a review of intervention research

Home visiting has been considered a promising strategy for addressing the multiple needs of families at risk. Research reviews are a valuable resource for researchers, policymakers, and practitioners who develop and support new home-visiting interventions. This review examines 13 research studies published between the years of 1980 and 2000 that test the effectiveness of home-visiting interventions using professional nurses as home visitors. Findings indicate that a wide range of client problems are addressed during home visits using a variety of nursing interventions. Missing from most of the reports is a clear theoretical link between the client problem addressed, the nursing intervention, and target outcomes. About half of the studies were successful in achieving desired outcomes. Future research should be directed by middle-range practice theory, clearly explicate the nursing intervention being tested, use power analysis to determine sample size, and report reliability and validity of dependent variable measures with culturally diverse samples.     

Peplau and professionalism: the emergence of the paradigm of professionalization

We asked Dr Grayce Sills, a long-time collegue and friend of Dr Hildegard Peplau, to write a historical paper to assist in understanding the contributions of Dr Peplau to the professionalization of nursing. This historical reflection reveals insights into Dr Hildegard Peplau as a person, her leadership and her scholarly abilities. Dr Peplau's theorizing is largely inductive and based on keen observations of her clinical work and her environment. This insight into her inductive curiosity is further revealed in the papers that follow.     

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.     

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.     

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.     

Control and restraint in contemporary psychiatric nursing: some ethical considerations

Nursing theories which have evolved from mental health-psychiatric nursing have focused on the individual nurse-client relationship Other nursing theories generally focus on the individual as client Therefore, nurses working with families may have difficulty in applying these frameworks to their practice Nursing theories need to be expanded to include families, groups and communities more explicitly The well established theory of Hildegard Peplau, which previous studies have found to be the theory most frequently used by psychiatric nurses, and the family systems nursing theory of Wright and Leahey share a complementary focus Both theories form part of the interpersonal paradigm of nursing, both view nursing from an interactional perspective, rather than focusing on individuals Use of a combined theoretical approach offers several advantages The approach explicitly considers both the individual and the family The combination provides grounding for family work in an articulated nursing theory     

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 nurse-patient relationship results of an examination about relationships between patients and nurses in hospitals

The nurse-patient relationship has received particular attention in the relevant literature. For patients in life threatening and existentially challenging situations, nursing activities often require a close intimacy. A good nurse-patient relationship is a precondition for effective nursing interventions, but by itself also contributes to the healing process. How such a relationship is realized in everyday nursing situations remains, however, unclear Literature predominantly details normative expectations on the nurse-patient relationship that are based on nursing theory or concepts from humanistic psychology. The operationalisation of these concepts into nursing practice is not given. In order to answer the research question "How do nurses experience their relationship with the patient?" qualitative interviews were conducted. Thus, the nurse-patient relationship was explored from the perspective of the nurses and considered in the context of their specific working situations. Nurses related their experiences, emotions and stress resulting from different kinds of nurse-patient relationships. Data were collected, organised and analysed following Giorgi's 1985 phenomenological analysis. Results show an ambivalence by nurses between closeness and distance in their relationship with patients. These relationships also show a polar vascillation between, for example, "sympathy" and "antipathy", or "being able to help" and "helplessness". The development of the relationship is often not very professional and depends on the specific situation and those individual persons participating in it. It is also apparent that those models of the humanistic psychology which have been discussed in nursing contexts cannot serve as such as a basis for the development of the nurse-patient relationship. A particular aspect of developing relationships in nursing are nursing interventions which necessitate bodily contact and physical work with patients. Concepts including these aspects of nursing can serve as valid and concrete starting points in order to find a way unique to nursing to create effective relationships with patients.     

The transition to a nursing home: meeting the family's needs. Family members face their own transition when a loved one enters a nursing home.

The lack of preparation for the experience of admission to a nursing home, as represented by these family members, indicates there is a need for nursing interventions targeted to the family before the admission of a loved one to the nursing home. The program could address information and problem solving, as well as provide emotional support. The day of admission is too late to prepare for this experience. Access to families occurs before any admission to LTCFs. Nurses in acute care and home care are in a position to inform, assist, and advocate for families in this decision-making and admission process. The family members we questioned have provided some of the content for an educational preparation program that may be useful to all families. The responses also indicate that each family will have its own concerns and functional relationships that would alter specific content. Maslow's framework could aid the identification of needs and direct the specific interventions to empower the family to cope with this transition. A few guidelines have been suggested in this article to stimulate discussion about the family's transition to the nursing home. Appraisal of a family's perceptions about the use of nursing homes may alert the nurse to potential conflicts and areas of uncertainty. These assessments provide direction for family interventions that may alleviate the extent of uncertainty and conflict before the admission and serve as ongoing family-centered activity in the nursing home. The view of this experience as a family transition also supports the concept of continuity of care through nursing interventions.     

The Practice of Empowerment and Coercion by Expert Public Health Nurses

This article describes the dialectic of public health nursing responsibility to empower families in self care as well as the nursing responsibility to evoke authority as needed to protect children from violence and neglect. Through qualitative study of expert home visiting public health nurses' anecdotes (N=95), these apparently contradictory activities were discovered to co-exist in helping relationships. The synthesis of the apparent contradictions applies community rather than autonomy as the fundamental moral guide