A Glance Back in Time: Nurse-Doctor Relationships

As individuals, we have history, the present, and the future. Dr. Hildegard Peplau, the "mother of psychiatric nursing, "developed the role of the nurse in the nurse-patient relationship. When she died in March of this year, she left a great legacy to the nursing profession. We reprint here, almost in its entirety, this article from Nursing Forum, 1966,5(1), 60-75, in which Dr. Peplau traces the nurse-doctor relationship from the beginning of this century. Her conclusions, written more than 30 years ago, are valid today.     

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.     

Psychiatric mental health nursing: challenge and change

. We invited Dr Peplau to provide a personal reflection on the recent history of psychiatric nursing and her thoughts on immediate challenges facing the profession. The paper is an individual scholar's commentary on the way that psychiatry has waxed and waned over the years, in relation to nursing. This historical review discovers and reports a challenge to current practice. Dr Peplau describes a professional shift that is pulling nurses toward the subordinate role observed earlier this century. The paper draws attention to how contemporary practice can be positively influenced, e.g., by giving a structure to the allocation and conduct of nurse–patient time.     

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.     

Hildegard E. Peplau: The psychiatric nursing legacy of a legend

Hildegard Peplau is remembered by nurses worldwide as the “mother of psychiatric nursing.” Her scope of influence transcended her psychiatric nursing specialty and had a profound effect on the nursing profession, nursing science, and nursing practice. Peplau played a leadership role by influencing and emphasizing the advancement of professional, educational, and practice standards, and the importance of professional self-regulation through credentialing. She made a major contribution to nursing science, professional nursing, and, of course, to the psychiatric nursing specialty through development of the Interpersonal Relations paradigm, a mid-range theory that has influenced the importance with which the nurse-patient relationship is regarded. The essential nature of the nurse-patient relationship and its significance as a therapeutic modality operationalizes Peplau's scholarship and provides the basis for both the art and science of nursing practice. Peplau would challenge psychiatric nurses to thrive in the new millennium through continued commitment to the importance of the nurse-patient relationship, engagement in evidence-based practice, support of competence in information technology, and provision of leadership in influencing the health care paradigm shift to community-based health care delivery.     

A literature review of the progress of the psychiatric nurse-patient relationship as described by Peplau

Knowledge is limited with regard to the progress of the nurse and patient through the phases of the psychiatric nurse-patient relationship (PNPR). Relationship progress is indicative of patient progress in the healing and recovery process. Hildegard Peplau described the phases of the therapeutic relationship in her Interpersonal Relations Theory (IRT). This review of literature describes the state of nursing science using IRT as the theoretical framework. Research conducted on the progress of the PNPR has generated evidence of the relevance of IRT to clinical practice, the importance of the PNPR to the patients themselves, and the importance of nursing knowledge regarding the progress of the orientation phase of the PNPR to patient care. However, all studies were done in Canada, and additional studies are needed. Knowledge of the relationship established between psychiatric nurses and patients is essential to the nursing process in psychiatric mental health settings.     

A LITERATURE REVIEW OF THE PROGRESS OF THE PSYCHIATRIC NURSE-PATIENT RELATIONSHIP AS DESCRIBED BY PEPLAU

Knowledge is limited with regard to the progress of the nurse and patient through the phases of the psychiatric nurse-patient relationship (PNPR). Relationship progress is indicative of patient progress in the healing and recovery process. Hildegard Peplau described the phases of the therapeutic relationship in her Interpersonal Relations Theory (IRT). This review of literature describes the state of nursing science using IRT as the theoretical framework. Research conducted on the progress of the PNPR has generated evidence of the relevance of IRT to clinical practice, the importance of the PNPR to the patients themselves, and the importance of nursing knowledge regarding the progress of the orientation phase of the PNPR to patient care. However, all studies were done in Canada, and additional studies are needed. Knowledge of the relationship established between psychiatric nurses and patients is essential to the nursing process in psychiatric mental health settings.     

Hildahood: Taking the interpersonal theory of nursing to the neighborhood

This article examines the use of problematic patterns of interpersonal interactions as an intervention focus that is based on the interpersonal theory of nursing developed by Hildegard Peplau. In previous articles, interpersonal change strategies have been suggested that focus on the patterns that emerge between the client and the nurse. This article proposes an elaboration of the technique by shifting the focus from the “virtual” interactions that occur in the laboratory of the therapeutic nurse-client relationship to the “real” relations between the clients and their significant others. Measurement of the effect of the intervention by the appearance, intensity, and persistence of changes in outcomes along the lines predicted by the theory are illustrated.     

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.     

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.     

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.     

A comparison of the works of Peplau and Orlando

Peplau and Orlando have had a great impact on the past and current practice of mental health nursing. Their works represent some of the first attempts at theory development in nursing. This article compares and critiques the works of these two theorists. The emphasis on the interpersonal relationship is a major focus of both theorists. Peplau has a greater emphasis on the development of the individual, while Orlando focuses on the immediate needs of the client. They both contribute greatly to the development of nursing science. Appreciating their work only for its historical significance would be a major oversight.     

Empathy: we know what we mean, but what do we teach?

This article resulted from a paper, presented by the author, at the Hildegard Peplau seminar on the interpersonal role of psychiatric nurses, given at the Highland College of Nursing and Midwifery, Inverness. It discusses empathy — the ability to see things from another person's point of view. That ability is held to be the core characteristic of a helping relationship, but a review of the literature reveals that there is little agreement about how empathy should be defined. Consequently, it is argued that there is a need for nurse teachers to define what they mean by empathy. Failure to do so may result in confusion about what is being taught. Furthermore, it is proposed that all teachers should be trained in experiential teaching methods, and that the effects of structured empathy training should be investigated within an experimental research design.     

Perspectives on nursing knowledge.

On May 19, 1991, in Tokyo, Japan, four nurse theorists participated in a panel discussion at Discovery International, Inc.'s Biennial Nurse Theorist Conference. The participants were Imogene M. King, Hildegard E. Peplau, Rosemarie Rizzo Parse, and Martha E. Rogers. The goal of the conference was to present the latest views on nursing knowledge of these nurse leaders. The panel discussion provided the nurse theorists with an opportunity to engage in dialogue regarding issues of concern to the audience. The panel moderator was Hiroko Minami of St. Luke's College of Nursing in Tokyo.     

Interpersonal relations: a theoretical framework for application in nursing practice.

Peplau discusses major features of the theory of interpersonal relations. She describes her theory as among the most useful to apply during nursing practice in order to understand nurse-patient interactive phenomena. Peplau addresses how she derived constructs from clinical data and identified their congruence with nursing practice. She further addresses the specific concepts of her theory and their relations, and specific uses of the theory in practice.     

Book Reviews

Book reviewed in this article: Recovery from Schizophrenia: Psychiatry and Political Economy, 2nd edn Richard Warner Schizophrenia: A Scientific Delusion? Mary Boyle Hildegard Peplau: Selected Works — Interpersonal Theory in Nursing A. W. O'Toole & S. R. Welt, Macmillan Managing the Clinical Resource: An Action-Guide for Health Care Professionals A. Jones & McDonnell Rehabilitation for Mental Health Problems: An Introductory, 2nd edn Handbook Clephane Hume & Ian Pullen, Churchill Livingstone Schizophrenia: From Mind to Molecule Nancy Andreason     

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