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Initially being a set of purely practical skills and unquestionable application of a physician’s guidelines, nursing has gradually transformed into a science incorporating theoretical knowledge, practical experience, scientific judgment, and critical thinking. As a profession, it is different from medical practice and requires special non-medical knowledge. These differences, as well as the growing role of nurses in the health care system, provided necessary conditions for the rapid development of this field. Today, the importance of nursing continues to increase steadily, and nursing professionals around the world demonstrate their desire to make valuable contributions to the creation of a qualitatively new level of health care. Such approach has resulted in the emergence of a wide array of nursing theories that impact the activities of modern nurses. However, in order to use such theory as guidance, one must analyze and assess it to determine its potential shortcomings. Therefore, the paper focuses on the comprehensive analysis and evaluation of Hildegard Peplau’s theory of interpersonal relationships as well as reviews the ways of its application to the nursing practice.
Hildegard Peplau presented her middle range theory in 1948 emphasizing the relationship between nurses and their patients as the cornerstone of nursing (Forchuk, 1993). At the time, such approach was perceived as a groundbreaking one not only because the work was completed by a nurse, but also due to the fact that according to the research, the nursing staff in any facility occupied the leading position. In fact, the idea could be traced to Peplau’s past. She was born in Reading, Pennsylvania, hailing from the family of German immigrants. When Peplau was a child, watching people’s behavior was one of her hobbies. Later, Hildegard was a witness of a flu epidemic of 1918, which took lives of many people, including those who committed suicide to avoid the illness or being devastated by the death of their loved ones (Forchuk, 1993). This experience enabled Peplau to understand the effect of a disease and death on families. Moreover, it had an impact on her future career making her reassess the role of a nurse in the process of treatment. Additionally, Peplau was influenced by the works of several other scholars, including Harry Stack Sullivan, an American psychiatrist who developed the theory of interpersonal relations. Such scientists as Percival Symonds (a scientific study of personality), Abraham Maslow (human needs), and Neal Elger Miller (behavior in real-life situations) also had an impact on her work (Forchuk, 1993).
At the same time, Peplau’s theory has become the basis of the studies of other scholars due to its novelty and relevance. In particular, in 1961, Dr. Hays used Peplau’s work to conduct a research that focused on teaching the concept of anxiety to the patients. In turn, it was discovered that people were able to apply the obtained knowledge even after the termination of the connections with the group that served as its source (Forchuk, 1993). As a result, it became clear that the relationships between the individuals have long-term consequences. Another example is Dr. Burd having used Peplau’s theory for the development of the framework of nursing intervention that was focused on the patients who demonstrated a high level of anxiety. In turn, nurses have developed the skills and abilities required for the initiation of the interpersonal relationship (Forchuk, 1993). These facts demonstrate the relevance of Peplau’s work.
Peplau’s theory addresses the problems of a relationship between a nurse and their patient. At the same time, this issue concerns the give-and-take interaction, which opposes the principle of the passivity of the patients and nursing staff that has been common at the time. In particular, the primary focus of the theory was the process of creation of shared experience, which nurses can achieve by observing, describing, formulating, interpreting, validating, and intervening (George, 2011). In turn, it is possible to establish a partnership with a patient providing efficient treatment and ensuring the personal growth of both parties.
The theory of interpersonal relations primarily employs inductive reasoning. It means that the inference process is based on the position of the transition from a particular concept to a general one with the help of conclusion (George, 2011). In particular, Peplau has summarized her personal experiences related to the connection between illness and family’s well-being as well as the findings of other scholars on an individual’s needs, behavior, and other aspects. Therefore, the final result is a set of generalized conclusions (concepts) that were drawn from the knowledge acquired earlier.
The primary concepts of Peplau’s theory are the following. First, the purpose of nursing is to help the patients as well as other people to define and identify the difficulties they experience. Moreover, regardless of the level of nursing experience, when a problem arises, nurses should utilize the principles of human relations to address the issue. Additionally, the relationship between health professionals and patients consists of several phases: orientation, identification, exploitation, and resolution. At these stages, nurses can play many different roles, such those of a leader, counselor, stranger, teacher, or someone else. At the same time, nursing is an interpersonal process that is therapeutic in nature involving the interaction between various individuals who have a common goal as well as focusing on a person’s health. The final concept of the theory is related to the collaboration of a nurse and a patient, which provides necessary conditions for the enhancement of their knowledge and maturity (Forchuk, 1993).
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Taking into account that Peplau was influenced by the works of prominent psychiatrists as well as considerable personal experience in the fields of nursing and psychology, it is possible to state that the provided concepts are defined both theoretically (the application of the principles of human relations) and operationally (the therapeutic nature of nursing and the collaboration between the nurse and the patient). At the same time, given the fact that the worldview of the author is phenomenological in nature, which means Peplau relies on her primary experience, the concepts of her theory remain consistent. Moreover, all of them are expressed clearly, which proves that they are defined explicitly. In addition, there is a particular relationship between the concepts of the theory. In particular, the utilization of the principles of human relations is connected with the fact that nursing is an interpersonal or relation-based process. Finally, the primary goal of nursing, helping people, is intertwined with the therapeutic nature of this process: in other words, these two concepts are united by the focus on the well-being of a patient.
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The theory of interpersonal relations is based on several assumptions. In fact, there are explicit assumptions, the most significant of which are related to the individual experience of nurses, which provides for a substantial difference in the knowledge the patients obtain from health professionals. In other words, each nurse is a unique source of information, and the outcome of their collaboration with a patient is always different. Additionally, there is an explicit assumption that focuses on the facilitation of the development of one’s personality and its subsequent maturity as a primary function of nursing education. On the other hand, there are also implicit assumptions. The first one concerns the fact that illness is a stimulus for personal growth of both a nurse and a patient within the boundaries of their relationship; therefore, there is a chance the latter will obtain competencies beyond those associated with a disorder. Moreover, the reactions of people to their personal problems, including the ones that are related to their health, may become a unique focus of nursing (Forchuk, 1993). On the whole, the aforementioned four assumptions form the basis of Peplau’s theory.
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Furthermore, Peplau’s work contains a description of all four concepts of a nursing metaparadigm: person, environment, health, and nursing. In particular, according to it, a person is an organism that is constantly developing while trying to reduce its anxiety which is, in fact, caused by the presence of needs. Next concept, environment, is perceived as a set of the external forces, which usually exist in the context of a particular culture. In turn, the concept of health is described as the development of a personality, which presupposes its movement toward a productive and community-based life. Finally, nursing is considered to be an interpersonal process of a therapeutic nature, which is focused on the cooperation (Smith & Parker, 2015). Thus, the inclusion of these concepts contributes to the relevance of the theory, hence its effectiveness in terms of application to the contemporary nursing practice.
In general, the theory of Hildegard Peplau is relatively easy to understand, and the majority of its concepts and statements are presented in a simple language. In turn, Peplau’s theory of interpersonal relationships is considered lucid. Moreover, the author’s worldview appeals to her primary experience making her theory quite consistent. All these facts contribute to the relevance and usability of Peplau’s theory in the modern world.
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The concepts of Peplau’s theory of interpersonal relationships as well as the stages and roles it describes may serve as guidance during the establishment of a partnership with a patient, which is particularly important taking into account the recent health care reform. Today, nurses are not just the assistants of physicians who simply follow the orders of their superiors, but they are rather the representatives of an independent profession who possess the necessary skills ensuring the provision of integrated and comprehensive care. They also alleviate patients’ suffering, ensure their rehabilitation, and apply their expertise in the field of psychology and psychotherapy along with their other competences. When people are treated in the hospital or clinic, they inevitably form their own impression of the health care facility; and it does not depend only on the treatment they receive but also on the behavior of the health professionals there, including nurses (Meleis, 2012). In this context, the first contact with the medical staff, a nurse, in particular, is especially crucial as it defines the further relationship between the parties. As a result, the patients and nurses might develop a sense of trust or mistrust, affection or ill will as well as create a partnership or stay distant and not cooperate at all.
In order for the treatment to be efficient, a patient needs to feel that a nurse wants to help them. Thus, it is imperative to define a patient’s psychological portrait and, using the reviewed theory as a basis, assume a nursing role that is the most suitable for a particular situation. In turn, it will be possible to have a trusting dialogue with a client, which means that the nurse will be able to obtain the necessary information on the patient, his opinion about the disease, hospitalization, recovery hopes, and plans for the future. During these conversations, one can determine what attitude the patient has toward their relatives, work, and other aspects of life (Meleis, 2012). Thus, this information provides a nurse with an opportunity to make an accurate diagnosis as well as establish a bilateral knowledge exchange, which ensures personal growth.
At the same time, a nurse must bear in mind that the partnerships with their patients cannot become very familiar and they must always be a leader in such relationships. In accordance with the concepts of the theory of interpersonal relations, a nurse must sympathize with the sick establishing empathy. In other words, they need to be able to understand the nature and severity of the experience and suffering of their patient; however, a nurse does not identify themselves with their feelings relying on their personal experience to address the arising problems. Moreover, in accordance with the therapeutic nature of nursing, the patient should always be confident that their conversations with medical staff are confidential. In turn, knowing the characteristics of the patient’s experience and their personality, a nurse can tactfully explain the patient’s rights and responsibilities as well as describe the necessary diagnostic procedures and upcoming treatment (Meleis, 2012). Thus, a nurse plays a role of an educator, which is one of the core roles of a health professional, according to the theory of interpersonal relations.
To conclude, despite being one of the oldest middle range theories, the theory of interpersonal relations of Hildegard Peplau remains especially relevant even today as the health care system focuses on the establishment of partnerships between patients and health care professionals, including nurses. In particular, Peplau’s theory provides the necessary guidelines and describes the phases of the interaction process as well as the roles that a nurse can perform. As a result, its application facilitates the process of establishing a relationship with a patient making it more systematic for a nurse. In turn, the time required for a so-called recruitment of patient shortens with every new case, thus increasing the efficiency of treatment as a whole. All these facts serve as the evidence of the value of Hildegard Peplau’s theory, which can be recommended to the medical staff in various areas of nursing.
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