hildegard E.peplau Psycho dynamic nursing theory Presented by : Bashair shomo Fatima abdalla Hanan abdelrahman Rehab abdelrahim

Objective: By the end of this seminar the student will be able to: 1) know the historical background of the theorist. 2) Recognize the theoretical resources. 3) Understand the major concept and definition. 4) Identify the major assumption and the acceptance by the nursing community. 5) Know the critique.

Historical background Hildegard E. peplau was born September 1,1909 in reading, Pennsylvania. She died peacefully in her sleep 89 years later on march 17, 1999 in her home in California. Peplau began her nursing career in 1931 after graduating from Pottstown, Pennsylvania School of nursing. she received a B.A.in interpersonal psychology from Bennington college, Vermont, in 1943; an M.A. in psychiatric nursing from Teachers college.

Peplau received honorary doctoral degrees during her prestigious career from the following universities: Alfred, Duke. Hildegard peplau is considered to be the mother of psychiatric nursing.

Peplaus most significant contribution to nursing science. professional nursing and the psychiatric nursing specialty may be the development of the theory of interpersonal relation a midrange theory focusing on the relationship between the nurse and the patient.

in 1954 peplau went to Rutgers where she developed and chaired the graduate psychiatric nursing program until her retirement in While at Rutgers paplu created the first graduate level program for the preparation of clinical specialists in psychiatric nursing.

after her retirement from Rutgers peplau served as a visiting professor at the university of leuven in Belgium where she helped establish the first graduate nursing program in Europe. in 1969 paplau became executive director of the American nurses association. she served as president of the American nurses association from 1970 to 1972 as second vice president from 1972 to 1974.

peplau is the only nurse to have been both the executive director and the president of the American nurses association. she has also served as director of the new jersey state nurses association a number of the expert advisory council of the world health organization The national nurse consultant to the surgeon general of the air force and a nursing consultant to the united state public health service the national institute of mental health and various foreign countries.

in 1994 peplaus career was highlighted by her induction into the American academy of nursing living legends hall of fame. in 1995 peplau was selected as one of the 50 great American chosen in America.

Theoretical sources Peplaus theory of interpersonal relation integrated existing theories into her model at a time when nursing theory development was relatively new

peplau used knowledge borrowed from behavioral science and what can be termed the psychological model to develop her theory of interpersonal relation. it gave nurses an opportunity to teach patients how to experience their feeling and to explore client how to hear their feeling.

the conceptual framework of interpersonal relation seeks to develop the nurses skills in using these concepts. Sullivan Symonds maslow mittleman and miller are some of the major sources peplau used in developing her conceptual framework.

Use of empirical evidence: Theories that were available when peplau developed her theory : The principles of social learning. The concept of human motivation. The concept of personality development.

 Peplau combined the various ideas of maslow, sullivan, miller, and symonds.  freud, fromm, adler, and pavlov initiated these theories.  Freud emphasized the importance of motivation, conflict, and the role of family in early childhood and discovered the significance of the unconscious.

 although Pealau used the and interpersonal theories of Sullivan and Freud as the theoretical base for her model she did not take into consideration interrelationships between man and society.

Maslow's theory of human motivation is well known and he theorized that people are motivated to attain their inherent potential, a process referred to self actualization.

 Pavlov's stimulus response model influence miller's principles of social learning.  Miller's work focused on personality theory, adjustment mechanism, psychotherapy and principle of social learning.  Miller assisted in psychoanalytical theory and practice into learning theory terms.

Sullivian was a pioneer in field of modern psychiatry, with other theorists and therapists he broadened the basic freudian psychoanalytics.

is being able to understand one’s own behavior to help others identify, felt difficulties, and to apply principle of human relations to problems that arise at all level of experience. Psycho dynamic nursing

 Peplau describe four phases of the nurse patient relationship.  Although separate they are overlap and occur over the time of relation ship. Nurse patient relationship:

phases of the nurse patient relationship Orientation Identification Exploration Resolution

 During the orientation phase the individual has a felt of need and seeks professional assistance.  The nurse helps the patient recognize and understand his or her problem and determine his or her need for help. Orientation phase:

 The patient identifies with those who can help him or her (relatedness).  The nurse permits exploration of feelings to aid the patient in undergoing illness as an experience that reorients feeling and strengthens positive forces in the personality and provide needed satisfaction. Identification phase:

 During the exploitation phase the patient attempts to derive full value from what he or she is offered through the relationship.  The nurse can project new goals to be achieved through personal effort and power shifts from the nurse to the patient as the patient delays gratification to achieve the newly formed goals. Exploitation phase:

 The patient gradually puts aside old goals and adopts new goals.  This is a process in which the patient frees himself or herself from identification with the nurse. Resolution phase:

Role of stranger Role of the resource person Teaching role Leadership role Surrogate role. Counseling role Nursing roles:

 The nurse should treat the patient with ordinary courtesy.  During this non personal phase, the nurse should treat the patient as emotionally able unless evidence indicates otherwise.  This coincides with the identification phase. Role of stranger:

The nurse provides specific answer to questions, especially health information, and interprets to the patient the treatment or medical plan. Role of the resource person:

Teaching role InstructionalExperiential

 The leadership role involves the democratic process.  The nurse helps the patient meet tasks at hand through a relationship of cooperation and active participation. Leadership role:

 The patient casts the nurse in the surrogate role.  The nurse’s attitudes and behaviors create feeling tones in the patient reactivate feelings generated in a previous relationship.  In this phase, the patient and nurse define areas of dependence, independence and interdependence. Surrogate role:

Counseling function in the nurse-patient relationship by the way nurses respond to patient’s demands. Counseling role:

Psychobiological experiences Needs Frustration ConflictAnxiety

Identification Exploration Resolution Orientation On admission During intensive treatment period Convalescence and rehabilitation discharge

Patient: personal goals patient Nurse: Professional goals Entirely separate goal and interest. Both are stranger to each other. Individual pre conception on the meaning of the medical problem, the role of each on the problematic situation. Partial mutual and partially individual understand- ing of the nature of the medical problem. Mutual understanding of the nature of the problem, roles of nurse and patient and requirements of nurse and patient in the solution of the problem. Common shared heath goals. Collaborative effort directed to ward solving the problem together productively. nurse

Stranger infant child adolescent adult person orientation identification exploitation resolution Strangerunconditional surrogate mother counselor mother sibling resource person leadership surrogate : adult person Nurse patient phases in nurse patient relation ship Phases and changing roles in nurse- patient relationships

Major Assumptions: Peplua identifies two explicit assumptions: 1- ''The kind of person that the nurse becomes makes a substantial difference in what each patient will learn as he or she receives nursing care". 2- "Fostering personality development toward maturity is a function of nursing and nursing education. Nursing uses principles and methods that guide the process toward resolution of interpersonal problems".

 One implicit assumption was that "the nursing profession has legal responsibility for the effective use of nursing and for its consequences to patients

Major assumption Nursing Person Health environment

Nursing:  Peplau describes nursing as "a significant, therapeutic, interpersonal process.  It functions cooperatively with other human processes that make health possible for individuals in communities".

 When professional health teams offer health services, nurses participate in the organization of conditions that facilitate natural ongoing tendencies in human organisms.  "Nursing is an educative instrument, a maturing force that aims to promote forward movement of personality in the direction of creative, constructive, productive, personal, and community living".

Person:  Peplau defines person in terms of a man. Man is an organism that lives in an unstable equilibrium.

Health Peplau defines health as "a word symbol that implies forward movement of personality and other ongoing human process in the direction of creative, constructive, productive, personal, and community living".

Environment: Peplau implicitly defines the environment in terms of : "existing forces outside the organism and in the context of culture," from which mores, customs, and beliefs are acquired.

Acceptance By The Nursing Community: Practice:  Peplau brought "a new perspective, a new approach, a theoretically based foundation for nursing practice for therapeutic work with patients.  Peplau's ideas provide a design for the practice of psychiatric nursing with explication of the design in usable from.

 Some of Peplau's ideas were not accepted in the early years, such as the concept of experiential learning for the patient and students and disagreed with Peplau on the methodology of psychotherapeutic functions and the role of the nurse as a surrogate. Several researchers stand out in their use of Peplau's theory to guide a program of study that applies this theory to clinical practice.  She states, "In working with individuals with psychological problems, the development of the interpersonal process is of the utmost importance.

 Peden used Palau's process of practice based theory development to direct a program of research in the area of depression.  Using Palau's theory, peden completed initial studies that investigated the recovery process in depressed women.  In that research, pedant found that women were able to describe interpersonal patterns that resulted from negative thinking and identified stategies to manage them.

Education:  Smoyak and Rosulin state that after 1952, no psychiatric nursing text could ignore Peplau's work.  Many scientists state that "Peplau's theoretical ideas, particularly her definition of nursing and nursing process, elaboration of anxiety and learning, and her psychotherapeutic methods, have becomes a part of the collective culture of the discipline of nursing.

Research:  Sills states that Peplau's work influenced the direction of clinical work and studies, initial efforts to use research as a tool to develop a body nursing knowledge were uneven in quality and quantity and often did not explicitly recognize underlying assumptions.

 For more than 30 years, Peplau's model has formed the basis for numerous application of research methods.  Assumptions from Peplau's model continue to be used in current research.  The researchers found that interpersonal intervention structures allow patients to achieve maximum quality of life by enlisting the support of others.  Peplau made a significant contribution to the nursing community through the research done to evaluate, validate, and make more precise the Theory of Interpersonal Relations.

simplicity: The major focus of Peplau's theory, interpersonal relations between patient and nurse, is easily understood. she clearly defines the theory basic assumptions and key concep of the assumptions,Peplau listed, two are explicit and one is implicit.

she takes ideas from observations of the specific and applies them to the general. Peplau’s theory can be described as meeting the evaluative quality of simplicity.

Generality: Peplau believed that her theory of interpersonal relationship met the criteria of generality. she felt that nurses could apply these principles in any area of their lives. but the theory is adaptable only to nursing settings in which communication can occur between the patient and nurse.

Its use is limited in working with the comatose,, or newborn patient. In such situations, the nurse-patient relationship is often one sided. The nurse and the patient cannot work together to become more knowledgeable, develop goals, and mature. Even peplau admits "understanding of the meaning of the experience to the patient is required in order for nursing to function as an educative, therapeutic, maturing force". Peplaus theory cannot be applied to all patients, therefore the quality of generality is not met.

Empirical precision: The relationship between the theory and empirical data allow other scientists to validate and verify the theory. Peplau operationally defnes the four phases of the interpersonal process, the nurse with regard to his or her roles, and the patient with regard to his or her state of dependence.

ssssssss Peplau’s theory can be considered empirically precise. With further research and development, the degree of precision will increase.

Derivable consequences : In historical perspective, peplau is one of the first theorists since nightingale to present a theory for nursing. Therefore her work can be considered pioneering in the nursing field. She provided nursing with a meaningful method of self-directed practice at a time when medicine dominated the health care field.

Peplau work, thoughts, and ideas have touched many nurses, from students to practitioners. Although her book was published in 1952, five decades ago, it continues to provide direction for nursing practice, education, and research. The evaluative criteria of derivable consequences are unquestionably met.