"HILDEGARD" E. PEPLAU PSYCHODYNAMIC NURSING

• BACKGROUND
  
  Hilda Peplau was born September 1, 1909, in reading Pennsylvania.
• As a child, she witnessed the devastating flu epidemic of 1918. This personal experience greatly influenced her understanding of the impact of illness and death on families.
• Peplau began her career in nursing in 1931 as a graduate of the Pottstown Hospital School of Nursing in Pennsylvania.
• She then worked as a staff nurse in Pennsylvania and new York City. A summer position as nurse for the New York University Summer camp led to a recommendation for degree in interpersonal psychology in 1943.
• From 1943-1945 Peplau served in the Army Nurse Corps and was assigned to the 312th Field Station Hospital in England where the American School of Military Psychiatry was located.
• Peplau held master's and doctoral degrees from Teachers College, Columbia University. She was also certified in psychoanalysis by the William Alanson White Institute of New York City. In the early 1950s, Peplau developed and taught the first classes for graduate psychiatric nursing students at Teachers College.
• Dr. Peplau was a member of the faculty of the College of Nursing at Rutgers University from 1954-1974.
• At Rutgers, Peplau created the first graduate level program for the preparation of clinical specialists in psychiatric nursing.
• Peplau vigorously advocated that nurses should become further educated so they could provide truly therapeutic care to patients rather than the custodial care that was prevalent in the mental hospital of that era.
• During the 1950's and 1960's, she conducted Summer workshop for nurses throughout the United States, mostly in state psychiatric hospitals. In these seminars, she taught interpersonal concepts and interviewing techniques, as well as individual, family and group therapy.
• Peplau was an advisor to the World Health Organization and a visiting professor at universities in Africa, Latin America, Europe and throughout the United Sates.
• After her retirement from Rutgers, she served a visiting professor at the University of Leuven in Belgian in 1975 and 1976. There she helped establish the first graduate nursing program in europe.
  
  MAJOR CONCEPTS AND DEFINITIONS
  
  PSYCHODYNAMIC NURSING Peplau defines psychodynamic nursing because her model evolves through this type of nursing. Psychodynamic nursing is being able to understand one’s own behavior to help others identify felt difficulties, and to apply principles of human relations to the problems that arise at all levels of experience.
  
  NURSE-PATIENT RELATIONSHIP
  
  Orientation Phase
  
  
• When the nurse and patient first meet is known as the orientation phase.
• This is a time when the patient and nurse come to know each other as people and each other’s expectations and roles are understood.
• The patient at this time needs to recognize and understand their difficulty and the need for help, be assisted to plan to use the professional services offered, and harness the energy derived from felt needs (Peplau, 1952, p 19).
• It may be expected that the patient will test limits in order to establish the integrity of the nurse.
• The tasks of this phase are to build trust, rapport, establish a therapeutic environment, assess the patients strengths and weakness and establish a mode of communication acceptable to both patient and nurse (Shives, 1994, p 91).
• When the patient can begin to identify problems the relationship progresses to the working phase.
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  Working Phase :
  
  Identification phase :
  
  
• Trust begins to develop and the patient begins to respond selectively to persons who seem to offer help.
• The patient begins to identify with the nurse and identify problems, which can be worked on.
• The meaning behind feelings and behavior of the nurse and patient are explored. Peplau (1952, p31) states that when a nurse permits patients to express what they feel, and still get all of the nursing that is needed, then patients can undergo illness as an experience that reorients feelings and strengthens positive forces in the personality.
• The tasks of this phase are to develop clarity about the patient's preconceptions and expectations of nurses and nursing, develop acceptance of each other, explore feelings, identify problems and respond to people who can offer help.
• In particular the nurse assists in the expression of needs and feelings, assists during stress, shows acceptance and provides information.
• The nurse and patient may make plans for the future but the implementation of the plan signifies the beginning of the exploitation phase of the working relationship.
  
  Exploitation phase
  
  
• The patient realistically exploits all of the services available to them on the basis of self interest and need (Peplau, 1952, p 37).
• The nurse assists the patient in their efforts to strike a balance between the needs for dependence and independence.
• The plan of action is implemented and evaluated. The patient may display a change in manner of communicating, as new skills in interpersonal relationships and problem solving are developed (Forchuk & Brown, 1989, p 32).
• The nurse continues to assess and assists in meeting new needs as they emerge.
  
  
  Resolution Phase
  
  
• The resolution phase involves the gradual freeing from identification with helping persons, and the generation and strengthening of ability to stand alone, eventually leading to the mutual termination of the relationship (Peplau, 1952, p 39).
• The patient abandons old needs and aspires to new goals.
• She or he continues to apply new problem solving skills and maintains changes in style of communication and interaction.
• Resolution includes planning for alternative sources of support, problem prevention, and the patient’s integration of the illness experience.

NURSING ROLES

1. Role of stranger

Peplau states that because the nurse and patient are strangers to each other, the patient should be treated with ordinary courtesy. In other words, the nurse should not prejudge the patient, but accept him as he is. During this nonpersonal phase, the nurse should treat the patient as emotionally able, unless evidence indicates otherwise.

2. Role of resource person

Nurse provides specific answers to questions, especially health information, and interprets to the patient the treatment or medical plan of care. These questions often arise within the context of a larger problem. The nurse determines what type of response is appropriate for constructive learning, either straightforward factual answers or providing counseling.

3. Teaching role

The teaching role is a combination of all roles and “always proceeds from what the patient knows and…..develops around his interest in wanting and ability to use…..information.

Peplau separates teaching into two categories :

Instructional : which consists largely of giving information and is the form explained in educational literature.

Experiential : which is using the experience of the learner as a basis from which learning products are developed.
Leadership role

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

4. Surrogate role

The patient casts the nurse in the surrogate role. The nurse’s attitudes and behaviors create feeling tones in the patient that reactivate feelings generated in a prior relationship.

The nurse’s function is to assist the patient in recognizing similarities between herself and the person recalled by the patient.
She then helps the patient see the differences in her role and that of the recalled person.

In this phase, both patient and nurse define areas of dependence independence, and finally interdependence.

5. Counseling role

Peplau believes the counseling role has the greatest emphasis in psychiatric nursing.

Counseling functions in the nurse patient relationship by the way nurses respond to patient demands.

Peplau says the purpose of interpersonal techniques is to help the patient remember and understand fully what is happening to him in the present situation, so that the experience can be integrated rather than dissociated from other experiences in life.


MAJOR ASSUMPTIONS

Peplau identifies two explicit assumptions :

• The kind of person the nurse becomes makes a substantial difference in what each patient will learn as he receives nursing care.
• 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.
  
  Nursing
  Nursing described as a significant, therapeutic, interpersonal process.
  
  Person
  Peplau defines person in terms of 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 processes 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.