MIDDLE RANGE THEORY

HILDEGARD PEPLAU Hildegard Peplau was born in Reading, Pennsylvania on

September 1st, 1909. After graduating from the Pottstown, Pennsylvania Hospital School of Nursing in 1931 she worked as an operating room supervisor at Pottstown Hospital. She later received a B.A. in interpersonal psychology from Bennington College, Vermont, in 1943, an M.A. in psychiatric nursing from Teachers College, Columbia, New York, in 1947, and an Ed.D in curriculum development from Columbia in 1953.

During World War II, Hildegard Peplau was a member of the Army Nurse Corps and worked in a neuropsychiatric hospital in London, England. She also did work at Bellevue and Chestnut Lodge Psychiatric Facilities and was in contact with renowned psychiatrists Freida Fromm-Riechman and Harry Stack Sullivan. Hildegard Peplau holds numorous awards and positions. She retired in 1974. On March 17th, 1999, Hildegard Peplau died peacefully at her home in Sherman Oaks California after a brief illness. She was 89 years old

HILDEGARD PEPLAU’S THEORY OF INTERPERSONAL RELATIONS :

Nursing is the interpersonal therapeutic process of functioning cooperatively with other human processes that make health possible for individuals in communities through education that aims to promote forward movement of personality.

HILDEGARD PEPLAU(INTERPERSONALRELATIONSHIP and PSYCHODYNAMIC

NURSING)

The theory explains the purpose of nursing is to help others identify their felt difficulties.

Nurses should apply principles of human relations to the problems that arise at all levels of experience.

HILDEGARD PEPLAU(INTERPERSONALRELATIONSHIP and

PSYCHODYNAMIC NURSING)

Peplau's theory explains the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process.

Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care.

Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal.

The attainment of goal is achieved through the use of a series of steps following a series of pattern.

The nurse and patient work together so both become mature and knowledgeable in the process.

Metaparadigm in Nursing Person: A developing organism that tries to reduce

anxiety caused by needs.

Environment: Existing forces outside the organism and in the context of culture

Health: 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.

Nursing: A significant therapeutic interpersonal process. It functions cooperatively with other human process that make health possible for individuals in communities

ROLES OF NURSES Stranger: receives the client in the same way one meets a stranger

in other life situations provides an accepting climate that builds trust.

Teacher: who imparts knowledge in reference to a need or interest

Resource Person : one who provides a specific needed information that aids in the understanding of a problem or new situation

Counselors : helps to understand and integrate the meaning of current life circumstances ,provides guidance and encouragement to make changes

Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate.

Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way

ADDITIONAL ROLES1. Technical expert 2. Consultant 3. Health teacher 4. Tutor 5. Socializing agent 6. Safety agent 7. Manager of environment 8. Mediator 9. Administrator 10. Recorder observer 11. Researcher

- The behavior of the nurse as a person interacting with the patient as a person has significant impact on the patient’s well being and quality and outcome of nursing care.

Phases of interpersonal relationship

1. Orientation 2. Identification 3. Exploitation 4. Resolution

ORIENTAION PHASE On admission

Problem defining phase

Starts when client meets nurse as stranger

Defining problem and deciding type of service needed

Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations of past experiences

Nurse responds, explains roles to client, helps to identify problems and to use available resources and services

Factors influencing orientation phase

IDENTIFICATION PHASEDuring intensive treatment period

Selection of appropriate professional assistance

Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness

EXPLOITATION/WORKING Convalescence and rehabilitation

Use of professional assistance for problem solving alternatives

Advantages of services are used is based on the needs and interests of the patients

Individual feels as an integral part of the helping environment

They may make minor requests or attention getting techniques

The principles of interview techniques must be used in order to explore, understand and adequately deal with the underlying problem

Patient may fluctuates on independence

Nurse must be aware about the various phases of communication

Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step

RESOLUTION PHASE Discharge

Termination of professional relationship

The patients needs have already been met by the collaborative effect of patient and nurse

Now they need to terminate their therapeutic relationship and dissolve the links between them.

Sometimes may be difficult for both as psychological dependence persists

Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals

Interpersonal theory and nursing process

Both are sequential and focus on therapeutic relationship

Both use problem solving techniques for the nurse and patient to collaborate on, with the end purpose of meeting the patients needs

Both use observation communication and recording as basic tools utilized by nursin

Assessment•Data collection and analysis [continuous]

•May not be a felt need

Orientation•Non continuous data collection 

•Felt need 

•Define needs

Nursing diagnosis Planning•Mutually set goals 

Identification•Interdependent goal setting

Implementation•Plans initiated towards achievement of mutually set goals

•May be accomplished by patient , nurse or family

Exploitation•Patient actively seeking and drawing help 

•Patient initiated

Evaluation•Based on mutually expected behaviors 

•May led to termination and initiation of new plans  

Resolution/TERMINATION•Occurs after other phases are successfully completed •Leads to termination of the relationship

APPLICATION OF THE THEORY

Peplau’s theory is significant in terms of the different phases of the nurse-patient interaction and the different roles the nurse can play in giving nursing care to patients. It thus, becomes important for nurses to understand the principles behind each of these concepts so that clinical nursing will be more meaningful for the nurse.

Eventually, this will translate to better patient outcomes like improved health, prevention of disease, and or enhancement of care faculties.