Hildegard E. Pepalu IPR Theory

Hildegard E. Pepalu IPR Theory

• Name: Hildegard Elizabeth Peplau \
• Nickname: Hilda
• Birthday: September 1, 1909
• Died: March 17, 1999 in Sherman Oaks, California  
• Birthplace: Reading, Pennsylvania
• Parents: immigrants of German descent
• Father: Gustav Peplau (illiterate but hard-working)
•  Mother: Otyllie Peplau (oppressive and perfectionist)
• Birth Order: She was the second daughter born of six  children

• Strong-willed
• Strong motivation
• Has a vision to grow beyond traditional women’s  roles
• Wanted more out of life

Career Timeline

• 1931 - Diploma program in Pottstown, Pennsylvania
•  1943 BA in interpersonal psychology - Bennington College
• 1947 - MA in psychiatric nursing from Colombia  University, New York
• 1952 - Published Interpersonal Relations in Nursing
• 1953 - EdD in curriculum development in 1953 Professor emeritus from Rutgers university Started first post baccalaureate program in  psychiatric nursing
• 1968 - interpersonal techniques - the crux of psychiatric  nursing

• Worked as executive director for ANA
• President of ANA from 1970-1972
• Vice-President of ANA from 1972-1974
• Worked with W.H.O., NIMH and Nurse Corps.
• She was the first published nursing theorist since Florence Nightingale
• Created the middle-range nursing theory of  interpersonal relations, which helped to  revolutionize the scholarly work of nurses
• Staff Nurse in Pennsylvania and New York City
• School Nurse at Bennington College, VT
• Certified in Psychoanalysis at the William Alanson  White Institute of New York City
• Faculty of the College of Nursing at Rutgers University
• Created first graduate level program for the  preparation of clinical specialists in Psychiatric Nursing
• Therapeutic Care vs Custodial Care in mental hospitals
• Strong advocate for graduate education and research  in nursing
• She is the primary contributor to mental health law  reform, leading the way towards humane treatment  of patients with behavior and personality disorders

• Interpersonal Relations Model
• Psychodynamic Nursing

• Using an understanding of one’s own  behavior to help others identify their  difficulties
• Applies principles of human relations
• Patient has a felt need

• Emphasized the nurse-client relationship as the  foundation of nursing practice
• The interpersonal model emphasizes the need  for a partnership between nurse and client as  opposed to the client passively receiving  treatment (and the nurse passively acting out  doctor's orders).
• Shared experience - Nurses could facilitate this  through Observation, description, formulation, interpretat  ion, validation, and intervention

• 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.
• 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.
• Theory of interpersonal relations is a middle  range descriptive classification theory
• The theory was influenced by Harry Stack  Sullivan's theory of inter personal relations  (1953)
• The theorist was also influenced by Percival  Symonds, Abraham Maslow's and Neal Elger  Miller
• Peplau's theory is also referred as psychodynamic nursing, which is the  understanding of ones own behavior

• An individual
• A developing organism that tries to reduce  anxiety caused by needs.
• Lives in stable equilibrium

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.
• Involves problem-solving

Peplau’s Seven Roles of a Nurse

• 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
• Counselor : 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
• Technical Expert: provides physical care by  displaying clinical skills and operates equipment

Additional Roles

• Consultant
• Health teacher
• Tutor
• Socializing agent
• Safety agent
• Manager of environment
• Mediator
• Administrator
• Recorder observer
• Researcher

Four Sequential Phases in the  Interpersonal Relationship

• Orientatio
• Identification
• Exploitation
• Resolution

Orientation Phase

• 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
• Get acquainted phase of the nurse-patient  relationship.
• Preconceptions are worked through
• Parameters are established and met
• Early levels of trust are developed
• Roles begin to be understood

Identification Phase

• 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
• The client begins to identify problems to be  worked on within relationship
• The goal of the nurse: help the patient to  recognize his/her own  interdependent/participation role and promote  responsibility for self

Exploitation Phase

• 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
• Client’s trust of nurse reached full potential
• Client making full use of nursing services
• Solving immediate problems
• Identifying and orienting self to [discharge] goa

Resolution Phase

• 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
• Client met needs
• Mutual termination of relationship
• Sense of security is formed
• Patient is less reliant on nurse
• Increased self reliance to deal with own  problems.
• The patient gradually puts aside old goals and  adopts new goals. This is a process in which the  patient frees himself from identification with the  nurse.

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 nursing

Application of Theory to Areas in Nursing
Nursing Education

• Has an impact on the Psychiatric Nursing  especially in the baccalaureate program in  nursing teaching CARE OF CLIENTS WITH  MALADAPTIVE PATTERNS OF BEHAVIOR  (NCM 105) composed of 72 hours lecture  and 102 hours RLE

Practice

• Focuses on the interpersonal processes and therapeutic  relationship that develops between the nurse & client.
• It requires that the nurse attends to the interpersonal  processes that occur between the nurse and client.
• Interpersonal process is maturing force for personality.It includes the nurse- client relationship, communication, pattern integration and  the roles of the nurse.
• Psychodynamic nursing is understanding one’s own  behavior to help others identify felt    and perceived  difficulties and to apply principles of human relations to  the problems that arise at all levels of experience.

Research Based on Peplau’s Theory

• Hays, D. (1961). Phases and steps of experimental  teaching to patients of a concept of anxiety:  Findings revealed that when taught by the  experimental method, the patients were able to  apply the concept of anxiety after the group was  terminated.
• Burd, S.F. Develop and test a nursing intervention  framework for    working with anxious patients:  Students developed competency in beginning  interpersonal relationship.
   

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