The future in the past: Hildegard Peplau and interpersonal relations in nursing Researchers, educators and clinicians have long recognized the profound influence of the mid-twentieth century focus on interpersonal relations and relationships on nursing. Today, in nursing, as well as in medicine and other social sciences, neuroanatomy, neurobiology and neurophysiology have replaced interpersonal dynamics as keys to understanding human behavior. Yet concerns are being raised that the teaching, research and practice of the critical importance of healing relationships have been overridden by a biological focus on the experiences of health and illness. As a way to move forward, we return to Hildegard Peplau's seminal ideas about the transformative power of relationships in nursing. We propose that Peplau's formulations and, in particular, her seminal Interpersonal Relations in Nursing can provide direction. We do not propose that her formulations or her book be simply transposed from the 1950s to today's classroom and clinic. But we do believe that her ideas and writings are dynamic documents containing concepts and derived operations that can be brought to life in clinical practice. Finally, we explore Peplau's transformative idea that nursing is, at its core, an interpersonal process both to acknowledge an idea that has shaped our past and can guide us into our future.
Beginning with the publication of Interpersonal Relations in Nursing ( 1952), Peplau espoused the philosophy that effectiveness in interpersonal relationships was a legitimate concern in professional nursing practice. Consideration of the process occurring between patient and nurse shifted the view of patientas-object whom the nurse &dquo;did things to or for&dquo; to one where the skill and maturity of the nurse was brought to bear on the creation of an interpersonal growth process. For the first time, the nurse's behavior was seen as occurring in complex interaction with the behavior of the patient. Understanding and using interpersonal interactions as an &dquo;educative instrument&dquo; brought new depth to nursing practice.Each encounter with the patient offered the possibility for the creative synthesis of experience toward the goal of more integrated human functioning (Peplau, 1952). Four key elements in Peplau's model are (a) mutuality, (b) phasic relatedness, (c) the anxiety gradient, and (d) uniqueness.Mutuality is best described as the reciprocal process that legitimatizes growth in both nurse and patient under specific conditions. Inherent in this principle is the notion of the drama of likeness and difference interacting with each other to form the experience of mutual learning. Peplau described a process whereby the nurse and patient begin as strangers with an understanding based only on preconceived meanings. Through interacting, both patient and nurse move to greater mutuality until their efforts toward common health goals culminate in a collaborative effort centered around the &dquo;forward movement&dquo; of the patient toward creative constructive living. One of the identified constraints on this process is the development and creative capacity of the nurse, for the &dquo;kind of person that is the nurse determines what each patient will learn&dquo; (Peplau, 1952). In helping the patient identify problem elements, the nurse gains insight and grows through the experience.Phasic relatedness concerns the deliberative, artificial, purposeful nurturing of a relationship with a patient that proceeds through predictable stages to a planned ending. The deliberative aspect requires that the nurse understand personal behavior for the purpose of helping the patient identify interpersonal difficulties arising out of the situation at hand. Using principles of human behavior, the nurse develops new experiences with the patient for the purpose of improving the skills with which the patient is negotiating present circumstances. As these experiences are learned, reconciliation with past events occurs, accompanied by the development of new strategies for handling problems in the future. Artificial elements, such as contractual arrangements, differentiation of educative functions for nurse and patient, and the ultimate termination of the relationship, distinguish therapeutic relationships from social relationships. Phases of orientation, identification, exploitation, and resolution occur and require different behav...
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