Introduction

• Hildegard E. Peplau (1909-1999)

• She is known as mother of psychatric nursing (Aligood 2008).
• She graduates from Posttown, Pennsylvia hospital, SON in 1931. She
received B.A 1943, M. A 1947 Ed. D in 1953.
• She served as Executive director and president of American Nursing
Association (ANA).
• She taught the 1st class of graduation of psychiatric nursing student.
Cont……
• She delivered lectures in USA, Canada, Africa,
and South America.
• Her first book was on Interpersonal
Relationship published on 1952.
• Peplau’s was selected as one of the 50 great
American chosen to be included in 50th edition
of who is who in 1995.
 Why theories are important
• Aim to describe, predict and explain the
phenomenon of nursing.
• Provide foundation of nursing practice, help
generate further knowledge and indicate in
which direction nursing should n future.
• Help us to decide what we know and what
need to know.
• Help to distinguish what should from the basis
of practice by explicitly describing nursing.
 Psychodynamic Nursing
• it is defined as dynamic relationship between
nurse and a patient.
• Psychodynamic Nursing is defined as
understanding one’s own behavior to assist
others by identifying the difficulties, and by
applying principle of human relations to the
problem that arise at all level of experience.
 Four Millennium
• The nurse-patient relationship
• Engagement in evidence based practice
• competence in information technology
• Leadership in shifting the health care
paradigm to community based delivery.
 Interpersonal Relationship
• Interpersonal Relationship in nursing (1952)
describe the importance of nurse-patient
relationship as “significant therapeutic
interpersonal process” (Peplau 1952).
 Orientation
• Orientation
• nurse meet the client as stranger, identify the
problem and Patient felt need and seek
professional assistance, understand about the
problem and need for help.
• Provide explanation.
• Answer question.
• Discuss preconception.
• Early levels of trust established.
Factors which influence on Orientation
phase
 Identification
• Identification
• Patient identify the nurse and there by accepting help.
• Palau states that when a nurse permits to patient what
they feeling about the disease then patient feel positive
reinforcement and strengthens in personality.
• The aim of this phase is to develop
clarity about the patient
preconceptions and expectation
from the nurse.
• Express feeling
• Feel stronger
 Exploitation
• Patient makes use of nurse’s help by self interest and need
• The plan of action is implemented and evaluated.
• The client 3 responses in terminate phase
• Interdependent
• Autonomous & independent
• Passive & dependent
 Resolution
• Terminate the therapeutic relationship and
dissolve the link between them)
• The goal are meet.
• It also included the
planning of alternative
source of support
and problem prevention.
 Role of Nurse
• Stranger
• Resource person
• Teacher
• Leader
• Surrogate
• Counselor
 Additional role of a nurse
1. Technical expert
2. Consultant
3. Health teacher
4. Tutor
5. Socializing agent
6. Safety agent
7. Manager of environment
8. Administrator
9. Recorder observer
10. Researcher
 NURSING METAPARADIGM
• Nurse:
nursing is a maturing force and an educative instrument.

• 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.
 Practice

• Trust
• Humanity
• Making of verbactum
• Strengthen nursepatient relationship.
• The start of psychiatric nursing.
• Used for counseling
patient undergoing
depression.
 Education
• Interpersonal Relations in Nursing, used as a
manual of instruction to nursing students.
• Foundation of psychiatric nursing education.
• Making of varbactum
 Research
• Different studies on the nursing phenomena.
• Improvement of the social system.
• Stress management program.
• Formation of behavior scale.
• Therapeutic behavior
of the nurses.
 Major Assumption
• Different patient received nursing care from
which what they learn that will be decided by
nurse because nurse makes the different
behavior in different situation.

• Nurse foster the personality development.

Nursing uses principal and methods that guide
the process towards resolution of
interpersonal problem.
 Analysis of the Theory

• SIMPLICITY
• The theory is easily understand able.
• Assumption and key concepts were clearly given,
explained, broken down and outlined.
• Defined clearly phases of nurse-patient
relationship and interpersonal model.
• Applied effectively in the nursing profession.
 Analysis of the Theory
• Generalizability
Applicable to all nurses in any setting. This simplicity leads to
adaptability in any nurse-patient interaction, thus providing
generalizability.

• EMPIRICAL PRECISION
Based on reality. Tested and observed using pure observation.
Theoretical area and empirical data are validated and verified.

• DERIVABLE CONSEQUENCES
Widens the perception of nursing profession.
Broaden the scope of nursing practice.
 Strengthen/Weakness
• The phases provide simplicity regarding the
natural progression of the nurse-patient
relationship.
• Also used for psychiatric patients.

• Used only in the situations that communication

can occur.
• It is impossible in working with unconscious,
comatose or newborn patients (one-sided
relationship)
 Introduction

• Ida Jean Orlando (Pelletier)

• August 12, 1926.
• Diploma in nursing from New York Medical college
• B.S in public health nursing 1951, in mental health
consultation from Columbia 1954,
• She was research associate and principal investigator
on a federal project grant entitled Integration of mental
health concept in a basic Curriculum” until 1958.
 Conti……
• She was clinical nursing consultant at Mclean
Hospital in Belmont in 1972
• She also served as Assistant Director of
Nursing for Education and research at
Metropolitan Stat Hospital.
 Major concept

Presenting Behavior

Nurse Reaction

Nurse Action
 Presenting behavior
• To find out the immediate need for help the nurse must
first recognize the situation as problematic.
• The presenting behavior of the patient, the stimulus,
causes an automatic internal response in the nurse, and the
nurses behavior causes a response in the patient
• All patient behavior, no matter how insignificant, must be
considered an expression of need for help.
• Behavior may be verbal or non verbal .
• If the behavior is hard to interpret
leads to difficult in providing care.
 Nurse reaction
• The nurse and patient’s individual
perceptions, thoughts and feeling.
 Nurse Action
• Any nursing professional nursing action which
is benefit for the patient, the action may be
direct/ automatic or indirect/deliberatively
involvement.
• Direct: by nurse own wish.
• Indirect: by patient wish.
 Nursing: Orlando defined
nursing as “the function of Person: person behave
professional nursing is verbally or non verbally.
conceptualized as finding Person is an individual in
out and meeting the need.
patient immediate need for
help”.
NURSING
METAPARADIGM

Environment: assuming that a

nursing situation occur when
Health: freedom from there is a nurse patient contact
mental or physical and both nurse and patient
discomfort and feeling of perceive, think, feel and act on
adequacy and well being immediate situation. The
contribute to health. Being observation of behavior of patient
without emotional or is continue process for the nurse
physical discomfort. because behavior could be a part
of distress.
 Strengths/Weaknesses

Use of her theory assures that the patient will be treated as individuals
and they will have an active and constant input into their own care.
Assertion of nursing’s independence as a profession and her belief that
this independence must be based on a sound theoretical frame work.
Guides the nurse to evaluate her care in terms of objectively observable
patient outcomes.

Lack the operational definitions of society or environment which limits the
development of research hypothesis.
The theory focuses on short term care, particularly aware and conscious
individuals and on the virtual absence of reference group or family
members.
 Practice
• Clearly applicable to nursing practice.
• Basis of practice in hospital.
Education
• Orlando’s process recording has made a
significant contribution to nursing education.
• Process recording is a tool to facilitate self
evaluation of whether or not the process
discipline was used.
 Research
• The nursing profession in the area of research
and has been applied to a variety of research
setting.
 Major Assumption
• When patient cannot cope with their needs
without help, they become distressed and
helplessness.
• Every patient is unique and individual in their
response.
• The nurse patient situation is dynamic, action
and reaction are influenced by both the nurse
and patient
 Analysis of the Theory
• Clarity: clearly defined concepts.
• Simplicity: Concepts and relationships are able
to make some predictive statement.
• Generality: Focus on limited number of
situation, it could be adopted to other nursing
situation and other professional fields.
• Derivable Consequences: beneficial in
achieving valued outcome.
 Comparison
Hildegard E. Pepau Ida Jean Orlando Pelletier
• Born in 1909 • Born in 1929
• She is known as mother of • B.S in public health nursing
psychiatric nursing. 1951, in mental health
• She served as Executive consultation from Columbia
director and president of 1954,
American Nursing • She was research associate
Association (ANA). and principal investigator
 Comparison
Hildegard E. Peplau Ida Jean Orlando (Pelletier)
• Nursing: • Nursing:
Maturing force and educative • Identify immediate need of
instrument. the patient and help to
meet the need.

• Person: • Person:
Patient is an unstable is an individual in need and
equilibrium. nature.
 Comparison
Hildegard E. Peplau Ida Jean Orlando (Pelletier)
• Health: • Health :
• Ongoing human processes in • freedom from mental,
the direction of creative, physical discomfort and well
constructive, productive, being
personal, and community
living.
• Environment:
• Environment:
• existing forces outside the • The observation of behavior
organism (person) in the of patient is continue process
context of culture, from which for the nurse because
mores, customs, and beliefs are behavior could be a part of
acquired. distress.