Theory of interpersonal relationships in nursing

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The theory of interpersonal relationship in nursing is one of the American Pflegetheoretikerin Hildegard Peplau developed nursing theory , which in 1952 under the title Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing was published. Peplu's theory is the first nursing theory that appeared after Florence Nightingales' Notes on Nursing , published in 1859 , and had a decisive influence on the development of nursing research , nursing education , nursing culture and nursing self-image. Within the German-speaking nursing science, this theory is also referred to with the established expression interpersonal relationships in nursing .

The theory sets the conceptual frame of reference for psychodynamic nursing , the nursing model assigned to the plausible theory , which is primarily used in psychiatric nursing . Peplaus theory is classified within the nursing science research as grand theory ( English for significant theory ), the nursing model described therein is counted among the interaction models .

The starting point of the theory is the relationship between the caregiver and the person being cared for within a care situation, which reflects the everyday difficulties of life. The focus is on the interaction between those involved and the determination of the underlying structures of this relationship. This knowledge is intended to enable the caregiver to design the interaction in such a way that it becomes a learning experience for the carer and the carer. In the metatheoretical examination of Peplaus' theory, various critical points were discussed, for example the asymmetry of the power structure within the care relationship or the applicability of the theory to those in need of care who are unable to communicate.

Nursing history background

Peplaus theory is of particular importance in connection with the nursing history and social context of the 1950s. During this time, based on developments in medicine and the general belief in progress, the first hospitals with a modern design emerged . The practical care, which until then was mostly not institutionalized in the family environment, experienced massive mechanization and adaptation to the changed structures. In the understanding of the 1950s, humans were viewed in the separate units of body and mind ( Cartesian dualism ), with medicine focusing exclusively on the body. At this time, nursing was dominated by medicine and had no independent or scientific basis and was defined by the framework conditions of the health system. For Peplau, these framework conditions made the personal relationship between the cared for and caregiver taboo ; contrary to the medical dominance, she tried to reduce nursing to her core activity in the interpersonal relationship and understood medicine in this sense as a reference science of nursing. Against this background, Peplaus' nursing theory met with criticism and resistance both in nursing and in the health system.

Influences and sources

Peplu's analytical work was mainly influenced by Erich Fromm , with whom she took several courses during her studies. Her theoretical foundations on interpersonal perception come from the field of neo-psychoanalysis , the pioneers of which she met in the 1940s during internships at the Chestnut Lodge psychiatric hospital . In this facility in Rockville , Maryland , a number of important American therapists and those who had emigrated from Germany worked at the time, who were concerned with the development of analytically oriented psychotherapy; it was there that the influential Chestnut Lodge Studies originated , which examined the long-term results of psychiatric treatments. The collaboration with Karen Horney , Frieda Fromm-Reichmann , Harry Stack Sullivan and Clara Thompson had a lasting impact on Peplaus' understanding of the interaction between care and well-groomed care and formed the basis for the development of psychodynamic care. Peplau himself names a strong influence Freud had on the approaches to personality theory and the work of the humanistic psychologist Abraham Maslow in the field of motivation and needs theory .

Nursing division

Nursing theories, which are also referred to as conceptual nursing models, do not describe the actual practical nursing or its condition, but rather represent the individual understanding of nursing itself. In addition to the definition of central factors and phenomena , these theories are also sorted according to their origin, their emergence, their Their meaning, their logic, their applicability and their transferability or according to their level of abstraction . The range of the theory for the associated nursing model is of decisive importance for the ability to derive further smaller theories and models, for the applicability within different nursing cultures and for the school of thought to which it is assigned. Typical of the theories of the first generation, to which Peplaus theory belongs, are comprehensive, mostly inductive concepts with a long range, which are classified as grand theory . The theory of interpersonal care was an exception within these theories, as it initially focused on applicability in psychiatric care. As a result, it initially only had a medium range, but this was extended to general applicability in Peplaus' subsequent theoretical considerations. Another distinguishing feature of nursing theories is the concept of man on which the theory is based. This can be systemic, mechanistic or, as with Peplau, holistic or holistic .

Various classification systems are used within nursing science and research, in which the division into a model group allows conclusions to be drawn about the type of theory. Afaf Ibrahim Meleis , who draws on the basic research of Donaldson and Crowley, arranges nursing theories in four schools of thought; within this division, the theory of interpersonal care is classified as an interaction model. Other Care scientists use other classifications, such as it is of Marriner-Tomey as humanistic model referred.

Objectives and priorities

Goal setting

According to Peplaus theory, nursing is helpful if it succeeds  in promoting the further development of the interaction  partners - those in need of care and caregivers - and supporting them with interpersonal problems that arise in the nursing process. To this end, nursing training must not only train the intellect, but also the personality of the nursing staff, as their behavior influences how well or how badly the patient copes with his illness. It is crucial that the caregiver recognizes, clarifies and develops an understanding of the effect that their care has on the person in need of care.

Metaparadigm

According to the nursing science aspect, nursing theories can be divided into four paradigms. In their entirety, they are referred to as the metaparadigm of care and encompass the areas of man or person, the environment, health or illness and care. Using these criteria, the objective, the self-image and the systematic of each theory can be described and recorded. The metaparadigm as a descriptive element is controversial in nursing science and metatheoretically, but is used within nursing education to provide a comprehensive overview of a nursing theory.

Metaparadigm in care : people, environment, health / disease, care
human
The Peplauschen theory is based on a holistic view of man, that is, man is perceived as a unique, individual being and not reduced to the function of his organs. The interpersonal relationships of the individual, which are part of and influence their existence, are controlled by various internal and external circumstances.
environment
Peplau describes the environment as a microcosm . This includes all caregivers as well as all interpersonal relationships within which the person in need of care moves.
Health / illness
Peplau defines health as an ongoing process of personality development and other human needs, such as emotions. Health is geared towards a creative, active, useful and productive personal life as well as community life. Peplau understands illness as an inevitable human experience which can then become an experience of growth when the person can find meaning in the illness.
maintenance
In Peplau's nursing theory, nursing is described as a therapeutically meaningful interpersonal process that aims to promote health. This should give the strength to develop a personality that enables the person in need of care to participate in everyday life. Care can also be seen as an educational tool.

Key concepts

The structure of Peplau's nursing theory is based on four key concepts:

  • The concept of reciprocity
  • The concept of phase relatedness
  • The needs and levels of fear
  • The concept of interpersonal learning

Concept of reciprocity

According to Peplau, the relationship between the carer and the cared for is at the center of a care situation. Based on the basic assumption that every person always strives for a maturation and educational process and a high level of individual productivity, this also applies to the two interaction partners in the care situation. The two parties take on different roles, from which a mutual learning and maturing process emerges in the mutual relationship, which characterizes a successful care situation.

Concept of the reciprocity of roles within the nursing interaction in relation to the phases of the relationship

This basic assumption applies equally to the person in need of care and the caregiver, although both have different roles in the situation. It follows that both learn and mature in a successful care situation through mutual exchange. In contrast to the dominant role model of the 1950s, Peplau calls for an emotionally meaningful exchange between the participants in the interaction. The caregiver should bring their self into the care situation as a mature and educational force by fulfilling various roles assigned by the person in need of care or by society. These roles are determined by their professionalism and comprise a number of duties, rights and expectations that are linked to the respective role.

Learning within the care situation is equally possible for the caregiver and the person being cared for. The prerequisite is that the nurse is aware of their role and can change roles to enable the patient to learn new behaviors. It must also recognize when maintaining a role will reduce anxiety in the groomed. The roles that a caregiver can assume or that are ascribed to her were individually described by Peplau, without claiming to be exhaustive: First of all, caregivers and those in need of care encounter each other as strangers . Then there are the roles of the supportive person and the teaching person , caregivers can also serve as substitutes for mother, father or sibling if this enables the person being cared for to live out past feelings such as dependency or helplessness. Finally, there is the advisory role of the nursing expert, which, according to Peplau, represents one of the most important roles in professional nursing.

Concept of phase relatedness

The four phases of the interaction between caregiver and patient described by Peplau describe the most favorable development of an interpersonal relationship between the person in need of care and the caregiver. The phases are not to be viewed in isolation, but can partially overlap.

Overlapping phases of the caregiver / patient relationship
  • In the orientation phase , the caregiver tries to assess and identify the care problem together with the person being cared for. Furthermore, it is important that the person in need of care recognizes and understands their condition as well as the need for help. The caregiver takes on the role of listener and advisor. This phase is completed when the interaction partners attach the same level of importance to the problem and have informed each other about future joint work. During this phase, nursing diagnostics based on the nursing history takes place together with the person in need of care.
  • In the identification phase, the patient identifies positively or negatively with the caregiver. There are three ways a patient can react: by actively participating in the care, which leads to a two-way relationship between the carer and patient, by refusing to cooperate, or by passively letting it happen. The nurse's job is to allow and understand the patient's feelings without neglecting professional care. In this phase, care planning and care problems are defined together.
  • In the phase of use or exploitation , the person being cared for makes full use of the services offered. He surrenders himself completely to the institution and expects unconditional “parental” care. For this phase, the care documentation and the adaptation of the care planning to any changing care situations are important.
  • The replacement phase describes the development of what is well-groomed towards the ability to take care of oneself again. This phase only follows after the previous development has been completed and is a prerequisite for restoring health. As a rule, it initiates the discharge of the person being cared for from the care facility. At the end of this phase, the quality of care is checked, which is referred to as an evaluation in nursing terms .

Concept of needs and levels of fear

needs

Peplau starts from the assumption that the needs of an individual influence his actions and thus also his ongoing and goal-oriented behavior. This assumption is based on the work of Maslow and Sullivan. Peplau describes two types of needs, which, however, only serve analytical purposes: on the one hand, the physical needs of the organism and, on the other hand, the interpersonal needs that promote human development. Any further differentiation, as presented by Henderson in the model of the 14 basic needs , for example , does not take place with Peplau. If the needs of the well-groomed are not met, they develop fears, which then have to be communicated within the interpersonal relationship. Causes of incomplete satisfaction of needs can be, among other things, conflicts in the microcosm, i.e. the environment of the person in need of care.

Levels of fear

Building up the fear level and varying degrees of fear

According to Peplau, every person tries to satisfy their needs for physical integrity, interpersonal security, affection, recognition, ability and new experiences. On the way to the satisfaction of needs, obstacles or conflicts arise that give rise to fears and confront people with feelings of insecurity and fear over and over again in the course of their lives. In the peplauschen theory, three levels of fear are distinguished, which differ in their level and have an influence on the individual's ability to learn and act. At the low level of fear, people are still able to learn and act independently, only their perception is sharpened. At the medium fear level, people lose track of the situation and their perception is significantly restricted. He is no longer able to develop coping strategies or gain new experiences. If a person reaches a high level of fear, for example panic , he completely loses the ability to act and perceive. Learning processes are no longer possible at this level of fear. In this situation, the nurse has the task of appropriately assessing the fear and reducing it through appropriate measures.

Concept of interpersonal learning

This concept takes up the central aspects of Peplaus theory. This includes the assumptions that human action is forward-looking, that man is an independent and social individual and that his actions are goal-oriented. Learning is defined by Peplau as an essential means of the desired forward movement and takes place in interpersonal relationships. The nursing department aims to enable these learning processes, with the help of which people can integrate the experience of “illness” into their lives. For the caregiver, their professionally performed role gives them the opportunity to benefit from this experience and to learn in a creative synthesis and to develop to greater maturity.

Nursing significance and aftermath

According to Nightingales, the Peplaus theory forms the first scientific basis in nursing science, which has had a strong impact on the development of nursing practice, nursing education and nursing research and has resulted in a fundamental change in the nursing culture. The change in nursing self-image was so far-reaching that nurses now take some approaches to the theory for granted; Marriner-Tomey assumes that Peplaus's theory has significantly influenced the development of modern care by creating a frame of reference for therapeutic work with those in need of care. Within psychiatric nursing, the peplausche model is established as the basis of nursing and is used as a model of psychodynamic nursing primarily in American clinics.

In the historical context of the theoretical development of care, the publication of Peplaus’s theory has put an end to the uncertainty in the relationship between caregiver and person in need of care. Their theory has had a decisive impact on nursing education and is now an internationally established component in nursing education and vocational training at all levels . The inclusion of psychology and the social sciences in the canon of academic nursing education was also strongly influenced by Peplau. Various nursing scientists see their theory as the basis for the nursing process that was developed later . Some deductive nursing theories of the second and third generation take up the theoretical foundations of the peplauschen theory and develop them further or incorporate them into new models, for example the theories of Rüdiger Bauer, who published the "concept of congruent relationship maintenance" in 1997, or Monika Krohwinkel , who took up the relationship as an additional element in an adaptation of her 1984 " System of Promoting Process Maintenance " published in 1999 . Other researchers have been influenced by Peplu's theory, and much research has been based on Peplu's views on the role of the carer.

Metatheoretical analysis

Pablo's theory has been criticized for a number of reasons. This includes, among other things, Peplaus concentrating on a relationship between two people; surrounding social systems, relatives or other care workers and their influence on the care situation are hardly taken into account. In professional nursing, it is unrealistic and cannot be assumed that a single nurse accompanies the entire nursing process, in particular specialization and functional nursing make a continuous interpersonal relationship almost impossible; reference nursing that promotes interpersonal relationships is not generally practicable everywhere. In addition, the very general definition of the paradigms of nursing and health or illness is criticized, which makes it difficult or impossible to differentiate from other therapeutic or nursing professions. Although Peplau assumes that her theory, which is aimed at a single person in need of care, can also be extended to families and social groups, Grünewald, for example, assumes that a conceptual adaptation or a change in certain aspects would be necessary.

Another point of criticism that was taken up by Marriner-Tomey is the limited general validity of the plausible theory, which requires a communicative partner. If the relationship partner is unable to understand the concept of learning and illness as a life experience, the theory cannot be used effectively. As a result, the theory cannot be applied, or only to a very limited extent, to unconscious, demented or newly-born people.

The asymmetry of the relationship between the caregiver and the person in need of care, shown in the theory, gives rise to further approaches for metatheoretical criticism: On the one hand, it is assumed that learning can only be done within a care situation. The reverse of this statement, that a person cannot learn without a carer, was questioned, but no conclusive assessment is made because Peplau does not make any statements about learning experiences outside of the care situation. On the other hand, it is criticized that the reciprocity of the care relationship was not clearly formulated. Due to the shifted power structure in the direction of the caregiver, which is conceivable in theory, the question arises whether the leadership role of the carer leads to a restriction of the autonomy of the cared for.

literature

  • Barbara J. Callaway: Hildegard Peplau: Psychiatric Nurse of the Century. Springer Publishing Company 2002, ISBN 0-8261-3882-9 .
  • Afaf Ibrahim Meleis: Theoretical Nursing: Development and Progress. Lippincott Williams & Wilkins, 1997, ISBN 0-397-55259-9 .
  • Hildegard E. Peplau, Gerhard Kelling, Maria Mischo-Kelling: Interpersonal Relationships in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. RECOM-Verlag 1995, ISBN 3-315-00098-0 .
  • GM Sills, LS Beeber: Hildegard Peplaus interpersonal care concepts. In: Maria Mischo-Kelling, Karin Wittneben: Nursing education and nursing theories. Urban & Schwarzenberg 1995, ISBN 3-541-16791-2 .
  • Hilde Steppe : Care models in practice, 3rd episode: Hildegard Peplau. In: The sister, the nurse . Edition 9, year 1990, Bibliomed, p. 767.

Web links

Individual evidence

  1. ↑ Hildegard E Peplau: Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing . Putnam, 1952 (English).
  2. ↑ a b Classification within the Meleis list, cf. Afaf Ibrahim Meleis: Theoretical Nursing: Development and Progress . Lippincott Williams & Wilkins, 1997, ISBN 0-397-55259-9 , pp. 310 .
  3. ↑ a b c d e G. M. Sills, LS Beeber: Hildegard Peplaus interpersonal care concepts . In: Maria Mischo-Kelling, Karin Wittneben (ed.): Nursing education and nursing theories . Urban & Schwarzenberg, 1995, ISBN 3-541-16791-2 , pp. 37-45 .
  4. ↑ Hildegard E Peplau, Gerhard Kelling, Maria Mischo-Kelling: Interpersonal relationships in nursing: A conceptual frame of reference for psychodynamic nursing . In: Nursing Education and Nursing Theories . Recom, 1995, ISBN 3-315-00098-0 , pp. 32 .
  5. ↑ Thomas H. McGlashan, William T. Carpenter: Identifying Unmet Therapeutic Domains in Schizophrenia Patients: The Early Contributions of Wayne Fenton From Chestnut Lodge . In: Schizophrenia Bulletin . tape 33 , no. 5 . Oxford University Press, September 2007, pp. 1086-92 , PMC 2632345 (free full text) - (English). , The studies were published by Thomas H. McGlashan as The Chestnut Lodge follow-up study. I-IV. , Archives of General Psychiatry , published 1984-1986.
  6. ↑ Barbara J. Callaway: Hildegard Peplau: Psychiatric Nurse of the Century . Springer Publishing Company, 2002, ISBN 0-8261-3882-9 , pp. 65-94 .
  7. ↑ Ann Marriner-Tomey: Nursing theorists and their work . Recom, 1992, ISBN 3-315-00082-4 , pp. 310 .
  8. ↑ The four schools of thought, also called “schools of thought”, refer to the classification system of care models defined by Meleis
  9. ↑ See table 2 in Beate Rennen-Allhoff: Handbuch Pflegewwissenschaft . Juventa, 2000, ISBN 3-7799-0808-5 , Nursing Theories, p. 52-53 .
  10. ↑ Ann Marriner-Tomey: Nursing theorists and their work . Recom, 1992, ISBN 3-315-00082-4 , pp. 22-56 .
  11. ↑ Hilde Steppe: Care models in practice . 3rd episode: Hildegard Peplau. In: The sister, the nurse . tape 9 . Bibliomed, 1990, p. 767-768 .
  12. ↑ The paradigms developed by Kuhn in 1970 and differentiated by Kim are questioned in particular because of the use of the nursing paradigm as a self-description of nursing, see also Beate Rennen-Allhoff: Handbuch Pflegewwissenschaft . Juventa, 2000, ISBN 3-7799-0808-5 , Nursing Theories, p. 53-55 .
  13. ↑ Hildegard E Peplau, Gerhard Kelling, Maria Mischo-Kelling: Interpersonal relationships in nursing: A conceptual frame of reference for psychodynamic nursing . In: Nursing Education and Nursing Theories . Recom, 1995, ISBN 3-315-00098-0 , pp. 37 .
  14. ↑ Werner Marschall, M Gacmann, Jörg Utschakowski: Psychiatric nurses - Mental Health Care . Springer, 2006, ISBN 3-540-29432-5 , pp. 68-69 .
  15. ↑ Hildegard E Peplau, Gerhard Kelling, Maria Mischo-Kelling: Interpersonal relationships in nursing: A conceptual frame of reference for psychodynamic nursing . In: Nursing Education and Nursing Theories . Recom, 1995, ISBN 3-315-00098-0 , pp. 101 .
  16. ↑ A diagram of the successive roles within the interpersonal relationship can be found as Fig. 4.2 in Werner Marschall, M. Gacmann, Jörg Utschakowski: Psychiatrische Gesundheits- und Krankenpflege - Mental Health Care . Springer, 2006, ISBN 3-540-29432-5 , pp. 68-69 .
  17. ^ Christel Conzen: Care Management . Elsevier, Urban & FischerVerlag, 2008, ISBN 3-437-27850-9 , 5 Nursing Science, pp. 116 .
  18. ↑ Hildegard E Peplau, Gerhard Kelling, Maria Mischo-Kelling: Interpersonal relationships in nursing: A conceptual frame of reference for psychodynamic nursing . In: Nursing Education and Nursing Theories . Recom, 1995, ISBN 3-315-00098-0 , pp. 45 .
  19. ^ Maria Mischo-Kelling, Karin Wittneben: Nursing education and nursing theories . Urban & Fischer Verlag, 1995, ISBN 3-541-16791-2 , pp. 44 .
  20. ↑ Hildegard E Peplau, Gerhard Kelling, Maria Mischo-Kelling: Interpersonal relationships in nursing: A conceptual frame of reference for psychodynamic nursing . In: Nursing Education and Nursing Theories . Recom, 1995, ISBN 3-315-00098-0 , pp. 151-153 .
  21. ↑ a b c Ann Marriner-Tomey: Nursing theorists and their work . Recom, 1992, ISBN 3-315-00082-4 , pp. 318 f .
  22. ↑ Werner Marschall, M Gacmann, Jörg Utschakowski: Psychiatric nurses - Mental Health Care . Springer, 2006, ISBN 3-540-29432-5 , pp. 175 .
  23. ^ Herbert Müller: Work organization in geriatric care: A contribution to quality development and quality assurance . 3. Edition. Schlütersche, 2008, ISBN 3-89993-193-9 , theory-guided work, p. 52-54 .
  24. ↑ a b Matthias Grünewald: Theory of the Interpersonal Relationship - HE Peplau (1952). (PDF) In: Medical facilities of the Heinrich Heine University Düsseldorf. Heinrich Heine University Düsseldorf, February 28, 2000, page 6 , accessed on August 8, 2009 .
  25. ↑ Ann Marriner-Tomey: Nursing theorists and their work . Recom, 1992, ISBN 3-315-00082-4 , pp. 322 .
This version was added to the list of articles worth reading on February 23, 2010 .