a personal nursing philosophy related to hildegard...

Running head: A PERSONAL NURSING PHILOSOPHY 1

A Personal Nursing Philosophy Related to Hildegard Peplau

Kjersti T. York

Dixie State University

A PERSONAL NURSING PHILOSOPHY 2

A Personal Nursing Philosophy Related to Hildegard Peplau

Death can have a profound impact and life changing effect on personal values. Each

nurse has a personal and professional story that contribute to their theory of nursing. In addition

to this, most people can identify vastly influential and inspiring people in their lives who have

taught them valuable life lessons. These people also have a profound impact on a person’s

philosophy about life and a nurse’s philosophy about nursing. For many generations nurses have

developed their own personal theories to explain, comprehend, and advance the nursing process.

The writer of this paper has established her own nursing philosophy linked to both life and

nursing experiences (York, 2013).

Definition of Nursing

Defining nursing has long been a topic of discussion for professional nurses. Definitions

provide answers to questions such as “What is nursing” or “What do nurses do?” Each nurse

may have their own personal definition of nursing that guides their nursing practice. The

American Nurses Association (2013) states “Nursing is the protection, promotion, and

optimization of health and abilities, prevention of illness and injury, alleviation of suffering

through the diagnosis and treatment of human response, and advocacy in the care of individuals,

families, communities, and populations.”

The author of this paper has been a nurse for three months, prior to this time she worked

as a Certified Nursing Assistant for approximately seven years. She has been able to develop her

personal definition of nursing from the experiences she has had as a CNA, student nurse, and

practicing nurse. Her definition is: Nursing is the ability to use a specialized skill set and body

of knowledge to provide individualized, evidence based care to patients in collaboration with

other disciplines. Nurses facilitate healing and are persistent advocates for patients. They also


encourage prevention of disease and maintenance of both physiological and psychosocial well-

being. Nurses always strive to assist patients to achieve the best possible quality of life until

death. Nurses will assist dying patients through the dying process comfortably. This definition

of nursing is comparable to the Royal College of Nursing’s definition. It also aligns closely with

Florence Nightingale’s definition. (Black, 2011)

Evidence Based v. Theory Based

With the implementation of Evidence-Based practice some may question the relevance or

importance of nursing theory in today’s nursing practice. Nursing theory has been criticized as

being untested philosophical writings, with no sound proof of improving patient outcomes.

Though there may be a lack of evidence to support nursing theorists work, practicing nurses can

attest to the importance of nursing qualities such as ‘caring’. For example, when a patient is

admitted to the hospital they often are accompanied by feelings of anxiety and stress, these

feelings may be reduced by a caring nurse who takes the time and effort to make the patient feel

at ease. Nurses in this situation aren’t guided by evidence based research, but by theory and

ethics. According to McCrae (2012) “The most valued activities of nurses are those relating to

compassion and empathy, but these are the elements least supported by hard scientific data.”

Hildegard Peplau

One theorist that made a significant impact in the world of nursing is Hildegard Peplau.

She was born in Pennsylvania on September 1, 1909. She graduated from high school in 1928

and then from Pottstown Hospital School of Nursing in 1931. She completed her nursing clinical

training at Norristown State Mental Hospital. After nursing school she obtained a Bachelor of

Arts degree in interpersonal psychology, then a masters in psychiatric nursing, and finally a

doctorate degree in educational curriculum development in 1953. Peplau served during World


War II as a lieutenant Army Nurse. After which she served as the instructor and director of a

graduate program for advanced psychiatric nursing in Columbia. Eventually she worked her way

into being the director of psychiatric nursing at Rutgers University College of Nursing in

Newark, New Jersey. During her time at Rutgers she also saw patients part time at her own

psychotherapy practice. Peplau published her first book in 1952 called Interpersonal Relations

in Nursing. After that time she wrote numerous articles, served on advisory boards, and

provided consultation to health agencies and professional organizations. She held positions on

the World Health Organization, the International Council of Nurses, and American Nurses

Association. She was a national nurse consultant to the Surgeon General, United States Public

Health Service, and the National Institute of Mental Health.

Peplau has been recognized for her work in nursing and mental health by receiving nine

honorary doctorate degrees, numerous awards, and inducted into the America Nurses Association

Hall of Fame. She was also the only nurse named one of Marquis Who’s Who “Fifty Great

Americans” (Beatty, 2004).

One of her greatest accomplishments was the creation of her nursing theory. Peplau’s

theory was born at a time when many theories were being developed. Her theory is complex,

comprehensive, and centers on the nurse-patient relationship. Peplau believed that the focus

should be on the relationship between nurse and patient rather than only the patient. There are

two goals of a therapeutic nurse-patient relationship: first is survival of the patient, second is the

patient having adequate understanding of their health issues and developing new behavior

patterns to improve their health situation.

Peplau also described a four step process to improve patient behavior patterns, very

similar to the nursing process. Furthermore, she described six roles the nurse must fill to assist


the patient in improving their behavior: leader, counselor, surrogate, resource, technical expert,

and teacher (Black, 2011). Known for thinking well ahead of her time, Peplau believed in

evidence-based nursing and included observation, hypothesis, and experiment in her theory. At

the time, this part of Peplau’s theory was highly revolutionary and not accepted by many (Parker,

2005).

Recently, Peplau’s theory was used as the structure for research development in the area

of female depression. A study was conducted on the usefulness of psychosocial therapy in

addition to anti-depressant medications. The study showed positive outcomes in support of the

use of therapy in addition to anti-depressant medication in the treatment of depression in adult

females (Parker, 2005).

Another psychiatric advancement that Peplau was part of was advanced practice

psychiatric nurses. According to Caldwell, Sclafani, Piren, and Torre (2012) “Peplau’s

contributions to advanced practice nursing began with the development of the role of the clinical

nurse specialist.” A special American Nurse Association task force developed the CNS and

published it in the “Statement of Psychiatric Nursing Practice” in 1967.

Though Peplau’s theory has been used most frequently in the specialty of psychiatric

nursing it is applicable to many areas of nursing.

Application

Peplau’s theory has many parts, each of which are easily relatable to experiences of a

working nurse. The core of Peplau’s theory, the nurse-patient relationship is strongly tied to the

work of a hospice nurse. I had the opportunity to care for a young patient who had a unique

story. The patient had fought a tough battle with cancer and won, she was in remission. But the

chemotherapy that helped her obtain this victory would also have an intense negative impact on


her health. It suppressed her immune system and she acquired an infection. With all of her

body’s defenses unable to maintain her health, the patient developed sepsis. Her body went

through a vicious cycle of poor health until eventually she was unconscious and unable to

breathe on her own. She had a loving family by her side throughout the entire process. They

were all hoping she would recover, though her prognosis was poor. I was able to care for this

patient the day they decided to put her on comfort measures and ensured she would leave this life

comfortably.

The decision for comfort measures was not reached easily by the patient’s family. It took

numerous visits from the palliative care nurse, hospice nurse, and multiple physicians for them to

make the decision. Following the decision being made there was an extensive conversation

between the palliative care nurse and the patient’s family about the dying process and what to

expect. An important thing for nurses to do is tailor education according to their patient or

family’s needs. (Koivunen, Huhtasalo, Makkonen, Valimaki, & Hatonen, 2012). The patient was

medicated and weaned off of life support machines and died in a short amount of time. The

family was by her side and at peace when their loved one died.

Peplau’s theory was applied many times by many nurses during the delivery of this

patient’s nursing care. It was applied not only to the patient, but her family as well. The nurse-

patient/family relationship was essential to the comfort and peace felt by this patient and her

family. The nurse’s role in transition to end of life care is to advocate for, encourage reflection,

and provide care to the patient (Lewis, 2013). Though Peplau’s goal of survival was not met, the

second perhaps most vital goal of understanding health problems and recognizing

behaviors/actions that need to be changed for this patient to be comfortable were realized and

carried out.


Conclusion

Evidence based and theory based care are both essential parts of nursing. Though

evidence based care can guide many nursing practices, there is still a need for nursing theory to

contribute to a nurses ability to make patient’s feel comfortable and at ease. Hildegard Peplau

was an impressive theorist who accomplished many great things for the nursing profession.

Though most of her work was done for psychiatric nursing, it is applicable to many fields of

nursing. The profession of nursing has evolved and will continue to evolve, it is vital for

practicing nurses to possess a strong ethical theory to accompany evidence-based practice in

order to provide excellent patient care.


References

American Nurses Association (ANA): What is Nursing?, (2013). (website). Available at

www.nursingworld.org

Beatty, R., (2004). Hildegard E. Peplau. Philadelphia: University of Pennsylvania.

Black, B. P., (2011). Professional Nursing: Concepts and Challenges. St. Louis: Elsevier.

Caldwell, B. A., Scalfani, M., Piren, K., & Torre, C. (2012). The Evolution of the Advanced

Practice Role in Psychiatric Mental Health in New Jersey: 1960-2010. Issues In Mental

Health Nursing, 33(4), 217-222.

Hamilton, D. (2013). Research Informed Design Supports Evidence-Based ICU Medicine.

Health Environments Research & Design Journal (HERD), 6(4), 97-100.

Koivunen, M., Huhtasalo, J., Makkonen, P., Valimaki, M., & Hatonen, H., (2012). Nurses’ roles

in systematic patient education sessions in psychiatric nursing. Journal Of Psychiatric &

Mental Health Nursing, 19(6), 546-554.

Lewis, K. (2013). How nurses can help ease patient transitions to end of life care. Nursing Older

People, 25(8), 22-26.

McCrae, N. (2012). Whither Nursing Models? The value of nursing theory in the context of

evidence-based practice and multidisciplinary health care. Journal Of Advanced Nursing,

68(1), 222-229. doi: 10.1111/j.1365-2648.2011.05821.x.

Parker, M.E. (2005). Nursing Theories and Nursing Practice. Philadelphia: F.A. Davis.

York, K. (2013). Kjersti York’s Nursing Theory. Unpublished manuscript, Dixie State University.

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