Running head: A PERSONAL NURSING PHILOSOPHY
A Personal Nursing Philosophy Related to Hildegard Peplau
Kjersti T. York
Dixie State University
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A PERSONAL NURSING PHILOSOPHY
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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
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encourage prevention of disease and maintenance of both physiological and psychosocial wellbeing. 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
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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
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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
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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 nursepatient/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.
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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.
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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
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Health Nursing, 33(4), 217-222.
Hamilton, D. (2013). Research Informed Design Supports Evidence-Based ICU Medicine.
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Koivunen, M., Huhtasalo, J., Makkonen, P., Valimaki, M., & Hatonen, H., (2012). Nurses’ roles
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Lewis, K. (2013). How nurses can help ease patient transitions to end of life care. Nursing Older
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evidence-based practice and multidisciplinary health care. Journal Of Advanced Nursing,
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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.