Hildegard Peplau

Nurse and psychiatric nursing theorist

• Born: September 1, 1909
• Birthplace: Reading, Pennsylvania
• Died: March 17, 1999
• Place of death: Sherman Oaks, California

Education: Pottstown Hospital School of Nursing; Bennington College; Teachers College, Columbia University; William Alanson White Institute

Significance: By dedicating her professional career to nursing and nursing theories, Hildegard Peplau made a major impact on the development of these fields, especially psychiatric nursing. She was particularly influential in promoting reforms in mental health nursing and in increasing understanding of interpersonal relations between nurses and their patients.

Background

Hildegard Peplau was born on September 1, 1909, in Reading, Pennsylvania, into a German American family as one of six children. Even as a young child, she was a keen observer of human behavior. At the age of nine, a major flu epidemic raged across the world, striking down between 30 and 50 million people worldwide and killing approximately 675,000 Americans. The pandemic had a major impact on Peplau, and she determined that she wanted to become a nurse. She was trained in her home state of Pennsylvania at the Pottstown Hospital School of Nursing, completing her nursing degree in 1931. Nursing was still a relatively young field at the time, and professional aspects of the field were still being developed.

From 1932 to 1936, Peplau worked as a private duty and general staff nurse in both Pennsylvania and New York. In 1936, she accepted a position as head nurse at the College Health Services department of Bennington College in Vermont. During the school year, she continued to pursue her education, studying with Erich Fromm, the internationally acclaimed German American psychologist, and training in the field of nursing psychiatry at Chestnut Lodge with Frieda Fromm-Reichmann, a German American psychotherapist, and Harry Stack Sullivan, a noted American Freudian. By the time she left Bennington College in 1942, she had become executive officer of the Health Services department.

American nurses were recruited for military services after the Japanese attacked Pearl Harbor on December 7, 1941. Peplau joined the Army Nurse Corps and was ordered to report for duty with neuropsychiatric units within the United States and in England between 1943 and 1945. Following the end of World War II, she began studying for advanced degrees at Columbia University’s Teachers College. While obtaining both a master’s degree and a doctorate, she taught nursing classes. Between 1948 and 1953, she also served as director of the school’s psychiatric nursing program and worked as a psychoanalyst at the William Alanson White Institute in New York.

Establishing the Theory of Interpersonal Relations

As her career developed, Peplau helped to define the field of psychiatric nursing in the United States. She had become one of the most respected names in the field by the early 1950s and was the first professor to teach graduate classes for psychiatric nurses at Columbia University. Between 1956 and 1974, she taught at Rutgers University, where she trained clinical specialists in psychiatric nursing with funding from the National Institute of Mental Health. Her work at Rutgers led to a greater understanding of the complexities of the field and to the development of new theories based on that understanding. Using data collected through clinical interviews, Peplau became an expert at bridging the gap between theory and practice.

Throughout the 1950s and 1960s, Peplau spent summers giving workshops at mental hospitals in both the United States and overseas. These classes dealt with topics such as individual, family, and group therapy, interpersonal communication, and interviewing techniques. She also traveled widely, speaking and lecturing on topics relevant to nursing in general and to psychiatric nursing in particular. She stressed the need for greater professionalism within nursing and emphasized the need for advanced degrees for nurses while continuing to produce a growing body of research.

The work for which Peplau is best known is The Theory of Interpersonal Relations (1952), which clearly reflects the influence of noted names in the field, such as Sullivan and American psychologist Percival Symonds, and advocated that psychiatric nursing move away from the custodial method and toward more therapeutic care. She developed four components to explain her significant nursing theory of interpersonal relations, suggesting that the person component refers to a natural inclination to attempt to meet individual needs by reducing anxiety, the environment component is composed of external forces dictated by culture, the health component reflects personality development, and the nursing component involves community-wide cooperation. Within this nursing model, she examined the phases of orientation, identification, exploitation, and resolution. As interpersonal relationships develop, she argued that the role of nurse in relation to the patient sequences from stranger to resource provider to teacher to counselor to surrogate to active leader and, finally, to technical expert.

Peplau served as president of the American Nurses Association from 1970 to 1972 and as second vice president from 1972 to 1974. Though she retired from her position at Rutgers in the mid-1970s, she continued to teach periodically. Throughout her career, she served as visiting professor at universities in the United States, Africa, Latin America, and Europe. She also further advanced the field of psychiatric nursing by serving on a number of advisory committees, working with the World Health Organization and the International Council of Nursing, among others.

Impact

Peplau’s greatest impact was on the development of the understanding of interpersonal relationships between nurse and patient. As a pioneer in the field, she brought greater insight into how this relationship functions, helping to redefine the relationship as a dynamic process and eradicating earlier beliefs that nurses were intended to function solely as channels for transmitting information from physicians to patients. In 1996, she was declared a Living Legend by the American Academy of Nursing.

Personal Life

Peplau became a mother in 1945 when her daughter Letitia Anne (Tish) was born. She chose not to marry the child’s father, Donald McIntosh. Illegitimacy and single motherhood were not accepted social practices at the time, and Peplau agreed to let her brother adopt Tish. It was not until 1984 that she openly acknowledged her daughter and moved to Sherman Oaks, California, where her daughter served as a social psychology professor at the University of California.

Principal Works

• Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing (1952)
• Aspects of Psychiatric Nursing (1957)
• Basic Principles of Patient Counseling (1964)

Bibliography

Callaway, Barbara J. Hildegard Peplau: Psychiatric Nurse of the Century. New York: Springer, 2002. Print.

D’Antonio, Patricia, et al. "The Future in the Past: Hildegard Peplau and Interpersonal Relations in Nursing." Nursing Inquiry 21.4 (2014): 311–17. Print.

Masters, Kathleen. Nursing Theories: A Framework for Professional Practice. 2nd ed. Burlington: Jones, 2015. Print.

Smith, Marlaine C., and Marilyn E. Parker, eds. Nursing Theories and Nursing Practices. 4th ed. Philadelphia: Davis, 2015. Print.

Stuart, Gail Wiscarz. Principles and Practice of Psychiatric Nursing. 10th ed. St. Louis: Elsevier, 2013. Print.

Winship, Gary, et al. "Collective Biography and the Legacy of Hildegard Peplau, Annie Altschul, and Eileen Skellern: The Origins of Mental Health Nursing and Its Relevance to the Current Crisis in Psychiatry." Journal of Research in Nursing 14.6 (2009): 505–17. Print.