Hildegard E. Peplau, RN ED. D.
Psychodynamic Nursing
“Psychiatric Nurse of the Century”
Definition Of Nursing
Nursing is a healing art (therapeutic) of the “human relationship between an individual who is sick,
or in need of health services, and a nurse specially educated to recognize and to respond to the need
for help.” Nursing is viewed as an interpersonal process because it involves two or more
individuals with a common goal. Nursing is a “maturing force and an educative instrument.
Metaparadigm In Nursing
1. Person - An organism that lives in an unstable balance of a given system.
2. Health - Symbolizes movement of the personality and other ongoing processes that direct the
person towards creative, constructive, productive, and community living.
3. Environment - Forces outside the organism in the context of a socially approved way of living
from which vital social processes are derived.
4. Nursing – a significant, therapeutic, interpersonal process.
Nurse-patient relationship (Interpersonal Relations Theory)
She described four phases of this relationship:
Orientation - in which the person and the nurse mutually identify the person's problem
Identification - in which the person identifies with the nurse, thereby accepting help
Exploitation - in which the person makes use of the nurse's help
Resolution - in which the person accepts new goals and frees herself or himself from the
relationship.
Orientation Phase
1. When the nurse and patient first meet is known as the orientation phase.
2. This is a time when the patient and nurse come to know each other as people and each other’s
expectations and roles are understood.
3. The patient at this time needs to recognize and understand their difficulty and the need for
help, be assisted in planning to use the professional services offered and harness the energy
derived from felt needs.
4. It may be expected that the patient will test limits to establish the integrity of the nurse.
5. The tasks of this phase are to build trust, and rapport, establish a therapeutic environment,
assess the patient’s strengths and weaknesses, and establish a mode of communication
acceptable to both patient and nurse.
6. When the patient can begin to identify problems the relationship progresses to the working
phase
Identification Phase
1. Trust begins to develop and the patient begins to respond selectively to persons who seem to
offer help.
2. The patient begins to identify with the nurse and identify problems, which can be worked on.
3. The meaning behind the feelings and behavior of the nurse and patient are explored. Peplau
states that when a nurse permits patients to express what they feel, and still get all of the
nursing that is needed, then patients can undergo illness as an experience that reorients
feelings and strengthens positive forces in the personality
4. The tasks of this phase are to develop clarity about the patient's preconceptions and
expectations of nurses and nursing, develop acceptance of each other, explore feelings,
identify problems, and respond to people who can offer help.
5. In particular the nurse assists in the expression of needs and feelings, assists during stress,
shows acceptance, and provides information.
6. The nurse and patient may make plans for the future but the implementation of the plan
signifies the beginning of the exploitation phase of the working relationship.
Exploitation Phase
1. The patient realistically exploits all of the services available to them based on self-interest
and need.
2. The nurse assists the patient in their efforts to strike a balance between the needs for
dependence and independence.
3. The plan of action is implemented and evaluated. The patient may display a change in
the manner of communicating, as new skills in interpersonal relationships and problem
solving are developed.
4. The nurse continues to assess and assist in meeting new needs as they emerge.
Resolution Phase
1. The resolution phase involves the gradual freeing from identification with helping persons,
and the generation and strengthening of the ability to stand alone, eventually leading to the
mutual termination of the relationship.
2. The patient abandons old needs and aspires to new goals.
3. She or he continues to apply new problem-solving skills and maintains changes in the style of
communication and interaction
4. Resolution includes planning for alternative sources of support, problem prevention, and the
patient’s integration of the illness experience
Psychological Mothering:
The patient is accepted unconditionally to satisfy his needs.
There is recognition of and in response to the patient’s readiness for growth and his initiative.
Power in the relationships shifts to the patient as the patient can delay gratification and invest
in goal achievement.
NURSING ROLES
1. Stranger Role: Receives the client the same way one meets a stranger in other life situations;
provides an accepting climate that builds trust. Accepting the patient objectively.
2. Resource Person Role: Answers questions, interprets clinical treatment data, and gives
information. Interpreting the medical plan to the patient.
3. Teaching Role: Gives instructions and provides training; involves analysis and synthesis of
the learner's experience. Offering information and helping the patient to learn. Peplau
separates teaching into two categories:
Instructional—which consists largely of giving information and is the form explained in
educational literature.
Experiential— which is using the experience of the learner as a basis from which learning
products are developed.
4. Counselling Role: Helps client understand and integrate the meaning of current life
circumstances; provides guidance and encouragement to make changes. Working with the
patient on current problems.
5. Surrogate Role: Helps client clarify domains of dependence, interdependence, and
independence and acts on client’s behalf as an advocate. Figuratively standing in for a person
in the patient's life.
6. Active Leadership Role: Helps client assume maximum responsibility for meeting treatment
goals in a mutually satisfying way. Working with the patient democratically.
