Hildegard E. Peplau Interpersonal Relations paradigm

Abstracts Has been praised as the “mother of psychiatric nursing”. Developed the Interpersonal Relations paradigm, a mid-range theory (p23; p51). Engaged in evidence-based practice, support of competence in information technology, and provision of leadership in influencing the health care paradigm shift to community-based health care delivery.

What is Nursing? Recognition of nursing as a unique profession (district from medicine). Nursing is the diagnosis and treatment of human responses to actual or potential health problems. Peplau’s emphasis on the nurse's responsibility to objectively observe, define, and label patient problems, discover and use principles to understand and resolve difficulties, and evaluate the effectiveness of those actions, paralleled the scientific method and foreshadowed development of the nursing process.

Self-regulation through certification Peplau (1985) provides cogent arguments about the importance of the master’s degree as the required educational preparation for all advanced practice categories to substantiate the credibility of theory and research as the foundation for clinical practice.

Theory, practice, research Peplau pioneered the idea that theory was essential to the practices of all professionals. Always concerned that theory, either developed by nurse theorists or borrowed from other disciplines, should explain phenomena through a nurse lens (p41~42). 5

理論、實務、研究的關係 (p221) 理論 研究 實務

「護理實務」、「護理理論」與「護理研究」三者之間相輔相成。 理論 (nursing theory)： 修改或延伸已有的理論。 實務 (nursing practice) ： 由護理實務經驗及密集閱讀文獻，將概念及其之間關係找出，而形成理論。 研究 (nursing research) ： 可用量性（統計）和質性（紮根理論；現象學）二種研究。 由於理論、實務、研究三者關係密切，往往很難確切劃分 理論構成的起始點是由何種開始。

Peplau’s Interpersonal Relations Theory It was developed deductively and inductively. Deductive reasoning (p64) Peplau drew on the grand theories of Freud (1936), Sullivan (1953), and Maslow (1954) to structure her theory as an interpersonal psychodynamic framework (p74). Inductive reasoning Peplau’s inductively based research method was to use case studies from observation and process recordings. Thus nursing knowledge derived from the context of clinical practice through a synthesis of existing scientific theories, clinical observation, practice judgment, and patient voice, provided a context for the transformation of practice into nursing knowledge.

Nursing Research Methods The Quantitative research paradigm (p77) It is the systematic scientific investigation of quantitative properties and phenomena and their relationships. The objective of quantitative research is to develop and employ mathematical models, theories and/or hypotheses pertaining to natural phenomena. The process of measurement is central to quantitative research because it provides the fundamental connection between empirical observation and mathematical expression of quantitative relationships. The Qualitative research paradigm Phenomenology

Quantitative research is generally approached using scientific methods, which include: The generation of models, theories and hypotheses The development of instruments and methods for measurement Experimental control and manipulation of variables Collection of empirical data Modeling and analysis of data Evaluation of results

Advancing clinical practice Peplau described nursing functions as “both educative and therapeutic when they lead people to develop skills for solving problems” proposed that these roles and functions take place within the context of the four phases of the nurses-patient relationship (p27).

人際互動關係圖 人：護理人員 人：病人 自我了解 運用所有概念與過程 運用角色自我了解 學習 其他人際關係 思考先入為主的觀念 焦慮 人：護理人員 人：病人 介紹期 認同期 探索期 解決期 入院時 密切治療時期 恢復期及復健期 出院 自我了解 運用所有概念與過程 運用角色自我了解 學習 其他人際關係 思考先入為主的觀念 焦慮 發展能力 自我了解 健康 學習 其他人際關係 思考先入為主的觀念 焦慮

治療性人際關係 動力的（dynamic），是不斷進展且隨時改變的過程。可分為四個階段：互動前期、介紹期、工作期（認同期及探索期）及結束期，各階段是環環相扣的，因護士與病患的認知及治療歷程變化而不斷地轉變。 互動前期 介紹期 工作期 結束期

Thriving in the new millennium (1/6) Firstly,- nurse-patient relationship as a therapeutic tool (護病關係) Society where globalization and technology are on the increase, the importance of human relationships is becoming more and more essential. 全球化和技術不斷增加的社會，人際關係的重要性正變得越來越必要。 Clinical staff needs to be informed by cultural awareness, knowledge and competence. 當臨床護理人員應需有文化意識，知識和能力。 Therefore psychiatric nurses should continue to value the nurse-patient relationship as a therapeutic tool. 因此精神科護士應該繼續重視護病關係作為一件治療的工具。

Thriving in the new millennium (2/6) Second, -Importance of clinical research in support of evidence based psychiatric nursing practice. 其次 - 實証(精神科)護理實務需建基於臨床的研究結果 (換言之: 研究的重要性)。 An essential part of nursing practice is a scientific investigative approach. 護理實務的一重要項部分,乃是以一種科學調查的方法來(逐一)進行。

Thriving in the new millennium (3/6) Thirdly, -Standardization of nursing classification system and language. 第三，-標準化護理分類系統和語言。 In the 21st century standardized nursing classification systems and language would serve as a basis for research, knowledge development and testing, as well as providing a common language for the profession and health care community. 在21世紀標準化護理分類系統及語言將作為研究、知識發展和知識測試的一個基礎，同時予以專業及健康照護團體的一種共通語言。 Peplau emphasizes research as an important tool in refining classification systems such as NANDA. 像NANDA那樣的分類系統是Peplau強調的研究及作為一個重要的工具

Thriving in the new millennium (4/6) Fourthly, -Therapeutic relationship – From hospital to community 第四， - 治療性關係 從醫院走入社區 Peplau recognizes the need to broaden the context of their practice to a variety of community based settings, especially ones that support the prevention of mental illness and psychiatric rehabilitation as an approach to treatment of serious neurobiological disorders. Peplau認為擴大護理實務的內涵至不同的環境當中 (以社區為基礎), 尤其是著重預防與復健精神疾病為(嚴重神經疾患)治療的手段, 是非常需要的.

Thriving in the new millennium (5/6) Fifth, -Peplau also urged psychiatric nurses to build up a solid foundation in psychiatrics. 第五，-Peplau極力鼓舞精神科護士需強化個人的精神醫學知識。 By means of educating the public concerning clinical practice and the difference, it make in people's lives. 透過教育民眾關心臨床實務與相互間的不同, 來改善 自我的生活 (品質)。

Thriving in the new millennium (6/6) She also challenges nurses to become more political savvy. Peplau 激發護士們要有更多的政治覺醒。 Active participation in political action in relation to health care can help ensure suitable allocation of resources benefit both patient needs and that may affect psychiatric-mental health care. (護士) 積極的參與政治行動, 尤其是有關健康照護的議題, 更加能確保資源適宜的分配. 藉此方式, 一方面能受益於病患的需要, 另一方面也實踐了(精神健康照護)專業對社會的責任

考題 Q1: Choice the correct answers/ Ref.(選擇正確的答案) 請選出何者為APA－5的1.Book 2.chaper in the book 3.Journal 4.website 1.Forchuk, C., & Reynolds, B. (1998). Guest editorial-Interpersonal theory in nursing practice: The Peplau legacy. Journal of Psychiatric and Mental Health Nursing, 5, 165-166 2.North American Nursing Diagnosis Association. (1999). Nursing diagnosis: Definitions and classification 1999-2000. Philadelphia: Author. 3.Peplau. H. E. (1989b). Theory: The professional dimension. In A. W. O’Toole and S. R. Welt (Eds.), Interpersonal theory in nursing practice: Selected works of Hildegard E. Peplau (pp. 21-30). New York: Springer Publishing. 4.Van Sell, S. W. (2002). Nursing: Receding and evolving paradigms. Online ICU and Nursing Web Journal , 10, 1-7. Retrieved October 23, 2003, from htpp://www.nursing.gr/selleditorial. pdf

Q2: Describe the different stages of interpersonal relationships (Nurse-patient relationships). (請描述護病關係的四個時期) Q3: The relationships between nursing practice, research, and theory. (實務、研究、理論三者之間的關係) Q4: Could the Peplau’s theory be used in varied settings (e.g., nurses/patients)? Explain briefly. (Peplau的護理理論只能用於精神病患嗎？ 請舉例) Q5: What is the meaning of the self-awareness among nurses (護理人員如何反思自己的護理專業能力增長)