Introducing the Theorist
Hildegard Peplau was an outstanding leader and
pioneer in psychiatric nursing whose career
spanned seven decades. A review of the events in
her life also serves as an introduction to the history
of modern psychiatric nursing. With the publica-
tion ofInterpersonal Relations in Nursingin 1952,
Peplau provided a framework for the practice of
psychiatric nursing that would result in a paradigm
shift in this field of nursing. Prior to this, patients
were viewed as objects to be observed. Peplau
taught that patients were not objects but were sub-
jects and that psychiatric nurses must participate
with the patients, engaging in the nurse-patient re-
lationship. This was a revolutionary idea. Although
Interpersonal Relations in Nursingwas not well re-
ceived when it was first published in 1952, it has
since been reprinted (1988) and translated into at
least six languages.
Hildegard Peplau entered nursing for practical
reasons, seeing it as a way to leave home and have
an occupation. As she adapted to nursing school,
she made the conscious decision that if she was
going to be a nurse, then she would be a good one
(Peplau, 1998).
Peplau served as the college head nurse and later
as executive officer of the Health Service at
Bennington College, Vermont. While working there
as a nurse, she began taking courses that would lead
to a bachelor of arts degree in interpersonal psy-
chology. Dr. Eric Fromm was one of her teachers at
Bennington. An experience while working in the
Health Service served to pique Peplau’s interest in
psychiatric nursing. A young student with symp-
toms of schizophrenia came to the clinic seeking
help. Peplau did not know what to do for her. The
student left Bennington to receive treatment and
returned to complete her education later. The suc-
cessful recovery of this young woman was a positive
experience for Peplau.
Upon graduation from Bennington, Peplau
joined the Army Nurse Corps. She was assigned to
the School of Military Neuropsychiatry in England.
This experience introduced her to the psychiatric
problems of soldiers at war and allowed her to work
with many great psychiatrists. After the war, Peplau
attended Columbia University on the GI Bill and
earned her master’s in psychiatric-mental health
nursing.
After her graduation in 1948, Peplau was invited
to remain at Columbia and teach in their master’s
program. She immediately searched the library for
books to use with students, but she found very few.
At that time, the psychiatric nurse was viewed as a
companion to patients, someone who would play
games and take walks but talk about nothing sub-
stantial. In fact, nurses were instructed not to talk
to patients about their problems, thoughts, or feel-
ings. Peplau began teaching at Columbia, knowing
that she wanted to change the education and prac-
tice of psychiatric nursing. There was no direction
for what to include in graduate nursing programs.
She took educational experiences from psychiatry
and psychology and adapted them to nursing edu-
cation. Peplau described this as a time of “innova-
tion or nothing.”
Her goal was to prepare nurse psychotherapists,
referring to this training as “talking to patients”
(Peplau, 1960, 1962). She arranged clinical experi-
ences for her students at Brooklyn State Hospital,
the only hospital in the New York City area that
would take them. At the hospital, students were as-
signed to back wards, working with the most
chronic and severely ill patients. Each student met
twice weekly with the same patient, for a session
lasting one hour. According to Peplau, the nurses
resisted this practice tremendously and thought
this was an awful thing to do (Peplau, 1998). Using
carbon paper, verbatim notes were taken during the
session. Students then met individually with Peplau
to go over the interaction in detail. Through this
process, both Peplau and her students began to
learn what was helpful and what was harmful in the
interaction.
In 1955, Peplau left Columbia to teach at
Rutgers, where she began the Clinical Nurse
Specialist program in psychiatric–mental health
nursing. The students were prepared as nurse psy-
chotherapists, developing expertise in individual,
group, and family therapies. Peplau required of her
students “unflinching self-scrutiny,” examining
their own verbal and nonverbal communication
and its effects on the nurse-patient relationship.
Students were encouraged to ask, “What message
am I sending?”
In 1956, Peplau began spending her summers
touring the country, offering week-long clinical
workshops in state hospitals. This activity was
instrumental in teaching interpersonal theoryCHAPTER 6 Hildegard E. Peplau’s Process of Practice-based Theory Development and Its Applications 59