64 SECTION II Evolution of Nursing Theory: Essential Influences
participants in the experimental group indicated
that the intervention was beneficial. There were
more significant decreases from pretest to post-test
in the experimental group in negative thoughts and
depressive symptoms and an increase in self-esteem
than in the control group. Although the sample size
was small, the intervention had a significant posi-
tive effect on depression.
Testing the Intervention with
At-Risk Women
Upon recommendation of Peplau (personal com-
munication, January 16, 1993), the intervention
was tested on at-risk college women to determine
if it had preventive effects (Peden, Hall, Rayens,
& Beebe, 2000a, 2000b). A randomized controlled
prevention trial was conducted to test the efficacy
of a cognitive-behavioral group intervention in re-
ducing negative thinking and depressive symptoms
and enhancing self-esteem in a sample of 92
college women ages 18 to 24. Depression risk
status was determined by scores on the Center for
Epidemiologic Studies—Depression Scale (CES-D)
(Radloff, 1977) and the BDI (Beck et al., 1961).
As they were enrolled, the participants were
randomly assigned to either the control or experi-
mental groups. Those participants assigned to
the experimental group participated in the six-
week cognitive-behavioral group intervention.
Data on self-esteem, depressive symptoms, and
negative thinking were collected from both groups
at one month, at six months, and at eighteen
months after the intervention to assess the inter-
ventions’ long-term effects (Peden, Hall, Rayens, &
Beebe, 2001).
The intervention did have a positive effect on
depressive symptoms, negative thinking, and self-
esteem in a group of at-risk college women.
Reducing negative thinking in at-risk individuals
may decrease the risk for depression. The interven-
tion has also been tested with low-income single
mothers who were identified as being at-risk for de-
pression (Peden, Hall, Rayens, & Grant, in press).
Plans are underway to continue to test the inter-
vention with other at-risk groups to continue to
gather further support for its preventive effects.
THE FUTURE
Study of Peplau’s work is very timely. In 1969 she
proposed using practice as the basis for theory de-
velopment. At that time it was a radical idea. Now
the trend is to return to practice for knowledge de-
velopment. Peplau used clinical situations to derive
theories inductively and then tested them in clini-
cal practice. She also applied existing social science
theories to nursing phenomena, combining induc-
tion (observation and classification) with deduc-
tion (the application of known concepts and
processes to data). This provided a creative, nonlin-
ear approach to the formation of ideas.
She also proposed the linkage of qualitative and
quantitative methods. Using her methodology, the
nurse would begin with an in-depth look at a phe-
nomenon, which would evolve into a quantitative
study testing an intervention directed at the phe-
nomenon. These ideas, proposed during the posi-
tivist period of nursing, were highly revolutionary.
It is unlikely that Peplau’s contemporaries would
have embraced her process of practice-based theory
development. In fact, the debates related to knowl-
edge development in nursing and the accompany-
ing quantitative/qualitative rift did not occur until
the 1980s. However, as nursing has come to recog-
nize practice knowledge as one of the ways of
knowing, researchers may return to Peplau’s ideas
offered at the first Nursing Theory Conference
(Peplau, 1969) for direction.Peplau’s process of practice-based theory de-
velopment came at a time in nursing when
grand theories were being developed and
theoretical nursing was highly valued. These
theories are now being criticized as too broad
and too remote from nursing to be applied.
Now, nurses are returning to practice for
knowledge development. Peplau, always ahead
of her time, provided an “approach to knowl-
edge development through the scholarship of
practice; nursing knowledge is developed in
practice as well as for practice” (Reed, 1996, p.
29). Peplau used observations in clinical situa-
tions as the basis for hypotheses and interven-
tions that were then tested in clinical practice.
She also applied existing theories from the so-
cial sciences to nursing phenomena:
The process of combining induction (observa-
tion and classification) with deduction (the ap-
plication of known concepts and processes to