INTERVENTIONS
The last step of the process leads to the develop-
ment of interventions. Peplau viewed nursing
interventions as those that “assisted patients in
gaining interpersonal and intellectual competencies
evolved through the nurse-patient relationship”
(O’Toole & Welt, 1989, p. 351). Useful interventions
are derived and tested (Peplau, 1989c).
Peplau used this process to study clinical phe-
nomena. Both she and her students collected
verbatim recordings of interactions with patients.
These recordings were examined for regularities.
Similar-looking data were then transcribed onto
3-by-5-inch index cards, which were then sorted,
classified, and counted. As early as 1948, Peplau’s
students at Teachers College (Columbia University)
were asked to make carbon copies of their interac-
tions with patients. Peplau studied these and no-
ticed that the students could not talk in a friendly
way until the patients had said “I need you” or “I
like you.” Her analysis of similar nurse-patient in-
teractions led to her theory of anxiety and subse-
quently to nursing interventions to decrease
anxiety (O’Toole & Welt, 1989).
PART TWO
Applications
Peplau’s work has had remarkable influence on
nursing practice and education as we know it today
and on development of later nursing theories.
One of her major contributions to nursing was
reinforcing nurses’ awareness of the knowledge-
rich content of practice. The next part of this
chapter reviews in depth Peplau’s practice-based
process as applied to a set of four related research
studies. It then discusses future applications of
Peplau’s work.
RESEARCH
Peplau’s process of practice-based theory develop-
ment has directed a program of research in the area
of depression in women (Peden, 1998). Beginning
with the identification of a clinical phenomenon—
women recovering from depression—and culmi-
nating in the testing of an intervention to reduce
Beginning with the identification of a clini-
cal phenomenon—women recovering from
depression—and culminating in the testing
of an intervention to reduce negative
thinking in depressed women, Peplau’s
process of practice-based theory develop-
ment has provided direction and structure
for four studies.negative thinking in depressed women, Peplau’s
process of practice-based theory development has
provided direction and structure for four studies.
The treatment of depression had been studied
extensively. Nevertheless, a thorough description of
the recovery process of women with depression was
not reflected in the literature. The identification of
a clinical phenomenon and a review of available in-
formation related to that phenomenon were the
first steps in Peplau’s process.
In the second step, researchers conducted a
descriptive, exploratory study (Peden, 1993). Seven
women who were recovering from depression
were interviewed, and a process of recovering was
described. Peplau assisted in the design of the
semistructured interview guide (personal commu-
nication, December 14, 1990). Verbatim transcripts
of the audiotaped interviews were analyzed. The
process of recovering was initiated by a crisis or
“turning point” experience. It continued with pro-
fessional support and the support of friends and
family. Recovering, according to the participants,
required determination, work over time, and a
series of successes that enhanced self-esteem and
maintained balance. The process was dynamic, oc-
curring in a nonserial order, with back-and-forth
movement among the categories and phases. It was
internal and ongoing. This study raised many ques-
tions and provided further direction for study.
While participating in the interviews, the women
shared strategies or techniques that facilitated re-
covering (Peden, 1994). These included cognitive
skills, positive self-talk, and use of affirmations.
They also identified negative thinking as the most
difficult symptom to overcome.
Follow-up Study
Continuing in step two of the process, a follow-up
study (Peden, 1996) was conducted a year later to
further describe the recovery process of women
who had been depressed. No new phases of the re-62 SECTION II Evolution of Nursing Theory: Essential Influences