Hildegard Peplaus Theory of Interpersonal Relations

Hildegard Peplaus Theory of Interpersonal Relations
Presented by Group 1: Pamela Beringer, Kimberly Hargrove, Sheila Lucas, Miranda Peterson Ferris State University
1931
Peplau graduated from Pottstown Hospital School of Nursing where she assisted in surgery She remained at Pottstown hospital where she was the operating room Supervisor She also headed the staff at Bennington College infirmary
Peplau, H. (2004). Peplau, Hildegard E. September 1, 1909-March 17, 1999. Notable American Women: Completing the Twentieth Century, Retrieved from http://0-www.credoreference.com.libcat.ferris.edu/entry/hupnawiii/peplau_hildegard_e_september_1_1909_march_17_1999
During World War II Peplau enlisted in the U.S. Army Nurse Corps During this time she was assigned to the School of Military Neuropsychiatry in England where she met the worlds top Psychiatrists At Bellevue Psychiatric Department of New York City Womens Disturbed Service, Peplau worked as a staff nurse for a short period of time.
Continued Education
At the age of thirty-three Peplau received her BA in Interpersonal Psychology in 1943 from Bennington College In 1947 at Teachers College of Columbia University in New York Peplau received an MA in teaching and supervision of psychiatric nursing.
1948-1953
Peplau was the first nurse educator to advocate baccalaureate education for nurses She received a Ed.D in curriculum development from Columbia in 1953
Peplau, H. (2004). Peplau, Hildegard E. September 1, 1909-March 17, 1999. Notable American Women: Completing the Twentieth Century, Retrieved from http://0www.credoreference.com.libcat.ferris.edu/entry/hupnawiii/peplau_hildegard_e_september_1_1909_march_17_1999
1954-1974
Peplau was an instructor and advanced to Head of the Department of Psychiatric Nursing and the Graduate Program in Psychiatric Nursing She developed first graduate program in clinical specialist in psychiatric nursing at Rutgers University
Writings
In 1948 Peplau finished her book Interpersonal Relations in Nursing but no one would publish it without a physician coauthor 1953 Peplaus book was finally published by G. Putnam and Sons without a co-author
Many Regard Dr. Peplau as the mother of psychiatric nursing.

Sills, G., Peplau, A., & Reppert, B., (1999). Hildegard Peplau 1909-1999. Hildegard Peplau Nursing Theorist Homepage, Retrieved October 16, 2009, from http://publish.uwo.ca/~cforchuk/peplau/obituary.html.
Peplau looked at both the patient and the nurse. Her theory is based on promoting health thru a partnership
Kearney-Nunnery, R. (2008). Advancing your career. Philadelphia, PA: F. A. Davis Company p.72
Interview with Hildegard Peplau
Hildegard. (Nov 2007). Retrieved on Oct 14, 2009 from http://www.youtube.com/watch?v=3ZvwNVVWyZ4
Peplaus traditional Metaparadigm theory
Person: Individual that lives in a unstable environment with physiological, psychological a fluidity Health: A word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, production, personal and community living
Forchuk, C. (1991). Peplau's Theory: Concepts and Their Relations. Nursing Science Quarterly, 4(2), 54-60
Peplaus traditional Metaparadigm theory (cont.)

Environment: Forces existing outside the organism and in the context of culture in which mores, customs and beliefs are acquired (p. 163)
Johnson, L. (2006). Providing a Framework for the Nurse-Patient Relationship: The Nursing Theory of Hildegard Peplau. A History of Nursing Ideas, Retrieved October 16, 2009, from http://books.google.com/books?id=pJnYFMQLa_MC&printsec=copyright&source=gbs_pub_info_s&cad=2#v=onepage&q=&f=fals e
Nursing:
Is an educative instrument, a maturing force, that aims to promote forward movement of the personality in the direction of creative, construction, productive, personal and community living.
Forchuk, C. (1991). Peplau's Theory: Concepts and Their Relations. Nursing Science Quarterly, 4(2), 54-60.
What does that all mean?
Lets find out
Person:
Which has been revised to Human being
This represents:
Patient
Family Member Group Community Receiving Care
Health:
Which is the primary goal of nursing
We have to look at what type of nursing does our patient need.
Physiological Demands
Interpersonal Needs (Personal and Social)
(Peplau, 1952, p. 6).
Environment:
This is viewed as being and occurring in the context of the NursePatient relationship
Mores: The nurse needs to accept the patients cultural group. Customs: What beliefs may affect the patients care
Nursing:
It is not just focusing on the sick it is a way to help people to stay well
Goal as Nurses: Promote forward movement in: Creative Constructive Productive Personal Community living of our patients
Peplau, 1952
Peplaus theory in the real world (or clinical setting)

Always remember the focus is on the nurse-patient relationship!
Lets get back to the basics first!
Theory is based upon four basic components:
1.) Nurse 2.) Patient 3.) Knowledge of the nurse 4.) Patients problem
Four distinct phases are distinguished:
1.) Orientation 2.) Working
A.) Identification B.) Exploitation
3.) Termination
Orientation
Phase is primarily one-way contact
Peplau, H. (1997). Peplau's Theory of Interpersonal Relations. Nursing Science Quarterly, 10(4), 162-167. Retrieved from http://nsq.sagepub.com/cgi/content/abstract/10/4/162
Orientation
1.) Nurse introduces self to the patient 2.) Nurse describes the purpose of the interaction as well as the time available 3.) Interview, health history and assessment occur 4.) Tone set for future interaction
Orientation
The nurses attention during this phase is focused on the patient.
Orientation
Focus of the nurse is:
Listening Hearing Asking descriptive questions to get the patients description and prompt them to talk
Factors influencing Orientation phase

Theory of Interpersonal Relations. (2009, March 16). Retrieved October 1, 2009, from http://currentnursing.com/nursing_theory/interpersonal_theory.htm
Working
As the name suggests, most work occurs during this phase.
Working
Nurses must always remember that discharge planning begins during the working phase of treatment.
Application of Interpersonal Theory in Nursing Practice. (2009, March 16). Retrieved October 12, 2009, from http://currentnursing.com/nursing_theory/application_Peplau%27s_interpersonal_theory.htm
Working
Phase consists of 2 Subphases:
Working
Identification
The
patient learns how to use the nursepatient relationship Patient participates in goal setting Nurse role is to encourage patient to explore feelings related to illness
Working
Exploitation
Nurse role is to project new goals which the patient can meet through personal effort.
Termination
Work accomplished is summarized Closure of the relationship is provided
Application of Interpersonal Theory in Nursing Practice . (2009, March 16). Retrieved October 12, 2009, from http://currentnursing.com/nursing_theory/application_Peplau%
27s_interpersonal_theory.htm Fotosearch. (2009). Retrieved October 11, 2009 from www.fotosearch.com
Overlapping phases
of the nurse-patient relationship
Peplaus theory and patient assessment

Communication is the key!
Effective communication causes the nurse to take on many different roles throughout the relationship
Stranger Role
Treat a patient with courtesy, the same as one would a stranger in any other situation Provide an accepting climate to build trust Do not prejudge the patient, accept them as they are.
http://www.geocities.com/nishatoor/nursingroles.html
Resource Role
Answer questions Interpret medical information Give information
Teaching Role
Peplau suggested two levels of teaching: Instructional giving direction and providing training Experiential using the experience of the learner as a basis from which learning products are derived.
Counseling Role
Provide guidance and encourage patient to make necessary changes Help client understand current situation and incorporate it into life
Surrogate Role
Nurse acts as an advocate for patient Also, assists patient to clarify dependence, interdependence, and independence.
Leadership Role
Assist the patient in meeting treatment goals Involves the democratic process
ADDITIONAL
ROLES
-Technical expert -Consultant -Health teacher -Tutor -Socializing agent -Safety agent -Manger of environment -Mediator -Administrator -Recorder observer -Researcher
Theory of Interpersonal Relations. (2009, March 16). Retrieved October 16, 2009, from http://currentnursing.com/nursing_theory/interpersonal_theory.htm
Now lets use what weve learned in an actual setting
Case Study:
25 year old female patient presents with complaints of severe abdominal pain with nausea and vomiting over the past several weeks. Patients last menstrual period was six weeks ago. She also has a history of drug and alcohol abuse.
Case Study Orientation phase
Nurse introduces herself, asks questions, and obtains a health history and assessment Nurse helps to identify problem (i.e. abdominal pain with nausea and vomiting) Both the patient and the nurse are in the stranger role at this time and must gain mutual trust
Case Study - Working phase

Identification Nurse and patient identify the problems to address: Abdominal pain Nausea/Vomiting Alcohol Abuse
Goals will be set:
Patient will have a decrease in abdominal pain and N/V Patient will enter counseling regarding ETOH abuse and attend support meetings Patient will begin seeing an OB/GYN due to positive pregnancy test
The nurse will act as a counselor and advocate throughout this phase
http://www.testandcalc.com/Richard/resources/Remembering%20Peplau%20-%20Vision%20-%20Lakeman.pdf
Exploitation
Education and resources provided regarding alcohol abuse during pregnancy Hospital resources used for abdominal pain diagnosis (including pregnancy test/labs, CT/xray, ultrasound)

The nurse will serve many roles throughout this phase including teacher, resource person, advocate, and mediator.
Case Study Termination Phase

Problems are resolved:
Patient is free of abdominal pain and N/V Patient continues follow up appointments with OB/GYN Patient has a plan to attend meetings and counseling to deal with ETOH abuse
Video of Peplaus Theory of Interpersonal Relations
Peplau Theory. (Aug 2009). Retrieved on Oct 14, 2009 from http://www.youtube.com/watch?v=EuW25fEjao&feature=related
There are 4 components to Peplaus Clinical Methodology
Observation
Communication
Recording
Data Analysis
(p. 72)
Kearney-Nunnery, R. (2008). Advancing your career. Philadelphia, PA: F. A.Davis Company.
Observation:
Has 4 elements to consider in how the nurse-patient relationship will develop.
Nurses behavior:
The patient observes the nurses actions:

Time spent with patient (Is it quality time?) Does she seem interested? Tone of voice Body language Sincerity Eye contact
How the nurse acts depends on the patients responsiveness.
Patients behavior:
The nurse observes the patients actions
Tone of voice Body language Facial expressions Comprehension of conversation Interest in conversation Eye contact
The method of response depends on the patients actions and the nurses understanding of the meaning.
Interpersonal Phenomena
Patient and nurse observe what is happening between them

Is there tension in relationship? Does nurse understand patients communication (verbal & nonverbal)? Is patient receptive to nurses communication? Is nurse receptive to patients need?
Observation of what goes on between the patient and the nurse (p. 72).
Communication
Interpersonal techniques
Verbal interventions Questioning to force a response Nurse takes bits and pieces of conversation over time and assists in patient understanding of problem and care
Principle of clarity
Principles of continuity
Recording
Charting of the communication Observations Outcomes for further evaluations Continuity of care
Kearney-Nunnery, R. (2008). Advancing your career. Philadelphia, PA: F. A.Davis Company. p. 73)
Data Analysis
Testing of the nurses hunches about the patient

Identify the phase communication occurred Identify the roles each took in the phase Identify the connection with other relations that may have had impact Identify what brings satisfaction/security with other relationships related to problem
Kearney-Nunnery, R. (2008). Advancing your career. Philadelphia, PA: F. A.Davis Company. p. 73)
Nursing Education
Nursing Process
Peplaus definition of Nursing Process

Nursing Process is a deliberate intellectual activity that guides the professional practice of nursing in providing care in an orderly, systematic manner.
Current Nursing (2009)
Nursing Process
Assessment
Nursing
Diagnosis Planning Implementation Evaluation
Assessment
~ Nurse and patient meet as strangers ~ Assessment is preformed together to gain information
Patient helps plan their own healthcare goals
Gives feelings of belonging and encourages independence
Mutually agreed upon goals are carried out
Final Stage
Evaluation
Resolution Phase
~ Occurs when other phases are completed successfully ~ Relationship between the nurse and patient is over
Current Research Status
Types of Research
Journals Process
(2009)
Courey (2008)
Recordings
Peterson
Independent
Research
Journals
Journal Examples
Journal
of the American Psychiatric Nurses Association Public Health Nursing British Journal of Nursing Journal of Psychiatric and Mental Health Nursing Journal of Advanced Nursing
Used to monitor effectiveness of such theories currently
Explain new research
Used in educational research
Process Recordings
What are process recordings?

Process
recordings are written reports of verbal and nonverbal interactions between people. Helps evaluate the situation Used as a tool for educational development Used as a tool to monitor effectiveness
Independent Research
Variable types of independent research Does Peplaus theory work in long term care?
Does Peplaus theory work in short tem care?

Does Peplaus theory only work on a psychiatric level? Does Peplaus theory work with every single person?
Downfalls of Research
Poor economy
Causing restricted, fragmented, minimal research efforts
Research has been inconsistent and scattered throughout different countries.

Most research has been qualitative, not qualitative.
Forchuk & Reynold (1998), Peterson (2009)
Needed Nursing Research

Quantitative and Qualitative research with positive healthcare outcomes Research that would verify this theorys contemporary value.
Jones, 1996
Unique to Peplaus theory

Peplau's theory encouraged nurses to work with patients, instead of working for them.
PEPLAU, Hildegard E.. September 1, 1909-March 17, 1999. (2004). In Notable American Women: Completing the Twentieth Century. Retrieved from http://0www.credoreference.com.libcat.ferris.edu/entry/hupnawiii/peplau_hildegard_e_september_1_1909_march_17_1999

Theory is based upon elements of psychology

Peplau is considered the founder of mental health/psychiatric nursing

First nursing theory to qualify nursing as a profession, not a mere skill

According to Peplau, The kind of person that the nurse becomes makes a substantial difference in what each patient will learn as he or she receives nursing care.
Masters, K. (2005). Role development in professional nursing practice (pp. 46-47). Sudbury, MA: Jones and Bartlett Publishers.

Peplaus book, Interpersonal Relations in Nursing, was initially not published because it was not co-authored by a medical doctor.
Unique to Peplaus Theory

Peplau believed fostering personality development toward maturity is a function of nursing and nursing education. Nursing uses principles and methods that guide the process toward resolution of interpersonal problems.
Masters, K. (2005). Role development in professional nursing practice (pp. 46-47). Sudbury, MA: Jones and Bartlett Publishers.
Strengths
Promotes a trusting relationship between the nurse and patient At the termination phase the theory promotes independence on the part of the client
Current Nursing. (2008). Nursing Theories: A companion to nursing theories and models: Theory of Interpersonal Relations. Retrieved on October 8, 2009 from http://currentnursing.com/nursing_theory/interpersonal_theory .htm
Limitations
Provides for a dependent relationship on the part of the client at the beginning of the interaction Requires that the patient has a trusting relationship with every nurse assigned
Current Nursing. (2008). Nursing Theories: A companion to nursing theories and models: Theory of Interpersonal Relations. Retrieved on October 8, 2009 from http://currentnursing.com/nursing_theory/interpersonal_th eory.htm
Limitations
Many factors can influence the relationship process, such as:

Current Nursing. (2008). Nursing Theories: A companion to nursing theories and models: Theory of Interpersonal Relations. Retrieved on October 8, 2009 from http://currentnursing.com/nursing_theory/interpersona l_theory.htm
Values Race Beliefs Past Experiences Expectations Preconceived Ideas
Analysis of overall model

Studies continue to show that interpersonal sensitivity, as stressed by Peplau, increase positive patient outcomes.
http://www.nnvawi.org/pdfs/alo/Draucker_Hildegard_Pelplau.pdf, McNaughton, D. (2005). A Naturalistic Test of Peplaus's Theory in Home Visiting. Public Health Nursing, 22(5), 429-438. doi:10.1111/j.0737-1209.2005.220508.x, Thelander, B. L. (1997). The psychotherapy of Hildegard Peplau in the treatment of people with serious mental illness. Perspectives in Psychiatric Care, 33. Retrieved October 1, 2009, from http://www.questia.com/googleScholar.qst?docId=5000508687
Illustration of Peplaus theory in practice

Douglass, J. L., Sowell, R. L., & Phillips, K. D. (2003). Using Peplau's theory to examine the psychosocial factors associated with HIVinfected women's difficulty in taking their medications. Journal of Theory onstructionandTesting, 7(1), 10.
Analysis of model
Nursing is a significant, therapeutic, interpersonal process. It functions co-operatively with other human processes that make health possible for other individuals in communities. In specific situations in which a health team offers health services, nurses participate in the organization of conditions that facilitate natural ongoing tendencies in human organisms. Nursing is a educative instrument maturing force, that aims to promote forward movement of personality in the direction of creative, constructive, productive, personal and community living.
(Peplau, H.E. (1991). Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. New York, N.Y.: Springer Publishing Retrieved on Oct 15, 2009 from http://books.google.com/books?id=ck8-E6FL1UC&printsec=frontcover&dq=interpersonal+relations+in+nursing&lr=#v=onepage&q=&f=false p. 16)
References
Advanced Downtown Aquatic Physical Therapy. (2008). Retrieved October 11, 2009, from http://www.adaptpt.com/ Application of Interpersonal Theory in Nursing Practice. (2009, March 16). Retrieved October 12, 2009, from http://currentnursing.com/nursing_theory/application_Peplau%27s_inte rpersonal_theory.htm Courey, T.L., Martsolf, D.S., Draucker, C.B., Strickland, K.B. (2008). Hildegard Peplaus Theory and the Health Care Encounters of Survivors of Sexual Violence. Journal of the American Psychiatric Nurses Association. 14(2) 137-143 Retrieved on Oct 13, 2009 from http://www.nnvawi.org/pdfs/alo/Draucker_Hildegard_Pelplau.pdf Current Nursing. (2008). Nursing Theories: A companion to nursing theories and models: Theory of Interpersonal Relations. Retrieved on October 8, 2009 from http://currentnursing.com/nursing_theory/interpersonal_theory.htm Dhillon, H., Toor, N. (2000). Nursing Roles. Retrieved on Oct 8, 2009 from http://www.geocities.com/nishatoor/nursingroles.html
References (cont.)
Douglass, J. L., Sowell, R. L., & Phillips, K. D. (2003). Using Peplau's theory to examine the psychosocial factors associated with HIV-infected women's difficulty in taking their medications. Journal of Theory onstructionandTesting, 7(1), 10. Fotosearch. (2009). Retrieved October 11, 2009 from www.fotosearch.com Forchuk, C., (2007). Hildegard Peplau Nursing Theorist Homepage. Retrieved on Oct 15, 2009 from http://publish.uwo.ca/~cforchuk/peplau/hpcb.html Forchuk, C., & Reynolds, B. (1998). Guest editorial interpersonal theory in nursing practice: the Peplau legacy. Journal of Psychiatrick and Mental Health Nursing. 39(5). 193-196. Hildegard. (Nov 2007). Retrieved on Oct 14, 2009 from http://www.youtube.com/watch?v=3ZvwNVVWyZ4 Jones, A. (1996). Education and debate. The value of Peplaus theory for mental health nursing. British Journal of Nursing. 5(14). 877-881. John Hopkins University. (2009). Research Activities. Retrieved October 11,2009 from www.son.jhml.edu/research Johnson, L. (2006). Providing a Framework for the Nurse-Patient Relationship: The Nursing Theory of Hildegard Peplau. A History of Nursing Ideas, Retrieved October 16, 2009, from http://books.google.com/books?id=pJnYFMQLa_MC&printsec=copyright&source=gbs _pub_info_s&cad=2#v=onepage&q=&f=false Kearney- Nunnery, R. (2008). Advancing Your Career: Concepts of Professional Nursing (4th ed.). Philadelphia: F.A. Davis Company.
References (cont.)
Lakeman, R. Remembering Hildegard Peplau. Retrieved on Oct 8, 2009 from http://www.testandcalc.com/Richard/resources/Remembering%20Pepl au%20-%20Vision%20-%20Lakeman.pdf Marriner-Tomey, A., Raile-Alligood, M. (2006). Nursing Theorists and Their Work (6th ed.). St. Louis, MO.: Mosby Elsevier. Masters, K. (2005). Role development in professional nursing practice (pp. 46-47). Sudbury, MA: Jones and Bartlett Publishers. McCarthy, C.T., Aquino-Russell, C. (2009). A Comparison of Two Nursing Theories in Practice: Peplau and Parse. Nursing Science Quarterly. 22; 34. Retrieved on October 6, 2009 from http://0nsq.sagepub.com.libcat.ferris.edu/cgi/reprint/22/1/34 McNaughton, D. (2005). A Naturalistic Test of Peplau's Theory in Home Visiting. Public Health Nursing, 22(5), 429-438. Retireved on Oct 13, 2009 from doi:10.1111/j.0737-1209.2005.220508.x Peplau, H.E. (1991). Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing. New York, N.Y.: Springer Publishing Retrieved on Oct 15, 2009 from http://books.google.com/books?id=ck8-E6FL1UC&printsec=frontcover&dq=interpersonal+relations+in+nursing&lr= #v=onepage&q=&f=false Peplau, H. (1997). Peplau's Theory of Interpersonal Relations. Nursing Science Quarterly, 10(4), 162-167. Retrieved Oct 11, 2009 from http://nsq.sagepub.com/cgi/content/abstract/10/4/162
References (cont.)
Peplau, Hildegard E., Sept 1, 1909- March 17, 1999. (2004). Notable American Women: Completing the Twentieth Century. Retrieved Oct 11, 2009 from http://0www.credoreference.com.libcat.ferros.edu/entry/hupnawiii/peplau_hild egard_e_september_1_1909_march_17_1999 Peplau Theory. (Aug 2009). Retrieved on Oct 14, 2009 from http://www.youtube.com/watch?v=EuW25fEj- ao&feature=related Peterson, S.J. & Bredow, T.(2009). Middle Range theories: Applications to nursing research (2nd edition). Philadelphia, PA: Lippincott Williams & Wilkins. Polifko, K. (2007). Chapter 6: Theoretical Basis for the Practice of Nursing. Concepts of the Nursing Profession. Thompson. Retrieved on Oct 8, 2009 from http://www.delmarlearning.com/companions/content/14018088 67/ppt/ C_h06.ppt Thelander, B. L. (1997). The psychotherapy of Hildegard Peplau in the treatment of people with serious mental illness. Perspectives in Psychiatric Care, 33. Retrieved October 1, 2009, from http://www.questia.com/googleScholar.qst?docId=5000508687

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Hildegard Peplaus Theory of Interpersonal Relations

Many Regard Dr. Peplau as the mother of psychiatric nursing.

Interview with Hildegard Peplau

Hildegard. (Nov 2007). Retrieved on Oct 14, 2009 from http://www.youtube.com/watch?v=3ZvwNVVWyZ4

Peplaus traditional Metaparadigm theory

Peplaus traditional Metaparadigm theory (cont.)

What does that all mean?

Lets find out

Which has been revised to Human being

Which is the primary goal of nursing

We have to look at what type of nursing does our patient need.

Interpersonal Needs (Personal and Social)

(Peplau, 1952, p. 6).

Peplaus theory in the real world (or clinical setting)

Lets get back to the basics first!

Theory is based upon four basic components:

Four distinct phases are distinguished:

1.) Orientation 2.) Working

A.) Identification B.) Exploitation

The nurses attention during this phase is focused on the patient.

Factors influencing Orientation phase

Phase consists of 2 Subphases:

Work accomplished is summarized Closure of the relationship is provided

27s_interpersonal_theory.htm Fotosearch. (2009). Retrieved October 11, 2009 from www.fotosearch.com

Peplaus theory and patient assessment

Answer questions Interpret medical information Give information

Now lets use what weve learned in an actual setting

Case Study Orientation phase

Case Study - Working phase

Case Study - Working phase

Goals will be set:

Case Study - Working phase

Case Study - Working phase

Case Study - Working phase

Case Study Termination Phase

Video of Peplaus Theory of Interpersonal Relations

There are 4 components to Peplaus Clinical Methodology

Kearney-Nunnery, R. (2008). Advancing your career. Philadelphia, PA: F. A.Davis Company.

The patient observes the nurses actions:

How the nurse acts depends on the patients responsiveness.

Kearney-Nunnery, R. (2008). Advancing your career. Philadelphia, PA: F. A.Davis Company.

Patient and nurse observe what is happening between them

Testing of the nurses hunches about the patient

Peplaus definition of Nursing Process

Current Nursing (2009)

Diagnosis Planning Implementation Evaluation

Patient helps plan their own healthcare goals

Gives feelings of belonging and encourages independence

Mutually agreed upon goals are carried out

Current Research Status

Used to monitor effectiveness of such theories currently

Explain new research

Used in educational research

What are process recordings?

Does Peplaus theory work in short tem care?

Research has been inconsistent and scattered throughout different countries.

Forchuk & Reynold (1998), Peterson (2009)

Needed Nursing Research

Unique to Peplaus theory

Unique to Peplaus theory

Unique to Peplaus theory

Unique to Peplaus theory

Unique to Peplaus theory