Theorists Enrich Nursing Profession

Hildegard Peplau and Florence Nightingale Considered Pioneers

Nov 7, 2009 Christine Musser

Florence Nightingale believed a patient's environment improved their health, while Peplau's theory taught that the relationship between nurse and patient is important.

Both theorists Florence Nightingale and Hildegard Peplau realized that there is more to a nursing career than making sure the patient receives the proper medication and following the doctors’ orders. The patient’s surroundings, attitude, and trust level contributes to the improvement of their health.

Differences in Nursing Theories

Although Peplau agreed with Nightingale’s theory, she felt it needed to go a step further by developing an interpersonal relationship between nurse and patient. The following explains their theories:

Florence Nightingale: "Environmental Theory" defines nursing as “the act of utilizing the environment of the patient to assist him in his recovery.” This theory focuses on changing the environment in order to improve the patient’s surroundings in order for his health to improve, e.g., cleanliness, germfree, well-ventilated, clean water, fresh air, sunlight.
Hildegard Peplau: "Interpersonal Relations Theory" defines nursing as “an interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help.” Peplau identifies four phases of the nurse-patient relationship: 1) Orientation, 2) Identification, 3) Exploitation, 4) Resolution.

Centuries apart and living with the same prejudices, Florence Nightingale and Hildegard Peplau persevered and are now considered pioneers of the nursing profession. Hildegard and Florence published works on how to improve the nursing profession and how to further the nursing career.

Notes on Nursing: What it is and What it is not was published by Florence Nightingale in 1859.
Interpersonal relations in nursing was published by Hildegard Peplau in 1952.

Changing the Role of Nurses

In England during the middle of the 19th century, nursing was considered an occupation of the lower class and therefore Florence’s father forbade her to become a nurse.

Florence’s friend, Elizabeth Blackwell, the first qualified female doctor in the United States, encouraged Nightingale to persevere and in 1851, her father finally approved of his daughter’s career choice.

From money raised by her publications and supported by wealthy friends, Nightingale raised £59,000, which she used to open the Nightingale School and Home for Nurses at St. Thomas’s Hospital. Nightingale also taught nurses in workhouses established after the signing of the 1834 Poor Law Act.

During the Crimean War in 1854, Britain’s Secretary of State, Sidney Herbert, recruited Nightingale and 38 nurses to go to Scutari and work in the British military hospital.

Appalled by the condition of the hospital, Florence took action to improve the wounded soldiers’ environment. She sanitized the areas and opened windows to allow sunlight and fresh air into the hospital. She soon became popular amongst the British soldiers.

In the evening, Nightingale visited the wounded soldiers to make sure they were okay. The result of her night visits brought her the name “Lady with the Lamp.”

By World War II , the Nightingale nursing schools were no longer in operation, they were now run by hospitals where physicians saw nurses “as source of free and inexpensive labor.” Women were no longer encouraged to seek out nursing as a professional career.

Florence Nightingale Founder of Modern Day Nursing

After Florence left Scutari, she returned to England. She was still appalled by the conditions of the military hospital she served in while in Scutari. She immediately began a campaign to improve the quality of nursing in military hospitals. She met with Queen Victoria and Prince Albert to discuss the unsanitary conditions of the hospitals. She later presented a report to the Sanitary Commission, which led to the opening of the Army Military College.

Nightingale fought to improve the role of the nurses to the point where she voiced her opinion that it was better to have well trained nurses than women doctors.

Florence suffered from poor health most of her life and in 1895, she went blind. The woman honored as the “founder of modern nursing” died in London in 1910. She was 90 years old.

Hildegard Peplau Encourages Nurses to Further Education

Hildegard Peplau was strong willed and determined to succeed as a nurse and improve the nursing profession while doing so. She attended nursing school and earned her BA in Psychology in 1943 at which time she joined the Army Nurse Corps and worked in London at a neuropsychiatric hospital.

Peplau was not only an advocate for the mentally ill, but she also fought to get respect for the nursing profession. She encouraged nurses to further their education and she led by example.

Cindy Swartz, a Clinical Nurse Specialist at Holy Spirit Hospital, shares how Peplau inspired her:

My inspiration from Hildegard Peplau centers around her passion for being an advocate on the behalf of nurses by advancing their status as professionals. Her tireless efforts to further her career via education has inspired me to move beyond my infancy of nursing as a Licensed Practical Nurse to earn a Bachelor’s degree and Advanced Practice Nursing Master’s Degree.

In addition, her theory of human relation principles speaks to the core of how I try daily to base my nursing practice. We must remember her thoughts that to be successful the patient and the nurse must work as a team to increase self awareness, level of maturity and knowledge. She explains “ as nurses become self-aware of their own behaviors and patterns, they can connect with patients in a more therapeutic way and foster the concept of nursing as a healing art.”

During my nursing practice I have strived to utilize the science of nursing and the concept of nursing as a healing art to provide a therapeutic environment where the patients and families can optimize the medical outcomes within the health care arena. But not forgetting the basic of human relationships and the art of healing.

This statement by a Clinical Nurse Specialist is a prime example of Peplau's theory in regards to interpersonal relationships and why it is important for nurses to further their education.

Sources:

Bostridge, Mark. Florence Nightingale: The Making of an Icon. Farrar, Straus, and Giroux, 2008.

Marrinner-Tomey, A. (1994). Nursing Theorists and their Work. St. Louis, Missouri: Mosby.

Callaway PhD, Barbara J. Hildegard Peplau: Psychiatric Nurse of the Century. NYC: Springer Publishing Company; 1 edition (June 18, 2002).

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