Nursing Theorists of Historical Significance

Marie. E Pokorny

“The idea of nursing, historically rooted in the care of the sick and in the provision of nurturance for those vulnerable to ill health, is foundational to the profession” (Wolf, 2006, p. 301).

HILDEGARD E. PEPLAU

Theory of Interpersonal Relations

Hildegard E. Peplau has been described as the mother of psychiatric nursing because her theoretical and clinical work led to the development of the distinct specialty field of psychiatric nursing. Her scope of influence in nursing includes her contributions as a psychiatric nursing expert, educator, author, and nursing leader and theorist.

Peplau provided major leadership in the professionalization of nursing. She served as Executive Director and later as President of the American Nurses Association. She promoted professional standards and regulation through credentialing. She taught the first classes for graduate psychiatric nursing students at Teachers College, Columbia University, where she stressed the importance of nurses’ ability to understand their own behavior so they can help others identify perceived difficulties. Her seminal book, Interpersonal Relations in Nursing (1952), described the importance of the nurse-patient relationship as a “significant, therapeutic interpersonal process” (p. 16) and is considered by many to be the first nursing theory textbook since Nightingale’s work in the 1850s. She identified four phases of the nurse-patient relationship: orientation, identification, exploitation, and resolution (Figure 5-1).

Figure 5-1 Overlapping Phases in Nurse-Patient Relationships. (From Peplau, H. E. [1952]. *Interpersonal relations in nursing*. New York: G. P. Putnam’s Sons.) G. P. Putnam’s Sons

Peplau diagrammed changing aspects of nurse-patient relationships (Figure 5-2) and proposed and described the following six nursing roles: stranger, resource person, teacher, leader, surrogate, and counselor (Figure 5-3). In addition, she discussed four psychobiological experiences that compel destructive or constructive responses, as follows: needs, frustrations, conflicts, and anxieties.

Figure 5-2 Continuum Showing Changing Aspects of Nurse-Patient Relationships. (From Peplau, H. E. [1952]. *Interpersonal relations in nursing*. New York: G. P. Putnam’s Sons.) G. P. Putnam’s Sons

Peplau’s experiences with professionals from psychiatry, medicine, education, and sociology influenced her view of what a profession is and does and what it should be (Sills, 1998). Her work was influenced by Freud, Maslow, and Sullivan’s interpersonal relationship theories, and by the contemporaneous psychoanalytical model. She borrowed the psychological model to synthesize her Theory of Interpersonal Relations (Haber, 2000). Peplau’s work is specific to the nurse-patient relationship and is categorized as a theory for the practice of nursing.

VIRGINIA HENDERSON

Definition of Nursing

Virginia Henderson viewed the patient as an individual who requires help toward achieving independence and completeness or wholeness of mind and body. She envisioned the practice of nursing as independent from the practice of physicians and acknowledged her interpretation of the nurse’s function as a synthesis of many influences. Her work is based on (1) that of Thorndike, an American psychologist, (2) her student experiences with the Henry House Visiting Nurse Agency, (3) her experience in rehabilitation nursing, and (4) Orlando’s conceptualization of deliberate nursing action (Henderson, 1964; Orlando, 1961).

Henderson emphasized the art of nursing and identified 14 proposed basic human needs on which nursing care is based. Her contributions include defining nursing, delineating autonomous nursing functions, stressing goals of interdependence for the patient, and creating self-help concepts. Her self-help concepts influenced the works of Abdellah and Adam (Abdellah, Beland, Martin, & Matheney, 1960; Adam, 1980, 1991).

Henderson made extraordinary contributions to nursing during her 60 years of service as a nurse, teacher, author, and researcher, and she published extensively throughout those years. Henderson wrote three books that have become nursing classics: Textbook of the Principles and Practice of Nursing (1955), Basic Principles of Nursing Care (1960), and The Nature of Nursing (1966). Her major contribution to nursing research, an 11-year Yale-sponsored Nursing Studies Index Project, resulted in a four-volume annotated index to nursing’s biographical, analytical, and historical literature from 1900 to 1959.

In 1958, the nursing service committee of the International Council of Nurses (ICN) asked her to describe her concept of nursing. This now historical definition, published by ICN in 1961, represented her final crystallization on the subject:

The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will, or knowledge; and to do this in such a way as to help him gain independence as rapidly as possible (Henderson, 1964, p. 63).

Henderson’s definition of nursing was adopted subsequently by ICN and disseminated widely; it continues to be used worldwide.

In The Nature of Nursing: A Definition and Its Implications for Practice, Research, and Education, Henderson (1966) identified 14 basic needs upon which nursing care is based (Box 5-1). In addition, she identified three levels of nurse-patient relationships in which the nurse acts as the following: (1) a substitute for the patient, (2) a helper to the patient, and (3) a partner with the patient.

Box 5-1 Henderson’s 14 Needs

1. Breathe normally.

2. Eat and drink adequately.

3. Eliminate body wastes.

4. Move and maintain desirable postures.

5. Sleep and rest.

6. Select suitable clothes; dress and undress.

7. Maintain body temperature within a normal range by adjusting clothing and modifying the environment.

8. Keep the body clean and well groomed and protect the integument.

9. Avoid dangers in the environment and avoid injuring others.

10. Communicate with others in expressing emotions, needs, fears, or opinions.

11. Worship according to one’s faith.

12. Work in such a way that there is a sense of accomplishment.

13. Play or participate in various forms of recreation.

14. Learn, discover, or satisfy the curiosity that leads to normal development and health, and use the available health facilities.

From Henderson, V. A. (1991). The nature of nursing: Reflections after 25 years (pp. 22-23). New York: National League for Nursing Press. National League for Nursing Press

The nurse through the interpersonal process must in a sense get “inside the skin” of each of her patients in order to know what help is needed (Harmer and Henderson, 1955, p. 5). Although she believed that the functions of nurses and physicians overlap, Henderson asserted that the nurse works in interdependence with other health professionals and with the patient; she used wedges of a pie graph to illustrate the relative contributions of members of the healthcare team. In The Nature of Nursing: Reflections after 25 Years, Henderson (1991) added addenda to each chapter of the 1966 edition to present changes in her views and to discuss her opinions. Henderson’s work may be viewed as a philosophy of the purpose and function of nursing.