Chapter 9 Nursing Theory: The Basis for Professional
Nursing
Theories of Nursing: From Grand to Middle Range
Introduction:
Theories classified according to their breadth & depth
o Less abstract than models & usually propose specific outcomes
Grand theory broad conceptualization of nursing phenomena
Middle-range theory narrower in focus & makes connections between grand theories &
nursing practice
Peplau’s Theory of Interpersonal Relations in Nursing:
Peplau born 1909
o One of earliest nurse theorists who recognized importance of work of nursing rather
than continuing to define & delineate nursing
o 1931 received basic nursing training at Pottstown, Pennsylvania, Hospital School
of Nursing
o Earned:
BA in interpersonal psychology at Bennington College in Vermont
Master’s of Arts degree in teaching & supervision of psychiatric nursing
EdD from Teachers College, Columbia University, in New York City
o Although Peplau’s 1st book was published in 1952 it was published again in 1988
Book called Interpersonal Relations in Nursing
This reflected both the value of her work & nursing’s continuing focus on
interpersonal relationships
Peplau drew from developmental, interactionist, & human needs theories in
developing her work which grew from her interest in nursing care for psychiatric
patients
o HOWEVER Peplau believed that ALL nursing is based on interpersonal process &
nurse-patient relationship
Peplau’s theory = based on premise that relationship between patient & nurse is
focus of attention rather than the patient only as unit of attention
o Nursing care occurs within context of patient-nurse relationship
o Goals of therapeutic interpersonal relationship = twofold:
(1) Survival of patient
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, (2) Patient’s understanding of his/her health problems & learning from these
problems as he/she develops new behavior patterns
o As nurse assists patient in developing new behavior patterns nurse also grows &
develops greater understanding of effects of universal stressors on lives & behaviors
of individual patients
Using Peplau’s Theory in Practice:
Although Peplau’s theory grew from her experience as a psychiatric nurse her work is
applicable to wide variety of practice settings
o Peplau describes 4-pronged process similar to nursing process by which nurse
assists patient in achieving personal growth
o Completion of this process involves 6 roles by nurse:
(1) Counselor
(2) Resource
(3) Teacher
(4) Technical expert
(5) Surrogate
(6) Leader
o Depending on the setting nurse will spend more of less time in each of these roles
For instance:
Nurse in critical care unit will likely spend more time as technical
expert & less time as a counselor
Whereas nurse on a postpartum unit may act as surrogate, guiding
new mother into independent care of her newborn infant, with less
time spent as leader
Peplau’s theory is complex
o Its importance lies in focus on what happens between nurse & patient in therapeutic
relationship
o Furthermore Peplau was visionary in recognizing importance of relationship
between nurse & patient publishing her ideas early & continuing to refine &
expand her work over several decades
Orlando’s Nursing Process Theory:
Ida Orlando born in New York in 1926
o Received her basic nursing education at a diploma program like many early nurse
theorists
o Attended nursing school at New York Medical College School of Nursing
o 1951 graduated w/ BS in public health nursing from St. John’s University in
Brooklyn, New York
o 1954 completed MSN from Columbia University
o Her early practice settings included maternity, medicine, & emergency department
nursing
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