Peplau encountered several obstacles. She was unable to publish her seminal article which publishers rejected for want of a physician co-author. In an era of chauvinism, she studied relentlessly, obtaining a nursing diploma, a B. A. in interpersonal psychology, an M. A. in psychiatric nursing from Columbia University, and a Doctorate of Education, finally earning the title of professor emeritus at Rutgers. She also served as president of the American Nurses Association. She worked progressively in the mental health field and ultimately created a conceptual framework for the interpersonal relationship between nurses and their patients.
In psychodynamic nursing, the nurse starts with an understanding of the basis for his or her own behavior. This understanding then helps the nurse-patient team to identify perceived difficulties. Working as a team, the nurse and the patient increase self-awareness, maturity, and knowledge of the medical problem and its remedies. In other words, they interact. Peplau was the first to apply human relation principles conceptually to nursing, borrowing from other disciplines.
The nurse and patient interaction consists of four overlapping phases: orientation, identification, exploitation and resolution. While these phases tend to occur in order, they do overlap.
During orientation, the nurse and patient must get to know each other and deal with any differences in background including culture and level of education.
During identification, the medical team focuses on discovering and understanding the health problem.
During exploitation, the team uses the resources of the nurse, and the facility in general, to address the problem.
Finally, during resolution, the team works to resolve the health problem for the patient.
Peplau's theory lists six primary nursing roles: stranger, teacher, resource manager, counselor, surrogate and leader. When the nurse first meets the patient, he (as stranger) must overcome the distance between them. As a teacher, she must transfer important knowledge to the patient, especially for long-term care. He, as the resource manager, must allocate the often scarce medical resources effectively. She counsels the patient and must at times stand in for the patient (surrogate). Finally, he must lead the team in bringing initiative and goal setting to the table.
The nurse plays some secondary roles as well, including tutor, researcher, mediator, technical expert and safety manager. While important, the nurse spends less time in these roles.
When the nurse is self-aware, she notes her own patterns of behavior, acts to resolve interpersonal problems, and better interacts with the patient. Able to provide therapy and education, the nurse improves the results of the patient's care.