Nursing, as a distinct profession, is anchored in a unique body of knowledge that sets it apart from other healthcare disciplines. This commitment to a specific knowledge base is crucial for both nursing practice and the advancement of nursing science. At its core, nursing is a science deeply rooted in theoretical frameworks that define its essence, actions, and rationale. Understanding these frameworks provides a robust foundation for effective and meaningful patient care. This paper delves into a comprehensive analysis of two pivotal nursing theories, Hildegard Peplau’s Theory of Interpersonal Relations and Rosemarie Parse’s Theory of Human Becoming, viewed through a Comparative Lens. These theories, as highlighted by McEwen and Wills, offer invaluable frameworks for grasping the complexities of nurse-patient relationships and fostering holistic care practices. By employing a comparative lens, we aim to illuminate the distinct yet complementary relevance and practical application of these theories in the ever-evolving landscape of modern nursing practice, using a detailed clinical case scenario as our focal point.
Clinical case scenario
Consider a 75-year-old woman admitted to the emergency department of a hospital in a low-and-middle-income country (LMIC). Her extensive medical history includes hypertension, diabetes, ischemic heart disease, uterine fibroids, bilateral knee deformities, bipolar disorder, severe depression, and advanced-stage breast cancer with metastasis. Due to the complexity of her conditions and the progression of her cancer, surgery was not a viable option. The treatment plan was therefore centered on radiation and chemotherapy to manage her advanced illness and improve her quality of life.
Understanding Nursing Theories Through a Comparative Lens
Nursing theories serve as structured frameworks that guide and inform nursing practice. To truly appreciate the nuances and utility of these theories, employing a comparative lens is essential. This approach allows for a systematic examination of similarities and differences, strengths and limitations, and unique perspectives offered by each theory. When we apply a comparative lens, we move beyond simply understanding a theory in isolation and begin to see its position within the broader landscape of nursing knowledge. This paper uses a comparative lens to juxtapose Hildegard Peplau’s Theory of Interpersonal Relations with Rosemarie Parse’s Theory of Human Becoming. These two theories, while both influential in nursing, originate from different philosophical underpinnings and offer distinct approaches to patient care. Peplau’s theory, rooted in psychodynamic principles, emphasizes the interpersonal processes between nurse and patient, particularly in psychiatric settings. Parse’s theory, drawing from humanistic and existential perspectives, focuses on the lived experience of health and becoming, offering a more abstract and holistic view. By placing these theories side-by-side through a comparative lens, we can gain a richer understanding of their individual contributions and their collective impact on shaping patient-centered nursing practice. The clinical case scenario presented earlier will serve as a practical backdrop against which we will evaluate and compare these theoretical frameworks, revealing how each theory might inform nursing care in a complex, real-world situation.
Peplau’s Theory of Interpersonal Relations: A Detailed Look
Hildegard Peplau’s Theory of Interpersonal Relations is a foundational theory, especially within psychiatric nursing and in understanding the therapeutic dynamics of nurse-patient relationships. The theory’s central tenet is the nurse-patient relationship itself, emphasizing therapeutic communication as the primary tool for nursing intervention. Through a comparative lens, Peplau’s theory stands out for its structured approach to understanding and guiding the interpersonal aspects of nursing care. Several core assumptions and concepts within Peplau’s framework provide a clear roadmap for nurses, even when faced with intricate cases like the one described.
1. The Continuous Search for Improvement: A fundamental assumption in Peplau’s theory is the inherent human drive for improvement and well-being, even amidst mental health challenges. Applying a comparative lens, we can see how this assumption contrasts with perspectives that might solely focus on deficits or pathology. In our case study, despite the patient’s multiple physical comorbidities and diagnoses of bipolar disorder and severe depression, Peplau’s theory directs nurses to recognize and nurture her innate desire for betterment. This perspective encourages nurses to shift their focus towards the patient’s strengths, resilience, and potential for growth, rather than being solely defined by her conditions. This is not to diminish the severity of her illnesses, but rather to acknowledge her humanity and capacity for positive change within her circumstances.
2. Concept of “Man” (the Patient): Peplau’s conceptualization of “man” (referring to the patient) is as an individual constantly striving for inner peace and personal growth, even when experiencing mental illness. Seen through a comparative lens, this concept is particularly empowering. It moves away from a passive recipient model of the patient and towards one of an active agent in their own health journey. In practice, this means nurses should approach the patient with optimism and hope, recognizing their inherent strengths and motivation to improve their situation. For the 75-year-old patient, this perspective acknowledges her life experiences, her coping mechanisms, and her inner resources that can be mobilized to support her through her current health crisis.
3. A Holistic Perspective on “Health”: Peplau’s theory defines health as a dynamic state, marked by an individual’s continuous progression towards personal development and a fulfilling life. Through a comparative lens, this definition of health extends beyond the mere absence of disease. While the patient in the case study faces significant physical health challenges, Peplau’s holistic perspective prompts nurses to evaluate and address her emotional, psychological, and social well-being as equally vital components of her overall health. This broader view is crucial in ensuring comprehensive care that addresses not just the physical symptoms of her cancer and comorbidities, but also her mental and emotional state, especially given her diagnoses of bipolar disorder and severe depression.
4. Incorporation of “Environment”: The concept of “environment” in Peplau’s theory is comprehensive, encompassing not just the physical surroundings but also the patient’s cultural values, social context, and situational factors. Using a comparative lens, we can appreciate how Peplau’s theory explicitly integrates cultural and contextual considerations, unlike some theories that might focus more narrowly on individual or biological factors. For the patient in our LMIC case study, her environment adds significant layers of complexity to her care. Nurses must be keenly aware of and sensitive to her cultural background, values, beliefs, and the specific challenges and resources available within her environment. This may include involving family in care decisions, considering cultural norms around health and illness, and adapting communication styles to be culturally appropriate.
5. Nursing as a Therapeutic Relationship: Peplau fundamentally defines nursing as a professional and therapeutic relationship that develops between the nurse and the patient. Viewing this through a comparative lens, we see how Peplau’s theory uniquely positions the relationship itself as the core of nursing practice, rather than just a means to an end. This emphasizes the nurse’s active role in establishing and nurturing a relationship characterized by trust, empathy, and mutual respect. In the context of the case study, even a student nurse plays a vital role in creating a safe and collaborative environment. The quality of this therapeutic relationship can significantly impact the patient’s experience of care, her adherence to treatment, and her overall well-being, especially in the face of complex and distressing health issues.
Alt text: Black and white portrait of Hildegard Peplau, a prominent nursing theorist known for her Theory of Interpersonal Relations, emphasizing nurse-patient communication and therapeutic relationships.
Parse’s Theory of Human Becoming: A Unique Perspective
Rosemarie Parse’s Theory of Human Becoming offers a strikingly different, yet equally valuable, perspective on patient care. It emphasizes the uniqueness of each individual’s lived experiences and views patients holistically, not as collections of problems or diagnoses. Applying a comparative lens, Parse’s theory stands in contrast to more traditional medical models by prioritizing the patient’s subjective experience and meaning-making in health and illness. Parse’s theory is particularly relevant when caring for patients like the one in our case study, whose complex, multifaceted health issues necessitate an approach that goes beyond the biomedical.
1. The Uniqueness of Lived Experiences: At the heart of Parse’s theory is the belief that each patient is a unique individual, shaped by their own distinct lived experiences, values, and perspectives. Through a comparative lens, this concept challenges the tendency in healthcare to categorize and standardize patient care. Parse’s theory encourages nurses to move beyond seeing patients as mere diagnostic categories and to recognize them as individuals with rich, complex lives. In our case study, the patient’s multiple comorbidities, advanced cancer, mental health diagnoses, and life circumstances in an LMIC all contribute to her unique individuality. Understanding and honoring this uniqueness becomes paramount in providing truly patient-centered care.
2. “Meaning” in Health Experiences: “Meaning” is a central construct in Parse’s theory, referring to the subjective significance individuals ascribe to their health experiences. Using a comparative lens, we see how Parse’s theory prioritizes the patient’s interpretation of their illness, rather than solely relying on objective medical indicators. For the nurse caring for the 75-year-old patient, it is crucial to understand her personal perception of her health conditions. What does a diagnosis of advanced breast cancer mean to her? How does she understand her multiple comorbidities? What are her personal goals and values related to her health journey? Exploring these questions of meaning is essential for providing care that is aligned with the patient’s own lived reality.
3. “Rhythmicity” and Continual Transformation: Parse’s theory introduces “rhythmicity,” which suggests that individuals are constantly creating patterns and rhythms in their lives and interactions with the world. Seen through a comparative lens, this concept highlights the dynamic and ever-changing nature of human experience, contrasting with static or fixed views of health. In nursing practice, this means recognizing and respecting the patient’s unique life rhythms, routines, and preferences. For the patient in our case study, understanding her daily routines, what brings her comfort and stability, and how her illnesses disrupt these rhythms is important. Care planning should then be tailored to respect and, where possible, accommodate these rhythms.
4. “Transcendence” and Growth: Parse’s theory posits that individuals are constantly transforming and evolving, even in the face of significant challenges, and striving to reach their highest potential. Applying a comparative lens, this concept is particularly hopeful and empowering, especially in situations of chronic illness or end-of-life care. Nurses, within this framework, play a role in supporting and encouraging these transformations. In our case study, despite the advanced stage of her cancer and other health issues, the nurse should recognize the patient’s inherent capacity for growth, adaptation, and finding meaning even in suffering. Providing emotional support, fostering hope, and encouraging her to identify and pursue personal goals, even within her limitations, are key aspects of nursing care guided by Parse’s theory. The nurse’s role includes helping the patient find strength and purpose, supporting her transcendence in the face of adversity.
Alt text: Portrait of Rosemarie Rizzo Parse, a contemporary nursing theorist celebrated for her Theory of Human Becoming, emphasizing the lived experience of health and individual uniqueness.
Incorporating Peplau’s and Parse’s theories into nursing practice for the patient in the case study requires a thoughtful and nuanced approach. Using a comparative lens to understand their strengths and focuses is crucial. Peplau’s theory offers a structured approach to initiating therapeutic communication and addressing the patient’s mental health challenges. It reminds nurses to focus on the patient’s inherent drive for improvement and to consider the broader context, including her cultural background. Parse’s theory, on the other hand, encourages nurses to move beyond the immediate diagnosis and delve into the patient’s unique lived experiences, rhythms, and the personal meaning she ascribes to health and illness. It emphasizes acknowledging the patient’s potential for growth and transformation, even in dire circumstances. In the context of our case study, this means that the nurse, guided by Peplau, would proactively establish a therapeutic relationship, focusing on communication and addressing the patient’s bipolar disorder and depression. Simultaneously, guided by Parse, the nurse would deeply listen to the patient’s narrative, respecting her unique perspective, values, and aspirations, understanding what this experience means to her.
Comparative Analysis: Peplau vs. Parse – Different Lenses on Patient Care
To fully appreciate the distinct contributions of Peplau’s and Parse’s theories, applying a comparative lens directly to their core elements is essential. While both theories aim to enhance patient care, they approach this goal from fundamentally different perspectives, offering nurses a range of tools and insights.
Focus and Approach: Through a comparative lens, we see that Peplau’s theory is more structured and linear, focusing on the stages of the nurse-patient relationship and the development of therapeutic communication skills. It is particularly geared towards psychiatric nursing and addressing mental health needs within an interpersonal framework. In contrast, Parse’s theory is more abstract and holistic, emphasizing the lived experience of health and becoming. It is less about structured stages and more about understanding the patient’s unique, ever-changing journey. Parse’s theory offers a broader philosophical perspective that can be applied across various nursing specialties, not just mental health. Peplau seeks to improve patient outcomes through targeted interpersonal interventions, while Parse seeks to enhance quality of life by honoring and understanding the patient’s lived experience.
Key Concepts Compared: When we place the key concepts of both theories side-by-side using a comparative lens, the differences become clearer. Peplau’s key concepts revolve around the nurse-patient relationship, phases of interaction, roles of the nurse, and communication techniques. Parse’s key concepts are more philosophical: human becoming, meaning, rhythmicity, and transcendence. While Peplau provides a practical, step-by-step guide for nurses in their interactions, Parse offers a framework for understanding the patient’s world and being with them in a way that honors their unique journey. For example, both theories consider the “patient,” but Peplau’s “patient” is seen in the context of interpersonal dynamics and potential for growth through the relationship, while Parse’s “patient” is viewed as a unique, indivisible, and ever-evolving being. Similarly, “health” in Peplau is a movement towards personal development, whereas in Parse, it is a constantly changing process of becoming, intertwined with the individual’s lived experience.
Strengths and Limitations (from a comparative perspective): Using a comparative lens also allows us to identify the strengths and limitations of each theory. Peplau’s theory is praised for its practicality and its clear guidelines for developing therapeutic nurse-patient relationships, particularly beneficial in mental health settings. However, it can be seen as somewhat linear and less flexible in situations that require a more fluid and less structured approach. Parse’s theory, on the other hand, is lauded for its holistic and humanistic perspective, which deeply values patient uniqueness and lived experience. Its limitation, however, lies in its abstract nature, which can make it challenging for some nurses to translate directly into concrete actions in daily practice. When viewed comparatively, we see that Peplau’s strength is in its operationalizability and focus on interpersonal skills, while Parse’s strength is in its depth of philosophical insight and its emphasis on patient-centeredness at a fundamental level. A nurse might find Peplau more immediately applicable for structuring a therapeutic interaction, while Parse might provide a deeper, underlying philosophy to guide their overall approach to care.
Practical Implications for Nursing Practice: Enhancing Patient-Centered Care Through a Comparative Understanding
The integration of Peplau’s Theory of Interpersonal Relations and Parse’s Theory of Human Becoming has profound implications for nursing practice, especially in advancing patient-centered care. When viewed through a comparative lens, the synergistic application of these theories can significantly enhance the quality and depth of care nurses provide.
Holistic vs. Specific Approaches: Using a comparative lens, we can see how Peplau and Parse, when combined, offer a more comprehensive approach than either theory alone. Peplau’s theory provides specific strategies for building therapeutic relationships and addressing psychosocial needs, while Parse’s theory broadens the scope to encompass the patient’s entire lived experience and meaning-making. Integrating these perspectives means nurses not only focus on specific interpersonal dynamics (as highlighted by Peplau) but also consider the patient’s holistic well-being, unique perspectives, and life rhythms (as emphasized by Parse). This combined approach ensures that care is both targeted and comprehensive, addressing both specific needs and the broader context of the patient’s life. In our case study, this means attending to the patient’s mental health and communication needs (Peplau) while also deeply understanding her personal experience of illness, her values, and her sources of strength (Parse).
Compassionate and Empathetic Care: Comparative Strengths: Both theories, when viewed through a comparative lens, powerfully promote compassionate and empathetic care, albeit in slightly different ways. Peplau’s theory emphasizes empathy as crucial for building the nurse-patient relationship, urging nurses to understand the patient’s perspective within the therapeutic interaction. Parse’s theory takes empathy to an even deeper level, encouraging nurses to truly “be with” the patient in their lived experience, striving to understand their unique world. Integrating these means nurses are not only empathetic in their communication and interactions (Peplau) but also cultivate a deep, existential empathy that honors the patient’s entire being and journey (Parse). This dual emphasis on empathy ensures care is not only technically competent but also profoundly human and supportive.
Communication and Dialogue: A Combined View. Effective communication is central to both theories, but a comparative lens reveals different facets. Peplau’s theory positions communication as a primary tool for data collection, establishing rapport, and facilitating therapeutic change within the nurse-patient relationship. Parse’s theory emphasizes dialogue as a way to understand the patient’s lived experience, fostering openness and trust. Combined, these theories underscore the importance of communication both as a therapeutic technique (Peplau) and as a means of deeply connecting with and understanding the patient’s world (Parse). In practice, this means nurses need to hone their communication skills for both therapeutic purposes and for fostering genuine human connection and understanding. For our case study patient, effective communication is crucial for building trust, understanding her concerns, providing information, offering emotional support, and conducting holistic assessments, aligning with both Peplau and Parse’s principles.
Patient Autonomy and Cultural Competence: A Comparative Lens. Patient autonomy and cultural competence are highlighted in both theories, though with different emphasis. Using a comparative lens, we see that Peplau’s theory acknowledges patient autonomy by emphasizing the patient’s active role in the therapeutic relationship and decision-making. It also explicitly includes the patient’s cultural background as part of the “environment” that nurses must consider. Parse’s theory deeply respects patient autonomy by emphasizing their uniqueness and their role as co-creators of their health experience. It implicitly acknowledges cultural context within the “lived experience” of the patient. Together, they reinforce the need for nurses to respect patient autonomy and cultural diversity as fundamental aspects of patient-centered care. Nurses must empower patients to make informed decisions (Peplau) and deeply respect their unique values and cultural context (Parse). Involving the patient in our case study in decision-making, despite her mental health challenges, is crucial. Approaching this with sensitivity and empathy, ensuring her voice is heard and preferences considered, aligns with both theories and promotes her sense of control and agency.
Continuity of Care and Respect for Dignity: Synergistic Effects. Finally, when viewed comparatively, both theories contribute to continuity of care and respect for human dignity. Peplau’s focus on the therapeutic relationship encourages consistent and supportive interactions throughout the care journey. Parse’s emphasis on rhythmicity and the continuous nature of human becoming highlights the importance of attending to the patient’s evolving experience over time. Both theories, in their unique ways, underscore the inherent worth and dignity of each patient. Integrating them ensures that care is not fragmented but continuous, respectful of the patient’s journey, and always grounded in a deep respect for their humanity.
Nurse Roles: A Comparative View from Peplau and Parse
Hildegard Peplau’s Theory of Interpersonal Relations explicitly defines seven key roles for nurses, providing a structured framework for nurse-patient interactions. In contrast, Rosemarie Parse’s Theory of Human Becoming, while not prescribing specific roles, offers a philosophical perspective that shapes how nurses should approach their interactions. Using a comparative lens, we can examine how these different approaches to nurse roles contribute to comprehensive and compassionate care.
Peplau’s Defined Roles: Structure and Function: Peplau’s seven roles—Stranger, Resource Person, Teacher, Leader, Surrogate, Counselor, and Technical Expert—offer a practical guide for nurses navigating the therapeutic relationship. Through a comparative lens, these roles can be seen as providing a structured, almost staged, approach to the nurse-patient interaction. Each role represents a different aspect of the nurse’s function and becomes relevant at different phases of the relationship. For instance, the “Stranger” role emphasizes initial respect and courtesy, while the “Counselor” role highlights the nurse’s function in supporting emotional and psychological well-being. The “Technical Expert” role ensures competent physical care. These roles are not mutually exclusive but rather overlapping and fluid, allowing nurses to adapt their approach based on the patient’s evolving needs and the phase of their relationship. They provide a concrete framework for nurses to understand and enact their professional responsibilities in a therapeutic context.
Parse’s Perspective: Embracing Uniqueness and Co-creation: Parse’s Theory of Human Becoming, when viewed through a comparative lens, offers a more fluid and less structured perspective on nurse roles compared to Peplau. Instead of defined roles, Parse’s theory emphasizes principles that should guide the nurse’s approach. These include embracing patient uniqueness, facilitating co-creation of health experiences, understanding rhythmicity, and supporting transcendence. In Parse’s framework, the nurse’s role is less about enacting specific functions and more about “being with” the patient in a way that honors their unique journey and potential. The nurse becomes a facilitator of the patient’s own becoming, rather than a director or expert. This approach emphasizes mutuality, respect for patient autonomy, and a deep understanding of the patient’s lived experience.
Synergistic Application: Combining Structured Roles with Holistic Understanding: Applying a comparative lens, we see that Peplau’s structured roles and Parse’s holistic principles are not mutually exclusive but can be synergistically combined to enhance nursing practice. Peplau’s roles offer a practical framework for action—a nurse can consciously adopt the role of “Resource Person” to provide information or “Counselor” to offer emotional support. Parse’s theory provides a deeper philosophical underpinning, ensuring that these roles are enacted in a way that is truly patient-centered, respectful of uniqueness, and focused on the patient’s lived experience. A nurse might use Peplau’s roles as a guide for action while simultaneously embodying Parse’s principles of being present, honoring uniqueness, and facilitating co-creation. This integration allows for both structured and compassionate care, combining the practicality of Peplau’s framework with the profound humanism of Parse’s theory. For the patient in our case study, this could mean a nurse uses Peplau’s roles to guide specific interactions (e.g., acting as a “Counselor” to address depression) while also maintaining a Parse-inspired stance of deeply respecting her unique experience and supporting her journey towards becoming, even within the context of advanced illness.
In conclusion, employing a comparative lens to analyze Hildegard Peplau’s Theory of Interpersonal Relations and Rosemarie Parse’s Theory of Human Becoming reveals both their distinct approaches and their complementary strengths in guiding nursing practice. Peplau’s theory offers a structured, interpersonal framework particularly valuable for therapeutic communication and mental health nursing. Parse’s theory provides a holistic, humanistic perspective that emphasizes the lived experience, uniqueness, and becoming of each patient. While different in their focus and approach, both theories converge on the fundamental importance of patient-centered care, human dignity, and the therapeutic value of the nurse-patient interaction. By understanding these theories through a comparative lens, nurses can draw upon the strengths of each to provide more comprehensive, compassionate, and ultimately, more effective care that honors the individuality and inherent worth of every patient.
