Intersecting Pathways: Examining Hildegard Peplau's and Rosemarie Parse's Nursing Theories through a Comparative Lens

Background: Nursing theories are organized bodies of knowledge providing a way to define nursing as a unique discipline that is separate from other disciplines. As a profession, nursing is committed to recognizing its own unparalleled body of knowledge vital to nursing practice and science. Nursing is a science based on the theory of what nursing is, what nurses do, and why.

Aim: This paper aims to elucidate the practical application of Hildegard Peplau's and Rosemarie Parse's nursing theories, individually and in synthesis, in modern nursing practice.

Key points: These include a) Hildegard Peplau's Theory of Interpersonal Relations emphasizes the nurse-patient relationship, therapeutic communication, and the continuous search for improvement in patients, even those facing mental health challenges. b) Rosemarie Parse's Theory of Human Becoming underscores the uniqueness of each patient's lived experiences, the significance of "meaning" in health experiences, "rhythmicity" in patterns, and the potential for "transcendence" and growth. c) Integrating Peplau's and Parse's theories promotes holistic patient-centered care, compassionate and empathetic nursing, enhanced communication skills, patient autonomy, cultural competence, continuity of care, and a deep respect for human dignity. d) By embracing both theories, nurses can provide comprehensive, compassionate, and patient-centered care that respects each patient's individuality and capacity for growth.

Conclusion: The synthesis of Hildegard Peplau's and Rosemarie Parse's nursing theories offers nurses a comprehensive framework for modern nursing practice. It guides nurses in providing high-quality, patient-centered care that preserves human dignity and recognizes the uniqueness of each patient. Drawing from multiple theoretical perspectives enhances nursing practice and ensures the well-being of patients in today's evolving healthcare landscape.

Nursing theories are organized bodies of knowledge that provide a way to define nursing as a unique discipline that is separate from other disciplines. As a profession, nursing is committed to recognizing its own unparalleled body of knowledge vital to nursing practice and science [1]. Nursing is a science based on the theory of what nursing is, what nurses do, and why [2]. Briefly describing a clinical case scenario, this paper presents an extensive analysis of two nursing theories: Hildegard Peplau's Theory of Interpersonal Relations and Rosemarie Parse's Theory of Human Becoming. According to McEwen and Wills [3], these theories provide valuable frameworks for understanding the dynamics of nurse-patient relationships and promoting holistic care. Through a comparative analysis, this paper seeks to elucidate the relevance and practical application of these theories in modern nursing practice.

Clinical case scenario

The case involves a 75-year-old female patient in a hospital in a low-and-middle-income country (LMIC) who presented to the emergency department. Her medical history revealed multiple health conditions, including hypertension, diabetes, ischemic heart disease, uterine fibroids, bilateral knee deformities, bipolar disorder, severe depression, and late-stage breast cancer with metastasis to multiple organs. Given her complex comorbidities and the advanced stage of her cancer, surgical interventions were deemed unsuitable, and the treatment plan focused on radiation and chemotherapy.

Application of assumptions and concepts: Peplau and Parse

The analysis of the assumptions and concepts inherent in both Hildegard Peplau's Theory of Interpersonal Relations and Rosemarie Parse's Theory of Human Becoming within the context of the clinical patient case offers profound insights into their practical applications. These two nursing theories provide distinctive lenses through which nurses can approach patient care, and their assumptions and concepts guide nurses in understanding and addressing the multifaceted needs of patients [4-6].

Peplau's theory of interpersonal relations

Hildegard Peplau's Theory of Interpersonal Relations serves as a cornerstone in the realm of psychiatric nursing and the development of therapeutic nurse-patient relationships [7]. It is fundamentally centered on the nurse-patient relationship and therapeutic communication [8]. Within this theory, several assumptions and concepts shed light on how nurses can approach patient care, even in cases as complex as the one presented in the case study.

1. The continuous search for improvement: One of the fundamental assumptions of Peplau's theory is that individuals, even those facing mental health challenges, continuously seek solace and improvement. In the context of the case study, this assumption is particularly relevant. Despite the patient's numerous comorbidities and the diagnosis of bipolar disorder and severe depression, Peplau's theory reminds nurses that the patient has an innate drive for betterment. This perspective encouraged the assigned nurses to focus on the patient's strengths and aspirations rather than dwelling solely on the patient’s conditions.

2. Concept of "man" (the patient): Peplau's theory views the patient as an individual who, even in the face of mental illness, persistently strives to find inner peace and betterment [9]. This concept underscores the importance of recognizing the patient's resilience and capacity for growth. In practice, nurses should approach the patient with a sense of hope, acknowledging their inherent strength and motivation for improvement.

3. A holistic perspective on "health": Peplau's theory considers health as a marker of an individual's continual movement toward betterment. This concept challenges nurses to look beyond the immediate physical symptoms and delve into the patient's broader well-being. In the case study, while the patient's physical health is undoubtedly a concern, Peplau's perspective encourages nurses to assess and address the patient's emotional and psychological well-being as integral components of her health.

4. Incorporation of "environment": The concept of "environment" in Peplau's theory encompasses the patient's cultural values and context. It emphasizes the importance of cultural competence and sensitivity in nursing practice. For the patient in the case study, being in an LMIC adds a layer of complexity to her care. While caring for this patient nurses were attentive to the patient's cultural background, values, and beliefs. Such as involving the patient's family in the care.

5. Nursing as a therapeutic relationship: Peplau defines nursing as a professional and therapeutic relationship between the nurse and the patient. This concept underscores the importance of the nurse's role in establishing and maintaining a therapeutic rapport with the patient. In the context of the case study, this means that the nurse, even as a nursing student, plays a crucial role in creating an environment of trust and collaboration.

Parse's theory of human becoming

Rosemarie Parse's Theory of Human Becoming offers a distinctive perspective on patient care by emphasizing the uniqueness of each individual's lived experiences [10]. It posits that patients cannot be reduced to mere problems or diagnoses and encourages nurses to comprehend patients holistically. Parse's theory is particularly relevant in the context of patients like the one in the case study.

1. The uniqueness of lived experiences: Parse's theory is grounded in the belief that each patient is a unique individual with their own lived experiences, values, and perspectives. It challenges nurses to move beyond seeing patients as sets of problems or diagnoses and to view them as individuals with multifaceted lives. In the case study, this perspective becomes essential as the patient's multiple comorbidities and complex health issues make her a unique individual with specific needs and aspirations.

2. "Meaning" in health experiences: Within Parse's theory, "meaning" is a central concept. It suggests that individuals attach significance and meaning to their health experiences. For the nurse in the case study, understanding the patient's perception of her health conditions, her understanding of her diagnosis, and her goals for her health journey becomes crucial. What does being diagnosed with breast cancer mean to her, and how does it influence her decisions and emotions?

3. "Rhythmicity" and continual transformation: Parse's theory introduces the concept of "rhythmicity," which suggests that individuals continuously generate patterns within their world [11,12]. In the context of nursing practice, this implies that the nurse should recognize and respect the patient's unique patterns and rhythms in life. For the patient in the case study, it means acknowledging her routines, preferences, and the factors that bring her comfort and stability.

4. "Transcendence" and growth: Parse's theory acknowledges that individuals transform in response to challenging situations, striving to reach their highest potential. Nurses, in this framework, have a role in supporting and encouraging these transformations. In the case study, the nurse recognized the patient's capacity for growth and development, even in the face of significant health challenges. The nurse played a crucial role in providing emotional support and encouragement to the client. This support helped the patient maintain a positive outlook and continue with her radiation and chemotherapy treatments.

Incorporating Peplau's and Parse's theories into nursing practice for the patient in the case study requires a delicate balance. Peplau's theory provides a structured approach to establishing therapeutic communication and addressing the patient's mental health challenges. It reminded nurses to see the patient's innate drive for improvement and consider the broader aspects of her well-being, including her cultural context.

On the other hand, Parse's theory encourages nurses to go beyond diagnosis and delve into the patient's unique experiences, rhythms, and meanings attached to health and illness. It encouraged nurses to acknowledge the patient's capacity for growth and transformation. In the context of the case study, this means that the nurse should actively listen to the patient's narrative, respecting her unique perspective and aspirations.

Ultimately, the synthesis of Peplau's and Parse's perspectives creates a holistic and patient-centered approach to nursing care. It allowed nurses to address the patient's specific health challenges while recognizing her as a unique individual with her own lived experiences and capacity for growth [13]. Both theories, despite their differences, converge on the importance of preserving human dignity and viewing patients as unique beings deserving of respect and compassionate care. In case studies like the one presented, these theories provide invaluable guidance to nurses striving to provide holistic, meaningful, and patient-centered care.

Implications for nursing practice: enhancing patient-centered care

The integration of Peplau's Theory of Interpersonal Relations and Parse's Theory of Human Becoming has far-reaching implications for nursing practice, particularly in the context of patient-centered care [14]. This section outlines these implications and highlights how both theories can be synergistically applied to enhance the quality of care provided by nurses.

1. Holistic patient-centered care: Integrating Peplau's emphasis on therapeutic relationships and Parse's focus on holistic understanding places the patient at the center of care. Nurses are encouraged to build trust, provide emotional support, and actively engage with patients to understand their unique needs and concerns. Recognizing the patient as an active participant in their care and decision-making process creates a more patient-centered care environment.

2. Compassionate and empathetic care: The integration of these theories promotes compassionate and empathetic care. Peplau's theory underscores the importance of the nurse-patient relationship, characterized by respect, empathy, and active listening. Parse's theory complements this by encouraging nurses to step into the patient's shoes, striving to comprehend their unique perspectives and feelings. This empathetic approach enables nurses to provide care that is not only physically competent but emotionally supportive as well.

3. Enhanced communication skills: Both theories highlight the role of effective communication in nursing practice. Peplau's theory places communication as a prime tool for data collection and therapeutic collaboration. Nurses are encouraged to hone their communication skills to facilitate meaningful interactions with patients. Parse's theory underscores the importance of dialogue in gaining insights into the patient's lived experiences, fostering trust and openness between the nurse and the patient. The nurse caring for this patient should employ effective communication techniques to build trust, actively listen to her concerns, provide clear and empathetic information, offer emotional support, and conduct holistic assessments. By doing so, the nurse can establish a therapeutic relationship and ensure that the patient's unique needs and perspectives are comprehensively addressed, aligning with the core tenets of both Peplau's and Parse's nursing theories.

4. Patient autonomy and shared decision-making: Integrating these theories promotes patient autonomy and shared decision-making. Peplau's theory acknowledges the importance of patients actively participating in their care. Nurses empower patients to make informed decisions about their health by recognizing and respecting their autonomy. Parse's theory aligns with this perspective by emphasizing that patients should not be viewed as divisible entities based on problems or diagnoses. Instead, they are unique individuals with their values and experiences, encouraging nurses to involve patients in the decision-making process. It is crucial to involve the patient in the decision-making process despite the challenges posed by her mental health condition. The nurse should approach this with sensitivity and empathy, ensuring that the patient's voice is heard and her preferences considered. By actively engaging the patient in discussions about her care, the nursing care team can help her regain a sense of control and agency over her healthcare decisions, which can be particularly empowering in the context of severe depression [13].

5. Cultural competence: Both theories stress the significance of considering the patient's cultural values and worldview. Peplau's theory recognizes the environment as including the patient's cultural background, encouraging nurses to be culturally competent in their care provision. Parse's theory further supports this notion by highlighting the importance of understanding the patient's unique experiences within their cultural context. Nurses should be sensitive to cultural differences, respecting and valuing diverse perspectives.

6. Continuity of care: Integrating these theories also promotes continuity of care. Peplau's theory, with its focus on the therapeutic nurse-patient relationship, encourages nurses to maintain consistent and supportive interactions with patients throughout their care journey. Parse's theory complements this by emphasizing the continuity of phenomena and the patient's rhythmicity in their experiences. Nurses are encouraged to be present and attentive throughout the patient's care trajectory, adapting care plans as needed to address evolving needs and circumstances.

7. Respecting human dignity: A fundamental implication of integrating these theories is the recognition and respect for human dignity. Both Peplau and Parse's theories underscore the importance of viewing patients as unique individuals with inherent worth. This perspective ensures that care is provided with the utmost respect, compassion, and consideration for the patient's humanity.

Roles of the nurse: Guiding comprehensive and compassionate care

Hildegard Peplau's Theory of Interpersonal Relations delineates seven essential roles for nurses, offering a comprehensive framework to navigate interactions with patients and provide care that is both comprehensive and deeply compassionate. These roles are not just a set of responsibilities but represent fundamental aspects of nursing practice that, when applied effectively, contribute to the well-being of patients and enhance the overall quality of care.

1. Stranger: In the role of a "stranger," the nurse approaches the patient with courtesy and respect, recognizing the patient's individuality and uniqueness. This initial encounter sets the foundation for building trust and rapport, crucial for establishing a therapeutic nurse-patient relationship. By adopting the role of a stranger, nurses create a safe and welcoming environment for patients to share their concerns and needs.

2. Resource person: As a "resource person," nurses serve as a wellspring of information and knowledge for patients. This role involves sharing relevant information, providing explanations about medical conditions and treatment options, and ensuring that patients have access to the information they need to make informed decisions about their care. Nurses act as educators, empowering patients with the knowledge necessary to actively participate in their health management.

3. Teacher: In the role of a "teacher," nurses play a pivotal role in patient education. This includes both formal and informal teaching, where nurses help patients understand their health conditions, treatment plans, medication regimens, and self-care strategies. Effective teaching not only enhances patient understanding but also fosters a sense of empowerment, enabling patients to take charge of their health to the best of their abilities.

4. Leader: As a "leader," nurses guide patients and their families through the decision-making processes involved in their care. This role requires providing support and direction, helping patients make informed choices that align with their values and preferences. Nurses facilitate discussions, clarify options, and empower patients to participate actively in making decisions about their treatment and care plans.

5. Surrogate: The "surrogate" role involves offering emotional support and comfort to patients, often stepping in as caregivers, especially in situations where the patient lacks family or loved ones nearby. This role extends beyond the clinical aspects of care and emphasizes the importance of being a source of solace and companionship during times of vulnerability. Compassion and empathy are central to this role, ensuring that patients feel valued and cared for [15,16].

6. Counselor: In the role of a "counselor," nurses create a safe and non-judgmental space for patients to express their thoughts, feelings, and concerns. This role is pivotal in addressing the emotional and psychological aspects of a patient's well-being. By actively listening, providing emotional support, and offering guidance when needed, nurses help patients navigate through challenging emotional experiences and promote emotional healing and coping.

7. Technical expert: In the role of a "technical expert," nurses apply their clinical skills, knowledge, and expertise to provide physical care. This includes tasks such as administering treatments, medications, and interventions with precision and competence. Being a technical expert requires nurses to stay updated with the latest evidence-based practices and ensure the highest standards of care delivery.

Rosemarie Parse's Theory of Human Becoming operates within the simultaneity paradigm of nursing, which asserts that humans are inherently irreducible, perpetually interconnected, and in constant interaction with their surroundings. While Parse's theory does not prescribe specific roles for nurses in the same structured manner as Peplau's theory, it offers profound insights into how nurses should approach their interactions with patients in a holistic and patient-centered way.

In the context of Parse's theory, nurses are encouraged to

1. Embrace uniqueness: Parse's theory emphasizes that each patient is a unique individual with their own lived experiences, values, and perspectives. By following Parse's theory and embracing the patient's uniqueness, the nursing care team provided holistic care that considered her individuality in the context of her physical and mental challenges [17]. This approach ensured that her care was genuinely patient-centered and respectful of her unique needs and experiences, promoting her overall well-being and quality of life.

2. Facilitate co-creation: Parse's theory highlights the idea that patients are active participants in shaping their health and well-being. Nurses should aim to collaborate with patients, respecting their autonomy and involving them in the decision-making process regarding their care [18-23].

3. Understand rhythmicity: Rhythmicity in Parse's theory refers to the continuous generation of patterns within an individual's world. Nurses can acknowledge and respect these patterns in a patient's life, adapting care plans to align with the patient's values and preferences.

4. Support transcendence: Parse's theory recognizes that patients transform in response to challenging situations, striving to reach their highest potential. Nurses can support and encourage these transfor-mations by fostering an environment that promotes growth and development.

In essence, Parse's Theory of Human Becoming highlights the importance of viewing patients as unique beings and recognizing their capacity for self-transcendence and growth. While it does not prescribe specific roles, it encourages nurses to approach patient care with empathy, respect, and a deep understanding of the patient's experiences and values.

Incorporating both Peplau's and Parse's perspectives can lead to a more comprehensive, compassionate, and patient-centered approach to nursing practice. Peplau's roles provide a structured framework for nurses to navigate their interactions with patients, while Parse's emphasis on uniqueness and co-creation reinforces the importance of recognizing and respecting each patient's individuality and capacity for growth. Together, these theories guide nurses in providing care that not only addresses the clinical aspects of illness but also promotes holistic well-being and preserves human dignity throughout the care journey.

Synthesizing Peplau and Parse for comprehensive care

In conclusion, the comprehensive analysis of Hildegard Peplau's Theory of Interpersonal Relations and Rosemarie Parse's Theory of Human Becoming within the context of a patient case emphasizes their vital contributions to modern nursing practice. These theories, when thoughtfully integrated, provide nurses with invaluable guidance to elevate the quality of patient care.

By synthesizing elements from both theories, nurses can craft a comprehensive patient-centered approach that not only addresses specific health issues but also upholds the patient's holistic well-being and ethical considerations. The key takeaway for nurses is to recognize the significance of these theories in delivering comprehensive care while acknowledging their limitations.

In this synthesis, nurses gain insights into the importance of embracing multiple theoretical perspectives in clinical practice. The merger of Peplau's emphasis on the nurse-patient relationship with Parse's focus on human experiences and interconnectedness empowers nurses to cultivate a holistic, patient-driven approach to nursing. Furthermore, it highlights the utmost importance of respecting human dignity and treating each patient as a unique individual with their own lived experiences.

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