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Publication of Hildegard Peplau's book Interpersonal Relations in Nursing (1952) heralded the introduction of the first systematic theoretical framework for psychiatric nursing and focused on the nurse-client relationship. Her theory has been described as drawing from developmental (Blake, 1980) interpersonal (Peplau, 1952) and learning (Lego, 1980) theories. Peplau (1952) has defined nursing as, "a significant, therapeutic, interpersonal process that aims to promote a patient's health in the direction of creative, constructive, productive, personal, and community living" (page 16).
Peplau considered the relationship between nurse and client the key to the nursing process (Peplau, 1962; 1965). She conceptualized the nurse-client relationship as developing through phases: orientation, identification, exploitation, and resolution. The nurse and client have changing goals and roles as they pass through each phase. Peplau (1952) described the phases as "overlapping" and "interlocking" (page 17). For example, the nurse and client may return to an earlier phase. After initial issues have been resolved during exploitation they may return to problem identification to identify new issues to work on. Within this theory, awareness of the current stage of the relationship is essential for the nurse to plan appropriate interventions.
Peplau also laid the groundwork for the development of other theoretical approaches to psychiatric nursing (Mellow, 1957; Orlando, 1961). These psychiatric nursing frameworks, Peplau 's in particular, have generated considerable clinical articles describing the nurse-client relationship, often citing case studies. More specifically, emphasis has been placed on exploring the phases of the nurse-client relationship, such as orientation and termination; discussing clinical concepts that are manifest within the context of the nurse-client relationship including anxiety, resistance, trust, anger, and empathy; and suggesting specific methods and strategies to foster an effective communication style, both verbally and nonverbally (Lego, 1980). In addition, psychiatric nursing textbooks and workbooks emphasize the nurse-client relationship as the basis of psychiatric nursing and usually devote a chapter of explanation to Peplau 's framework.
Several scales have also emerged in psychiatric nursing that purport to measure aspects of the nurse-client relationship. The Social Interaction Inventory (Methven, 1962) assessed the nature of verbal responses selected by nurses when confronted with emotionladen situations. Mathews (1962) attempted to develop an instrument to measure the quality of psychological aspects of the nurse-client interaction. Aiken and Aiken (1973) focused on measuring...