2. ROGERS AND PEPLAU 41
phenomena of interest to nursing can be examined.
The Rogerian position challenges nurses to con-
sider concepts derived from a traditional model
(logical positivism), in which the scientific method
is applied to phenomena. Briefly, logical positiv-
ism assumes that a solution to any problem exists
and can be measured, discovered, and recreated
(Herbert, 1985). Rogers' theory states that al-
though solutions might be found, solutions might
also be temporary and contextually based. Using a
physics analogy, the traditional model of the
atomic nucleus includes protons, electrons, and
neutrons, all located in discrete areas and measur-
able in terms of energy emission and location. Ad-
vances in physics determined that atomic particles
were comprised of both energy and matter and
could only be located in terms of probability in one
general area or another. Subsequently, numerous
other atomic particles have been inferred, and their
discovery sparked questions about preexisting
theoretical models of atomic dynamics (Herbert,
1985; Gleich, 1987).
Rogers likewise suggests that persons manifest
mass and energy through pattern and organization,
simultaneously interacting and being in process
with the environment. Using another physics met-
aphor, like Heisenberg (Herbert, 1985), Rogers
believes that the act of observation affects the ob-
served phenomena and include the observer.
Heisenberg stated that some events could not be
explained by universal laws or principles and could
not be predicted because of inherent characteristics
in the universe such as chance, randomness, un-
certainty, spontaneity, and novelty. The probabil-
ity of these occurrences supported an appropriate
attitude of openness for possibilities to happen in
the future. Conceptually translating findings in
physics and natural sciences to nursing and to Rog-
ers' framework, nurses and patients comprise part
of an environment and influence each other in mu-
tual and simultaneous ways that are not necessarily
measurable or predictable. Rogers' model repre-
sents a grand theory that contributes to an emerg-
ing paradigm for nursing. Rather than providing
definitive answers to practice questions, the theory
suggests provocative questions that must be ex-
plored.
Middle-RangeTheory
Middle-range theories examine a portion of re-
ality and identify key variables (Wilson, 1989).
In middle-range theories, propositions are clear
and testable hypotheses can be derived. Because of
their relevance and use to clinical practice, middle-
range theories are commonly applied to nursing
practice settings. Peplau's theory is a middle-range
theory because the propositions of the theory are
specific, testable, and limited. Peplau's theory
emerged from the traditional, positivist scientific
worldview (Meleis, 1985) and is essentially em-
piric evolving from practical application of inter-
ventional techniques with psychiatric patients
(Forchuck, 1991). For example, Peplau focused on
the phenomena of relationship and language. Pep-
lau's theory identifies phenomena of concem to
psychiatric nurses and analyzes key principles of
learning, language, and relationship. The theory
describes discrete interventional behaviors along a
linear continuum of interpersonal relations involv-
ing practicing psychiatric nurses and their patients.
ROGERS AND PEPLAU: BEINGAND DOING
Rogers' theory has been described as difficult to
operationalize (Tuyn, 1992). As nurses at the Vet-
eran's Affairs Medical Center progressively used
Martha Rogers' Science of Unitary Human Be-
ings, they also examined middle-range theories for
practical application and theoretical consistency
with Rogers. Some middle-range theories are con-
gruent with Rogers' framework, others are not. In
the psychiatric and mental health nursing division,
we examined Peplau's Theory because the theoret-
ical application that Peplan described offered clin-
ical exemplars and testable interventional strate-
gies for direct clinical practice. Over time, we used
both Peplau's and Rogers' models in mental health
nursing to conceptualize and structure care. We
found both theories complementary; one serving as
a grand theory providing a conceptual base, and
the other as a middle-range theory providing a
practical base for nursing practice. Because this
article offers clinical integration of Rogers' and
Peplau's theories, a brief review of each theory is
provided.
ASSUMPTIONS OF ROGERS'THEORY
The Rogerian perspective provides an ever-
emerging worldview, a world view where individ-
ual field pattern manifestations are observable in
the real world. Human field pattern manifestations
are all behaviors, beliefs, and actions that charac-
3. 42 ARMSTRONG AND KELLY
terize individual persons. Both human and envi-
ronmental fields are dynamic, in continuous mo-
tion, and infinite. Energy signifies the nature of the
fields. The Science of Unitary Human Beings is
based on six philosophical assumptions that de-
scribe human beings, environment, and nursing.
Rogers assumed that people are identified whole
beings possessing their own integrity, and mani-
festing characteristics that are more than, and dif-
ferent from, the sum of their parts; human beings
and their environment are continuously exchang-
ing matter and energy with one another; life pro-
cess evolves irreversibly and unidirectionally
along the space time continuum; pattern and orga-
nization identify human beings and reflect their
innovative wholeness; human beings are character-
ized by the capacity for abstraction and imagery,
language and thought, sensation and emotion; and
finally that nursing is a science and an art. Nursing
is not a verb but a noun representing a body of
knowledge concerning unitary human beings.
PRINCIPLES OF ROGERS' THEORY
Three principles of homeodynamics flow from
and further define these assumptions. The princi-
ple of resonancy is defined as the continuous
change from lower to higher frequency of wave
patterns in human and environmental fields (Rog-
ers, 1976). For example, as one grows older the
perception of time commonly changes as time
seems to go faster, suggesting a higher frequency
pattern of organization.
The principle of helicy suggests that continuous,
innovative, and unpredictable increasing diversity
characterizes human and environmental fields. For
example, the increase in communication method-
ology during the past 50 years produced a complex
and vast informational system. Nurses have access
to increasing sources of information because of the
development of computerization and satellite tele-
communication. Health care practitioners are more
specialized in knowledge systems, and are becom-
ing ever more specialized.
The principle of integrality states that humans
and environments are in continuous and dynamic
process. For example, as mammals breathe they
inspire oxygen and expire carbon dioxide, whereas
photosynthetic plants inspire carbon dioxide and
expire oxygen. We do not think about this every
time we take a breath, but we continuously and
dynamically exchange matter and energy as part of
being in process with the environment (being in
relation). In a like manner, we exchange energy
with patients and others in our environment.
PEPLAU'S THEORY OF
INTERPERSONAL RELATIONS
Influenced by Sullivan and other interpersonal
theorists (Peplau, 1952), Peplau's methods of psy-
chiatric nursing practice also incorporate develop-
mental psychology (Blake, 1980), and learning
theory (Lego, 1980). Peplau defines interpersonal
relations as a theoretical construct referring to
"... connections, linkages, ties, and bonds be-
tween people and things" (O'Toole & Welt, 1989,
p. 58). Through interpersonal relations established
between nurse and patient, therapeutic interven-
tions are used to move patients toward mental
health.
Nursing is a significant, therapeutic interpersonal process.
It functions cooperatively with other human processes that
make health possible for individuals in communities . . .
Nursing is an educative instrument, a maturing force, that
aims to promote forward movement of personality in the
direction of creative, constructive, productive, personal
and community living. (Peplau, 1952, p. 16)
Knowledge of conceptual constructs such as anx-
iety states, communication competencies, and
stages of learning assist the nurse in establishing
and maintaining therapeutic alliances with their pa-
tients. Peplau (1952) conceived (O'Toole & Welt,
1989) a linear and purposeful pattern of relation-
ship between nurse and patient that has been in-
vestigated and operationalized (Thompson, 1986;
Forchuk & Brown, 1989). Within Peplau's sys-
tematic approach to establishment of nurse-patient
relationship and therapeutic intervention are con-
tained ideas that resonate with Rogers' theoretical
assumptions about human pattern and organiza-
tion. However, the theoretical constructs differ on
the idea of temporality. Rogers theory includes
noncausal, immediate and reciprocal interchange
of energy and pattern, whereas Peplau's theory is
linear and causal.
MORE THAN THE SUM OF THEIR PARTS
Rogerian theory provides a world view that is
not presently a testable model. Clinicians continue
to struggle with operationalizing the model and
developing testable approaches to support tenets of
the science (Tyun, 1992). Conversely, Peplau pro-
4. ROGERS AND PEPLAU 43
vides a middle-range theory that is widely used
(Forchuck, 1991). Similarities between the models
provide theoretical fit and affinity for conceptual-
izing human beings as energy fields. For example,
like Rogers, Peplau defined nursing as manifested
energy, "... an educative instrument, a maturing
force" (Peplau, 1952, p. 16). It is the authors' con-
tention that relationship (we define relationship as
a verb indicating simultaneous and mutual energy
exchange) between nurse and patient is the vehicle
through which the force, or energy, of nursing is
manifest. "Quality nursing in psychiatric work re-
quires very little technical skill and is very much a
matter of competence exercised within the rela-
tionship of nurse and patient" (O'Toole & Welt,
1989, p. 192). Rogerian science conceives dy-
namic relationship, and Peplau's model articulates
dynamic relationship.
MANIFESTATIONS OF INTEGRALITY
AND PATTERN
Rogers defined the principle of integrality as
continuous mutual human field and environmental
field process (Barrett, 1990). "In a universe of
open systems, causality is not an option....
change, then, is continuously innovative and cre-
ative. Moreover, association does not mean cau-
sality" (Rogers, 1992). Therefore, as a function of
relation, or being in relationship, or through the
passage of time or any other dynamic, both the
patient and the nurse change.
Peplau's emphasis on communication compe-
tencies of patients relates to Rogers' concept of
integrality. The patient, said Peplau, could not in-
teract or relate to or engage in commerce with
society unless the patient was able to communicate
(O'Toole & Welt, 1989). Impaired communication
isolates and progressively creates an insular and
solitary world for the psychiatric patient. Engaging
a patient in a process to develop communication
competencies is one of the tasks of the professional
psychiatric nurse. Through a series of specific
evaluative and interventional steps, the nurse eval-
uates the patient's current communication compe-
tencies and moves the patient toward increasing
language competency during therapeutic interac-
tions with the patient. The patient is engaged in
observing, describing, and synthesizing observa-
tions of the world and self in the world. Through
language and relationship, the patient and nurse
experience integrality.
Pattern is a key postulate in Rogers' science. It
is defined as "... the distinguishing characteristic
of an energy field perceived as a single wave"
(Rogers, 1992). Pattern is an abstraction, its' na-
ture changes continuously, and gives identity to
the energy field. Moreover, each human field pat-
tern is unique and integral with its' own environ-
mental field pattern. Pattern is not directly observ-
able. However, manifestations of field patterning
are observable events in the real world.
Peplau describes patterning as connections,
linkages, and ties between people and things,
"... such relations.., are identified in terms of
their nature (pattern), origin (history), their func-
tion (intention, motive, expectations, purpose),
their mode (form, style, method), or by integra-
tions (patterns of two or more people which to-
gether, link or bind them)" (O'Toole & Welt,
1990, p. 58). Thus, Peplau and Rogers view be-
havior, communication, and bodily rhythms as
manifestations of pattern. To both theorists, in-
creasing diversity in field patterning characterizes
change.
Peplau describes several phenomena of the
nurse-patient relationship that are congruent with
Rogers' concepts of patterning. Peplau's observa-
tions and thoughts about language acquisition,
manifestations of anxiety and nursing interventions
based on anxiety reduction techniques operation-
alize Rogers' concepts of continual repatterning.
Although Peplau's approach states a causal rela-
tionship between nursing intervention and patient
response, Peplau embraces the concept of environ-
ment as nurse and patient in relation, "The first
thing to note about this definition is that it uses the
term relation ... 'relations,' refers to connec-
tions, linkages, ties and bonds between things and
people" (p. 58). The more relations the nurse is
able to achieve in the nursing process with the
patient, the greater the potential for the curative
and educative force of nursing. To this end, Peplau
suggested flexibility on the part of the nurse to
be present with the patient to create a variety of
situational experiences in which patients can expe-
rience relation. In this way the nurse provides
curative teaching, mentoring, coaching, and prob-
lem-solving activities.
DISCUSSION
Transition and interaction are domains of in-
quiry for nursing practice. Rogers and Peplau have
5. 44 ARMSTRONG AND KELLY
made major contributions to the science and prac-
tice of nursing specifically related to these do-
mains. Rogers' challenge is to view the world in
dynamic interaction and constant change. Peplau
asks nurses to use interpersonal relations with pa-
tients to improve their ability to live as part of a
community. Both theorists ask nurses to collabo-
rate with patients. As defined by Peplau, relations
embody integrality. Relating is interacting. Ther-
apeutic relating is thoughtful application of knowl-
edge in the form of therapeutic presence; in-
formed, skillful, and knowledgeable. The totality
of the nurse and patient is present in relation. The
nurse and patient function in relation to increase
the potential to repattern and reorganize.
Peplau views this process as linear, Rogers does
not. However, in being open to the dynamic nature
of the world could not some processes be linear? It
is the authors' contention that Peplau's practice-
based model gives nurses concrete guidance and
direction on methods or patterns to practice to be
present to patients. Nursing practice in the 1950s
was characterized by regulated and predictable
ways of interacting with patients, nurses had little
sanction for independent activity. Acceptance of
independent activity was, and still is, more easily
gained by basing practice on an accepted theoret-
ical model. Thus, Peplau's model for practice pro-
vides a prescription for interaction based on the-
ory, a development particularly valuable in 1950
and as nurses still seek autonomy, also valuable in
1994. This formula for nurse-patient interaction
lowers both patients' and nurses' anxiety, and in-
creases the probability for the emergence of cre-
ative and flexible ways of interaction in relation.
Today, Peplau's formula allows the nurse to ex-
plore the nonlinear, noncausal, and simultaneous
model of nursing described by Rogers.
However, causality must be discarded to be con-
sistent with the Rogerian worldview. It is the au-
thors' contention that removing causality from
Peplau's theory does not make its' practice-based
guidance less useful. Rather, it may make sug-
gested clinical application of knowledge and ther-
apeutic self freer and more creative. In exploring
new paradigms individuals must take risks. To
take risks one must feel safe. Knowledge and guid-
ance in ways of being assists the nurse in taking
those risks and in seeing or sensing the possibility
or potential of new options.
As nurses struggle to operationalize the Roge-
rian perspective we must strive to use knowledge
from nursings' rich and complex history. The
thoughtful synthesis of both theoretical knowledge
and applied practice is essential if nurses are to
fulfill the profession's mandate for service to so-
ciety.
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