Albert Bandura and Hildegard Elizabeth Peplau

Applied Summary: Albert Bandura and Hildegard Elizabeth Peplau

Albert Bandura is a psychologist known for examining health promotion and disease prevention with the perspective that human health is a social matter, not just an individual one (Bandura, 2004).   Hildegard Elizabeth Peplau, who is referred to as the mother of psychiatric nursing conceptualized the interaction that takes place between the nurse and patient (Gregg, 1999).  Bandura and Peplau’s theories will be described, analyzed, compared, and contrasted in terms of their utility to nursing.

Description of Theories

        Bandura’s Self-efficacy Theory is central to his Social Cognitive Theory which focuses on the relation between a person’s actions, cognition, experiences, and environment (Maddux, 1995).  Beliefs in one’s capabilities to organize and execute the course of action required to produce given attainments is referred to as self-efficacy (Bandura, 1997).  Self-efficacy essentially influences how individuals act, feel, think, and motivate themselves (Lenz & Shortridge-Baggett, 2002).  According to Bandura (1997), “People will approach, explore, and try to manage situations within their perceived capabilities, but unless they are externally coerced, they avoid transactions with those aspects of their environment that they perceive exceed their coping abilities” (p.14).  His work was influenced by Skinner’s radical behaviorism in which he added the concept of modeling (Grusec, 1992).  The theory overall provides guidelines on how to enable men/women to exercise some influence over how they live their lives and is used as a predictor of diverse forms of behavior (Bandura, 1997).  

Peplau, on the other hand, developed the Theory of Interpersonal Relations, which was influenced by the work of Maslow, Sullivan, and Freud (Alligood & Tomey, 2010).  She believed that the nurse-patient relationship should facilitate forward movement for both the nurse and the patient (Peplau, 2004).  In her theory, the four phases of nurse-patient relationship were identified: orientation, identification, exploitation, and resolution.  The six nursing roles, according to Peplau, are stranger, resource person, teacher, leader, surrogate, and counselor.  The theory primarily focuses on the process by which the nurse helps patients make positive changes in their health care status and well-being (Varcarolis & Halter, 2010).

Analysis and Argument

        Bandura does not define the four nursing metaparadigms of person, health, environment, and nursing in his theory.  The concepts, however, are indirectly described.  He states that “People are proactive aspiring organisms who have a hand in shaping their own lives and the social systems that organize, guide, and regulate the affairs or their society” (Bandura, 1997, p.vii).  Bandura explores health as a wide range of biological processes that mediate human health and disease can be stimulated by a sense of efficacy (Bandura, 1997).  The mechanisms that decrease control over stressors and the direction of causation result in adverse health (Bandura, 1997).  He also argues that the environment where people live is not a situational entity that establishes their life course; rather, it is the various accomplishments of desired behaviors that play a role in shaping personal development (Bandura, 1997).  In nursing, the measurement of self-efficacy in executing the behaviors necessary for self-management by patients with chronic illnesses is significant to the development of interventions that enhance health lifestyles (Lenz & Shortridge-Baggett, 2002).

Bandura’s theory has undergone an abundant amount of conceptual and empirical tests, thus, it is well-established that one’s self-efficacy influences the chances of changed behavior (Lenz & Shortridge-Baggett, 2002).  His theory is clearly supported by research directed toward the development of programs that focus on interventions that improve self-efficacy and determine the best way to measure self-efficacy for different actions and clinical populations (Lenz & Shortridge-Baggett, 2002).  Bandura’s theory continues to emerge as a way to understand and influence behavior modification (Lenz & Shortridge-Baggett, 2002).  

Peplau, on the contrary, directly defines and describes all four nursing metaparadigms in her theory.  She states man is an organism that lives in an unstable equilibrium who continually deals with stress (Peplau, 2004).  Health “is a word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living” (Peplau, 2004, p.12).   Peplau refers to the environment as “existing forces outside the organism and in the context of culture into which it is born” (Peplau, 2004, p.12).  She explains that nursing encompasses the ability to understand one’s own behavior as means of helping other individuals identify difficulties (Peplau, 2004).  

According to Sills (1999), Peplau empirically tested her theory in practice.  She shifted “the focus from what nurses do to patients to what nurses do with patients” (Varcarolis & Halter, 2010, p.31).  Research supports the theory given its “ability to test hypotheses based on interpersonal processes” (Andrist, Nicholas, & Wolf, 2006, p.273).  There is no doubt that Peplau’s theory will continue to be used a solid framework for guiding the nurse-patient relationship in field of nursing (Andrist et al., 2006).  

Compare and Contrast

Similarities are drawn between Bandura and Peplau’s theories.  The Self-efficacy Theory, although not referred to as a nursing theory, is clear and applicable to nursing like the Interpersonal Relations Theory.  Lenz and Shortridge-Baggett (2002) emphasize “There is increasing evidence that a vital ingredient in health-related behavior is the perceived self-efficacy of the individual to behave differently” (p.6).  Bandura’s theory was implemented to examine health promotion among diabetic patients.  Persons with a low sense of self-efficacy were found to avoid difficult tasks, such as adhering to their diabetic diet or monitoring blood glucose levels, which they observed as a personal threat (Lenz & Shortridge-Baggett, 2002).  The Interpersonal Relations Theory, according to Varcarolis and Halter (2010), “is well accepted in the United States and Canada and has become an important tool for all nursing practice” (p.163).  Peplau’s theory serves as an educative instrument designed to help individuals use their capacities in living more productively (Varcarolis & Halter, 2010).  Nurses are reminded to “care for the person as well as the illness and think exclusively of patients as persons” (Varcarolis & Halter, 2010, p.31).