Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example

Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example
Please answer the following 2 questions:
1. In what ways might Peplau’s theory of interpersonal relations need to be revised to be the most useful to nurses in the health care environment in which contact time between nurse and client is limited?
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2. One of the patterns of attachment is referred to as ”earned secure” This pattern, characterized by coherence and balance, is achieved by adults who experienced unloving or harsh parenting. What individual characteristics or life experiences might contribute to achievement of this pattern? Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example.
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Text: Middle Range Theories: Application to Nursing Research
Sandra J. Peterson PhD RN, Timothy S. Bredow PhD RN NP-C
LWW, Fourth, 2017 (ISBN-10: 0060000449)
Other sources: Articles within the last 5 years, from from peer-reviewed nursing journals may be used. Please attempt to add at least two other sources.
Refer to the Rubric for further assignment details. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example.
Peplau and Bowlby Theories
Question 1. In what ways might Peplau’s theory of interpersonal relations need to be revised to be the most useful to nurses in the health care environment in which contact time between nurse and client is limited?
Peplau’s Theory holds that the core function of nurses is to aid others who are in difficulty and need their help. In fact, it explains that nurses are therapeutic agents. In this case, it emphasizes the importance of the contact between nurses and their clients since this allows the nurses to have closer interactions with patients. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. For that matter, it views maintaining good interpersonal relationships as a core responsibility of nurses. Longer interaction times allows the relationship between the nurse and client to become mature at a faster rate so that they arrive at an acceptable goal speedily. The implication is that should the contact time between the patient and the client be limited, then the relationship will mature at a much slower pace and an acceptable solution will only be developed at a later time (Barker, 1998). To address the concern of limited contact time between the nurse and client that results in slower rate of relationship maturity, there is a need to revise Peplau’s Theory so that it allows for adoption of information technology solutions, particularly self-guiding applications that direct the clients through routine processes such as acting as a resource that offers specific required information on a situation or emerging problem. Self-guiding applications entail simple operations without the need for complex user guides. This would allow the theory to be abreast with the social transformations that have characterized the 21st century to include information technology advances and Internet developments (Peplau, 1997). Social transformations refer to social changes that have been experienced to include the internet and social media. These information technology solutions (such as smartphone applications and online resource centers) can substitute for the nurses in routine activities and only require nurses to intervene in areas where automated application cannot substitute for them. It is important to note that the revision does not eliminate the need for nurses Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. Rather, it assigns them a supervisory role where they only intervene when in-depth clarification is necessary (Peplau, 1997). For instance, when the nurse acts as a contact point and is required to assess the patient’s suitability for the technology or when building the interpersonal aspect of the relationship. In this respect, Peplau’s Theory should be revised to adopt information technology solutions and self-guiding applications to address the issues brought about by limited contact time between the nurses and clients.
Question 2. One of the patterns of attachment is referred to as “earned secure” This pattern, characterized by coherence and balance, is achieved by adults who experienced unloving or harsh parenting. What individual characteristics or life experiences might contribute to achievement of this pattern?
The term ‘earned secure’ refers to a specific pattern of attachment that describes persons who had initially been evaluated to be insecure but later in time would change their assessment to secure. The change between secure and insecure describes the level of trust assigned to relationships. For instance, a trusting relationship is considered secure. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. The change from insecure during childhood to securing in adulthood is typically seen in adults whose childhood was particularly difficult and caused an expected assessment of insecure and yet their state of mind turns out to be secure in adulthood. In essence, it can be interpreted that the adult being assessed has an interchangeable attachment status since he or she does not have a specific way of regulating attachment distress and can regulate it over time. There are specific individual characteristics and life experiences that might contribute to the achievement of ‘earned secure’ pattern of attachment (Peterson & Bredow, 2017). The most common contributor is relationships that allow children to change from insecure when younger to secure as they turn into adults. In this case, the child understands the difficulties associated with insecurity and tries to address these difficulties by striving for security in adulthood. For that matter, if the child had uncooperative and insensitive parents and complained about the detriments of such a relationship, then he or she would try to be cooperative and sensitive as an adult so that a secure relationship is created. It can be understood that security and insecurity are resultant of relationships so that ‘earned secure’ ensues when the individual gains greater control over the relationship and can pursue desired outcomes. Additionally, it would explain an acknowledgment of attachment needs. For instance, being avoidant and failing to acknowledge attachment needs results in insecurity with ‘earned secure’ resulting when an attachment is acknowledged. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. This is typically seen when clingy children deal with unpredictable and preoccupied parents who are caught up in their attachment experiences. The children envision the security that they desire and apply it as they grow older resulting in ‘earned secure’ (Peterson & Bredow, 2017). As a result, experiencing insecure childhoods with disorganized, insensitive, uncooperative, dismissive and preoccupied parents can result in secure adulthoods when the child seeks to reverse the bad childhood-relationship experiences.
References
Barker, P. (1998). The future of the Theory of Interpersonal Relations? A personal reflection on Peplau’s legacy. Journal of Psychiatric and Mental Health Nursing, 5, 173-180.
Peplau, H. E. (1997). Peplau’s Theory of Interpersonal Relations. Nursing Science Quarterly, 10(4), 162-167.
Peterson, S. J. & Bredow, T. S. (2017). Middle Range Theories: Application to nursing research (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example.
 
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<69 Unacceptable 70-80 Developing 80-90 Competent 90-100 Exemplary 1. Original response Original response is at least 100 words in length Original response is at least 150 words in length Original response is at least 200 words in length Original response does not exceed 350 words in length 2. Critical thinking Does not demonstrate critical thinking, only repeats concepts stated. Posting demonstrates some critical thinking but does not connect the subject matter of the discussion with the assigned reading – including examples outside of what is mentioned in the text. Posting demonstrates some critical thinking where student connects the subject matter of the discussion with the assigned reading and demonstrates some understanding of concepts presented in the post question including examples outside of what is mentioned in the text. Posting demonstrates critical thinking where student connects the subject matter of the discussion with the assigned reading and clearly demonstrates understanding of concepts presented in the post question including examples outside of what is mentioned in the text. 3. Engagement Not engaged through the week, posted late on the weekend, which did not actively engage others in discussions. Engaged in the discussion forums with at least two (2) postings to other learners per post forum in a manner that demonstrates substantive evaluation. Did not include a minimum of 100 word response that addresses the learner’s post, shares an experience or provides an example relevant to the assigned subject matter in the post, OR ask a follow-up question to move the post forward. Actively engaged in the discussion forums with at least two (2) postings to other learners per post forum in a manner that demonstrates substantive evaluation. Did not include a minimum of 100 word response that addresses the learner’s post, shares an experience or provides an example relevant to the assigned subject matter in the post, AND asks a follow-up question to move the post forward. Actively engaged in the discussion forums with at least two (2) postings to other learners per post forum in a manner that demonstrates substantive evaluation. This includes a minimum of 100 word response that addresses the learner’s post, shares an experience or provides an example relevant to the assigned subject matter in the post, AND asks a follow-up question to move the post forward. 4. APA Does not attempt assignment, multiple errors, no citations Posting is polished some errors in mechanics, spelling, usage and sentence structure as well as APA format of citations and reference list Posting is polished minor errors in mechanics, spelling, usage and sentence structure as well as APA format of citations and reference list Posting is polished generally free of errors in mechanics, spelling, usage and sentence structure as well as APA format of citations and reference list 5. Citations and references No citation or references used. Citations and appropriate references no relevant to support the postings. No other credible used to support the post. A clear connection of the citation to support the post must be evident. Citations and appropriate references are included from the assigned reading to support the main post OR Other credible sources in ADDITON TO THE TEXT may be used to support the post. A clear connection of the citation to support the post NOT evident. Citations and appropriate references are included from the assigned reading to support the main post. Other credible sources in ADDITON TO THE TEXT may be used to support the post. A clear connection of the citation to support the post must be evident.   The legacy In formal terms, psychiatric nursing has been the beneficiary of Peplau’s interpretation of the theory of interpersonal relations for more than 45 years (e.g. Peplau 1952, 1962, 1963, 1964, 1969, 1987, 1990, 1992, 1996). For those nurses who were her colleagues, or her early students, the legacy of her understanding of the significance of that theory, and of the proper focus of nursing, is even longer. As someone whose encounter with Peplau’s work was serendipitous, and occurred relatively late in my career, my appetite for her theoretical, professional and practical writing derives, in part, from an appreciation of what I might have missed. That said, I hope that this paper will be read neither as an apologia for Peplau’s position on psychiatric–mental health nursing (PMHN) nor a hagiography. Whichever perspective one takes, Peplau’s exploration and clarification of the theory, and her examination of its relevance to various practice contexts, has significance. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. However, the greatest compliment anyone might pay to this pioneer, in the professional and academic development of PMHN, would be to submit her work to continuing critical appreciation and appraisal. A significant dimension of Peplau’s work involves its focus on human issues. It is that aspect of Peplau’s oeuvre that I shall emphasize, in this estimate of her value for future generations of PMH nurses (cf. Peplau 1995). Peplau’s humanity has been acknowledged by her colleagues, who recognize the ‘mother of psychiatric nursing’ (Lego 1996) as a: wise, caring and gentle person (who) is one of the finest and best scholars the profession has known . . . for over 60 years her scholarship has been evocative, informative, and provocative (Sills 1989, p. viii). This suggests the complex dimensions of true leadership, and connotes the benefits accrued by the field during her tenure as one of its leaders. Today, PMHN is under threat in most of the countries in the developed world, either in terms of its presumed function or its substantive focus (cf. Barker 1995, Dawson 1997). During the writing of this Journal of Psychiatric and Mental Health Nursing, 1998, 5, 213–220 © 1998 Blackwell Science Ltd 213 The future of the Theory of Interpersonal Relations? A personal reflection on Peplau’s legacy P. BARKER P h D RN FRCN Professor of Psychiatric Nursing Practice, Department of Neuroscience and Psychiatry, University of Newcastle, Royal Victoria Infirmary, Newcastle Upon Tyne BARKER P. (1998) Journal of Psychiatric and Mental Health Nursing 5, 173–180 The future of the Theory of Interpersonal Relations? A personal reflection on Peplau’s legacy The work of Hildegard Peplau represents the most significant influence, worldwide, on the development of psychiatric nursing practice. Her use of the Theory of Interpersonal Relations created the basis for defining the potential significance of the psychiatric nurse’s role as a therapeutic agent. Forty years later she has indicated the means by which nurses might sharpen their focus on the person often overshadowed by the ‘patient’ label. Peplau’s writings have, over this 40-year period, helped clarify the broad range of roles required of the nurse in general and in particular, within psychotherapeutic nursing. Keywords: interpersonal relations, Peplau’s theory, psychiatric–mental health nursing Accepted for publication: 15 January 1998 Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example Correspondence: Phil Barker Department of Neuroscience and Psychiatry University of Newcastle Royal Victoria Infirmary Newcastle Upon Tyne NE1 4LP UK paper, I received requests, simultaneously, from colleagues in Spain and England to help them argue the case against the removal of nurses from specific mental health care settings (especially for people with ‘chronic mental illness’) and their replacement with ‘generic care workers’. Nurses around the globe, almost daily on the Internet, echo such defensive actions. As the ‘mother of psychiatric nursing’ grows toward her 90th year, one wonders who might, conceivably, take her place in providing the evocative and provocative advocacy that psychiatric and mental health nursing appears to need now more than ever. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. Paper models and living theories Peplau is, unarguably, the most widely acclaimed psychiatric nursing theorist. However, McKenna (1993) discovered that, at least at the level of implementation in practice, she had only limited popularity. It is not altogether clear what this might mean for nursing theory or practice. Given the academic significance of Peplau’s exposition of the theory of interpersonal relations in nursing, no obvious acceptable explanation exists for the disinterest or apparent hostility towards her work (Gournay 1995). These conditions may be a function of cultural differences. The North American nursing tradition, within which Peplau’s work is embedded, characteristically differs from that of other countries. There exists a well-established graduate tradition within PMHN, including a 40-year history of Master’s level education. These twin traditions also have enjoyed a theoretical and practical understanding of psychotherapeutic nursing which, arguably, is to be found in no other part of the world. In 1994 the American Psychiatric Nurses Association hosted a conference based upon a critical appraisal of psychiatric nursing spanning almost five decades (1947–94). No other nation could match the sheer quantity of literature published since the end of World War Two, far less the quality of its academic standing. In that sense most, if not all, other nations are ‘underdeveloped’ by comparison with the USA. Nurses in other countries who have tried to ‘implement’ Peplau’s theory may, in a professional sense, simply not be ready for the challenges associated with Interpersonal Theory. In more specific terms, it is clear that many of the nurses who have tried to accommodate the Theory of Interpersonal Relations in their work will have only limited opportunity to experience, at first hand, the experiential teaching dimension (Peplau 1957) of education in practice, for practice. In the UK, for example, many generations of nurses have been taught in classrooms by nurse teachers, both of which are remote from the everyday clinical practice context to which Peplau referred (cf. Reynolds 1982). By contrast, many North American nursing students will have been exposed to ‘clinically focused learning’ by their teachers – up to and including the Professor of Nursing – in the clinical milieu. If there are any grounds for accepting this professional–cultural hypothesis, it may be that the nature of their educational preparation generates, unwittingly, a contextual threat when nurses are required to ‘experience directly’ and ‘reflect upon the experience’ of relating to their patients, far less (how they experience) themselves. Such anxieties may encourage nurses to elect to employ ‘models’ of nursing (as opposed to a theory) that provide them with the security they desire: structures that will contain their interactions with patients. Such ‘containment’ may also serve as a buffer against too close an engagement with people in severe mental distress. A handful of authors have, within recent history, expressed overtly critical views of Peplau and her theorizing, wishing to consign them both to the dustbin of history, or to write them off as mere footnotes to nursing history. Such criticisms may have a critical subtext. They may merely be extreme examples of the ‘continuing critical appreciation and appraisal’ of Peplau’s contribution Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. They may, alternatively, be illustrations of the experiences of nurses who have not been acculturated in the experiential tradition that underpins Peplau’s theorizing. Such criticisms may even be interpreted as indicative of a lack of understanding of Peplau’s work, or a failure to appreciate its significance. In Lego’s view, some critics – such as Gournay (1995) – may even be harbouring competing ambitions for the future of PMHN (cf. Lego 1997). What is not in dispute, and is remarkable, is that the first theory to be applied rigorously within nursing, and its advocate, should still be at the heart of an academic controversy almost 50 years after its first publication. Despite having been in retirement for more than two decades Peplau continues to contribute to debates about nursing, mental illness and health, and the role of the nurse in describing and responding to such phenomena. However, her recent re-emphasis of the personal dimension of interpersonal theory presents some nurses with a conundrum. As Rolfe (1996) has observed, Peplau is proposing that everyone should be treated as individuals, emphasizing how people differ from one another. However, this may mean that (Rolfe 1996, p. 332): She is saying, in effect: my model, which applies to everyone, is that there are no models which apply to everyone. Thus, if the proper focus of nursing is the unique and individual therapeutic relationship, then neither models nor theories (nor indeed, research-based practice) have a primary role to play in the planning and implementation of nursing care. Rolfe’s view presents an intriguing challenge: does the P. Barker 214 © 1998 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 5, 213–220 mere existence of any model or theory of interpersonal relations prejudice naturalistic inquiry into the ‘uniqueness’ of the individual patient? Alternatively, how shall we ‘map’ the unique territory of the individual person qua patient, without the guiding parameters of some model or theory? (cf. Grinder & Bandler 1976). Given that the answers to such questions are not immediately apparent, they may represent areas of further research into the roles and functions of models and theories for professional practice. The identity of psychiatric nursing: paradigms old and new Although not specifically concerned with consciousness per se Peplau’s use of the Theory of Interpersonal Relations encouraged nurses to look beyond the delimiting parameters of the patient label and to begin to consider what it might mean to be the person. Indeed, her recent interest in ‘persons’ (Peplau 1995) suggested the almost infinite possibilities afforded by the exploration of interpersonal dialogue. As Oatley (1990, p. 83) observed: Freud’s striking proposal is that in a dialogue, that can be retold in a story form, about abuses of power, about imperfections and evasions, we can take a few steps towards truths that may be transformative. It was this idea that Freud glimpsed; even if not quite clearly enough to transform himself . Peplau had earlier remarked that: ‘language influences thought, thought then influences action; thought & action together evoke feelings in relation to a situation or context (Peplau 1969, p. 267). The interest in the role of language extends to contemporary cognitive scientists. Fodor (1983, p. 56) has acknowledged that: Our privileged access to thoughts is, to a considerable extent, a matter of the contents of our beliefs and intentions being available for verbal report [emphasis added]. Common sense logic decrees that we could hardly overstate the importance of such ‘verbal reports’, as contributions towards our understanding of what it means to be a person, in any given situation – including that of health or illness. Yet, increasingly the examination and exploration of the state of being – on an existential level – has been marginalized. The emerging consensus is that we might understand what it means to be human, by unravelling the mysteries of the brain through which our beliefs and intentions are expressed. This raises the question, what is the proper focus of nursing? (Barker & Reynolds 1996). More specifically, we might ask is nursing concerned with the ‘mind’ or its brain? Almost 20 years ago the US government pledged its support for a portfolio of neuroscientific research earning the 1980s the title ‘Decade of the Brain’. Although the impetus for that paradigm shift has grown exponentially, it remains unclear to what extent laboratory-based research will explain, far less resolve, human problems that may derive from a complex of person–environment interactions in the organized chaos of the everyday world (Barker 1996a). The influence of the ascendancy of neuroscience is now being felt within PMHN. It has been advocated that psychiatric nurses should accommodate various biomedical models of understanding human problems (e.g. Torrance & Jordan 1995) and should employ biological or psychopharmacological models as a means of understanding their patients (cf. Gournay 1995). Whether or not such approaches will help us understand those patients as persons (cf. Rolfe 1996) remains unclear. These views appear closely aligned to the contemporary drive towards ‘clinical effectiveness’ and ‘evidence-based practice’ (e.g. NHSE 1993), both of which appear to favour the perceived ‘gold standard’ of randomized control trials (RCTs) and the virtue of quantifying human experience. At the risk of stereotyping, these latter-day representations of the ‘old (Cartesian–Newtonian) paradigm’ (cf. Capra 1976) appear to represent an overtly ‘masculine’ psychiatric world view: focused on the negative attributes of people; their conflicts and past traumas, or their contemporary consequences. That paradigm adopts an essentially rational, analytic, linear, objectifying, fragmenting, dismantling, disempowering and distancing approach to human distress; assuming the presence of a subject-object duality that neither fits with everyday experience nor with the propositions of contemporary physics, far less psychology and sociology. Ultimately, its conjoint aims may be the control of such psychiatric phenomena, through the refinement of its techniques. Peplau Interpersonal Relations Theory and Bowlby Human Attachment Theory essay example. The ‘old paradigm’ may represent the patriarchal imbalance in post-modern society, one that fails to acknowledge – far less approve of – its ‘feminine’ side. Dawson (1997, p. 70) has argued that: the language of nursing, of meaning, of care, of subjectivity and of spirituality has been suborned by the onedimensional language of the technocratic society, which purchases a spurious exactness at the cost of meaning. In healthcare that ‘old paradigm’ technocracy finds expression in materialism and managerialism, both of which implicitly challenge the principles upon which many nurses believe that nursing is founded, and is (Dawson 1997 p. 70): revealed in the tortured vocabulary that attempts to reconstitute the whole from the pieces left strewn on the battlefield of rational investigation: ‘biopsychosociocultural’, ‘psychosocial’ mantras that are repeated ad nauseam in psychiatric nursing texts. The words themFuture of Interpersonal Relations © 1998 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 5, 213–220 215 selves indicate the essentially divided and atomistic nature of the constructed reality that their enforced unity parodies; the mode of reasoning being employed is still, in essence, analytic rather than holistic, and the praxis is instrumental and objectifying. In its ambition to ‘treat’ people, albeit compassionately, approaches derived from the ‘old paradigms’ largely eschew attempts at understanding. Despite its continued celebration of the value and relevance of post-positivist methodology (cf. Guba 1991), Western culture has been flooded with proposals for a ‘new paradigm’ of science; one that suggests the inherent wisdom of balancing ‘masculine’ and ‘feminine’ world views. Borrowing the Oriental metaphor of Yin and Yang, this new paradigm recognizes that science and the arts are complementary and, more importantly, emphasize the need to view human experience in terms of contexts and wholes, rather than isolated parts (cf. Barker 1998). Within the context of mental distress and health the new paradigm emphasizes the value: in research, of co-operative inquiry (Heron 1996); in practice, of working alliances (Anderson 1991); in mental health, of valuing personal experience (Chamberlin 1984, Fisher 1992); and, generally, of tolerating paradox and uncertainty (Ikehara 1995). Given these assumptions, the ‘new paradigm’ honours people’s feelings and intuition, recognizing that in deciding upon and enacting life change a person must first reclaim her (sic) inner wisdom and power. Qualitative research methods are integral to this paradigm shift and nursing has, perhaps, embraced such approaches to human inquiry, more so than other health care disciplines. Several studies have suggested that the ‘value’ attributed to psychiatric nursing, by people receiving nursing, is predicated on the form and function of the interpersonal relationship (Barker 1995, Barker et al. 1997, Beech & Norman 1995, Hellzen et al. 1995, Wray 1994). These studies echo the dictum of the ANA (1980) that nursing is focused on human responses to health care problems rather than on the problems themselves. Of particular note, in this context, was the English national survey of over 500 former ‘patients’ which not only reported greater value attached to nurses over any other discipline, but a preference for the ‘soft focus’ of relationships over formal methods of counselling or therapy (Rogers, Pilgrim & Lacey 1993). Even some psychiatrists have challenged the potential confusion between what might be happening in the brain as opposed to what might be happening within the person (cf. Thomas 1997). Given the importance of psychopharmacology in contemporary psychiatry, Healy (1990) proposed the need to re-establish a phenomenological approach to drug treatment: how do drugs affect the mind or the individual consciousness? These examples suggest that reflective psychiatrists also recognize the interpersonal importance of the psychiatric experience: persons may have as much of a relationship with their brains as they do with other aspects of their experiential world. Relationships, partnerships and alliances These contemporary developments carry discrete implications for the role of the PMH nurse. As awareness of the interdependent, or reflexive, nature of the interpersonal relationship grows, it has been recognized that ‘consumers’ of mental health services need (or perhaps rather deserve) a voice to determine their own affairs. This has led, indirectly, to greater emphasis being put upon the potential for, or desirability of, a more collaborative style of relationship; one guided more by co-operative inquiry than the objective style of inquisition often favoured by the ‘old paradigm’. Contemporaneously, the value (and virtue) of psychotherapy in general has been attacked (Masson 1988), and many mental health service consumers appear openly antagonistic to any form of ‘systematic’ therapy (Rogers, Pilgrim & Lacey 1993). Although representing differing perspectives, these critiques invite us to consider the potential of concepts such as ‘working in partnership’ (cf. DoH 1994). Given that partnerships are predicated on equality, conspicuously absent from most, if not all, care and treatment settings, it might be more appropriate to consider a future established on alliances (cf. Bordin 1976). Such a concept might form the basis for exploring the interpersonal relationship between nurse and patient (sic). This concept might also represent a new dimension for the supervisory and mentoring relationship which, despite widespread popularity, is still misunderstood (Barker 1990). More than 30 years ago Peplau began to identify some of the issues involved (O’Toole & Welt 1989, p. 165): (what would it [clinical supervision] be like?), e.g. a systematic study of instances of clinical data in one case or several cases; relevant literature; and a beginning formulation of an explanation of the data. The kind of supervisory relationship which Peplau was discussing appeared to be predicated on a power relationship: where the supervisor and supervisees were defined, at least in part, by their respective qualifications, experience, etc. Currently, I am a member of a peer supervision group where, despite my professional status as ‘the Professor’ I am re-defined – by my colleagues – as being on the same level as the most ‘junior’ staff nurse member. The agenda for all meetings of the group are mutually negotiated and, despite the differentials in length of experience and social status, my contribution is (in principle) of no greater value P. Barker 216 © 1998 Blackwell Science Ltd, Journal of Psychiatric and Mental Health Nursing 5, 213–220 than that of any other member. Such developments in the structure of clinical supervision suggest the potentially limitl

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