Hildegard Peplau Theory of Interpersonal Relations

Introduction

Theorist -Hildegard. E. Peplau

Born in Reading, Pennsylvania [1909], USA

Diploma program in Pottstown, Pennsylvania in 1931.

BA in interpersonal psychology - Bennington College in 1943.

MA in psychiatric nursing from Colombia University New York in 1947.

EdD in curriculum development in 1953.

Professor emeritus from Rutgers university

Started first post baccalaureate program in nursing

Published Interpersonal Relations in Nursing in 1952

1968 :interpersonal techniques-the crux of psychiatric nursing

Worked as executive director and president of ANA.

Worked with W.H.O, NIMH and Nurse Corps.

Died in 1999.

Theory of interpersonal relations is a middle range descriptive classification theory.

The theory was influenced by Harry Stack Sullivan's theory of inter personal relations
(1953).

The theorist was also influenced by Percival Symonds, Abraham Maslow's and Neal
Elger Miller.

Peplau's theory is also refered as psychodynamic nursing, which is the understanding of

ones own behavior.

Major Concepts

The theory explains the purpose of nursing is to help others identify their felt difficulties.

Nurses should apply principles of human relations to the problems that arise at all levels
of experience.

Peplau's theory explains the phases of interpersonal process, roles in nursing situations
and methods for studying nursing as an interpersonal process.

Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in

need of health care.

Nursing is an interpersonal process because it involves interaction between two or more

individuals with a common goal.

The attainment of goal is achieved through the use of a series of steps following a series
of pattern.

The nurse and patient work together so both become mature and knowledgeable in the
process.

Definitions

Person: A developing organism that tries to reduce anxiety caused by needs.

Environment: Existing forces outside the organism and in the context of culture

Health: A word symbol that implies forward movement of personalityand other ongoing
human processes in the direction
of creative,constructive, productive, personal and community living.

Nursing: A significant therapeutic interpersonal process. It functions cooperatively with

other human process that make health possible for individuals in communities.

Roles of nurse

Stranger: receives the client in the same way one meets a stranger in other life situations
provides an accepting climate that builds trust.

Teacher: who imparts knowledge in reference to a need or interest

Resource Person : one who provides a specific needed information that aids in the
understanding of a problem or new situation

Counselors : helps to understand and integrate the meaning of current life

circumstances ,provides guidance and encouragement to make changes

Surrogate: helps to clarify domains of dependence interdependence and independence

and acts on clients behalf as an advocate.

Leader : helps client assume maximum responsibility for meeting treatment goals in a
mutually satisfying way

Additional Roles include:

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Technical expert
Consultant
Health teacher
Tutor
Socializing agent
Safety agent
Manager of environment
Mediator
Administrator
Recorder observer
Researcher

Phases of interpersonal relationship

Identified four sequential phases in the interpersonal relationship:
1.

Orientation

2.

Identification

3.

Exploitation

4.

Resolution

Orientation phase

Problem defining phase

Starts when client meets nurse as stranger

Defining problem and deciding type of service needed

Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and
expectations of past experiences

Nurse responds, explains roles to client, helps to identify problems and to use available
resources and services

Factors influencing orientation phase

Identification phase

Selection of appropriate professional assistance

Patient begins to have a feeling of belonging and a capability of dealing with the problem
which decreases the feeling of helplessness and hopelessness

Exploitation phase

Use of professional assistance for problem solving alternatives

Advantages of services are used is based on the needs and interests of the patients

Individual feels as an integral part of the helping environment

They may make minor requests or attention getting techniques

The principles of interview techniques must be used in order to explore, understand and
adequately deal with the underlying problem

Patient may fluctuates on independence

Nurse must be aware about the various phases of communication

Nurse aids the patient in exploiting all avenues of help and progress is made towards the
final step

Resolution phase

Termination of professional relationship

The patients needs have already been met by the collaborative effect of patient and nurse

Now they need to terminate their therapeutic relationship and dissolve the links between
them.

Sometimes may be difficult for both as psychological dependence persists

Patient drifts away and breaks bond with nurse and healthier emotional balance is
demonstrated and both becomes mature individuals

Interpersonal theory and nursing process

Both are sequential and focus on therapeutic relationship

Both use problem solving techniques for the nurse and patient to collaborate on, with the
end purpose of meeting the patients needs

Both use observation communication and recording as basic tools utilized by nursing

Assessment

Data collection and analysis

Orientation

Non continuous data collection

Felt need

Define needs

[continuous]

May not be a felt need

Nursing diagnosis

Identification

Planning

Mutually set goals

Implementation

Plans initiated towards achievement of

Exploitation

mutually set goals

Interdependent goal setting

May be accomplished by patient , nurse

Patient actively seeking and drawing

help

Patient initiated

or family

Evaluation

Resolution

Based on mutually expected behaviors

Occurs after other phases are completed

successfully

May led to termination and initiation of

new plans

Leads to termination

Peplaus work and characteristics of a theory

Interrelation of concepts

o Four phases interrelate the different components of each phase.

Applicability

o The nurse patient interaction can apply to the concepts of human being, health,
environment and nursing.

Theories must be logical in nature -

o This theory provides a logical systematic way of viewing nursing situations

o Key concepts such as anxiety, tension, goals, and frustration are indicated with
explicit relationships among them and progressive phases

Generalizability

o This theory provides simplicity in regard to the natural progression of the NP

relationship.

Theories can be the bases for hypothesis that can be tested

o Peplau's theory has generated testable hypotheses.

Theories can be utilized by practitioners to guide and improve their practice.

o Peplaus anxiety continuum is still used in anxiety patients

Theories must be consistent with other validated theories, laws, and principles but will
leave open unanswered questions that need to be investigated.
o Peplau's theory is consistent with various theories

Limitations

Personal space considerations and community social service resources are considered
less.

Health promotion and maintenance were less emphasized

Cannot be used in a patient who doesnt have a felt need eg. With drawn patients,
unconscious patients

Some areas are not specific enough to generate hypothesis

Research Based on Peplaus Theory

Hays .D. (1961). Phases and steps of experimental teaching to patients of a concept of
anxiety: Findings revealed that when taught by the experimental method, the patients
were able to apply the concept of anxiety after the group was terminated.

Burd .S.F. Develop and test a nursing intervention framework for working with anxious
patients: Students developed competency in beginning interpersonal relationship.

References
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Philadelphia, Lippincott.

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Philadelphia, Lippincott.
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