Interpersonal Relations Theory

By Hildegard Peplau

In Partial Fulfillment for the Requirements in

Theoretical Foundations in Nursing MN-101

Submitted to
Kristine Acanto Condes
Subject Teacher

Submitted by
Gallo, Ara Gayares, RN
Student

Northern Negros State College of Science and Technology

Bacolod City

January 16, 2016

Interpersonal Relations Theory

Hildegard Peplau (1909-1999)

Hildegard E. Peplau, 89, one of the worlds leading nurses
and theorists, known to many as the Nurse of the Century and
"Mother of Psychiatric Nursing," coined the term and developed the
concept of psychodynamic nursing (understanding ones own
behavior to help others identify felt difficulties).
Peplaus original intent was not theory development per se.
She wanted only to convey to the nursing profession ideas she
thought were important to improve practice. Her focus was the
quality of nurse-patient interactions and nursing education.
Philosophical Foundations and Origins of the Theory
Though it was not directly stated, a philosophical foundation was implied throughout
Peplaus theory. Over the years, there have been differing perspectives regarding the
philosophical underpinnings of her work. In 1998, Existential Phenomenology was identified as
the philosophical foundation of Peplaus theory.
Values and Beliefs:
1. Behavior is purposeful & has meaning.
2. The nurse must observe & interpret.
3. The nurse meets the needs of the patient.
4. The nurse-patient interaction influences recovery.
5. The personality of the patient is involved in his/her illness.
6. There are some ideas about nursing care that relate to anxiety.

Peplau introduced the "nurse-patient relationship" idea 40 years ago, a time when patients
did not actively participate in their own care.

Peplau used both deductive and inductive methods in her theory development work.
Deductively, she integrated ideas from a number of theories into her theory. She was
influenced by the work of:
Sigmund Freud, his interest in unconscious motivation;
Harry S. Sullivans theory of interpersonal relations, concepts of anxiety, self-system,
and modes of experiencing;
Elements from developmental psychology and learning theory;
Ideas of the humanistic psychologists Abraham Maslow, Rollo May, and Carl Rogers.

Inductive process of theory development involved using data from student-patient

interactions. It was from these observations that psychotherapy by nurses in the context
of the interpersonal relationship emerged.
MAJOR CONCEPTS

Person/ Man- an organism that strives in its own way to reduce tension generated by
needs. The client is an individual with a felt need.

Environment- existing forces outside the organism and in the context of culture, from
which mores, customs and beliefs are acquired.

Health- 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.

Nursing- considered to be a significant, therapeutic, interpersonal process. She defines

it as a human relationship between an individual who is sick, or in need of health
services, and a nurse specially educated to recognize and to respond to the need for help.

The person has human needs that are affected by their environment. Once the environment
affects the persons health in a negative way, nurses make an encounter with the patient and
make their contribution. Peplau has a holistic view of nursing, because she focuses on the
interpersonal relationship of the whole person.
Theoretical Framework

Interpersonal Focus
The interpersonal focus of Peplaus theory requires that the nurse attend to the
interpersonal processes that occur between the nurse and client. This is in sharp contrast to many
nursing theories that focus on the client as the unit of attention. Although individual client factors
are assessed, the nurse also self-reflects. The focus is the interpersonal process and relationships,
not the constituent parts (or individuals). Interpersonal processes include: the nurse-client
relationship, communication, pattern integration, and the roles of nurse. The Interpersonal
Relations Theory assists the nurse to observe more intelligently and intervene more sensitively.
Therapeutic Nurse-Patient Relationship
Involves interaction between two or more individuals with a common goal, focusing on
the clients needs, feelings, problems, and ideas. Nurses own emotional needs should not get in
the way of tending to the needs of the patient. The attainment of this goal, or any goal, is
achieved through a series of steps following a sequential pattern.
Four Phases of the therapeutic nurse-patient relationship:
1. Orientation Phase
Directed by the nurse and involves engaging the client in treatment, providing
explanations and information, and answering questions. It 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.

2. Identification Phase

Begins when the client works interdependently with the nurse, expresses feelings, and
begins to feel stronger.
Client works interdependently with the nurse
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

3. Exploitation Phase

Client makes full use of the services offered.

Individual feels as an integral part of the helping environment
The principles of interview techniques must be used in order to explore, understand and
adequately deal with the underlying problem
Patient may fluctuate on independence
Nurse aids the patient in exploiting all avenues of help and progress is made towards the
final step
Use of professional assistance for problem solving alternatives
Advantages of services are used is based on the needs and interests of the patients
They may make mirror 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
Nurse must be aware about the various phases of communication

4. Resolution Phase

The patients needs have already been met by the collaborative effect of patient and nurse
Client no longer needs professional services and gives up dependent behavior. The
relationship ends.
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
Termination of professional relationship
Now they need to terminate their therapeutic relationship and dissolve the links between
them.

SUBCONCEPTS
Roles of the Nurse in the Therapeutic relationship
The nurse may enact several roles with the client. The roles depend on the needs of the
client and the skills and creativity of the nurse. The possible roles will also be influenced by the
nurses position and agency policies.
The primary roles identified are as follows:

Stranger: offering the client the same acceptance and courtesy that the nurse would to
any stranger in other life situations providing an accepting climate that builds trust.

Resource person: providing specific answers to questions within a larger context that
aids in the understanding of a problem or new situation

Teacher: who imparts knowledge in reference to a need or interest, helping the client to
learn formally or informally

Leader: offering direction to the client or group; helps client assume maximum
responsibility for meeting treatment goals in a mutually satisfying way

Surrogate: serving as a substitute for another such as a parent or a sibling; helps to

clarify domains of dependence interdependence and independence and acts on clients
behalf as an advocate.

Counselor: promoting experiences leading to health for the client such as expression of
feelings; helps to understand and integrate the meaning of current life circumstances,
provides guidance and encouragement to make changes

Peplau also believed that the nurse could take on many other roles, including consultant,
tutor, safety agent, mediator, administrator, observer, and researcher. These were not
defined in detail but were left to the intelligence and imagination of the readers.

Anxiety was defined as the initial response to a psychic threat.

Four Levels of Anxiety
1. Mild anxiety is a positive state of heightened awareness and sharpened senses, allowing
the person to learn new behaviors and solve problems. The person can take in all available
stimuli (perceptual field). Person is alert and perceptual field is increased; can motivate
learning and produce personal growth.
2. Moderate anxiety involves a decreased perceptual field (focus on immediate task only);
the person can learn new behavior or solve problems only with assistance. Another person
can redirect the person to the task. Person focuses only on immediate concerns; involves
narrowing of the perceptual field.
3. Severe anxiety involves feelings of dread and terror. The person cannot be redirected to a
task; he or she focuses only on scattered details and has physiologic symptoms of
tachycardia, diaphoresis, and chest pain. Marked by a reduction in the perceptual field. The
person focuses on a specific detail.
4. Panic anxiety can involve loss of rational thought, delusions, hallucinations, and complete
physical immobility and muteness. The person may bolt and run aimlessly, often exposing
himself or herself to injury. Associated with dread and terror. Person is unable to do things
even with direction. Involves disorganization of the personality and can be life threatening.
Person is unable to communicate or function effectively.

Assumptions
1) The kind of nurse each person becomes makes a substantial difference in what each client
will learn as she or he is nursed throughout his or her experience with illness.
2) Fostering personality development in the direction of maturity is a function of nursing
and nursing education; it requires the use of principles and methods that permit and guide
the process of grappling with everyday interpersonal problems or difficulties.

3) Nursing can take as its unique focus the reactions of clients to the circumstances of their
illness or health problems,
4) Since illness provides opportunity for learning and growth, nursing can assist clients to
gain intellectual and interpersonal competencies, beyond those that they have at the point
of illness, by gearing the nursing practices to evolving such competencies through nurseclient interactions.
5) Psychodynamic nursing crosses all specialty areas of nursing. It is not synonymous with
psychiatric nursing since every nurse-client relationship is an interpersonal situation in
which recurring difficulties of everyday life arise.
6) Difficulties in interpersonal relations recur in varying intensities throughout the life of
everyone.
7) The need to harness energy that derives from tension and anxiety connected to felt needs
to positive means for defining, understanding and meeting productively the problem at
hand is a universal need.
8) All human behavior is purposeful and goal-seeking in terms of feelings of satisfaction
and/or security.
9) The interaction of nurse and client is fruitful when a method of communication that
identifies and uses common meanings is at work in the situation.
10) The meaning of behavior to the client is the only relevant basis on which nurses can
determine needs to be met.
11) Each person will behave, during any crises, in a way that has worked in relation to crises
in the past.
Nurse and patient can interact.
Peplau stresses that both the patient and nurse mature as the result of the therapeutic
interaction.
Communication and interviewing skills remain fundamental nursing tools.
Peplau believed that nurses must clearly understand themselves to promote their clients
growth and to avoid limiting clients choices to those that nurses value.
Propositions
Relations between major concepts in Peplaus theory can be seen as concepts that are all
interrelated, and that a change in one concept generally is reflected by future changes of other
concepts. Most critically, the evolving nurse-client relationship moves the client through growth
and therefore health.

APPLICATIONS OF THE THEORY

Nursing Practice
The phases of the therapeutic nurse-client are highly comparable to the nursing process making it
vastly applicable.
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
Orientation
Data collection and analysis
Non continuous data collection
[continuous]
Felt need
May not be a felt need
Define needs
Nursing diagnosis
Planning

Identification

Mutually set goals

Implementation

Interdependent goal setting

Plans
initiated
towards
achievement of mutually set
goals

Exploitation

Patient actively
drawing help

Patient initiated

seeking

and

May be accomplished by
patient , nurse or family

Evaluation

Resolution

Based on mutually expected

behaviors

Occurs after other phases

completed successfully

May led to termination and

initiation of new plans

Leads to termination a

are

 It implies that a nurses duty is not just to care but the profession encompasses every activity that
may affect the care of the patient.
The concepts are highly applicable with the care of psychiatric patients, but it is not limited in
those set of individuals. It can be applied to any person capable and has the will to
communicate.
The nurse can more easily obtain important information form the patient when there is a good
patient-nurse relationship
To utilize this theory in the nursing practice, the nurse recognizes that the client move from one
phase of dependence to independence during the nurse-patient interaction for the provision of
health care.
Nursing Education
Because nursing theory is used primarily to establish the profession's place in the
university, it is not surprising that nursing theory has become more firmly established in
academia than in clinical practice. Many nursing programs identified the major concepts into a
conceptual framework and then attempted to organize the entire curriculum around that
framework. Peplaus theory applies to both educator and the student. In a classroom setting,
developing a student teacher relationship will help the student become more eager to learn,
resulting in a better understanding and better grades. In the health care setting, the nurse educates
the patient. This makes the patient feel more comfortable when being educated on their
medications and treatments.
An example of a research conducted is the: Power to Gain Knowledge (Bradbury
Jones, 2012), a study on nursing students 2007-2009 which produced the following results on the
effect of interpersonal relationships on education: Students felt empowered, Increased clinical
ability, Increased ability to empower patients.
Nursing Research
In research, Nurse scholars have repeatedly insisted that nursing research identifies the
philosophical assumptions or theoretical frameworks on which it is based. That is because all
thinking, writing, and speaking is based on previous assumptions about people and the world.
1. Theory provides direction for nursing research. Use the theory as framework in
research.
2. Relationships of components in a theory help to drive the research questions for
understanding nursing. Develop propositions using concepts of the theory.
Example studies are the following:

Home Health Care Nurse Perceptions of Geriatric Depression and Disability Care
Management
Purpose of the Study: Psychosocial interventions alone or combined with antidepressant
medication can effectively treat mild to moderate geriatric depression.

Incorporating Peplaus Theory of Interpersonal Relations to Promote Holistic

Communication Between Older Adults and Nursing Students
The purpose of the Study: to examine Hildegard Peplaus interpersonal relations theory
as a framework to assist nursing students to understand holistic communication skills
during their encounters with older adults.

Ideology of Nursing Care in Child Psychiatric Inpatient Treatment

The aim of this study was to describe and explore the ideological approaches guiding
psychiatric nursing in child and adolescent psychiatric inpatient wards in Finland, and
discuss the ethical, theoretical and practical concerns related to nursing ideologies.

The Button Initiating the PatientNurse Interaction

Patientnurse interactions are foundational to care that is desired by patients. Evidence
about patient-initiated interactions with nurses is scant and little focus has been placed on
the meaning to patients of ways to call for help when needed. The purpose of this
secondary analysis was to provide a more intensive focus on initiative, one of four
categories identified in a grounded theory study related to the perception of feeling safe
in intensive care.

Improving Subject Recruitment, Retention, and Participation in Research through

Peplaus Theory of Interpersonal Relations
Recruitment and retention of persons participating in research is one of the most
significant challenges faced by investigators. Although incentives are often used to
improve recruitment and retention, evidence suggests that the relationship of the patient
to study personnel may be the single, most important factor in subject accrual and
continued participation. Peplaus theory of interpersonal relations provides a framework
to study the nurse-patient relationship during the research process.

Area of Interest: PSYCHIATRY

Since the theory was influenced by Harry Stack Sullivans Theory of Interpersonal
Relations, and since Hildegard Peplau is known as the Mother of Psychiatric Nursing, it is
therefore safe to say that the area of interest of Hildegard Peplaus theory is on Psychiatry.

Peplaus Theory led the way towards humane treatment of patients with behavior and
personality disorders. Nurses, she thought, could facilitate this through observation, description,
formulation, interpretation, validation and intervention. She also taught interpersonal concepts
and interviewing techniques, as well as individual, family and group therapy.
Peplaus Interpersonal Relations Theory stresses the importance of nurses ability to
understand their own behaviors to help others identify perceived difficulties considering that
psychiatric patients, at times, have difficulty explaining themselves. In communication, verbal
and nonverbal requires nurse to recognize and understand its meaning. Nurses own selfunderstanding helps nurse to respond to tensions and coping mechanisms, guiding patients
toward healing; tension and anxiety are converted into purposeful action as the result of the
therapeutic relationship. It emphasizes the focus on the interpersonal processes and therapeutic
relationship that develops between the nurse and client.
Trust is a big issue with psychiatric patients, but without their trust you cannot gain their
cooperation. This is where the interlocking functions a nurse undertake to assist a client, coupled
with the application of the four phases of the therapeutic nurse-patient relationship. When your
perform the different roles of a nurse, you are showing your patient that you are able to adjust to
their needs, could offer them answers, impart in them knowledge, be their advocate, encourage,
and guide them and show them the acceptance and courtesy they deserve. Historically,
psychiatric nurses acted as surrogate parent, promoting dependency and custodial care to the
patient, but Peplau believed this unhealthy, preventing healing and growth., instead, show them
that you are worthy of their trust and thus achieving their cooperation and aid them in their path
to good health, without compromising both parties; helping patients to help themselves.
But then Peplaus theory is not limited to only one specific area. It can be used in any
specialty area or setting and not confined to just psychiatry, since it is holistic in nature. It may
be used in practice domains where interpersonal or intrapersonal difficulties are taking place
Strengths:

Peplaus theory helped later nursing theorists and clinicians develop more therapeutic
interventions regarding the roles that show the dynamic character typical in clinical
nursing.
The phases provide simplicity regarding the natural progression of the nurse-patient
relationship; leading to adaptability in any nurse-patient interaction, thus providing
generalizability.
This theory provides a logical systematic way to viewing nursing situations
Key concepts such as anxiety, tension, goals and frustration are indicated with explicit
relationships among them and progressive phases.

Weaknesses:

Health promotion and maintenance were less emphasized.

The theory cannot be used in a patient who doesnt have a felt need such as with
withdrawn patients, paralyzed or unconscious patients.

Personal space considerations and community social services resources are considered
less.
Some areas are not specific enough to generate hypothesis.

Analysis of the Theory

The Interpersonal Relations Theory is easily understood, consistent and semantic, with
conceptualized clear sets of nurses roles that can be used by each and every nurse with their
practice. Its assumptions and key concepts were clearly given, explained, broken down and
outlined. It demonstrates clearly and identified properly the four phases of nurse-patient
relationship and interpersonal model. The basic core of the theory is simple, but certain aspects
of the psychology in communication make it more complex. The concepts are highly applicable
with the care of psychiatric patients considering Peplaus background. But it is not limited in
those set of individuals. It can be applied to any person capable and has the will to communicate,
which could then be tested and observed using pure observation, where in fact Peplaus anxiety
continuum is still used in anxiety patients.
The phases of the therapeutic nurse-client are highly comparable to the nursing process
making it vastly applicable. Assessment coincides with the orientation phase; nursing diagnosis
and planning with the identification phase; implementation as to the exploitation phase; and
lastly, evaluation with the resolution phase. It widens the perception of nursing profession and
touched the lives of many, focusing on improving patients autonomy and maturity.
In real life application, nurses should be treating patients in a holistic fashion, no matter
the context it should be utilized more than it is, for the patients sake. It might require time and
practice to master, so start with the basics with a continual process improvement. Observation
and understanding of what is observed are essential operations for making judgements and
designing experiences with patients that aid them in the solution of their problems. The
interactions with the patient would spawn deeper thinking in both the patient and the nurse
towards a positive healthcare outcome. Integrating the theory into daily practice within any area
of clinical nursing will produce multi-faceted effects. Nurses will be less self-gratifying, and
more in tune to the needs of the patient and support systems, as well as filtering into peer and
professional relationships. Patients would perceive being better understood.
CONCLUSION

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.
Peplaus 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.
Treating patients in a holistic fashion, no matter the context. Helping patients to help
themselves.

SOURCES

Middle Range Theories: Application to Nursing Research, edited by Sandra J. Peterson,

Timothy S. Bredow

Mastering Fundamentals of Nursing Second Edition- Concepts and Clinical Application, Jose
Quiambao-Udan, RN, MAN

Fundamentals of Nursing Fifth Edition- The Art and Science of Nursing Care, Carol Taylor,
Carol Lillis, Priscilla LeMone

http://gerontologist.oxfordjournals.org/

http://nursingtheories.weebly.com

http://slsu-coam.blogspot.com

http://www.scielo.br

https://www.questia.com/

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