Interpersonal Relations Theory

Hildegard Peplau (1909-1999)

"Mother of Psychiatric Nursing,"

Coined the term and developed the
concept of psychodynamic nursing
(understanding ones own behavior to
help others identify felt difficulties).

Origins of the Theory

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.

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.
Therapeutic Nurse-Patient Relationship
Involves interaction between two or more
individuals with a common goal, focusing on
the clients needs, feelings, problems, and ideas.
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

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

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.

available resources and services

2. Identification Phase

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

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

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

Roles of the Nurse in the Therapeutic

Relationship
The primary roles she identified are as follows:
Stranger
Resource person
Teacher
Leader
Surrogate
Counselor

consultant, tutor, safety agent, mediator,

administrator, observer, and researcher.

Application to Nursing Practice

The phases of the therapeutic nurse-client are
highly comparable to the nursing process
making it vastly applicable.

Assessment
--orientation phase;
Nursing diagnosis
and planning --identification phase;
Implementation --exploitation phase;
Evaluation
--resolution phase.

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
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 nursepatient
interaction,
thus
providing
generalizability.
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.
Research Based on Peplaus theory
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.
Develop and Test a Nursing Intervention
Framework for Working with Anxious Patients:
Students develop competency in beginning
interpersonal relationships
Recovering in depressed women: research with
Peplau's theory
A Naturalistic Test of Peplau's Theory in Home
Visiting: This article reports a small study that
tested the applicability of Peplau's theory of
interpersonal relations in nursing in the context
of home visiting. Findings of this study
supported Peplau's theory.