PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP

INTRODUCTION
 Hildegard Peplau’s Interpersonal Relationship Theory emphasized the
nurse-client relationship as the foundation of nursing practice.
 It gave emphasis on the give-and-take of nurse-client relationships that was
seen by many as revolutionary.
 Peplau went on to form an interpersonal model emphasizing the need for a
partnership between nurse and client as opposed to the client passively
receiving treatment and the nurse passively acting out doctor’s orders.
HISTORY AND BACKGROUND
 Hildegard Peplau’s was an American nurse who is the only one to serve the
American Nurses Association (ANA) as Executive Director and later as
President.
 She became the first published nursing theorist since Florence Nightingale.
 Peplau was well-known for her Theory of Interpersonal Relations, which
helped to revolutionize the scholarly work of nurses.
 Her achievements are valued by nurses all over the world and became
known to many as the “Mother of Psychiatric Nursing” and the “Nurse of
the Century.”
 She was the second daughter, having two sisters and three brothers.
 Though illiterate, her father was persevering while her mother was a
perfectionist and oppressive.
 With her young age, Peplau’s eagerness to grow beyond traditional
women’s roles was precise.
 She considers nursing was one of few career choices for women during her
time.
 After graduation, she worked as a staff nurse in her place and in New York
City.
 A summer position as a nurse for the New York University summer camp
led to a recommendation for Peplau to become the school nurse at
Bennington College in Vermont, where she earned a Bachelor’s degree in
interpersonal psychology in 1943.
PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP

 Peplau’s lifelong work was largely focused on extending Sullivan’s

interpersonal theory for use in nursing practice.
 She studied psychological issues together with Erich Fromm, Frieda
Fromm-Reichmann, and Harry Stack Sullivan at Chestnut Lodge, a private
psychiatric hospital in Maryland.
 She met and worked with all the leading figures in British and American
psychiatry.
 After the war, Peplau was at the table with many of these same men as they
worked to reshape the health system in the United States through the
passage of the National Mental Health Act of 1946.
 She was certified in psychoanalysis by the William Alanson White Institute
of New York City.
DATE EVENT PLACE
September 1, 1909 born & was raised by Reading,
her parents of German Pennsylvania
descent, Gustav and
Otyllie Peplau.
1918 she witnessed the
devastating flu
epidemic that greatly
influenced her
understanding on the
impact of illness and
death on families.
1931 Graduated Pottstown,
Pennsylvania School
of Nursing.
1947 Peplau held her Teachers College,
master’s and doctoral Columbia University.
degrees
1943-1945 Served in Army was assigned to the
Nurse Corps 312th Field Station
Hospital. in England,
where the American
PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP

School of Military
Psychiatry was
located
early 1950s she developed and at Teachers College.
taught the first batch
of graduates in
psychiatric nursing
students
1954-1974 Peplau was a member the College of Nursing
(retirement) of the faculty. at Rutgers University
professor emerita 

 At Rutgers University, she created the first graduate level program for
the preparation of clinical specialists in psychiatric nursing.
 She was a prolific writer and was equally well known for her
presentations, speeches, and clinical training workshops.
 Peplau vigorously advocated that nurses should become further
educated so they could provide truly therapeutic care to patients rather
than the custodial care that was prevalent in the mental hospitals of that
era.
 During the 1950s and 1960s, she supervised summer workshops for
nurses throughout the United States, mostly in state psychiatric
hospitals.
 In these seminars, she taught interpersonal concepts and interviewing
techniques, as well as individual, family, and group therapy.
 Peplau was an advisor to the World Health Organization and was a
visiting professor at universities in Africa, Latin America, Belgium, and
throughout the United States.
 A strong advocate for graduate education and research in nursing,
Peplau served as a consultant to the U.S. Surgeon General, the U.S. Air
Force, and the National Institute of Mental Health.
 She participated in many government policy making groups.
 Peplau was devoted to nursing education at full length of her career.
PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP

 After her retirement from Rutgers, she served as a visiting professor at

the University of Leuven in Belgium in 1975 and 1976. There she
helped establish the first graduate nursing program in Europe.
 She was the only nurse who served the ANA as executive director and
later as president, she served two terms on the Board of the International
Council of Nurses (ICN).
 And as a member of the New Jersey State Nurses Association, she
actively contributed to the ANA by serving on various committees and
task forces.
 Her fifty-year career in nursing left an unforgettable mark on the field
and on the lives of the mentally challenged in the United States.
 During the peak of her career, she became the founder of modern
psychiatric nursing, an innovative educator, advocate for the mentally
ill, proponent of advanced education for nurses, Executive Director and
then President of the ANA and prolific author.
 And just like any other famous personalities, her life was often marked
with controversy, which she faced with boldness, prowess and
conviction.
PUBLISHED BOOKS AND WORK
1. Interpersonal Relations In Nursing: A Conceptual Frame of Reference for
Psychodynamic Nursing
2. Interpersonal Theory in Nursing Practice: Selected Works of Hildegard E.
Peplau
3. Basic principles of patient counseling: Extracts from two clinical nursing
workshops in psychiatric hospitals
4. A Glance Back in Time:
 An article from Nursing Forum, On Semantics (psychiatric nursing):
 An article from: Perspectives in Psychiatric Care, The Psychiatric
Nurse–Accountable? To Whom? For What?
 An article from: Perspectives in Psychiatric Care, and
Psychotherapeutic Strategies
 An article from: Perspectives in Psychiatric Care.
PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP

 Peplau was acknowledged with numerous awards and honors for her
contributions to nursing and held 11 honorary degrees.
 She was awarded honorary doctoral degrees from universities including:
Alfred, Duke, Indiana, Ohio State, Rutgers, and the University of Ulster in
Ireland.
 She was named one of “50 Great Americans” in Who’s Who in 1995 by
Marquis.
 She was also elected fellow of the American Academy of Nurse and Sigma
Theta Tau, the national nursing honorary society.
AWARDS AND HONOR
 In 1996, the American Academy of Nursing honored Peplau as a “Living
Legend.” 
 She received nursing’s highest honor, the “Christiane Reimann Prize,” at
the ICN Quadrennial Congress in 1997. This award is given once every four
years for outstanding national and international contributions to nursing and
healthcare.
 And, in 1998, the ANA inducted her into its Hall of Fame.
 On March 17, 1999, Peplau died peacefully in her sleep at her home in
Sherman Oaks, California. 
INFLUENCES OF THE THEORY
 Peplau’s theory was the first nursing theory to borrow concepts from other
disciplines.
 The theory was influenced by the Psychoanalytic theory of Freud, Maslow’s
Hierarchy of Needs and Sullivan’s theory of Interpersonal Relationship
MAJOR CONCEPTS OF PEPLAU`S THEORY
PERSON
 A developing organism that tries to reduce anxiety caused by needs
 An individual is made of physiological, psychological and social spheres
striving towards equilibrium in life
PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP

HEALTH
 Peplau didn't include an exact definition of health within her model.
 Peplau viewed health as "a word symbol that implied forward movement of
personality and other ongoing human processes in the direction of creative,
constructive, productive, personal, and community living.
ENVIRONMENT
 Being and occurring in the context of the nurse client relationship
 Existing forces outside of the individual
NURSING
 “An interpersonal process of therapeutic interactions between an individual
who is sick or in need of health services and a nurse especially educated to
recognize, respond to the need for help.” 
 It is a “maturing force and an educative instrument” involving an interaction
between two or more individuals with a common goal
 In nursing, this common goal provides the incentive for the therapeutic
process in which the nurse and patient respect each other as individuals,
both of them learning and growing as a result of the interaction.
 An individual learns when she or he selects stimuli in the environment and
then reacts to these stimuli.
 A significant therapeutic interpersonal process
KEY CONCEPT OF PEPLAU`S THEORY
THERAPEUTIC NURSE-CLIENT RELATIONSHIP
 A professional and planned relationship between client and nurse that
focuses on the client’s needs, feelings, problems, and ideas.
 The attainment of this goal, or any goal, is achieved through a series of
steps following a sequential pattern.
4 PHASES OF THE THERAPEUTIC NURSE-CLIENT RELATIONSHIP
1. ORIENTATION PHASE
PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP

The orientation phase is directed by the nurse and involves engaging

the client in treatment, providing explanations and information, and
answering questions.
 Problem defining phase
 Starts when the client meets nurse as a stranger
 Defining problem and deciding the type of service needed
 Client seeks assistance, conveys needs, asks questions, shares
preconceptions and expectations experiences
 Nurse responds, explains roles to the client, helps to identify
problems and to use available services
2. IDENTIFICATION PHASE
 The identification phase begins when the client works
interdependently with the nurse, expresses feelings, and begins to
feel stronger.
 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
 In this phase, the client makes full use of the services offered.
 Use of professional assistance for problem-solving alternatives
 Advantages of services are used is based on the needs and interests
of the patients
 The individual feels like 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 fluctuate on independence
PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP

 Nurse must be aware of the various phases of communication

 Nurse aids the patient in exploiting all avenues of help and progress
is made towards the final step
4. RESOLUTION PHASE
 In the resolution phase, the client no longer needs professional
services and gives up dependent behavior. The relationship ends.
 Termination of professional relationship
 The patient’s 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 the bond with the nurse and healthier
emotional balance is demonstrated and both becomes mature
individuals.
 Peplau’s model has proved of great use to later nurse theorists and
clinicians in developing more sophisticated and therapeutic nursing
interventions
ROLES OF THE NURSE IN THE THERAPEUTIC RELATIONSHIP
IDENTIFIED BY PEPLAU:
 STRANGER
 Offering the client the same acceptance and courtesy that the nurse
would to any stranger
 RESOURCE PERSON
 Providing specific answers to questions within a larger context
 TEACHER
 Helping the client to learn formally or informally
 LEADER
 Offering direction to the client or group
 SURROGATE
PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP

 Serving as a substitute for another such as a parent or a sibling

 COUNSELOR
 Promoting experiences leading to health for the client such as
expression of feelings
 TECHNICAL EXPERT
 Providing physical care for the patient and operates equipment
 Peplau also believed that the nurse could take on many other roles but these
were not defined in detail. However, they were “left to the intelligence and
imagination of the readers.”
 ADDITIONAL ROLES INCLUDE:
 Consultant  Manager of
 Health teacher environment
 Tutor  Mediator
 Socializing agent  Administrator
 Safety agent  Recorder observer
 Researcher
ANXIETY
 Another concept of Peplau and is defined as the initial response to a
psychic threat. There are four levels of anxiety described below.
 4 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).
2. MODERATE ANXIETY
 Involves a decreased perceptual field (focus on immediate
task only); the person can learn a new behavior or solve
problems only with assistance. Another person can redirect
the person to the task.
3. SEVERE ANXIETY
 Involves feelings of dread and terror.
PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP


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.
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.
ASSUMPTIONS OF THE THEORY
1. Nurse and the patient can interact.
2. Peplau emphasized that both the patient and nurse mature as the result of
the therapeutic interaction.
3. Communication and interviewing skills remain fundamental nursing tools.
4. Peplau believed that nurses must clearly understand themselves to promote
their client’s growth and to avoid limiting the client’s choices to those that
nurses’ value.
STRENGTHS OF THE THEORY
 Peplau’s theory helped later nursing theorists and clinicians develop more
therapeutic interventions regarding the roles that show the dynamic
character typical in clinical nursing.
 Its phases provide simplicity regarding the natural progression of the nurse-
patient relationship, which leads to adaptability in any nurse-patient
interaction, thus providing generalizability.
LIIMITATION
 Though Peplau stressed the nurse-client relationship as the foundation of
nursing practice, health promotion, and maintenance were less emphasized.
 Also, the theory cannot be used in a patient who doesn’t have a felt need
such as with withdrawn patients.
APPLICATION TO NURSING PRACTICE, EDUCATION & RESEARCH
PEPLAU`S THEORY OF INTERPERSONAL RELATIONSHIP

 Peplau’s ideas paved way for integrating other scientific disciplines into
nursing especially in formulating the paradigm of psychiatric nursing in
early days.
 As it became apparent that nursing practice is its true value could only be
accomplished through starting and strengthening the nurse – patient
relationship, many clinicians now believe that it’s in the interest of the
profession and of the patient to utilize her Interpersonal Model extensively.
 In Psychiatric Nursing, Peplau’s Interpersonal Model is used in counselling
women undergoing depression.
 Because of the maintained and strengthened nurse – patient relationship,
women were able to describe patterns that resulted from their negative
thinking and independently found strategies to manage them.
 Hildegard Peplau’s book, Interpersonal Relations in Nursing is being used
as a manual of instruction to help graduate nurses and nursing students alike
in creating a significant nurse – patient relationship.
 Her theoretical ideas, particularly her views of nursing and nursing process,
the psychodynamic theory, and her prescribed methods, have been an
essential part of the collective culture of the nursing profession
 When Peplau’s model was slowly integrated into research, research has
shifted to perspectives within the social system as newer studies indicate
that broader relationships could also affect a person in many ways.