THEORETICAL FOUNDATIONS IN NURSING
nurses) in Germany.
★ Historical Evolution in Nursing
❖ Period of Intuitive Nursing/Medieval
Period
- Nursing was untaught and instinctive.
- Performed out of compassion and wish to
help.
- No caregiving training, only through
observation and experience.
- A nurturing job and function belonged to
women.
- Primitive men believed that illnesses came
from the bad spirits
- Medicine man/Shaman had the power to
heal using white magic, hypnosis etc.
Trephining: drilling a hole in the skull using a
stone without anesthesia (last resort to drive
away spirits)
Sickness is due to the active intervention of:
- Human (witchcraft)
- Non-human (ghosts)
- Superhuman beings (superstitious)
❖ Period of Apprentice Nursing/Middle
Ages/Renaissance
- Care given by crusaders, prisoners,
developed by religious orders (Christian
Church)
- No formal education in Nursing and
people directed by more experienced
nurses (OJT)
- Nursing went down to the lowest level
(Dark Period of Nursing 17th to 19th
century)
- The wrath/anger of Protestantism;
confiscated properties of hospitals and
schools connected with Roman
Catholicism.
- Nurses fled their lives; a shortage of
people to care for the sick Hundreds of
hospitals closed, no provision (care) for
the sick
- Nursing became the work of the least
desirable of women - prostitutes,
alcoholics, prisoners
- Pastor Theodore Fliedner and his wife,
Frederika established the Kaiserswerth
Institute for the training of Deaconesses
(the 1st formal training school for
- This was where Florence Nightingale
received her 3-month course of study in
nursing.
❖ Period of Educated
Nursing/Nightingale Era /19th-20th
Century/Modern Nursing
- Development was strongly influenced by:
Crimean, civil war
- Arousal of social consciousness
- Emancipation (freedom) of women
- Increased educational opportunities
offered to women.
❖ Period of Contemporary Nursing/20th
Century
★ Florence NIGHTINGALE
- An English lady from a wealthy family
during the Victorian era
- During the Crimean War- "Lady with the
Lamp
- Her favorite dictum, "DO THE PATIENT
NO HARM"
- Where history of professional nursing
The Nightingale Training School of Nurses
● Nightingale focus: vision of nursing was
developing the profession within hospitals.
● Nurses should be taught in hospitals
associated with medical schools and
curriculum should include both theory and
practice.
● It was the 1st school of nursing that
provided both theory-based knowledge
and clinical skill building.
● Nursing evolved as an art and science
● Formal nursing education and nursing
service begun
HISTORY OF NURSING THEORY
- Development of nursing knowledge apart
from medical knowledge to guide nursing
practice
★ NURSING THEORY
- Conceptualization of reality invented or
discovered that pertains to nursing.
- Are organized bodies of knowledge to
define what nursing is, what nurses do,
and why they do it
 - Interrelated concepts from studies of
discipline and experiences
- Essence of care
- Improve quality of care
PURPOSE OF NURSING THEORY:
- Describes, Explains, Predicts, Prescribes
USES OF NURSING THEORY:
1) To differentiate the focus of nursing from
other professions
2) To structure professional nursing into
practice, education, and research
3) To help build a common nursing
terminology to use in communicating with
other healthcare professionals
4) To enhance autonomy of nursing thru
defining its own independent functions
FOCUS OF THE THEORY
1) CLIENT CENTERED
2) CLIENT-NURSE DYNAMICS
3) CLIENT-NURSE ENVIRONMENT
NURSING PARADIGM
- patterns or models used to show a clear
relationship among the existing theoretical
works in Nursing
- idea formulated by the mind and
experience or describe a phenomenon
- Building blocks of and generates
theories
- Enhances capacity to understand and
define
- Used in conceptual or operational
definitions
● Abstract: indirectly or intangible,
independent
● Concrete: directly or tangible
Definition: descriptions giving general meaning
reducing vagueness of concepts
● Conceptual: meaning based on how
literature defines it (own pov)
● Operational: meaning based on the
method how it was measured
Proposition: explains relationship of concepts
Assumption: statement specifying relationship of
concepts or explains nature of concepts (hold as
factual)

4 COMPONENTS:
1. Person: The recipient of nursing care
2. Nursing: The actions of the person care
Nursing: focused in supporting communities in
3. Environment: The internal and external
achieving a state of optimum health concerned
conditions
with the quality of life.
4. Health: patient’s level of wellness

American Nursing Association (ANA):

Nursing Theory: explains the Science and Art of
diagnosis and treatment of human responses to
Nursing
actual or potential health problems
Nursing Science: melting-pot of different
International Council of Nurses (ICN):
knowledge, background of care and healing
- autonomous (freedom to govern itself)
collected and preserved
collaborative care of individuals of all
ages.
★ Theory:
- Promotion of health, prevention of illness,
- organized system of accepted knowledge
care of the ill, disabled, and dying people.
composed of concepts, propositions,
definitions, assumptions intended to
Henderson: assist clients in activities contributing
explain a set of fact, event or phenomena.
to health, recovery or peaceful death
- Creative and rigorous structuring of ideas
that projects a tentative, purposeful and
Association of Deans of Philippine Colleges of
systemic view of phenomena
Nursing (ADPCN):
- Dynamic discipline
Concept:
 - Art and science caring for individuals
towards promoting and restoring health
Grand theories: broad scope and complex
(occasional)
Middle-range: researches are frequently based
on, discovery of concepts
Critical: describe theories that clarify how social
structures influenced human experience
Phenomenon: describes an idea, situation or
event
TYPES OF THEORIES:
Descriptive (Factor-Isolating): know properties
and working
- Primary level
- Identity and describe concepts
- Does not explain relationship of concepts
- Present a phenomenon based on the 5
senses
Explanatory (Factor-Relating): how properties
related and affect
- Present relationship of concepts
- Provide information on how and why
concepts are related
- E.g. cause and effect
Predictive (Situation-Relating): relationship and
its occurrence
- Relationships of concepts under a
condition are able to describe future
outcomes consistently
- Generated through experimental research
Prescriptive (Situation-Producing): which
conditions relationship occur
- Nursing actions, test validity of new
nursing intervention
Theoretical models: established set of concepts
(testable)
Conceptual models: representations of idea
based on own understanding
(diagram/structure/paradigm)
Nursing Paradigm: patterns or model to show
clear relationship among theoretical works
Meta - with; paradeigma - pattern
Philosophy:
- Next knowledge level after metaparadigm
- Definition of metaparadigm concepts
through analysis, reasoning, and logical
argument
Science
- Scientia - knowledge
- Systematic knowledge or practice
- Acquiring knowledge based on scientific
method/research
1) Observation: integration of knowledge
2) Gathering data: recognition and
collecting data
3) Forming hypothesis: attempt to explain
or suggest nature of phenomenon
(testable)
4) Experimental investigation: set of
examinations done to solve a query
5) Conclusion of Theoretical explanation:
statement explaining a set of natural
phenomena
Knowledge:
- Information, skills and expertise acquired
through experiences
- Abstract or workable understanding
- Known to a discipline
- Facts and information
- No agreed classification of knowledge
TYPES OF COGNITIVE PROCESS
1) Perception: achieving understanding
2) Association: combining concepts to form
new
3) Learning: acquiring experience, skills
4) Reasoning: mental process of seeking
conclusions
5) Communication: transferring data from
sender to receiver
SOURCES OF KNOWLEDGE
1. Traditional: nursing practice passed
down
2. Authoritative: idea of a person of
authority perceived true because of
expertise
3. Scientific: scientific method through
research
Phenomenon: sets of empirical data or - Functions cooperatively with human processes
experiences (physically observed/tangible) presenting health as a goal
- Nurses use interpersonal model to identify
the needs of others
Research: systematic methods to study a
phenomenon Person
- Man, an organism living in an unstable
balance of given system
Induction: specific to general; Deduction:
general to specific Health
- movement of the personality
Theory-generating research: discover and - for one’s health to be achieved and
maintained, his needs must be met such as
describe relationships without imposing notions physiological demands and interpersonal
(beliefs) conditions

Environment
Theory-testing research: determine accuracy of
- forces outside the organism in a socially-
theory describes a phenomenon approved way of living
- includes interpersonal process
Is theory proven?
Interpersonal Relations Theory
It can be tested to validate its
- nurse-patient relationship as four-phase
accurateness but even if a theory is accepted as phenomenon
fact, it remains a theory.
In science, theories never become facts
★ PHASES OF NURSE-PATIENT
but rather theories explain facts. RELATIONSHIP
Once it is accepted, it becomes a scientific
law. 1. Orientation
A theory is only ever assumed to be true - initial interaction
- there is a need and expresses desire for
until proved otherwise. professional assistance
- nurse assists patients in understanding
NURSING PHILOSOPHIES patient experience

★ HILDEGARD PEPLAU
“Interpersonal Relations Theory”
2. Identification
“The kind of person that the nurse becomes makes a - explore the experience and needs of
substantial difference in what each patient will learn as patient leading to feeling of relatedness
he or she receives nursing care” - reorienting and sustaining positive
environment
● Psychiatric Nurse of the Century
● American Journal of Nursing 3. Exploitation
● The Christiane Reimann Prize - full value of relationship from moving to a
dependent role to an independent role
- Born on September 1, 1909 - Goals are achieved through personal or self-
- Born in Reading, Pennsylvania effort, power is at the patient
- Paternalistic society: She would not leave
school, go to work and hand her wages to her 4. Resolution
family because she was raised to believe that - Earns independence over his care
they had to choose between marriage and - Experience leaves lasting impression
work.
- She save the American Nurses Association Interpersonal Therapeutic Process or
from bankruptcy Psychological Mothering
- Member of army corps - psychiatric patients becoming receptive for
- National Mental Health Act of 1946 therapy
- 1. Patient is accepted unconditionally as a
- She died at 89 on March 7, 1999 participant in a relationship satisfying his
needs
★ METAPARADIGM IN NURSING 2. A recognition of and response to the patient’s
- Psychiatric Nursing (Intrapsychic needs) readiness for growth and initiative
3. Power in the relationship ships to the patient
Nursing: because it is able to delay gratification and
- significant, therapeutic interpersonal process invest goal achievement

★ NURSING ROLES
Role of the:
1. Stranger (Identification Phase)
- Nurse and client are strangers
- Nurses should treat patient with utmost
courtesy
2. Resource Person
- Client assumes a dependent role, nurses
provide specific answers and simple
explanation
- to appropriately change her responses to the
client’s level of understanding
3. Teaching Role
- Teaches about the importance of self-care and
understanding the therapeutic plan
- Nurses should determine how the client
understands the subject
4. Leadership Role
- through cooperation and active
participation, the nurse must you have clients
best interest and enable him to make
decisions over his own care
5. Surrogate Role
- The clients dependency for his care gives the
nurse a surrogate (temporary caregiver)
- The nurse must assess the clients to make
sure that her surrogate role is different and
temporary
6. Counseling Role
- Greatest importance and emphasis in Nursing
- Strengthens nurse-patient relationship by
becoming a listening friend, understanding
family, and gives a sound advices
- The client should remember and understand
the experience and how it could be integrated
in his daily life.
★ ACCEPTANCE BY THE NURSING
COMMUNITY
PRACTICE
- Wasn’t widely accepted at first
- Give and take of nurse-patient relationship is
seen as new and revolutionary
- It is in the interest of the profession and client
to use their interpersonal models
EDUCATION
Interpersonal Relations in Nursing - 1952 (book)
- Emphasize the importance of the nurse-patient
relationship in providing healthcare
- Manual of instruction to graduate nurses in
establishing nurse-patient relationship
RESEARCH
- Client problems were within the person
phenomena and dealt inside the nurse-patient
interaction studies
★ THEORY ANALYSIS
Clarity:
- The concepts of the phases in the
interpersonal relationship, the nurse’s roles
and psychobiological experiments are well
defined, consistent and logically presented.
Simplicity:
- Inductive reasoning: specific observations
and applies them
- Discover patterns enabling nurse-patient
relationship
- Meeting the quality and simplicity
Generality
- She believed that all nurses were able to use
her model effectively
- Her theory can only be used in situations
requiring communication can be one sided
(senile, comatose)
- Evaluation standard is not met
Accessibility
- Theory based on reality using pure
observation (theoretical and empirical area)
Importance
- One of the first theorists after Nightingale
- Pioneering works
- Her works touched the lives of people
providing direction for nursing.
VIRGINIA HENDERSON
Needs Theory: The unique function of the nurse is to
assist the individual, sick or well, in the performance of
those activities contributing to health or its recovery (or
to peaceful death) that he would perform unaided if he
had the necessary strength, will or knowledge.
● First Lady of Nursing & International Nurse
● Nightingale of Modern Nursing
● Modern-day Mother of Nursing
● 20th Century Florence Nightingale
● American Nurses Association Hall of Fame
● Sigma Theta Tau International Library
● Virginia Historical Nurse Leadership Award
● One of the 51 Pioneer Nurses in Virginia
“The nurse is temporarily the consciousness of
the unconscious, the love of life for the suicidal, the leg
of the amputee, the eyes of the newly blind, a means
of locomotion for the infant, knowledge and confidence
for the mother, the multipiece for those too weak or
withdrawn to speak and so on”
- Advocate of psychiatric nursing
● Nature of Nursing - Believe about the
essence of nursing and influence the hearts
and minds of the readers
★ METAPARADIGM OF NURSING
Nursing
 - Nurses must promote the treatment plan
prescribed by the physician.
- They must act independently + coordination
with the therapeutic plan to help both the sick
and well individual.
- Must empower client to gain independence as
possible
- A nurse must be knowledgeable in both
biological and social sciences and have the
ability to assess basic human needs.
- Her definition of nursing = the “signature” of
the profession.
Person (Client)
- Individuals have basic health needs and
require assistance to achieve health and
independence or a peaceful death.
- Concepts of the mind and body of a person
are inseparable.
- To function properly, he must be able to
maintain physiological and emotional
balance.
Health
- quality of life and is a basic for a person to
function fully.
- Health requires independence and
interdependence. influenced by both internal
and external factors
- Prioritizing health promotion is more important
than care of the sick.
Environment
- Any place where the therapeutic interaction
between patient and nurse occurs.
- To manage the patients' surroundings to
protect patients from any harm or any
mechanical injuries.
- Educated about safety and must be aware of
different social customs and religious practices
to assess dangers.
- They should provide physicians data about the
safety needs as the latter use this as the basis
in prescribing protective devices.
- It is their responsibility to recommend changes
in order for him or her to minimize chances of
injury.
Needs Theory: 14 Fundamental Needs of Humans
1. Breathe normally
2. eat and drink adequately
3. eliminate body wastes
4. move and maintain a desirable position or
posture
5. sleep and rest
6. Select suitable clothes
7. Maintain body temperature within a normal
range by adjusting clothing and modifying
environment
8. Keep the body clean and well-groomed and
protect the integument (skin)
9. Avoid dangers in the environment and avoid
injuring others
10. Communicate with others in expressing
emotions, needs, fear, or opinion
11. Worship according to one’s faith
12. Work in such a way that there is a sense of
accomplishment
13. Play or participate in various forms of
recreation
14. Learn, discover or satisfy the curiosity that
leads to normal development and health, and
use the available health facilities
- Nurses should and you client and his family as
a single unit
The Nurse - Patient Relationship
1. The nurse as a substitute for the client.
Help as to what the clients lacks (knowledge,
will and strength) to make him complete,
whole and independent once again.
2. The nurse as a helper to the client. Nurses
help clients to accomplish his basic needs to
achieve health and regain independence as
quickly as possible.
3. The nurse as a partner with the patient. The
nurse and the client formulate the plan of care
together. Both as an advocate person and as
a resource person, the nurse can empower the
client to make effective decisions regarding his
care plans. The client and the nurse see each
other as partners whose interests are the
same having the client achieve health and
independence.
4. The Nurse-Physician Relationship. Nurses
function independently from physicians.
Though the nurse and client, as partners,
formulate the plan of care, it must be
implemented in such a way that will promote
the physician’s prescribed therapeutic plan.
- Nurses do not follow doctor’s orders; rather
they follow a philosophy that allows physicians
to give orders to clients or other healthcare
team members.
5. The Nurse as a MEMBER OF the Healthcare
Team For a team to work together in harmony,
every member must work interdependently
does not include taking other member’s role
and responsibilities.
★ Acceptance by the nursing Community
Practice
Nursing process: problem-solving process used to
answer client’s need
1) Assessment Phase - assessing the 14
fundamental needs of the clients and checking which
one is lacking or fully met.
2) Planning Phase – giving the plan of care to meet
the needs and personality of the client and serve as a
record and must fit in the prescribed plan by the
physician.
3) Implementation Phase – maintaining health, to
recover from illness, or to aid in peaceful death.
4) Evaluation Phase – the nurse and the client review
the relationship and decide whether the goals are met
or not.
EDUCATION
1. First Phase – helping the client perform
activities of daily living.
2. Second Phase – assisting clients achieve
their needs in times of marked body
disturbances or illness.
3. Third Phase – client and his family together
with the dynamics affecting the relationship
inside the unit.
Research
She used this to improve the practice of nursing and
insisted that it is the nurse’s responsibility to identify
problems, continuously validate her practice, improving
the methods used, and reassuring the effectiveness of
her care.
Theory Analysis
Virginia Henderson’s definition of nursing person,
health and environment could be considered as a
grand theory of philosophy.
CLARITY
In her 14 Fundamental Needs all are clearly defined
and consistent, stated in a straightforward and direct
manner. Her theory has no structural form or diagram,
only linear ideas.
Simplicity
Her concept of nursing is complex rather than
simplistic. The 14 basic needs have undergone several
revisions to make them clear, simple, and concise.
The sixth edition of Henderson's book, "The Principles
and Practice of Nursing" is comprehensive and well-
illustrated explanation that makes the basic needs
clear and more understandable.
Generality
The definitions provided by Henderson are broad in
scope and cover all areas of nursing practice and
could be applied in every setting.
Accessibility
The Needs Theory is focused on assisting individuals
to gain independence in relation to the performance of
activities contributing to health or its recovery.
Abstract concepts - indirectly measurable
(expressing emotions, needs, fears, worship according
to one's faith and sense of accomplishment).
Concrete concepts - directly measurable (breathing,
eating and drinking and eliminating body wastes).
Importance
Importance of Nursing's independence from
and interdependence on the different healthcare
professions. Advocated curriculum development.
Her definition of the unique function of a nurse
is widely accepted in developing nursing to a
professional scientific discipline.
JOYCE TRAVELBEE
“Human-to-Human Relationship Model”
- Born in 1926
- Psychiatric nurse
- Passed away at 47
● Interpersonal Aspects of Nursing
● Intervention in Psychiatric Nursing:
Process in the One to One Relationship
★ METAPARADIGM IN NURSING
- conceptual
- wrote about illness, suffering, pain,
hope, communication, interaction,
empathy, sympathy, rapport, and
therapeutic use of self.
Nursing:
- interpersonal process
- Purpose: assisting an individual, family, or
community to prevent or cope with the
experience of illness and suffering and to find
meaning in these experiences.
Person
- human being
- a human being is a unique, irreplaceable
individual who is in the continuous process of
becoming, evolving, and changing.
Health
- Subjective health: state of well-being in
accord with self-appraisal of physical-
emotional-spiritual status.
- Objective health: absence discernible
disease, disability, or defect measured by
physical examination, laboratory tests,
 assessment by a spiritual director, or
psychological counselor.“
Environment:
- human conditions and life experiences
encountered by all men as sufferings, hope,
pain, and illness.
HUMAN-TO-HUMAN RELATIONSHIP MODEL
- Her theory was influenced by her Ida Jean
Orlando experiences and nursing education
and practice in Catholic charity institutions
- The nurse and patient into relate with each
other and buy her description of the purpose of
Nursing
- Travelbee concluded that the nursing care
rendered to clients in these institutions lacked
compassion. She thought that nursing care
needed a "humanistic revolution" - a return to
focus on the caring function towards the ill
person.
1. Original Encounter - first impression by the
nurse of the sick person and vice versa. The
nurse and patient see each other in
stereotyped or traditional roles.
2. Emerging Identities - perceiving each other
as unique individuals. The link of a
relationship begins to form.
3. Empathy: ability to share in the person’s
experience
2 Qualities Enhancing Empathy Process
1. Similarities of experience
2. Desire to understand another person.
4. Sympathy - nurse wants to lessen the cause
of the client's suffering. It goes beyond
empathy. "When one sympathizes, one is
involved but not incapacitated by the
involvement." Nurses used discipline
intellectual approach with therapeutic use of
self
5. Rapport - Nursing interventions lessening
client's suffering. The sick person shows trust
and confidence in the nurse. "A nurse is able
to establish rapport because she possesses
the necessary knowledge and skills required to
assist ill persons, and because she is able to
perceive, respond to, and appreciate the
uniqueness of the ill human being."
★ ACCEPTANCE BY THE NURSING
COMMUNITY
Practice
- In a Hospice, nurse attempts to build a
working relationship with the client
- Understanding illness and suffering in the bus
client do use it as self-actualizing life
experience.
- A dying person must find meaning in his or her
death before he or she can ever begin to
accept the actuality of death
Education
- Better assistance for nurses who help
individuals understand the meaning of illness
and suffering. intervention in psychiatric
nursing: process in one-to-one relationship
- Philosophy and Religion helpful in preparing
nursing students to fulfill the purpose of
nursing sufficiently.
Research
- Discovered how individuals with cancer
described their personal search for meaning
= spiritual and psychosocial process. No
other theory of Travelbee that would create
further development is available.
THEORY ANALYSIS
- It is imperative for nurses to understand their
concept of what is human, for their relationship
with another human being will be otherwise
determine by that concept
Clarity
- Not consistent in clarity and origin.
- Used different terms for the Same definition.
- Focused more on adult individuals who are
sick and the nurse’s role in helping them to
find meaning in their sickness and
suffering.
- dealt with families and their needs but not the
community
Simplicity
- Contains different variables (numerous)
- Simplicity is not that evident.
- Assist nurses appreciate and understand not
only the client’s humanness
- Theory was not able to meet this criterion.
Generality
- Has wide scope of application but applicable
only to those patients in distress and life
changing events.
Accessibility
- Low measures of empirical soundness result
from lack of simplicity defining concepts
theoretically but does not define them
operationally.
- The model has not been tested.
Importance

- Development of quality of caring.

- Ability to describe, explain, predict and control
a phenomena.
- explains the variables that affect the
establishment of a therapeutic relationship
between nurses and patients.
- lack of empirical precision = lack of
usefulness.
- Caring: major characteristic a nurse should
possess

Hildegard Peplau
“The Interpersonal Relations Theory”
- Psychiatric Nurse of the Century
 - Born on: September 1, 1909
- Birthplace: Reading, Pennsylvania
- Daughter of immigrant parents of German
descent, Gustav and
- Otyllie Peplau
- Raised in a Paternalistic family/ society
- Diedon: March 17, 1999
Education
● 1931 - Pottstown Hospital School of
Nursing
● 1943 - Bachelor of Arts in Interpersonal
Psychology from Bennington College,
Vermont
● 1947 - Master of Arts in Psychiatric
Nursing
● 1953 - Doctor of Education in Curriculum
Development from Columbia
Hildegard Peplau's Contribution
From the beginning of her career in late 1930s,
Peplau left a remarkable stamp on the profession
and on the lives of the mentally ill around the
world, some of her contributions includes:
Theory of Interpersonal relations
Saved the American Nurse Association from the
point of bankruptcy
Member of the Army Nurse Corps
National Mental Health Act of 1946
Advocate professional, educational, and practice
standards in nursing
Participation in government policy-making
The Interpersonal Relations in Nursing
Published in 1952
Focuses on the therapeutic nurse-client
relationship by using
problem-solving techniques to meet the patient's
needs.
ivfluenced by the interpersonal relationship
theories by Freud
Maslow, Sullivan, and by the contemporaneous
pshycoanalytical model.
Awarded in The Christiane Reimann Prize at the
International
Council of Nurses Quadrennial Congress and a
fellowship at
the American Academy of Nursing.
The Metaparadigm in Nursing according to
Peplau
NURSING
-Described as a significant, therapeutic
interpersonal process. It functions cooperatively
with human processes that present health as a
possible goal for individuals.
HEALTH
-A word that symbolizes movement of the
personality and other ongoing human processes
that directs the person towards a creative,
constructive, productive, and community living.
PERSON
-Defined as a man who is an organism that lives
in an unstable balance of a given system.
ENVIRONMENT
-The forces outside the organism and in the
context of the socially-approved way of living,
from which vital human social processes are the
derived such as norms, customs, and beliefs.
The four-phase phenomenon according to Peplau
1.) ORIENTATION
The initial interaction between the nurse and the
patient wherein the latter has a felt need and
expresses the desire for professional assistance.
The nurse assists the patient in recognizing and
understanding the "patient" experience.
3.) EXPLOITATION
In this phase, the patient derives the full value of
the relationship as he moves on from a
dependent role to an independent one. New goals
are projected by the nurse, but the power is
shifted to the patient as these goals would be
achieved through personal or self-effort.
2.) IDENTIFICATION
The patient and the nurse explore the experience
and the needs of the patient which leads to a
feeling of relatedness. It is very important in the
relationship that the nurse assists the patient in
reorienting his feelings and sustaining a constant
positive environment.
4.) RESOLUTION
In its final stages, the patient earns independence
over his care as he gradually puts aside old goals
and formulates new ones. Even though the
patient and the nurse end the relationship, it is
very apparent that the experience leaves a lasting
impression on the patient since illness and
assuming a dependent role is a unique human
experience.
Major Concepts
of Interpersonal Relations Theory
1.
Nursing is an interpersonal process because it
involves interaction between two or more
individuals with a common goal.
2.
The purpose of nursing is to help others identify
their felt difficulties.
3.
Nurses should apply principles of human relations
to problems.
4.
Nursing is therapeutic or a healing art.
5.
The goal is attained through series of steps
following a series of pattern.
6.
The nurse and patient work together and both
become mature and knowledgeable in the
process.
Interpersonal Therapeutic Process
The Interpersonal Therapeutic Process is based
on the theory proposed by Peplau and particularly
useful in helping psychiatric patients become
receptive for therapy. Often referred by Peplau
as"Psychological Mothering”, it includes the
following steps:
1. The patient is accepted unconditionally as a
participant in a relationship that satisfies his
needs;
2. There is recognition of and response to the
patient’s readiness for growth, as his initiative;
and
3. Power in the relationships shifts to the patient,
as the patient is able to delay gratification and to
invest in goal achievement (Stuart & Laraia,
2005).
Nursing Roles
Role of Stranger
In their initial contact, the nurse and the client are
strangers to one another. As the nurse attempts
to know the client better, she must treat him with
outmost courtesy, which includes acceptance of
the client as a person and due respect over his
individuality. This role is coincides with the
Identification Phase.
Nursing Roles
Role of the Resource Person
As the client assumes a dependent role, the
nurse provides specific answers to his queries
which include health information, advices, and a
simple explanation of the healthcare team's
course of care. It is the responsibility of the nurse
to appropriately change her responses to the
client's level of understanding.
Nursing Roles
Teaching Role
As the interaction progresses, the nurse assumes
a teaching role as she gives much importance for
self-care and in helping him understand the
therapeutic plan. In assuming this role, the nurse
must determine how the client understands the
subject at hand. She must develop her discussion
around the interest of the client and his ability in
using the information provided.
Nursing Roles
Leadership Role
Although dependent to the healthcare team over
his care, the client is still considered vital in
deciding as to what course his plan of care would
take. The nurse as a leader must act in behalf of
the client's best interest and at the same time
enable him to make decisions his own care. This
is achieved through cooperation and active
participation.
Nursing Roles
Surrogate Role
The client's dependency for his care gives the
nurse a surrogate (temporary care giver) role.
This creates the atmosphere wherein feelings
previously felt, such as feelings towards her
mother. Some other relationships are reactivated
and nutured, Although the client recognizes that
the nurse has similarities with the person whom
he recalls in previous relationships, the nurse
must assist the client to make sure that her
surrogate role is different ang only temporary.
Nursing Roles
Counseling Role
Peplau believes that the counseling role has the
greatest importance and emphasis in nursing.
This role strengthens the nurse-patient
relationship as the nurse becomes a listening
friend, an understanding family member, and
someone who gives sound and emphatic advices.
The very core of the interpersonal technique is for
the client to remember and to understand the
experience and how could it be integrated into his
daily life.
ACCEPTANCE BY THE NURSING COMMUNITY
ACCEPTANCE BY THE NURSING COMMUNITY
Practice
Peplau introduced groundbreaking concepts in
nursing, emphasizing the importance of nurse-
patient relationships and learning through
experiences. Her Interpersonal Relations Model,
initially met with skepticism, later gained
recognition for its theoretical foundation in
nursing. It paved the way for integrating other
scientific disciplines into nursing, particularly in
psychiatric nursing. Today, clinicians widely
embrace her model, recognizing the value of
nurse-patient relationships. Researchers have
found that nurses who build trust and maintain a
consistent approach empower clients. In
psychiatric nursing, her model aids in counseling
women with depression, enabling them to identify
negative thinking patterns and develop coping
strategies.
ACCEPTANCE BY THE NURSING COMMUNITY
Education
Hildegard Peplau’s book “Interpersonal Relations
in Nursing” (1951) serves as an instructional
guide for graduate nurses and students, fostering
meaningful nurse-patient relationships across
various settings. Critiques of her model emerged
in academic circles, notably in psychiatric nursing,
with most comments appearing decades after her
initial work. Her theoretical ideas, encompassing
nursing concepts, psychodynamic theory, and
methods, have become integral to the nursing
profession’s culture.
ACCEPTANCE BY THE NURSING COMMUNITY
Research
The Interpersonal Model transformed nursing
research, shifting from a focus on individual
problems to considering broader social systems’
impact on individuals. Peplau’s influence
extended to emerging nursing leaders,
particularly in psychiatric nursing, reshaping
perceptions of the nurse’s role and anxiety’s
significance in learning. Her conceptual
framework led to the development of behavior
scales to reduce client anxiety and stress.
Peplau’s work resolved uncertainty surrounding
nurse-patient relationships and provided a
systematic, scientific foundation for nursing
practice
THEORY ANALYSIS
CLARITY
The concepts related to the phase in the nurse-
patient relationship are enough for understanding
the theory. It is noteworthy that the concepts of
the nurse role in the interpersonal process are
also important because they complement the
concept of the various phase. The concepts of the
phases in the interpersonal relationship, the
nurse’s roles and psychobiological experiments
are well define, consistent and logically
presented.
SIMPLICITY
The major focus of Peplau's theory, Interpersonal
Relations, is easily understood. The theory's
basic assumptions and key concepts were clearly
given, explained, broken down, and outlined in
return she also demonstrated how this model
could be used as a process when she it reduced
the Four Phases of Nurse-patient Relationship.
The different roles of the nurse added further
understanding on how nurses could effectively
use the Interpersonal Model by identifying which
role is appropriate at the given phase or situation
in perfect harmony with the nursing process.
GENERALITY
Peplau believed that all nurses, regardless of
their area or clinical setting, could effectively
utilize her model. However, the theory can be
used only two situations that communication can
occur between the nurse and the client. The use
of the model is limited or impossible in working
with senile, comatose, or newborn clients. In
these given situations, the nurse-patient
relationship is often one-sided. Knowing this, the
nurse and the client cannot work together to
develop goals and become more knowledgeable.
For the nurse to function as an educative,
therapeutic and maturing force, understanding the
meaning of the experience to the patient is very
important. This evaluative standard is not met.
ACCESSIBILITY
Peplau provided a theory based on reality. Her
theory could be tested and observed using pure
observation. The relationship between the
theoretical area and the empirical data could be
validated and verified. Peplau functionally
categorizes the four phases of the interpersonal
process, with the nurse's role taken into
consideration together with a client's level of
independence. We may consider Peplau's theory
to be precise but with continued research and
development, the degree of precision could be
more increased.
IMPORTANCE
Peplau's works, thoughts, and ideas have greatly
touch the lives of many clients and nurses, from
the students to practitioners. Although her work
has been published five decades ago, it never
ceases in providing the directions for nursing
practice, education, and research. Peplau's work
has provided a significant contribution to the
profession.