Hildegard Peplau’s Interpersonal Relations
Theory and reform.
Hildegard E. Peplau's
Overview of
Nursing Theory and Background:
- Born on September 1, 1909, in
Reading, Pennsylvania to
immigrant parents of German
descent.
- Raised in a paternalistic family
and society, with a workaholic and
illiterate father and an oppressive,
perfectionist mother.
- Despite higher education never
being discussed at home, Peplau
was strong-willed, motivated, and
had a vision to grow beyond
traditional women's roles.
- Peplau graduated from Pottstown,
PA Hospital School of Nursing
in 1931 and pursued a BA in
Psychology from Bennington
College in 1943.
- During World War II, she worked
in a neuropsychiatric hospital in
London, England, as part of the
Army Nurse Corps.
- Peplau earned an MA in
Psychiatric Nursing in 1947 and
an Ed.D. in Nursing Education in
1953, both from Teachers' College,
Columbia University.
- She also obtained certification in
Psychoanalysis for Teachers from
the William Alanson White Institute,
New York City, in 1954.
- Nursing is defined by Peplau as an
"interpersonal process of
therapeutic interactions"
between a patient in need of
health services and a specially
educated nurse.
- Peplau emphasized that the nurse-client
relationship is fundamental to nursing
practice.
- She described the nurse-patient
relationship in four phases, each with
unique contributions to the outcome
of the interaction.
- Peplau is the first published nursing
theorist in a century, since Florence
Nightingale.
- She created the nursing middle-range
theory of Interpersonal Relations and
revolutionized nursing scholarship.
- Peplau contributed to mental health laws
- Her work revolutionized the scholarly
pursuits of nurses, leaving an indelible
mark on the profession.
Foundation of Peplau's Framework
- Peplau witnessed injustices in life and
was determined to push past them for
social justice.
- Her first exposure to Interpersonal
Theory was at Bennington, where she
attended lectures by Harold Stack
Sullivan on Interpersonal Relations.
- Peplau had a vision to apply Sullivan's
theory to interactions with her patients,
believing that they needed humane
treatment, Dignity and respect, Healing
discussion
She created a nursing curriculum. The
purpose is two fold:
- In 1948, she finished writing her book,
"Interpersonal Relations in Nursing",
which was a conceptual framework for
nursing.
- She developed the nursing curriculum
which included studying nurse-patient
interactions through "Process
Recordings"
- Peplau formulated theories on
interpersonal relations in nursing (1952)
and the art and science of nursing (1988)
- To enhance the relationship between
nurses and patients
- To provide high-quality nursing
education.
The Interpersonal Relations Theory in
Nursing
- Working as a Nurse in a Hospital-
Based Setting - Envision yourself
working in an outpatient department,
where patients come in to seek medical
attention. Your role as a nurse starts by
evaluating the cause of the consultation.
This is where the nursing process
begins – it's an interpersonal and
therapeutic process that involves both
science and art. You will use the
knowledge you've acquired to provide
the patient with the necessary care.
Dignity & Respect
- The behavior of the nurse interacting
with the patient has a significant impact
on the patient's well-being and the
quality of nursing care.
- The purpose of the Interpersonal
Relations Theory is to improve the
interpersonal relationship between
 nurses and patients and quality nursing
education.
Healing Discussion
- Peplau formulated theories on
interpersonal relations in nursing (1952)
and the art and science of nursing
Health
(1988).
- Psychodynamic nursing is being able to
understand one's own behavior to help
others identify felt difficulties and to
apply principles of human relations to
the problems that arise at all levels of
experience.
Environment
The Significance of Interpersonal Processes in
Nursing
- According to Peplau, interpersonal
processes play a crucial role in shaping an
individual's personality. These processes
encompass the nurse-client relationship,
communication, pattern integration, and the
nurse's roles.
- Psychodynamic nursing is the practice of Nursing
applying principles of human relations to
issues that arise in different settings and
identifying one's own behavior to help
others address their problems.
- Peplau emphasizes the importance of the
nurse's behavior when interacting with
patients, which has a profound effect on
their well-being and the overall quality of
care they receive.
The Four Phases of the Nurse-Patient
Relationship
- Orientation Phase: Get acquainted phase
of the nurse-patient relationship. It is
important that a professional relationship is
established, parameters, and boundaries Nursing Roles
are established and met, and early levels of
trust are developed.
- Identification Phase: The client begins to
identify problems to be worked on within the
relationship. The goal of the nurse is to help
the patient recognize their participation role
and promote responsibility for self.
- Exploitation Phase or Working Phase:
The client's trust of the nurse reached full
potential, the client making full use of
nursing services, solving immediate
problems, and nurse and the patient work
towards discharge and termination goals.
Additional Roles Include:
Interventions of the problems are done.
- Resolution Phase/Termination Phase:
The final phase of the nurse-patient
relationship, client met needs, mutual
termination of the relationship, and the client
has increased self-reliance to deal with their
problem.
Metaparadigms
Human Beings
- According to Peplau, a person is an
organism that tries to reduce anxiety caused
by needs and lives in unstable equilibrium.
- Every person is viewed as a unique
biological-psychological-spiritual structure,
which reacts differently to any given
situation.
- Health is defined as 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.
- Peplau has a narrow perception of the
environment, which is a major limitation of
her theory.
- Today, the nurse must consider various
factors such as cultural background, home
and work environment, and the patient's
adjustments to the hospital.
- Peplau considers nursing to be a "significant
therapeutic, interpersonal process" that
functions cooperatively with others to make
health possible.
- Nursing involves problem-solving and is
therapeutic because it is a healing art that
assists individuals who are sick or in need
of medical care.
- The purpose of nursing is to educate and
be a maturing force so that the patient gets
a new view of himself given the need that
he has presented. This is achieved when
the nurse enters into a relationship with the
person, viewed as a medium for change.
- In the course of the nurse-patient
relationship, the nurse assumes several
roles which empower and equip her in
meeting patient's needs. These roles are:
- Stranger Role
- Resource Role
- Teaching Role
- Counseling Role
- Surrogate Role
- Active Leadership
- Technical Expert Role
i. Technical expert
ii. Consultant
iii. Health teacher
iv. Tutor
v. Socializing agent
vi. Safety agent
vii. Manager of environment
viii. Mediator
ix. Administrator
x. Recorder observer
 xi. Researcher
Factors that affect the N-P relationship
Needs
- Needs create tension
- Ex. Need to be loved + not being loved ==
TENSION/ ANXIETY
- Ex. Financially secured === to feel love
INTERFERENCE Conflicting habits and values
Physiological Dysfunction
- Manifests as frustrations and aggressions
- Three possible responses to repeated
frustrations: Dependent Exaggerated
independence Deny illness
- How can nurses facilitate FRUSTRATION?
- Help patient vary their goals
- Allow communicate their aggression
- Opposing Goals
- Hesitation Unable to decide
- Your role is to listen to the patient, interpret the
issue and perceive it as a barrier.
- Unexplained Discomfort
- Manifestations: Frustration Anxiety Needs
Conflict
- SELF Awareness
- Necessary to identify the cause of discomfort
and plan to achieve the goals.
Strengths (Applicability)
- Essential to a strong nurse-patient relationship
Weakness
- Personal space not considered
- Health promotion not emphasized
- Difficulty with patient who does not recognize
the "need"
Ida Jean Orlando's Theory: The Dynamic Nurse-
Patient Relationship
- “The role of the nurse is to find out and meet
the patient's immediate need for help. The
patient's presenting behavior may be a plea
for help, however, the help needed may not
be what it appears to be.”
- Orlando's theory was developed in the late
1950s, based on her observations of nurse-
patient interactions.
- She believed that the role of the nurse is to
identify and meet the immediate needs of the
patient, which may not be what it appears to be.
- The nurse helps patients to meet perceived
needs that they cannot meet for themselves by
exploring the meaning of their behavior.
- The deliberate nursing process is formulated
from the observations of interactions between
the client's behavior, nurse's reactions, and
nursing actions.
- Orlando's theory remains one of the most
effective practice theories available as it is clear,
concise, and easy to use.
- The theory focuses on the patient, but it does
not exclude nurses from using other theories
while caring for the patient
- The strength of Orlando's theory lies in its
clarity and simplicity, making it easy for nurses
to use while keeping the focus on the patient.
Additionally, her theory does not exclude the
use of other theories in patient care
Nursing Metaparadigm
Person - Unique individual behaving verbally and
nonverbally. Assumption is that individuals are at
times able to meet their own needs and at other
times unable to do so
Environment – Not defined
Health - Not defined. Assumption is that being
without emotional or physical discomfort and having
a sense of well-being contribute to a healthy state.
Nursing - Professional nursing is conceptualized
as finding out and meeting the client’s immediate
need for help
Lydia Hall’s Care Core Cure Theory
Background
- born in New York City on September 21, 1906
- A rehabilitation nurse who used her philosophy
of Nursing to establish the Loeb Center for
Nursing and Rehabilitation at Montefiore
Hospital in New York
- Administrative director from 1963 until 1969
- Published more than 20 articles about the Loeb
Center and her theories of long-term care and
chronic disease control
Core Care Cure Model
- Lydia Hall was a rehabilitation nurse who used
her philosophy of nursing to establish the Loeb
Center for Nursing and Rehabilitation at
Montefiore Hospital in New York.
- She served as administrative director of the
Loeb Center from the time of its opening in
1963 until her death in 1969.
- In the 1960s, she published more than 20
articles about the Loeb Center and her theories
of long-term care and chronic disease control.
- In 1964, Hall’s work was presented in “Nursing:
What Is It?” in The Canadian Nurse. In 1969,
the Loeb Center for Nursing and Rehabilitation
was discussed in the International Journal of
Nursing Studies.
- Hall argued for the provision of hospital beds
grouped into units that focus on the delivery of
therapeutic nursing. The Loeb plan has been
seen as similar to what later emerged as
“primary nursing” (Wiggins, 1980).
- An evaluation study of the Loeb Center for
Nursing published in 1975 revealed that those
admitted to the nursing unit when compared
with those in a traditional unit were readmitted
less often, were more independent, had higher
post-discharge quality of life, and were more
satisfied with their hospital experience (Hall,
Alfano, Rifkin, & Levine, 1975).
- The theory contains three independent but
interconnected circles:
- Core (The Person) - Therapeutic use of the
Self
- The core is the person or patient to whom
nursing care is directed and needed.
- The core has goals set by himself and not by
any other person. The core behaved according
to his feelings, and value system. Goals or plan
of care of the patient
- Care (The Body) - Intimate Bodily Care
- Represents the patient’s body the nurse gives
hands-on bodily care to the patient in relation to
activities of daily living such as toileting and
bathing
- Cure (The Disease) - Seeing the patient and
family through medical care
- The cure, on the other hand is the attention
given to patients by the medical professionals.
- The model explains that the cure circle is
shared by the nurse with other health
professionals.
- These are the interventions or actions geared
on treating or “curing” the patient from whatever
illness or disease he may be suffering from.
Intervention and Evaluation
- Nurses also share the circles with other
providers.
- Lydia hall’s theory was used to show
improvement in patient- nurse communication,
self-growth, and self-awareness in patients
whose heart failure was managed in the home
setting (mccoy, davidhizar, & gillum, 2007) and
for the Nursing process and critical thinking
linked to disaster preparedness (bulson, &
bulson, 2011).
- Hall believed that professional nursing care
hastened recovery, and as less medical care
was needed, more professional nursing care
and teaching were necessary.
- She stressed the autonomous function of
nursing.
- Her contribution to nursing theory was the
development and use of her philosophy of
nursing care at the Loeb Center for Nursing and
Rehabilitation in New York.
- She recognized professional nurses and
encouraged them to contribute to patient
outcomes. Hall’s work is viewed as a
philosophy of nursing.
Health as an Expanding Consciousness
Margaret Newman
Introduction
- Born on October 10, 1933.
- Bachelor’s degree - University of Tennessee in
1962
- Master’s degree - University of California in
1964
- Doctorate - New York University in 1971
- She has worked in - University of Tennessee,
New York University, Pennsylvania State
University, University of Minnesota
Theory Development
- Martha Rogers-theory of Unitary Human Beings
- Itzhak Bentov – The concept of evolution of
consciousness
- Arthur Young – The Theory of Process
- David Bohm – The Theory of Implicate
Focus
- Person in every situation, disordered hopeless
universal process of expanding consciousness.
Nursing Metaparadigm
Person - a dynamic energy pattern and an open
system interacting with the environment. Persons
can be defined by their patterns of consciousness.
- The patterns of individuals are embedded in
those of their family, and in turn, these are
embedded in the patterns of the community and
society.
- Humans are moving toward increasing
organization and are capable of making their
own decision.
- Consciousness - the information of the system;
the capacity of the system to interact with the
environment
Pattern - Depicts the whole
- a scheme, design, or framework and is seen in
person-environment interactions
- recognized on the basis of variation and may
not be seen all at once
- It is manifest in the way one moves, speaks,
talks, and relates with others.
Environment - not explicitly defined but is
described as being the larger whole, which is
beyond the individual
Health - expanding consciousness: “the evolving
pattern of the whole, the increasing complexity of
the living system and is characterized by
illumination and pattern recognition resulting in
transformation and discovery.
- Health is a synthesis of disease and non-
disease. It is an evolving pattern of the whole of
life; a unitary process, a fluctuating pattern of
rhythmic phenomena that includes illness within
the pattern of energy.
- Sickness can be the “shock that reorganizes the
relationships of the person’s pattern in a more
harmonious ways”
Nursing - “ caring in the human health experience “.

- Caring is a moral imperative for nursing.

Without caring, nursing does not occur.
- Nursing is the act of assisting people to use the
power within them to evolve toward higher
levels of consciousness.
- Nursing is directed toward recognizing the
patterns of the person in interaction with the
environment and accepting the interaction as a
process of evolving consciousness.

Application - The Benefits of Applying Newman's

Nursing Theory in Oncology Departments In
challenging situations where patients' morale may
be negatively affected by unfamiliar hospital
environments, Newman's nursing theory can
provide psychological assistance and instill hope.

- By using this model, nurses can increase

awareness and establish trust with patients in
need.
- This theory is particularly relevant in oncology
departments, where nursing support is vital to
prevent severe anxiety and depression.