Interpersonal

Relations Theory

HILDEGARD
PEPLAU
 Hildegard Peplau
Psychiatric Nurse of the Century
Born: September 1, 1909,
Reading, Pennsylvania, United
States.
Education:
William Alanson White
Institute(1954)
Pottstown Hospital, School of
Nursing(1931)
Columbia University
Bennington College
 Hildegard Peplau
Neuropsychiatric hospital in London,UK.
Member of the Army Nurse Corps
Worked at Bellevue and Chestnut Lodge
Psychiatric Facilities
Worked tirelessly to advance nursing
education and practice in 1930's.
Neuropsychiatric hospital in London,UK.
Member of the Army Nurse Corps
Worked at Bellevue and Chestnut Lodge
Psychiatric Facilities
Died: March 17, 1999, Sherman Oaks,
Los Angeles, California, United States
Interpersonal
Relations
Theory
DEFINITION OF INTERPERSONAL
RELATIONSHIP
Interpersonal relationships refer to
reciprocal social & emotional interactions
between two or more individuals in an
environment.
 Interpersonal relationship is defined as a
close association between individuals who
share common interests & goals.
Introduction to the Theory
Phases of Nurse-Patient Relationship
A. Orientation Phase
•Get acquainted phase of the nurse-patient
relationship.
•Preconceptions are worked through
•Parameters are established and metEarly
levels of trust are developed
•Roles begin to be understood

B. Identification Phase
•The client begins to identify problems to be
worked on within relationship
•The goal of the nurse: help the patient to
recognize his/her own interdependent/participation
role and promote responsibility for self
C.Exploitation Phase
Client’s trust of nurse reached full
potential
Client making full use of nursing
services
Solving immediate problems
Identifying and orienting self to
[discharge] goals

D.Resolution Phase
•Client met needs
•Mutual termination of relationship
•Sense of security is formed
•Patient is less reliant on nurse
•Increased self-reliance to deal with own
problems
 ELEMENTS INVOLVED IN NURSE-PATIENT
RELATIONSHIP
Contract
•The time, place and purpose of meetings
as well as conditions for termination are
established between the nurse and the
client.
Boundaries
•Roles of participants are clearly defined,
the nurse is defined as a professional
02/14/17
helper, the client’s needs and problems
peplau's inter personal theory 1
 Confidentiality
•The nurse should share information only with
professional staff who need to know. The nurse sho
obtain client’s written permission to share informati
with others outside the treatment team.
Therapeutic Nurse Behaviors
•Self-awareness

•Genuineness .

•Warmth and respectfulness .

•Empathy
02/14/17
•Cultural sensitivity
peplau's inter personal theory 1
NURSING
ROLES
• Stranger role
 Receives the client the same way one
meets a stranger in other life situations;
provides an accepting climate that builds
trust.

• Resource role
 Answers questions, interprets
clinical treatment data, gives
information.

• Teaching role
 Gives instructions and provides
training; involves analysis and synthesis
of the learner's experience.
• Counseling role
 Helps client understand and integrate
the meaning of current life
circumstances; provides guidance and
encouragement to make changes.
• Surrogate role
 Helps client clarify domains of
dependence, interdependence, and
independence and acts on clients behalf as
advocate.
• Active leadership role
 Helps client assume maximum
responsibility for meeting treatment goals
in a mutually satisfying way.
• Technical expert role
Additional Roles:

1. Technical expert
2. Consultant
3. Health teacher
4. Tutor
5. Socializing agent
6. Safety agent
7. Manager of environment
8. Mediator
9. Administrator
10. Recorder observer
11. Researcher
Major Concepts:
• Person
• Health
• Environment
• Nursing
• Therapeutic Nurse-Client Relationship

Sub- Concepts:
• Roles of the nurse in the Therapeutic Relationship
• Anxiety
a. Mild
b. Moderate
c. Severe
d. Panic
  Person
A man who is an organism that lives
in an unstable balance of a given
system.

 Nursing  Health
Significant, therapeutic Symbolizes movement of the
interpersonal process. It functions personality and other ongoing human
cooperatively with human processes that directs the person
processes that present health as a towards creative, constructive,
possible goal for individuals. productive and community living.

Environment
Forces outside the organism and in
the context of the socially-approved
way of living, from which vital human
social processes are derived such as
norms, customs and beliefs.
Interpersonal Theory and Nursing Process
 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
Assessment: Orientation:
tools
• Data utilized by nursing.
collection and analysis [continuous]· •Non continuous data collection.
• May not be a felt need. •Felt need ·
•Define needs
Nursing diagnosis Planning: Identification:
• Mutually set goals. Interdependent goal setting
Implementation: Exploitation:
•Plans initiated towards achievement of • Patient actively seeking and drawing help.
mutually set goals. • Patient initiated
•May be accomplished by patient , nurse or
family.
Evaluation: Resolution:
•Based on mutually expected behaviors. •Occurs after other phases are completed
•May led to termination and initiation of successfully.
new plans •Leads to termination.
Interpersonal Therapeutic Process
This type of process is based on the
theory proposed by Peplau and particularly
useful in helping psychiatric patients become
receptive for therapy.
Often referred as "Psychological
Mothering," it includes the following steps:

• The patient is accepted unconditionally as a

participant in a relationship that satisfies his
needs;
• There is recognition of and response to
the patient's readiness for growth, as his
initiative; and
• Power in the relationships shifts to the
patient, as the patient is able to delay gratification
and to invest in goal achievement.
PEPLAU‘S WORK AND CHARACTERISTICS OF A
THEORY 1.Interrelation of concepts .
•Four phases inter-relate the different
components of each phase
2.Applicability
•The nurse-patient interaction can apply to the
concepts of human being, health, environment
3.Theories must be logic in nature
and nursing
•This theory provides a logical systematic way of

viewing nursing situations .

•Key concepts such as anxiety, tension, goals and

frustration are indicated with explicit relationships

02/14/17 among them and progressive phases. 1
 4.Generalizability
This theory provides simplicity in regard to the
natural progression of the NP relationship
a.Theories can be the bases for hypothesis that
can be tested
•Peplau’s theory has generated testable
hypotheses.
b.Theories can be utilized by practitioners to
guide and improve their practice
•Peplau's anxiety continuum is still used in
anxiety patients.

02/14/17
1
 C,Theories must be consistent with other
validated theories , laws and principles but
will leave open unanswered questions that
need to be investigated
•Peplau s theory 15 consistent with various
theories.

02/14/17
2
Limitations
• Personal space considerations and
community social service resources are
considered less.
• Health promotion and maintenance
were less emphasized
• Cannot be used in a patient who doesn’t
have a felt need eg. With drawn patients,
unconscious patients
• Some areas are not specific enough to
generate hypothesis
Assumptions:

• Nurse and patient can interact.

• Both the patient and nurse mature as the
result of the therapeutic interaction.
• Communication and interviewing skills
remain fundamental nursing tools.
• Nurses must clearly understand themselves
to promote their client’s growth and to
avoid limiting client’s choices to those that
nurses value.
Strengths:

 T h e phases provide simplicity

regarding the natural progression of
the nurse-patient relationship.

 This simplicity leads to adaptability

in any nurse-patient interaction,
thus providing generalizability.
Weaknesses:

 Health promotion and

maintenance were less
emphasized.

 T h e theory cannot be used in a

patient who doesn’t have a felt need
such as with withdrawn patients.
Research Based on Peplau’s Theory
•Hays .D. (1961). 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.
•Burd .S.F. Develop and test a nursing intervention
framework for working with anxious patients:
Students developed competency in beginning
interpersonal relationship.
 Conclusion
• Peplau conceptualized clear sets of nurse’s roles that can be used by
each and every nurse with their practice. It implies that a nurse’s
duty is not just to care but the profession encompasses every
activity that may affect the care of the patient.
• The idea of a nurse-client interaction is limited with those
individuals incapable of conversing, specifically those who are
unconscious.
• The concepts are highly applicable with the care of psychiatric
patients considering Peplau’s 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.
• 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.