Hildegard Peplau economic, spiritual, emotional, and physical
“Interpersonal Relations Theory”
I. Background
 She was born on September 1, 1909 in
Reading, Pennsylvania.
 She was an American nurse and the first
published nursing theorist since Florence
Nightingale.
 She created the middle-range nursing theory
of interpersonal relations which helped
revolutionize the scholarly work of nurses.
 As a primary contributor to mental health law
reform, she led the way towards the humane
treatment of patients with behavior and
personality disorders.
 Considered as the “Psychiatric Nurse of the
Century” as well as the “Mother of
Psychiatric Nursing”.
 After experiencing the devastating flu
epidemic of 1918, this personal experience
greatly influenced her understanding of the
impact of illness and death on families,
especially having witnessed people jumping
from windows due to delirium caused by the
flu.
 Peplau began her nursing career in 1931.
 She served in the Army Nurse Corps from
1935 to 1945 where the American School of
Military Psychiatry was located.
 She died on March 17, 1999, aged 89.
II. Metaparadigms in Nursing
o Person – organism that lives in an unstable
balance of a given system
o Health – symbolizes movement of the
personality and other ongoing human
responses that directs the person towards
creative, constructive, and productive
community living
* To achieve health, we need to live in the
society as a productive individual; a person’s
needs must be met to achieve health:
physiological demands and interpersonal
conditions
o Environment – existing forces outside the
organism and in the context of the socially-
approved way of living; from which viral
human social processes are derived such as
norms, customs, and beliefs
o Nursing – a significant, therapeutic,
interpersonal process; functions cooperatively
with human processes that prevent health as
a possible goal for persons; projects health
holistically while considering the socio-
aspect of every person
III. Interpersonal Relations Theory
According to Peplau, nursing is therapeutic
because it is a healing art – assisting an individual
who is sick or in need of health care. Nursing can
be viewed as an interpersonal process because it
involves interaction between two or more
individuals with a common goal. In nursing, this
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.
IV. Therapeutic Nurse-Client Relationship
o A professional and planned relationship
between client and nurse that focuses on the
client’s needs, feelings, problems, and ideas.
o Nursing involves interaction between two or
more individuals with a common goal. The
attainment of this goal, or any goal, is
achieved through a series of steps following a
sequential pattern.
V. Four Phases of the Therapeutic Nurse-Client
Relationship
1) Orientation Phase
 Initial interaction between nurse and
client
 Client has a felt need and expressed the
desire for professional assistance
 Nurse helps the client recognize and
understand the problem and determine
his/her need for help
2) Identification Phase
 Client works interdependently with the
nurse, expresses feelings, and begins to
feel stronger
 Client and nurse explore the experience
and the need of the patient which leads
to the feeling of relatedness
 Nurse assists the patient in reorienting his
feelings and sustaining a constant positive
environment
3) Exploitation Phase
 Client makes full use of the services
offered
 Client attempts to derive full value from
what he is offered through the
relationship as he moves on from a
dependent role to an independent role
4) Resolution Phase
 Client no longer needs professional
services and gives up dependent behavior
  Client earns independence over his care
as he gradually puts aside his old goals
and formulate new ones
 Relationship between the nurse and the
client ends
VI. Roles of the Nurse in the Therapeutic
Relationship
1) Nurse as a Stranger
 Occurs at initial contact
 Nurse attempts to know the client better
 Nurse must treat client with utmost
courtesy
2) Nurse as a Resource Person
 Client assumes a dependent role
 Nurse provides specific answers to
questions especially health information
and interprets to client the treatment and
medical plan of care
 Responsibility of nurse to change
response according to client’s level of
understanding
3) Nurse as a Teacher
 Nurse gives much importance for self-care
and in helping the client; also determines
how client understands subject at hand
 Nurse must develop her discussion
around interest of the client and his
ability of using information
 Categories:
a) Instructional: giving information
b) Experiential: using experiences
learned as a basis
4) Nurse as a Leader
 Involves democratic process
 Nurse helps client meet tasks at hand
through a relationship of cooperation
 Client is considered vital in deciding the
course of his plan of care
 Nurse must act in behalf of the patient’s
best interest
5) Nurse as a Surrogate
 Client’s dependency for his care gives
nurse a temporary caregiver role
 Creates an atmosphere wherein feelings
previously felt, such as feelings towards
mother; some relationships are activated
and nurtured
6) Nurse as a Counselor
 Has great importance and emphasis in
nursing
 Nurse as an active listener; provides
sound and empathy
 Core is understanding the patient
VII. Four Levels of Anxiety
 Anxiety was defined as the initial response to
a psychic threat.
i. Mild Anxiety – 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).
ii. Moderate Anxiety – involves a decreased
perceptual field (focus on immediate task
only); the person can learn new behavior or
solve problems only with assistance. Another
person can redirect the person to the task.
iii. Severe Anxiety – involves feelings of dread
and terror. 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.
iv. 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.
VIII. Assumptions, Strengths, and Weaknesses
a) Assumptions
o Nurse and client can interact
o Both the client and nurse mature as a
result of the therapeutic interaction
o Communication skills remain as a
fundamental nursing tool
o Peplau believed that nurses must clearly
understand themselves to promote their
client’s growth
b) Strengths
o The phases provide simplicity regarding
the natural progression of the nurse-client
relationship
o This simplicity leads to adaptability in any
nurse-client interaction, thus providing
generalizability
c) Weaknesses
o Health promotion and maintenance were
less emphasized
o The theory cannot be used to a client who
doesn’t have a felt need (e.g. withdrawn
clients)
IX. Analysis
 Peplau conceptualized clear sets of nursing
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 client.
 The idea of a nurse-client interaction is
limited to 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. However, 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.