 Patient begins to have a feeling of
HILDEGARD PEPLAU is a nurse theorist
who created the Theory of Interpersonal
Relations. 
Therapeutic nurse-client
relationship
A professional and planned relationship
between client and nurse that focuses on the
client’s needs, feelings, problems, and ideas. It
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.
Four Phases of the therapeutic nurse-patient
relationship:
1. Orientation Phase
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 of past experiences
 Nurse responds, explains roles to the
client, helps to identify problems and to
use available resources and 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
belonging and a capability of dealing with
the problem which decreases the feeling
of helplessness and hopelessness
3. Exploitation Phase
In the exploitation phase, the client makes full use
of the services offered.
 In the exploitation 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
 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.
 In the resolution phase, the client no
longer needs professional services and
gives up dependent behavior. The
relationship ends.
 Termination of professional relationship
 The patients 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
MADELEINE LEININGER is a nursing
theorist who developed the
Transcultural Nursing Theoryor Culture
Care Nursing Theory.

Leininger’s Transcultural Nursing
Theory
The Transcultural Nursing
Theory or Culture Care Theory by Madeleine
Leininger involves knowing and understanding
different cultures with respect to nursing and
health-illness caring practices, beliefs and values
with the goal to provide meaningful and efficacious
nursing care services to people according to their
cultural values and health-illness context.
It focuses on the fact that different cultures
have different caring behaviors and different health
and illness values, beliefs, and patterns of
behaviors.
Description
In 1995, Madeleine Leininger defined
transcultural nursing as “a substantive area of
study and practice focused on comparative cultural
care (caring) values, beliefs, and practices of
individuals or groups of similar or different cultures
with the goal of providing culture-specific and
universal nursing care practices in promoting
health or well-being or to help people to face
unfavorable human conditions, illness, or death in
culturally meaningful ways.”
Major Concepts of the Transcultural
Nursing Theory
 Transcultural Nursing - is defined as a learned
subfield or branch of nursing which focuses upon
the comparative study and analysis of cultures with
respect to nursing and health-illness caring
practices, beliefs, and values with the goal to
provide meaningful and efficacious nursing care
services to people according to their cultural values
and health-illness context.
 Ethnonursing - this is the study of nursing care
beliefs, values, and practices as cognitively
perceived and known by a designated culture
through their direct experience, beliefs, and value
system (Leininger, 1979).
 Nursing - is defined as a learned humanistic and
scientific profession and discipline which is focused
on human care phenomena and activities in order to  Attachment or affiliative subsystem - is the
assist, support, facilitate, or enable individuals or
groups to maintain or regain their well-being (or
health) in culturally meaningful and beneficial ways,
or to help people face handicaps or death.
 Professional Nursing Care (Caring) - is defined
as formal and cognitively learned professional care
knowledge and practice skills obtained through
educational institutions that are used to provide
assistive, supportive, enabling, or facilitative acts to
or for another individual or group in order to improve
a human health condition (or well-being), disability,
lifeway, or to work with dying clients.
 Cultural Congruent (Nursing) Care
Cultural congruent (nursing) care is defined as
those cognitively based assistive, supportive,
facilitative, or enabling acts or decisions that are
tailor-made to fit with individual, group, or
institutional cultural values, beliefs, and lifeways in
order to provide or support meaningful, beneficial,
and satisfying health care, or well-being services.
 Health
It is a state of well-being that is culturally defined,
valued, and practiced, and which reflects the ability
of individuals (or groups) to perform their daily role
activities in culturally expressed, beneficial, and
patterned lifeways.
 Human Beings
Such are believed to be caring and to be capable of
being concerned about the needs, well-being, and
survival of others. Leininger also indicates that
nursing as a caring science should focus beyond
traditional nurse-patient interactions and dyads to
include families, groups, communities, total
cultures, and institutions.
 Society and Environment
These terms are not defined by Leininger; she
speaks instead of worldview, social structure, and
environmental context.
 Worldview
Worldview is the way in which people look at the
world, or at the universe, and form a “picture or
value stance” about the world and their lives.
DOROTHY E. JOHNSON was one of
the greatest nursing theorists who
developed the “Behavioral System Model.”
Her theory of nursing defines nursing
as “an external regulatory force which acts
to preserve the organization and integration
of the patients behaviors at an optimum
level under those conditions in which the
behavior constitutes a threat to the physical
or social health, or in which illness is found.”
7 Subsystems of the Behavior
System Model
“social inclusion intimacy and the formation and
attachment of a strong social bond.” It is probably
the most critical because it forms the basis for all
social organization. On a general level, it provides
survival and security. Its consequences are social
inclusion, intimacy, and the formation and
maintenance of a strong social bond
 Dependency subsystem- is the “approval,
attention or recognition and physical assistance.”
In the broadest sense, it promotes helping
 behavior that calls for a nurturing response. Its manipulate the environment. Its function is control
consequences are approval, attention or mastery of an aspect of self or environment to
or recognition, and physical assistance. some standard of excellence. Areas of
Developmentally, dependency behavior evolves achievement behavior include intellectual,
from almost total dependence on others to a physical, creative, mechanical, and social skills.
greater degree of dependence on self. A certain
amount of interdependence is essential for the
SET
survival of social groups.
The predisposition to act. It implies that despite
 Ingestive subsystem - is the “emphasis on the
having only a few alternatives from which to select
meaning and structures of the social events
a behavioral response, the individual will rank those
surrounding the occasion when the food is eaten.”
options and choose the option considered most
It should not be seen as the input and
desirable.
output mechanisms of the system. All subsystems
are distinct subsystems with their own input and
output mechanisms. The ingestive subsystem “has
to do with when, how, what, how much, and under
what conditions we eat.”
 Eliminative subsystem - states that “human
cultures have defined different socially acceptable
behaviors for excretion of waste, but the existence
of such a pattern remains different from culture to
culture.” It addresses “when, how, and under what
conditions we eliminate.” As with the ingestive
subsystem, the social and psychological factors
are viewed as influencing the biological aspects of
this subsystem and may be, at times, in conflict
with the eliminative subsystem.

 Sexual subsystem- is both a biological and social

factor that affects behavior. It has the dual
functions of procreation and gratification.
Including, but not limited to, courting and mating,
this response system begins with the development
of gender role identity and includes the broad
range of sex-role behaviors.
 Aggressive subsystem - relates to the behaviors
concerning protection and self-preservation,
generating a defense response when there is a
threat to life or territory. Its function is protection
and preservation. Society demands that limits be
placed on modes of self-protection and that people
and their property be respected and protected.
 Achievement subsystem - provokes behavior that
tries to control the environment. It attempts to