SANKAR MADHAB COLLEGE OF NURSING

SEMINAR
ON
NURSING THEORY
(PEPLAU’S THEORY)

Submitted to: Submitted by:

Ms. KH. Pinky K.C. Malsawmtluangi

Lecturer MSc Nursing 1st year

SMCON SMCON

Submitted on :

3rd / 10 / 2016
 PEPLAU’S THEORY
INTRODUCTION

Dr. Hildegard E Peplau was born in Reading, Pennsylvania, USA in 1909 and died in 1999.

In 1952, Dr. Hildegard Peplau described her major concepts of nursing. In later publications, she modified
some of the concepts. Peplau views the individual as a developing self-system with the unique biochemical
physiological and socio-psychological characteristics and needs, throughout life individual encounter anxiety
producing experiences, which create tension and can be transformed into either health promoting or health
debilitating behaviours. Peplau believes that an individual behaviours are purposeful and directed toward self
maintenance reduction of anxiety arising from unmet needs, and achievement of higher needs when unmet
needs are felt of recognized, individuals may seek professionals assistance.

Nursing theories and models are very important for development of a specialized body of knowledge.
Previous days nursing profession relied on theories from other disciplines such as medicine, psychology but
now we have our own theories to follow.Theories are composed of concepts (and their definitions) and
propositions that explain the relationships between the concepts.. Theories are based on stated assumptions
that are presented as givens. Theoretical assumptions may be taken as "truth" because they cannot be
empirically tested, such as in a value statement or ethic. Theories may be presented as models that provide a
diagram or map of the theory's content.

Peplau identifies six roles that nurses may assume while working with the patients: teacher, resource,
counselor, leader, technical expert, and surrogate. These roles are used in the four phases of the goal directed
interpersonal relationship to assist patients to – examine their interpersonal relationships, felt needs, and
problems and define, understand and productively resolve those problems. During the relationship, the
attitudes toward the patient and the relationship are also examined by nurse to understand their interpersonal
dynamics and develop therapeutic use of self. Nurses used communication techniques unconditional
acceptance, and empathy. These skills promote a trusting relationship, the patient’s self-reliance, and
independent decision-making.

DEFINITION

Nursing Theory – A conceptualization of some aspect of reality (invented or discovered) that pertains to
nursing. The concept is articulated for the purpose of describing, explaining, predicting, or prescribing
nursing care.

Person – A developing organism that tries to reduce anxiety caused by needs.

Environment – Existing forces outside the organism and in the context of culture.

Health – 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.

Nursing – A significant therapeutic interpersonal process. It functions cooperatively with other human
process that makes health possible for individuals in communities.
PEPLAU’S THEORY OF INTERPERSONAL RELATIONS

Peplau describes four phases of the nurse-patient relationship. Although separate, they overlap
and occur over the time of the relationship.

1. Orientation. During the orientation phase, the individual has a "felt need" and seeks professional
assistance. The nurses helps die patient recognize and understand his problem and determine his need for
help.

2. Identification. The patient identifies with those "who can help him (relatedness). The nurse permits
exploration of feelings to aid the patient in undergoing illness as an experience that reorients feelings and
strengthens positive forces in the personality and provides needed satisfaction.

3. Exploitation. During die exploitation phase the patient attempts to derive full value from what is offered
him through the relationship. New goals to be achieved through personal effort can be projected, and power
shifts from the nurse to the patient as the patient delays gratification to achieve the newlv formed goals.

4. Resolution. Old goals are gradually put aside and new goals adopted. This is a process in which the
patient frees himself from identification with the nurse.

However, in 1997, Peplau wrote that the nurse-patient relationship is composed of three phases

1. Orientation phase

2. Working phase (Identification + exploitation)

3. Termination phase

PEPLAU’S PHASES IN NURSING-

1. ORIENTATION:

In the initial phase, orientation, the nurse and patient meet as two strangers. The patient and/or the
family has a "felt need" therefore, professional assistance is sought. However, this need may not be
readily identified or understood by the individuals who are involved. Peplau emphasizes "Psychiatric
nurses who practice in either hospital or community settings need to pay more attention to families". It
is of the utmost importance that the nurse work collaboratively with the patient and family analyzing the
situation, so that together they can recognize, clarify, and define the existing problem.

The orientation phase is directly affected by the patient's and nurse's attitudes about giving or receiving
aid from a reciprocal person. In this beginning phase, the nurse needs to be aware of her or his personal
reactions to the patient. The nurse's, as well as the patient's, culture, religion, race, educational
background, experiences, and preconceived ideas and expectations all influence the nurse's reaction to
the patient. In addition, the same factors influence the patient's reaction to the nurse. Nursing is an
interpersonal process, and both the patient and nurse have an equally important part in the therapeutic
interaction. The nurse, the patient, and the family work together to recognize, clarify, and define the
 existing problem. Peplau (1995) discusses the need for the nurse to give not only support but health
teaching to family member. They need time to talk with staff about their concern about the patient".
This in turn decreases the tension and anxiety associated with the felt need and the fear of the unknown.
Decreasing tension and anxiety prevents future problems that might arise as a result of repressing or not
resolving significant events. Stressful situations are identified

In summary, in the beginning of the orientation phase, the nurse and the patient meet as strangers. At
the end of the orientation phase, they are concurrently striving to identify the problem and are becoming
more comfortable with one another. In addition, the patient becomes more comfortable in the helping
environment. The nurse and the patient are now ready to logically progress to the next phase, the
working phase,

2. WORKING PHASE :

The working phase encompasses the activities previously described in the identification and exploitation
phases. As this phase begins, in what was formerly the identification phase, the patient responds
selectively to people who can meet his or her needs. Each patient responds differently in this phase. For
example the patient might actively seek out the nurse or statistically wait until the nurse approaches.
The response to the nurse is threefold:

(1) Participate with and be Interdependent with the nurse,

(2) Be autonomous and independent from the nurse, or

(3) Be passive and independent on the nurse (Peplau, 1952/1988).

An example is that of a 70-year-old man who wants to plan his new 1,600 calorie diabetic diet. If the
relationship is interdependent, the nurse and patient collaborate on the meal planning. Should the re-
lationship be independent, the patient plans the diet himself with minimal input from the nurse. In a
dependent relationship, the nurse does the meal planning for the patient.

Throughout the working phase, both the patient and nurse must clarify each other’s perceptions and
expectations (Peplau, 1952/1988). Past experiences of both the patient and the nurse will influence their
expectations during this interpersonal process. As mentioned in the orientation phase, the initial attitudes
of the patient and nurse are important in building a working relationship for identifying the problem and
choosing appropriate assistance.

3. Termination
The last phase in Peplau's interpersonal process is termination. The patient's needs have already been met
by the collaborative efforts between the patient and nurse. The patient and nurse now need to terminate
their therapeutic relationship and dissolve the links between them.
Sometimes the nurse and patient have difficulty dissolving these links. Dependency needs in a therapeutic
relationship often continue psychologically after the physiological needs have been met. The patient may
feel that it "is just not tune yet" to end the relationship. For example, a new mother has a desire to learn
infant care. Readiness is one of the most important factors in the learning process and learning is initiated
by a need or purpose. During the first home visit, the community health nurse and the new mother set their
goal of having the mother properly demonstrate various' facets of infant care by the third visit. The setting
of these goals is important in order to evaluate whether or not the desired outcome has been achieved.
After instruction and demonstration by the community health nurse on the first visit, the mother takes a
more active role during the next home visits. In order for learning to become relatively permanent, it must
be used in actual practice. By the third visit the mother demonstrates correctly all facets of infant care.
Their goal is met. The relationship is ended because the mother's problem was solved. However, one week
after the resolution, the mother telephones the community health nurse five times with minor questions on
infant care. The mother has not dissolved the dependency link with the community health nurse.
The final resolution may also be difficult for the nurse. In the previous example, the mother may be
willing to terminate the relationship; however, the community health nurse may continue to visit the home
to watch the baby develop. The nurse may be unable to free herself or himself from this bond in their
relationship. This may be, in part, due to the nurse's knowledge of the importance of the parent child
relationship. Peplau (1994) refers to the "enormous influence which parents and significant caretakers
have on the early development of infants, and in the shaping of behaviour of growing children. In
termination as in the other phases, anxiety and tension increase in the patient and the nurse if there is
unsuccessful completion of the phase
During successful termination, the patient drifts away from identifying with the helping person, the nurse.
The patient then becomes independent from the nurse as the nurse becomes independent from the patient.
As a result of this process, both the patient and nurse become stronger maturing individuals. The patient's
needs are met, and movement can be made toward new goals. Termination occurs only with the successful
completion of the previous phases.

PEPLAU’S NURSING ROLES

Different nursing roles are assumed during the various phases. These roles can be broadly described
as follows-

1. Stranger - Receives the client the same way one meets a stranger in any other life situations
providing an accepting climate that builds trust
2. Teacher - Imparts knowledge concerning ones need or interest.
3. Resource – provides specific needed information that aids in understanding a problem or a new
situation
4. Counsellor – Through the use of certain skills and attitudes, aids another in recognizing, facing,
accepting and resolving problems that are interfering with the other person’s ability to live happily
and effectively.
 5. Leader – Carries out the process if initiation and maintenance of group goals through interaction.
6. Technical expert – Provides physical care by displaying clinical skills and operating equipment.
7. Surrogate – helps to clarify domains of dependence, interdependence and independence.

ADDITIONAL ROLES INCLUDE:

 Technical expert
 Health teacher
 Socializing agent
 Manager of environment
 Administrator
 Consultant
 Tutor
 Safety agent
 Mediator

PEPLAU’S THEORY AND NURSING'S METAPARADIGM

Man

According to Peplau, it is defined as an organism that "that lives in equilibrium and that strives in its own
way to reduce tension generated by needs."

Health

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."

Environment

Peplau defined it in terms of existing forces outside the organism and in the context of culture from where
customs and beliefs are acquired.

Nursing

"It is a significant, therapeutic, interpersonal process". She defines it as a "human relationship between an
individual who is sick, or in need of health services, and a nurse especially educated to recognize and to
respond to the need for help”.

INTERPERSONAL PROCESS AND NURSING PROCESS

Peplau’s theory and Interpersonal process can be compared to the nursing process. The nursing process is a
deliberate intellectual activity whereby the practice of nursing is approached in an orderly, systematic
manner.

 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 tools utilized by nursing.

Assessment Orientation

 Data collection and analysis [continuous]  Non-continuous data collection

 May not be a felt need  Felt need

 Define needs

Nursing diagnosis Identification

Planning  Interdependent goal setting

 Mutually set goals

Implementation Exploitation

 Plans initiated toward 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
successfully
 May lead to termination and initiation of
new plans  Leads to termination

APPLICATION AND IMPORTANCE OF THE THEORY

Practice

 Peplau theory is practice based theory. This provides an "approach to knowledge development
through the scholarship of practice: nursing knowledge is developed in practice as well as for the
practice."
 It leads to integration of scientific disciplines in formulating paradigm of psychiatric nursing and
strengthening nurse patient relationship and it makes the foundation of psychiatric nursing.
 Peplau used observations in clinical situations as the basis for hypothesis and interventions that were
then tested in clinical practice.
 The application of Hildegard Peplau’s Interpersonal Theory of Nursing relates to group
psychotherapy. The phases of the nurse patient relationship, including orientation, identification,
exploitation and resolution, are described as they relate to group psychotherapy, and clinical
examples are presented. The clinical examples also demonstrate the patient s movement in group
 therapy through the steps of the learning process: Observation, description, analysis, formulation,
validation, testing, integration and utilization. Finally, the roles of the nurse including stranger,
resource person, teacher, leader, surrogate and counselor are described as they occur in group
psychotherapy.
 Nurse client relationships have been considered the foundation of successful home-visiting programs
for vulnerable families. Nurse client relationships are important when working with community
people.

Education

 The theory urged the nurses to use nursing situations as a source of observations from which unique
concepts could be derived
 By applying this theory in clinical areas, nurse acts as a participant observer and thus upgrades her
previously acquired theoretical knowledge
 Interpersonal Relations in Nursing -used as a manual of instructions to nursing students.
 Foundation of psychiatric nursing education.

Research

 Different studies on the nursing phenomena

 Improvement of the social system
 Stress management program
 Formation of behavior scale
 Therapeutic behavior of the nurses.

PEPLAU’S THEORY APPLICATION NURSING PROCESS:

The nursing process for Mrs. XYZ, 27 years who was diagnosed as Inter vertebral disc prolapsed.

1. Assessment (orientation phase):

 Mrs. XYZ is on pelvic traction and she is restricted to bed.

 The need for bed rest and restriction was discussed.

2. Nursing diagnosis:

 Impaired physical mobility related to the presence of pelvic traction as evidenced by inability to
move.

3. Planning (Identification phase):

 Assess the general condition of the patient and the activity level.
 Provide active and passive exercises to all the extremities to improve the muscle tone and strength.
 Make the patient to perform the breathing exercises which will strengthen the respiratory muscle.
 Massage the upper and lover extremities which help to improve the circulation.
 Provide articles near to the patient and encourage doing activities within limits.
 Provide positive reinforcement for even a small improvement to increase the frequency of the desired
activity
4. Implementation (Exploitation phase):

 Provided active and passive exercises to all the extremities.

 Made the patient to perform breathing exercises.
 Massaged the upper and lower extremities.
 Provided article within the reach of the patient.
 Provided positive reinforcement to the patient.

5. Evaluation (Resolution phase):

 Mrs. XYZ was free to express problems regarding difficulty in mobilizing.

 She expressed satisfaction when able to move without difficulty.

PEPLAU’S WORK AND CHARACTERISTICS OF THEORY

Generally, Peplau’s work is a theory of Nursing, on the basis characteristics of theory.

1. Theories can interrelate concepts in such a way as to create a different way of looking at
particular phenomenon.
2. Theories must be logical in nature (Logical sequence).
3. Theories should be relatively simple yet generalizable (Simplicity).
4. Theories can be the bases for hypotheses that can be tested or for theory to be expanded.
5. Theories contribute to and assist in general body of knowledge within the discipline through
the research implementation to validate.
6. Theories can be used by practitioners to guide and improve their practice.
7. Theories must be consistent with other validated theories, laws, and principles but will leave
open unanswered questions that need to be investigated.

CONCLUSION
Peplau's (1952) Interpersonal relations in nursing is still applicable in theory and practice. T he core of
Peplau's theory of nursing focuses on the interpersonal process, which is an integral part of present-day
nursing. This process initially consisted of the sequential phases of orientation, identification,
exploitation, and resolution. More recently. Peplau (1997) redefined the phases as the orientation phase,
the working phase, and the termination phase These phases overlap, interrelate, and vary in duration. The
nurse and patient first clarify the patient's problems, and mutual expectations and goals are explored
while deciding on appropriate plans for improving health status. This process is influenced by both the
nurse's and patient's perceptions and preconceived ideas emerging from their individual uniqueness.
Peplau stresses that both the patient and nurse mature as the result of the therapeutic interaction. When two
persons meet in a creative relationship, there is a continuing sense of mutuality and togetherness
throughout the experience. Both individuals are involved in a process of self-fulfilment, which becomes a
growth experience.
BIBLIOGRAPHY

1. Brar NK, Rawat HC. Textbook Of Advanced Nursing Practice. 5th ed. Jaypee Brothers
Medical Publishers.2015. p673-80
2. Raj D.E.B. Nursing Theories.1st ed. Jaypee Brothers Medical Publishers.2011. p39-49
3. George B.J. Nursing Theories. The Base for Professional Nursing Practice.5 th ed. Julie
Levin Alexander Publishers.2002.p 61-79
4. Basavanthappa BT. Nursing Theories.1st ed. Jaypee Brothers Medical Publishers. 2007.
p110-8
5. Tomey AM. Nursing Theorists And Their Work.2nd ed. Pearson Education Publishers.
2002. p 203-10
6. Smith M.C., Parker M.E. Nursing Theories and Nursing Practice. 4 th ed. Jaypee Brothers
Medical Publishers.2015. p 68-74
7. M.S.R.I.N.E.R., National Conference on Theory In Nursing Practice, 1st ed. 16th-17th Feb.
2008