 THEORY OF INTERPERSONAL
RELATIONSHIP him/her. The nurse permits exploration of
Hidegard Peplau
-Was born in Reading, Pennsylvania in 1909.
-Graduate from a diploma program in
Pottstown, Pennsylvania in 1931.
-Earned Bachelor of Arts in Interpersonal
Psychology from Bennington College in 1943.
-Finished Master of Arts in Psychiatric Nursing
from Colombia University, New York in 1947.
-Published Interpersonal Relations in Nursing in
1952.
-In 1968, introduced Interpersonal techniques -
the crux of psychiatric nursing.
According to Peplau‟s “Theory of Interpersonal
Relations,” the three sequential phases in the
interpersonal nurse-patient relationship are as
follows:
1. ORIENTATION PHASE
-Problem defining phase
-Starts when the client meets nurse as stranger
-Defining problem and deciding type of service
needed
-Client seeks assistance, conveys needs, ask
questions, shares preconceptions and
expectations of past experiences
-Nurse responds, explains role to client, and
helps to identify problems and to use available
resources and services.
-the individual has a felt need and seeks
professional assistance.
--The nurse helps the individual to recognize and
understand his/her problem and determine the
need for help.
- Nurse and patient interacts for the first time.
-Nurse begins to know about the patient
-Tasks include establishing rapport, developing
trust, (and formulation of a nursing diagnosis).
-Major task is to develop a mutually acceptable
contract.
2. WORKING PHASE
-it is highly individualized
-More structured than the orientation phase
-The longest and most productive phase of the
nurse-patient relationship
-Limit-setting is employed
-Tasks include planning and implementation
-major task is identification and resolution of the
patient‟s problems.
A. IDENTIFICATION PHASE
-Selection of appropriate professional
assistance
-Patient begins to have a feeling of belonging
and a capability of dealing with the problem,
which decreases the feeling of helplessness and
hopelessness.
-The patient identifies with those who can help
feelings to and the patient in undergoing illness
as an experience that reorients feeling and
strengthens positive forces in the personality
and provides needed satisfaction.
B. EXPLOITATION PHASE
-Use of professional assistance for problem
solving alternatives.
-Advantages of services are used and based on
the needs and interests of the patient.
-Individual feels as an integral part of the
helping environment.
-The individual 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.
-During this phase, the patient attempts to
derive full value from what he is offered through
the relationship. The nurse can project new
goals to be achieved through personal effort
and power shifts from the nurse to the patient as
the patient delays gratification to achieve the
newly formed goals.
-Nurse must be aware about the various phases
of communication
-Nurse aids the patient in exploiting all avenues
of help and progress is made towards the final
step.
3. RESOLUTION PHASE
-Termination of professional relationship
-The patient‟s needs have already been met by
the collaborative effort 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 bond with nurse
and healthier emotional behavior is
demonstrated and both become mature
individuals.
-The patient gradually puts aside old goals and
adopts new goals. This is a process in which the
patient frees himself from identification with the
nurse.
C. TERMINATION PHASE
-Gradual wearing process
-It is a mutual agreement.
-Involves feelings of anxiety
-it should be recognized in the orientation
phase
-Tasks include evaluation
-Major tasks is to assist patient to review what processes that make health possible for
has been learned and to transfer his learning to individuals in communities.
his relationship with others.

ROLE OF THE NURSE IN THE

NURSE-PATIENT INTERPERSONAL RELATIONSHIPS:
According to Peplau (1952/ 1988), NURSING is
Stranger therapeutic because it is a HEALING ART,
- Receives the client in the same way one ASSISTING AN INDIVIDUAL WHO IS SICK OR IN
meets a stranger in other life situations. NEED OF HEALTH CARE.
-Provides an accepting climate that builds trust.
Teacher
- Who imparts knowledge in reference to a
need or interests.
Resource Person
- One who provides a specific needed
information that aids in the understanding of a
problem or a new situation.
Counselor
- Helps to understand and integrate the
meaning of current life circumstances; provides
guidance and encouragement to make
changes.
Leader
- Helps client assume maximum responsibility for
meeting treatment goals in mutually satisfying
way.
Surrogate
- Helps to clarify domains of dependence,
interdependence and independence and acts
on client‟s behalf as an advocate.

Additional Roles include:

 Technical Expert
 Consultant
 Health teacher
 Tutor
 Socializing agent
 Safety agent
 Manager of environment
 Mediator
 Administrator
 Record observer
 Researcher


CONCEPTS:
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, personal and community living.

NURSING
- A significant therapeutic interpersonal process.
It functions cooperatively with other numan
  NURSING PROCESS THEORY
IDA JEAN ORLANDO
-A first generation American of Italian descent
was born in 1926.
-Received her nursing diploma from New York
Medical College, her BS in public health nursing
from Columbia University, New York.
-Project investigator of a National Institute of
Mental Health grant entitled:Integration of
Mental Health Concepts in a Basic Nursing
Curriculum.
-It was from this research that she developed
her theory, which was published, in her 1961
book: “The Dynamic Nurse-Patient
Relationship.”
-She furthered the development of her theory
when at McLean Hospital in Belmont, MA as
Director of a Research Project: Two systems of
Nursing in a Psychiatric Hospital.
-The results of the research are contained in her
1972 book entitled: The Discipline and Teaching
of Nursing Processes.
-Orlando‟s theory was developed in the late
1950‟s from observations she recorded between
a nurse and patient.
-Despite her efforts, she was only able to
categorize the records as “good” or “bad”
nursing.
-It then dawned on her that both the
formulations for “good” and “bad” nursing
contained in the records. From these
observations she formulated the deliberative
nursing process.
STAGES OF NURSING PROCESS THEORY:
Assessment
-Observable/ data collection
Diagnosis
-problem identified
-diagnosis generated from NANDA (Northern
American Nursing Diagnosis Association)
-if the nursing evaluation is not working, go back
to reassessment
Planning
- Plan of care
Implementation
-translation of plan to reality
-nursing intervention: independent intervention
Evaluation
-is my implementation working?
The major dimensions of Orlando’s Nursing
Process Theory are as follows:
1. Professional nursing function
- organizing principle
2. The patient’s presenting behavior
-problematic situation
-pain can be objective(pain scale) or subjective
3. Immediate reaction
-internal response
-assessment
4. Deliberative nursing process
- reflective inquiry
- give nursing diagnosis (Stages of Nursing
Process Theory)
5. Improvement – resolution
1. Professional Nursing Function (Organizing
Principle)
 The nurse‟s unique function is “finding
out and meeting the patient‟s
immediate needs for help” (Orlando,
1972)
 Nursing… is responsive to individuals who
suffer or anticipate a sense of
helplessness, it is focused on the process
of care in an immediate experiences, it
is concerned with providing direct
assistance to individuals in whatever
setting they are found for the purpose of
avoiding, relieving, diminishing, or curing
the individual‟s sense of helplessness.
 The patient‟s sense of helplessness, stress,
or need originated from physical
limitations, adverse reaction to the
setting, and experiences that prevent a
patient from communicating his or her
needs.
 Need is situationally defined as a
requirement of the patient which, if
supplied, relieves or diminishes his
immediate distress or improving his
immediate sense of adequacy or well-
being.
 It is the nurse‟s responsibility to meet the
patient‟s immediate needs for help
either by supplying it directly or by
calling in the services of others.
 The central core of the nurse‟s practice
is to understand what is happening
between the patient and the nurse that
provides framework for the help the
nurse gives the patient.
Nursing Thought: “Does the patient have an
immediate need for help or not?”
- First, the nurse must take the initiative in
helping the patient express the specific
meaning of his behavior in order to
ascertain his distress.
- Second, she must help the patient explore
the distress in order to ascertain the help he
requires for his (immediate) need (for help)
to be met.
 The nurse‟s focus of inquiry is always on
the patient‟s immediate experience.
 If the patient is in need and the need is
fulfilled, the nursing function has been
fulfilled.
  “The product of meeting the patient‟s
immediate need for help is…
„improvement‟ in the immediate verbal
and nonverbal behavior of the patient.
This observable change allows the nurse
to believe or disbelieve that her activity
relieved, prevented, or diminished the
patient‟s sense of helplessness”.
(Orlando, 1961).
2. The Patient’s Presenting Behavior (Problematic
Situation)
 To find out the immediate need for help,
the nurse must first recognize the
situation as problematic.
 “The presenting behavior of the patient,
regardless of the form in which it
appears, may be a plea for help”
(Orlando, 1961).
 Both the patient and the nurse
participate in the exploratory process to
identify the problem as well as the
solution.
 The nurse-patient situation is a dynamic
4. Deliberative Nursing Process (Reflective
whole; each is affected by the behavior
Inquiry)
of the other. The interaction is unique for
each situation.
 The patient‟s behavior stimulates the
nurse‟s immediate reaction and
becomes the starting point of the
investigation.
3. Immediate Reaction ( Internal Response)
 The problematic situation, in the form of
the patient‟s presenting behavior (e.g.,
requests, comments, complaints,
questions, moaning, crying, wheezing,
clenching fist, pallor, reddened face,
difficulty of breathing, increased blood
pressure), triggers an automatic
immediate reaction in the nurse that is
both cognitive and affective.
 The reaction comprises the nurse‟s
perceptions, thoughts about the
perceptions, and the feelings evoked
from the thoughts; they cannot be
controlled. These items occurs in
automatic, almost instantaneous
sequence.
 In any person‟s process of action, four
(4) distinct items occurs sequentially:
1. The person perceives with any one of
his five sense organs an object/s;
2. The perceptions stimulated
automatic thought;
3. Each though stimulates an automatic
feeling; and
4. Then, the person acts
 The interaction of these items is called
the NURSING PROCESS. The first three
items cannot be observed; only the
action can. The action is what the
person says verbally or conveys
nonverbally.
 The nurse‟s immediate reaction is unique
for each situation. What the nurse
perceives, thinks, or feels reflects his
interpretation or meaning attached to
the perception. It may or may not be
correct from the patient‟s point of view.
 Regardless of the extent of nurse‟s
accuracy, the perceptions that evoked
the thoughts are communications from
the patient and represent the raw data
for the nurse to use in investigating or
exploring the patient‟s behavior.
 The deliberative nursing process views
the nurse-patient situation as a dynamic
whole.
 The nurse‟s behavior affects the patient,
and the nurse is affected by the
patient‟s behavior. Understanding the
patient‟s behavior is a complex process
in which observations and thoughts are
used in a serial responsive way to get
the “facts of the case”.
 To be successful, the nurse‟s focus must
be on the patient rather than on an
assumption that he/she knows what the
patient‟s problems are and on arbitrary
decisions about what action to take.
 The use of Orlando‟s deliberative
process requires that there us a shared
communication process between the
nurse and the patient to determine the
following:
1. The meaning of the patient’s behavior
2. The help required by the patient
3. Whether the patient was helped by the
nurse’s action
 Orlando describes the components of a
person‟s action process. In a person-to-
person encounter, each experiences an
immediate reaction. This contains the
following:
  The person‟s perception of the other
person‟s behavior
 The thought about this perception
 The feelings associated with the
thought.
 Unless the content of a person‟s reaction
is openly disclosed, it remains a secret
from the other person.
 If a nurse makes a statement to the
patient and does not disclose what
perceptions, thoughts, or feelings led to
his action, the patient remains unaware
of it because it was not expressed. This
action process often functions in secret.
 Guidelines that specify a person‟s use of
the content or his/her reaction in a
deliberative way are as follows:
a. “In a situation a person verbally states to
the other person any or all of the items
of his/her immediate reaction;
b. The stated items must be expressed as
self-designated; and
c. The person asks the other person to
verify or correct the items verbally
expressed” (Schmieding, 1993).
 The deliberative nursing process
describes as follows: “Whatever the
nurse perceives about the patient with
any one of the five sense organs and
thinks and feels about the perception
must, at least in part be verbally
expressed as self-designated to the
patient and then asked about”.
(Schmieding, 1993).
 According to Orlando (1961) “The nurse
does not assume that any aspect of her
reaction to the patient is correct, helpful,
or appropriate until she checks the
validity of it in exploration with the
patient.”
 The nurse will find it more efficient to find
out what the patient‟s immediate need
for help is by first exploring and
understanding the meaning of his
perception.
 The patient is more likely to agree with
the correctness of the perception and
often explains its meaning to the nurse.
 The longer it takes to find out the
patient‟s immediate need for help, the
more distressed its meaning to the nurse.
 The nurse uses thoughts to try to
understand the nature of the patient‟s
distress. When using thoughts, the nurse
must give the perception from which the
thought was derived and ask the patient
whether it is valid or not.
 Feelings come from the thought about
the perception. The nurse must state the
perception that evoked the thought
from which the feeling was derived.
 Example:
Nurse: “ I’m concerned that you keep asking for
the bedpan. But I don’t think you really need it.
Am I right or not?”
Patient: “Yes, but I’m afraid I might have
chest pain again and then I wouldn’t be able to
call for the nurse.”
 If nurses do not resolve their feelings with
patients, these same feelings occur
each time they are in contact with the
patients.
 Furthermore, unexpressed feelings may
show in the nurse‟s verbal or nonverbal
behavior.
 Regardless of what aspect of his/her
reaction the nurse uses, the patient is
affected by the action. Therefore, “the
nurse initiates a process of exploration to
ascertain how the patient is affected by
what she says or does. Only this way can
she be clearly aware of how and
whether her actions are helping the
patient”. (Orlando, 1961)
 When the nurse explain their immediate
actions to the patients in a deliberative
way, they are likely to meet the patient‟s
immediate needs for help because
when they use it, patients are more likely
to use it also.
 This approach minimizes the nurse‟s
opportunity to make private
interpretations about patients and
maximizes the chance to correct or
verify his private interpretation of the
patients action. Therefore, both nurses
and patients have a better
understanding of how each experience
the immediate situation. If this is not
done, patients remain distressed
because the communication between
them is unclear since the nurse stated an
automatic response to the patient.

 Orlando (1961) noted that automatic
personal responses contribute to
situation conflicts. Thus it is important to
understand them so that problems
associated with their use can be
avoided.
 Basing her ideas on Orlando (1972),
Schmieding (1993) emphasizes the
following reasons that automatic
personal responses are not helpful:
1. When the nurse withholds his or her
immediate reaction, the patient
cannot verify or correct it. The
withholding of the nurse’s
perceptions, thoughts, or feelings
allows the patient to make
assumptions about the nurse’s verbal
and nonverbal behavior.
2. If the nurse’s response is not stated
as self-designated, the patient is
allowed to make assumptions about
the origin of what is heard (the use of
“we” does not clearly provide the
origin)
3. If the nurse’s response is not in the
form of a question, the other person
may not feel free to correct or verify
what she heard.As a result, neither
person in the contact knows the
immediate reaction of the other;
therefore each is left with an
unverified understanding of the
other’s action.
 Actions base on the nurse‟s conclusion,
without the patient‟s participation, are
often not helpful. Therefore, the nurse
decides for reasons other than the
meaning of the patient‟s behavior. Thus
if actions are carried out automatically,
even though they could be correct,
they are ineffective in helping the
patient because the patient was not
involved.
 A nurse‟s past experience are not
sufficient as the basis for understanding
the patient‟s immediate behavior.
 Therefore, in each nurse-patient
experience, a deliberative process of
inquiry is required to prevent the use of
automatic responses and arbitrary
actions. When this occurs, the patient‟s
immediate behavior improves.
5. Improvement Resolution
 When a situation becomes clear, it loses
its problematic character and a new
equilibrium is established.
 When the patient‟s immediate need for
help have been determined and met,
there is improvement.
 If the patient‟s behavior has not
change, the function of nursing has not
been met and the nurse continues with
the inquiry process until there is
improvement.
 This change is observable both in
patient‟s verbal and nonverbal
behavior.
 This allows the nurse to conclude that
the patient‟s sense of helplessness has
been relieved, prevented, or diminished.
 According to Orlando, it is not then
nurse‟s activity that is evaluated but
rather itd results - namely whether the
nurse‟s action helped the patient
communicate his or her need for help
and whether that need was met.
 In each contact the nurse repeats a
process of learning how to help the
individual patient.
 The nurse's own individuality and that of
the patient requires that she go through
this each time she is called upon to
render service to those who need her.
ASSUMPTIONS:
 When patients cannot cope with
their needs without help, they
become distressed with feelings of
helplessness.
 Nursing, in its professional character,
does not add to the distress of the
patient.
 Patients are unique and individual in
their responses.
 Nursing offers mothering and nursing
analogous to an adult mothering
and nurturing of a child.
  Nursing deals with people,
environment, and health. Direct function:
 Patient needs help in -initiates a process of helping the patient
communicating needs; they are express the specific meaning of his behavior in
order to ascertain his distress and helps the
uncomfortable and ambivalent
patient explore the distress in order to ascertain
about dependency needs. the help he requires so that his distress may be
 Human beings are able to be relieved.
secretive or explicit about their
needs, perceptions, thoughts, and Indirect function:
feelings. -calling for help of others, whatever helps the
 The nurse-patient situation is patient may require for his need to be met.
dynamic, actions and reactions are
influenced by both nurse and
Discipline and Professional Activities:
patient.
-automatic activities plus matching of verbal
 Human beings attach meanings to and nonverbal responses, validation of
situations and actions that are not perceptions, matching of thoughts and feelings
apparent to others. with action.
 Patient‟s entry into nursing care is
through medicine. Automatic Activities:
-perception by five senses, automatic thoughts,
 The patient cannot state the nature
and automatic feeling and automatic action.
and meaning of the distress for his
need without the nurse‟s help or
without his need or finding out that
he is not in need at that time.
 Nurses are concerned with needs
that patients cannot meet on their
own.

CONCEPTS:

PERSON (HUMAN BEING)

-A developmental being with needs.
-Nursing clients are patients who are under
medical care and who cannot deal with their
needs or who cannot carry out medical
treatment alone.

ENVIRONMENT
-Not defined directly in Orlando‟s Theory but
implicitly in the immediate context for a patient.

HEALTH
-A sense of adequacy or well being
-Fulfilled needs
-Sense of comfort

NURSING
-Is a dynamic nurse-patient relationship
-Is responsive to individuals who suffer or
anticipate a sense of helplessness
-The goal of nursing is increased sense of well
being, increase in ability, and adequacy in
better care of self and improvement in patient‟s
behavior.
-Nursing therapeutics are composed of direct
function, indirect function, disciplined and
professional activities and automatic activities.