M.

Sc DEGREE COURSE IN NURSING

ADVANCED NURSING PRACTICE

UNIT – VI
Philosophy and Theories of Nursing

PEPLAU’S INTERPERSONAL THEORY

DR. T.JAYADEEPA
VICE PRINCIPAL
 HILDEGARD E.PEPLAU

PEPLAU’S INTERPERSONAL
THEORY
 INTRODUCTION HILDEGARD PEPLAU
Early life
Name: Hildegard Elizabeth Peplau Nickname: Hilda
Birthday: September 1, 1909
Died: March 17, 1999 in Sherman Oaks, California
Birthplace: Reading, Pennsylvania
Parents: immigrants of German descent
Father: Gustav Peplau (illiterate but hard-working) Mother:
Otyllie Peplau (oppressive and perfectionist)
Birth Order: She was the second daughter born of six
children
 HILDEGARD E.PEPLAU

• Regarded as “Mother of Psychiatric Nursing”.

 Why Nursing?

Nursing was one of few career choices for women in her

day. As a child, she witnessed the devastating flu

epidemic of 1918, a personal experience that greatly

influenced her understanding of the impact of illness and

death on families.
 Career Timeline
1931 - Diploma program in Pottstown, Pennsylvania 1943 -
BA in interpersonal psychology - Bennington
College
1947 - MA in psychiatric nursing from Colombia University,
New York
1952 - Published Interpersonal Relations in Nursing
1953 - EdD in curriculum development in 1953
Professor emeritus from Rutgers university Started first post
baccalaureate program in psychiatric nursing
1968 - interpersonal techniques - the crux of psychiatric
nursing
 Affiliations and Achievements
• Worked as executive director for ANA
• President of ANA from 1970-1972
• Vice-President of ANA from 1972-1974
• Worked with W.H.O., NIMH and Nurse Corps.
• She was the first published nursing theorist since Florence
Nightingale
• created the middle-range nursing theory of interpersonal
relations, which helped to revolutionize the scholarly work
of nurses
• Staff Nurse in Pennsylvania and New York City
• School Nurse at Bennington College.
• Certified in Psychoanalysis at the William Alanson White Institute
of New York City
• Faculty of the College of Nursing at Rutgers University

• Created first graduate level program for the preparation of clinical

specialists in Psychiatric Nursing
• Therapeutic Care vs Custodial Care in mental hospitals

• Strong advocate for graduate education and research in nursing

• She is the primary contributor to mental health law reform, leading

the way towards humane treatment of patients with behavior and
personality disorders
 What is Interpersonal Relations Theory?

• Emphasized the nurse-client relationship as the foundation of

nursing practice
• The interpersonal model emphasizes the need for a
partnership between nurse and client as opposed to the client
passively receiving treatment (and the nurse passively acting
out doctor's orders).
• shared experience - Nurses could facilitate this through
observation, description, formulation, interpretation, validation,
and intervention
 Major Concepts
• The theory explains the purpose of nursing is to help
others identify their felt difficulties.
• Nurses should apply principles of human relations to the
problems that arise at all levels of experience.
• Peplau's theory explains the phases of interpersonal
process, roles in nursing situations and methods for
studying nursing as an interpersonal process.
• Nursing is therapeutic in that it is a healing art, assisting
an individual who is sick or in need of health care.
 Major Concepts
• Nursing is an interpersonal process because it
involves interaction between two or more
individuals with a common goal.
• The attainment of goal is achieved through the use
of a series of steps following a series of pattern.
• The nurse and patient work together so both
become mature and knowledgeable in the process.
• Theory of interpersonal relations is a middle range
descriptive classification theory

• The theory was influenced by Harry Stack Sullivan's theory

of inter personal relations (1953)

• The theorist was also influenced by Percival Symonds,

Abraham Maslow's and Neal Elger Miller

• Peplau's theory is also referred as psychodynamic nursing,

which is the understanding of ones own behavior
 Metaparadigm
Person:
•An individual
•A developing organism that tries to reduce anxiety
caused by needs.
•Lives in stable equilibrium

Environment:
•Existing forces outside the organism and in the
context of culture
 Metaparadigm
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
make health possible for individuals in communities.
•Involves problem-solving
 Peplau’s Seven Roles of a Nurse

• Surrogate: helps to clarify domains of dependence

interdependence and independence and acts on clients
behalf as an advocate.

• Leader : helps client assume maximum responsibility for

meeting treatment goals in a mutually satisfying way

• Technical Expert: provides physical care by displaying

clinical skills and operates equipment
 Additional Roles
1. Consultant
2. Health teacher
3. Tutor
4. Socializing agent
5. Safety agent
6. Manager of environment
7. Mediator
8. Administrator
8. Recorder observer
10. Researcher
 Four Sequential Phases in the Interpersonal
Relationship

1. Orientation
2. Identification
3. Exploitation
4. Resolution
 Orientation Phase

• Problem defining phase

• Starts when client meets nurse as stranger
• Defining problem and deciding type of service
needed
• Client seeks assistance, conveys needs, asks
questions, shares preconceptions and expectations
of past experiences
• Nurse responds, explains roles to client, helps to
identify problems and to use available resources and
services
 Orientation Phase

• Get acquainted phase of the nurse-patient relationship.

• Preconceptions are worked through

• Parameters are established and met

• Early levels of trust are developed

• Roles begin to be understood

Factors Affecting the Orientation Phase
 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 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
 Exploitation Phase
• Use of professional assistance for problem solving
alternatives
• Advantages of services are used is based on the needs and
interests of the patients
• Individual feels as 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
 Exploitation Phase
• Patient may fluctuates on independence
• 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
• 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
 Resolution Phase

• 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 bond with nurse and
healthier emotional balance is demonstrated and both
becomes mature individuals
 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.
• 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.
 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 tools utilized by nursing
 INTERPERSONAL PROCESS AND NURSING
PROCESS
 Nursing process  Peplau’s process
 ASSESSMENT  ORIENTATION
 NURSING DIAGNOSIS  PATIENT CLARIFIES “FELT
NEEDS”
 PLANNING  IDENTIFICATION
 IMPLEMENTATION  EXPLOITATION
 EVALUATION  RESOLUTION
Assessment Orientation
Data collection and analysis Non continuous data collection Felt
[continuous] need
May not be a 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
mutually set goals drawing help Patient initiated
May be accomplished by patient,
nurse or family

Evaluation Resolution
Based on mutually expected behaviors Occurs after other phases are
May led to termination and completed successfully
initiation of new plans Leads to termination a
 Application of Theory to Areas in Nursing

Nursing Education
•Has an impact on the Psychiatric Nursing especially in
the baccalaureate program in nursing teaching CARE
OF CLIENTS WITH MALADAPTIVE PATTERNS OF
BEHAVIOR (NCM 105) composed of 72 hours lecture
and 102 hours RLE
 Application of Theory to Areas in Nursing
Practice
•Focuses on the interpersonal processes and therapeutic
relationship that develops between the nurse & client.
•It requires that the nurse attends to the interpersonal processes
that occur between the nurse and client.
•Interpersonal process is maturing force for personality.
It includes the nurse- client
relationship, communication, pattern integration and the roles of
the nurse.
•Psychodynamic nursing is understanding one’s own behavior to
help others identify felt and perceived difficulties and to
apply principles of human relations to the problems that arise at
all levels of experience.
 Summary of Application
1. Orientation phase
•Client is initially reluctant to talk due to pain.
•Client is expressing that while standing she is having much
pain.
•Client expressed without movement and supine position gave
her relief from pain.

2. Identification
•The client participates and interdependent with the nurse
•Expresses the need for measure to get relief from pain
•Expresses need for improving the mobility
•Expresses need to know more about prognosis, discharge and
home care and follow up.
 Summary
3. Exploitation
•Client explains that she gets relief of pain when lying down
supine.
•Cooperates and participates actively in performing exercises.
•Client mobilizes changes position and cooperates during
position changes.

4. Resolution
•Client expressed that pain has reduced a lot and she is able to
tolerate it now
•She has agreed upon to continue the exercises at home
•She also expressed that she would come for regular follow up
after discharge.
 ASSUMPTIONS
 Nurse and patient can interact.
 Peplau stresses that both the patient and nurse mature
as the result of therapeutic interaction.
 Communication and interviewing skills remain
fundamental nursing tools.
 STRENGHTS

 Thephases provide simplicity regarding the natural

progression of the nurse- patient relationship.

 This simplicity leads to adaptability in any nurse patient

interaction, thus providing generalizability.
 LIMITATIONS
 Its use is limited in working with the comatose, senile or
newborn patient.

 The lack of emphasis on health promotion and

maintenance; that intra-family dynamics, personal space
consideration and community social service resources are
less considered.

 Even Peplau admits, “Understanding of the meaning of the

patient is required in order for nursing to function as an
educative, therapeutic, maturing force.”
 REFERENCE

• http://v2011.blogspot.in/p/major-concepts.html

• http://currentnursing.com/nursing_theory/Henderson.html

• http://nursing-theory.org/theories-and-models/henderson-

need-theory.php