Hildegard

Peplau
Mother of Psychiatric Nursing
 Hildegard Peplau (1909-1999)
Biography:

• Born on September 1, 1909 in

Reading, Pennsylvania

• Second child of six children born to

German immigrant parents, Gustav
and Otyllie Peplau.
• At a very young age, Peplau was eager to
grow beyond the traditional role of women.

• As she witnessed the devastating flu

epidemic of 1918, her understanding of the
impact of illness and death on families
widened.
• 1931- Graduated from Pottstown, Pennsylvania School of
Nursing

• 1943 - Earned a Bachelor’s degree in Interpersonal Psychology

at Bennington College in Vermont

• 1947 - Received Master’s and doctoral degrees in Psychiatric

Nursing at Teachers College, Columbia University

• On March 17, 1999, Peplau died peacefully in her sleep at

home in Sherman Oaks, California
Career and Appointments:

• Served in the Army Nurse Corpse

• Certified in psychoanalysis by the William Alanson White

Institute of New York City

• In the early 1950s, Peplau developed and taught the first

classes for graduate psychiatric nursing students at Teachers
College

• Professor Emeritus at Rutgers University

• Executive Director and then President of the ANA

• Founder of Modern Psychiatric Nursing

• Peplau served as a consultant to the U.S. Surgeon General, the

U.S. Air Force, and the National Institute of Mental Health

• In 1975 she helped establish the first graduate nursing program

in Europe.

• Prolific writer
Works and Awards:

• Interpersonal Relations In Nursing: A Conceptual Frame of Refe

rence for Psychodynamic Nursing

• Named one of “50 Great Americans” in Who’s Who in 1995 by

Marquis

• In 1996, the American Academy of Nursing honored Peplau as

a “Living Legend.”
• She received nursing’s highest honor, the “Christiane Reimann
Prize,” at the ICN Quadrennial Congress in 1997

• In 1998, the ANA inducted her into its Hall of Fame

• Peplau was acknowledged with numerous awards and honors

for her contributions to nursing and held 11 honorary degrees
Hildegard Peplau’s Interpersonal Relations
Theory

Overview:

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.
MAJOR CONCEPTS:

Four Phases of Nurse-Patient

01 Relationship

Primary and Secondary Nursing

02 Roles
Nurse-Patient Relationship

• A four-phase phenomenon: orientation,

identification, exploitation, and resolution.

• A professional and planned relationship between the

patient and the nurse (needs, feelings, problems,
and ideas).
4 Phases of Nurse-Patient Relationship

Orientation:

involves engaging the client in treatment, providing

explanations and information, and answering questions.

• Problem defining phase

• It starts when the client meets the nurse as a stranger

• Defining the problem and deciding the type of service

needed
4 Phases of Nurse-Patient Relationship

Identification:

begins when the client works interdependently with the nurse,

expresses feelings, and begins to feel stronger.

• 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.
4 Phases of Nurse-Patient Relationship

Exploitation:

In the exploitation phase, the client makes full use of the services
offered.

• Use of professional assistance for problem-solving

alternatives

• The client may make minor requests or attention-getting

techniques.
4 Phases of Nurse-Patient Relationship

Resolution:

In the resolution phase, the client no longer needs

professional services and gives up dependent behavior. The
relationship ends.

• Termination of professional relationship

• The patient’s needs have already been met by the

collaborative effect of patient and nurse.
 Nursing Process and Interpersonal Theory
Assessment Orientation

• Continuous data collection and analysis • Non-continuous data collection

• May not be a felt need • Felt need

Diagnosis & Planning Identification

• Mutually set goals • Interdependent goal setting

Implementation Exploitation

• Plans initiated towards achievement of mutually set goals • Patient actively seeking and drawing help
• May be accomplished by patient, nurse, or • Patient-initiated
significant other.

Evaluation Resolution

• Based on mutually expected behaviors • Occurs after other phases are completed successfully
• May led to termination and initiation of new plans. • Leads to termination
 Nursing Roles

Stranger
acceptance of the patient as a person.

Resource Person
change responses to the patient’s level of understanding

Teacher
develop discussion around the interest of the patient.
 Nursing Roles

Leader
act in behalf of the patient’s best interest.

Surrogate
serving as a substitute for another, such as a parent or a sibling.

Counselor
promoting experiences leading to health for the client.
 Metaparadigm in Nursing

Person

• organism that “strives in its own way to reduce

tension generated by needs.”

• living in an unstable balance within a given

system.
 Four levels of Anxiety

Mild anxiety - positive state of heightened awareness

and sharpened senses, allowing the person to learn new
behaviors and solve problems.

Moderate anxiety involves a decreased perceptual field

(focus on the immediate task only).

Severe anxiety - involves feelings of dread and terror.

Panic anxiety - involve loss of rational thought.

 Metaparadigm in Nursing

Health

• 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.”
 Metaparadigm in Nursing

Nursing

• significant, therapeutic, interpersonal process.

• human relationship between an individual who is

sick, or in need of health services, and a nurse
specially educated to recognize and to respond
to the need for help.
Acceptance by the Nursing Community

A. Practice

• Peplau's ideas revolutionized nursing practice by

emphasizing the importance of nurse-patient relationships.

• Her model became a foundation for nursing practice,

particularly in psychiatric nursing.

• The model is used in counseling to strengthen nurse-patient

relationships.
Acceptance by the Nursing Community

B. Education

- Peplau's book "Interpersonal Relations in Nursing" serves as

an instructional manual for nurses and nursing students to build
meaningful relationships with the patient.

- Critiques of her work emerged in academic circles, often

decades after their initial publication.
Acceptance by the Nursing Community

C. Research:

• Initially, nursing research focused on individual patient

phenomena within the nurse-patient interaction.

• Peplau's model shifted research towards understanding

broader social systems' impact on individuals.

• Nursing experts used her framework to develop behavior

scales and reduce anxiety and stress in patients.
Theory Analysis

Clarity:

- Peplau's Interpersonal Relations Theory presents clear and well-defined concepts

related to the phases in the nurse-patient relationship.

- The concepts of the nurse's role in the interpersonal process complement the
understanding of the various phases.

- The theory is consistent and logically presented.

Theory Analysis

Simplicity:

- Peplau's theory focuses on interpersonal relations and is easily understood.

- She provides clear explanations of basic assumptions and key concepts, as well
as how they apply in the nurse-patient relationship.

- The theory can be used effectively in various nursing roles and situations, making
it adaptable.
Theory Analysis

Generality:

- Peplau believed her model could be used by all nurses in different clinical
settings, but it relies on communication between the nurse and the client.

- The theory may not apply in situations where communication is limited or

impossible, such as with senile, comatose, or newborn clients.
Theory Analysis

Accessibility:

- Peplau's theory is based on reality and can be tested and observed through
empirical data.

- It categorizes the four phases of the interpersonal process, considering the

nurse's role and client's dependence level.

- Ongoing research and development can further enhance its precision.

Theory Analysis

Importance:

- Hildegard Peplau is considered one of the pioneering nursing theorists, following

Florence Nightingale.

- Her work has greatly influenced the nursing profession, providing direction for
practice, education, and research.

- Even though her work was published decades ago, it continues to make a
significant contribution to the field.
 Activity:

Application of Hildegard Peplau’s

Interpersonal Relations Theory
Mrs. O, a 38 year old female, was diagnosed with colon cancer. Evaluation
revealed a locally invasive adenocarcinoma requiring surgical management
for symptom control and oncologic treatment. She underwent laparotomy
and permanent colostomy.
 2 days post operation, you visit Mrs. O’s room. Upon taking a closer look, you
notice that she looked weary and wouldn’t respond when you asked her how she
is feeling. You immediately remembered your classmate’s discussion about
Hildegard Peplau’s Interpersonal Theory. The first step to your Nursing Care Plan
is Assessment, which can be associated to what phase of the therapeutic nurse-
patient relationship?

a. Identification Phase c. Exploitation Phase

b. Orientation Phase d. Resolution Phase
 2 days post operation, you visit Mrs. O’s room. Upon taking a closer look, you
notice that she looked weary and wouldn’t respond when you asked her how she
is feeling. You immediately remembered your classmate’s discussion about
Hildegard Peplau’s Interpersonal Theory. The first step to your Nursing Care Plan
is Assessment, which can be associated to what phase of the therapeutic nurse-
patient relationship?

a. Identification Phase c. Exploitation Phase

b. Orientation Phase d. Resolution Phase
 Mrs. O verbalizes negative feelings about bodily changes especially
because of the unpleasant colostomy odor . She does not look at the stoma
site, and expresses fear of rejection by her spouse. Now, we move on to the
Nursing Diagnosis (Identification Phase). Which of the choices identifies the
cause of Mrs. O’s despondency best?

a. Knowledge deficit regarding c. Lack of moral support by the spouse

colostomy care
d. Disturbed body image related to
b. Imbalanced nutrition: less than colostomy and malodor.
body requirements related to presence
of GI disturbances
 Mrs. O verbalizes negative feelings about bodily changes especially
because of the unpleasant colostomy odor . She does not look at the stoma
site, and expresses fear of rejection by her spouse. Now, we move on to the
Nursing Diagnosis (Identification Phase). Which of the choices identifies the
cause of Mrs. O’s despondency best?

a. Knowledge deficit regarding c. Lack of moral support by the spouse

colostomy care
d. Disturbed body image related to
b. Imbalanced nutrition: less than colostomy and malodor
body requirements related to presence
of GI disturbances
 Goal setting was done along with the patient and this is
the objective of the care plan:

She identifies irrational beliefs and uses new coping strategies to enhance
perception about body image.

The objective of the Nursing Care Plan involves interdependent goal setting.
What phase of the therapeutical nurse-patient relationship comes after?

a. Exploitation c. Active Leadership

b. Implementation d. Resolution
 Goal setting was done along with the patient and this is
the objective of the care plan:

She identifies irrational beliefs and use new coping strategies to enhance
perception about body image.

The objective of the Nursing Care Plan involves interdependent goal setting.
What phase of the therapeutical nurse-patient relationship comes after?

a. Exploitation c. Active Leadership

b. Implementation d. Resolution
 Plan of Action (Exploitation Phase)

• Assess the support system

• Encourage the patient to express feelings about body changes

• Praise the patient every time she is cooperative and willing to participate in care

• Provide resources -- list of support groups

 Plan of Action (Exploitation) Which nursing roles are majorly
practiced in this phase?
• Assess the support system
• Stranger
• Encourage the patient to express • Resource person
feelings about body changes • Teacher
• Leader
• Praise the patient every time she is • Surrogate
cooperative and willing to participate • Counselor
in care • Technical Expert

• Provide resources -- list of support

groups
 Plan of Action (Exploitation) Which nursing roles are majorly
practiced in this phase?
• Assess the support system
• Stranger
• Encourage the patient to express • Resource person
feelings about body changes • Teacher
• Leader
• Praise the patient every time she is • Surrogate
cooperative and willing to participate • Counselor
in care • Technical Expert

• Provide resources -- list of support

groups
 Evaluation (Resolution)

Mrs. O was free to express her problems related to body image.

She expressed that she feels more confident related to handling

her stoma and participates in care
References:

A. G., RN. (2023). Hildegard Peplau: Interpersonal Relations Theory. Nurseslabs.

https://nurseslabs.com/hildegard-peplaus-interpersonal-relations-theory/

LORMA COLLEGES, COLEGE OF NURSING. (2018, July 29). Hildegard Peplau’s

Interpersonal Relations Theory. Nursing Theorist.
https://lormacollegesnursinginformatics2018.blogspot.com/2018/07/hildegard-peplaus-
interpersonal.html

Theoretical Foundation in Nursing (2nd ed.). (2020). Jose Quiambao-Udan.