THEORY OF INTERPERSONAL RELATIONS

Hildegard. E. Peplau
This page was last updated on 15-01-2010
----------------------------------------------------------------
Introduction
 Born in Reading, Pennsylvania [1909]
 Graduated from a diploma program in Pottstown,
Pennsylvania in 1931.
 Done BA in interpersonal psychology from
Bennington College in 1943.
 MA in psychiatric nursing from Colombia University
New York in 1947.
 EdD in curriculum development in 1953.
 Professor emeritus from Rutgers university
 Started first post baccalaureate program in nursing
 Published Interpersonal Relations in Nursing in
1952
 1968 :interpersonal techniques-the crux of
psychiatric nursing
 Worked as executive director and president of ANA.
 Worked with W.H.O, NIMH and nurse corps.
 Died in 1999.
Psychodynamic nursing
 Understanding of ones own behavior
 To help others identify felt difficulties
 To apply principles of human relations to the
problems that arise at all levels of experience
 In her book she discussed the phases of
 interpersonal process, roles in nursing situations
and methods for studying nursing as an
interpersonal process.
 According to Peplau, nursing is therapeutic in that
it is a healing art, assisting an individual who is
sick or in need of health care.
 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.
Definitions
 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 make health possible for
individuals in communities
Roles of nurse
 Stranger: receives the client in the same way one
 meets a stranger in other life situations provides an
accepting climate that builds trust.
 Teacher: who imparts knowledge in reference to a
need or interest
 Resource Person : one who provides a specific
needed information that aids in the understanding
of a problem or new situation
 Counselors : helps to understand and integrate the
meaning of current life circumstances ,provides
guidance and encouragement to make changes
 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
Additional Roles include:

1. Technical expert
2. Consultant
3. Health teacher
4. Tutor
5. Socializing agent
6. Safety agent
7. Manager of environment
8. Mediator
9. Administrator
10. Recorder observer
11. Researcher
Theory of interpersonal relations
 Middle range descriptive classification theory
 Influenced by Harry Stack Sullivan's theory of inter
personal relations (1953)
 Also influenced by Percival Symonds , Abraham
Maslow's and Neal Elger Miller
 Identified 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
Factors influencing 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
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
 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
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
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

Assessment Orientation
  Data collection and  Non continuous
analysis data collection
[continuous]  Felt need
 May not be a felt  Define needs
need

Nursing diagnosis Identification

Planning
 Interdependent goal
 Mutually set goals setting

Implementation Exploitation
 Plans initiated  Patient actively
towards seeking and drawing
achievement of help
mutually set goals  Patient initiated
 May be
accomplished by
patient , nurse or
family

Evaluation Resolution
 Based on mutually  Occurs after other
expected behaviors phases are
 May led to completed
termination and successfully
initiation of new  Leads to termination
plans

Peplau’s work and characteristics of a theory

 Theories can interrelate concepts in such a way as
to create a different way of looking at a particular
phenomenon. Four phases interrelate the different
components of each phase.
 The nurse patient interaction can apply to the
concepts of human being, health, environment and
nursing.
 Theories must be logical in nature. This theory
provides a logical systematic way of viewing nursing
situations
 Key concepts such as anxiety, tension, goals, and
frustration are indicated with explicit relationships
among them and progressive phases
 Theories should be relatively simple yet
generalizable. It provides simplicity in regard to the
natural progression of the NP relationship. Leads to
adaptability in any nurse patient relationship.
 The basic nature of nursing still considered an
interpersonal process
 Theories can be the bases for hypothesis that can be
tested.Has generated testable hypotheses.
 Theories contribute to and assist in increasing the
general body of knowledge within the discipline
through the research implemented to validate them.
In 1950’s two third of the nursing research
concentrated on N-P relation ship.
 Theories can be utilized by practitioners to guide
and improve their practice. Peplau’s anxiety
continuum is still used in anxiety patients
 Theories must be consistent with other validated
 theories, laws, and principles but will leave open
unanswered questions that need to be investigated.
Consistent with various theories
Limitations
 Intra family dynamics, personal space
considerations and community social service
resources are considered less
 Health promotion and maintenance were less
emphasized
 Cannot be used in a patient who doesn’t have a felt
need eg. With drawn patients, unconscious
patients
 some areas are not specific enough to generate
hypothesis
Research Based on Peplau’s Theory
 Hays .D. (1961).Phases and steps of experimental
teaching to patients of a concept of anxiety:
Findings revealed that when taught by the
experimental method, the patients were able to
apply the concept of anxiety after the group was
terminated.
 Burd .S.F. Develop and test a nursing intervention
framework for working with anxious patients:
Students developed competency in beginning
interpersonal relationship