Hildegard Peplaus Interpersonal

Relations Theory
The need for a partnership between nurse and client is very substantial in nursing practice. This
definitely helps nurses and healthcare providers develop more therapeutic interventions in the clinical
setting. Through these, Hildegard E. Peplau developed her Interpersonal Relations Theory in
1952, mainly influence by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal
Elgar Miller.
Contents [show]
Description
Peplaus theory defined Nursing as An interpersonal process of therapeutic interactions between an
individual who is sick or in need of health services and a nurse especially educated to recognize,
respond to the need for help. It is a maturing force and an educative instrument involving an
interaction between two or more individuals with a common goal.
In nursing, this common goal provides the incentive for the therapeutic process in which the nurse
and patient respect each other as individuals, both of them learning and growing as a result of the
interaction. An individual learns when she or he selects stimuli in the environment and then reacts to
these stimuli.
Assumptions
The assumptions of Peplaus Interpersonal Relations Theory are: (1) Nurse and patient can interact.
(2) Peplau emphasized that both the patient and nurse mature as the result of the therapeutic
interaction. (3) Communication and interviewing skills remain fundamental nursing tools. And lastly,
(4) Peplau believed that nurses must clearly understand themselves to promote their clients growth
and to avoid limiting clients choices to those that nurses value.
Major Concepts
The theory explains the purpose of nursing is to help others identify their felt difficulties and that
nurses should apply principles of human relations to the problems that arise at all levels of
experience.
Man
Peplau defines man as an organism that strives in its own way to reduce tension generated by
needs. The client is an individual with a felt need.
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.
Society or Environment
Although Peplau does not directly address society/environment, she does encourage the nurse to
consider the patients culture and mores when the patient adjusts to hospital routine.
Nursing
Hildegard Peplau considers nursing to be 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 specially educated to recognize and to respond to the need for help.
Therapeutic nurse-client relationship
A professional and planned relationship between client and nurse that focuses on the clients needs,
feelings, problems, and ideas. It involves interaction between two or more individuals with a
common goal. The attainment of this goal, or any goal, is achieved through a series of steps
following a sequential pattern.
Four Phases of the therapeutic nurse-patient relationship:
Orientation Phase
The orientation phase is directed by the nurse and involves engaging the client in treatment,
providing explanations and information, and answering questions.
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. Click to
enlarge.
Identification Phase
The identification phase 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
Exploitation Phase
In the exploitation phase, the client makes full use of the services offered.
In the exploitation phase, the client makes full use of the services offered.
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
In the resolution phase, the client no longer needs professional services and gives up dependent
behavior. The relationship ends.
In the resolution phase, the client no longer needs professional services and gives up dependent
behavior. The relationship ends.
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
Subconcepts
Peplaus model has proved of great use to later nurse theorists and clinicians in developing more
sophisticated and therapeutic nursing interventions.
The following are the roles of the Nurse in the Therapeutic relationship identified by Peplau:
Stranger: offering the client the same acceptance and courtesy that the nurse would to any stranger
Resource person: providing specific answers to questions within a larger context
Teacher: helping the client to learn formally or informally
Leader: offering direction to the client or group
Surrogate: serving as a substitute for another such as a parent or a sibling
Counselor: promoting experiences leading to health for the client such as expression of feelings
Technical Expert: providing physical care for the patient and operates equipment
Peplau also believed that the nurse could take on many other roles but these were not defined in
detail. However, they were left to the intelligence and imagination of the readers. (Peplau, 1952)
Additional roles include:
Technical expert
Consultant
Health teacher
Tutor
Socializing agent
Safety agent
Manager of environment
Mediator
Administrator
Recorder observer
Researcher
Anxiety was defined as the initial response to a psychic threat. There are four levels of anxiety
described below.
Four Levels of Anxiety
Mild anxiety is a positive state of heightened awareness and sharpened senses, allowing the person
to learn new behaviors and solve problems. The person can take in all available stimuli (perceptual
field).
Moderate anxiety involves a decreased perceptual field (focus on immediate task only); the person
can learn new behavior or solve problems only with assistance. Another person can redirect the
person to the task.
Severe anxiety involves feelings of dread and terror. The person cannot be redirected to a task; he or
she focuses only on scattered details and has physiologic symptoms of tachycardia, diaphoresis, and
chest pain.
Panic anxiety can involve loss of rational thought, delusions, hallucinations, and complete physical
immobility and muteness. The person may bolt and run aimlessly, often exposing himself or herself
to injury.
Interpersonal Theory and Nursing Process
Both Peplaus Interpersonal Relations Theory and the Nursing Process are sequential and focus on
therapeutic relationship by using 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
Continuous data collection and analysis
May not be a felt need
Orientation
Non-continuous data collection
Felt need
Definite needs
Nursing Diagnosis & Planning Identification
Mutually set goals Interdependent goal setting
Implementation
Plans initiated towards achievement of mutually
set goals
May be accomplished by patient, nurse, or
significant other.
Exploitation
Patient actively seeking and drawing help
Patient initiated
Evaluation
Based on mutually expected behaviors
May led to termination and initiation of new
plans
Resolution
Occurs after other phases are completed
successfully
Leads to termination
Strengths
Peplaus theory helped later nursing theorists and clinicians develop more therapeutic interventions
regarding the roles that show the dynamic character typical in clinical nursing.
Its phases provide simplicity regarding the natural progression of the nurse-patient relationship,
which leads to adaptability in any nurse-patient interaction, thus providing generalizability.
Weaknesses
Though Peplau stressed the nurse-client relationship as the foundation of nursing practice, health
promotion and maintenance were less emphasized.
Also, the theory cannot be used in a patient who doesnt have a felt need such as with withdrawn
patients.
Conclusion
Peplaus theory has proved of great use to later nurse theorists and clinicians in developing more
sophisticated and therapeutic nursing interventions including the seven nursing roles, which show the
dynamic character roles typical in clinical nursing. It entails that a nurses duty is not just to care but
the profession also incorporates every activity that may affect the clients health.
However, the idea of a nurse-client cooperation is found narrow with those individuals who are unfit
and powerless in conversing, specifically those who are unconscious and paralyzed.
Studying Peplaus Interpersonal Relations Theory of Nursing can be very substantial especially to
those who are aspiring to be part of the profession. Having the knowledge of the seven roles of
nursing, future nurses can apply different roles in different situations, which will guarantee their
patients to acquire the best care possible, and will ultimately speed along treatment and recovery.