Theory of Interpersonal Relation

“Nursing is an interpersonal process Because it involves interaction

Between two or more individuals with common goal. Nursing is Therapeutic
in that it is a healing art Assisting an individual who is sick or in need of
health care.”

Hildegard Peplau

Hildegard Peplau (1952)

 Peplau's theory focuses on the interpersonal process and therapeutic relationship that
develops between the nurse and client.
 The client is an individual with felt need.
 Nursing's goal is to educate the client and family and to help client reach mature
personality development (Chinn and Kramer, 2004).
 The nurse strives to develop a nurse-client relationship in which the nurse serves as a
resource person, counselor, and surrogate.
 Psychodynamic nursing involves:
 a. Understanding of one's behaviors
 b. Helping other identify felt difficulties
 c. Applying principles of human relations to the problems that arise at all levels of
experience.
 The attainment of goal is achieved through the use of a series of steps following a series
of pattern in the interpersonal relationship namely
1. Orientation Phase
2. Working Phase
A. Identification
B. Exploitation
3. Termination Phase (Resolution Phase)

History and Background

◦ Hildegard Peplau was born in Reading, Pennsylvania in 1909.

◦ Graduated 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. ◦
Achieved EdD in curriculum development in 1953.

◦ Has been Professor emeritus from Rutgers University.

◦ Started first post baccalaureate program in nursing.

◦ Published Interpersonal Relations in Nursing in 1952.

◦ In 1968, introduced interpersonal techniques - the crux of psychiatric nursing.

◦ Worked as executive director and president of ANA. (American Nurse's Association)

Enter

◦ Worked with WHO, NIHM (National Institute of Mental Health and nurse corps.

◦ She died in March 17, 1999 at the age of 90 years.

Overview of Peplau's "Theory of Interpersonal Relations"

◦ According to Peplau's "Theory of interpersonal Relations," the three sequential phases in the
interpersonal nurse-patient relationship are as follow:

1. Orientation Phase
Problem defining phase.

Starts when client meets nurse as stranger.

Defining problem and deciding type of service needed.

Nurse responds, explains roles to client, helps identify problems and to use available resources and
services.

During the orientation phase, 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.

Factors influencing orientation phase

Nurse Patient
Values
culture care Beliefs
Nurse Values
culture care Beliefs
Past Experience patient Past Experience
Expectation
Preconceived idea
Relationship Expectation
Preconceived idea

◦ 2. Working Phase
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 him/her. The nurse permits to exploration of
feelings by the patient in undergoing illness as an experience that reorients feeling and strengthens
positive forces in the personality and provides lite needed satisfaction.

◦ B. Exploitation Phase

Use of professional assistance for problem solving alternatives.

Advantage of services are used and based on the needs and interests of the patients

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/she is offered through the
relationship. The nurse can project new goals to be achieved Lou 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.

In capsule
Orientation: Nurse and patient come together as strangers; meeting initiated by patient who
expresses a "felt need", work together to recognize, clarify, and define facts related to the need.
Identification: Patient participates in goal setting; has feeling of belongingness and selectively responds to
those who can meet his/her needs.

Exploitation: Patient actively seeks and draws knowledge and expertise of those who can help.

Termination (Resolution): Occurs after other phases are completed successfully. This leads to
termination of the relationship

Peplau advocates that the roles of the nurse in the nurse-patient interpersonal
relationship are as follows:

Stranger: receives the client in the same way one meets a stranger in other life
situations. Provides an accepting climate that build trust.
Teacher: who imparts knowledge 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.

Counselor: 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 client's behalf as an advocate.

Leader: helps client assume maximum responsibility for meeting treatment goals in a
mutually satisfying way.

• Additional Role include:

1. Technical expert

2. Consultant

3. Health teacher

4. Tutor

5. Socializing agent

6. Safety agent

7. Manager of environmental

8. Mediator

9. Administrator

10. Recorder observer

11. Researcher

Interpersonal Theory and Nursing Process

◦ Both are sequential and focus on therapeutic relationship.

◦ Both use problem solving techniques for the nurse and the patient to collaborate with the end purpose
of meeting the patients need.

◦ Both use observation, communication, and recording as basic tools utilized by nursing.
ASSESSMENT ORIENTATION
 Data collection and analysis(continuous)  Non-continuous data collection
 May not be felt needed  Felt needed
 Define needs
NURSING DIAGNOSIS PLANNING IDENTIFICATION
 Mutually set goals  Interdependent goal setting

Interpersonal Theory and Nursing Process

◦ Theoretical Assertions

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 processes that make health possible for individuals in communities. According to Peplau
(1952/1988), nursing is therapeutic because it is a healing art, assisting an individual who is sick or in
need of health care.

Application of Peplau's Theory Interpersonal

relations
◦ Case History of Mrs. Daniella M.
Mrs. Daniella M., a 35 year old female came to the hospital with complaints of severe low back
pain that radiates to her lower extremities. She verbalized that she had been moving several
pieces of furniture in their living room when she heard a "click" from her back, followed by very
severe pain in the lower back. She claims that the pain is worse while standing, and relieved by
rest and lying down.
She is seeking medical help to relieve her pain, improve her ability to move, and be able to
perform her activities of daily living including her job as an elementary grade teacher. She wants
to know if she injured her back and what will be the consequence of her condition. She
expressed her willingness to cooperate with any prescribed diagnostic procedures, treatments,
and therapy.
After undergoing physical examination, myelography, and MRI, the patient was diagnosed to
have herniated nucleus pulposus (slipped disk), lumbar 4 and 5.
Nurse John Paul was assigned to care for Mrs. M. He decided to apply Peplau's Theory of
Interpersonal Relation for the patient.

In Summary
◦ Peplau’s (1952-1988) “Interpersonal Relations in Nursing Model” focuses on the interpersonal
process, which consists of sequential phases of orientation, identification, exploitation phase,
and resolution. More recently, Peplau revised the phases as the orientation phase, the working
phase and the termination phase. These phases overlap, interrelate, and vary in duration. The
nurse and patient first clarify the patient’s problem, and mutual expectation and goals are
explored while deciding on appropriate plan for improving health status.

◦ Peplau emphasizes that both the patient and the nurse mature as the result of therapeutic
interaction. When two persons meet in a creative relationship, there is a continuing sense of
mutuality and togetherness throughout the experience. Both individuals are involved in a
process of self-fulfillment, which becomes a growth experience.

◦ Peplau’s nursing theory has contributed to nursing areas of clinical practice, theory, and
research, adding to the present base of nursing knowledge. On the whole, the theory creates a
unique view for understanding the nurse-patient relationship.

◦ Peplau’s published her Theory of Interpersonal Relation in 1952 and 1968, Interpersonal
techniques became the crux of psychiatric nursing. The Theory of Interpersonal relations is a
middle-range descriptive classification theory. It was influenced by Henry Stack Sullivan,
Percival Symonds, Abraham Maslow, and Neal Elger Miller.

◦ The goal of psychodynamic nursing is to help understand one’s own behavior, help others
identify felt difficulties, and apply principles of human relations to the problems that come up at
all experience levels. Peplau explains that nursing is therapeutic because it is a healing art,
assisting a patient who is sick or in need of health care. It is also an interpersonal process
because of the interaction between two or more individuals who have a common goal. The
nurse and patient work together so both become mature and knowledgeable in the care
process.
◦ The nurse has a variety of roles in Hildegard Peplau’s nursing theory. The six main roles are:
stranger, teacher, resource person, counselor, surrogate, and leader

◦ As a stranger, the nurse receives the patient in the same way the patient meets a stranger in
other life situations. The nurse should create an environment that builds trust. As a teacher, the
nurse imparts knowledge in reference to the needs or interests of the patient. In this way, the
nurse is also a resource person, providing specific information needed by the patient that helps
the patient understand a problem or situation. The nurse’s role as a counselor helps the patient
understand and integrate the meaning of current life situations, as well as provide guidance and
encouragement in order to make changes. As a surrogate, the nurse helps the patient clarify the
domains of dependence, interdependence, and independence, and acts as an advocate for the
patient. As a leader, the nurse helps the patient take on maximum responsibility for meeting his
or her treatment goals. Additional roles of a nurse include technical expert, consultant, tutor,
socializing and safety agent, environment manager, mediator, administrator, record observer,
and researcher.

◦ Some limitations of Peplau’s theory include the lack of emphasis on health promotion and maintenance;
that intra-family dynamics, personal space considerations, and community social service resources are
less considered; it can’t be used on a patient who is unable to express a need; and some areas are not
specific enough to generate a hypothesis.