Peplau’s Theory of Interpersonal Relations

The Theory of Interpersonal Relations, developed by Hildegard Peplau in 1952, is a foundational nursing theory that emphasizes the importance of the nurse-patient relationship as a therapeutic and growth-promoting process. It’s especially influential in psychiatric and mental health nursing, but its principles apply broadly across healthcare settings.

Life Story of Hildegard Peplau

Hildegard Elizabeth Peplau (1909–1999) was a groundbreaking nurse theorist, educator, and mental health reformer whose Theory of Interpersonal Relations reshaped psychiatric nursing and elevated the nurse-patient relationship to a therapeutic alliance.

Early Life & Education

• Born September 1, 1909, in Reading, Pennsylvania, to German immigrant parents.
• Witnessed the 1918 flu pandemic as a child, which deeply influenced her understanding of illness and human suffering.
• Graduated from Pottstown Hospital School of Nursing in 1931.
• Earned a Bachelor’s in Interpersonal Psychology from Bennington College (1943), and later Master’s and Doctoral degrees from Teachers College, Columbia University.
• Certified in psychoanalysis by the William Alanson White Institute.

Wartime Service & Psychiatric Focus

• Served as a First Lieutenant in the U.S. Army Nurse Corps during WWII (1943–1945), stationed in England.
• Worked alongside leading psychiatrists at the American School of Military Psychiatry.
• Post-war, helped shape the National Mental Health Act of 1946, advocating for humane psychiatric care.

Interpersonal Relations Theory (1952)

• Published Interpersonal Relations in Nursing, a pioneering work that:
  • Defined nursing as a therapeutic, interpersonal process.
  • Identified four phases: Orientation, Identification, Exploitation, and Resolution.
  • Outlined six nursing roles: Stranger, Resource, Teacher, Counselor, Surrogate, and Leader.
• Influenced by Harry Stack Sullivan, Abraham Maslow, and Percival Symonds.

Academic & Global Impact

• Created the first graduate psychiatric nursing program at Rutgers University (1954–1974).
• Taught workshops across the U.S. and abroad, including Belgium, Africa, and Latin America.
• Advisor to the World Health Organization, U.S. Surgeon General, and National Institute of Mental Health.
• Served as President of the American Nurses Association (1970–1972).

Legacy & Honors

• Her theory remains central to mental health nursing, emphasizing empathy, communication, and personal growth.
• Known as the “Mother of Psychiatric Nursing” and “Nurse of the Century”.
• Inducted into the ANA Hall of Fame and named a Living Legend by the American Academy of Nursing (1996).

Phases of Nurse–Patient Relationship

1. Orientation Phase
   • Nurse and patient meet, establish trust, and define the problem.
   • Nurse clarifies roles, expectations, and goals.
2. Identification Phase
   • Patient identifies with the nurse, begins to accept help.
   • Nurse encourages patient participation in problem-solving.
3. Exploitation (Working) Phase
   • Patient uses available services and resources to address health needs.
   • Nurse supports, educates, and facilitates coping strategies.
4. Resolution (Termination) Phase
   • Patient’s needs are met, dependence on the nurse decreases.
   • Relationship ends in a therapeutic and professional manner.

In Nursing Process, the orientation phase parallels with assessment phase where both the patient and nurse are strangers; meeting initiated by patient who expresses a felt need.

Nursing Roles in Peplau’s Theory

• Technical Expert: Provides hands-on nursing care
• Resource Person: Provides information and guidance
• Teacher: Educates the patient about health and care
• Leader: Directs care collaboratively
• Counselor: Provides emotional support and coping strategies
• Surrogate: Represents support figures when needed

Application of Theory with Nursing Diagnosis

1. Promotes Therapeutic Communication
   • Use active listening and empathy to build trust.
   • Avoid judgment; validate patient feelings.
2. Supports Patient-Centered Care
   • Patient is active in their recovery, not just a passive recipient.
   • Encourages self-awareness and coping mechanisms.
3. Improves Mental Health and Emotional Support
   • Especially useful in psychiatric nursing, rehabilitation, and chronic care.

Case Scenario 1: Patient with Postoperative Anxiety

Scenario:
Mr. A, 45 years old, underwent gallbladder surgery yesterday. He is restless, frequently asking questions, and expresses fear of complications.

Application of Peplau’s Phases

1. Orientation Phase
   • Action: Nurse introduces self, explains role, and assesses anxiety level.
   • Intervention: Provide assurance, clarify surgical recovery process, and establish trust.
2. Identification Phase
   • Action: Patient expresses fears; nurse validates feelings and offers emotional support.
   • Intervention: Teach deep breathing and relaxation techniques to manage anxiety.
3. Exploitation (Working) Phase
   • Action: Patient uses education and coping strategies to reduce fear.
   • Intervention: Encourage mobility, wound care participation, and verbalization of concerns.
4. Resolution Phase
   • Action: Anxiety decreases; patient becomes confident in self-care.
   • Intervention: Prepare discharge plan, reinforce self-monitoring for complications.

Nursing Diagnosis:

• Anxiety related to unfamiliar hospital environment and surgical recovery
• Knowledge deficit related to postoperative care

Case Scenario 2: Patient with Major Depression

Scenario:
Ms. B, 30 years old, is admitted to the psychiatric unit with major depressive disorder. She is withdrawn, tearful, and refuses to interact with staff or other patients.

Application of Peplau’s Phases

1. Orientation Phase
   • Action: Nurse approaches calmly, explains role, and creates a safe environment.
   • Intervention: Use active listening and short, simple communication to build trust.
2. Identification Phase
   • Action: Patient slowly shares feelings of hopelessness.
   • Intervention: Acknowledge emotions and set small, achievable daily goals.
3. Exploitation (Working) Phase
   • Action: Patient participates in therapy sessions and begins journaling feelings.
   • Intervention: Encourage group therapy, self-expression, and coping strategies like relaxation or art therapy.
4. Resolution Phase
   • Action: Patient shows improved mood and social interaction.
   • Intervention: Prepare discharge plan, provide education on relapse prevention, and coordinate follow-up appointments.

Nursing Diagnosis:

• Social isolation related to depressive symptoms
• Hopelessness related to altered mood and loss of interest in life

REFERENCES

1. O’Toole, A.W., & Welt, S.R. (Eds.). (1989). Interpersonal theory in nursing practice: Selected works of Hildegard E. Peplau. New York, NY: Springer.
2. Peplau, H.E. (1952). Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. New York, NY: G.P. Putnam’s Sons. [Reprinted 1989. London, UK: Macmillan Education Ltd. Reprinted 1991. New York, NY: Springer.] (Translated into nine languages)
3. Hagerty TA, Samuels W, Norcini-Pala A, Gigliotti E. Peplau’s Theory of Interpersonal Relations: An Alternate Factor Structure for Patient Experience Data? Nurs Sci Q. 2017 Apr;30(2):160-167. doi: 10.1177/0894318417693286. PMID: 28899257; PMCID: PMC5831243. https://pmc.ncbi.nlm.nih.gov/articles/PMC5831243/
4. Peplau, H.E. (1964). Basic principles of patient counselling. Philadelphia: Smith, Kline and French Laboratories.
5. Peplau, H.E. (1965). The heart of nursing: Interpersonal relations. Canadian Nurse, 61, 273–275.
6. Peplau, H.E. (1992). Interpersonal relations: A theoretical framework for application in nursing practice. Nursing Science Quarterly, 5, 13–18.
7. Peplau, H. E. (1991). Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. New York, NY: Springer.
8. Peplau, H.E. (1997). Peplau’s theory of interpersonal relations. Nursing Science Quarterly, 10, 162–167
9. Chinn PL, and Kramer MK. Theory and nursing- a systemic approach. 3rd edition. Philadelphia:  Mosby year book;1991. Buy bestselling books online
10. George JB. Nursing theories. 5th edition. New Jersey: Prentice hall; 2002.
11. Alligood MR, Tomey AM. Nursing theory- utilization and application. 3rd edition. Missouri: Mosby Elsevier; 2006.
12. Craven RF, Hirnle CJ. Fundamentals of nursing – human health and function. 5th edition. Philadelphia: Lippincott Williams and Wilkins; 2007.
13. McQuiston CM and Webb AA. Foundations of nursing theory- Contributions of 12 key theorists. New Delhi: Sage Publications; 1995.

Stories are the threads that bind us; through them, we understand each other, grow, and heal.

JOHN NOORD

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