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 influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller.
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. Nursing can be viewed as an interpersonal process because it involves 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.
Peplau’s 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.
The assumptions of Peplau’s Interpersonal Relations Theory are: (1) Nurse and the 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 client’s growth and to avoid limiting the client’s choices to those that nurses value.
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.
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 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 patient’s culture and mores when the patient adjusts to hospital routine.
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 client’s 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:
1. 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 the client meets nurse as a stranger
- Defining problem and deciding the type of service needed
- Client seeks assistance, conveys needs, asks questions, shares preconceptions and expectations of past experiences
- Nurse responds, explains roles to the client, helps to identify problems and to use available resources and services
2. 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
3. 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
- The individual feels like 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 fluctuate on independence
- Nurse must be aware of the various phases of communication
- Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step
4. 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 the bond with the nurse and healthier emotional balance is demonstrated and both becomes mature individuals
Peplau’s 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
- Health teacher
- Socializing agent
- Safety agent
- Manager of environment
- Recorder observer
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 a 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 Peplau’s Interpersonal Relations Theory and the Nursing Process are sequential and focus on the therapeutic relationship by using problem-solving techniques for the nurse and patient to collaborate on, with the end purpose of meeting the patient’s needs. Both use observation communication and recording as basic tools utilized by nursing.
|Nursing Diagnosis & Planning||Identification|
Peplau conceptualized clear sets of nurse’s roles that can be used by each and every nurse with their practice. It implies that a nurse’s duty is not just to care but the profession encompasses every activity that may affect the care of the patient.
The idea of a nurse-client interaction is limited with those individuals incapable of conversing, specifically those who are unconscious.
The concepts are highly applicable to the care of psychiatric patients considering Peplau’s background. But it is not limited in those set of individuals. It can be applied to any person capable and has the will to communicate.
The phases of the therapeutic nurse-client are highly comparable to the nursing process making it vastly applicable. Assessment coincides with the orientation phase; nursing diagnosis and planning with the identification phase; implementation as to the exploitation phase; and lastly, evaluation with the resolution phase.
Peplau’s 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.
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 doesn’t have a felt need such as with withdrawn patients.
Peplau’s 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 nurse’s duty is not just to care but the profession also incorporates every activity that may affect the client’s health.
However, the idea of nurse-client cooperation is found narrow with those individuals who are unfit and powerless in conversing, specifically those who are unconscious and paralyzed.
Studying Peplau’s 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 for different roles in different situations, which will guarantee their patients to acquire the best care possible, and will ultimately speed along treatment and recovery.
- George B. Julia, Nursing Theories- The base for professional Nursing Practice, 3rd ed. Norwalk, Appleton & Lange.
- Peplau, H. E. (1952). Interpersonal relations in nursing. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
- Peplau, H.E. (1988). The art and science of nursing: Similarities, differences, and relations. Nursing Science Quarterly, 1, 8-15. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
- Interpersonal Relations In Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing
- Interpersonal Theory in Nursing Practice: Selected Works of Hildegard E. Peplau
With contributions by Wayne, G., Ramirez, Q.Last updated on