Hildegard Peplau: Interpersonal Relations Theory

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Hildegard Peplau Biography and Theory of Interpersonal Relations

Hildegard Peplau is a nurse theorist who created the Theory of Interpersonal Relations. Get to know Peplau’s theory and biography in this nursing theories study guide.

Biography of Hildegard E. Peplau

Hildegard Elizabeth Peplau (September 1, 1909 – March 17, 1999) was an American nurse who is the only one to serve the American Nurses Association (ANA) as Executive Director and later as President. She became the first published nursing theorist since Florence Nightingale.

Peplau was well-known for her Theory of Interpersonal Relations, which helped to revolutionize the scholarly work of nurses. Her achievements are valued by nurses all over the world and became known to many as the Mother of Psychiatric Nursing” and the “Nurse of the Century.” 

Early Life

Hildegard Peplau was born on September 1, 1909. She was raised in Reading, Pennsylvania by her parents of German descent, Gustav and Otyllie Peplau. She was the second daughter, having two sisters and three brothers. Though illiterate, her father was persevering while her mother was a perfectionist and oppressive. With her young age, Peplau’s eagerness to grow beyond traditional women’s roles was precise. She considers nursing was one of few career choices for women during her time. In 1918, she witnessed the devastating flu epidemic that greatly influenced her understanding of the impact of illness and death on families.

Education

Hildegard Elizabeth Peplau
Hildegard Elizabeth Peplau

When the autonomous, nursing-controlled, Nightingale era schools came to an end in the early 1900s, schools then were handled by hospitals, and the so-called formal “book learning” was put down. Hospitals and physicians considered women in nursing as a source of free or inexpensive labor. Exploitation was very common by nurse’s employers, physicians and educational providers.

In 1931, she graduated in Pottstown, Pennsylvania School of Nursing. Peplau earned a Bachelor’s degree in interpersonal psychology in 1943 at Bennington College in Vermont. She studied psychological issues together with Erich Fromm, Frieda Fromm-Reichmann, and Harry Stack Sullivan at Chestnut Lodge, a private psychiatric hospital in Maryland. Peplau held master’s and doctoral degrees from Teachers College, Columbia University in 1947.

Career and Appointments of Hildegard Peplau

Hildegard Peplau - Pottstown Hospital School of Nursing Yearbook Photograph 1931
Hildegard Peplau – Pottstown Hospital School of Nursing Yearbook Photograph 1931

After graduating in Pennsylvania, Hildegard Peplau then worked as a staff nurse in her place and in New York City. A summer position as a nurse for the New York University summer camp led to a recommendation for Peplau to become the school nurse at Bennington College in Vermont, where she earned a Bachelor’s degree in interpersonal psychology. Peplau’s lifelong work was largely focused on extending Sullivan’s interpersonal theory for use in nursing practice.

She served in the Army Nurse Corps and was assigned to the 312th Field Station Hospital from 1943-1945 in England, where the American School of Military Psychiatry was located. She met and worked with all the leading figures in British and American psychiatry. After the war, Peplau was at the table with many of these same men as they worked to reshape the mental health system in the United States through the passage of the National Mental Health Act of 1946.

“Nursing has made great progress from being an occupation to becoming a profession in the 20th. Century. As the 21st. Century approaches, further progress will be reported and recorded in Cyberspace – The Internet being one conduit for that. Linking nurses and their information and knowledge across borders – around the world – will surely advance the profession of nursing much more rapidly in the next century”
– Hildegard Peplau

Peplau was certified in psychoanalysis by the William Alanson White Institute of New York City. In the early 1950s, she developed and taught the first classes for graduate psychiatric nursing students at Teachers College. Peplau was a member of the faculty of the College of Nursing at Rutgers University from 1954 until her retirement in 1974. She was a professor emerita at the said university.

Hildegard Peplau 2
Peplau was known for her “Interpersonal Relations Theory.”

At Rutgers University, she created the first graduate level program for the preparation of clinical specialists in psychiatric nursing. She was a prolific writer and was equally well known for her presentations, speeches, and clinical training workshops. Peplau vigorously advocated that nurses should become further educated so they could provide truly therapeutic care to patients rather than the custodial care that was prevalent in the mental hospitals of that era.

During the 1950s and 1960s, she supervised summer workshops for nurses throughout the United States, mostly in state psychiatric hospitals. In these seminars, she taught interpersonal concepts and interviewing techniques, as well as individual, family, and group therapy. Peplau was an advisor to the the World Health Organization and was a visiting professor at universities in Africa, Latin America, Belgium, and throughout the United States. A strong advocate for graduate education and research in nursing, Peplau served as a consultant to the U.S. Surgeon General, the U.S. Air Force, and the National Institute of Mental Health. She participated in many government policy making groups.

Hildegard Peplau 10

Peplau was devoted to nursing education at full length of her career. After her retirement from Rutgers, she served as a visiting professor at the University of Leuven in Belgium in 1975 and 1976. There she helped establish the first graduate nursing program in Europe.

She was the only nurse who served the ANA as executive director and later as president, she served two terms on the Board of the International Council of Nurses (ICN). And as a member of the New Jersey State Nurses Association, she actively contributed to the ANA by serving on various committees and task forces.

Hildegard Peplau in Pottstown Hospital School of Nursing Yearbook 1931
Hildegard Peplau in Pottstown Hospital School of Nursing Yearbook 1931

Her fifty-year career in nursing left an unforgettable mark on the field and on the lives of the mentally challenged in the United States. During the peak of her career, she became the founder of modern psychiatric nursing, an innovative educator, advocate for the mentally ill, proponent of advanced education for nurses, Executive Director and then President of the ANA and prolific author.

And just like any other famous personalities, her life was often marked with controversy, which she faced with boldness, prowess and conviction.

Interpersonal Relations Theory

Peplau, ANA Hall of Fame Inductee
Peplau, ANA Hall of Fame Inductee

In 1952, Hildegard Peplau published her Theory of Interpersonal Relations that was influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller. Her theory is discussed further below.

Works

Some of Hildegard Peplau’s works include: Interpersonal Relations In Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing, Interpersonal Theory in Nursing Practice: Selected Works of Hildegard E. Peplau, Basic principles of patient counseling: Extracts from two clinical nursing workshops in psychiatric hospitals, A Glance Back in Time: An article from: Nursing Forum, On Semantics (psychiatric nursing): An article from: Perspectives in Psychiatric Care, The Psychiatric Nurse–Accountable? To Whom? For What?: An article from: Perspectives in Psychiatric Care, and Psychotherapeutic Strategies: An article from: Perspectives in Psychiatric Care.

Her book on her conceptual framework, Interpersonal Relations in Nursing, was completed in 1948. Publication took four additional years because it was groundbreaking for a nurse to contribute this scholarly work without a co-authoring physician.

Interpersonal Theory in Nursing Practice: Selected Works of Hildegard E. Peplau
Interpersonal Theory in Nursing Practice: Selected Works of Hildegard E. Peplau

Peplau’s original book from 1952 has been translated into nine languages and in 1989 was reissued in Great Britain by Macmillan of London. In 1989, Springer published a volume of selected works of Peplau from previously unpublished papers. Her ideas have, indeed, stood the test of time. The archives of her work and life are housed at the Schlesinger Library at Harvard University.

Awards and Honors

Peplau was acknowledged with numerous awards and honors for her contributions to nursing and held 11 honorary degrees. She was awarded honorary doctoral degrees from universities including: Alfred, Duke, Indiana, Ohio State, Rutgers, and the University of Ulster in Ireland.

She was named one of “50 Great Americans” in Who’s Who in 1995 by Marquis. She was also elected fellow of the American Academy of Nurse and Sigma Theta Tau, the national nursing honorary society.

Peplau, universally regarded as the "Mother of Psychiatric Nursing"
Peplau, universally regarded as the “Mother of Psychiatric Nursing”

In 1996, the American Academy of Nursing honored Peplau as a “Living Legend.” She received nursing’s highest honor, the “Christiane Reimann Prize,” at the ICN Quadrennial Congress in 1997. This award is given once every four years for outstanding national and international contributions to nursing and healthcare. And in 1998, the ANA inducted her into its Hall of Fame.

Death

On March 17, 1999, Peplau died peacefully in her sleep at home in Sherman Oaks, California. She is survived by Dr. Leitia Anne Peplau and her husband, Dr. Steven Gordon, and their son, David Gordon of Sherman Oaks, CA; sister, Bertha Reppert (Byron), Mechanicsburg, PA; brother, John D. Forster (Dorethy), Reading, PA; niece, Dr. Carolynn Sears (Phillip) and children, Jessica and Jacob Sears, Pound Ridge, NY; niece Majorie Reppert, Jim Thorpe, PA; niece, Nancy Reppert, Mechanicsburg, PA; niece, Susanna Reppert (David Brill), Mechanicsburg, PA; niece, Karen Bently (William) and son, William, Sudbury, MA; and nephew, Carl Peplau, Hopewell Junction, NY.

The family requested that memorial contributions be made to the Peplau Research Fund through the American Nurses Foundation.

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.

Hildegard Peplau’s Interpersonal Relations Theory

Hildegard Peplau’s Interperosonal Relations Theory emphasized the nurse-client relationship as the foundation of nursing practice. It gave emphasis on the give-and-take of nurse-client relationships that was seen by many as revolutionary. Peplau went on to form an interpersonal model emphasizing the need for a partnership between nurse and client as opposed to the client passively receiving treatment and the nurse passively acting out doctor’s orders.

The four components of the theory are: person, which is a developing organism that tries to reduce anxiety caused by needs; environment, which consists of existing forces outside of the person, and put in the context of culture; health, which is a word symbol that implies forward movement of personality and nursing, which is a significant therapeutic interpersonal process that functions cooperatively with other human process that make health possible for individuals in communities.

The nursing model identifies four sequential phases in the interpersonal relationship: orientation, identification, exploitation, and resolution.

It also includes seven nursing roles: Stranger role, Resource role, Teaching role, Counseling role, Surrogate role, Active leadership and Technical expert role.

Description

Hildegard E. 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.

Assumptions

The assumptions of Hildegard 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.

Major Concepts of the Interpersonal Relations Theory

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 patient’s 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 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
Factors influencing orientation phase. Click to enlarge.
Factors influencing orientation phase. Click to enlarge.

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

Subconcepts of the Interpersonal Relations Theory

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
  • 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 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.

Assessment

  • Continuous data collection and analysis
  • May not be a felt need
Orientation

  • Non-continuous data collection
  • Felt need
  • Definite needs
Nursing Diagnosis & Planning

  • Mutually set goals
Identification

  • 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

Analysis

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.

Strengths

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.

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 doesn’t have a felt need such as with withdrawn patients.

Conclusion

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.

See Also

You may also like the following nursing theories study guides: 

References

  1. Hildegard Peplau (1909-1999) 1998 Inductee. (n.d.). . Retrieved July 1, 2014, from http://www.nursingworld.org/HildegardPeplau
  2. Sills, G. (n.d.). Hildegard Peplau. Nursing Theorist Homepage. Retrieved January 3, 2014, from http://publish.uwo.ca/~cforchuk/peplau/obituary.html
  3. George B. Julia, Nursing Theories- The base for professional Nursing Practice, 3rd ed. Norwalk, Appleton & Lange.
  4. Peplau, H. E. (1952). Interpersonal relations in nursing. In George, J. (Ed.). Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
  5. 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.

External Links

With contributions by Wayne, G., Ramirez, Q.

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