Theory of Interpersonal Relations

This page was last updated on January 31, 2012

Introduction

 Theorist -Hildegard. E. Peplau

 Born in Reading, Pennsylvania [1909], USA
 Diploma program in Pottstown, Pennsylvania in 1931.
 BA in interpersonal psychology - Bennington College in 1943.
 MA in psychiatric nursing from Colombia University New York in
1947.
 EdD in curriculum development in 1953.
 Professor emeritus from Rutgers university
 Started first post baccalaureate program in nursing
 Published Interpersonal Relations in Nursing in 1952
 1968 :interpersonal techniques-the crux of psychiatric nursing
 Worked as executive director and president of ANA.
 Worked with W.H.O, NIMH and Nurse Corps.
 Died in 1999.
 Theory of interpersonal relations is a middle range descriptive
classification theory.
 The theory was influenced by Harry Stack Sullivan's theory of inter
personal relations (1953).
 The theorist was also influenced by Percival Symonds, Abraham
Maslow's and Neal Elger Miller.
 Peplau's theory is also refered as psychodynamic nursing, which is
the understanding of ones own behavior.

Major Concepts

 The theory explains the purpose of nursing is to help others identify

their felt difficulties.
 Nurses should apply principles of human relations to the problems
that arise at all levels of experience.
 Peplau's theory explains the phases of interpersonal process, roles
in nursing situations and methods for studying nursing as an
interpersonal process.
 Nursing is therapeutic in that it is a healing art, assisting an
individual who is sick or in need of health care.
 Nursing is an interpersonal process because it involves interaction
between two or more individuals with a common goal.
 The attainment of goal is achieved through the use of a series of
steps following a series of pattern.
 The nurse and patient work together so both become mature and
knowledgeable in the process.

Definitions

 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
personalityand 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 process that make health
possible for individuals in communities.
Roles of nurse

 Stranger: receives the client in the same way one meets a stranger
in other life situations provides an accepting climate that builds
trust.
 Teacher: who imparts knowledge in 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
 Counselors : 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 clients behalf as
an advocate.
 Leader : helps client assume maximum responsibility for meeting
treatment goals in a mutually satisfying way

Additional Roles include:

1. Technical expert
2. Consultant
3. Health teacher
4. Tutor
5. Socializing agent
6. Safety agent
7. Manager of environment
8. Mediator
9. Administrator
10. Recorder observer
11. Researcher

Phases of interpersonal relationship

Identified four sequential phases in the interpersonal relationship:

1. Orientation
2. Identification
3. Exploitation
4. Resolution

Orientation phase

 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

 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

Exploitation phase

 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

 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

Interpersonal theory and nursing process

 Both are sequential and focus on therapeutic relationship

 Both use 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 Orientation

 Data collection and  Non continuous data

analysis [continuous] collection
 May not be a felt need  Felt need
 Define needs

Nursing diagnosis Identification

Planning
 Interdependent goal setting
 Mutually set goals

Implementation Exploitation

 Plans initiated towards  Patient actively seeking and

achievement of mutually drawing help
set goals  Patient initiated
 May be accomplished by
patient , nurse or family

Evaluation Resolution

 Based on mutually  Occurs after other phases

expected behaviors are completed successfully
 May led to termination  Leads to termination a
and initiation of new
plans

Peplau’s work and characteristics of a theory

 Interrelation of concepts
o Four phases interrelate the different components of each
phase.
 Applicability
o The nurse patient interaction can apply to the concepts of
human being, health, environment and nursing.
 Theories must be logical in nature -
o This theory provides a logical systematic way of viewing
nursing situations
o Key concepts such as anxiety, tension, goals, and
frustration are indicated with explicit relationships among
them and progressive phases
 Generalizability
o This theory provides simplicity in regard to the natural
progression of the NP relationship.
 Theories can be the bases for hypothesis that can be tested
o Peplau's theory has generated testable hypotheses.
 Theories can be utilized by practitioners to guide and improve their
practice.
o Peplau’s anxiety continuum is still used in anxiety patients
 Theories must be consistent with other validated theories, laws, and
principles but will leave open unanswered questions that need to be
investigated.
o Peplau's theory is consistent with various theories

Limitations
  Personal space considerations and community social service
resources are considered less.
 Health promotion and maintenance were less emphasized
 Cannot be used in a patient who doesn’t have a felt need eg. With
drawn patients, unconscious patients
 Some areas are not specific enough to generate hypothesis

Research Based on Peplau’s Theory

 Hays .D. (1961). Phases and steps of experimental teaching to

patients of a concept of anxiety: Findings revealed that when taught
by the experimental method, the patients were able to apply the
concept of anxiety after the group was terminated.
 Burd .S.F. Develop and test a nursing intervention framework
for working with anxious patients: Students developed competency
in beginning interpersonal relationship.

References

1. Timber BK. Fundamental skills and concepts in Patient Care, 7th

edition, LWW, N
2. George B. Julia , Nursing Theories- The base for professional
Nursing Practice , 3rd ed. Norwalk, Appleton & Lange.
3. Wills M.Evelyn, McEwen Melanie (2002). Theoretical Basis for
Nursing Philadelphia. Lippincott Williams& wilkins.
4. Meleis Ibrahim Afaf (1997) , Theoretical Nursing : Development &
Progress 3rd ed. Philadelphia, Lippincott.
5. Taylor Carol,Lillis Carol (2001)The Art & Science Of Nursing Care
4th ed. Philadelphia, Lippincott.
6. Potter A Patricia, Perry G Anne (1992) Fundamentals Of Nursing –
Concepts Process & Practice 3rd ed. London Mosby Year Book.
7. Vandemark L.M. Awareness of self & expanding consciousness:
using Nursing theories to prepare nurse –therapists Ment Health
Nurs. 2006 Jul; 27(6) : 605-15
8. Reed PG, The force of nursing theory guided- practice. Nurs Sci Q.
2006 Jul;19(3):225
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practice, 2nd edition, Thomson, NY, 2002.