Peplau's Nursing Theory

(Theory of Interpersonal Relation)

 INTRODUCTION:

Hildegard. E. Peplau

 Born in Reading, Pennsylvania [1909]

 Graduated from a diploma program in Pottstown, Pennsylvania
in1931.
 Done BA in interpersonal psychology from 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.

Hildegard Peplau proposed in 1952 that nursing involved a set of interpersonal

relationships between nurse and patient. She carefully described these
relationships, applying other disciplines, such as psychology, which was a first
in the field of nursing. By raising standards to a higher level of examination, she
helped prepare nursing's move from a skill to a profession.

 INTRODUCTION

 Peplau’s theory focuses on the interpersonal processes and therapeutic

relationship that develops between the nurse and client.
 The interpersonal focus of Peplau’s theory requires that the nurse attend
to the interpersonal processes that occur between the nurse and client.
 Interpersonal process is maturing force for personality. Interpersonal
processes include the nurse- client relationship, communication, pattern
integration and the roles of the nurse.
 Psychodynamic nursing is being able to understand one’s own behavior
to help others identify felt difficulties and to apply principles of human
relations to the problems that arise at all levels of experience.
 This theory stressed the importance of nurses’ ability to understand own
behavior to help others identify perceived difficulties.

 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 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 process that make health possible for
individuals in communities 

 PSYCHODYNAMIC NURSING

In psychodynamic nursing

 The nurse starts with an understanding of the basis for his or her own
behavior. This understanding then helps the nurse-patient team to identify
perceived difficulties.
 Working as a team, the nurse and the patient increase self-awareness,
maturity, and knowledge of the medical problem and its
remediesUnderstanding of ones own behavior
 To help others identify felt difficulties
 To apply principles of human relations to the problems that arise at all
levels of experience
 In her book she discussed the phases of interpersonal process, roles in
nursing situations and methods for studying nursing as an interpersonal
process.
 According to Peplau, 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.
 ROLES OF THE NURSE

Peplau's theory lists six primary nursing roles:

 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

 PEPLAU’S WORK AND CHARACTERISTICS OF A THEORY

 Theories can interrelate concepts in such a way as to create a different

way of looking at a particular phenomenon. Four phases interrelate the
different components of each phase.
 The nurse patient interaction can apply to the concepts of human being,
health, environment and nursing.
 Theories must be logical in nature. This theory provides a logical
systematic way of viewing nursing situations
 Key concepts such as anxiety, tension, goals, and frustration are indicated
with explicit relationships among them and progressive phases
 Theories should be relatively simple yet generalizable. It provides
simplicity in regard to the natural progression of the NP relationship.
Leads to adaptability in any nurse patient relationship.
 The basic nature of nursing still considered an interpersonal process
 Theories can be the bases for hypothesis that can be tested.Has generated
testable hypotheses.
 Theories contribute to and assist in increasing the general body of
knowledge within the discipline through the research implemented to
validate them. In 1950’s two third of the nursing research concentrated on
N-P relation ship.
 Theories can be utilized by practitioners to guide and improve their
practice. 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. Consistent with various theories

 THE FOUR PHASES OF NURSE-PATIENT RELATIONSHIPS

ARE:

1. ORIENTATION:

 During this 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.
 Problem defining phase
 Starts when client meets nurse as stranger. 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
need.
 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

 2. IDENTIFICATION

 The patient identifies with those who can help him/ her.
 The nurse permits exploration of feelings to aid the patient in undergoing
illness as an experience that reorients feelings and strengthens positive
forces in the personality and provides needed satisfaction.
 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
 Patient participates in goal setting; has feeling of belonging and
selectively responds to those who can meet his or her needs

3. EXPLOITATION

 During this phase, the patient attempts to derive full value from what he/
she are offered through the relationship.
 The nurse can project new goals to be achieved through personal effort
and power shifts from the nurse to the patient as the patient delays
gratification to achieve the newly formed goals.
 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
  Patient actively seeks and draws knowledge and expertise of those who
can help.

4. RESOLUTION

 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.
 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

Overlapping phases in nurse- patient relationship

1.Orientation: 3.Interaction:

-know each other -indentify the problem

-recognize & understand -respond who offers help

problems
2.Exploitation:
-assess strength & weakness
-implementation of work
-establish communication
-assist the person in the work
-
-change in communication
manner
-explore behaviour & feelings
4.Resolution:
of nurse-patient relation
-gradual freeing from person
-assist during stress
-develop ability to stand alone
Nurse-Patient -mutual termination of
Interpersonal relationship

-new skills in IPR & problem Relationship -plan for alternative source of
solving develop support.

- -
 CONCEPTUAL FRAMEWORK ON PEPLU’S THEORY

 INTERPERSONAL THEORY AND NURSING

PROCESS./PEPLAU’S THEORY AND NURSING PROCESS:

Peplau defines Nursing Process as a deliberate intellectual activity that guides

the professional practice of nursing in providing care in an orderly, systematic
manner.

 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 analysis  Non continuous data collection

[continuous]  Felt need
 May not be a 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 set drawing help
goals
  May be accomplished by  Patient initiated
patient , nurse or family

Evaluation Resolution

 Based on mutually expected  Occurs after other phases are

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

 PEPLAU’S THEORY APPLICATION NURSING PROCESS:

The nursing process for Mrs. JAYABEN based on Peplau’s theory is as

follows: 

 Mrs. JAYABEN
 27 years
 Diagnosis: Inter vertebral disc prolapse 

Assessmen Nursing Planning Implementati Evaluation                

t diagnos (Identificati on (Resolution
(Orientati is on phase) (Exploitation phase)
on phase) phase)
Mrs. Impaire Goal setting Carried out Mrs. JAYABEN was free to
JAYABEN d was done plans express problems regarding
is on physical along with mutually difficulty in mobilizing.
pelvic mobility patient agreed upon.
traction related  
and she is to the    
restricted presenc She expressed satisfaction
to bed. e of Patient will   when able to move without
pelvic have difficulty.
The need traction. improved Provided
for bed rest physical active and
and mobility as passive
restriction evidenced by exercises to
was participating all the
discussed. in self care
within the extremities
limits.
 
Provide
active and Made the
passive patient to
exercises to perform
all the breathing
extremities exercises
to improve
the muscle  
tone and
strength. Massaged the
upper and
Make the lower
patient to extremities
perform the Provided
breathing article within
exercises the reach of
which will the patient
strengthen
the  
respiratory
Provided
muscle.
positive
Massage the reinforcement
upper and to the patient
lower
extremities
which help
to improve
the
circulation.

Provide
articles near
to the patient
and
encourage
doing
activities
 within limits.

Provide
positive
reinforcemen
t for even a
small
improvement
to increase
the
frequency of
the desired
activity. 

 SUMMARY

1. Orientation phase

 Client is initially reluctant to talk due to pain.

 Client is expressing that while standing she is having much pain.
 Client expressed without movement and supine position gave her relief
from pain. 

2. Identification

 The client participates and interdependent with the nurse

 Expresses the need for measure to get relief from pain
 Expresses need for improving the mobility
 Expresses need to know more about prognosis, discharge and home care
and follow up.

3. Exploitation

 Client explains that she gets relief of pain when lying down supine.
 Cooperates and participates actively in performing exercises.
 Client mobilizes changes position and cooperates during position
changes.

4. Resolution
  Client expressed that pain has reduced a lot and she is able to tolerate it
now
 She has agreed upon to continue the exercises at home
 She also expressed that she would come for regular follow up after
discharge.

 LIMITATIONS

 Intra family dynamics, 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 

 BIBLIOGRAPHY:

1. Chinn P L, and Kramer M K.” Theory and nursing- a systemic approach”. 3rd

edition. Philadelphia:  Mosby year book;1991

2. George J B. “Nursing theories.” 5th edition. New Jersey: Prentice hall; 2002

3. Alligood M R, Tomey A M. “Nursing theory- utilization and application”. 3rd

edition. Missouri: Mosby Elsevier; 2006

4. Craven R F, Hirnle C J. “Fundamentals of nursing – human health and function”.

5th edition. Philadelphia: Lippincott Williams and Wilkins; 2007

5. McQuiston C M and Webb A “A. Foundations of nursing theory- Contributions of

12 key theorists.” New Delhi: Sage Publications; 1995

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