THEORY OF INTERPERSONAL RELATIONS

Hildegard. E. Peplau
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.
 Ed. D 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 referred as psychodynamic nursing, which is the
understanding of one’s own behaviour.
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 personality and

other on-going human processes in the direction of creative, constructive,
productive, personal and community living.

Nursing: Nursing is significant therapeutic interpersonal process. It functions

cooperatively with other human process that makes 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: imparts knowledge in reference to a need or interest.

Resource Person: one who provides specific needed information that aids in
the understanding of a problem or new situation

Counsellors: 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 analysis  Non continuous data 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 set drawing help
goals  Patient initiated
 May be accomplished by patient,
nurse or family

Evaluation Resolution

 Based on mutually expected  Occurs after other phases are

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

Peplau’s work and characteristics of a theory:

 Interrelation of concepts:

Four phases inter relate the different components of each phase.

 Applicability:
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
 Generalizability
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
Peplau's theory has generated testable hypotheses.
 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.
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.