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Relations Theory
Zafar Iqbal
Sr. lecturer
Jinnah College of Nursing
Hildegard E. Peplaus Interpersonal
Relations in Nursing

Regarded as mother of psychiatric nursing
Born in 1909 , Pennsylvania
Diploma from Pottstown Hospital School of
BA in interpersonal psychology from
Bennington College Pennsylvania in 1931.
MA in psychiatric nursing from Colombia
University, New York in 1947
Her Theory was published in 1953
Framework for psychodynamic nursing

Theory was influenced by Harry Stack Sullivans
theory of interpersonal relations.
Middle range, descriptive, classification theory
she led the way towards humane treatment of
patients with behavior and personality disorders.
Nurses, she thought, could facilitate this
through observation, description, formulation,
interpretation, validation, and intervention.
she taught interpersonal concepts and
interviewing techniques, as well as individual,
family, and group therapy.

Interpersonal Relations in Nursing
Stresses the importance of nurses ability to
understand their own behaviors to help others
identify perceived difficulties.
Emphasizes the focus on the interpersonal
processes and therapeutic relationship that
develops between the nurse and client.
Four phases of the nurse-patient relationship
are identified

4 Phases of nurse-patient
Orientation-client seeking
assistance, meeting of
nurse-patient, identifying
the problem and services
needed ( interview
process), and guidance.
Get familiar phase of the
nurse-patient relationship.
Parameters are established
and met
Early levels of trust are
Roles begin to be

Phases cont.
Identification- identifying who is best to support
needs, patient addresses personal feelings about
the experience and is encouraged to participate
in care to promote personal acceptance and
The client begins to identify problems to be
worked on within relationship
The goal of the nurse: help the patient to
recognize his/her own
interdependent/participation role and promote
responsibility for self

Phases cont.
Exploitation- patient attempts to explore,
understand and deal with the problem, and gains
independence on achieving the goal
Clients trust of nurse reached full potential
Client making full use of nursing services
Solving immediate problems
Identifying and orienting self to [discharge] goals

Phases cont.
Resolution- termination of the therapeutic
relationship to encourage emotional balance for
nurse and patient ( difficult for both patient and
nurse as psychological dependence persists)
Client met needs
Mutual termination of relationship
Sense of security is formed
Patient is less reliant on nurse
Increased self reliance to deal with own

Peplau's Seven Nursing Roles

Peplau's Seven Nursing Roles illustrate the dynamic
character roles typical to clinical nursing.
Stranger role: Receives the client the same way one
meets a stranger in other life situations; provides an
accepting climate that builds trust.
Resource role: Answers questions, interprets clinical
treatment data, gives information.
Teaching role: Gives instructions and provides training;
involves analysis and synthesis of the learner's

Peplau's Seven Nursing Roles
Counseling role: Helps client understand and
integrate the meaning of current life circumstances;
provides guidance and encouragement to make
Surrogate role: Helps client clarify domains of
dependence, interdependence, and independence
and acts on clients behalf as advocate.
Active leadership: Helps client assume maximum
responsibility for meeting treatment goals in a
mutually satisfying way.
Technical expert role: Provides physical care by
displaying clinical skills; Operates equipment

Application of Interpersonal Theory in
Nursing Practice
An article in Current Nursing evaluated using the
theory in nursing practice
Assessment= Orientation phase
Nursing diagnosis
Planning=Identification phase
Implementing=Exploitation phase
Evaluation=Resolution phase
(the theory allowed clients needs to be assessed.
Application of the theory helped provide
comprehensive care to the client)

Research completed
Urology Nursing used the theory to educate
newly diagnosed bladder cancer patients with
the need for a urinary diversion, and ensure
Outcome shows that the scope of a patients needs
requires a competent nurse to assume the
changing roles in the four phases of the theory,
expressing the importance of involving the
patient in establishing goals and reviewing the
goals frequently.
Research completed
British Journal of Nursing had an article researching
the credibility of Peplaus theory, in mental health care,
due to the expansion of nursing knowledge and the
dynamics of a multidisciplinary team currently used in
todays practice.
Public Health Nursing did a study, in homecare visits,
(testing the use of Peplaus theory) to work with multi-
problem families, to identify interventions,
individualized for the members, to see if relationship
progression was increased within the family system
resulting in optimized care of the patient.
Application of theory in MY nursing
This theory would be useful with our newly diagnosed cancer patients
and their family. Resistance is met when trying to educate them about
the treatment, encouraging enrolment in studies, and education about
how to care for the patient in their home setting.
Orientation-patient gets admitted to the unit, nurse helps the patient to
recognize and understand that they have cancer and the importance of
Identification-Patient takes the time to internalize the diagnosis, the nurse
participates in helping the patient to do so.
-- Exploitation-the nurse works to have the patient explore what help is
needed to meet goals, incorporating other disciplines to problem solve
(oncologists, therapists, alternative medicine, etc.).Patient test the limits of
the nurses availability, and the nurse encourages patient to evaluate ways
to meet their final goals.
-- Resolution-when in-patient treatment is complete, the nurse has to
evaluate feelings and remove themselves from the bond that is made,
allowing the patient and family to move on and regain balance in their own