Peplau published her Theory of Interpersonal Relations in 1952, and in 1968,
interpersonal techniques became the crux of psychiatric nursing. The Theory of
Interpersonal Relations is a middle-range descriptive classification theory.
It was influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow,
and Neal Elger Miller.
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 other
other human processes toward creative, constructive, productive, personal, and
The nursing model identifies four sequential phases in the interpersonal relationship:
orientation, identification, exploitation, and resolution.
The orientation phase defines the problem. It starts when the nurse meets the patient,
and the two are strangers. After defining the problem, the orientation phase identifies
the type of service needed by the patient. The patient seeks assistance, tells the nurse
what he or she needs, asks questions, and shares preconceptions and expectations based
on past experiences. Essentially, the orientation phase is the nurse's assessment of
the patient's health and situation.
The identification phase includes the selection of the appropriate assistance by a
professional. In this phase, the patient begins to feel as if he or she belongs, and
feels capable of dealing with the problem which decreases the feeling of helplessness
and hopelessness. The identification phase is the development of a nursing care plan
based on the patient's situation and goals.
The exploitation phase uses professional assistance for problem-solving alternatives.
The advantages of the professional services used are based on the needs and interests
of the patients. In the exploitation phase, the patient feels like an integral part of
the helping environment, and may make minor requests or use attention-getting techniques.
When communicating with the patient, the nurse should use interview techniques to explore,
understand, and adequately deal with the underlying problem. The nurse must also be aware
of the various phases of communication since the patient's independence is likely to fluctuate.
The nurse should help the patient exploit all avenues of help as progress is made toward the
final phase. This phase is the implementation of the nursing plan, taking actions toward
meeting the goals set in the identification phase.
The final phase is the resolution phase. It is the termination of the professional
relationship since the patient's needs have been met through the collaboration of patient
and nurse. They must sever their relationship and dissolve any ties between them. This can
be difficult for both if psychological dependence still exists. The patient drifts away
from the nurse and breaks the bond between them. A healthier emotional balance is achieved
and both become mature individuals. This is the evaluation of the nursing process. The nurse
and patient evaluate the situation based on the goals set and whether or not they were met.
The goal of psychodynamic nursing is to help understand one's own behavior, help others
identify felt difficulties, and apply principles of human relations to the problems that
come up at all experience levels. Peplau explains that nursing is therapeutic because
it is a healing art, assisting a patient who is sick or in need of health care. It is
also an interpersonal process because of the interaction between two or more individuals
who have a common goal. The nurse and patient work together so both become mature and
knowledgeable in the care process.
The nurse has a variety of roles in Hildegard Peplau's nursing theory. The six main roles are:
stranger, teacher, resource person, counselor, surrogate, and leader.
As a stranger, the nurse receives the patient in the same way the patient meets a
stranger in other life situations. The nurse should create an environment that builds
trust. As a teacher, the nurse imparts knowledge in reference to the needs or interests
of the patient. In this way, the nurse is also a resource person, providing specific
information needed by the patient that helps the patient understand a problem or
situation. The nurse's role as a counselor helps the patient understand and integrate
the meaning of current life situations, as well as provide guidance and encouragement
in order to make changes. As a surrogate, the nurse helps the patient clarify the
domains of dependence, interdependence, and independence, and acts as an advocate for
the patient. As a leader, the nurse helps the patient take on maximum responsibility
for meeting his or her treatment goals. Additional roles of a nurse include technical
expert, consultant, tutor, socializing and safety agent, environment manager, mediator,
administrator, record observer, and researcher.
Some limitations of Peplau's theory include the lack of emphasis on health promotion
and maintenance; that intra-family dynamics, personal space considerations, and
community social service resources are less considered; it can't be used on a patient
who is unable to express a need; and some areas are not specific enough to generate