Application of Interpersonal Theory in Nursing

Practice

Introduction

Peplaus theory focuses on the interpersonal processes and therapeutic relationship that develops between the
nurse and client.

The interpersonal focus of Peplaus 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 ones 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.

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.

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.

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.

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.

Overlapping phases in nurse- patient relationship

Peplaus 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.
Peplau explains 4 phases such as:

Orientation: 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.

Identification: Patient participates in goal setting; has feeling of belonging and selectively responds to those who
can meet his or her needs.

Exploitation: Patient actively seeks and draws knowledge and expertise of those who can help.

Resolution: Occurs after other phases are completed successfully. This leads to termination of the relationship.

In Nursing Process, the orientation phase parallels with assessment phase where both the patient and nurse are strangers;
meeting initiated by patient who expresses a felt need.

Conjointly, the nurse and patient work together, clarifies and gathers important information.

Based on this assessment the nursing diagnoses are formulated, outcome and goal set.

The interventions are planned, carried out and evaluation done based on mutually established expected behaviours.

Peplaus theory application nursing process:

The nursing process for Mrs. JL based on Peplaus theory is as follows:

Mrs. JL
27 years
Diagnosis: Inter vertebral disc prolapse

Assessment
(Orientation phase)

Nursing
diagnosis

Planning (Identification
phase)

Implementation
(Exploitation phase)

Evaluation
(Resolution

phase)
Mrs. JL is on pelvic
traction and she is
restricted to bed.

Goal setting was done

along with patient

Carried out plans mutually

agreed upon.

Mrs. JL was free to express

problems regarding difficulty in
mobilizing.

Impaired
physical mobility
related to the
The need for bed rest presence of
and restriction was
pelvic traction.
discussed.
Patient will have
improved physical
She expressed satisfaction when
mobility as evidenced by
able to move without difficulty.
participating in self care Provided active and passive
within the limits.
exercises to all the
extremities
Provide active and
passive exercises to all
the extremities to improve
the muscle tone and
strength.
Made the patient to perform
breathing exercises
Make the patient to
perform the breathing
exercises which will
strengthen the respiratory
muscle.

Massage the upper and

lower extremities which
help to improve the
circulation.

Massaged the upper and

lower extremities
Provided article within the
reach of the patient

Provide articles near to

Provided positive
the patient and
encourage doing activities reinforcement to the patient
within limits.

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

Assessment (Orientation Nursing diagnosis Planning

Implementation
phase)
(Identification phase) (Exploitation phase)
Mrs. JL expresses pain in
the low back region.

Evaluation
(Resolution phase)

Goal setting was done Carried out plans mutually Mrs. JL was free to express
along with patient
agreed upon.
problems of pain.
Pain related to the
degenerative
changes in the
Mrs. JL will have
lumbar region.
reduction in pain as
evidenced by her
verbalisation of
Regarding pain, discussion
reduction in pain
was made to assess the
responses.
severity and the type and
duration of pain. Also the
Provided non
Expressed that she got slight
measures to reduce pain
pharmacological
relief from pain.
were
Provide nonmeasures like diversion,
discussed.
pharmacological
massaging, and pelvic
measures for pain relief traction.
such as diversional
activity which diverts the
patients mind.
Provided supine position
Give the client a
neutral position

to the client
Supported the back during
position change

Used pillows to support

Always use back
the back.
support while turning the
patient that reduces the
strain on the back.
Administered Tab. Hifenac
P and Cap. Myoril 4mg as
prescribed.
Support the areas with
extra pillow to allow the
normal alignment and to Given pelvic traction and
prevent strain.
explained the need for
traction
Administer analgesics
as prescribed by the

physician.

Provide pelvic traction to

the patient

Assessment
(Orientation phase)

Nursing diagnosis Planning (Identification

phase)

Implementation (Exploitation Evaluation

phase)
(Resolution phase)

Mrs. JL expresses that

she need assistance to
get down from bed.

Goal setting was done along Carried out plans mutually

with patient
agreed upon.
Self care deficit
related to the
presence of pelvic Client will achieve and
Regarding self care
traction.
maintain self care activities
discussion was done and
with assistance of caregiver
discussed regarding the
or within her limits.
measures to solve the
problems.
Keep all the articles within the
reach of the patient.

Provide a call bell to the

patient to call in any
emergency

Mrs. JL was free to

express problems of
self care.

She used to call for

the needs and all her
needs were met
appropriately

She achieved and

maintained self care
activities within her
limits

Kept the articles within t he

reach of the client

Frequently visit the patient

and enquire for any needs.

Assist the patient in doing her Frequently visited the patient

self care activities.
and enquired for any needs
Remove the weight of the
traction as needed by the
patient.

Assisted the client in doing her

self care activities

Removed the weight as and

when needed.

Assessment
(Orientation phase)

Nursing diagnosis

Mrs. JL is enquiring
about the disease
condition, its outcome Anxiety related to
and need for surgery hospital admission as
evidenced by
verbalisation and client
Discussed with the
& family appearing
client regarding the
withdrawn
disease process and
the findings in the
client

Planning (Identification
phase)

Implementation
(Exploitation phase)

Evaluation
(Resolution phase)

Goal setting was done

along with patient

Carried out plans mutually

agreed upon.

Mrs. JL was free to

express problems of
self care.

Client will have reduced

feeling of anxiety as
evidenced by
asking fewer questions

She asked her doubts

regarding the illness
and the diagnostic
procedures

Teach the family and client Taught the family regarding

regarding the disease
She verbalized that her
the disease process in
process.
anxiety has reduced to
simple Kannada
Explain in simple
some extent.
understandable language of
the client.

Allow and encourage the

client and family to ask
questions. Allow the client
and family to verbalize
anxiety.

Allowed the client and family

members to ask questions

She and her husband

expressed their anxiety

Stress that frequent

assessment are routine and
do not necessarily imply a
deteriorating condition.

Allow the family members to

visit the client frequently

Allowed the family members

to frequently visit the client

Assessment
(Orientation phase)

Nursing diagnosis Planning (Identification

phase)

Mrs. JL is enquiring
Goal setting was done
about the disease
along with patient
condition, its outcome Deficient knowledge
and need for surgery related to the
treatment measures Patient will acquire
to be continued even adequate knowledge
Discussed with the
after the discharge. regarding the treatment and
client regarding the
home care.
disease process and
the need for follow up
Explain the treatment
measures to the patient and
their benefits

Implementation
(Exploitation phase)

Evaluation
(Resolution phase)

Carried out plans mutually

agreed upon.

Mrs. JL was free to

express problems of self
care.

She expressed acquisition

of knowledge regarding
the disease and the signs
of aggravation of illness
Explained treatment
measures and the need for
follow up

Explain to the client the

signs of aggravation of
illness

Explained regarding the

signs of aggravation of
disease

Use simple and

understandable terms

Used simple and

understandable terms for
explaining
Clarified her doubts

Clarify all the doubts of the

patient of importance.

Repeat the information

whenever necessary to
reinforce learning.

Repeated the information

S u m m a r y

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.

Evaluation of the theory of interpersonal relations by Peplau

With the help of the theory of interpersonal relations, the client's needs could be assessed. It helped her to achieve them within
her limits. This theory application helped in providing comprehensive care to the client.

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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
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