HILDEGARD E.

PEPLAU

• Born in Reading, Pennsylvania in September 1, 1909

• First published nursing theorist in a century, since Nightingale
• Created the nursing middle-range theory of Interpersonal Relations

NURSING EDUCATION OF PEPLAU’S TIME

• The autonomous, nursing controlled Nightingale Era schools came to an end;

schools controlled by hospitals now and formal book learning is discouraged
• Hospitals and physicians saw women in nursing as a source of free or inexpensive
labor
• exploitation was not uncommon of nurse’s employers, physicians and educational
providers
• nursing practice was controlled by medicine

NURSING EDUCATION & MILITARY SERVICE

• Graduated from a nursing diploma program in Pottstown, Pennsylvania in 1931.

• After graduating from the Pottstown, Pennsylvania Hospital School of Nursing in
1931 she worked as an operating room supervisor at Pottstown Hospital.
• Done Bachelor of Arts in interpersonal psychology from Bennington College in
1943.
• World War II: Army Nurse Corps – worked in a neuropsychiatric hospital in
London, England
• Master of Arts in psychiatric nursing in 1947 and Ed.D in curriculum
development in 1953from Colombia University New York
• Published Interpersonal Relations in Nursing in 1952
• 1968 :interpersonal techniques-the crux of psychiatric nursing
•

FOUNDATIONS OF PEPLAU’S FRAMEWORK

• Hildegard witnessed injustices in life

• First exposure to Interpersonal Theory at Bennington
o Attended lectures by Harold Sullivan on Interpersonal Relations

• She had visions to bring the Sullivan theory to interations with her patients – they
needed:
o Humane treatment
o Dignity and respect
o Healing discussion
 • Her book, or conceptual famework, was completed in 1948, entitled Interpersonal
Relations in Nursing

GOALS OF THE THEORY

• Publishing her book took four additional years because it was groundbreaking for
a nurse to contribute this scholarly work without a coauthoring physician
• Peplau’s original intent was not to theory development per se
• She wanted “only to convey to the nursing profession ideas she thought were
important to improve practice”
• Peplau’s focus was the quality of nurse-patient interactions and nursing education

INTERPERSONAL RELATIONS THEORY

Basic Elements

• The patient
• The nurse
• The interaction between them

Definitions

• Patient/Client - 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
• Interpersonal – phenomena that occur between persons

FOUR PHASES IN THE INTERPERSONAL RELATIONS

Orientation phase

• Starts when client meets nurse as stranger

• Problem defining phase
• 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
• Goal of the Nurse: help the patient to recognize his own interdependent/
participation role and promote self responsibility

Exploitation phase

• Use of professional assistance for problem solving alternatives

• 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 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
• Clients has increased self-reliance in dealing with his problems

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: 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

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

[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 achievement • Patient actively seeking and drawing

of mutually set goals help
 • May be accomplished by patient , • Patient initiated
nurse or family
Evaluation Resolution

• Based on mutually expected • Occurs after other phases are

behaviors completed successfully

• May led to termination and initiation • Leads to termination

of new plans

APPLICATION OF INTERPERSONAL THEORY IN NURSING PRACTICE

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 behaviors.

Peplau’s theory application in nursing process:

The nursing process for Mrs. JL based on Peplau’s theory is as follows:

• Mrs. JL
• 27 years
• Diagnosis: Inter vertebral disc prolapse. Displacement of part of the gelatinous
interior of an intervertebral disc so that it protrudes through the fibrous outer coat.
The exuded disc material may press against adjacent nerves and cause severe
pain. So-called slipped discs preclude physical activity but, once the patient has
recovered, exercises are often used to strengthen the abdominal and back muscles
in order to reduce the risk of a recurrence of the prolapse.

I. Assessment (Orientation phase)

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

• The need for bed rest and restriction was discussed.

Nursing diagnosis

• Impaired physical mobility related to the presence of pelvic traction.

Planning (Identification phase)

 • Goal setting was done along with patient
• Patient will have improved physical mobility as evidenced by participating in self
care within the limits.
• Provide active and passive exercises to all the extremities to improve the muscle
tone and strength.
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.
Provide articles near to the patient and encourage doing activities within limits.
Provide positive reinforcement for even a small improvement to increase the
frequency of the desired activity.

Implementation (Exploitation phase)

• Carried out plans mutually agreed upon.

• Provided active and passive exercises to all the extremities
• Made the patient to perform breathing exercises
• Massaged the upper and lower extremities
Provided article within the reach of the patient
• Provided positive reinforcement to the patient

Evaluation (Resolution
phase)

• Mrs. JL was free to express problems regarding difficulty in mobilizing.

• She expressed satisfaction when able to move without difficulty

II. Assessment (Orientation phase)

• Mrs. JL is enquiring about the disease condition, its outcome and need for surgery
• Discussed with the client regarding the disease process and the findings in the
client

Nursing diagnosis

• Anxiety related to hospital admission as evidenced by verbalization and client &

family appearing withdrawn

Planning (Identification phase)

• Goal setting was done along with patient

• Client will have reduced feeling of anxiety as evidenced by
asking fewer questions
 • Teach the family and client regarding the disease process.
Explain in simple understandable language of the client.
Allow and encourage the client and family to ask questions. Allow the client and
family to verbalize anxiety.
Stress that frequent assessment are routine and do not necessarily imply a
deteriorating condition.
Allow the family members to visit the client frequently

Implementation (Exploitation phase)

• Carried out plans mutually agreed upon.

• Taught the family regarding the disease process in simple Kannada
• Allowed the client and family members to ask questions
She and her husband expressed their anxiety
• Allowed the family members to frequently visit the client

Evaluation (Resolution phase)

• Mrs. JL was free to express problems of self care.

• She asked her doubts regarding the illness and the diagnostic procedures
• She verbalized that her anxiety has reduced to some extent.

THEORY OF RECIPROCITY

Nurse - A person educated and trained to care for the sick or disabled.

Patient - is any person who receives medical attention, care, or treatment. The person is
most often ill or injured and in need of treatment by a physician or other health care
professional.

Cooperation - The act of taking part or sharing in something

Independent - Not relying on others for support, care, or funds; self-supporting

An Independent Person is someone who doesn't always need others. Others includes
influence, guidance, control, etc. You can rely on yourself, instead of constantly looking
to others for affirmation, or to help you. You can fend for yourself, and you can do so
well.

Reciprocity - a state or relationship in which there is mutual action, influence, giving and
taking, correspondence, etc., between two parties. a mutual exchange of privileges.
The norm of reciprocity is the social expectation that people will respond to each other
in kind—returning benefits for benefits, and responding with either indifference or
hostility to harms. The social norm of reciprocity often takes different forms in different
areas of social life, or in different societies. All of them, however, are distinct from
related ideas such as gratitude, the Golden Rule, or mutual goodwill.

Theory of Reciprocity

Orientation

Identification

Exploitation

Resolution

The paradigm depicts the level of cooperation of the nurse and patient
during the Nurse - Patient Interaction
 Holy Angel University
Angeles City

Graduate School

Master of Science in Nursing

HILDEGARD E. PEPLAU
(INTERPERSONAL RELATIONS THEORY)

Submitted By:

Arianne C. Gantan