Peplau’s Theory of Interpersonal Relations

Background 

Theorist’s Background 

Hildegard Elizabeth Peplau (1909-1999) was an American nurse recognized for her service as the Executive Director and later the president of the American Nurses Association (ANA). According to Gonzalo (2019), in the nursing community, Peplau was considered the “Mother of Psychiatric Nursing” in light of her  Theory of Interpersonal Relations.  Peplau witnessed the devastating 1918 flu pandemic that greatly shaped her considerate thoughts on the impact of sickness and death on families. she graduated in 1931 from the Pottstown, Pennsylvania School of Nursing after which she got her Bachelor’s degree in interpersonal psychology at Bennington College, Vermont in 1943 (Gonzalo, 2019).   

Gonzalo (2019) reports that Peplau joined Chestnut Lodge, a Maryland-based private psychiatric hospital she studied psychology. She earned her master’s and doctoral degrees from the Teachers College, Columbia University. Her lifelong work was to expand Sullivan’s interpersonal theory to be used in nursing practice. In the 1950s, Peplau developed and taught psychiatric nursing for graduate students at the Teachers College. Until her retirement in 1974, Peplau was a faculty member at the College of Nursing, Rutgers University since 195. Besides, she taught interviewing techniques and interpersonal concepts during U.S. nurses’ summer workshops. Influenced by the works of Neal Elgar Miller, Abraham Maslow, Percival Symonds, and Stack Sullivan, Peplau published the  Theory of Interpersonal Relations  in 1952 (Gonzalo, 2019).  

Phenomenon of Concern 

Peplau was concerned with the importance of an effective relationship between nurses and patients. She developed the  Theory of Interpersonal Relations  to emphasize nurse-client relationship as the basis of nursing practice. Peplau thought that a give-and-take relationship between the nurses and patients would eliminate passive treatment or service. According to Hagerty et al. (2017), Peplau sought to promote the nursing practice as a therapeutic service, healing art that would assist patients requiring health care. To her, nursing should be an interpersonal process that stresses effective interaction between the nurses and the patients. The  Theory of Interpersonal Relations  sets a clear definition of nursing:  

An interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse specially educated to recognize, respond to the need for help. It is a maturing force and an educative instrument (Gonzalo, 2019). 

The basis for the theory is to foster mutual respect between a nurse and a patient. This respect should be exercised in such a way that both the nurse and patient learn and grow because of their effective interaction.  

Theory Description 

Concepts  

Peplau’s theory explains that nursing’s purpose is to help people identify and respond to their felt needs. According to the theory, nurses should use human relations principles in solving patient problems at all levels (Hagerty et al., 2017). The theory states that studying and applying effective nursing practice encompasses interpersonal processes. Notably, Hariyati and Ungsianik (2018) submit that Peplau’s theory promotes nursing as a therapeutic, healing art that assists persons in need of healthcare or sick people. Furthermore, Peplau clarifies that nursing is an interpersonal process due to its reliance on the interaction between two or more people connected by a common goal, to eliminate the difficulty the client is facing. Gonzalo (2019) highlights that Peplau’s theory shows that the attainment of the common goals depends on a series of patterns and steps.  

The conceptual framework of Peplau’s  Interpersonal Relations Theory  focuses on promoting the nursing practice as a therapeutic process for helping other people take note of their felt challenges. It emphasizes that nurses should use human relations principles to the difficulties that emerge at all levels of their nursing experience (Hagerty et al., 2017). Peplau (1997) notes that for any form of nurse-client relationship to be built there should be human beings with the need for nursing care; in this case, there should be a patient. On the other hand, there should be a nurse willing to extend care ostensibly to lessen the burden or rather the difficulties that the client could be undergoing. The theory stresses that human beings should be living in a stable environment governed by existing morals and culture (Hariyati & Ungsianik, 2018). In this case, the environment involves the central settings within which the organism in need to reduce the anxiety-driven needs thrives. While the environment is central to the organism (person), it should not be a limiting factor in extending proper patient care; however, a nurse should consider the patient’s cultural context to allow them to adjust effectively to hospital settings (Delaney et al., 2017).  

The  Theory of Interpersonal Relations  creates a clear understanding of the role of a nurse in providing therapeutic care. The theory says that while nurses are strangers to their patients, they should provide an accepting climate for trust-building (Peplau, 1997). The theory presents a nurse as a teacher who offers knowledge in tandem with the interest or need of the client; besides, it considers the nurse as a resource person tasked with the provision of specific information that helps in understanding a new situation or problem (Hagerty et al., 2017). Based on the Peplau’s theory, a nurse is a counselor that assists in understanding and integrating meaning of the patient’s current circumstances while providing guidance and motivation for behavior change (Hariyati & Ungsianik, 2018). Likewise, this theory considers nurses as surrogates because they clarify domains of independence, interdependence, and dependence while at the same time acting as the client’s advocate (Delaney et al., 2017). All these aspects are bound together by the nurses’ leadership role in helping patients undertake maximum responsibility towards attaining treatment objectives in a mutually fulfilling manner.  

Assumption  

According to Gonzalo (2019), Peplau’s  Interpersonal Relations Theory  is founded on four distinct assumptions: First, both patient and nurse could interact. Second, Peplau underlines that both the nurse and the patient mature through the process of their therapeutic interaction. Third, Peplau assumes that interviewing and communication skills are basic tools in nursing. Lastly, Hildegard Peplau underscores that nurses should always understand themselves to be able to promote the growth of their clients and avoid limiting the patient’s choices to what the nurses consider valuable (Gonzalo, 2019).  

Metaparadigm 

Man 

Man is a central idea in the  Theory of Interpersonal Relations.  According to D'Antonio et al. (2014), Peplau provides a precise definition of man that allows the concept to demonstrate its core importance in the theory. Peplau states that a “man [is] an organism that strives in its way to reduce tension generated by needs” (Gonzalo, 2019). In light of this definition, it is apparent that a patient is usually a person characterized by felt needs.  

Health 

Health is also an imperative concept in Peplau’s  Theory of Interpersonal Relations.  Based on her model, Peplau describes health as a word representation that symbolizes “forward movement of personality” as well as other integral continuous human process designed to foster constructive, personal, creative, community, and productive living (D'Antonio et al., 2014). In this case, health creates a sense of purpose in people’s lives. 

Environment or Society 

Service delivery thrives in clearly defined settings that describe the environment or society in which the service is needed. Peplau does not address the environment or society directly. However, her theory encourages the nursing community to take into account the client’s mores and culture while the client adjusts to the set routine in the hospital (D'Antonio et al., 2014). The environment describes the forces that occur outside the man (organism). This concept aims to eliminate any form of conflict that could affect the therapeutic process negatively. 

Nursing 

Peplau sees nursing as a crucial, interpersonal, and therapeutic process that helps patients to recover and attain their health for a productive living. Peplau (1997) defines nursing as the human relationship between a person in need of health services or sick, and a nurse with specialized competence to identify and effectively respond to the patient’s need. In this Peplau’s nursing notion, two key ideas arise healthcare needs and competent nurses. As the theory illustrates, nursing should function collaboratively with other human processes focused on enhancing the health of individuals.  

Evaluation 

Clarity  

Peplau’s  Theory of Interpersonal Relations  precise with clear concept definitions and process descriptions. Peplau provides a rich definition of the core concepts of the theory in a way they occupy a central place in enhancing therapeutic service delivery. For instance, Peplau emphasizes man’s focus as to minimize tension created by human needs with health symbolizing not only productive but also community, personal, constructive, and creative living. These concepts demonstrate that while health is integral to people living, their ability to create tranquil and peaceful settings is imperative to the patient’s recovery process (D'Antonio et al., 2014). On the other hand, Peplau clearly illustrates the need to factor in the client’s culture and morals that could in a way hinder service delivery and ultimately the client-nurse relationship building. Indeed, it is clear that nursing is a therapeutic process that revolves around relationship building (Hariyati & Ungsianik, 2018). Peplau provides a though illustration of nursing with her recognition of a patient in need and a nurse qualified to identify and solve the need.  

Apart from the clearly described concepts, the theory creates a vibrant image of the therapeutic nurse-client alliance. According to D'Antonio et al. (2014), Peplau provides an exhaustive description of a four-phase therapeutic process in which a nurse establishes a productive and effective nurse-patient relationship for proper service delivery. This nurse-patient alliance-building involves an orientation phase that Peplau explains is nurse-directed and entails engaging the patient on the treatment process while providing information, answering questions, and offering explanations (Washington, 2013). In the second phase, the identification phase provides the place for the client in the relationship building. Peplau (1997) states that a patient should independently express feelings in the nurse-patient alliance building. Nonetheless, Peplau illustrates that the patient takes full advantage of the nursing services at the exploitation phase. In the exploitation phase, Peplau highlights the essence of interviewing and communication skills to understand and properly deal with the client’s problem (Delaney et al., 2017). Finally, Peplau provides an exit strategy for the nurse-patient relationship. This aspect is in the resolution phase in which the patient is no longer in need of professional services because the client's needs have been solved through the collaborative effect of the nurse and the patient (Hariyati & Ungsianik, 2018). In light of this clarification, Peplau shows clearly, how the therapeutic process is initiated, extended, and terminated in the interest of the patient’s needs.  

Congruence 

The basic premise of Peplau’s  Theory of Interpersonal Relations  is that change and stability in an individual’s behavior rely on the change and stability of their relationships with other people. Remarkably, this premise is tenable however as Dion (2014) alleges various modifications to the described personality approach are warranted. Peplau’s theory overemphasizes the effects that views from other persons could have on the self. Furthermore, Peplau exaggerates the role of different congruency-producing process in establishing and maintaining stability. Considerably, as McCarthy and Aquino-Russell (2009) claim, Peplau neglects the role self-creation plays in fostering stability.  

On a different note, the congruence of Peplau’s  Theory of Interpersonal Relations  faces a profound test on single party-approach on relationship building. Incidentally and contrary to expectations of a proper relationship building, Peplau insists on the person’s unilateral effort in maintaining congruence instead of seeing the relationship outcome and the identities involved as distinct products of both the patient and the nurse in their attempt to establish, maintain, and sometimes change themselves in line with their relationship-building process. However, concerning generalizability, Peplau’s theory offers simplicity on the natural progression of the nurse-client relationship (McCarthy & Aquino-Russell, 2009). Additionally, the theory is consistent with other nursing models. Dion (2014) states that nursing models should be consistent with other certified theories, principles, and laws but arouse open unanswered issues that need further research. Peplau’s  Theory of Interpersonal Relations  meets this critical criterion for a valid theory.  

Application 

Level  

Peplau’s  Theory of Interpersonal Relations  has four levels: orientation, identification, exploitation, and resolution. At the orientation level, the nurse engages the client to provide key information and explanation while in the identification level the client expresses feelings, an aspect that reduces hopelessness (Peplau, 1997). In the exploitation level, the client utilizes the nursing services fully with the assistance of the nurse (Washington, 2013). In the final level, the resolution phase, the client surrenders dependent behavior because the professional services of the nurse are no longer needed (Peplau, 1997). Therefore, at this level, the nurse-client relationship ends.  

Use  

Peplau’s theory is relevant to promote effective communication in a hospital setting. As Washington (2013) explains, this theory opens avenues for nurse-client communication by placing all factors that could hinder proper communication into context including the nurse and patient’s values, beliefs, culture, past experiences, and expectations, besides the nurse’s preconceived ideas (Senn, 2013). On another note, nursing professionals to improve and guide their practice can use Peplau’s theory. Delaney et al. (2017) present that the  Theory of Interpersonal Relations  is highly applicable in anxiety patients since it promotes the development of the integral therapeutic relationship between practitioners and clients. The theory fosters a planned relationship between the nurse and the client, a relationship that emphasizes the client’s ideas, problems, feelings, and needs (Senn, 2013). In this case, the nurse can assist the patient to exploit all possible options of help to ensure they achieve effective progress towards their common goal, healing the client. 

Weaknesses 

While Peplau emphasizes that the foundation of effective, productive, and constructive nursing practice is a nurse-client relationship, she fails to emphasize the role of maintenance and health promotion in nursing. She provides a shallow and utterly superficial description that leaves more to be desired. Moreover, the application of this theory faces limitations. Apparently, as McCarthy and Aquino-Russell (2009) state, it cannot be used in case a patient lacks the felt needs as shown in withdrawn clients. The theory does not provide information on how to promote nurse-client relationships in case a client is not able to converse such as paralyzed patients. Moreover, the theory provides minimal information on community social services and personal space.  

Future  

Peplau’s  Theory of Interpersonal Relations  has illustrated greater application in the later development of more improved and therapeutic nursing interventions. The theory shows the dynamic character of a clinical nurse as described in the seven nursing roles. Those considering a career in the nursing profession could find the seven nursing roles helpful in different situations. The duty of a nurse is not to just care for a patient but involves every other activity that could have any effect on the health of the patient. However, there is a significant need for further research and explanation on how a nurse-client relationship could be built in the event of a withdrawn client. The narrow approach to those powerless or unfit to converse is should be reviewed to create an approach that could foster effective nurse-client cooperation is such difficult situations. 

References 

D'Antonio, P. et al. (2014). The future in the past: Hildegard Peplau and interpersonal relations in nursing.  Nursing Inquiry ,  21 (4), 311-317. 

Delaney, K. R. et al. (2017). Capturing the interpersonal process of psychiatric nurses: A model for engagement.  Archives of Psychiatric Nursing ,  31 (6), 634-640. 

Dion, K. (2014, March). An analysis and comparison of the works of Peplau and Travelbee.  Nursing Research  (Vol. 63, No. 2, pp. E106-E106. 

Gonzalo, A. (2019, Aug. 24). Hildegard Peplau: Interpersonal Relations Theory. Nurselabs. Retrieved from https://nurseslabs.com/hildegard-peplaus-interpersonal-relations-theory/ 

Hagerty, T. A. et al. (2017). Peplau’s Theory of Interpersonal Relations: An alternate factor structure for patient experience data?  Nursing Science Quarterly ,  30 (2), 160-167. 

Hariyati, R. T. S., & Ungsianik, T. (2018). Improving the interpersonal competencies of head nurses through Peplau's theoretical active learning approach.  Enfermeria Clinica ,  28 , 149-153. 

McCarthy, C. T., & Aquino-Russell, C. (2009). A comparison of two nursing theories in practice: Peplau and Parse.  Nursing Science Quarterly ,  22 (1), 34-40. 

Peplau, H. E. (1997). Peplau's theory of interpersonal relations.  Nursing science quarterly ,  10 (4), 162-167. 

Senn, J. F. (2013). Peplau’s theory of interpersonal relations: Application in emergency and rural nursing.  Nursing science quarterly ,  26 (1), 31-35. 

Washington, G. T. (2013). The theory of interpersonal relations applied to the preceptor–new graduate relationship.  Journal for nurses in professional development ,  29 (1), 24-29.