RITIKA SONI ASS.PROF.

1. THEORY OF INTERPERSONAL
RELATIONS
Hildegard . E.Peplau
Life and Works

2. Who was Hildegard Peplau?
Biography:
Name: Hildegard Elizabeth Peplau
Nickname: Hilda
Birthday: September 1, 1909
Died: March 17, 1999 in Sherman Oaks, California
Birthplace: Reading, Pennsylvania
Parents: immigrants of German descent
Father: Gustav Peplau (illiterate but hard-working)
Mother: Otyllie Peplau (oppressive and perfectionist)
Birth Order: She was the second daughter born of six
children

3. Characteristics
• strong-willed
• strong motivation
• has a vision to grow beyond traditional women’s
roles
• wanted more out of life

4. Why Nursing?
Nursing was one of few career choices for
women in her day. As a child, she
witnessed the devastating flu epidemic of
1918, a personal experience that greatly
influenced her understanding of the
impact of illness and death on families.

5. Career Timeline
1931 – Graduated from a Diploma program in
Pottstown, Pennsylvania
1943 - BA in interpersonal psychology - Bennington
College
1947 - MA in psychiatric nursing from Colombia
University, New York
1952 - Published Interpersonal Relations in Nursing
1953 - EdD in curriculum development
-Professor emeritus from Rutgers university
-Started first post baccalaureate program in
psychiatric nursing
1968 - interpersonal techniques - the crux of psychiatric nursing

6. • Worked as executive director of ANA
• President of ANA from 1970-1972
• Vice-President of ANA from 1972-1974
• Worked with W.H.O., NIMH and Nurse Corps.
• She was the first published nursing theorist
since Florence Nightingale
• created the middle-range nursing theory of
interpersonal relations, which helped to
revolutionize the scholarly work of nurses
• Staff Nurse in Pennsylvania and New York City
Affiliations and Achievements

7. • Certified in Psychoanalysis at the William
Alanson White Institute of New York City
• Faculty of the College of Nursing at Rutgers University
• Therapeutic Care vs Custodial Care in mental hospitals
• Strong advocate for graduate education and research
in nursing
• She is the primary contributor to mental health law
reform, leading the way towards humane treatment
of patients with behavior and personality disorders

8. Interpersonal Theory
• Interpersonal Relations Model
• Psychodynamic Nursing/ major
concepts

9. Interpersonal Relations model
• This model explains an individual’s outlook
towards relationship and how one’s perception
changes in due course.
• The interpersonal model emphasizes the need
for a partnership between nurse and client.
• shared experience - Nurses could facilitate this
through observation, description, formulation,
interpretat ion, validation, and intervention

10. Acc. to model two directional components are
necessary in creating an individual’s perception
about relationships.
1. Other to self: represents an individuals
awareness of other’s attitude thoughts , beliefs
toward himself.
2. Self to other : represents an individual’s
awareness of his own behavior attitude,
towards others.

11. Psychodynamic nursing/ major
concepts
• Using an understanding of one’s own behavior
• to help others identify their difficulties
• Applies principles of human relations to the problems
• In her book , discussed phases of interpersonal
process, roles in nursing situation, & method for
studying nursing as an interpersonal process.
• Acc to Peplau, nursing is a healing art ,assisting an
individual who is sick or in need of health care.
• Nursing is an interpersonal process because it involves
interaction between two or more individual with a
common goal.

12. • The attainment of goal is achieved through the
use of a series of steps following a series of
pattern.
• The nurse and patient work together so both
become mature and knowledgeable in the
process.

13. Peplau’s Seven Roles of a 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
• Counselor : helps to understand and integrate the
meaning of current life circumstances, provides
guidance and encouragement to make changes

14. Peplau’s Seven Roles of a Nurse
• 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
• Technical Expert: provides physical care by
displaying clinical skills and operates equipment

15. Additional Roles
1. Consultant
2. Health teacher
3. Tutor
4. Socializing agent
5. Safety agent
6. Manager of environment
7. Mediator
8. Administrator
8. Recorder observer
10. Researcher

16. • Theory of interpersonal relations is a middle range
descriptive classification theory
• The theory was influenced by Harry Stack Sullivan's theory
of inter personal relations (1953)
• The theorist was also influenced by Percival Symonds,
Abraham Maslow's and Neal Elger Miller
• Peplau's theory is also referred as psychodynamic nursing,
which is the understanding of ones own behavior
• Identified four sequential phases in interpersonal relationship.
Theory of interpersonal relations

17. Four Sequential Phases in the Interpersonal
Relationship
1. Orientation phase
2. Identification phase
2. Exploitation phase
3. Resolution phase

18. 1. Orientation Phase
• Problem defining phase
• Starts when client meets nurse as stranger
• 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

19. • Get acquainted phase of the nurse-patient
relationship.
• Preconceptions are worked through
• Parameters are established and met
• Early levels of trust are developed
• Roles begin to be understood

20. Factors Affecting the Orientation
Phase

23. 2. 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
• 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

24. 3.Exploitation Phase
• Use of professional assistance for problem
solving alternatives
• Advantages of services are used is based on the
needs and interests of the patients
• 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

25. • Patient may fluctuates on independence
• Nurse must be aware about the various phases
of communication
• Nurse aids the patient in exploiting all avenues of
help and progress is made towards the final step
• Client’s trust of nurse reached full potential
• Client making full use of nursing services
• Solving immediate problems
• Identifying and orienting self to [discharge] goals

26. 4.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

27. • 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
problems.
• 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.

28. Metaparadigms
Person:
• It is defined as a individual: does not include
families , groups or communities.
• A developing organism that tries to reduce
anxiety caused by needs.
• Lives in an stable equilibrium
Environment:
• Existing forces outside the organism and in the
context of culture

29. Health:
• Described as a concept that implies forward
movement of personality and other ongoing
human processes in the direction of creative,
constructive, productive, personal and community
living
• Health is promoted through interpersonal process.

30. Nursing:
• A significant therapeutic interpersonal process that
makes health possible. It is a human relationship
between an individual who is sick or who has a felt
need and a nurse who is skilled to recognize and
respond to the need for the help.
• Involves the use of problem-solving techniques.
• Proceeds from general to specific in collecting
data and clarifying problems by use of
observation, communication, & recording as
basic tool.

31. characteristics
• Four phases interrelate the different
components of each phase. the interaction
between nurse-patient can apply to the concept
of human being, health, environment & nursing.
• This theory provides a logical, systematic way of
viewing nursing situations.
• This theory provides simplicity in regard to the
natural progression of the nursing patients
relationship. Leads to adaptability in any nurse-
patient relationship.
• Has generated testable hypothesis.

32. 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

33. Assessment
Data collection and analysis
[continuous]
May not be a felt need
Orientation
Non continuous data collection
Felt need
Define needs
Nursing diagnosis
Planning
Mutually set goals
Identification
Interdependent goal setting
Implementation
Plans initiated towards
achievement of mutually set
goals
May be accomplished by
patient, nurse or family
Exploitation
Patient actively seeking and
drawing help
Patient initiated
Evaluation
Based on mutually expected
behaviors
May led to termination and
initiation of new plans
Resolution
Occurs after other phases are
completed successfully
Leads to termination a

34. Application of Theory to Areas in
Nursing
Nursing Education
• Has an impact on the Psychiatric Nursing
especially in the baccalaureate program in
nursing teaching CARE OF CLIENTS WITH
MALADAPTIVE PATTERNS OF BEHAVIOR

35. Practice
• Focuses on the interpersonal processes and therapeutic
relationship that develops between the nurse & client.
• It requires that the nurse attends to the interpersonal
processes that occur between the nurse and client.
• Interpersonal process is maturing force for personality.
It includes the nurse- client relationship, communication, pattern
integration and the roles of the nurse.
• Psychodynamic nursing is understanding one’s own behavior to
help others identify felt and perceived difficulties and to apply
principles of human relations to the problems that arise at all
levels of experience.

36. Research Based on Peplau’s Theory
• Hays, D. (1961). Phases and steps of experimental
teaching to patients of a concept of anxiety:
Findings revealed that when taught by the
experimental method, the patients were able to
apply the concept of anxiety after the group was
terminated.
• Burd, S.F. Develop and test a nursing intervention
framework for working with anxious patients:
Students developed competency in beginning
interpersonal relationship.

37. Vignette/
Peplau’s theory application,
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

38. Assessment Nursing
(Orientation) diagnosis
andshe is
restricted
to bed.
The need for
bed rest and
restriction was
discussed.
Mrs. JL is on Impaired
pelvic traction physical
mobility
related to
the
presence
of pelvic
traction.
Planning
(Identification)
Goal setting was
done along with
patient
passive exercises
to all the
extremities to
improve the
muscle tone and
strength.
Provide articles near
to the patient and
encourage doing
activities within
limits.
Implementation
(Exploitation phase)
Carried out plans
mutually agreed
upon.
Provide active and Provided active and
passive exercises to
all the extremities
Provided article within
the reach of the patient
Evaluation
(Resolution)
Mrs. JL was free
to express
problems
regarding
difficulty in
mobilizing.
She expressed
satisfaction
when able to
move without
difficulty.

39. Nursing
diagnosis
Planning
(Identification)
Implementation
(Exploitation)
Evaluation
(Resolution)
Assessment
(Orientation)
Mrs. JL
expresses pain
in the low back
region.
Regarding pain,
discussion was
made to assess
the severity and
the type and
duration of pain.
Also the
measures
to reduce pain
were discussed.
the lumbar
region.
Pain related Goal setting was
to the done alongwith
degenerativ patient
e changes in
Mrs. JL will have
reduction in pain
as evidenced by
her verbalisation
of reduction in
pain responses.
Administer
analgesics as
prescribed by the
physician.
Provide pelvic
traction to the
patient
mutually agreed
upon.
Provided non
pharmacological
measures like
diversion,
massaging, and
pelvic traction.
Administered Tab.
Hifenac P; Cap.
Myoril 4mg as
prescribed.
Given and
explained need
for pelvic traction
Carried out plans Mrs. JL was free
to express
problems of pain.
Expressed that
she got slight
relief from pain.

40. Implementation
(Exploitation)
Evaluation
(Resolution)
Assessment
(Orientation)
Mrs. JL
Nursing
diagnosis
Self care
expresses that deficit
she needs related to
assistance to
get down frompelvic
bed. traction.
Self care
discussion was
done and
discussed
measures to
solve the
problems.
Planning
(Identification)
Goal settingwas
done along with
patient
presence of Client willachieve
and maintain self
care activities with
assistance of
caregiver or within
her limits.
doing her self care
activities.
mutually agreed
upon.
Keep all the articles Kept the articles
within the reach of within the reach
the patient. of the client
Assist the patient in Assisted the
client in doing her
self care activities
Carried out plans 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

41. Assessment Nursing
(Orientation) diagnosis
Implementation
(Exploitation)
Evaluation
(Resolution)
Mrs. JL is
enquiring
about the
disease
need for
surgery
Discussed
with the
client
regarding the
disease
process and
the findings
in the client
Anxiety
related to
hospital
and client &
family
appearing
withdrawn
Planning
(Identification)
Goal setting was done
along with patient
admission as feeling of anxiety as
condition, its evidenced byevidenced by
outcome and verbalisation asking fewer questions
Teach the family and
client regarding the
disease process.
and do not necessarily
imply a deteriorating
condition.
mutually agreed
Client will have reducedupon.
layman’s terms
Stress that frequent Allowed the
assessment are routine family members
to verbalize
anxiety
Carried out plans Mrs. JL was
free to
express
problems of
self care.
She asked her
doubts
Taught the family regarding the
regarding the illness and the
disease process indiagnostic
procedures
She verbalized
that her
anxiety has
reduced to
some extent.

42. Assessment Nursing
(Orientation) diagnosis
Mrs. JL is
enquiring
about the
disease
Discussed
with the
client
regarding the
disease
process and
the need for
follow up
Deficient
knowledge
treatment
condition, its measures to
need for even after
surgery
Planning
(Identification)
Goal settingwas
done along with
related to thepatient
Patient will acquire
adequateknowledge
outcome and be continued regarding the
treatment and home
the discharge.care.
to the patient and
their benefits
Use simple and
understandable
terms
Implementation
(Exploitation)
Carried out plans
mutually agreed
upon.
Explain the Explained
treatment measures treatment
measures and the
need for follow up
Used simple and
understandable
terms for
explaining
Evaluation
(Resolution)
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

43. Evaluation of the application 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.

44. Summary of Application
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.

45. 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.

46. -Thank you-