Running head: PEPLAU’S THEORY
Peplau’s Theory of Interpersonal Relations
Melissa Kiesel
Dixie State College
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PEPLAU’S THEORY
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Peplau’s Interpersonal Theory
Hildegard Peplau was the primary nursing author to use theory from other
scientific areas in developing a theory of nursing and to publish without a healthcare coauthor (Belcher, 2011). Peplau’s theory, first published in 1952, outlines the healing
connection between the nurse and client. “Peplau’s theory is based on the premise that
the relationship between patient and nurse is the focus of attention, rather then the patient
only as the unit of attention” (Forchuk, 1993). By studying and understanding Peplau’s
theory, nurses should be able to support their patients by providing a relationship that is
both nurse and patient oriented. This essay will examine three key points: Peplau’s
nursing background and history, her theory of interpersonal relationships in nursing, and
my personal experience with Peplau’s theory in a clinical care environment.
Peplau’s Background and History
Hildegard Peplau was born in Readings, Pennsylvania, in 1909 (Callaway, 2002).
In 1931, Peplau obtained her nursing degree from the Hospital School of Nursing, located
in Pottstown, Pennsylvania. Peplau didn’t continue nursing into a predicted position. She
instead found a position as a staff nurse at Bennington College in Vermont. Her work at
Bennington College earned her enough accreditation to admit her as a degree student,
with a major in psychology, tuition free. Soon after her graduation, Peplau enlisted in the
U.S. Army Nurse Corps. Based in a psychiatric hospital in England, Peplau soon began
treating wounded and emotionally scarred soldiers. After World War II ended, Paplau
took advantage of her G.I. Bill to pursue a postgraduate degree at Columbia University’s
Teachers College in New York City (Callaway, 2002). Soon after graduation, she was
invited back to develop and conduct the psychiatric nursing graduate program. She later
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began working as a professor at Rutgers University where served as the executive
director and president of the American Nurses Association (Gregg, 1999). Peplau wrote
hundreds of professional journal articles, published three books, and performed multiple
workshops throughout the United States. Each of these elements changed the way nurses
treated patients in state mental hospitals (Callaway, 2002).
Throughout her life, Peplau continued to support nursing and interpersonal
relationships. Peplau viewed nursing as a “significant, therapeutic, interpersonal process”
that works in collaboration with other human processes to make wellbeing achievable
(Peplau, 1952). Thus focusing on the interpersonal relationship between the nurse and
patient. “Peplau drew from developmental, interactionist, and human needs theories in
developing her work” (Pearson, Vaughan, & FitzGerald, 2005). Hildegard Peplau retired
in 1974, and died on March 17th, 1999 in her home in Sherman Oaks California (Gregg,
1999).
Interpersonal Theory
As stated above, Peplau’s theory concentrated on the healing connection that is
built between a patient and nurse. She argued that the goal of the nurse-patient
relationship is to deliver constructive nursing care leading to health support and
preservation. A therapeutic relationship is achieved when the healthcare provider
connects with and transforms a patient. It allows the patient to grow, change, learn and
gain understanding. The nurse can foster and encourage change by assisting the patient to
take control of their lives, develop healthier behaviors and providing education on the
effects of stressors on the lives and behaviors of the individuals (Pearson, Vaughan, &
FitzGerald, 2005).
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In Peplau’s model, several roles were created to help identify the position a nurse
plays in a therapeutic relationship. These roles include: leadership, surrogate, counselor,
teacher, technical expert, stranger, and resource (Andrist, Nicholas & Wolf, 2008). A
leader helps patients take responsibility for achieving treatment goals. A surrogate role
helps the patient identify dependence, interdependence, and independence and acts on a
client’s belief as an advocate. A counselor’s role provides direction and support to make
change. As a teacher, the nurse provides training and instruction to encourage learning. A
technical expert uses clinical skills to provide medical care. A stranger is the initial role.
They develop a safe and therapeutic environment. Lastly a resource answers questions,
offers clinical judgment and provides information (Peplau, 1991).
Peplau model illustrates four phases of a nurse-patient therapeutic relationship.
These phases include: orientation, identification, exploitation, and resolution (Peplau,
1991). The first stage or orientation phase begins when the patient seeks medical or
professional assistance. The nurse attempts to help the patient recognize and comprehend
both the problem and the need for help, developing the start of a relationship. As the
patient continues to build a therapeutic relationship with the nurse, the identification
stage begins. In the identification phase, the nurse leads the patient to discover their
emotions. The nurse’s role is also to re-orient the patient’s feelings and highlight the
positive qualities the patient possesses. During the exploitation phase, the patient begins
to take in all that is being presented to help the patient work toward new goals. The
patient starts to become more independent. The final phase, or resolution phase, is the
point where the relationship comes to an end and the client starts to take on new goals.
(Peplau, 1991)
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Clinical Integration
Before I became a registered nurse, I was a paramedic. I had worked as a
paramedic on a local ambulance company and in an emergency room for a number of
years before I decided to become a nurse. Throughout my emergency driven career, I
witnessed some very gruesome and hateful acts of violence. The reason I mention this is
because even though I had been doing emergency care for a number of years, nothing
prepared me for one of my first experience I would observe as a registered nurse. It was
three weeks after my intensive care nursing orientation. I had been assigned to a single
patient, an easy ICU patient, and was “open” for any incoming admissions. At 2300 I was
notified that I would be taking an incoming trauma. Within moments, two emergency
room nurses and a single critical care tech were rushing a female patient to the ICU. The
patient was unstable, had a plummeting blood pressure (70’s/30’s), was tachycardia, and
barely responsive. The only information I had about the patient was; female, 20’s-25
estimate age, no past medical history, no allergies, and multiple stab wounds to the
abdomen. As I received bedside report, I initiate my assessment immediately. Right away
I noticed massive amounts of blood down both of my patient’s legs and across her
abdomen. In the heat of the moment, the ED RN yelled, “She was raped then stabbed as
she tried to get away”. It took several seconds for me to process the information I had just
received. As I started a second IV I knew that additional blood would be arriving soon. I
then began prepping my patient for surgery.
Over the next couple days, I had the opportunity to take care of this sweet girl.
My patient was a twenty-year-old University of Utah student. She had been running
outside when she was attack, sexually assaulted and then left for dead. She wasn’t aware
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of how long she had been laying on the ground until a bystander who called EMS found
her. Within moments, she was rushed to the emergency room and admitted to ICU barely
holding onto life. She stayed over a week in the ICU. I spent four shifts with her
throughout her ICU admission. It became an experience I will never forget.
This experience helped me gain a better understanding of what it really means to
build a trusting relationship with my patients. I was able to meet all four phases of
Peplau’s theory. During orientation phase, I talked with my patient and patient’s family. I
keep both my patient informed and her family informed as I rushed to save her life. I
struggled to provide a safe environment before she entered surgery so she would know
that we are here to help. In the identification phase, my patient was able to recognize
those she could trust. She began to rely on both social health workers and registered
nurses. She expressed her feelings of fear, anxiety, depression, and vulnerability. During
the exploitation phase, my patient and I were able to talk about ways to increase feelings
of both safety and security. She expressed her desire to not let this event destroy her but
to make her stronger. By day four, I saw my patient start to take charge of her situation.
She began to make improvements both psychologically and physically. By the time the
resolution phase started, she was able to come out of her depression and take control of
her life. She decided she wouldn’t let this horrifying experience define her. She began to
develop new ambitions. She grew to be someone I admired.
I also fulfilled many of Peplau’s roles. As a stranger, I was able to meet my
patient and establish a trusting and respectful relationship. I became a counselor,
providing guidance and constructive support. I served as a resource by being able to
provide feedback and accurate health information both on sexual assault and trauma. I
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was a teacher by offering resources and education on ways to improve both her physical
health as well as psychological health. By providing guidance and support, I was able to
take on a leadership role. My patient had multiple family support systems, so my role as a
surrogate was very minimal. As a leader, I collaborated care to help achieve treatment
goals. I was able to provide direction and support to encourage participation in
maintaining and improving her health.
As I reflect back on this experience, I was able to see the importance of providing
a therapeutic relationship. As Peplau’s theory became a part of my career, I was able to
offer support, advice, and help my patient survive a terrible encounter. As I carry on
through my nursing career, I will continue to utilize Peplau’s theory to help me build
healing relationships.
Conclusion
Peplaus’s interpersonal relations model relates to the meta-paradigm of the
discipline of nursing (Forchuk, 1993). The strong point of her model is the focus on the
nurse-client relationship. This focus allows the nurse and patient to work collectively as
partners in problem solving (Chesnay & Anderson, 2008). Peplau’s theory focuses on the
collaboration of the nurse and the patient. It highlights the importance of achieving the
goals of the patient. It also offers a basis for many types of interactions involving the
nurse and patient to improve wellbeing. Hildegard Peplau continues to play a vital role in
building and improving the nursing world. As we continue to grow and better understand
Hildegard Peplau’s important model, as nurses we will be able to enhance nursing care.
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References
Forchuk, C. (1993). Hildegard e. peplau: interpersonal nursing theory. Newbury Park,
CA: Sage Publications.
Andrist, L. C., Nicholas, P. K., & Wolf, K. A. (2008). A history of nursing ideas. (2 ed.).
Sudbury, MA: Jones and Bartlett Publishers.
Belcher, J. (2011). Nursing theories: the base for professional nursing practice. (6 ed.).
Upper Saddle River: Pearson.
Callaway, B. J. (2002). Hildegard peplau: Psychiatric nurse of the century. (1 ed.). New
York: Springer Publishing.
Chesnay, M., & Anderson, B. (2008). Caring for the vulnerable. (2 ed.). Sudbury, MA:
Jones and Bartlett Publishers.
Forchuk, C. (1993). Hildegard e. peplau: interpersonal nursing theory. Newbury Park,
CA: Sage Publications.
Gregg, D.E. (1999). Hildegard e. peplau: her contributions. Perspectives in Psychiatric
Care, 35(3), 10-13. Retrieved from http://nsq.sagepub.com.
Pearson, A., Vaughan, B., & FitzGerald, M. (2005). Nursing models in practice.
Edinburgh, United Kingdom: Butterworth Heinemann.
Peplau, H. (1991). Interpersonal relationships in nursing. New York, NY: Springer
Publishing.