Hildegard Peplau’s Theory of Interpersonal Relationships
Peplau’s Theory of Interpersonal Relations and Her Impact on Nursing Today
Ferris State University Nursing 324
Jamie K. Dykstra
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Hildegard Peplau’s Theory of Interpersonal Relationships
Abstract
This paper explores the theoretical and clinical work of Hildegard Peplau. The work of Peplau
has laid a strong foundation upon which we base nursing today. Hildegard Peplau was
instrumental in creating a theory which empowers nurses to establish strong relationships with
patients. These relationships allow for accurate and intimate assessments, help the patients get
the best care, and help lead them to wellness. This paper examines the depth of Peplau’s work
and her impact in nursing today.
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Nursing theory has impacted the nursing community greatly in the last fifty years by
stimulating growth of nursing education and literature. These increased educational
opportunities have in turn stimulated more structure to the training of nurses. Nursing was once a
“vocational education that was focused on skillful completion of tasks” (Tomey p.3) The
development of nursing theory has created “nursing knowledge on which to base nursing
practice” (Tomey, p.3). The Theory of Interpersonal Relations was developed by Hildegrad
Peplau. As Silas (2000) states “Hildegard Peplau has been involved with and active in almost
every movement toward professionalism of the nursing profession” (p. 29). The Theory of
Interpersonal Relations has impacted the role of the nurse to be that of a leader and an active part
of the healthcare team.
According to Fawcett (2005) Hildegard Peplau’s educational, practice, and teaching
experiences “led to an interest in clarifying what happens in a nurse-patient relationship”
(Peplau, 1952, p.v). Through these experiences, Peplau developed the Theory of Interpersonal
Relations. Fawcett (2005) stated that: “Pepelau’s work is a middle-range descriptive
classification theory that focuses on the phases of the interpersonal process that occur when an ill
person and a nurse come together to resolve a health-related difficulty” (p. 528). This
relationship is built between every patient who comes in contact with a nurse. Peplau’s theory
lays the groundwork to build strong relationships. Merritt and Procter (2010, p. 2) state that the
Peplau model establishes “a partnership between the nurse and patient, and with it a notion of
shared humanity between the nurse and patient” (Peplau 1952, 1991, and 1997). This model is
Hildegard Peplau’s Theory of Interpersonal Relationships
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used in clinical practice at every encounter, and helps the nurse to set themselves in a position
that builds trust thus enabling a complete and thorough assessment.
Fawcett (2005 p. 531) uses Peplau’s words to differentiate between nursing and medicine
by stating that:
Physicians are mainly concerned about the incidence, etiology, diagnosis and
treatment of disease. The information which their work requires obtains largely through
physical examination and tests which patients undergo…Much of the medical theoretical
framework flows from anatomy, pathology, physiology, biology, chemistry, genetics- the
“hard sciences.” The relationship (often brief) of physician to patient is largely scripted
by the treatment, based on diagnosis and laboratory findings. Nurses collaborate in
carrying out orders and in health teaching related to the medical treatment. However, the
nurse-patient relationship is unscripted. It is dependent largely upon the conceptual
knowledge which each nurse has about the patient’s presenting data and the phenomena
in the domain of nursing. This knowledge is in the nurse’s head, available for recall and
application during the interaction. It is this kind of intellectual work by nurses that can
transform nurse-patient interactions into a learning event for patients. Much of the
current nursing knowledge framework flow from the social sciences-the “soft sciences”psychology, sociology, and the humanities, with some uses of other basic sciences, such
as biology. This may change when nursing science is fully developed (Peplau, 1997
pp.165-166).
Peplau was instrumental in identifying the importance of the nurse-patient relationship.
“She argued that the purpose of the nurse-client relationship is to provide effective nursing care
Hildegard Peplau’s Theory of Interpersonal Relationships
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leading to health promotion and maintenance” ( Courey, Martsolf, Draucker, &Strickland, 2008,
p. 137). Peplau laid the groundwork that has empowered nurses to seek out the opportunity to
build an influential relationship with her patients. According to Courey et al. (2008), in Peplau’s
theory the nurse adopts one or more of six helping roles when providing care: stranger, resource
person, teacher, leader, surrogate, and counselor. According to Fawcett (2005) a seventh role of
technical expert was added later.
Many nursing care plans of today are designed to focus on the importance of this
relationship such as: disruption of family routine, spirituality, knowledge, and hopelessness.
Clearly, none of these areas would be able to be addressed without the nurse and patient having a
strong and trusting relationship. Today, nurses are taught in school the importance of this
relationship and it is often the primary focus of every nurse. Working in pediatrics, the nurse/
patient and nurse/family of the patient relationship plays an extremely important role. If a nurse
in today’s society functioned as a nurse of the past and only used technical skills to care for
patients, not only would she not be successful in practice, but patients would not get the care
they deserve. Fawcett (2005, p. 530) used Peplau’s work to conclude that Interpersonal
Relations enable nurses to understand the meaning of the experience that the patient is having.
(Peplau, 1952, p.41). Through this understanding, nurses are able to encourage the patient to
participate in identifying and assessing his problem and to engage him as an active partner in his
recovery. (Peplau, 1952, 23).
While it is obvious that Peplau made a tremendous impact on nursing of today with the
Theory of Interpersonal Realtions, it could be easy to confuse some of the roles and see where
boundaries may get blurred. As a nurse working in pediatrics, I have relationships with many of
the patients that I care for that I have had for my entire nursing career. Working in the roles of
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surrogate, leader and teacher for example have enabled me to become very close to these patients
and their families. It is often times considered almost a “friendship” however, it was formed by
using the roles that Peplau described. I have seen this turn into a co-dependent relationship, but
have also seen it lead patients on their way to wellness.
On the other hand, Peplau’s Theory of interpersonal Realtions has led the way in
encouraging hospitals to develop care models such as Relationship Based Care (RBC). Hospitals
compete for patients by advertising the care model that they use. Healthcare consumers of today
look as these care models and see great value in things such as family centered care rounds and
nurse taught educational opportunities such as breastfeeding classes. Peplau was ahead of the
times in which she worked. Peplau’s work was unique because when she worked in the 1950’s
the nurse role was so technical. The models such as RBC have just become widespread in the
last several years. Peplau focused on the patient, their wellness, the factors surrounding their
wellness, health promotion and relationships at a time when the primary focus was supportive
care.
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References
Alligood, Martha Raile, and Tomey, Ann Marriner. (2010). Nursing Theorists and Their Work
(7thed.). Maryland Heights, MO: Mosby Elesvier.
Courney, Tamara J, Martsolf, Donna S., Draucker, Claire B., & Strickland, Karen M. (2008).
Hildegard Peplau’s Theory and the Health Care Encounters of Survivors of Sexual
Violence. Journal of the American Psychiatric Nurses Association, 14 (2), 136-143. doi:
10.1177/1078390308315613
Fawcett, Jacqueline. (2005). Contemporary Nursing Knowledge: Analysis and Evaluation of
Nursing Models and Theories (2nd ed.). Philadelphia, PA: F.A. Davis Company.
Merrit, Michael K., and Procter, Nicholas G. (2010, March 27). Conceptualizing the Functional
Role of the Mental Health Consultation-Liason nurse in Multi-Morbidity, Using Peplau’s
Nursing Theory [Contemporary Nurse Journal]. Retrived from http://www.contemporary
nurse.com/archives/vol34/issue/2/article/3589.
Silas, Grayce M. (2000). Pepelau and Professionalism: The Emergence of the Paradigm if
Professionalization. Journal of the American Psychiatric Nurses Association, 6(1), 2934. doi: 10.1177/107839030000600107
Hildegard Peplau’s Theory of Interpersonal Relationships
Grading Rubric for Theory Paper
1. Introduction of theory/model
a. Introduction clear and well focused
b. History and significance of model
2. Analysis of Model
a. Explain the model in terms of: Person, Environment, Health, and
Nursing.
b. Explain other concepts that are unique to the model.
c. Demonstrate how the model can be used in clinical practice.
d. Explain how the model can be used as a Framework for patient
assessment.
e. Explain the model within the context of nursing education.
f. Identify strengths and limitations of the model.
g. Analyze the model overall, demonstrating new insights about the model.
3. Evidence of Academic Writing
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Possible
points
5
5
10
10
10
10
10
10
10
a. Development of a clear, logical, well-supported paper; demonstrating
original thought and content.
b. Evidence of research with a minimum of 2 research articles in addition to
the course required texts. Correct acknowledgement of sources using APA
style referencing. Attaches APA checklist
c. Overall presentation; grammar, spelling, punctuation, clean and legible.
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d. Stays within page limit which includes: one cover page, one reference
page, body of paper is to have a maximum of 5 pages and a minimum of 3 full
pages.
Total Possible Points
Total Points Earned
5
5
5
100
CHECKLIST FOR SUBMITTING PAPERS
Points
Earned
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CHECK
DATE,
PROOFREAD FOR: APA ISSUES
TIME, &
INITIAL
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1. Page Numbers: Did you number your pages using the automatic functions of your Word
program? [p. 230 and example on p. 40)]
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2. Running head: Does the Running head: have a small “h”? Is it on every page? Is it less
than 50 spaces total? Is the title of the Running head in all caps? Is it 1” from the top of your
title page? (Should be a few words from the title of your paper). [p. 229 and example on p.
40]
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it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the
margin without an indentation? Is your abstract a summary of your entire paper?
Remember it is not an introduction to your paper. Someone should be able to read the
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use ‘Introduction’ as a heading following the title. The first paragraph clearly implies the
introduction and no heading is needed. [p. 27 and example on p. 42]
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7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin
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9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a
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Space twice after punctuation marks at the end of a sentence. [p. 87-88]
10. Typeface: Did you use Times Roman 12-point font? [p. 228]
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be cited. You may be citing many times…this is what you are supposed to be doing! [p.
170]
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citation would look like this:
“The variables that impact the etiology and the human response to various disease states
will be explored” (Bell-Scriber, 2007, p. 1).
Please note where the quotation marks are placed, where the final period is placed, no first
name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p.
170-172]
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13. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40
words or longer? [p. 170-172]
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14. Paraphrase: A paraphrase citation would look like this:
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Patients respond to illnesses in various ways depending on a number of factors that will be
explored (Bell-Scriber, 2007). Do all paraphrased citations look like this? [p. 171 and
multiple examples in text on p. 40-59]
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15. Headings: Did you check your headings for proper levels? [p. 62-63].
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A. Did you start the References on a new page? [p. 37]
B. Did you cut and paste references on your reference page? If so, check to make
sure they are in correct APA format. Often they are not and must be adapted. Make
sure all fonts are the same.
C. Is your reference list double spaced with hanging indents? [p. 37]
PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE
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13. Did you follow the assignment rubric? Did you make headings that address each major
section? (Required to point out where you addressed each section.)
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14. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing
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example, “Well so I couldn’t believe nurses did such things!” or “I was in total shock over
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that.” Did you stay in a formal/professional tone?
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improper use of etc. & i.e.?
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20. Stay in subject agreement. When referring to 1 nurse, don’t refer to the nurse as “they”
or “them”. Also, in referring to a human, don’t refer to the person as “that”, but rather
“who”. For example: The nurse that gave the injection….” Should be “The nurse who gave
the injection…” Did you check for subject agreement? Likewise, don’t refer to “us”, “we”,
“our”, within the paper…this is not about you and me. Be clear in identifying. For example
don’t say “Our profession uses empirical data to support ….” . Instead say “The nursing
profession uses empirical data…..
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21. Did you check your sentences to make sure you did not end them with a preposition?
For example, “I witnessed activities that I was not happy with.” Instead, “I witnessed
activities with which I was not happy.”
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22. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?
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23. Did you have other people read your paper? Did they find any areas confusing?
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24. Did you include a summary or conclusion heading and section to wrap up your paper?
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25. Do not use “we” “us” “our” “you” “I” etc. in a formal paper! Did you remove these
words?
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26. Does your paper have sentence fragments? Do you have complete sentences?
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27. Did you check apostrophes for correct possessive use. Don’t use apostrophes unless it is
showing possession and then be sure it is in the correct location. The exception is with the
word it. It’s = it is. Its is possessive.
Signing below indicates you have proofread your paper for the errors in the checklist:
_Jamie Dykstra_____________________________________________________
DATE:___4/1/2010_____________
A peer needs to proofread your paper checking for errors in the listed areas and sign below:
_Jodi Ruster R. N._______________________________________________________DATE:_4/1/2010______________
Revised Fall 2009
(signature may be typewritten)