Running head: INTERPERSONAL RELATIONS THEORY: THE CONCEPT OF
Interpersonal Relations Theory: The Concept of Therapeutic Nurse-Patient Relationships
Shawn Limber
Stenberg College
Basic Concepts and Contexts of Psychiatric Nursing
Psyn 101-6(B)
Janice Titleborn
June 1, 2012
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INTERPERSONAL RELATIONS THEORY: THE CONCEPT OF
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Abstract
Therapeutic nurse-patient relationships form the basis of psychiatric nursing. Theory that
describes the process of caring relationships within the psychiatric health service is based largely
on the work of Dr. Hildegard Peplau, Dr Peplau’s theory of interpersonal relations form the
mandate for current psychiatric nursing standards. Her empirically derived process of
understanding patients as people has reformed the psychiatric nursing practice and defined it as a
specialty and a profession. Peplau developed her theory during the 1950’s in an post war era of
social change, working within large psychiatric facilities, Papleu was given the resources to train
insightful nurses to develop relationships with patients that formed the basis of her theories and
provided opportunities for graduate psychiatric training, Peplau provided a strategy for nursing
roles and practices that is relevant for all aspect of present day nursing.
INTERPERSONAL RELATIONS THEORY: THE CONCEPT OF
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Interpersonal Relations Theory: The Concept of Therapeutic Nurse-Patient Relationships
Therapeutic alliances and interpersonal connections are the foundation of psychiatric
nursing. Healing relationships have become the definitive work of mental health nurses and a
mandate for those working and entering the field of psychiatric nursing. Hildegard Peplau
developed the theory of interpersonal relationships to provide a framework for substantiating the
therapeutic influence within nurse-patient relationships. Based on the principles of human
relationships, the nurse patient relationship is cultured as a venue to identify and express
experiential difficulties. Interpersonal relations theory has influenced all realms of nursing and is
the base of the client directed practices that are evolving presently. Therapeutic relationships
have defined psychiatric nursing as a professional specialty; without the work of Peplau and her
interpersonal theory psychiatric nursing would not exist as the compassionate discipline that it
currently strives to be.
Interpersonal connections and therapeutic alliances form the substance of psychiatric
nursing support to clients in community outreach or clinical settings. Canadian standards of
practice for psychiatric nurses clearly defines in its first standard that, “A Registered Psychiatric
Nurse: Acts as a role model for positive professional, interpersonal, and therapeutic
relationships.” (RPNC 2010) Psychiatric nursing has evolved in the direction of compassionate
therapeutically focused nurse-patient relationships, due to the theory of interpersonal
relationships as introduced and promoted by Peplau in the 1950’s. (Spray, 1999)
American born and educated, Peplau was a Professor emeritus from Rutgers University,
working on developing masters and bachaurette programs in psychiatric nursing, when she
published Interpersonal Relations in Nursing in 1952. The theory was developed through student
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nurse interviews with patients that were written down verbatim and reviewed as data by Peplau.
(Spray, 1999)
The climate of caring for the mentally ill at the time of Interpersonal Relations in
Nursing, consisted of isolation in huge mental institutes, staffed by nurses preoccupied with
preventing suicides and assisting in electric shock treatments, overseen by the paternal eye of
Doctors of psychiatry. (Sills, 1999) Peplau, had completed her theory in 1948, she then spent
four years working to get it published without the hand of a physician co-author. At that time
nursing was not established as an independent profession, or an academic endeavor, however
Peplau, determined to have a contribution to nursing theory that was original and empirically
derived laid the groundwork for nursing establishment and reform. Peplau crossed the country in
her summers off, teaching and promoting the concepts of therapeutic relationships to a grassroots
audience hungry to hear clinical tales of the healing that talking with patients could bring. (Spray
1999)
Peplau had her educational roots in psychology, and was influenced by psychoanalyst
and innovator, Harry stack Sullivan, the creator of the interpersonal theory of personality.
Sullivan’s theory clarified the interplay between interpersonal relationships and lived experience
as influences defining personality. (http://currentnursing.com) His theory divides the problems
that are termed mental disorders; into intrapersonal, the troubling experiences that the person
complains of, or interpersonal, the person’s troubling behavior that others complain about. His
theory was very basic yet profound and brought analysis to the lived experience; people
experienced problems with themselves, or in their relationships with others. (Barker 2009)
Although Peplau only mentions Sullivan briefly in her personal interviews, (Spray 1999) his
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contribution to the influential genre of talking about lived experience is evident in her
philosophy.
Peplau would agree with Sullivan, that mental illness is socially constructed. In her
article, On Semnatics (1999), Peplau is quoted as saying “Mental illness is a label stamped upon
persons rejected or abandoned by the community.” She describes the mammoth task of tackling
mental illness because of what she defines as the source of mental illness, “relationships among
men”. (1999 p. 13) One of the challenges of mental health nursing is the abstract nature of
relationships, which nurses attempt to classify into words. One of her goals was to clarify
psychiatric terminology and support staff and patients to find common terminology. She strove
to find language that supported and gave voice to the experience of those in psychiatric settings
as opposed to labels that separated and extricated them from society. Her efforts were focused on
reclassifying the phenomenon of mental illness and removing its stigma. (Peplau 1999) During
the developmental phase of her research with patients, Peplau’s nursing students were engaging
in what was essential psychotherapy with clients and referring to it as counseling, to avoid
scrutiny by the established Doctors of psychiatry. Nurses were experiencing the excitement of
dealing with and eliminating psychiatric symptoms through verbal work, while theory was
worked out in a psychiatric setting and based on evidence.(Sills 1999)
Peplau did much to define the role of nurses. She describes the role of nursing as helping
others to identify their feelings regarding difficulties that they are experiencing. In the theory she
outlines the phases of interpersonal processes. Her description of nursing as interpersonal is
justified as it involves at least two individuals working toward a common objective. Both nurse
and patient pursue a series of steps that follow a consistent pattern, with the shared goals of
gaining knowledge and maturing in the process. (http://currentnursing.com)
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The theory incorporates four distinct phases in the nurse patient bond and six specific
roles for nurses. (Wisp, 2012) The therapeutic relationship begins with orientation, during this
initial phase, the nurse embodies the role of a stranger in the client’s world. The trust that
develops within therapeutic relationships cannot be assumed, each relationship is unique and
therefor must proceed from this beginning point. (Barker 1999) The next phase, orientation,
includes the nurse establishing the “felt need” of the patient and identifies and addresses
background differences that might affect the relationship. Followed by, identification, the
presenting issue is assessed; in this phase the role of teacher is present to deliver health and care
information to the patient. Within the phase of exploitation the health care unit and staff are
employed to focus on the health and emotional issues presented. The roles of the nurse expand to
include resource manager, accessing available services for client. The counseling role develops
as the nurse is present to listen and integrate the patient’s circumstances of being The identified
role of surrogate may emerge during this phase as the nurse responds to the patience’s
dependency issues, acts on the patient’s behalf, or provides advocacy for the patient. The
resolution phase marks the fulfillment of treatment goals and includes recovery planning and
possibly termination of the nurse-patient relationship, the role of leader is required throughout
this process as the nurse oversees goal completion and instigates treatment termination.
Concepts that Peplau introduces and defined in her theory make a significant contribution
to the general body of knowledge within psychiatric nursing. After establishing nurse patient
relationships, Peplau began integrating group work, and later family therapy, into her theory.
Group work theory was well represented in social work at the time, from that platform Peplau
and her nursing students began working amongst themselves to develop group theory for
working with patients in a psychiatric setting. (Sills 1999) Conceptual models were developed
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for family therapy in the late 1950’s. Peplau had much to say regarding therapeutic milieu, her
nursing students compiled studies summarizing the relationship between the patient and the ward
environment, her commitment to improving the state hospital setting and eliminating “illness
maintenance systems” initiated changes that have affected nursing in general. (Sills 1999 p, 6)
Other significan contributions include concept of anxiety and the role of nurse-patient
relationship in reducing stress by humanizing care. (Barker 2009) The process of hallucination as
a relationship with an illusionary partner, (Barker 2009) Peplau’s description of need integration
describes the interconnected needs of both nurse and patient, (Spray 1995)
Based on her understanding of the role of therapeutic self, she is clear that professional
nurses training include self-awareness and a personal understanding of one’s own behavior. Her
insistence upon nurse’s functional awareness, her theory is also referred to as psychodynamic
nursing. (http://currentnursing.com) Nursing educator, Lisa Vandemark (2006) outlines Peplaus
standards for professional nurse development, placing high priority on personal insight and
maturity for nurses engaging in therapeutic relationships with patients and groups. Peplau
establishes psychological tasks as standards for mental health professionals; these include
trusting others and establishing and recognizing dependency, delaying gratification, ongoing
self-identification and participatory skills that enhance group involvement. These skills, Peplau
believed, were essential for “the nurse as a person and as a professional who uses the self in a
therapeutic manner.” (p, 609)
Peplau’s life and experiences are definitive of an era and chart the changes within
nursing education and professionalism; her theory and history cannot be separated from the
history of present day nursing. Peplau was mindful that patients in acute distress would not be
understood nor come to an understanding of themselves without nurses developing a curious
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approach to their experiences and get to know them as people.(Barker 1999) Her commitment to
basic scientific research created a drive toward empiricism that place her experiences and theory
beyond refute. In a culture ripe for change within its health nursing practice Papleu designed an
environment for shared growth for both nurse and patient. Her theory is relevant; the basis of
human pain is human relationships, therefor the culture for healing lies within relationships.
Psychiatric nursing is fortunate that Papleu had the vision and drive to incorporate her found
truths into nursing practice.
INTERPERSONAL RELATIONS THEORY: THE CONCEPT OF
References
Barker, P. (2009) Psychiatric and mental health nursing the craft of caring (2nd ed.) London
U.K. Hodder Arnold
Masters, K. (2009). Role development in professional nursing practice (2 ed.). Mississauga
Ont. Jones Bartlett Retrieved from http://books.google.ca/books?
Peplau, H. E. (1999). On semantics. Perspectives In Psychiatric Care, 35(3), 13.
Peplau, H.E. (1999) Perspectives In Psychiatric Care, 35(3), 27.
Sills, G. (1999) Hildegard E. Peplau: leader, practitioner, academician, scholar, and theorist,
Perspectives In Psychiatric Care, 35(3), 5-9
Spray, S. (1999). The evolution of the psychiatric clinical nurse specialist: An interview with
Hildegard E. Peplau Perspectives in Psychiatric Care, 35(3), 7-9
Vandemark, L. M. (2006). Awareness of self and expanding consciousness: using nursing
theories to prepare nurse-therapists.. Issues In Mental Health Nursing, 27(6), 605-615.
Wisp, W. (2012). Peplau’s nursing theory. Retrieved , from ebooks.com
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