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Interpersonal Relations
Middle Range Nursing Theory
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Interpersonal Relations
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Background
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Created by Hildegard Peplau in early 20th century
Interpersonal Relations Theory
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Basic Elements
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Definitions
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Guiding Assumptions
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Evaluation of Theory
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Hildegard Peplau
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Born in 1909
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In Reading, PA to German immigrant parents
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Raised by paternalistic parents in a paternalistic society
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First nursing theorist since Florence Nightingale
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Her time was one where nursing was more art than science
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Hildegard Peplau
 Primary
clinical background was psychology
 Wanted
to bring humane treatment, dignity &
respect, and healing & discussion to her
patients.

Witnessing injustices in her life pushed Peplau on a
quest for social justice
 She
created the nursing theory of
Interpersonal Relations (also known as
psychodynamic nursing) to focus on the nursepatient relationship
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The Birth of a Theory
 Director
Of Advanced Program in
Psychiatric Nursing at Teacher’s College
 Created
nursing curriculum
 Studied nurse-patient interactions through
“process recordings”
 Analyzed interactions of students with patients
 Interpersonal
 Publishing
Relations in Nursing, 1948
took additional 4 years; at the time it
was groundbreaking for nurse to contribute a
scholarly work without a coauthoring physician.
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Goals of Theory
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Peplau’s original intent was to
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“convey to the nursing profession ideas she thought were
important to improve practice.”
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Focus on quality of nurse-patient interactions and nursing
education
Ultimately, she wound up revolutionizing the scholarly work
of nurses and contributing to mental health laws and reform
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Interpersonal Relations Theory
Basic Elements
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Patient
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Nurse
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Interaction between the two
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Interpersonal Relations Theory
Definitions
 Client/Patient
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Person, couple, group, community, etc. deserving of
humane care with dignity, privacy and ethics
 Environment
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Physiological, psychological, and social fluidity that
may be illness-maintaining or health-promoting
 Health
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Forward movement of personality and other ongoing
human processes in the direction of creative,
constructive, personal, and community living
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Definitions Continued
 Interpersonal
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Phenomena that occurs between persons
 Nurse
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The medium of the art of nursing: a maturing force.
“The unique blend of ideals, values, integrity, and
commitment to the well-being other others…”
 Nursing
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Roles
Assiting a patient starting as stranger, then technical
expert, resource person, surrogate, counselor, teacher
and others.
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Guiding Assumptions of Theory
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Two Original
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(1)Kind of nurse one becomes makes a substantial difference in
what each patient will learn
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(2)Fostering personality development in the direction of maturity
is a function of nursing and nursing education
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Requires use of principles and methods that permit and guide
the process of grappling with every day interpersonal
problems or difficulties.
Two added later by Peplau
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(3)Nursing can uniquely focus on the reactions of clients to the
circumstances of their health problems
(4)Since illness provides opportunity for learning and growth,
nursing can assist patients in gaining intellectual and
interpersonal competencies
 Such competencies evolve through nurse-patient interactions
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Guiding Assumptions of Theory
Inferred From Peplau’s Writing
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(5)Psychodynamic nursing crosses all specialty areas
 Not just psych nursing
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(6)Difficulty in interpersonal relations reoccurs in
varying intensities throughout everyone’s life
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(7) The need to harness energy derived from tension
and anxiety to positive means for addressing the
problem at hand is universal
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(8)All human behavior is purposeful and goal-seeking
in terms of feelings of satisfaction and/or security
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(9)The interaction of nurse and patient is fruitful when a
method of communication that identified and uses
common meanings is at work in the situation
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Guiding Assumptions of Theory
Inferred From Peplau’s Writing
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(10)The meaning of behavior to the client is the only relevant
basis on which nurses can determine needs to be met
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(11)Each person will behave, during any crisis, in a way that
has worked in relation to crisis in the past
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(12) Function of personality is to grow and develop
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(13) Because illness is an event that is experienced along
with feelings that derive from older experiences, the nursepatient relationship is an opportunity for nurses to help
patients to complete unfinished psychological tasks of
childhood.
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Nurse Patient Relationship
4 Phases
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(1) Orientation
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Get acquainted
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Work through preconceptions
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Establish parameters
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Develop trust
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Begin to understand roles
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Nurse Patient Relationship
4 Phases
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(2) Identification
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Patient identifies problems to be worked on in relationship
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Goal of nurse:
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Help patient recognize their own role and promote
responsibility for self
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Nurse Patient Relationship
4 Phases
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(3) Exploitation
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Patient’s trust of nurse at full potential
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Patient makes full use of nursing services
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Immediate problems are solved
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Identifying and orienting self to discharge goals
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Nurse Patient Relationship
4 Phases
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(4) Resolution
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Final phase of nurse-patient relationship
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Sense of security is found as patient has less reliance upon nurse
helper
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Patient has increased self-reliance to deal with their problems
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Interpersonal Relations Theory
Nurses Assists by Fulfilling
Roles
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Interlocking functions to assist patient
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Specific roles variable; imagination of nurse is the only
limitation
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Historically, nurses acted as surrogate parents
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With Interpersonal Relations Theory, focus is on autonomy and
growth
Rather than feeding someone, teach them to fish
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Interpersonal Processes
 Nursing
Process Methods
 Observation
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Understanding observations essential for making
judgements and designing experiences with patients
that aid them in problem resolution
 Communication
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Verbal and nonverbal
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Nurse must recognize and understand meanings
 Process
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Recordings
Analyze
Evaluate
Used as educational tools
 Nurse
self-scrutiny
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Nurse Patient Relationship
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Theory Insights
 Nurse
gains competencies of higher
understanding of self, concepts, roles and
processes to help patient toward growth and
healing
 Peplau
warns against “social talk” with patients
 Nurse’s
the way
 Can
own emotional needs should not get in
assist nurse to
Observe more intelligently
 Interene more sensitively
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Comparison of IPV Screening
 Without
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Using Theory
New patient to be
screened for IPV
Nurse senses
fear/tension and tries to
‘lighten mood’ through
distraction
Nurse uses closed-ended
questions during
screening
Continued reliance upon
nurse throughout process
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Using Theory
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New patient to be
screened for IPV
Nurse recognizes anxieties
about IPV, as well as
patient’s anxieties
Nurse uses open-ended
questions during
screening
Assists patient directly at
first, then patient to
become more
independent in use of
resources
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Interpersonal Relations
Evaluation
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Clarity / Parsimony
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Clear and logical
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Definitions straightforward
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Concepts abstract, but can be learned with practice and utility
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Interpersonal Relations
Evaluation
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Significance & Internal Consistency
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Metaparadigm concepts addressed and explained explicitly
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Concepts and ideas are unchanged through time
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Based on philosophical foundations
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All elements of theory congruent
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Has been widely implemented in the United States and abroad
Logical Development
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Inductively and deductively based
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Uses many psychological theorists’ work
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Nursing role promotes patient’s movement through steps of
nursing process
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Interpersonal Relations
Evaluation
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Testability
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Theory can easily be tested by following the established
guidelines
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Results are heavily dependent on the goals of the patient and the
critical thinking skills of the nurse
Complexity
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At its core, theory is simple
Reality convergence
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Basic tenents are reality-based
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Real-life application
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Requires time and practice to master
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Interpersonal Relations
Evaluation
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Pragmatic Adequacy
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Contributes to nursing process
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Consistent with nursing’s values and mission
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Applicable to a multitude of clinical problems
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Can be used in any nursing specialty
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Holistic in nature
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Consistent with legal and ethical requirements of nursing practice
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Research has found positive correlation between the theory and
patient satisfaction, nurse satisfaction, quality of life, and cost
Empirical Adequacy
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Multiple research studies found that the nursing stages described
by Peplau are observable in nurse-patient encounters
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Interpersonal Relations
Evaluation
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Utility
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Beyond task-oriented nursing
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Directly affects interventions dealing with communication
Scope
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Very useful in settings of nursing education where focus is on
nurse-patient relationship and communication
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Can be implemented in many areas of nursing
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Health education
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Palliative care
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AIDS care
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Oncology
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Limitations
 Patients
with overwhelming physiological needs
not good candidates
 Usefulness
limited in patients with impaired
communication, such as the sedated, comatose,
demented, and neonates
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References
Beeber, L. S., & Bourbonniere, M. (1998). The concept of interpersonal pattern in Peplau’s theory of nursing Journal
of Psychiatric and Mental Health Nursing, 5(3), 187-192. doi: 10.1046/j.1365-2850.1998.00124.x
Callaway, B.J. (2002). Hildegard Peplau: Psychiatric nurse of the century. New York, NY: Springer Publishing
Company, Inc.
Current Nursing (2012). Application Peplau's interpersonal theory. Retrieved November 21, 2014, from http://
currentnursing.com/nursing_theory/application_Peplau's_interpersonal_theory.html
Fawcett, J., & DeSanto-Madeya, S. (2012). Contemporary nursing knowledge: Analysis and evaluation of nursing
models and theories (3rd ed.). Philadelphia, PA: F.A. Davis.
Forchuk, C. (1993). Hildegarde E. Peplau: Interpersonal nursing theory. Newbury Park, CA: Sage Publications.
Forchuk, C., Westwell, J., Martin, M., Bamber-Azzapardi, W., Kosterewa-Tolman, D., & Hux, M. (2000). The
Developing
Nurse-Client Relationship: Nurses' Perspectives. Journal of the American Psychiatric Nurses
Association, 6(1), 3-10. doi: 10.1177/107839030000600102
Peterson, S. J., & Bredow, T. S. (2013). Middle range theories: Application to nursing research (3rd ed.). Philadelphia,
PA: Lippincott Williams & Wilkins.