INTRODUCING THE THEORY

In 1969, at the first nursing theory conference, Peplau proposed a research methodology to guide
"development of knowledge in nursing situations." Peplau urged nurse to use nursing situations
as a source of observations from which unique nursing concepts could be derived

MAJOR CONCEPTS OF PEPLAU'S THEORY

It is also referred as psychodynamic nursing, which is the understanding of one's own behavior.
The theory explains the purpose of nursing is to help others identify their felt difficulties:

Nurses should apply principles of human relations to the problems that arise at all levels of
experience. Peplau's theory explains the phases of interpersonal process, roles in nursing
situations and methods for studying nursing an interpersonal process.

Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of
healthcare. Nursing is an interpersonal process because it involves interaction between two or
more individuals with a common goal.

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 that both become mature and knowledgeable in
the process

Different Nursing Roles Assumed During the Various Phases of Nurse-patient Relationship (

Different Nursing Roles Assumed During the Various Phases of Nurse-

patient Relationship
Role of the Stranger

Role of Resource Person

Teaching Role

Counsellor Role

Leadership Role

Surrogate Role

Technical Expert Role

Fig1 : Different Nursing Roles

Different nursing roles
1) Stranger: Receives the client in the same way one meets a stranger in other life
situations, provides an accepting climate that builds trust.
2) Resource person: One who provides a specific needed information that aids in the
understanding of a problem or new situation.
3) Teacher: Who imparts knowledge in reference to a need or interest
4) Counselors: Help to understand and integrate the meaning of current life circumstances,
provide guidance and encouragement to make changes.
5) Surrogate: Helps to clarify domains of dependence, interdependence and independence
and acts on clients behalf as an advocate.
6) Leader. Helps client assume maximum responsibility for meeting treatment goals in a
mutually satisfying way. Additional Roles include:
7) Technical expert Consultant Health teacher Socializing agent Tutor Manager of
environment Administrator. Safety agent Mediator

Elements involved in Nurse-patient Relationship

 Contract

The time, place and purpose of meetings as well as conditions for termination are established
between the nurse and client

 Boundaries

Roles of participants are clearly defined, the nurse is defined as a professional helper, the client's
needs and problems are the focus of the interaction.

 Confidentiality

The nurse should share information only with professional staff who need to know. The nurse
should obtain client's written permission to share information with others outside the treatment
team.

Therapeutic Nurse Behaviors

 Self-awareness
  Warmth and respectfulness

 Cultural sensitivity

 Ethical practice.

 Genuinenes

 Empathy

 Responsibility

Identified four sequential phases in the interpersonal relationship:

Orientation

Identification

Exploitation

Resolution

1. Orientation Phase

Theory development begins with observations mode in practice. This is continuing clinical
observation of the nurse who seeks regularities in the phenomenon.

Examples of orientation phase

Problem Defining Phase

 Introduction: Nurse as stranger

 Asking questions
 Client conveys needs and expectations
 Nurse helps client identify problem.

Mr Ankur , 32 years old patient, is assigned to you. He is alcohol abuser and this is his third
admission for this diagnosis in the 9 months. His first admission occurred when he was found
wandering on the street. He had been drinking heavily and lost his purse.
Three months ago, he requested readmission after drinking heavily and feeling depressed. He
had attended all the g meetings and all alcoholic anonymous meetings and seemed interested in
his treatment and excited for being discharged. Now he reports that he has been drinking fifth of
'vodka' and few beers daily. In tears he says, 'I am in failure' he return his occupation as a high
school teacher and felt that he did not have time for the group meetings. He also says that his che
dependency counselor never listens to him. His family lives in another state and alcohol is the
only friend.

Characteristics of 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.

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 helplessness
 In this step of process, nurse sorts and classifies information about the phenomenon
 Decoding subdividing-categorizing data-identifying layers of meaning at different levels
of abstraction applying a conceptual framework to explain the phenomenon.

Identification Phase

Nurse as a Counselor and an Advocate

EXAMPLES

 Identify problems to be addressed

 Patient begins to have a feeling of belonging and a capability of dealing with the problem
which decreases the feeling helplessness.
 Over the next few days, you explore that he identifies that group therapy and AA really
helped his last admission, his counselor was not so supportive and poor friend circle and
busy schedule acted as hindrance to attend the group meetings.

3. Exploitation Phase

 Use of professional assistance for problem-solving alternatives

 Advantages of services are used that are 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
 Patient may fluctuate 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 toward the
final step

EXAMPLE

 Nurse as teacher, resource person, advocate and mediator

 Utilize available services and implement plan You elect to participate the patient in the
group therapy and AA meetings again. The chemical dependency counselor is also
changed and he is more comfortable with him. He is advised to share his feelings with his
fellow teachers in an effort to develop friends who are not drug abusers, regular
counseling sessions are organized for him

4. Resolution Phase

 Termination of professional relationship

 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 become mature individuals.

EXAMPLE
He has developed skills that will help his functions without drug abuse. The
therapist and counselor agree with him, he prepares to be discharged. It is time to
terminate the relation. You verify that he has developed how to share his needs
with his fellow teachers. He also contacted his AA counselor. He states that he
has commitment to attend AA meetings and have appointment with his outpatient
 counselor. He shares that his counselor listens to him and is supportive to him. He
makes his schedule l proper time management. You congratulate Mr Ankur in his
progress and say GOOD BYE

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 patients'
needs

 Both use observation communication and recording as basic tools utilized by nursing.

ASSESSMENT ORIENTATION
 Data collection and analysis  Non-continuous data collection
(continuous).
 May not be a felt need  Felt need
 Define needs

Nursing diagnosis Identification

Planning  Interdependent goal setting
 Mutually set goals Implementation

Implementation Exploitation
 Plans initiated toward achievement of  Patient actively seeking and
mutually set goals drawing help
 Patient initiated
 May be accomplished by patient, nurse
or family

Evaluation Resolution
 Based on mutually expected behaviors  Occurs after other phases are
 May lead to termination and initiation completed successfully
of new plans
 Leads to termination
Overlapping Phases in Nurse-patient Relationships
NURSE Stranger Surrogate Mother counselor
Resource person Adult person
Leader
Mother
Sibling
Patient Stranger Infant child and adolescent adult person
Phases in -------------orientation-----------------------identification--------
relationship Exploitation-------------------------resolution----------

PEPLAU'S WORK AND CHARACTERISTICS OF A THEORY

 Interrelation of concepts

Four phases interrelate the different components of each phase

 Applicability

The nurse-patient interaction can apply to the concepts of human being, health,
environment and nursing

 Theories must be logical in nature

This theory provides a logical systematic way of viewing nursing situations

Key concepts such as anxiety, tension, goals, and frustration are indicated with explicit
relationships among them and progressive phases

 Generalizability

This theory provides simplicity in regard to the natural progression of the NP relationship

 Theories can be the bases for hypothesis that can be tested

 Peplau's theory has generated testable hypotheses

 Theories can be utilized by practitioners to guide and improve their practice

Peplau's anxiety continuum is still used in anxiety patients

 Theories must be consistent with other validated theories, laws, and

principles but will leave open unanswered questions that need to be
investigated

Peplau's theory is consistent with various theories

APPLICATION AND IMPORTANCE OF THE THEORY

Practice

 Peplau theory is practice based theory. This provides an "approach to knowledge

development through the scholarship of practice; nursing knowledge is developed in
practice as well as for the practice."
 It leads to integration of scientific disciplines in formulating paradigm of psychiatric
nursing and strengthening nurse patient relationship and it makes the foundation of
psychiatric nursing
 Peplau used observations in clinical situations as the basis for hypothesis and
interventions that were then tested in clinical practice.
 The application of Hildegard Peplau's Interpersonal Theory of Nursing relates to group
psychotherapy. The phases of the nurse-patient relationship, including orientation,
identification, exploitation and resolution, are described as they relate to group
psychotherapy, and clinical examples are presented. The clinical examples also
demonstrate the patient's movement in group therapy through the steps of the learning
process: Observation, description, analysis, formulation, validation, testing, integration
and utilization. Finally, the roles of the nurse including stranger, resource person,
teacher, leader, surrogate and counselor are described as they occur in group
psychotherapy
 Nurse-client relationships have been considered the foundation of successful home-
visiting programs for vulnerable fam lies. Nurse-client relationships are important when
working with community people.

Education
  The theory urged the nurses to use nursing situations as a source of
observations from which unique concepts could b derived.

 By applying this theory in clinical areas, nurse acts as a participant observer

and thus upgrades her previously acquired theoretical knowledge.

 Interpersonal Relations in Nursing-used as a manual of instructions to

nursing students,

 Foundation of psychiatric nursing education.

Research
 Different studies on the nursing phenomena

 Improvement of the social system

 Stress management program Formation of behavior scale

 Therapeutic behavior of the nurses.

CRITIQUE

 Personal space considerations and community social service resources are considered less
 Health promotion and maintenance were less emphasized
 Cannot be used in a patient who does not have a felt need, eg withdrawn patients,
unconscious patients
 Some areas are not specific enough to generate hypothesis.

SUMMARY AND CONCLUSION

Hildegard E. Peplau has been described as the mother of psychiatric nursing because her
theoretical and clinical work led to the development of the distinct specialty field of
psychiatric nursing. Her scope of influence in nursing includes her contributions as
a psychiatric nursing expert, educator, author, and nursing leader and theorist. Peplau
provided major leadership in the professionalization of nursing. She served as executive
director and president of the American Nurses Association. Different Nursing Roles
Assumed During the Various Phases of Nurse-patient Role of the Stranger, Resource
Person , Teaching role ,Counsel , Leader, Surrogate Role ,technical Expert Role
dentified four sequential phases in the interpersonal
relationship ,Orientation ,Identification ,Exploitation, Resolution. Nurse-client
 relationships have been considered the foundation of successful home-visiting programs
for vulnerable fam lies. Nurse-client relationships are important when working with
community people. However, the idea of nurse-client cooperation is found narrow with
those individuals who are unfit and powerless in conversing, specifically those who are
unconscious and paralyzed.

.
BIBLIOGRAPHY

Bibliography
Navdeep Kaur Brar, H. r. (n.d.). Textbook of advanced nursing practice. jaypee brothers.

soni, s. (n.d.). textbook of advance nursing practice. jaypee brothers.

Bibliography
soni, s. (n.d.). textbook of advance nursing practice. jaypee brothers.

Bibliography
Martha Raile Alligood. (n.d.). Nursing Theorists. (8, Ed.) Elsevier.

Navdeep Kaur Brar, H. r. (n.d.). Textbook of advanced nursing practice. jaypee brothers.

soni, s. (n.d.). textbook of advance nursing practice. jaypee brothers.