HILDEGARD PEPLAU

THEORY OF INTERPERSONAL RELATIONS

 INTRODUCTION
OUR GROUP WILL BE REPORTING ABOUT HILDEGARD E. PEPLAU’S THEORY OF
INTERPERSONAL RELATIONSHIP. I HAVE DIVIDED DIFFERENT TOPICS TO BE
DISCUSSED TO MY MEMBERS AND COMPILED THEM. HERE ARE THE LISTS:
MARIA DIMAPILIS - Biography of Hildegard E. Peplau, Early Life , Education , Career and
Appointments of Hildegard Peplau , Interpersonal Relations Theory , Works ,Awards and
Honors,Death
ALESSANDRA GALUTAN - Hildegard Peplau’s Interpersonal Relations Theory, Description
Assumptions , Major Concepts of the Interpersonal Relations Theory ,Man ,Health, Society or
Environment
MELODY DORIA – Nursing ,Therapeutic nurse-client relationship: Orientation Phase,
Identification Phase , Exploitation Phase ,Resolution Phase. Subconcepts of the Interpersonal
Relations Theory
CARYLLE KAYE GECA- Four Levels of Anxiety ,Interpersonal Theory and Nursing Process,
Analysis , Strengths , Weaknesses , Conclusion
HILDEGARD E.
PEPLAU
 Biography of Hildegard E. Peplau

• Hildegard Elizabeth Peplau (September 1,

1909 – March 17, 1999) was an American
nurse who is the only one to serve the
American Nurses Association (ANA) as
Executive Director and later as President.
She became the first published nursing
theorist since Florence Nightingale.
• With her young age, Peplau’s eagerness to
grow beyond traditional women’s roles was
precise.
• In 1918, she witnessed the devastating flu
epidemic that greatly influenced her
understanding of the impact of illness and
death on families
• Peplau was well-known for her Theory of
Interpersonal Relations, which helped to
revolutionize the scholarly work of nurses.
Her achievements are valued by nurses all
over the world and became known to
many as the “Mother of Psychiatric
Nursing” and the “Nurse of the Century”. 
 EDUCATION
• Hospitals and physicians considered
women in nursing as a source of free or
inexpensive labor. Exploitation was very
common by nurse’s employers, physicians
and educational providers.
• In 1931, she graduated in Pottstown,
Pennsylvania School of Nursing. After
graduating in Pennsylvania, Hildegard Peplau
then worked as a staff nurse in her place and
in New York City.
• A summer position as a nurse for the New
York University summer camp led to a
recommendation for Peplau to become
the school nurse at Bennington College in
Vermont
• Peplau earned a Bachelor’s degree in
interpersonal psychology in 1943 at
Bennington College in Vermont.
• She studied psychological issues together
with Erich Fromm, Frieda Fromm-Reichmann,
and Harry Stack Sullivan at Chestnut Lodge, a
private psychiatric hospital in Maryland.
• “When you watch my books, I’m going to the
barn and take an exam. But I’ll comeback. I
need to talk to you, I don’t feel very good.”
• “I knew she was disturbed”
- Suffering or resulting from emotional and
mental problems.
• “It was really kind of crossroad point for me,
because I really thought I was a competent
nurse and here is a situation where I really
didn’t know what to do, I didn’t know whether
I should ever like code, gave my shoes on her
feet, go with her, stop her on going or
whatever. What should I’ve done.”
• “Most of you know, sitting down, talking with
patient is a gun, cornerstone (or foundation)
in my world and that’s where it began.”
• “I sat down and of course, I didn’t knew what
to say, so I let her talk.”
• Peplau’s lifelong work was largely focused
on extending Sullivan’s interpersonal
theory for use in nursing practice.
• She served in the Army Nurse Corps and
was assigned to the 312th Field Station
Hospital from 1943-1945 in England,
where the American School of Military
Psychiatry was located.
• 2 years - avent garde
• Peplau held master’s and doctoral degrees from
Teachers College, Columbia University in 1947.
• She met and worked with all the leading figures
in British and American psychiatry. After the
war, Peplau was at the table with many of these
same men as they worked to reshape the mental
health system in the United States through the
passage of the National Mental Health Act of
1946. (The National Mental Health Act,
authorized the Surgeon General to improve
the mental health of U.S. citizens through
research into the causes, diagnosis, and
treatment of psychiatric disorders)
• In the early 1950s, she developed and taught
the first classes for graduate psychiatric
nursing students at Teachers College.
• Peplau was a member of the faculty of the
College of Nursing at Rutgers University
from 1954 until her retirement in 1974. She
was a professor emerita (Emeritus or emerita is
an honorary title for professors who want to
stay active in scholarship following
retirement) at the said university.
• At Rutgers University, she created the first
graduate level program for the preparation of
clinical specialists in psychiatric nursing.
• Peplau vigorously advocated that nurses should
become further educated so they could provide
truly therapeutic care to patients rather than the
custodial care that was prevalent in the mental
hospitals of that era.
• Therapeutic care - means services necessary to
develop, maintain, or restore, to the greatest
extent practice
• Custodial care - is non-medical care that helps
individuals with their activities of daily living (ADL),
such as eating and bathing
• During the 1950s and 1960s, she
supervised summer workshops for nurses
throughout the United States, mostly in
state psychiatric hospitals.
• In these seminars, she taught interpersonal
concepts and interviewing techniques, as
well as individual, family, and group therapy.
• Peplau was an advisor to the the World
Health Organization and was a visiting
professor at universities in Africa, Latin
America, Belgium, and throughout the
United States.
• Peplau served as a consultant to the U.S. Surgeon
General, the U.S. Air Force, and the National
Institute of Mental Health.
• She participated in many government policy
making groups.
• She was the only nurse who served the ANA as
executive director and later as president, she
served two terms on the Board of the
International Council of Nurses (ICN).
• And as a member of the New Jersey State Nurses
Association, she actively contributed to the ANA
by serving on various committees and task forces.
• Her fifty-year career in nursing left an
unforgettable mark on the field and on the
lives of the mentally challenged in the United
States.
• During the peak of her career, she became
the founder of modern psychiatric nursing,
an innovative educator, advocate for the
mentally ill, proponent of advanced education
for nurses, Executive Director and then
President of the ANA and prolific author.
 Awards and Honors
• She was named one of “50 Great Americans” in Who’s
Who in 1995 by Marquis. She was also elected fellow of
the American Academy of Nurse and Sigma Theta Tau,
the national nursing honorary society
• In 1996, the American Academy of Nursing honored
Peplau as a “Living Legend.” She received nursing’s
highest honor, the “Christiane Reimann Prize,” at the ICN
Quadrennial Congress in 1997. This award is given once
every four years for outstanding national and
international contributions to nursing and healthcare.
• And in 1998, the ANA inducted her into its Hall of Fame
• Hildegard E. Peplau developed her “Interpersonal
Relations Theory” in 1952, mainly influenced by Henry
Stack Sullivan, Percival Symonds, Abraham Maslow, and
Neal Elgar Miller
• Hildegard Peplau’s Interpersonal Relations Theory
emphasized the nurse-client relationship as the
foundation of nursing practice. Nursing can be viewed
as an interpersonal process because it involves
interaction between two or more individuals with a
common goal. In nursing, this common goal provides
the incentive for the therapeutic process in which the
nurse and patient respect each other as individuals,
both of them learning and growing as a result of the
interaction.
• An individual learns when she or he selects stimuli in
the environment and then reacts to these stimuli
 HILDEGARD PEPLAU’S
INTERPERSONAL RELATIONS THEORY
• Peplau’s Interpersonal Relations Theory emphasized the nurse-client
relationship as the foundation of nursing practice.
• Peplau went to form an interpersonal model emphasizing the need
for a partnership between nurse and client.
THE FOUR COMPONENTS OF THE THEORY:
Meta-Paradigm of Nursing
 MAN
-Peplau defines man as an organism that “strives in its own way to reduce tension
generated by needs.”
 SOCIETY OR ENVIRONMENT
Although Peplau does not directly address society/environment, she does encourage the nurse
to consider the patient’s culture and mores when the patient adjusts to hospital routine
 HEALTH
-Health is defined as “a word symbol that implies forward movement of personality and other ongoing
human processes in the direction of creative, constructive, productive, personal, and community living.”
 NURSING

- which is a significant therapeutic interpersonal process that functions cooperatively with other human
process that make health possible for individuals in communities.
• She discussed four psychobiological experiences that compel
destructive or constructive patient responses, as follows:
needs, frustrations, conflicts, and anxieties.
 The nursing model identifies four sequential phases in the
interpersonal
relationship: orientation, identification, exploitation,
and resolution.
 It also includes seven nursing roles: Stranger role, Resource role,
Teaching role, Counseling role, Surrogate role, Active leadership
and Technical expert role.
:
Assumptions of Hildegard Peplau’s Interpersonal Relations
Theory:
(1) Nurse and the patient can interact. (2) Peplau
emphasized that both the patient and nurse mature as
the result of the therapeutic interaction. (3)
Communication and interviewing skills remain
fundamental nursing tools. And lastly, (4) Peplau believed
that nurses must clearly understand themselves to
promote their client’s growth and to avoid limiting the
client’s choices to those that nurses value
MAJOR KEY CONCEPTS AND DEFINITIONS
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 as an interpersonal process.
 Nursing is therapeutic in that it is a healing art, assisting an individual who is
sick or in need of health care.
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 both become mature and
knowledgeable in the process
NURSIN
G

• Hildegard Peplau considers nursing to be a

"significant, therapeutic, interpersonal process.“

• She defines it as a "human relationship between an

individual who is sick, or in need of health, and a nurse
specially educated to recognize and to respond to the
need for help."
2
5
THERAPEUTIC
NURSE-PATIENT
RELATIONSHIPS
- a professional and planned
relationship between client and
nurse that focuses on the client's
feelings, problems, and ideas

- It involves interaction between

two or more individuals with a
common goal

The attainment of this goal, or any goal, is achieved

2
through a series of steps following a sequential6
pattern
OVERLAPPING PHASES IN
NURSE-PATIENT RELATIONSHIPS

1. 2. IDENTIFICATION
ORIENTATION PHASE
PHASE

3.
EXPLOITATI 4.
ON RESOLUTIO
PHASE N
PHASE
2
7
01
ORIENTATION PHASE
 directed by the nurse and involves engaging the
client in treatment, providing explanations and
information, and answering questions
• Problem defining phase
• Starts when the client meets nurse as a stranger
• Defining problem and deciding the type of service
needed
• Client seeks assistance, conveys needs, asks questions,
shares preconceptions and expectations of past
experiences 2
8
• Nurse responds, explains roles to the client, helps to
identify
problems and to use available resources and services
01
ORIENTATION PHASE

FACTORS INFLUENCING
ORIENTATION PHASE

2
9
 IDENTIFICATION
02 PHASE

 begins when the client works interdependently

with the nurse, expresses feelings, and begins to
feel stronger.

• Selection of appropriate professional assistance

• Patient begins to have a feeling of belonging and
a capability of dealing with the problem which
decreases the feeling of helplessness and
hopelessness
3
0
 EXPLOITATION
03 PHASE

 the client makes full use of the services

offered
• Use of professional assistance for problem-
solving alternatives
• Advantages of services are used is based on the
needs and interests of the patients
• The individual feels like an integral part of the
helping environment
• They may make minor requests or attention-
getting techniques
3
1
 EXPLOITATION
03 PHASE

• 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 of the various phases of
communication
• Nurse aids the patient in exploiting all avenues of
help and progress is made towards the final step

3
2
04 RESOLUTION PHASE

 the client no longer needs professional services

and gives up dependent behavior. The
relationship ends.
• Termination of professional relationship
• The 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.

3
3
04
RESOLUTION PHASE

.
• Sometimes may be difficult for both as
psychological dependence persists
• Patient drifts away and breaks the bond with the
nurse and healthier emotional balance is
demonstrated and both becomes mature
individuals

3
4
 SUBCONCEPTS OF
INTERPERSONAL THEORY
The following are the 6 roles of the Nurse in the Therapeutic
relationship identified by Peplau:
Leader

Stranger

Surrogate

Resource person

Counselor

Teacher
3
5
 SUBCONCEPTS OF
INTERPERSONAL THEORY

Nurse as a
stranger: offering
the client the same
acceptance and
courtesy that the
nurse would to any
stranger

3
6
 SUBCONCEPTS OF
INTERPERSONAL THEORY

Nurse as a resource
person: providing
specific answers to
questions within a larger
context

3
7
 SUBCONCEPTS OF
INTERPERSONAL THEORY

Nurse as a
teacher: helping the
client to learn formally or
informally

3
8
 SUBCONCEPTS OF
INTERPERSONAL THEORY

Nurse as a
leader: offering
direction to the client or
group

3
9
 SUBCONCEPTS OF
INTERPERSONAL THEORY

Nurse as a
surrogate: serving as a
substitute for another
such as a parent or a
sibling

4
0
 SUBCONCEPTS OF
INTERPERSONAL THEORY

Nurse as a counselor:
promoting experiences
leading to health for the
client such as expression
of feelings

 
4
1
 SUBCONCEPTS OF
INTERPERSONAL THEORY
Peplau also believed that the nurse could take on many other roles but these were
not defined in detail. However, they were “left to the intelligence and imagination
of the readers.” (Peplau, 1952) • Technical expert
• Consultant
• Health teacher
• Tutor
• Socializing agent
• Safety agent
• Manager of environment
• Mediator
• Administrator
• Recorder observer 4
2
• Researcher
PHASES AND CHANGING ROLES IN
NURSE-PATIENT RELATIONSHIPS

4
3
CHANGING ASPECTS OF NURSE-PATIENT RELATIONSHIPS

4
4
 ANXIETY
• Some degree of anxiety when under stress is
expected. Anxiety is your body's way of
communicating that something either makes you
feel temporarily unsafe or stressed. Your body
responds to anxiety in many different ways, causing
more numerous and intense symptoms as the level
of anxiety increases. The founder of psychiatric
nursing, Hildegard E. Peplau, described 4 levels of
anxiety: mild, moderate, severe and panic. Each
level of anxiety can be experienced differently.
 ANXIETY
• Anxiety was defined as the initial response
to a psychic threat. There are four levels of
anxiety described below.
• Four Levels of Anxiety
• Mild anxiety 
• Moderate anxiety
• Severe anxiety
• Panic anxiety
 MILD ANXIETY
• Mild anxiety is a positive state of heightened awareness and sharpened
senses, allowing the person to learn new behaviors and solve
problems. The person can take in all available stimuli (perceptual field).
• Mild anxiety is common in everyday life. At this level, you're likely open-
minded, although stressed. You might experience this level of anxiety as
you await a job performance review or if you're lost in a new city.
Symptoms might include fidgeting, irritability, sweaty palms and
heightened senses. Mild anxiety is typically motivational, meaning it
helps you focus on seeking a solution to the challenge you face. For
example, if you're lost in a new place, you might look for a safe place to
ask for directions. Once you get your bearings, your anxiety will likely
dissipate quickly. This is typical of mild, situational anxiety.
MILD ANXIETY
 MODERATE ANXIETY
• Moderate anxiety involves a decreased perceptual field (focus on
immediate task only); the person can learn a new behavior or solve
problems only with assistance. Another person can redirect the person
to the task.
• At a moderate level of anxiety, you're likely to focus exclusively on the
stressful situation directly in front of you and ignore other tasks. Say
you've taken a child to the playground and lose sight of him. You might
experience a faster heartbeat, dry mouth, sweating and stomach pain
or nausea. Your speech may be rapid and high-pitched, and your hand
and arm movements are likely more exaggerated. Nervous habits, like
biting your nails or wringing your hands, are common. Your singular
focus is likely where the child might be. Once you find him playing with
other children, your symptoms subside.
MODERATE ANXIETY
 SEVERE ANXIETY
• Severe anxiety involves feelings of dread and terror. The person cannot be
redirected to a task; he or she focuses only on scattered details and has
physiologic symptoms of tachycardia, diaphoresis, and
• With severe anxiety, symptoms intensify and others develop, such as a
pounding heartbeat, chest pain, headache, vomiting or diarrhea, trembling,
scattered thoughts, erratic behavior and a sense of dread. Learning a loved
one has been in an accident or died unexpectedly, or the unexpected loss of
employment, are examples of situations that can provoke these symptoms.
With severe anxiety, your ability to focus and solve problems is impaired,
which can lead to further anxiety. You may not even be able to recognize or
take care of your own needs. Attempts of others to redirect your attention
are likely to be unsuccessful. chest pain.
SEVERE ANXIETY
 PANIC ANXIETY
• Panic anxiety can involve loss of rational thought, delusions,
hallucinations, and complete physical immobility and muteness. The
person may bolt and run aimlessly, often exposing himself or herself to
injury.
• Panic-level of anxiety is the most disruptive and challenging, as it
overwhelms your capacity to function normally. You may experience an
inability to move or speak, but sometimes the opposite is true. Some
people take off running or find it impossible to sit or stay still. Your
ability to think rationally will likely be impaired, and your perceptions
might be distorted. You might not identify danger or understand your
needs in the moment. Extreme life stressors can provoke these types
of reactions, such as being victim of a crime or living through a disaster.
PANIC ANXIETY
 Interpersonal Theory and Nursing Process
• Both Peplau’s Interpersonal Relations Theory and the Nursing Process
are sequential and focus on the therapeutic relationship by using problem-
solving techniques for the nurse and patient to collaborate on, with the end
purpose of meeting the patient’s needs. Both use observation
communication and recording as basic tools utilized by nursing.
  Orientation
Assessment  
 
Non-continuous data collection Felt need
Continuous data collection and analysis May not Definite needs
be a felt need
Nursing Diagnosis & Planning Identification
   
Mutually set goals Interdependent goal setting
Implementation  
  Exploitation
Plans initiated towards achievement of mutually  
set goals Patient actively seeking and drawing help Patient-
May be accomplished by patient, nurse, or initiated
significant other.

Evaluation Resolution
   
Based on mutually expected behaviors Occurs after other phases are completed
successfully
May led to termination and initiation of new plans
Leads to termination
 ANALYSIS
• Peplau conceptualized clear sets of nurse’s roles that can be used by each and
every nurse with their practice. It implies that a nurse’s duty is not just to care but
the profession encompasses every activity that may affect the care of the patient.

• The idea of a nurse-client interaction is limited with those individuals incapable of

conversing, specifically those who are unconscious.

• The concepts are highly applicable to the care of psychiatric patients considering
Peplau’s background. But it is not limited in those set of individuals. It can be
applied to any person capable and has the will to communicate.

• The phases of the therapeutic nurse-client are highly comparable to the nursing
process making it vastly applicable. Assessment coincides with the orientation
phase; nursing diagnosis and planning with the identification phase;
implementation as to the exploitation phase; and lastly, evaluation with the
resolution phase.
 STRENGTHS AND WEAKNESSES
Strengths
• Peplau’s theory helped later nursing theorists and clinicians develop more
therapeutic interventions regarding the roles that show the dynamic
character typical in clinical nursing.
• Its phases provide simplicity regarding the natural progression of the
nurse-patient relationship, which leads to adaptability in any nurse-patient
interaction, thus providing generalizability.
Weaknesses
• Though Peplau stressed the nurse-client relationship as the foundation of
nursing practice, health promotion, and maintenance were less
emphasized.
• Also, the theory cannot be used in a patient who doesn’t have a felt need
such as with withdrawn patients.
 CONCLUSION
• Peplau’s theory has proved of great use to later nurse theorists and clinicians in
developing more sophisticated and therapeutic nursing interventions including
the seven nursing roles, which show the dynamic character roles typical in
clinical nursing. It entails that a nurse’s duty is not just to care but the
profession also incorporates every activity that may affect the client’s health.

• 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.

• Studying Peplau’s Interpersonal Relations Theory of Nursing can be very

substantial especially to those who are aspiring to be part of the profession.
Having the knowledge of the seven roles of nursing, future nurses can apply for
different roles in different situations, which will guarantee their patients to
acquire the best care possible, and will ultimately speed along treatment and
recovery.