Hildegard Peplau
1909 – 1999
Theory of Interpersonal
Relations
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 (ANA).
She was instrumental in the ANA (1980) definition of nursing that was nursing’s
declaration of a social contract with society in Nursing: A Social Policy Statement. She
promoted professional standards and regulation through credentialing. Peplau taught
the first classes for graduate psychiatric nursing students at Teachers College,
Columbia University, and she stressed the importance of nurses’ ability to understand
their own behavior to help others identify perceived difficulties. Her seminal
book, Interpersonal Relations in Nursing (1952), describes the importance of the nurse-
patient relationship as a “significant, therapeutic interpersonal process” and is
recognized as the first nursing theory textbook since Nightingale’s work in the 1850s.
She discussed four psychobiological experiences that compel destructive or
constructive patient responses, as follows: needs, frustrations, conflicts, and anxieties.
Peplau identified four phases of the nurse-patient relationship: orientation, identification,
exploitation, and resolution (Figure 5-1). Diagrammed changing aspects of nurse-patient
relationships (Figure 5-2), and proposed and described six nursing roles: stranger,
resource person, teacher, leader, surrogate, and counselor (Figure 5-3).
Peplau had professional relationships with others in psychiatry, medicine,
education, and sociology that influenced her view of what a profession is and does and
what it should be. Her work was influenced by Freud, Maslow, and Sullivan’s
interpersonal relationship theories, and by the contemporaneous psychoanalytical
model. She borrowed the psychological model to synthesize her Theory of Interpersonal
Relations. Her work on nurse-patient relationships is known well internationally and
continues to influence nursing practice and research. Recent publications using her
model include research in staff-student relationships, psychiatric workforce
development, care of patients with attention-deficit/hyperactivity disorder, subject
recruitment, retention and participation in research, the practice environment of nurses
working in inpatient mental health, and therapeutic relationships between women with
anorexia and health care professionals. Peplau’s work is specific to the nurse-patient
relationship and is a theory for the practice of nursing.
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.
FIGURE 5-1. Overlapping
Phases in Nurse-Patient
Relationships.
FIGU
RE 5-2 Continuum Showing Changing Aspects of Nurse-Patient Relationships.
FIGURE 5-3 Phases and
Changing Roles in
Nurse-Patient
Relationships.
