Course Title : THEORETICAL FOUNDATIONS OF NURSING

Course Code : NCM 100A

Hildegard Peplau
“Theory of Interpersonal Relations”

“Nursing is an interpersonal process because it involves interaction between two or

According to Peplau’s Theory, the three sequential phases in the interpersonal nurse-
patient relationship are orientation, working, and resolution or termination phase.

1. Orientation Phase
 Problem defining phase.
 Starts when client meets nurse as stranger.
 Defining problem and deciding type of service needed.
 Nurse responds, explains roles to client, helps to identify problems and to use
available resources and services.
 During the orientation phase, the individual has a felt need and seeks
professional assistance. The nurse helps the individual to recognize and
understand his/her problem and determine the need for help.
2. Working Phase
A. 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 feeling of helplessness and hopelessness.
 The patient identifies with those who can help him/her. The nurse permits
exploration of feelings by the patient in undergoing illness as an experience
that reorients feeling and strengthens positive forces in the personality and
provides needed satisfaction.
B. Exploitation Phase
 Use of professional assistance for problem solving alternatives.
 Advantage of services are used and based on the needs and interests of the
patients.
 Individual feels as an integral part of the helping environment.
 The individual 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.
 During this phase, the patient attempts to derive full value from what he/she
is offered through the relationship. The nurse can project new goals to be
achieved through personal effort and power shifts from the nurse to the
patient as the patient delays gratification to achieve the newly formed goals.
 Nurse must be aware about the various phases of communication.
  Nurse aids the patient in exploiting all avenues of help and progress is made
towards the final step.
3. Resolution or Termination Phase
 Termination of professional relationship.
 The patient’s needs have already been met by the collaborative effort 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 behavior
is demonstrated and both become mature individuals.
 The patient gradually puts aside old goals and adopts new goals. This is a process
in which the patient frees himself from identification with the nurse.

Peplau advocates that the roles of the nurse in the nurse-patient interpersonal
relationship are as follows:
 Stanger: receives the client in the same way one meets a stranger in other life situations.
Provides an accepting climate that build trust.
 Teacher: who imparts knowledge reference to a need or interest.
 Resource Person: one who provides a specific needed information that aids in the
understanding of a problem or new situation.
 Counselor: helps to understand and integrate the meaning of current life circumstances;
provides guidance and encouragement to make changes.
 Surrogate: helps to clarify domains of dependence, interdependence and independence
and acts on client’s behalf as an advocate.
 Leader: helps client assume maximum responsibility for meeting treatment goals in a
mutually satisfying way.

Interpersonal Theory and Nursing Process

Assessment Orientation
 Data collection and analysis  Non-continuous data collection
(continuous)  Felt need
 May not be a felt need  Define needs
Nursing Diagnosis Identification
Planning  Interdependent goal setting
 Mutually set goals
Implementation Exploitation
 Plans initiated towards achievement  Patient actively seeking and drawing
of mutually set goals help
  May be accomplished by patient,  Patient initiated
nurse or family
Evaluation Resolution
 Based on mutually expected  Occurs after other phases are
behaviors completed successfully
 May lead to termination and initiation  Leads to termination
of new plans

Theoretical Assertions
Person. A developing organism that tries to reduce anxiety caused by needs.
Environment. Existing forces outside the organism and in the context of culture.
Health. A word symbol that implies forward movement of personality and other ongoing human
processes in the direction of the creative, constructive, productive, personal and community
living.
Nursing. A significant therapeutic interpersonal process. It functions cooperatively with other
human processes that make health possible for individuals in communities.