InterpersonalRelations Theory

Hildegard E. Peplau’sA Middle-Range Nursing Theory Analysis

SAIMA, SHAHIDA, SIMON,ZESHAN,SUNEEL

Dated 09-06-2016

Hildegard PeplauPsychiatric Nurse of the Century

Born: September 1, 1909, Reading, Pennsylvania, United

States.

Education:

William Alanson White Institute(1954)

Pottstown Hospital, School of Nursing(1931)

Columbia University

Bennington College

Worked tirelessly to advance nursing education and practice

in 1930's.

Neuropsychiatric hospital in London,UK.

Member of the Army Nurse Corps

Worked at Bellevue and Chestnut Lodge Psychiatric Facilities

Died: March 17, 1999, Sherman Oaks, Los Angeles, California,

United States (Nursing Inquiry 2014-21-4)

Psychiatric Nurse of the Century

Born: September 1, 1909, Reading, Pennsylvania, United

States.

Education:

William Alanson White Institute(1954)

Pottstown Hospital, School of Nursing(1931)

Columbia University

Bennington College

Worked tirelessly to advance nursing education and practice

in 1930's.

Neuropsychiatric hospital in London,UK.

Member of the Army Nurse Corps

Worked at Bellevue and Chestnut Lodge Psychiatric Facilities

Died: March 17, 1999, Sherman Oaks, Los Angeles, California,

United States (Nursing Inquiry 2014-21-4)

PersonA man who is an organism that livesin an unstable balance of a givensystem.

HealthSymbolizes movement of thepersonality and other ongoing humanprocesses that directs the persontowards creative, constructive,productive and community living.

NursingSignificant, therapeuticinterpersonal process. It functionscooperatively with humanprocesses that present health as apossible goal for individuals.

HealthSymbolizes movement of thepersonality and other ongoing humanprocesses that directs the persontowards creative, constructive,productive and community living.

EnvironmentForces outside the organism and inthe context of the socially-approvedway of living, from which vital humansocial processes are derived such asnorms, customs and beliefs.

NursingSignificant, therapeuticinterpersonal process. It functionscooperatively with humanprocesses that present health as apossible goal for individuals.

InterpersonalRelations

Theory

InterpersonalRelations

Theory

Introduction to the Theory

Phases of Nurse-Patient Relationship

A.Orientation PhaseGet acquainted phase of the nurse-patientrelationship.Preconceptions are worked throughParameters are established and metEarlylevels of trust are developedRoles begin to be understood

B.Identification PhaseThe client begins to identify problems to beworked on within relationshipThe goal of the nurse: help the patient torecognize his/her owninterdependent/participation role and promoteresponsibility for self

A.Orientation PhaseGet acquainted phase of the nurse-patientrelationship.Preconceptions are worked throughParameters are established and metEarlylevels of trust are developedRoles begin to be understood

B.Identification PhaseThe client begins to identify problems to beworked on within relationshipThe goal of the nurse: help the patient torecognize his/her owninterdependent/participation role and promoteresponsibility for self

C.Exploitation PhaseClient’s trust of nurse reached fullpotentialClient making full use of nursing servicesSolving immediate problemsIdentifying and orienting self to[discharge] goals

D.Resolution PhaseClient met needsMutual termination of relationshipSense of security is formedPatient is less reliant on nurseIncreased self-reliance to deal with ownproblems

C.Exploitation PhaseClient’s trust of nurse reached fullpotentialClient making full use of nursing servicesSolving immediate problemsIdentifying and orienting self to[discharge] goals

D.Resolution PhaseClient met needsMutual termination of relationshipSense of security is formedPatient is less reliant on nurseIncreased self-reliance to deal with ownproblems

Both are sequential and focus on therapeutic relationship.Both use problem solving techniques for the nurse and patientto collaborate on, with the end purpose of meeting the patientsneeds.Both use observation communication and recording as basictools utilized by nursing.

Assessment:•Data collection and analysis [continuous]·•May not be a felt need.

Orientation:Non continuous data collection.Felt need ·Define needs

Interpersonal Theory and Nursing Process

Assessment:•Data collection and analysis [continuous]·•May not be a felt need.

Orientation:Non continuous data collection.Felt need ·Define needs

Nursing diagnosis Planning:•Mutually set goals.

Identification:Interdependent goal setting

Implementation:•Plans initiated towards achievement ofmutually set goals.•May be accomplished by patient , nurse orfamily.

Exploitation:•Patient actively seeking and drawing help.•Patient initiated

Evaluation:•Based on mutually expected behaviors.•May led to termination and initiation of newplans

Resolution:•Occurs after other phases are completedsuccessfully.•Leads to termination.

Interpersonal Therapeutic ProcessThis type of process is based on the theory

proposed by Peplau and particularly useful in helpingpsychiatric patients become receptive for therapy.

Often referred as "Psychological Mothering," itincludes the following steps:

•The patient is accepted unconditionally as a participantin a relationship that satisfies his needs;•There is recognition of and response to the patient'sreadiness for growth, as his initiative; and•Power in the relationships shifts to the patient, as thepatient is able to delay gratification and to invest in goalachievement.

This type of process is based on the theoryproposed by Peplau and particularly useful in helpingpsychiatric patients become receptive for therapy.

Often referred as "Psychological Mothering," itincludes the following steps:

•The patient is accepted unconditionally as a participantin a relationship that satisfies his needs;•There is recognition of and response to the patient'sreadiness for growth, as his initiative; and•Power in the relationships shifts to the patient, as thepatient is able to delay gratification and to invest in goalachievement.

NURSINGROLES

• Stranger role Receives the client the same way one

meets a stranger in other life situations;provides an accepting climate that buildstrust.

• Resource role Answers questions, interprets clinical

treatment data, gives information.

• Teaching role Gives instructions and provides training;

involves analysis and synthesis of thelearner's experience.

• Stranger role Receives the client the same way one

meets a stranger in other life situations;provides an accepting climate that buildstrust.

• Resource role Answers questions, interprets clinical

treatment data, gives information.

• Teaching role Gives instructions and provides training;

involves analysis and synthesis of thelearner's experience.

• Counseling role Helps client understand and integrate the

meaning of current life circumstances;provides guidance and encouragement tomake changes.

• Surrogate role Helps client clarify domains of dependence,

interdependence, and independence andacts on clients behalf as advocate.

• Active leadership roleHelps client assume maximum

responsibility for meeting treatment goalsin a mutually satisfying way.

• Technical expert roleProvides physical care by displaying clinical

skills; Operates equipment

• Counseling role Helps client understand and integrate the

meaning of current life circumstances;provides guidance and encouragement tomake changes.

• Surrogate role Helps client clarify domains of dependence,

interdependence, and independence andacts on clients behalf as advocate.

• Active leadership roleHelps client assume maximum

responsibility for meeting treatment goalsin a mutually satisfying way.

• Technical expert roleProvides physical care by displaying clinical

skills; Operates equipment

1. Technical expert2. Consultant3. Health teacher4. Tutor5. Socializing agent6. Safety agent7. Manager of environment8. Mediator9. Administrator10. Recorder observer11. Researcher

Additional Roles:

1. Technical expert2. Consultant3. Health teacher4. Tutor5. Socializing agent6. Safety agent7. Manager of environment8. Mediator9. Administrator10. Recorder observer11. Researcher

• Person• Health• Environment• Nursing• Therapeutic Nurse-Client Relationship

Major Concepts:

Sub- Concepts:Sub- Concepts:• Roles of the nurse in the Therapeutic Relationship• Anxietya. Mildb. Moderatec. Severed. Panic

visual MODEL OF MAJOR CONCEPTS

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 applyto the concepts of human being, health, environment andnursing.Theories must be logical in nature -

-This theory provides a logicalsystematic way of viewing nursing situations

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

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 applyto the concepts of human being, health, environment andnursing.Theories must be logical in nature -

-This theory provides a logicalsystematic way of viewing nursing situations

-Key concepts such as anxiety, tension,goals, and frustration are indicated with explicit relationshipsamong 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 testablehypotheses.Theories can be utilized by practitioners to guide andimprove their practice.

-Peplau’s anxiety continuum is still usedin anxiety patientsTheories must be consistent with other validatedtheories, laws, and principles but will leave openunanswered questions that need to be investigated.

-Peplau's theory is consistent withvarious theories

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 testablehypotheses.Theories can be utilized by practitioners to guide andimprove their practice.

-Peplau’s anxiety continuum is still usedin anxiety patientsTheories must be consistent with other validatedtheories, laws, and principles but will leave openunanswered questions that need to be investigated.

-Peplau's theory is consistent withvarious theories

Limitations• Personal space considerations and

community social service resources areconsidered less.

• Health promotion and maintenancewere less emphasized

• Cannot be used in a patient who doesn’thave a felt need eg. With drawn patients,unconscious patients

• Some areas are not specific enough togenerate hypothesis

Limitations• Personal space considerations and

community social service resources areconsidered less.

• Health promotion and maintenancewere less emphasized

• Cannot be used in a patient who doesn’thave a felt need eg. With drawn patients,unconscious patients

• Some areas are not specific enough togenerate hypothesis

• Nurse and patient can interact.• Both the patient and nurse mature as the

result of the therapeutic interaction.• Communication and interviewing skills

remain fundamental nursing tools.• Nurses must clearly understand themselves

to promote their client’s growth and toavoid limiting client’s choices to those thatnurses value.

Assumptions:

• Nurse and patient can interact.• Both the patient and nurse mature as the

result of the therapeutic interaction.• Communication and interviewing skills

remain fundamental nursing tools.• Nurses must clearly understand themselves

to promote their client’s growth and toavoid limiting client’s choices to those thatnurses value.

The phases provide simplicityregarding the natural progression ofthe nurse-patient relationship.

This simplicity leads to adaptabilityin any nurse-patient interaction,thus providing generalizability.

Strengths:

The phases provide simplicityregarding the natural progression ofthe nurse-patient relationship.

This simplicity leads to adaptabilityin any nurse-patient interaction,thus providing generalizability.

Weaknesses:

Health promotion andmaintenance were lessemphasized.

The theory cannot be used in apatient who doesn’t have a felt needsuch as with withdrawn patients.

Health promotion andmaintenance were lessemphasized.

The theory cannot be used in apatient who doesn’t have a felt needsuch as with withdrawn patients.

CASE STUDYTOPIC. The use of Peplau's interpersonal nursingtheory with people suffering from serious mental

disorder.PURPOSE. To describe Peplau's theory and its

application using a case study.CONCLUSION. Peplau's theory can be used to helppatients resolve symptoms by guiding them through

the steps of observation, description, analysis,formulation, validation, testing, integration,

utilization.Key words: Nurse-patient relationship, Peplau's

interpersonal nursing theory, psychotherapy,schizophrenia, serious mental illness

TOPIC. The use of Peplau's interpersonal nursingtheory with people suffering from serious mental

disorder.PURPOSE. To describe Peplau's theory and its

application using a case study.CONCLUSION. Peplau's theory can be used to helppatients resolve symptoms by guiding them through

the steps of observation, description, analysis,formulation, validation, testing, integration,

utilization.Key words: Nurse-patient relationship, Peplau's

interpersonal nursing theory, psychotherapy,schizophrenia, serious mental illness

CASE STUDY• In the age of managed care, we hear little about long-

term psychotherapy with people experiencingserious mental illness (SMI). This is unfortunate,because despite the biopsychopharmacologicalmovement, the number of those diagnosed with SMIhas not decreased. While it is an accepted fact todaythat people who are depressed recover best with acombination of psychotherapy and medication, thesame has not been documented for those sufferingfrom schizophrenia. Many believe these peoplecannot be helped by psychotherapy. While many ofus know anecdotally of patients who have recovered,we seldom read of these in the psychiatric nursingliterature.

• A person with serious mental illness suffers fromsymptoms over an extended period of time thatconstantly or intermittently remit and relapse. Thesesymptoms seriously interfere with function andquality of life in such areas as

• In the age of managed care, we hear little about long-term psychotherapy with people experiencingserious mental illness (SMI). This is unfortunate,because despite the biopsychopharmacologicalmovement, the number of those diagnosed with SMIhas not decreased. While it is an accepted fact todaythat people who are depressed recover best with acombination of psychotherapy and medication, thesame has not been documented for those sufferingfrom schizophrenia. Many believe these peoplecannot be helped by psychotherapy. While many ofus know anecdotally of patients who have recovered,we seldom read of these in the psychiatric nursingliterature.

• A person with serious mental illness suffers fromsymptoms over an extended period of time thatconstantly or intermittently remit and relapse. Thesesymptoms seriously interfere with function andquality of life in such areas as

Cont….

• A person with serious mental illnesssuffers from symptoms over an extendedperiod of time that constantly orintermittently remit and relapse. Thesesymptoms seriously interfere with functionand quality of life in such areas as

• A person with serious mental illnesssuffers from symptoms over an extendedperiod of time that constantly orintermittently remit and relapse. Thesesymptoms seriously interfere with functionand quality of life in such areas as

CASE STUDY• work, social interaction, recreation, intimate

relationships, and meeting community standards.• Dr. Hildegard Peplau introduced an interpersonal

relations paradigm for the study and practice ofnursing in the late 1940s and early 1950s (Peplau,1995). The paradigm evolved from her work withH. Sullivan, E. Fromm, F. Fromm-Reichmann,other eminent clinicians, and her experienceworking with seriously mentally ill patients inpublic and private psychiatric hospitals (O'Toole& Welt, 1989). Her Interpersonal RelationsTheory has had particular relevance andusefulness in understanding and intervening toreduce symptoms, re-establish relatedness,restore a sense of self-identity, improve function,and promote health.

• work, social interaction, recreation, intimaterelationships, and meeting community standards.

• Dr. Hildegard Peplau introduced an interpersonalrelations paradigm for the study and practice ofnursing in the late 1940s and early 1950s (Peplau,1995). The paradigm evolved from her work withH. Sullivan, E. Fromm, F. Fromm-Reichmann,other eminent clinicians, and her experienceworking with seriously mentally ill patients inpublic and private psychiatric hospitals (O'Toole& Welt, 1989). Her Interpersonal RelationsTheory has had particular relevance andusefulness in understanding and intervening toreduce symptoms, re-establish relatedness,restore a sense of self-identity, improve function,and promote health.

CASE STUDY• Practicing psychotherapy at a public psychiatric

hospital, I have found interpersonal theory andinterventions useful for patients with a wide variety ofdiagnostic labels, including schizophrenia, depression,mood disorders, borderline personality disorders, andmild mental retardation. These interventions are usefulboth in one-to-one therapeutic relationships and milieuinterventions. The theory and interventions provide aneffective adjunct for psychopharmacology andpsychiatric rehabilitation, particularly with people whohave complex behavioral problems refractory topsychopharmacological intervention. My anecdotalclinical experience is not consistent with Beeber's (1995)contention that the Peplau model does not fit psychiatricnursing practice in inpatient settings. Employed as acertified specialist/nurse psychotherapist with anassigned caseload of patients with complex behaviorproblems and as Assistant Director of Nursingresponsible for milieu intervention, I sought to answerBeeber's questions:

• Practicing psychotherapy at a public psychiatrichospital, I have found interpersonal theory andinterventions useful for patients with a wide variety ofdiagnostic labels, including schizophrenia, depression,mood disorders, borderline personality disorders, andmild mental retardation. These interventions are usefulboth in one-to-one therapeutic relationships and milieuinterventions. The theory and interventions provide aneffective adjunct for psychopharmacology andpsychiatric rehabilitation, particularly with people whohave complex behavioral problems refractory topsychopharmacological intervention. My anecdotalclinical experience is not consistent with Beeber's (1995)contention that the Peplau model does not fit psychiatricnursing practice in inpatient settings. Employed as acertified specialist/nurse psychotherapist with anassigned caseload of patients with complex behaviorproblems and as Assistant Director of Nursingresponsible for milieu intervention, I sought to answerBeeber's questions:

CASE STUDY• I discovered that patients are able to identify

patterns and contextual variables through my useof the interpersonal paradigm andpsychotherapeutic interventions suggested byPeplau (1989a, b; 1995, 1996b). This presentationwill briefly discuss concepts and definitions ofPeplau's paradigm that help explain the reasonsfor the seriously mentally ill person's problems,and it concludes with a case presentation.

• I discovered that patients are able to identifypatterns and contextual variables through my useof the interpersonal paradigm andpsychotherapeutic interventions suggested byPeplau (1989a, b; 1995, 1996b). This presentationwill briefly discuss concepts and definitions ofPeplau's paradigm that help explain the reasonsfor the seriously mentally ill person's problems,and it concludes with a case presentation.

•Hays .D. (1961). Phases and steps of experimental teaching

to patients of a concept of anxiety: Findings revealed that

when taught by the experimental method, the patients were

able to apply the concept of anxiety after the group was

terminated.

•Burd .S.F. Develop and test a nursing intervention framework

for working with anxious patients: Students developed

competency in beginning interpersonal relationship.

Research Based on Peplau’s Theory

•Hays .D. (1961). Phases and steps of experimental teaching

to patients of a concept of anxiety: Findings revealed that

when taught by the experimental method, the patients were

able to apply the concept of anxiety after the group was

terminated.

•Burd .S.F. Develop and test a nursing intervention framework

for working with anxious patients: Students developed

competency in beginning interpersonal relationship.

• Peplau conceptualized clear sets of nurse’s roles that can be used byeach and every nurse with their practice. It implies that a nurse’sduty is not just to care but the profession encompasses everyactivity that may affect the care of the patient.

• The idea of a nurse-client interaction is limited with thoseindividuals incapable of conversing, specifically those who areunconscious.

• The concepts are highly applicable with the care of psychiatricpatients considering Peplau’s background. But it is not limited inthose set of individuals. It can be applied to any person capable andhas the will to communicate.

• The phases of the therapeutic nurse-client are highly comparable tothe nursing process making it vastly applicable. Assessmentcoincides with the orientation phase; nursing diagnosis andplanning with the identification phase; implementation as to theexploitation phase; and lastly, evaluation with the resolution phase.

Conclusion• 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’sduty is not just to care but the profession encompasses everyactivity that may affect the care of the patient.

• The idea of a nurse-client interaction is limited with thoseindividuals incapable of conversing, specifically those who areunconscious.

• The concepts are highly applicable with the care of psychiatricpatients considering Peplau’s background. But it is not limited inthose set of individuals. It can be applied to any person capable andhas the will to communicate.

• The phases of the therapeutic nurse-client are highly comparable tothe nursing process making it vastly applicable. Assessmentcoincides with the orientation phase; nursing diagnosis andplanning with the identification phase; implementation as to theexploitation phase; and lastly, evaluation with the resolution phase.

References

• Hildegard Peplau (1909-1999) 1998 Inductee.(n.d.). . Retrieved July 1, 2014, fromhttp://www.nursingworld.org/HildegardPeplau

• Sills, G. (n.d.). Hildegard Peplau. NursingTheorist Homepage. Retrieved January 3, 2014,fromhttp://publish.uwo.ca/~cforchuk/peplau/obituary.html

• Hildegard Peplau (1909-1999) 1998 Inductee.(n.d.). . Retrieved July 1, 2014, fromhttp://www.nursingworld.org/HildegardPeplau

• Sills, G. (n.d.). Hildegard Peplau. NursingTheorist Homepage. Retrieved January 3, 2014,fromhttp://publish.uwo.ca/~cforchuk/peplau/obituary.html