3. Who was Hildegard Peplau?
Early life
Name: Hildegard Elizabeth Peplau
Nickname: Hilda
Birthday: September 1, 1909
Died: March 17, 1999 in Sherman Oaks, California
Birthplace: Reading, Pennsylvania
Parents: immigrants of German descent
Father: Gustav Peplau (illiterate but hard-working)
Mother: Otyllie Peplau (oppressive and perfectionist)
Birth Order: She was the second daughter born of six
children
5. Why Nursing?
Nursing was one of few career choices for
women in her day. As a child, she
witnessed the devastating flu epidemic of
1918, a personal experience that greatly
influenced her understanding of the
impact of illness and death on families.
6. Career Timeline
1931 - Diploma program in Pottstown, Pennsylvania
1943 - BA in interpersonal psychology - Bennington
College
1947 - MA in psychiatric nursing from Colombia
University, New York
1952 - Published Interpersonal Relations in Nursing
1953 - EdD in curriculum development in 1953
Professor emeritus from Rutgers university
Started first post baccalaureate program in
psychiatric nursing
1968 - interpersonal techniques - the crux of psychiatric
nursing
7. • Worked as executive director for ANA
• President of ANA from 1970-1972
• Vice-President of ANA from 1972-1974
• Worked with W.H.O., NIMH and Nurse Corps.
• She was the first published nursing theorist
since Florence Nightingale
• created the middle-range nursing theory of
interpersonal relations, which helped to
revolutionize the scholarly work of nurses
• Staff Nurse in Pennsylvania and New York City
• School Nurse at Bennington College, VT
Affiliations and Achievements
8. • Certified in Psychoanalysis at the William Alanson
White Institute of New York City
• Faculty of the College of Nursing at Rutgers University
• Created first graduate level program for the
preparation of clinical specialists in Psychiatric Nursing
• Therapeutic Care vs Custodial Care in mental hospitals
• Strong advocate for graduate education and research
in nursing
• She is the primary contributor to mental health law
reform, leading the way towards humane treatment
of patients with behavior and personality disorders
9. Interpersonal Theory
• Interpersonal Relations Model
• Psychodynamic Nursing
In a nutshell:
• Using an understanding of one’s own
behavior to help others identify their
difficulties
• Applies principles of human relations
• Patient has a felt need
10. What is Interpersonal Relations Theory?
• Emphasized the nurse-client relationship as the
foundation of nursing practice
• The interpersonal model emphasizes the need
for a partnership between nurse and client as
opposed to the client passively receiving
treatment (and the nurse passively acting out
doctor's orders).
• shared experience - Nurses could facilitate this
through
observation, description, formulation, interpretat
ion, validation, and intervention
11. Major Concepts
• 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.
12. Major Concepts
• 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.
13. • Theory of interpersonal relations is a middle
range descriptive classification theory
• The theory was influenced by Harry Stack
Sullivan's theory of inter personal relations
(1953)
• The theorist was also influenced by Percival
Symonds, Abraham Maslow's and Neal Elger
Miller
• Peplau's theory is also referred
as psychodynamic nursing, which is the
understanding of ones own behavior
14. Metaparadigm
Person:
• An individual
• A developing organism that tries to reduce
anxiety caused by needs.
• Lives in stable equilibrium
Environment:
• Existing forces outside the organism and in the
context of culture
15. Metaparadigm
Health:
• 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:
• A significant therapeutic interpersonal process.
• It functions cooperatively with other human process
that make health possible for individuals in
communities.
• Involves problem-solving
16. Peplau’s Seven Roles of a Nurse
• Stranger: receives the client in the same way one
meets a stranger in other life situations provides an
accepting climate that builds trust.
• Teacher: who imparts knowledge in 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
17. Peplau’s Seven Roles of a Nurse
• Surrogate: helps to clarify domains of
dependence interdependence and
independence and acts on clients behalf as an
advocate.
• Leader : helps client assume maximum
responsibility for meeting treatment goals in a
mutually satisfying way
• Technical Expert: provides physical care by
displaying clinical skills and operates equipment
19. Four Sequential Phases in the
Interpersonal Relationship
1. Orientation
2. Identification
3. Exploitation
4. Resolution
20. 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
21. Orientation Phase
• Get acquainted phase of the nurse-patient
relationship.
• Preconceptions are worked through
• Parameters are established and met
• Early levels of trust are developed
• Roles begin to be understood
23. 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 client begins to identify problems to be
worked on within relationship
• The goal of the nurse: help the patient to
recognize his/her own
interdependent/participation role and promote
responsibility for self
24. Exploitation Phase
• Use of professional assistance for problem
solving alternatives
• Advantages of services are used is 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
25. Exploitation Phase
• Patient may fluctuates 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 towards the final step
• Client’s trust of nurse reached full potential
• Client making full use of nursing services
• Solving immediate problems
• Identifying and orienting self to [discharge] goals
26. Resolution Phase
• 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.
• 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 becomes mature individuals
27. Resolution Phase
• Client met needs
• Mutual termination of relationship
• Sense of security is formed
• Patient is less reliant on nurse
• Increased self reliance to deal with own
problems.
• 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.
28. 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 on, with the
end purpose of meeting the patients needs
• Both use observation communication and
recording as basic tools utilized by nursing
29. 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 of mutually set
goals
May be accomplished by
patient, nurse or family
Exploitation
Patient actively seeking and
drawing help
Patient initiated
Evaluation
Based on mutually expected
behaviors
May led to termination and
initiation of new plans
Resolution
Occurs after other phases are
completed successfully
Leads to termination a
30. Application of Theory to Areas in Nursing
Nursing Education
• Has an impact on the Psychiatric Nursing
especially in the baccalaureate program in
nursing teaching CARE OF CLIENTS WITH
MALADAPTIVE PATTERNS OF BEHAVIOR
(NCM 105) composed of 72 hours lecture
and 102 hours RLE
31. Application of Theory to Areas in Nursing
Practice
• Focuses on the interpersonal processes and therapeutic
relationship that develops between the nurse & client.
• It requires that the nurse attends to the interpersonal
processes that occur between the nurse and client.
• Interpersonal process is maturing force for personality.
It includes the nurse- client
relationship, communication, pattern integration and
the roles of the nurse.
• Psychodynamic nursing is understanding one’s own
behavior to help others identify felt and perceived
difficulties and to apply principles of human relations to
the problems that arise at all levels of experience.
32. Application of Theory to Areas in Nursing
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.
33. Vignette
The nursing process for Mrs. JL based on
Peplau’s theory is as follows:
• Mrs. JL
• 27 years
• Diagnosis: Inter vertebral disc prolapse
34. Assessment
(Orientation)
Nursing
diagnosis
Planning
(Identification)
Implementation
(Exploitation phase)
Evaluation
(Resolution)
Mrs. JL is on
pelvic traction
and she is
restricted to
bed.
The need for
bed rest and
restriction was
discussed.
Impaired
physical
mobility
related to
the
presence
of pelvic
traction.
Goal setting was
done along with
patient
Provide active and
passive exercises
to all the
extremities to
improve the
muscle tone and
strength.
Provide articles near
to the patient and
encourage doing
activities within
limits.
Carried out plans
mutually agreed
upon.
Provided active and
passive exercises to
all the extremities
Provided article within
the reach of the patient
Mrs. JL was free
to express
problems
regarding
difficulty in
mobilizing.
She expressed
satisfaction
when able to
move without
difficulty.
35. Assessment
(Orientation)
Nursing
diagnosis
Planning
(Identification)
Implementation
(Exploitation)
Evaluation
(Resolution)
Mrs. JL
expresses pain
in the low back
region.
Regarding pain,
discussion was
made to assess
the severity and
the type and
duration of pain.
Also the
measures
to reduce pain
were discussed.
Pain related
to the
degenerativ
e changes in
the lumbar
region.
Goal setting was
done along with
patient
Mrs. JL will have
reduction in pain
as evidenced by
her verbalisation
of reduction in
pain responses.
Administer
analgesics as
prescribed by the
physician.
Provide pelvic
traction to the
patient
Carried out plans
mutually agreed
upon.
Provided non
pharmacological
measures like
diversion,
massaging, and
pelvic traction.
Administered Tab.
Hifenac P; Cap.
Myoril 4mg as
prescribed.
Given and
explained need
for pelvic traction
Mrs. JL was free
to express
problems of pain.
Expressed that
she got slight
relief from pain.
36. Assessment
(Orientation)
Nursing
diagnosis
Planning
(Identification)
Implementation
(Exploitation)
Evaluation
(Resolution)
Mrs. JL
expresses that
she needs
assistance to
get down from
bed.
Self care
discussion was
done and
discussed
measures to
solve the
problems.
Self care
deficit
related to
presence of
pelvic
traction.
Goal setting was
done along with
patient
Client will achieve
and maintain self
care activities with
assistance of
caregiver or within
her limits.
Keep all the articles
within the reach of
the patient.
Assist the patient in
doing her self care
activities.
Carried out plans
mutually agreed
upon.
Kept the articles
within the reach
of the client
Assisted the
client in doing her
self care activities
Mrs. JL was free to
express problems
of self care.
She used to call for
the needs and all
her needs were
met appropriately
She achieved and
maintained self
care activities
within her limits
37. Assessment
(Orientation)
Nursing
diagnosis
Planning
(Identification)
Implementation
(Exploitation)
Evaluation
(Resolution)
Mrs. JL is
enquiring
about the
disease
condition, its
outcome and
need for
surgery
Discussed
with the
client
regarding the
disease
process and
the findings
in the client
Anxiety
related to
hospital
admission as
evidenced by
verbalisation
and client &
family
appearing
withdrawn
Goal setting was done
along with patient
Client will have reduced
feeling of anxiety as
evidenced by
asking fewer questions
Teach the family and
client regarding the
disease process.
Stress that frequent
assessment are routine
and do not necessarily
imply a deteriorating
condition.
Carried out plans
mutually agreed
upon.
Taught the family
regarding the
disease process in
layman’s terms
Allowed the
family members
to verbalize
anxiety
Mrs. JL was
free to
express
problems of
self care.
She asked her
doubts
regarding the
illness and the
diagnostic
procedures
She verbalized
that her
anxiety has
reduced to
some extent.
38. Assessment
(Orientation)
Nursing
diagnosis
Planning
(Identification)
Implementation
(Exploitation)
Evaluation
(Resolution)
Mrs. JL is
enquiring
about the
disease
condition, its
outcome and
need for
surgery
Discussed
with the
client
regarding the
disease
process and
the need for
follow up
Deficient
knowledge
related to the
treatment
measures to
be continued
even after
the discharge.
Goal setting was
done along with
patient
Patient will acquire
adequate knowledge
regarding the
treatment and home
care.
Explain the
treatment measures
to the patient and
their benefits
Use simple and
understandable
terms
Carried out plans
mutually agreed
upon.
Explained
treatment
measures and the
need for follow up
Used simple and
understandable
terms for
explaining
Mrs. JL was
free to express
problems of
self care.
She expressed
acquisition of
knowledge
regarding the
disease and
the signs of
aggravation of
illness
39. Evaluation of the application of the theory
of interpersonal relations by Peplau
• With the help of the theory of interpersonal
relations, the client's needs could be assessed.
• It helped her to achieve them within her limits.
This theory application helped in providing
comprehensive care to the client.
40. Summary of Application
1. Orientation phase
• Client is initially reluctant to talk due to pain.
• Client is expressing that while standing she is having much
pain.
• Client expressed without movement and supine position
gave her relief from pain.
2. Identification
• The client participates and interdependent with the nurse
• Expresses the need for measure to get relief from pain
• Expresses need for improving the mobility
• Expresses need to know more about prognosis, discharge
and home care and follow up.
41. Summary
3. Exploitation
• Client explains that she gets relief of pain when lying down
supine.
• Cooperates and participates actively in performing
exercises.
• Client mobilizes changes position and cooperates during
position changes.
4. Resolution
• Client expressed that pain has reduced a lot and she is
able to tolerate it now
• She has agreed upon to continue the exercises at home
• She also expressed that she would come for regular follow
up after discharge.
