1. Chapter 12
Theories Focused
on Interpersonal
Relationships

2. Introduction
• Interpersonal theory posits that anxiety arises
from relationships with significant others.
• Interpersonal theory in health care grew from
psychiatric research that attributed mental
illness to social-cultural factors.
• Health-related theories focus on humans as
social beings that require support and
nurturance from their environment.

3. Sign of the Times: 1800s to 1970s
• Early nursing theorist concentrated on the
difference between nursing knowledge and
medical knowledge.
• During the 1950s, conceptual frameworks in
nursing were developed base on other areas.
• The psychiatric care movement and psychotropic
drug development in the 1960s and 1970s led to
nursing theory focused on interpersonal
communication.

4. Peplau: Theory of Interpersonal Relations
in Nursing (1 of 2)
• Peplau posited that nurses serve as nurse-
therapists and function in a counseling role.
• Focused on the idea that nurse-patient
relationships have a starting point, proceed
through definable phases, and have an end point.
• Utilized personality development tasks associated
with stages of personality described by Freud and
Sullivan.

5. Peplau: Theory of Interpersonal Relations in
Nursing (2 of 2)
• Divided relationship development into four
phases:
– Preorientation
– Orientation
– Working
– Resolution
• Important to nursing because it emphasized the
relationship between therapeutic use of self and
patient well-being in the treatment milieu.

6. Orlando: Nursing Process Theory (1 of 2)
• Orlando posited that nursing be governed by
patient needs rather than organizational rules.
• Liked effective care to the nurse’s knowledge of
patient needs validated by patient response.
• Suggested that nursing practice is circular and
reflexive, not linear like the processes taught in
nursing education.

7. Orlando: Nursing Process Theory (2 of 2)
• Proposed three components of nursing:
– Patient behavior
– Nurse reaction
– Nursing action appropriate to patient need
• Delineated automatic (dictated) and deliberative
(decision-based) nursing processes.
• Important to nursing because it focused on the
whole patient and improved nurses’ decision-
making skills.

8. Travelbee: Human-to-Human Relationship
Model (1 of 2)
• Travelbee posited that caring is the basic goal of
nursing and involved helping individuals, families,
and communities cope with and find meaning in
illness.
• Promoted understanding and acknowledgement of
the uniqueness of patients.
• Introduced the concept of hope for patients with
mental and long-term illnesses.

9. Travelbee: Human-to-Human Relationship
Model (2 of 2)
• Promoted five stages of care relationships:
– Original encounter
– Emerging identities
– Developing feelings of empathy
– Developing feelings of sympathy
– Rapport
• Important to nursing because it defined areas
of concern for mental health nurses and
advanced the hospice movement.

10. Sign of the Times: 1970s to Present
• During the 1970s and 1980s, human interaction
in health and wholeness became the focus of
nursing theory.
• Change was reflected in education and theory
based in modern and postmodern philosophies.
• Postmodern phenomenology added an
experiential human element to modern
exploration of empirical finding validity.

11. Paterson and Zderad: Humanistic Nursing
Theory (1 of 2)
• Paterson and Zderad posited that understanding
how people experience existence facilitates
nursing.
• Proposed that nursing is an existential experience
enhanced by phenomenological descriptions of
experience.
• Coined the term “humanistic nursing” to
highlight importance of the nurse’s existential
awareness of self and others.

12. • Described nursing care as a call and response
relationship.
• Conceptualized health as a process of becoming
whatever is possible for the human being.
• Important to nursing because it focused on the
process of interaction and dialogue between
nurse and patient.
Paterson and Zderad: Humanistic Nursing
Theory (2 of 2)

13. Watson: Transpersonal Care (1 of 2)
• Watson posited that curing is the domain of
medicine and caring is the domain of nursing
through the transpersonal care relationship.
• Based on a moral commitment to human dignity,
wholeness, caring, and healing.
• Utilized “carative factors” in addition to kindness,
concern, love of self and others, and the ecology
of the earth.

14. Watson: Transpersonal Care (2 of 2)
• Promoted four components of care:
– Affirmation of patient significance
– Connection with the spirit of the patient
– Unity with the patient’s state of being
– Caring, healing modalities that potentiate comfort
and harmony
• Important to nursing because it focuses on both
the physical body and the embodied spirit, both
of which must be cared for in order for patients
to achieve healing.

15. Newman: Theory of Health as
Expanding Consciousness (1 of 2)
• Newman posited that expanding consciousness is
essential for gaining a deeper appreciation of life
and having meaningful relationships.
• Proposed that health is a synthesis of being well
and being ill, and that these two states together
reflect wholeness.

16. • Focused on the importance of the nurse-patient
relationship in helping patients gain meaning
from their evolving health patterns.
• Important to nursing because it calls for a shift in
the nursing worldview from health and illness to
transformation and pattern recognition.
Newman: Theory of Health as Expanding
Consciousness (2 of 2)

17. Parse: Humanbecoming Theory (1 of 2)
• Parse posited that lived experiences and
preferences influence healthcare choices.
• Focused on structuring meaning, configuring
rhythmical patterns of relating, and
cotranscending possibles.
• Proposed three health-related assumptions:
– It is freely choosing personal meaning
– It is configuring rhythmical patterns of relating
– It is cotranscending limits with emerging
possibilities

18. • Emphasized a non-judgemental approach that
reveres a patient’s expertise in knowing what is
best for him or her within the nurse-patient
relationship.
• Important to nursing because it focuses on
quality of life as the articulator of the goal of
nursing practice.
Parse: Humanbecoming Theory (2 of 2)

19. Non-Nursing Theories: Interpersonal
Relations Theory
• Posits that personality is defined as behavior
observable within interpersonal relationships.
• Socialization occurs throughout developmental
stages and failure to proceed lays the foundation
for maladaptive behavior.
• Unsatisfactory personal relationships are the
primary cause of developmental progression.
• Harry Stack Sullivan was an adherent to the theory.

20. Humanistic Theory
• Posits that each person is a work in progress.
• Focuses on the personal worth of the individual
and the essential role of human values.
• Draws on humanistic philosophy and
psychology.
• Carl Rogers was an adherent to the theory.

21. Existentialism and Phenomenology
• Posits that existence takes precedence over
essence, that humans are free to act, and are
responsible for their acts.
• Focuses on knowledge as the result of decision
making.
• Points to creativity, initiative, ad self-fulfillment
as important personality factors
• Victor Frankl and Rollo May were adherents to
the theory.

22. Positive Psychology
• Posits that people want more than an end to
suffering and seek to lead meaningful lives.
• Aims to move psychology away from the
preoccupation with repairing the worst in life
toward building positive qualities.
• Proposes that positive experiences, positive
individual traits, and positive institutions are the
three central concerns for psychology.

23. Positive Psychology: Seligman
• Posits that happiness could be analyzed into
three different elements that one chooses for
their own sake: positive emotion, engagement,
and meaning.
• Five crucial elements of well-being: PERMA
– Positive Emotion
– Engagement
– Relationships
– Meaning
– Accomplishment

24. Transpersonal Psychology
• Posits that spiritual self-development, peak
experiences, mystical experiences, systemic
trance, and other occult experiences of living
help humanity reach its highest potential.
• Stems from psychoanalysis, behaviorism, and
humanistic psychology.
• Seeks to describe and integrate mystic
experiences with modern psychological theory.

25. Recovery-Oriented Care Systems(1 of 2)
• Recovery-oriented care has become central to SAMHSA’s and
CSAT’s misisons.
• Recovery indicates a normal adaptation process of healing,
improvement, or mending, to mention a few meanings.
• Redefined to: a process of personal discovery, of how to live
(and to live well) with enduring symptoms and vulnerabilities.
• SAMSHA’s Working Definition of Recovery from Mental Disorders
and/or Substance Use Disorders provides a working definition of
recovery, and set of recovery principles.

26. • Elements of Recovery-Oriented Care:
– Encourage individuality
– Promote accurate portrayals/ fight discrimination
– Focus on strengths
– Use language of hope
– Variety of treatment options
– Supports risk taking, even when failure is possible
– Actively involve service users and family
– Encourage participation
– Help develop connections with communities
– Help people develop valued social roles/ activities
Recovery-Oriented Care Systems(2 of 2)

27. Back to the Future
• Nursing has shifted from a focus on medical
knowledge to a focus on nurse-patient
relationships to a focus on existentialism.
• We have shifted from positivism to postmodernism
and increasingly to neomodernism.
• Opportunities for healthcare system growth found
in recovery-oriented and trauma-informed care
seem poised to foster new directions in nursing
care and national wellbeing.

28. Summary
• Interpersonal theory in nursing has undergone
many changes over the years and sought to
emphasize the importance of the individual
patient in practice.
• Nursing theories build upon theories of other
fields and one another to promote patient-
focused care.
• Philosophical shifts in the discipline have also
played key roles in theoretical change.