Nursing concept

1. Hildegard e. Peplau; theory of interpersonal
relations (psychodynamic nursing theory)
Sushila Hamal
M.Sc. Nursing 1st Year(B-2023)
BPKIHS, Dharan

2. Objectives
General objective
•At the end of this session, the participant will be able to
explain about Hildegard E. Peplau; Theory of interpersonal
relations (psychodynamic nursing theory)
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3. Specific objective
At the end of this session the participant will be able to:
• describe about Hildegard e. Peplau; Theory of interpersonal
relations
•describe the major concepts
• describe the Peplau's seven nursing roles
•describe the elements of interpersonal relationship
• explain the phases of interpersonal relationship
• explain the Paplau's theory and four major concepts
•explain the application of Peplau's theory in nursing process
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4. Hildegard e. Peplau; Theory of interpersonal relations
(psychodynamic nursing theory)
Introduction
• Born in Reading, Pennsylvania (1909), USA.
• Diploma Nursing program in Pottstown, Pennsylvania in 1931.
• BA in interpersonal psychology - Bennington College in 1943.
• MA in psychiatric nursing from Colombia University New York in
1947.
• Ed.D (a doctorate in nursing education) in curriculum development in
1953.
• Started first post baccalaureate program in nursing.
• Published Interpersonal Relations in Nursing in 1952. 4

5. Introduction (Contd…)
• 1968, Interpersonal Techniques-the crops of psychiatric nursing.
• Worked as executive director and president of ANA.
• Worked with WHO, the National Institute of Mental Health (NIMH)
and Nurse Corps.
• Died in 1999.
• Theory of interpersonal relations is a middle range descriptive
classification theory.
• Theory of was influenced by Harry Stack Sullivan's theory of inter
personal relations (1953)
• Peplau's theory is also referred as psychodynamic nursing theory, which
is the understanding of ones own behavior. 5

6. 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.
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7. Major Concepts (Contd…)
•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.
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8. Peplau's Seven Nursing Roles
Peplau's Seven Nursing Roles illustrate the dynamic character roles
typical to clinical nursing.
• 1. Stranger role: Receives the client the same way one meets a stranger
in other life situations provides an accepting climate that builds trust.
• 2. Resource role: Answers questions, interprets clinical treatment data,
and gives information.
• Resource person provides specific needed information that aids in the
understanding of a problem or new situation.
• 3. Teaching role: Gives instructions and provides training involves
analysis and synthesis of the learner's experience. Teacher imparts
knowledge in reference to a need or interest. 8

9. Peplau's Seven Nursing Roles (Contd…)
4. Counseling role: Helps client understand and integrate the
meaning of current life circumstances; provides guidance and
encouragement to make changes.
5. Surrogate role: Helps client clarify domains of dependence,
interdependence, and independence and acts on clients' behalf as
advocate.
6. Active leadership: Helps client assume maximum
responsibility for meeting treatment goals in a mutually
satisfying way.
7. Technical expert role: Provides physical care by displaying
clinical skills; Operates equipment. 9

10. Elements of interpersonal relationship
•Contract: the time, place and purpose of meetings as well as
conditions for termination are established between the nurses
and client.
•Boundaries: roles of participants are clearly defined; the nurse
is defined as a professional helper. he client's needs and
problems are the focus of the interaction.
•Confidentiality: the nurse should share information only with
professional staff who need to know. The nurse should obtain
client's written permission to share information with others
outside the treatment team.
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11. Elements of interpersonal relationship (Contd…)
Therapeutic nurse behaviors:
a. self-awareness
b. genuine, warm and respectful
c. Empathy
d. cultural sensitivity
e. collaborative goal setting
f. responsible, ethical practice.
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12. Phases of interpersonal relationship
1. Orientation
2. Identification
3. Exploitation
4. Resolution
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13. Phases of interpersonal relationship (Contd…)
1. Orientation phase
• Problem defining 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.
•Starts when client meets nurse as stranger.
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14. Orientation phase (Contd…)
•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.
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15. Phases of interpersonal relationship (Contd…)
2. 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.
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16. Phases of interpersonal relationship (Contd…)
3. 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. Patient may fluctuate on independence.
• Nurse must be aware about the various phases of communication
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17. 3. Exploitation Phase (Contd…)
•Nurse aids the patient in exploiting all avenues of help and
progress is made towards be 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.
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18. Phases of interpersonal relationship (Contd…)
4. Resolution Phase
•Termination of professional relationship.
• The patients need 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.
• 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.
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19. Phases of interpersonal relationship (Contd…)
Phase Focus
Orientation Problem defining phase
Identification Selection of appropriate professional assistance
Exploitation Use of professional assistance for problem
solving alternatives
Resolution Termination of the professional relationship
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20. Four Major Concepts( Metaparadigm)
•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 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. 20

21. Interpersonal Theory and Nursing Process
Assessment
 Data collection and analysis (continuous).
 May not be a felt need
Orientation
 Non continuous data collection.
 Felt need, definite needs.
Nursing Diagnosis
 Planning
 Mutually Set Goals
Identification
 Interdependent goal setting
Implementation
 Plan 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 of termination.
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22. Application of Peplau's Theory in nursing process
The nursing process for Mrs. Sharma, 40 years female diagnosed
with Pelvic Inter-vetebral Disc Prolapse and is on traction; based
on Peplau's theory is as follows:
•Assessment:
•Mrs. Sharma is restricted to bed. She expresses mild to
moderate pain in the low back region and discomfort by
traction. Pain is assessed for the severity, type and duration. The
need for the pain relief and bed rest and mobility restriction is
discussed.
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23. Nursing Diagnosis
1. Pain related to Pelvic Inter-vetebral Disc prolapse evidenced by
verbalization.
2. Impaired physical mobility related to the presence of traction, pain and
discomfort evidenced by observation, facial expression and verbalization
by patient.
3. Self-care deficit related to the presence of traction, discomfort
4. Anxiety related to hospitalization as evidenced by verbalization and
client & family appearing withdrawn.
5. Altered sleep pattern related to noise, light and unfamiliar environment
6. Deficient knowledge related to the treatment measures, duration of
hospitalization and prognosis 23

24. Implementation
1. Use pillows to support the back.
2. Provide back rub periodically.
3. Provide non-pharmacological measures like diversion, massaging,
positioning.
4. Administer analgesics as prescribed.
5. Provide active and passive exercises to all the extremities.
б. Advice the patient to perform breathing exercises.
7. Arrange or manage articles within the reach of the patient.
8. Provide positive reinforcement to the patient.
9. Maintain traction and explain the need of the traction.
10. Assist the patient doing self-care activities. 24

25. Evaluation (Resolution phase)
•Evaluation will be done according to presetting goals.
For examples, client explains, relief of pain, free to express
feelings, thoughts, use call bell, cooperate and achieve activities
within her limits, perform active and passive exercise, explain
disease and treatment process etc.
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26. Research article
• Peplau's theory is one of the early Nursing theories, published in 1952. The
nurse-patient relationship consists of four steps (orientation, identification,
development and conclusion). In these steps nurse could have the role of
foreign, reliable person, teacher, guide in nursing care, substitute and
consultant. Nurse-patient relationship is influenced by psychobiological
experiences (needs, frustrations, conflicts and anxiety) which need
dynamism. Peplau thinks that Nursing care is an important opportunity for
nurse because she can help patient to complete the infancy psychological
tasks (learning to rely on other people, learning to show satisfaction, self-
identifying, and developing ability in sharing) if these are not completed. For
these reasons Nursing, by Peplau, is a maturation strength of civilization.
Vellone E, Piras G. La teoria del nursing psicodinamico di Hildegard E.
Peplau [The psychodynamic nursing theory by Hildegard E. Peplau]. Prof
Inferm. 1997.
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27. Summary
• In her Interpersonal Relationship theory, Dr. Peplau emphasized the
nurse -client relationship as the foundation of nursing practice. She
emphasized on the give-and-take of nurse-client relationships. Peplau
develop interpersonal model emphasizing 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). Nurses,
she thought, could facilitate this through observation, description,
formulation, interpretation, validation, and intervention.
• For example, as the nurse listens to her client she or he develops a
general impression of the client's situation. The nurse then validates his
or her inferences by checking with the client for accuracy. The result
may be experiential learning, improved coping strategies, and personal
growth for both parties.
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28. References
• Sharma M. Nursing Concepts and Principles. 3rded. Gattekulo Rautahadevi,
Kathmandu: Samiksha Publication Pvt. Ltd;2019: 219-224.
• Rai L. Nursing Concepts, Theories and Principles. 3rded. Chettrapati,
Kathmandu: Tara Books and Stationery; 2015: 230-235.
• Vellone E, Piras G. La teoria del nursing psicodinamico di Hildegard E.
Peplau [The psychodynamic nursing theory by Hildegard E. Peplau]. Prof
Inferm. 1997 Oct-Dec;50(4):39-44. Italian. PMID: 10474451.
• Peplau HE. Interpersonal Relations: A Theoretical Framework for
Application in Nursing Practice. Nursing Science Quarterly. 1992;5(1):13-
18. doi:10.1177/089431849200500106
• Peplau HE. Peplau’s Theory of Interpersonal Relations. Nursing Science
Quarterly. 1997;10(4):162-167. doi:10.1177/089431849701000407
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