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Interpersonal Relations Theory

Hildegard Peplau proposed the interpersonalrelations theory. She was born in the year 1909 to immigrantparents who lived in Pennsylvania. In 1931, Peplau graduated fromPottstown Hospital School of Nursing with a diploma (Masters, 2015).In 1943, she graduated from Bennington Collegewith a Bachelor of Arts degree in Interpersonal Psychology. She thendid her master’s degree in psychiatric nursing graduating in 1947at Columbia University’s Teachers College. Ultimately, HildegardPeplau attained her curriculum development EdD from the sameinstitution in 1953. Most often, she has been considered the brainsbehind psychiatric nursing besides the theory. Additionally, Peplauwas significant in establishing credible contributions to nursing asa profession, enhancing professional education, and upholding nursingstandards by emphasizing on the need for self-regulation of theprofession (Masters, 2015). The greatest anchorage of her work is inthe personal practice and experiences that she undertook as aprofessional nurse and a polymath. As such, the interpersonalrelations theory carries important concepts and vital relationshipsthat can help a nurse render therapeutic interventions to anindividual, family, community, and other populations.


The “interpersonal relations” is a middle-range theory thatfocusses on the relationship between the patient and the nurse. Itcaptures all the meta-paradigms in nursingbut majorly inclines towards an importantconcept the relationship between a person withanother. In this regard, Peplau posits that the epicenter ofnursing is the nurse-patient relationship (Masters, 2015). During theearly years of proposing this theory, Peplau identified fouroverlapping phases of the nurse-patient relationship orientation,identification, exploitation, andresolution. However, she merged the identificationand exploitation phases in1997 to “workingphase.”. Thus, the resultant phases areorientation, working and termination. Despite this phenomenon, someof the practicing nurses still utilize the initial four stages.During the orientation phase, there is theemergence of a health problem requiringprofessional assistance due to need that isfelt by the patient. Thus, the client seeks help. In the workingphase, there is the identification ofexperts who can assistthe patient and the nurse explores the feelings of the client.Furthermore, the nurse focusses the patient on new therapeutic goalsthat need to be achieved. Finally, thepatient will adopt the new goals anddisengage himself or herself from the nurse (Masters, 2015).

When these phases are explored, thepatient will assume various roles such asthe stranger and patient. There is no doubt that thepatient may adopt roles of infants, children, adolescents or adultsbased on his or her personality or previous encounters.However, the pressure and stress of the disease or illness maysubject him or her to regression. Therefore, the nurse’s roleduring the interaction is heavily influenced by the patient’s roleas well. In this regard, Hildegard Peplau identified refined roles ofthe nurse as a teacher, counselor, resource, surrogate, technicalexpert, and a leader. When acting as a teacher, the nurse will giveout knowledge about a certain problem orneed. The nurse as a counselor will help in the recognition, facing,acceptance and resolution of challenges. Aresource nurse provides information that helps in understanding theproblem. Through interaction, the nurse leader partakes in theinitiation and maintenance of group goals. Furthermore, he/sheutilizes the clinical skills in the provision of physical care in thecapacity of a technical expert.

Imperatively, Peplau notes that the nurse may assume the role ofanother person who may not be available. Thisis in relations to the role of a surrogate (Masters, 2015).

Peplau also presented four experiences that are psychobiologicalfrustrations, conflict, needs, and anxiety.She insists that these experiences possess some energy that can beconverted to an actionable course. As such,they form part of the base in the establishment of goals and nursinginterventions. When the psychological or biological security of anindividual is threatened, he or she willdevelop anxiety. Anxiety is elicited inrelationship to communication with other people. In this regard,Peplau established that illness and anxietyare directly related because the energy expressed in the latter canbe assessed and used in equal measuretowards achieving the solution to the problem (Peplau, 2012). Throughthe utilization of a nurse-patient relationship, the nurse canknow how anxiety affects the patients’ decision-makingprocess, achievement of goals and willingness to change for thebetter. Therefore, the nurse needs to be skilled enough in theassessment of the client’s communication and the changes that mayhave been initiated by anxiety. Additionally, the patternintegration concept is linked to theimplementation of the theory. It refers to the uncanny identificationof patterns in the interpersonal relationshipsand being able to manipulate them to foster the transformation ofenergy towards a necessary course. Thisconcept occurs in four phases alternating patterns, complimentarypatterns, mutual patterns, and antagonistic patterns. Themeta-paradigm concepts of the theory hold that a person encompassesthe patient having problems that need nursing services, and a nursewho is the expert (Peplau, 2012). It also describes the environmentas the external forces from the organism within the culture’scontext. Moreover, health is seen as aforward personality movement and other human processes that areongoing in the course of constructive, creative, personal, communityand productive living (Peplau, 2012). Importantly, the theory viewsnursing as the interpersonal therapeutic process between the nurseand his or her patient.


As mentioned earlier, Peplau’s theory is mainlyinclined towards her practice and personal experiences. It allranges from her interaction with professionals in medicine,education, and sociology to psychiatry (Townsend, 2015). Theunderstanding that she had about the effects of illnesses to peoplewas supported by the 1918 great influenza epidemic that directlyaffected her. Moreover, she had vast teaching and clinicalexperiences (Senn, 2012). During the Second World War, Peplau workedin a neuropsychiatric facility (Townsend, 2015). Additionally, shetaught psychiatric nursing at graduate levels at both Rutgers andColumbia Universities. Again, she later retired but still served asUniversity of Leuven’s visiting professor, helping in theestablishment of Europe’s first nursing program at the graduatelevel. Peplau also considerably partook inthe leadership of nursing professional bodies. She was AmericanNurses Association’s president and executive director, New JerseyState Nurses Association’s director, and a member of World HealthOrganization’s Expert Advisory Council. These among other roleshelped foster the coining of the interpersonal relations theory(Senn, 2012).

Patients with a coronary artery bypass are prone to dangerouslevels of anxiety and depression because of various personal andclinical reasons (Zarea, Maghsoudi, Dashtebozorgi, Hghighizadeh &ampJavadi, 2014). When we revisit the four psychobiological experiencesof the patient as established in theory,one can see that anxiety is essential.Therefore, a proper nurse-patient relationship that isanchored on communication is known to lower anxietylevels. The theory posits that the energy that isused in the expression of anxiety can beredirected towards the realization of the therapeutic goals.When the nurse utilizes his or her role of a technical expert toexplain the physiological risks of depression and anxiety and giveclinical interventions to a patient with a coronary artery bypass,the results shall be good, and the healingprocess shall be shortened (Zarea et al.,2014). To see these effects, the nurse can use depression and anxietyscale to understand the outcomes of the interventions. Through thefour stages of the relationship, the nurseuses all the six roles to see the patient through a proper,interactive and successful health care session.

The interpersonal relations theory can be employedin the practice of research mainly in improving the recruitment ofthe subject, participation, collection of data, and its analysis(Penckofer, Byrn, Mumby &amp Ferrans 2011). The selection of thesubject is anchoredon the relationship between the patients and study personnel. It alsoimproves the participation of clients in the research process. Thetheory identifies the three phases of the relationship that can alsobe utilized in a surveyprocess orientation, working and termination. Penckofer andcolleagues in a study identified that the nurses who carried out asuccessful research were directly advantagedby their soft skills of interpersonal relationships and goodcommunication with the patients, who were respondents in this case(Penckofer, Byrn, Mumby &amp Ferrans 2011). The researchers alsoconcluded that the theory is not only helpful in clinical situations,but also in the context of research. Therefore, it isclearly identified that Peplau’s theory is highly relevantto research.


Hildegard Peplau is the proponent of the interpersonal relationstheory that identifies three phases of a nurse-patient relationship.These phases are orientation, working and the termination phase. Thetheory also captures the nursingmeta-paradigms of a person, nursing,health, and the environment. Peplau was born in Pennsylvania toimmigrant parents in 1909. She is personallylinked with the theory. She worked as a psychiatric nurseduring the Second World War and a nurse educationist across Americaand Europe. The theory is also importantfor patients who have a coronary artery bypass because of themanifestation of depression and anxiety. Additionally, it is vital indoing research as established by Penckofer and a group of otherresearchers. Again, it is imperative to look at the limitations andstrengths of this theory.


  • The theory provides phases that create simplicity about the natural progression of the relationship between the nurse and the patient.

  • The simplicity causes adaptability in the nurse-patient relationship.

  • It provides a logical way of viewing the patient in a systematic manner through the four phases.

  • The anxiety continuum of the theory has been successful and continues to be utilized in modern practice.

  • The theory is consistent with others such as Florence Nightingale’s Environmental theory. Therefore, they can be used simultaneously for the good of the patient (Spray, 2015).


  • There is less consideration of the personal space and the resources of community social service in theory.

  • Health maintenance and promotion are less-emphasized by Peplau.

  • Some areas like the relationships are not very accurate to be utilized in the creation of hypotheses.

  • The theory is less effective in patients who do not have a “felt need”. These patients include those who are unconscious and withdrawn (Spray, 2015).


Masters, K. (2015).&nbspNURSINGTHEORIES: a Frameworkfor Professional Practice&nbsp(2nded., pp. 168-174).

Penckofer, S., Byrn, M., Mumby, P., &amp Ferrans, C. E. (2011).Improving subject recruitment, retention, andparticipation in research through Peplau’s theory of interpersonalrelations. Nursing science quarterly, 24(2),146-151

Peplau, H.(2012).&nbspInterpersonalRelations in Nursing (Reviewed)&nbsp(1sted.). New York: Springer Pub. Co.

Senn, J. (2012). Peplau`sTheory of Interpersonal Relations: Application in Emergency and RuralNursing.&nbspNursingScience Quarterly,&nbsp26(1),31-35.

Spray, L. (2015). LivingInterpersonal Theory: The Hildegard Peplau-Suzanne Lego Letters,March 1998-March 1999.&nbspPerspectivesIn Psychiatric Care,&nbsp35(4),24-42.

Townsend, M.(2015).&nbspPsychiatricmental health nursing&nbsp(1sted.). Philadelphia: F a Davis.

Zarea, K., Maghsoudi, S., Dashtebozorgi, B., Hghighizadeh, M. H., &ampJavadi, M. (2014). The impact of Peplau`stherapeutic communication model on anxiety and depression in patientscandidate for coronary artery bypass. Clinicalpractice and the epidemiology in the mental health:CP &amp EMH, 10, 159.