Hildegard Peplau's Theory of Interpersonal Relations incorporated psychology into
the field of nursing and created the framework that explains communication between
nurses and their patients. Her contributions to nursing practice and education were
instrumental in changing nursing from a skill to an independent profession.
Peplau developed her theory after years of clinical experience and education. Even
though she had a bachelor's degree in interpersonal psychology and a master's degree
in psychiatric nursing when she completed her theory manuscript, she was not able to
find a publisher because it was not co-authored by a physician. By improving nursing
practice and education, she fought to eradicate this kind of prejudice. Her book,
Interpersonal Relations in Nursing, was finally published in 1952 after she waited
four years to find a publisher.
Although Peplau's specialty was psychiatry, her theory can be applied to almost all
areas of nursing. She was the first person to apply the concepts of interpersonal
relationships to nursing. Psychodynamic nursing requires that nurses have an understanding
of their own behaviors and apply that understanding to their interaction with patients.
Nurses and patients work together to identify problems and find solutions.
Phases of Interaction
- The orientation phase identifies the problem. The patient and nurse become acquainted and decide on the type of service that is needed. They share expectations, and the nurse assesses the patient's health status.
- The identification phase includes the development of the nursing care plan. The plan depends on the patient's health status and goals. In this phase, the patient has a sense of belonging and develops the skills to deal with problems. These skills decrease the sense of helplessness.
- The exploitation phase is the use of professional services by the patient. Resources are utilized for problem solving. The nurse needs to understand the patient and make him or her a part of the treatment plan. This phase carries out the nursing plan and moves toward meeting goals that were set.
- The resolution phase is the end of the professional relationship between the patient and the nurse. If a psychological dependence is present, this can be difficult. This is also the time for evaluation of the nursing process. Both the nurse and patient need to determine if the mutually set goals were adequately met.
Primary Nursing Roles
Peplau describes nursing as a healing art. The goals of psychodynamic nursing are
to understand behaviors, help others to recognize their problems and apply the principles
of interpersonal relationships to these problems. Nurses and patients work together to
achieve these goals and become knowledgeable in the process of care.
There are some limitations to Peplau's nursing theory. It does not speak to preventative
health, health promotion or health maintenance. While it emphasizes interpersonal
relationships between patients and nurses, it does not address the larger issues of
family dynamics, the social environment or social service resources. It cannot be
used for patients who are incapable of communicating their needs. Some portions of
the theory are very general in interpretation.
Even with its shortcomings, Peplau's Theory of Interpersonal Relations was revolutionary
for its time and is still used in nursing practice today. Hildegard Peplau studied the
masters of psychiatry, applied their thoughts to nursing and provided the framework for
the specialty of psychiatric nursing. Even though her theory emphasizes psychiatric
aspects of nursing care, it can be used in conjunction with other theories and all
areas of nursing will benefit from applying sound principles of psychiatry to their
- Nurses communicate with patients and learn to know them. They are no longer strangers.
- Nurses are teachers who convey important health information to patients.
- Nurses manage medical resources by interpreting data and answering questions.
- Nurses counsel patients and help them understand the meaning of their current situation. They provide guidance and encouragement.
- Nurses act as patient advocates.
- Nurses serve as leaders who initiate goal setting.
- Nurses are technical experts who provide physical care and operate equipment.
Publications related to the Theory of Interpersonal Relations
Several short videos can be viewed on YouTube that give an insight into the strength
and determination of Hildegard Peplau. Collections of her works are stored at the
University of Pennsylvania and in the Schlesinger Library at Harvard University.