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‡‘ Born in Reading, Pennsylvania on September 1,1909.

‡‘ Graduated from Pottstown, Pennsylvania in 1931.

‡‘ Done B.A. in interpersonal psychology from Bennington College in 1943.

‡‘ M.A. in psychiatric nursing from Colombia University, New York in 1947.

‡‘ Ed.D. in curriculum development in 1953.

‡‘ Started first post baccalaureate program in nursing.

‡‘ Published the book Interpersonal Relations in Nursing in 1952.

‡‘ 1968: interpersonal techniques-the crux of psychiatric nursing.

‡‘ 1969:executive director of ANA.

‡‘ 1970-1972: president of ANA .

‡‘ As second vice-president from 1972-1974.

‡‘ Worked with W.H.O, NIMH and army nurse corps during world war II,worked in a
neuropsychiatric hospital England.

‡‘ Dr.Peplau ³retired´ in 1974.

‡‘ Her 1952 book was reissued in 1988 by Springer ,New York.

‡‘ Director of the New Jersy State Nurses Association.

‡‘ National Nurse Consultant to the Surgeon General of the Airforce.

‡‘ Nursing consultant to the United States Public Health Service.

‡‘ Chaired the editorial board of ¦
¦   


 


‡‘ Editorial board of the Journal of Psychosocial Nursing and the Î

  



and   

.

‡‘ In 1987, honoured as first psychosocial nurse of the year by  Î

 


  



‡‘ In 1994,Peplau¶s career was highlighted by her induction into the American Academy
of Nursing Living Legends Hall of Fame.

‡‘ In 1995, one of the 50 Great Americans chosen to be included in the 50th Edition of
Who¶s Who in America.

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 a‘ Nurse thinks and feels about the patient before interacting according to her
knowledge, fears and misconcepts.
a‘ Collect information from secondary sources.
a‘ ahe nurse plans how she is going to interact with the patient.
a‘ She plans her ob+ective for interaction phase.
a‘ ahe nurse may experience anxiety.

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a‘ ³Will the patient talk to me?

a‘ He may not accept me or like me?
a‘ He may beat me?´
a‘ Once she goes to the patient then anxiety reduces.

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a‘ She can go through their record.

a‘ aalk to the clinical supervisor or other nurses about her fears.
a‘ Can set her goals very clearly.
a‘ Plan a brief interaction with the patient.

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a‘ Begins when the nurse goes to the patient, introduces herself and gets introduction
about him.
a‘ ahe nurse and client get acquainted.
a‘ Ends when the nurse and the patient begin to accept each other as a unique human
being.

* +
'   Ê ,

a‘ Establishment of Contact
a‘ Making Agreement or Pact
a‘ aalking with the Patient
a‘ Assess the Clients Need, Coping Strategies, Defense Mechanisms, Strengths and
Weakness


  
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a‘ Establishing an agreement or pact.

a‘ Social class of the patient or the nurse.
a‘ Status of the patient.
a‘ Anxiety level of the patient and nurse.
a‘ aransference
a‘ Counter transference

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a‘ Actively work on meeting the goals which they had establish during the
orientation phase.
a‘ Nurse is able to overcome anxiety and the patient¶s fear of unknown is also
decreased.

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a‘ ahe nurse collects the data.

a‘ Identifies the needs of the patient.

-,

a‘ ao identify his or her problem.

a‘ ao communicate.
a‘ ao socialize.
a‘ ao find an alternative solution to his or her problems
a‘ ao use new patterns of behavior.
a‘ ao develop positive coping behaviors.
a‘ ao understand that he has a significant role in his treatment.
a‘ ao explore the clients perception of reality and provide constructive feed back.
a‘ Developing and implementing plan of action with a realistic goals.
a‘ Evaluating the results of plan of action.
a‘ Also prepares the patient for termination of relationship.

Ê-

a‘ ao develop knowledge and skill in psychiatric nursing.

a‘ ao identify her strengths and weakness
a‘ ao achieve the goals which they have plan.

ahe end results lead the patient to verbalize, socialize, identify and faces the problems
realistically.

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Example:

a‘ Patient: ³please continue talking I am very upset today««.´ If the nurse gives in
to his demand, it indicates manipulation.
a‘ He may deliberately be aggressive to test whether he is able to arouse anger in the
nurse.

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‡‘ A mentally ill patient may not show a quick progress. He may progress then regress
and remains stagnant before making further progress.

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Fear of closeness

 
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a‘ Learn the sub+ect in depth

a‘ aaking help from supervisors and experts
a‘ Discussions with peer group

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a‘ ahe nurse terminates the relationship when they mutually agreed: or goals are
reached
a‘ ahe nurse discusses the termination phase with the client.
a‘ clients commonly exhibit regressive behaviour demonstrates hostility or
experience sadness.
a‘ ahe client may attempt to prolong the relationship.

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a‘ ahe client is transferred or discharge.

a‘ ahe nurse is finished clinical rotation.
a‘ ahe client has improved and no longer needs to have one to one relationship.

* + /
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'

a‘ Bring a therapeutic end to the relationship.

a‘ Review feelings about relationship.
a‘ Evaluate progress towards goal.
a‘ Establish mechanisms for meeting future therapy needs.
a‘ Summarize entire communication and follow up treatments.

 
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'

a‘ Explain whatever goals of therapeutic relationship where plans have been met.
a‘ Allow the patient to talk about his or her fear.
a‘ A psychiatric social worker can be contacted to meet to visit the office and family
of the patient.
a‘ ahe patient may be sent through a half way home.
a‘ ahe patient may be asked to attend the day care center for few days.

ÿ

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'Ê 

a‘ ahe patient may ask the nurse to write to him or come back from duty and see
him.
a‘ ahe patient may ask the address and telephone number of nurse
a‘ Gift giving
a‘ ahe nurse may withdraw earlier from the patient due to her own anxiety she may
not interact with the patient

 
  . ^ / ,

a‘ Nurse needs to explore her own feelings and thoughts about separation from the
patient.
a‘ ahe patient should be explained that µevery relationship terminates¶
a‘ Getting help from supervisors
a‘ After discharge the patient comes for intervention he or she should be referred to a
second in charge.
a‘ If the patient is giving some gifts: the patient need to be explained about the
professional ethics, if he wants to give a gift he may be encourage to gift out
something for the utilization of other patients.

 
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a‘ It is the nurse-client interaction that is toward enhancing the client's well-being,

and the client may be an individual, a family, a group or a community.
a‘ Peplau thought the basic element of the relationship is what goes on between
the nurse and patient .
a‘ ahe relationship depends on the interaction of thoughts, feelings, and actions of
each person .
a‘ ahe patient will experience better health when all their needs are fully considered
in the relationship.

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a‘ Problem defining phase.
a‘ Starts when client meets nurse as stranger.
a‘ ahe patient /the family has a ³felt need´.
a‘ Defining problem and deciding type of service needed.
a‘ Client seeks assistance, conveys needs , asks questions, shares preconceptions and
expectations of past experiences.
a‘ Nurse - patient rapport is established and continues to strengthened.
a‘ Nurse responds, explains roles to client, helps to identify problems and to use
available resources such as psychologist, social worker or psychiatrist and other

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 services.


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a‘ In summary, in the beginning of the orientation phase , the nurse and the patient
meet as strangers.
a‘ At the end of the orientation phase , they are concurrently striving to identify the
problem and are becoming more comfortable with one another.
a‘ In addition , the patient becomes more comfortable in the helping environment .
a‘ ahe nurse and the patient are now ready to logically progress to the next phase,
identification.


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By Phillips,KennethD. Journal of American college of health,35,11-14.

#: Although combination therapies slow progression of HIV disease, HIV-infected

women face new challenges that must be overcome to increase their life expectancy. One
challenge is adherence to strict, and often unpleasant, drug regimens. Peplau's aheory of
Interpersonal Relationships provides a framework for identifying and examining factors that
influence medication adherence, in particular difficulties in taking medication. ahis study
supports the importance of a therapeutic relationship between PHCPs and patients in
overcoming difficulties associated with taking HIV medications.

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‡‘ Each patient responds differently in this phase


 For e.g. the patient might actively seek out the nurse or stoically wait until the nurse
approaches. ahe response to the nurse is threefold:

±‘ Participate with and be interdependent with the nurse

±‘ Be autonomous and independent from the nurse, or

±‘ Be passive and dependent on the nurse.

a‘ both the patient and nurse must clarify each other¶s perceptions and expectations.
a‘ Past experiences of both the patient and the nurse will influence their expectations
during this interpersonal process
a‘ ahe patient is now responding to the helper selectively. ahis requires a more intense
therapeutic relationship.

a‘ Selection of appropriate professional assistance

a‘ Patient begins to have a feeling of belonging and a capability of dealing with the
problem which decreases the feeling of helplessness and hopelessness.

G‘ --,
a‘ Use of professional assistance for problem solving alternatives.
a‘ Advantages of services are used is based on the needs and interests of the patients
a‘ Individual feels as an integral part of the helping environment
a‘ make minor requests or use other attention getting techniques, depending on their
individual needs.
a‘ ahe principles of interview techniques must be used in order to explore
,understand and adequately deal with the underlying patient problems.
a‘ Encourage the patient to recognise and explore feelings ,thoughts ,emotions and
behaviours by providing a non- +udgemental atmosphere.
a‘ Some patient¶s may take an active interest in, and become involved in, self care.
a‘ Such patients become self±sufficient and demonstrate intiative by establishing
appropriate behaviour for goal attainment.
a‘ ahrough self determination patients progressively develop responsibility for self,
believe in potentialities, and ad+ustment to word self-reliance and independence.
a‘ ahey strive to achieve a directions in their lives that promotes a feeling of well-
being.
a‘ As a result of this self determination, they develop sources of inner strength that
allow them to face new challenges.
a‘ Nurse must be aware about the various phases of communication tools such as
clarifying, listening, accepting, teaching and interpreting to offer services to the
patient.

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a‘ aermination of professional relationship.

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 a‘ ahe patients needs have already been met by the collaborative effect of patient
and nurse.
a‘ Sometimes may be difficult for both as psychological dependence persists. for e.g.
a new mother has a desire to learn infant care.

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a‘ Orientation a‘ Problem defining phase

a‘ Identification a‘ Selection of appropriate professional

assistance
a‘ Exploitation
a‘ Use of professional assistance for problem
a‘ Resolution solving alternatives

a‘ aermination of the professional relationship

/1  /
')

1. ahe kind of person the nurse becomes makes a substantial difference in what each patient
will learn as he receives nursing care.

2. Fostering personality development toward maturity is a function of nursing education.

Nursing uses principles and methods that guide the process toward resolution of
interpersonal problems.

One implicit assumption was, ³ahe nursing profession has legal responsibility for the
effective use of nursing and for its consequences to patients.´

 
Ê '' 
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‡‘ /'-as an organism that ³strives in its own way to reduce tension generated by
needs´.

‡‘ Ê Ê-is defined as ³a word symbol that implies forward movement of

personality and other ongoing human processes in the direction of creative,
constructive, productive, personal, and community living´.

‡‘ Although Peplau (1952/1988) does not directly address ë
 

J she
does encourage the nurse to consider the patient¶s culture and mores when the patient
ad+usts to hospital routine. Peplau has a narrow perception of the environment, which
is a ma+or limitation of her theory. ahe theory does not examine the broad range of
environmental influences on the person but focuses more on the psychological tasks
³within the person´.

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 ‡‘ ' 
') ³a significant, therapeutic, interpersonal process´.

She defines it as a ³human relationship between an individual who is sick, or in

need of health services, and a nurse especially educated to recognise and to respond to the
need for help´.

 
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‡‘ Nursing process is defined as an ³a deliberate, intellectual activity whereby the

practice of nursing is approached in an orderly, systematic manner.´

1.‘ Both are sequential and focus on therapeutic interactions.

2.‘ Both stress the nurse and the patient should use problem-solving techniques
collaboratively, with the end purpose of meeting the patient¶s needs.

3.‘ Both emphasize assisting the patient to define general complaints more specifically
so that specific patient needs can be identified.

4.‘ Both use observation, communication, and recording as basic tools for nursing
practice.

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Data collection and analysis continuous data collection

May not be a felt need Felt need
Define needs

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Summary statement based on nurse Interdependent goal setting. Patient has

analysis. feeling of belonging and selectively
responds to those who can meet his/her
''
' needs.
Mutually set goals

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'

Plans initiated towards achievement of Patient actively seeking and drawing on

mutually set goals knowledge and expertise of those who can
help.
May be accomplished by patient , nurse or
family Patient initiated

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'

Based on mutually expected behaviours. Occurs after other phases are completed
successfully
May led to termination and initiation of
new plans Leads to termination of relationship.

-
"---,

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c  -

a‘ Client is initially reluctant to talk due to pain.

a‘ Client is expressing that while standing she is having much pain.
a‘ Client expressed without movement and supine position gave her relief from
pain.

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a‘ ahe client participates and interdependent with the nurse

a‘ Expresses the need for measure to get relief from pain
a‘ Expresses need for improving the mobility
a‘ Expresses need to know more about prognosis, discharge and home care and
follow up.

G -

a‘ Client explains that she gets relief of pain when lying down supine.
a‘ Cooperates and participates actively in performing exercises.
a‘ Client mobilizes changes position and cooperates during position changes.

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a‘ Client expressed that pain has reduced a lot and she is able to tolerate it now
a‘ She has agreed upon to continue the exercises at home
a‘ She also expressed that she would come for regular follow up after discharge.

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1.‘    -   %"      %" 
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a‘ Four phases interrelate the different components of each phase.
a‘ ahe nurse patient interaction can apply to the concepts of human being ,health,
environment and nursing.

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a‘ Provides a logical systematic way of viewing nursing situations

a‘ Key concepts such as anxiety, tension, goals, and frustration are indicated with
explicit relationships among them and progressive phases.
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a‘ It provides simplicity in regard to the natural progression of the Nurse-Patient
relationship.
a‘ Leads to adaptability in any nurse patient relationship.
a‘ ahe basic nature of nursing still considered an interpersonal process

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5. ##"%%
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a‘ In 1950¶s two third of the nursing research concentrated on Nurse-Patient

relationship.

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a‘ Peplau¶s anxiety continuum is still used in anxiety patients

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a‘ Intra family dynamics, personal space considerations and community social service
resources are considered less.
a‘ Health promotion and maintenance were less emphasized.
a‘ Cannot be used in a patient who doesn¶t have a felt need e.g. With drawn patients,
unconscious patients.
a‘ Some areas are not specific enough to generate hypothesis.


-,

 -"-"  Ê -   !  -- % 
!

By Burton L. ahelander. Journal of psychosocial nursing,2,35-38

^ '^ 
': Peplau's theory can be used to help patients resolve symptoms by
guiding them through the steps of observation, description, analysis, formulation, validation,
testing, integration, utilization.

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‘ ‘ 
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p a‘ p‘   

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a
c ÿG$ +  Developed and tested a nursing
intervention framework for
working with anxious patients.
Sample was 25 psychiatric
nursing students consisting of 15
freshman and 10 postgraduate
students.
c ÿcÊ"$  Provided a description of phases
and steps of experiential
teaching about anxiety to a
patient group. Sample was 6
female psychiatric patients.
^
'^ 

'
Freshman students can develop
beginning competency in
interpersonal relationships. ahe
earlier the students gains theoretical
knowledge, the more the student is
aware of his/her own anxiety. As
students work with patients, patients
respond by going through sequential
phases including denial, ambivalence
and awareness of anxiety.
Verbal analysis of the group revealed
that, when taught by the experiential
method, the patients were able to
apply the concepts of anxiety after
the group was terminated.
+Ê
)

a‘ Interpersonal theory is especially useful in psychiatric nursing and is useful in

relation to psychosocial problems and nurse-patient relationships in all clinical
areas of nursing.
a‘ It has contributed to nursing in the areas of clinical practice, theory, and research,
adding to today¶s base of nursing knowledge.

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