By: Amanda Badgley Tori Gwilt Christine Demler

Born in Reading, Pennsylvania in 1909 Obtained her RN through a diploma program in 1931 1943- BA in interpersonal psychology 1947- MA in psychiatric nursing 1952- Published Interpersonal Relations in Nursing Executive and president of ANA, 1998 inducted into the ANA Hall of Fame (Current Nursing, 2012)

After working with psychiatric patients, Peplau wanted nurses to develop a nurse-client relationship Peplau was inspired by her psychiatric patients and they way they were treated to change how nursing was being practiced (Forchuk, 2007)

Explains the phases of interpersonal process, the roles in nursing situations and the methods for studying nursing as an interpersonal process (Forchuk, 2007). Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal (the patient, nurse, family, ect). The attainment of the goal is achieved through the use of a series of steps following a series of pattern (reflects the nursing process).

The nurse and patient work together so both become mature and knowledgeable in the process. Nurses should apply principles of human relations to the problems that arise at all levels of experience (Current Nursing, 2012). The theory focuses on the patient-nurse relationship being therapeutic.

The four global concepts of nursing play an important role in Peplaus theory. According to Peplau, a person is defined as an evolving arrangement of mind, body, and sociality that strive to live in homeostasis, yet are unable to reach that stable condition. The environment, although not directly defined by Peplau, is viewed in the relationship between the nurse and the patient. Peplau does encourage the nurse to step outside of the hospital arena and take into account the patients cultural beliefs and surroundings. The term health, is described as a symbol that implied forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal, and community living" (Peplau, 1992, p.12).

Peplau is credited with stating that the concepts of nursing have changed as our world has transformed. Nursing in the past was about healing sick people, whereas today, it is more about keeping people from getting sick. Peplau believed that nursing was comprised of two major qualities; that of education and therapy. Peplau believed that when the two actions are combined together, it creates an environment where the nurse can benefit the patients needs and develop critical thinking skills. Peplaus theory of interpersonal relations expertly uses the definitions of the four global concepts to directly focus on the nurse, patient, and fostering the healthy and supporting relationship between the two.

Counselor Resource Teacher Technical expert Surrogate Leader Note: Depending on the setting, the nurse will spend more or less time in each of the roles, (Chitty & Black, 2011).

Definition: helps to understand and integrate the meaning of current life circumstances ,provides guidance and encouragement to make changes (Current Nursing, 2012) The nurse as a counselor provides guidance and plenty of encouragement to make positive changes in the patients life.

Definition: one (the nurse) who provides a specific needed information that aids (the patient and family) in the understanding of a problem or new situation; Answers questions, interprets clinical treatment data, gives information Patients rely on their nurses to be their primary resource for their needs. Nurses provide education regarding a wide variety of issues, and the nurse must be knowledgeable to provide them information.

Definition: one who imparts knowledge in reference to a need or interest Nurses are teachers by trade; nurses are always giving patients education regarding medications, disease processes, ect. Example: A nurse must teach a patient about their new diagnoses of diabetes. The patient needs to know about their medications, diet, exercise, what to do on a sick day, use a glucometer, and how to overall manage their condition.

Definition: provides physical care by displaying clinical skills; Operates equipment (Landry, 2009) The nurse provides physical care to each patient by performing dressing changes, starting IVs, inserting Foley catheters, and providing basic care needs. Nurses operate IV pumps, pain pumps, medication carts, lift equipment, respiratory equipment (i.e. vents) Patients rely on nurses to be trained and knowledgeable about the equipment they are using daily and the skills they are performing

Definition: the nurse must be supportive of the patients needs, and at times, assume the role of some meaningful person in the patients life in an effort to develop a close bond and assist in the healing process. There are times when the nurse must adopt the role of the patients representative or conduit in order to support emotional well-being.

Example- In the event that a patient has experienced some sort of trauma, it is the nurses responsibility to be empathetic and have an understanding and comforting soul. Many times, it means treating the patient as a close friend or relative so that the patient feels reassured and free to express emotions. This therapeutic action will greatly contribute to the emotional and mental restoration of the patients psyche.

Definition: the nurse and patient must first learn to trust one another based upon the understanding of working toward accomplish a goal. Peplau theorizes that the nurse acts as the patients leader whilst receiving care. In order for the relationship to succeed, the nurse must understand the objective, communicate and cooperate with the patient to set achievable goals, and take action in order to achieve the final result. In a situation such as this, the nurse and patient must agree on the final aim in order to collaborate together and make progress on the goal(s).

Example: Goal: A patient decides to quit smoking cigarettes. Communication: The nurse discusses this goal with the patient, and creates an action plan based upon the patients readiness to change lifestyle. Action: The nurse and patient work together, communicate frequently, and take steps to achieve the end goal. In this illustration, the nurse took the leadership role to ensure that the patient was mentally, emotionally, and physically ready to take the steps necessary to quit smoking.

1) Orientation 2) Identification 3) Exploitation 4) Resolution

Get acquainted phase Relationship parameters are established Early stages of trust are being developed Roles begin to be understood Problem beginning to be understood and services required are discussed Expectations are reviewed

Problem fully identified and reviewed Nurse and patient decide on level of assistance needed Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness, (Current Nursing, 2012).

Patients trust of the nurse has reached full potential The patient should be making full use of nursing services offered Solving immediate problems Identifying and orienting patient to goals The patient should feel as an integral part of the helping environment (Current Nursing, 2012)

Termination phase Patients needs/goals have been met collaboratively Mutual termination of relationship Sense of security is formed Patient is less reliant on nurse Increased self reliance and esteem to deal with own problems

Both use problem solving techniques for the nurse and patient to collaborate on, with the end purpose of meeting the patients needs, (Current Nursing, 2012) Both have a sequential order they follow from a starting point to meet at an end point Both requires therapeutic communication

Nursing Process
Assessment Nursing Diagnosis/Planning Implementation Evaluation

Peplaus Phases
Orientation

Identification Exploitation Resolution

Is this philosophy unique to nursing? Hildegard Peplaus theory of interpersonal relations is unique to the nursing field because its primary focus is to build and foster the relationship between the patient and the nurse. This bond created between the patient and nurse then serves to aid the patient in physical, emotional, and spiritual healing. Is it clear what influenced this model? Peplaus career in psychiatric nursing played a key role in her development of the interpersonal relations theory. Her ability to relate to the patient as well as understand and empathize with their situation proved to be a significant discovery in the way nursing is practiced.

Are the concepts abstract or specific? Peplaus ideas and notions of her interpersonal relations theory are accurately and thoroughly defined. Because of this, her theory of nursing provides a consistent and organized method for dealing with situations in the nursing field. Have other theories been generated from this model? Peplaus nursing theory follows the model of a couple of different interpersonal theories, one created by a psychologist named Erich Fromme and the second shaped by a psychiatrist named Harry Stack Sullivan. In addition, Peplaus theory has been thoroughly studied. Narrow view? (Can this model be used in OB and OR?) Peplaus theory does have the basic, yet necessary properties needed in order to function in nursing specialty areas. For example, Peplaus theory could be effectively and efficiently used in floor nursing, labor and delivery, and psychiatric nursing, to name just a few areas.

What practice situations can/has this model been used in? Any situation in which the nurse is trying to relate to patient/situation is a great time to use Peplaus theory of interpersonal nursing. For example, this theory could be utilized as a nurse in labor and delivery attempts to connect with the patient who is about to give birth to her first child. The nurse would use this time to provide care and comfort to the expectant mother. Another illustration would be a patient on a post-surgical floor. The nurse could develop a bond with the patient by empathizing with the pain the patient is experiencing, while continuing to help the patient heal and return to normal activities. This type of relationship helps the patient to feel cared for, while the nurse is also promoting health and wellness.

Not a useful theory for patients who cannot create a meaningful relationship with another. Example: unconscious patient, withdrawn patient Some areas where health promotion and maintenance are less emphasized Complex family dynamics, and strictly limited personal space preferences of the patient

Mrs. Smith is a 25 year old female newly diagnosed with Diabetes Mellitus type 2. She was hospitalized for a blood sugar of 650 after presenting to the emergency room. Mrs. Smith was admitted to the CCU for ketoacidosis. She had severe vomiting, dehydration, and mental status change. After 4 days in the CCU, she was transferred to the medical floor. Mrs. Smith is in need of education regarding her diagnosis before anticipated discharge in 2-3 days. Mrs. Smith has 2 small children at home that she must care for along with herself when she returns home. She is also facing a divorce and has no family support that lives close by. Mrs. Smith is hesitant to learn about her new diagnosis and reports she is scared of needles. She is also having financial difficulties as well and is concerned about affording her new medications and diabetic supplies. Mrs. Smith does not comprehend the dietary guidelines that she needs to follow to control her diabetes. After a long education session with Mrs. Smith she states, I am too young to have to deal with this! Its not fair. As her nurse, answer the following questions regarding her care.

What roles do you think that the nurse is going to take on while caring for Mrs. Smith? Why? Do you think that having an interpersonal relationship with this patient is essential for her well-being? Give an example. By using Peplaus Phases of an Interpersonal Relationship, develop a nursing diagnosis, and a brief plan of action for this patient to be successful in managing her diabetes.

Arun (2011). Peplaus Theory and Application in Nursing. Slide World. Retrieved October 9, 2012 from http://www.slideworld.org/slideshow.aspx/peplaus-theory-.pptx-ppt2847041 Basavanthappa, T.P. (2007). Psychiatric Mental Health Nursing. New Delhi, India: Jaypee Brothers Medical Publishers Chitty, K.K., & Black, B.P. (2011). Professional nursing: Concepts and challenges (6th ed.) Maryland Heights, MO: Saunders Courey, T. J. (2008). Hildegard peplaus theory and the healthcare encounters of survivors of sexual violence. Journal of American Psychiatric Nurses Association, 14(2), 136-143. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163527/ Current Nursing. (2012, March). Nursing theories. Retrieved from http://currentnursing.com/nursing_theory/interpersonal_theory.html Forchuk, C. (2007). Hildegard peplau. Retrieved from http://publish.uwo.ca/~cforchuk/peplau/abotjrn.html Landry, A. (2009). Hildegard peplau. Suite 101, Retrieved from http://suite101.com/article/hildegard-peplau-a146646 Peplau, H.E. (1992). Interpersonal Relations in Nursing. New York: Springer