Theory of Interpersonal Relations

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Theory ofInterpersonal RelationsHildegard E.
PeplauA Middle-Range Nursing Theory

• By Sharetha Hollier

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Hildegard E. Peplau

• She was born on September 1 , 1909 in Reading,
  Pennsylvania.
• She was number two of six children from
  immigrants parents from Germany.
• After World War I ended in 19 18, the Flu
  Pandemic greatly impacted her understanding on
  illness and death in families.
• Schools were controlled by hospitals, formal
  learning was discouraged.
• Physicians and hospitals saw nurses as free
  labor or low wage labor.
• Nursing practice was controlled by medicine.
• http//publish.uwo.ca/cforchuk/peplau/obituary.ht
  ml)

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Hildegard E Peplau

• Nevertheless, in 1931, she graduated from
  Pottstown, PA, School of Nursing diploma program.

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Hildegard E. Peplau Continued

• After Nursing school she earned her Bachelor
  Degree in Interpersonal Psychology from
  Bennington College in 1943.
• Later , in 1947 she earned a Master in
  Psychiatric Nursing from Teachers College,
  Colombia University.
• In 1953, Ed. D. Nursing Education second
  graduate degree and curriculum developed from
  Columbia University.

• She received many honorary degrees
• She is known as the mother of psychiatric
  nursing
• Helped revolutionize the scholarly work of
  nurses.
• (Alligood Tomey, 2010)

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Work History

• In the beginning of her career she worked as a
  staff nurse in Pennsylvania and New York City.
• She held a position of Executive Director and
  President of the American Nurses Association and
  The National Institute of Mental Health
• She served as an Consultant for World Health
  Organization.
• She developed the first Graduate Program for
  clinical Specialist in Psychiatry.
• In 1943-1945 she served in the Army Nurse Corps
  World War II and assigned to an Hospital in
  England.
• (http//publish.uwo.ca/cforchuk/peplau/obituary.h
  tml)

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Foundation of Hildregard Peplaus Framework

• Her work was influenced by Freud, Maslow, and
  Harold Stack Sullivan.
• She attended lectures by Sullivan on
  Interpersonal Relations.
• She borrowed the psychological model to
  synthesize her Theory of Interpersonal Relations.
• Her work is specific to nurse-patient
  relationship.
• Her work is categorized as a theory for practice
  of nursing.
• (Alligood Tomey, 2010)

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Hildegard Peplau

• The first published nursing theorist in a century
  since Nightingale
• (Alligood Tomey, 2010)

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Publications

• In 1952 published Interpersonal Relations in
  Nursing.
• Published three books.
• Published numerous journals and speeches.
• Significance first nurse to synthesize nursing
  theory from other scientific fields.
• http//publish.uwo.ca/cforchuk/peplau/obituary.ht
  ml)

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Hildegard E. Peplau

• Professional Influences on Nursing

• She influence the advancement of professional,
  educational, and practice standard in nursing.
• Her scope of influence in nursing includes her
  contributions as a psychiatric nursing expert,
  educator, author, and nursing leader and theorist
• Nursing as a profession, not just a skill.
• Made a way for psychosocial nursing.

• She developed the Theory of Interpersonal
  Relations, a midrange theory focusing on the
  relationship between the nurse and the patient.
• (http//publish.uwo.ca/cforchuk/peplau/obituary.h
  tml)

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Hildegard E. Peplau

• Theory of Interpersonal Relations
• Peplau believed that nurses play an important
  role in helping clients reduce their anxiety and
  in converting it into constructive action.
• (McEwen, 2010)

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Purpose of Theory of Interpersonal Relations

• To aid in the development of problem solving
  skills through interpersonal relationships
  between the nurse and the client with the
  utilization of education through therapeutic
  interactions.
• Psychodynamic nursing facilitates
• Understanding ones own behavior.
• Helping others identify felt difficulties.
• Nurse-patient relationship as partners.
• The application of human relations to problems
  at all levels of experience.
• (http//publish.uwo.ca/cforchuk/peplau/obituary.h
  tml Peplau, 1994)

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The 4 basic metaparadigms

• 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 or symbol that involves forward
  movement of personality and other on-going human
  processes in the direction of creative,
  constructive, productive, personal community
  living.
• Nursing- A therapeutic interpersonal process. It
  functions cooperatively with other human process
  that make health possible for individual in
  communities.
• (Peplau, 1994)

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Six Nursing Roles in Theory of Interpersonal
Relations

• Peplau diagramed changing aspects of
  nurse-patient relationships and proposed and
  described the following six nursing roles
• Stranger
• Resource person
• Teacher
• Leader
• Surrogate/Advocate
• Counselor
• Technical expert. (7th role not include in
  original theory) later added (Fawcett, 2005).
• (Alligood Tomey, 2010)

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Theory of Interpersonal Relations Continued

• Four psychobiological experiences that compel
  destructive or constructive responses, as
  follows
• Needs
• Frustrations
• Conflicts
• Anxieties
• (Alligood Tomey, 2010)

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The Theory of Interpersonal Relation Consist of 4
stages, ( Alligood Toomey, 2010)
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Interpersonal Relations Compared to Nursing
Process

• Ida Jean Orlando created the Nursing Process
  Theory
• Orlando (1961) based her nursing theory on
  Peplaus theory
• The Nursing Process can be compared to Peplaus
  theory.
• (McEwen, 2010)

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Interpersonal Relations Compared to Nursing
Process

• Four Stages

• Nursing Process

• Orientation Get acquainted phase, perceptions
  are worked through, parameters established, early
  level of trust.
• Identification patient begins to identify
  problems, the nurse sets goals and participate
  his or her role in goal attainment, and
  promotions of responsibly for self.
• (Alligood Tomey, 2010)

• Assessment- The data collection step.
• Diagnosis and Planning
• Nursing diagnosis is made. Setting of goals to
  improve the outcome. Communication is essential.
• (McEwen, 2010 http//currentnursing.com/nursing_t
  heory/Orlando_nursing_process.html )

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Continued

• Four Stages

• Nursing Process

• Exploitation patients trust is fully developed
  and uses the nursing services solving immediate
  problems.
• Resolution mutual termination of relationship
  security is formed patient attains more
  self-reliance.
• (Alligood Tomey, 2010)

• Implementation- Setting plans into motion.
• Evaluation- Ongoing process. Evaluate goals and
  interventions
• (McEwen, 2010 http//currentnursing.com/nursing_t
  heory/Orlando_nursing_process.html)

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Case Study

• Jennifer Pitt is a single 21 year old white
  female in good health with no significant past
  medical history. Jennifer has lived in Dallas her
  entire life and is currently a nursing student at
  Texas Womans University. She is a swimmer and
  works out daily. Jennifer is confident, outgoing
  and has many friends.
• Jennifer was recently a victim of a robbery. She
  was held at gunpoint and was unharmed. She
  reported the crime, but now has an overwhelming
  feeling of anxiety and fear to leave her home.
  She does not want to go to school, swim, or meet
  her friends if it involves leaving home. She
  avoids talking about the incident and secludes
  herself to her bedroom where she is alone.
  Jennifer states She has trouble sleeping at
  night and is having nightmares re-living the
  experience. She has become withdrawn due to
  anxiety of becoming a victim of a crime again.
  Jennifer has made an appointment with a
  Psychiatric Mental Health Nurse Practitioner.
• (Picture retrieved on Nov. 1, 2015 from
  http//kaleidoscope.cybertranslator.idv.tw/archive
  s/date/2009/01)

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Case Study Model
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Research Study

• In a recent study for the improvement of subject
  recruitment, retention, and participation in
  research using Peplaus theory of interpersonal
  relations, evidence supports the relationship of
  the patient to study personnel may be the most
  important factor in compliance and completion.
• This clinical trial included female participants
  with type 2 diabetes. As with many clinical
  trials these subjects are offered incentives for
  retention which include monetary compensation. In
  addition, they incorporate Peplaus nurse-client
  relationship model to build trust and assist
  their subjects identify problems, implement
  interventions to resolve those problems and
  provide closure (Penckofer, Byrn, Mumby, and
  Ferrans, 2011).
• The three phases of interpersonal relations
  identify the process in which therapeutic patient
  care encompasses a caring relationship in
  Peplaus theory for desirable outcomes. The
  Orientation stage establishes trust in
  participants and reduces feeling of anxiety. The
  Working phase promoted type 2 diabetes health
  education with old and new found knowledge, but
  also required attentive listening and inquiry by
  the nurse. The Termination phase summarizes the
  accomplishments and prepares the client for the
  end of the therapeutic relationship (McCarthy and
  Aquino-Russell, 2009).
• In this study Peplaus framework demonstrated an
  86 retention rate and provided valuable
  strategies to recruit, encourage, and retain
  participants using the interpersonal relations
  theory in the study platform. The interpersonal
  relations theory transcends various realms of
  nursing and is applicable to endless situations
  and settings.

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Strengths of the Theory

• Peplaus writings are still used today to assist
  nursing students and graduate nurses.
• Provides structure and organized process to heal
  patients.
• Easily accessibility to practitioners to improve
  and guide their practice.
• Theory is open and testable for nursing
  research.
• Situation-producing
• Adaptability to any nurse patient relationship
  with end purpose of meeting the patients needs.
• Integrates into any area of nursing.
• http//publish.uwo.ca/cforchuk/peplau/obituary.ht
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Weakness of the Theory

• Building rapport and trust take time, and not
  always applicable to certain time restraints.
• Middle range theories are limited to nursing
  phenomena and does not cover the full scope of a
  phenomena.
• The patient has to be able to participate in an
  interpersonal relationship in order for the
  theory to work.
• http//publish.uwo.ca/cforchuk/peplau/obituary.ht
  ml

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Areas for further Research

• Further research warranted to those who can not
  communicate or communicate effectively. For
  example withdrawn patients.
• The theory can be refined through further
  research.
• http//publish.uwo.ca/cforchuk/peplau/obituary.ht
  ml

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Interpersonal Theorys major contribution to
nursing

• She made many contribution to nursing during a
  crucial time in history.
• Peplaus theoretical ideas, particularly her
  definition of nursing and nursing process,
  elaboration of anxiety and learning and her
  psychotherapeutic methods, have become a part of
  the collective culture of discipline of
  nursing. (OToole Welt, 1989).

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Compassion and Care Theory

• The Compassion and Care theory is based on
  incorporating compassion and caring into the
  nursing practice to promote healing. This theory
  uses Peplaus model of interpersonal relations to
  improve patient outcomes in various settings and
  situations. We believe that by incorporating
  these concepts into routine nursing practice,
  this will implement quality care and overall
  benefit both patients and staff. The Nursing
  Metaparadigm consists of person, environment,
  health, and nursing (McEwen and Wilis, 2011). The
  Compassion and Care theory is embedded in the
  basic model of nursing by creating an environment
  for all patients that promotes healing on a
  holistic scale.
• Theory is defined as a set of interrelated
  relational statements about a phenomenon that is
  useful for description, explanation, prediction,
  and prescription or control (Walker Avant,
  2005, p. 160). The concept of implementing
  compassion and care for patients is based on
  assessing the individual needs of the person and
  helps to establish caring interactions that are
  necessary to promote healing. If nurses fail to
  recognize the individual needs of a person, they
  only have their needs met, and not that those of
  the patients (Penckofe, Byrn, Mumby, and Ferrans,
  2011). Caring and compassion are used throughout
  all three phases of the nurse-patient
  relationship regardless of the situation or
  clinical setting. First the orientation phase, it
  is imperative to display our innate ability of
  compassion and empathy to establish a strong
  level of trust. Secondly implement the working
  phase, where the client and nurse work as a team
  to identify problems and plan a solution for
  optimal outcomes. Finally, the termination phase
  allows for both patient and nurse to review their
  accomplishments and acknowledge termination of
  relationship.

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Compassion and Care Theory Model
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A Message from Hildegard Peplau

• Nursing has made great process from being an
  occupation to becoming a profession in 20th
  Century. As the 21st Century approaches, further
  progress will be reported and recorded in
  Cyberspace-The Internet being one conduit for
  that. Linking nurses and their information and
  knowledge across borders-around the world-will
  surely advance the profession of nursing much
  more rapidly in the next century.
• Retrieved from http//publish.uwo.ca/cforchuk/
  peplau/obituary.html on Oct, 31st, 2015

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Video of Hildegard Peplau
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References

• Alligood, M.R. Tomey, A.M. (2010). Nursing
  theorists and their work (7th ed.). St. Louis,
  MO Mosby, Inc. an affiliate of Elsevier Inc.
• Courey, T., Martsolf, Draucker, C.(May, 2008)
  Journal of American Psychiatry Nurses
  Association. Hildegard Peplaus Theory and the
  Healthcare Encounters of Survivors of Sexual
  Violence. 14(2) 136-143.
• Currentnursing. (2012). Retrieved Oct 31, 2015.
  from http.currentnursing.com/nursing_theory/inter
  personal_therory.html.
• Fawcett J. Contemporary nursing knowledge
  Analysis and evaluation of nursing models and
  theories. (2). Philadelphia Davis 2005.
• OToole , A. Wett, S. (1989). Interpersonal
  theory in nursing practice selected works of
  Hildegard E. Peplau. New York Springer.
• Penckofer, S., Byrn, M., Mumby, P., Ferrans, C.
  (2011). Improving subject recruitment, and
  participation in research through Peplau's
  theory of interpersonal relations. Nursing
  Science Quarterly, 24 (2), 146-151.
• Peplau, H.E. (1994). Quality of life an
  interpersonal relations perspective. Nursing
  Science Quarterly. Spring7 (1) 10-5.

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Reference

• McCarthy, C., Aquino-Russell, C. (2009). A
  comparison of two nursing theories in practice
  Peplau and Parse. Nursing Science Quarterly,
  22(1), 34-40.
• McEwen, M., Wills, E. M. (2011). Theoretical
  basis for nursing (3rd ). Philadelphia, PA
  Lippincott, Williams, Wilkins.
• Sills, G., Peplau, L. A., Reppert, B.
  Hidelgard Peplau Nursing Theorist Homepage.
  Retrieved on Oct 30, 2015, from
  http//publish.uwo.ca/cforchuk/peplau/obituary.h
  tml
• Walker, L. O. Avant, K. C. (2011) Strategies
  for theory Construction in nursing (5th Ed.)
  Upper Saddle River, NJ Pearson Prentice Hall.