nursing theory

Hildegard Peplau’s Theory of Interpersonal Relationships 1

Peplau’s Theory of Interpersonal Relations and Her Impact on Nursing Today

Ferris State University Nursing 324

Jamie K. Dykstra


Abstract

This paper explores the theoretical and clinical work of Hildegard Peplau. The work of Peplau

has laid a strong foundation upon which we base nursing today. Hildegard Peplau was

instrumental in creating a theory which empowers nurses to establish strong relationships with

patients. These relationships allow for accurate and intimate assessments, help the patients get

the best care, and help lead them to wellness. This paper examines the depth of Peplau’s work

and her impact in nursing today.


Nursing theory has impacted the nursing community greatly in the last fifty years by

stimulating growth of nursing education and literature. These increased educational

opportunities have in turn stimulated more structure to the training of nurses. Nursing was once a

“vocational education that was focused on skillful completion of tasks” (Tomey p.3) The

development of nursing theory has created “nursing knowledge on which to base nursing

practice” (Tomey, p.3). The Theory of Interpersonal Relations was developed by Hildegrad

Peplau. As Silas (2000) states “Hildegard Peplau has been involved with and active in almost

every movement toward professionalism of the nursing profession” (p. 29). The Theory of

Interpersonal Relations has impacted the role of the nurse to be that of a leader and an active part

of the healthcare team.

According to Fawcett (2005) Hildegard Peplau’s educational, practice, and teaching

experiences “led to an interest in clarifying what happens in a nurse-patient relationship”

(Peplau, 1952, p.v). Through these experiences, Peplau developed the Theory of Interpersonal

Relations. Fawcett (2005) stated that: “Pepelau’s work is a middle-range descriptive

classification theory that focuses on the phases of the interpersonal process that occur when an ill

person and a nurse come together to resolve a health-related difficulty” (p. 528). This

relationship is built between every patient who comes in contact with a nurse. Peplau’s theory

lays the groundwork to build strong relationships. Merritt and Procter (2010, p. 2) state that the

Peplau model establishes “a partnership between the nurse and patient, and with it a notion of

shared humanity between the nurse and patient” (Peplau 1952, 1991, and 1997). This model is


used in clinical practice at every encounter, and helps the nurse to set themselves in a position

that builds trust thus enabling a complete and thorough assessment.

Fawcett (2005 p. 531) uses Peplau’s words to differentiate between nursing and medicine

by stating that:

Physicians are mainly concerned about the incidence, etiology, diagnosis and

treatment of disease. The information which their work requires obtains largely through

physical examination and tests which patients undergo…Much of the medical theoretical

framework flows from anatomy, pathology, physiology, biology, chemistry, genetics- the

“hard sciences.” The relationship (often brief) of physician to patient is largely scripted

by the treatment, based on diagnosis and laboratory findings. Nurses collaborate in

carrying out orders and in health teaching related to the medical treatment. However, the

nurse-patient relationship is unscripted. It is dependent largely upon the conceptual

knowledge which each nurse has about the patient’s presenting data and the phenomena

in the domain of nursing. This knowledge is in the nurse’s head, available for recall and

application during the interaction. It is this kind of intellectual work by nurses that can

transform nurse-patient interactions into a learning event for patients. Much of the

current nursing knowledge framework flow from the social sciences-the “soft sciences”-

psychology, sociology, and the humanities, with some uses of other basic sciences, such

as biology. This may change when nursing science is fully developed (Peplau, 1997

pp.165-166).

Peplau was instrumental in identifying the importance of the nurse-patient relationship.

“She argued that the purpose of the nurse-client relationship is to provide effective nursing care


leading to health promotion and maintenance” ( Courey, Martsolf, Draucker, &Strickland, 2008,

p. 137). Peplau laid the groundwork that has empowered nurses to seek out the opportunity to

build an influential relationship with her patients. According to Courey et al. (2008), in Peplau’s

theory the nurse adopts one or more of six helping roles when providing care: stranger, resource

person, teacher, leader, surrogate, and counselor. According to Fawcett (2005) a seventh role of

technical expert was added later.

Many nursing care plans of today are designed to focus on the importance of this

relationship such as: disruption of family routine, spirituality, knowledge, and hopelessness.

Clearly, none of these areas would be able to be addressed without the nurse and patient having a

strong and trusting relationship. Today, nurses are taught in school the importance of this

relationship and it is often the primary focus of every nurse. Working in pediatrics, the nurse/

patient and nurse/family of the patient relationship plays an extremely important role. If a nurse

in today’s society functioned as a nurse of the past and only used technical skills to care for

patients, not only would she not be successful in practice, but patients would not get the care

they deserve. Fawcett (2005, p. 530) used Peplau’s work to conclude that Interpersonal

Relations enable nurses to understand the meaning of the experience that the patient is having.

(Peplau, 1952, p.41). Through this understanding, nurses are able to encourage the patient to

participate in identifying and assessing his problem and to engage him as an active partner in his

recovery. (Peplau, 1952, 23).

While it is obvious that Peplau made a tremendous impact on nursing of today with the

Theory of Interpersonal Realtions, it could be easy to confuse some of the roles and see where

boundaries may get blurred. As a nurse working in pediatrics, I have relationships with many of

the patients that I care for that I have had for my entire nursing career. Working in the roles of


surrogate, leader and teacher for example have enabled me to become very close to these patients

and their families. It is often times considered almost a “friendship” however, it was formed by

using the roles that Peplau described. I have seen this turn into a co-dependent relationship, but

have also seen it lead patients on their way to wellness.

On the other hand, Peplau’s Theory of interpersonal Realtions has led the way in

encouraging hospitals to develop care models such as Relationship Based Care (RBC). Hospitals

compete for patients by advertising the care model that they use. Healthcare consumers of today

look as these care models and see great value in things such as family centered care rounds and

nurse taught educational opportunities such as breastfeeding classes. Peplau was ahead of the

times in which she worked. Peplau’s work was unique because when she worked in the 1950’s

the nurse role was so technical. The models such as RBC have just become widespread in the

last several years. Peplau focused on the patient, their wellness, the factors surrounding their

wellness, health promotion and relationships at a time when the primary focus was supportive

care.


References

Alligood, Martha Raile, and Tomey, Ann Marriner. (2010). Nursing Theorists and Their Work

(7thed.). Maryland Heights, MO: Mosby Elesvier.

Courney, Tamara J, Martsolf, Donna S., Draucker, Claire B., & Strickland, Karen M. (2008).

Hildegard Peplau’s Theory and the Health Care Encounters of Survivors of Sexual

Violence. Journal of the American Psychiatric Nurses Association, 14 (2), 136-143. doi:

10.1177/1078390308315613

Fawcett, Jacqueline. (2005). Contemporary Nursing Knowledge: Analysis and Evaluation of

Nursing Models and Theories (2nd ed.). Philadelphia, PA: F.A. Davis Company.

Merrit, Michael K., and Procter, Nicholas G. (2010, March 27). Conceptualizing the Functional

Role of the Mental Health Consultation-Liason nurse in Multi-Morbidity, Using Peplau’s

Nursing Theory [Contemporary Nurse Journal]. Retrived from http://www.contemporary

nurse.com/archives/vol34/issue/2/article/3589.

Silas, Grayce M. (2000). Pepelau and Professionalism: The Emergence of the Paradigm if

Professionalization. Journal of the American Psychiatric Nurses Association, 6(1), 29-

34. doi: 10.1177/107839030000600107


Grading Rubric for Theory Paper Possible points

Points Earned

1. Introduction of theory/model a. Introduction clear and well focused 5 b. History and significance of model 5

2. Analysis of Model a. Explain the model in terms of: Person, Environment, Health, and Nursing.

10

b. Explain other concepts that are unique to the model. 10 c. Demonstrate how the model can be used in clinical practice. 10 d. Explain how the model can be used as a Framework for patient assessment.

10

e. Explain the model within the context of nursing education. 10 f. Identify strengths and limitations of the model. 10 g. Analyze the model overall, demonstrating new insights about the model. 103. Evidence of Academic Writing

a. Development of a clear, logical, well-supported paper; demonstrating original thought and content.

5

b. Evidence of research with a minimum of 2 research articles in addition to the course required texts. Correct acknowledgement of sources using APA style referencing. Attaches APA checklist

5

c. Overall presentation; grammar, spelling, punctuation, clean and legible. 5

d. Stays within page limit which includes: one cover page, one reference page, body of paper is to have a maximum of 5 pages and a minimum of 3 full pages.

5

Total Possible Points 100Total Points Earned

CHECKLIST FOR SUBMITTING PAPERS


CHECK

DATE,

TIME, &

INITIAL

PROOFREAD FOR: APA ISSUES

4/1 JD 1. Page Numbers: Did you number your pages using the automatic functions of your Word

program? [p. 230 and example on p. 40)]

4/1JD 2. Running head: Does the Running head: have a small “h”? Is it on every page? Is it less

than 50 spaces total? Is the title of the Running head in all caps? Is it 1” from the top of your

title page? (Should be a few words from the title of your paper). [p. 229 and example on p.

40]

4/1 JD 3. Abstract: Make sure your abstract begins on a new page. Is there a label of Abstract and

it is centered at the top of the page? Is it a single paragraph? Is the paragraph flush with the

margin without an indentation? Is your abstract a summary of your entire paper?

Remember it is not an introduction to your paper. Someone should be able to read the

abstract and know what to find in your paper. [p. 25 and example on p. 41]

4/1JD 4. Introduction: Did you repeat the title of your paper on your first page of content? Do not

use ‘Introduction’ as a heading following the title. The first paragraph clearly implies the

introduction and no heading is needed. [p. 27 and example on p. 42]

4/1JD 5. Margins: Did you leave 1” on all sides? [p. 229]

4/1JD 6. Double-spacing: Did you double-space throughout? No triple or extra spaces between

sections or paragraphs except in special circumstances. This includes the reference page. [p.


229 and example on p. 40-59]

4/1JD 7. Line Length and Alignment: Did you use the flush-left style, and leave the right margin

uneven, or ragged? [p. 229]

4/1JD 8. Paragraphs and Indentation: Did you indent the first line of every paragraph? See P.

229 for exceptions.

4/1JD 9. Spacing After Punctuation Marks: Did you space once at the end of separate parts of a reference and initials in a person’s name? Do not space after periods in abbreviations. Space twice after punctuation marks at the end of a sentence. [p. 87-88]

4/1JD 10. Typeface: Did you use Times Roman 12-point font? [p. 228]

4/1JD 9. Abbreviation: Did you explain each abbreviation the first time you used it? [p. 106-111]

4/1JD 11. Plagiarism: Cite all sources! If you say something that is not your original idea, it must

be cited. You may be citing many times…this is what you are supposed to be doing! [p.

170]

4/1JD 12. Direct Quote: A direct quote is exact words taken from another. An example with

citation would look like this:

“The variables that impact the etiology and the human response to various disease states

will be explored” (Bell-Scriber, 2007, p. 1).

Please note where the quotation marks are placed, where the final period is placed, no first

name of author, and inclusion of page number, etc. Do all direct quotes look like this? [p.

170-172]

4/1JD 13. Quotes Over 40 Words: Did you make block quotes out of any direct quotes that are 40

words or longer? [p. 170-172]


4/1JD 14. Paraphrase: A paraphrase citation would look like this:

Patients respond to illnesses in various ways depending on a number of factors that will be

explored (Bell-Scriber, 2007). Do all paraphrased citations look like this? [p. 171 and

multiple examples in text on p. 40-59]

4/1JD 15. Headings: Did you check your headings for proper levels? [p. 62-63].

4/1JD 16. General Guidelines for References:

A. Did you start the References on a new page? [p. 37]

B. Did you cut and paste references on your reference page? If so, check to make

sure they are in correct APA format. Often they are not and must be adapted. Make

sure all fonts are the same.

C. Is your reference list double spaced with hanging indents? [p. 37]

PROOFREAD FOR GRAMMAR, SPELLING, PUNCTUATION, & STRUCTURE

4/1JD 13. Did you follow the assignment rubric? Did you make headings that address each major

section? (Required to point out where you addressed each section.)

4/1JD 14. Watch for run-on or long, cumbersome sentences. Read it out loud without pausing

unless punctuation is present. If you become breathless or it doesn’t make sense, you need

to rephrase or break the sentence into 2 or more smaller sentences. Did you do this?

4/1JD 15. Wordiness: check for the words “that”, and “the”. If not necessary, did you omit?

4/1JD 16. Conversational tone: Don’t write as if you are talking to someone in a casual way. For


example, “Well so I couldn’t believe nurses did such things!” or “I was in total shock over

that.” Did you stay in a formal/professional tone?

4/1JD 17. Avoid contractions. i.e. don’t, can’t, won’t, etc. Did you spell these out?

4/1JD 18. Did you check to make sure there are no hyphens and broken words in the right margin?

4/1JD 19. Do not use “etc.” or "i.e." in formal writing unless in parenthesis. Did you check for

improper use of etc. & i.e.?

4/1JD 20. Stay in subject agreement. When referring to 1 nurse, don’t refer to the nurse as “they”

or “them”. Also, in referring to a human, don’t refer to the person as “that”, but rather

“who”. For example: The nurse that gave the injection….” Should be “The nurse who gave

the injection…” Did you check for subject agreement? Likewise, don’t refer to “us”, “we”,

“our”, within the paper…this is not about you and me. Be clear in identifying. For example

don’t say “Our profession uses empirical data to support ….” . Instead say “The nursing

profession uses empirical data…..

4/1JD 21. Did you check your sentences to make sure you did not end them with a preposition?

For example, “I witnessed activities that I was not happy with.” Instead, “I witnessed

activities with which I was not happy.”

4/1JD 22. Did you run a Spellcheck? Did you proofread in addition to running the Spellcheck?

4/1JD 23. Did you have other people read your paper? Did they find any areas confusing?

4/1JD 24. Did you include a summary or conclusion heading and section to wrap up your paper?

4/1JD 25. Do not use “we” “us” “our” “you” “I” etc. in a formal paper! Did you remove these


words?

4/1JD 26. Does your paper have sentence fragments? Do you have complete sentences?

4/1JD 27. Did you check apostrophes for correct possessive use. Don’t use apostrophes unless it is

showing possession and then be sure it is in the correct location. The exception is with the

word it. It’s = it is. Its is possessive.

Signing below indicates you have proofread your paper for the errors in the checklist:

_Jamie Dykstra_____________________________________________________

DATE:___4/1/2010_____________

A peer needs to proofread your paper checking for errors in the listed areas and sign below:

_Jodi Ruster R. N._______________________________________________________-

DATE:_4/1/2010______________

Revised Fall 2009 (signature may be typewritten)

nursing theory

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