Hildegard E.

Peplau’s
psychodynamic nursing theory:
school of nursing in 1931. Peplau received a B.A in interpersonal psychology from Bennington College, Vermont, in 1943 and M.A in psy

Hildegard E.
Peplau’s Interpersonal
Relations in Nursing

Theory was published in

1953
Framework for
psychodynamic nursing
Theory was influenced
by Harry Stack Sullivan’s
theory of interpersonal
relations.
Middle range,
descriptive, classification
theory
Introduction of theorist:

•Regard as “ Mother of psychiatric nursing”

•Born in 1909, reading, Peennsylvania
•Graduated from a diploma program in
Pottstown, Pennsylvania in 1931
•BA in interpersonal psychology from
Bennington College in 1943
 cont’d…

• MA in psychiatric nursing from Columbia

University, New York in 1947
• PhD on curriculum development in 1953
• Professor emeritus from Rutgers University
• Certified in psychoanalysis by William
Alanson White Institute of New York City
• Died in 1999
Experiences
• Private and general duty hospital nursing, two years in
the US Army and part time private practice in
psychiatric nursing.
• Started published Interpersonal Relations in Nursing in
1952, and interpersonal techniques-the crux of
psychiatric nursing in 1968.

• Worked as executive director and president of ANA, has

served as a nursing consultant to various foreign
countries and to the Surgeon General of the Air Force.
• Retired in 1974 and remained active in nursing.
Influences:

• It is a middle range descriptive classification

theory

• First nursing theory to borrow concepts from

other disciplines such as Harry Stack
Sullivan's theory of interpersonal relations
(1953) and also by Percival Symonds,
Abraham Maslow and Neal Elger Miller.
Conceptual frame work
 Psychodynamic nursing theory
• Psychodynamic nursing is defined as understanding one’s
behavior to help others identify felt difficulties and applying
principles of human relations to problems arising during the
experience.
• Nurses enter into a personal relationship with an individual
when a felt need is present. This nurse-patient relationship
evolves in four phases
1. Orientation phase
2. Identification phase
3. Exploitation phase
4. Resolution phase
cont’d…
• Each of these phases overlaps, interrelates and
varies in duration as the process evoles toward a
solution. However, in 1997, Peplau wrote that the
nurse- patient relationship is composed of three
phases.
• 1. Orientation phase
• 2. Working phase –identification and exploitation
• 3. Termination –resolution
 Orientation phase
• Begins when a client expresses a ‘felt need’. This
need provides the impetus for a meeting between
the nurse and the patient.
• It is the problem defining phase.

• The nurse and the client meet as strangers and

strive to become comfortable with each other
while collaboratively defining the problem and
deciding type of service needed.
 cont’d…
• Client seeks assistance, conveys needs, asks
questions, shares preconceptions and
expectations of past experiences.

• Nurse responds, explains roles to client, helps

to identify problems and to use available
resources and services.

• Nurse responds, explains roles to client, helps

to identify problems and to use available
resources and services.
 cont’d..
• Peplau( 1995) emphasizes that psychiatric nurses
who practice in either hospital or community
settings need to pay more attention to families.

• It is of the utmost importance that the nurse work

collaboratively with the patient and family analyzing
the situation, so that together they can recognize
clarify and define the existing problem.
• Collaboratively clarifying and defining of the
problem allows the client to direct energy away
from the anxiety of unmet needs toward
constructive activities.

• The client and the nurse work together to

understand their reactions to each other
mindful of potential influencing factors such as
culture, religion, personal experiences and
preconceived ideas.
Working phase
The patient responds selectively to the people who
can meet the needs.
The patient’s reactions differ like dependent,
independent, active or passive.
Patient clarifies the felt need

In this phase, there must be a selection of

appropriate professional assistance.

The patient and the nurse must continue to clarify

each other’s perceptions and expectations because
these determine personal reactions.
Contd.
The nurse’s expressed feelings can help an ill
patient respond with positive emotions while her
strengthened personality can provide needed
satisfaction.
The patient may begin to feel a sense of
belonging and may gain confidence in dealing
with the targeted problem.
These positive responses can decrease a sense of
helplessness and hopelessness, creating an
optimistic attitude that further promotes inner
strength.
 Cont’d…
• The patient may use all available services
based on personal interests and needs.
• The nurse assists the patient in using these
services, maintaining a therapeutic
relationship at all times.
• The patient can thereby derive full value from
what is offered through the nurse patient
relationship.
• During this phase, the nurse and the patient
can identify new goals; power may shift from
the nurse to the patient.
Nurse aids the patient in exploiting all avenues of help
and progress is made towards the final step.

The patient may feel like a participant in the helping

environment and may develop control over some aspects
of the situation.

This new outlook may make the patient more demanding,

in which case the nurse must use interviewing techniques
to explore and understand the patient’s actions.

Nurse must be aware about the various phases of

communication.
 Termination phase

• After the patient’s needs have been met by the

collaborative efforts of the nurse and the patient,
the therapeutic relationship ends.

• The patients needs have already been met by the

collaborative effect of patient and nurse.

• Now they need to terminate their therapeutic

relationship and dissolve the links between them.
Contd.
This may sometimes be difficult for both as
psychological dependence persists.

Resolution is achieved when the patient drifts away

from identifying with the nurse and dissolves the nurse-
patient bond.

Successful resolution results directly from successful

completion of the other three phases.
The patient moves toward new goals during this phase.
Roles of nurse:
According to this theory, a nurse falls into
various roles as the four phase take place. She
is:
1. Stranger
2. Teacher
3. Resource Person
4. Counselors
5. Surrogate
6. Leader
 Cont’d…
• Stranger role: Receives the client the same
way one meets a stranger in other life
situations; provides an accepting climate that
builds trust.
• Resource role: Answers questions, interprets
clinical treatment data, gives information.

• Teaching role: Gives instructions and

provides training; involves analysis and
synthesis of the learner's experience.
 Cont’d…
• Counselling role: nurse helps client understand and
integrate the meaning of current life circumstances;
provides guidance and encouragement to make
changes.

• Surrogate role: Helps client clarify domains of

dependence, interdependence, and independence and
acts on clients behalf as advocate.
 Cont’d…
• Active leadership: Helps client assume maximum
responsibility for meeting treatment goals in a
mutually satisfying way.

• Technical expert role: Provides physical care by

displaying clinical skills; Operates equipment[
Four Major Concepts
Person: An individual who lives in an unstable
equilibrium as a developing organism tries to reduce
anxiety caused by needs. She does not include families,
groups or communities.

Environment: is not specifically defined. Environment is

implied in that the nurse must consider culture and values
when acclaiming the patient to the hospital environment,
but Peplau does not address possible environmental
influences on the patient, existing forces outside the
organism and in the context of culture.
Health : A word symbol that implies forward movement
of personality and other ongoing human processes in the
direction of creative, constructive, productive, personal
and community living.

Nursing: A significant therapeutic interpersonal

process. It functions cooperatively with other human
processes that make health possible for individuals in
communities. Involves the problem solving techniques;
both patient and nurse learn this technique from the
relationship. Proceeds from the general to the specific
in collecting data and clarifying problems, and uses
observation, communication and recording as basic
tools.
Uniqueness

• Theory was considered revolutionary at the

time of development
• Nursing as profession, not just a skill

• Made the way for psychiatric nursing

specialty
cont’d…

Psychodynamic nursing facilitates:

1. Understandings of one’s own behavior

2. Helping others indentify felt difficulties
3. Nurse-patient relationship as partner
4. Application of human relations to problem s
at all levels of experience
 Conclusion

• Peplau’s theory focuses on the interpersonal

processes and therapeutic relationship that develops
between the nurse and client.
• The interpersonal focus of Peplau’s theory requires
that the nurse attend to the interpersonal processes
that occur between the nurse and client.
• Interpersonal process is maturing force for
personality. Interpersonal processes include the
nurse- client relationship, communication, pattern
integration and the roles of the nurse.
• Psychodynamic nursing is being able to understand
one’s own behavior to help others identify felt
difficulties and to apply principles of human
relations to the problems that arise at all levels of
experience.

• This theory stressed the importance of nurses’ ability

to understand own behavior to help others identify
perceived difficulties.
Interpersonal Theory and Nursing Process
• Assessment - Orientation
Does collection and analysis
Nursing Diagnosis- Identification
Implementation- Exploitation
Evaluation- Resolution
Thank You
Thank
You