Hildegard Peplau’s middle-range theory, “Interpersonal Relations in Nursing,” is built on several core principles that influence nurse-patient relations and healthcare. The dynamic and vital component of nurse-patient relationships is essential to nursing as an interpersonal practice. This theory includes nurse-client orientation, identification, exploitation, and resolution (Hagerty et al., 2017). The orientation phase develops trust and the therapeutic alliance. This identification step helps the nurse understand the particular environment of the patient by identifying their needs and concerns. The exploitation phase uses healthcare resources according to patient needs, and the resolution phase terminates therapeutic engagement. This framework allows nurses to communicate, build trust, and resolve issues with patients.
The therapeutic use of self is a vital part of Peplau’s philosophy, where the nurse is seen as a leader and guide in the patient’s health journey. This involves the nurse actively problem-solving by supporting, empathizing, and understanding the patient’s problem-solving (Vogelsang, 2022). Peplau’s philosophy mainly focuses on interpersonal interactions rather than tasks in nursing to achieve better health outcomes. The nurse needs to adjust to the changing dynamics of the nurse-client relationship and understand that each patient interaction is different. Peplau’s theory is a comprehensive approach to nursing practice that enables practitioners to form meaningful relationships with patients, improve communication, and support health and well-being.
Interpersonal Relations in Nursing theory focuses on the interrelationship between healthcare and its increasing importance for nurses’ patient interaction. The therapeutic relationship paradigm consists of four stages (orientation, identification, exploitation, and resolution) (Hagerty et al., 2017). Every step influences nurse-patient interaction. Orientation establishes trust and rapport; the identification stage determines the patient’s needs. In the exploitation phase, resources are used to fulfil these needs, and at the resolution stage, the therapeutic relationship is terminated. Peplau defines the nurse as a ‘therapeutic agent’ who helps patients manage and resolve their problems. This is because adaptation needs a new shift toward nursing to allow nurses to move through the successive stages, make senseful connections, establish cooperation, and achieve better patient outcomes.
“Interpersonal Relations in Nursing” is relevant to many therapeutic environments, including mental health nursing. This approach may be used in treating acute psychiatric patients (Vogelsang, 2022). The four-phase therapeutic relationship paradigm offers a better fit for the nature and complexity of mental health issues that flower over time. When orienting fragile, anxious patients, the nurse may develop trust at initial contact. Identification can allow the nurse to determine the needs for mental health, emotions, and concerns of a patient. During the exploitation stage, a nurse and patient use resources, treatments, and coping mechanisms that are critical for mental health care. This stage enables mental health-based care approaches. The resolution phase helps the nurse assess intervention effectiveness, improve patient independence, and facilitate adaptation for improved mental well-being.
The concept is relevant to medical-surgical settings, particularly long-term care and chronic disease management. During orientation, the nurse establishes rapport and trust, vital for participation (Vogelsang, 2018). The identification stage involves analyzing the impact of chronic disease on a patient’s life and designing care plans to suit particular issues. The nurse collaborates with a patient during exploitation to optimize resource utilization in self-management and wellness enhancement. In the resolution phase, the nurse evaluates interventions, adapts treatment plans or programs, and facilitates optimum quality of life for patients.
While Peplau’s hypothesis has significant weaknesses, it gives clinically relevant information. The concept needs high interpersonal skills and emotional intelligence, and it takes much time to develop, which could be challenging in fast-paced settings such as the healthcare industry. The subjective nature of this theory may cause healthcare practitioners to perceive and apply the concept differently from one another (Vogelsang, 2022). These challenges may be addressed by extensive nursing, continuous professional growth, and a corporate environment that highly values the nurse-patient relationship as underpinning good care.
A literature review reveals that Peplau’s interpersonal relations theory in nursing significantly impacts mental health and psychiatric nursing practice. Many researchers suggest that Peplau’s four-phase therapeutic relationship paradigm improves outcomes. Hartley et al. (2020) showed that following Peplau’s approach increased patient satisfaction, treatment adherence, and mental health therapeutic alliances. Exploitation, characterized by collective decision-making and resource use, led to enhanced patient participation and performance. According to Köktaş et al. (2023), the Peplau approach enhances patient-centered chronic disease treatment delivered in medical-surgical environments. Throughout the exploitation phase, resources were applied, and patients were involved in their treatment; self-management increased while hospital readmissions decreased. While the literature reviews her concept favorably, it barely touches upon obstacles and barriers that healthcare workers face in attempting its application, including in high-energy clinical environments. Future studies must consider the above problems and make this theory more pragmatic.
Peplau’s Interpersonal Relations in Nursing theory highlights the circle of nurse-patient relationships (Hagerty et al., 2017). The hypothesis is applicable in various healthcare settings and patient populations. The four-step process guides communication, trust, and partnership between nurses and clients through a systematic method for therapeutic alliances. Peplau also attaches particular importance to the diversity of relationships, considering each patient’s needs and promoting a personalized approach to treatment.
However, first-year nurses might face difficulty comprehending and using the theory because of its complexity. Interpersonal interactions involve different patient responses and nurse treatments; hence, learning them takes time (Hagerty et al., 2017). Peplau’s theoretical training should be the focus of educational programs and clinical orientations to equip healthcare practitioners with its use adequately. Nurses can develop their confidence levels when they get the continued assistance and guidance that will bridge between theory and practice.
The concept is relevant to contemporary healthcare problems and innovative care practices. It is compatible with modern trends in health care of patient-centered treatment and shared decision-making (Hagerty et al., 2017). Time limitations and severe workloads might prevent personal interactions between nurses and patients in high-acuity settings. Reduction of documentation and the utilization of technology for communication can allow nurses to spend more time providing relationship care. Peplau’s Interpersonal Relations in Nursing theory can lead to successful patient care by establishing effective nurse-patient relationships, necessitating further exploration and implementation into the contemporary nursing practice.
In summary, Hildegard Peplau’s Interpersonal Relations in Nursing has permanently impacted nursing knowledge, particularly the nurse-patient relationship. Its focus on interactive human relationships, teamwork, and patient participation complies with the changes in health care. The theory’s practicality can be achieved by directed education and ongoing support to nurses. As such, the adaptability of Peplau’s framework to numerous clinical situations aligns with patient-centered care and collaborative decision-making in modern nursing. With the continued changes in healthcare and how it is delivered, studying Peplau’s concept through implementation can help build therapeutic partnerships that lead to better patient outcomes and care delivery. Peplau’s Interpersonal Relations in Nursing theory can provide nurses with a framework to manage healthcare’s complicated human relationships through intentional use and continuing elaboration.
Hagerty, T. A., Samuels, W., Norcini-Pala, A., & Gigliotti, E. (2017). Peplau’s theory of interpersonal relations. Nursing Science Quarterly, 30(2), 160–167. https://doi.org/10.1177/0894318417693286
Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2020). Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102(1), 1–9. https://doi.org/10.1016/j.ijnurstu.2019.103490
Köktaş, N. Ç., Yiğitoğlu, G. T., & Nur, A. (2023). The effect of interpersonal relations theory-based motivational interviews on functional recovery and insight levels of patients with schizophrenia: A randomized controlled trial. https://doi.org/10.1016/j.apnu.2023.04.018
Vogelsang, L. (2022, December 21). Peplau’s Theory of Interpersonal Relations: Application to Asynchronous Nursing Education | Canadian Journal of Nursing Informatics. Canadian Journal of Nursing Informatics. https://cjni.net/journal/?p=10464