Guide to Hildegard Peplau’s Theory of Interpersonal Relations

Nursing is all about relationships. Hildegard Peplau’s theory offers a framework for understanding how nurses and patients interact and build connections. You might notice this framework in action during your next clinical rotation or work shift. Let’s explore what her theory states and how it applies to nursing practice.

Who Was Hildegard Peplau?

Hildegard Peplau, sometimes referred to as the mother of psychiatric nursing, was a nurse, educator, theorist, and leader who served as First Lieutenant in the U.S. Army Nurse Corps in World War II. She also worked as a nurse educator at Columbia University and Rutgers University, and held roles in the World Health Organization, International Council of Nursing, American Nurses Association, United States Public Health Service, and National Institute of Health.

Peplau published her Theory of Interpersonal Relations in 1952, centering the nurse-patient dynamic in the therapeutic process. Her work contributed to a shift in psychiatric nursing from a focus on custodial care to human connections.

Peplau’s Interpersonal Relations Theory: A Breakdown

This middle-range nursing theory focuses on the interpersonal phases of the nurse-patient relationship. Peplau outlined four components of this theory:

• Personal: An organism whose natural drive is to meet its own psychological needs by reducing anxiety. Peplau believed that individuals are constantly seeking solace and improvement.
• Environmental: External forces created by culture and context.
• Health: A current state within the ongoing development and improvement of the person.
• Nursing: An interpersonal, community-wide process that promotes health for people and communities.

The 4 Phases of Peplau’s Theory

Peplau argued that the relationship between the personal and nursing components is the cornerstone of care. This relationship works on a shifting continuum, broken down into four distinct phases:

• Orientation: The nurse and patient are initially strangers, introduced within the context of care.

• Identification: The patient understands the nurse’s role and how the nurse may help meet their needs.

• Exploitation: The nurse acts as teacher, counselor, and leader to the patient, and the patient relies on the nurse for these services.

• Resolution: The relationship between the patient and nurse ends when care is terminated.

Notice how the nurse’s role evolves throughout this care continuum — from stranger to resource, teacher, surrogate, leader, technical expert, and counselor. Initially, the nurse needs to build trust for the relationship to progress.

Why Is Interpersonal Relations Theory Important?

While it might not seem revolutionary today, Peplau’s perspective represented a major shift in the way that nurses approached patients, specifically those in psychiatric wards. For much of modern psychiatry, patients were viewed as passive care recipients who had no business making decisions for themselves. Peplau emphasized radical ideas like collaborating and communicating with patients, which shifted this dynamic towards a more equitable relationship.

Peplau believed that nurses were more than pill-pushers, but were also responsible for creating an environment where patients could heal. She encouraged soft skills like empathy, listening, and cultural competency. Her ideas laid the groundwork not just for psychiatric nursing, but for modern nursing care across settings as well.

Applying Peplau’s Theory in Psychiatric Nursing Practice

Looking for practical examples of the work of Hildegard Peplau? Theory application examples can be found in a variety of settings. Check out four cases specific to psychiatry:

Example 1: Orientation Phase

A psychiatric nurse meets a newly admitted patient who presents with severe anxiety. The nurse calmly introduces herself, explains her role, and encourages the patient to share how they’re feeling. By listening and creating a calm environment, the nurse helps reduce initial anxiety and establishes trust with the patient.

Example 2: Identification Phase

A patient was admitted to the psychiatric unit overnight, and this morning, a new nurse is coming on shift. When introducing himself, the new nurse makes a point to orient the patient to the unit and give an overview of the daily routine and what the patient can expect. This helps build trust in the nurse and the healthcare environment.

Example 3: Exploitation Phase

During ongoing group therapy sessions, a nurse helps a patient with major depressive disorder identify negative thought patterns contributing to hopelessness. Together, they set small, achievable goals such as getting out of bed each morning and journaling feelings. The nurse provides encouragement and feedback, pointing out the patient’s progress and building their self-esteem.

Example 4: Termination Phase

A patient recovering from a manic episode prepares to leave the hospital. In the discharge meeting, the nurse discusses coping strategies and relapse warning signs. They review medication routines and community support options. The nurse acknowledges the patient’s progress and helps them reflect on what they’ve learned. This helps the patient contextualize their hospital experience and empowers them to maintain stability at home.

Peplau’s Interpersonal Relations Theory FAQ

How is this theory used in nursing practice?

As a nurse or nursing student, you probably use the framework of this theory without noticing it. For example, when you introduce yourself to a new patient, you’re initiating the orientation phase. When you explain a new medication to a patient, you’re showing them that they have ownership over their treatment. While theories are not always front of mind, the nurse-patient relationship is the context for clinical nursing practice.

How does Peplau view the patient?

Peplau described the patient as a being with an innate drive for improvement, who exists within the context of the broader environment.

Is Peplau’s work still relevant today?

Absolutely. Amidst growing dependence on technology and AI in healthcare, Peplau’s theory centers on the humanity in nursing care and the relationships between patients and clinicians.

Apply Peplau’s Theory in a New Work Setting

Whether you work in psychiatric care or another specialty, the nurse-patient relationship is a key part of nursing practice. If you’re looking for a new opportunity to care for patients, we can help you find it. Sign up for personalized job notifications to learn about roles in your area.