Peplau Interpersonal Relation Theory

            The contribution of Hildegard Peplau to theories on nursing, especially on psychiatric nursing practice, is widely recognized (Barker, 1998). In a period of forty years, Peplau was able to provide valuable insights as to the broad range of roles that a nurse can play, both in general and particular aspects, of psychotherapeutic nursing (Barker, 1998).

            Psychological theories and psychosocial interpersonal theories of her time, such as those of Erich Fromm, Harry S. Sullivan, and Karen Horney led Peplau to formulate and build her own theory, which was destined to become popular among the nursing community (Nystrom, 2007). Peplau was also influenced by the contributions of Lewin and the Gestalt theorists with respect to the meaning of the concept of interaction (Peplau, 1954). She cites, in her work entitled Utilizing Themes in Nursing Situations, Lewin’s concept of a “whole framework within which an individual operates and interacts with other forces at work in a situation (Peplau, 1954).” She is likewise influenced by the concept of interacting forces, as referred to by Einstein as the “pushes and pulls” that influence a situation (Peplau, 1954).

            Peplau is considered a pioneer in understanding and contributing much on the field of psychiatric-mental health  nursing, through her examination and clarification of the theory of interpersonal relations and its relevance to various practice contexts (Barker, 1998). Indeed, she has been tagged by her colleagues, who called her the “mother of psychiatric nursing (Barker, 1998).”

            Through Peplau’s many works, the definition of nursing care has evolved as “an interpersonal, investigative, nurturing and growth-provoking process (Nystrom, 2007).” For Peplau, it is essential that a nurse be aware of the therapeutic environment, which refers to the  field where the interacting forces exist (Peplau, 1954). The interactions that occur in the environment shape the situation (Peplau, 1954). On the other hand, the nurse should learn how to respond to the unique characteristics of the given situation and interact with her patient (Peplau, 1954).

            In 1980, the American Nurses’ Association based their definition of the work of nurses on the theory of Peplau (Guest editorial – Interpersonal Theory in nursing practice: the Peplau legacy, 1998). The said definition refers to nurses’ work as “the diagnosis and treatment of human responses to actual and potential health problems (Guest editorial – Interpersonal Theory in nursing practice: the Peplau legacy, 1998).” It is pointed out that the definition places emphasis on the psychosocial and behavioral problems of patients, rather than diagnostic aspects of their illness (Guest editorial – Interpersonal Theory in nursing practice: the Peplau legacy, 1998).

            Peplau concerned herself with determining “the role of the nurse in describing and responding” to mental illness and health (Barker, 1998). Her interpersonal relation theory proposes that every patient be treated as individuals, since people are different from one another (Barker, 1998). Thus, the therapeutic relationship should be characterized by uniqueness and individuality (Barker, 1998). Thus, for Peplau, models and theories play little role in the planning and implementation of nursing care (Barker, 1998).

            Peplau’s theory emphasized the role of two actors in the promotion of the health of a patient, namely the patient himself, and the nurse taking care of him (Nystrom, 2007; Guest editorial – Interpersonal Theory in nursing practice: the Peplau legacy, 1998). Their responses to each other constitute the “pushes and pulls” that determine the outcome of the situation (Peplau, 1954).

            Her theory is based on her position that interpersonal relations offer great relevance to health care situations, and that the interaction that occurs between the nurse or health care provider and the patient can effect a qualitative impact on the health outcomes of the patient (Nystrom, 2007). For example, she noted that everyday interactions of nurses with their patients lead the latter to form human responses, such as anxiety, self-system and hallucinations (Guest editorial – Interpersonal Theory in nursing practice: the Peplau legacy, 1998). These human responses call for appropriate action from the nurses (Guest editorial – Interpersonal Theory in nursing practice: the Peplau legacy, 1998).

            The discussion above shows that Peplau believed that humans, the environment, and nursing all contribute to the promotion of health of the patient. Again, this is a manifestation of the influence of Einstein’s theory of “pushes and pulls” and Gestalt theorists on her work (Peplau, 1954).

            Peplau proposed “the deliberate use of the interpersonal relationship into the professional practice of nursing” in 1952, through her work entitled Interpersonal Relations in Nursing (Beeber & Bourbonniere, 1998). A more systematic use such relationship in nursing practice can be achieved and promoted with the understanding of interpersonal pattern. Peplau defined interpersonal pattern as the “category of a group of separate (interpersonal) acts having distinctive, similar features including thoughts, feelings and actions (Beeber & Bourbonniere, 1998).”

            Patterns are characterized by their descriptors, themes, names, and processes (Beeber & Bourbonniere, 1998). These characteristics allow nurses to identify the patterns. Identification of patterns is useful, because it would justify the intervention of nurses where the identified patterns serve as barriers to the health of the patients (Beeber & Bourbonniere, 1998).

            Studies such as the one conducted by Beeber and Bourbonniere illustrate how the nurse-client relationship can provide a rich ground for developing interpersonal relations between them, and how such relations between patients and their nurses could hinder or facilitate the health of the former (Beeber & Bourbonniere, 1998).

            Peplau’s works have influenced  a number of nurses, such as Forchuk and Brown and Barker, et al. to integrate and apply her theory on contemporary psychiatric nursing (Chambers, 1998). Her theories had also been the subject of clinical studies that aim to validate her theory and apply them to other aspects of nursing theory and practice (Chambers, 1998; Lego, 1998).

            One application of Peplau’s theory of Interpersonal Relationship in Nursing is in the field of group psychotherapy. Lego describes how the nurse can assume several different roles while in group psychotherapy, which shows how effective Peplau’s theory can be in application (1998). In particular, he conducted clinical studies where the nurse played the roles of stranger, resource person, teacher, leader, surrogate and counselor while within group psychotherapy (Lego, 1998). He also described how the nurse helps the patient go through different steps in the learning process, namely,” observation, description, analysis, formulation, validation, testing, integration, and utilization.” His clinical studies, therefore, are manifestations of the efficacy of Peplau’s theory of nursing as applied in practice (Lego, 1998).

            Peplau’s theory is helpful in nursing practice because it shows that the practice of many nurses in not interacting with patients beyond the nurses’ station hinders the facilitation and promotion of the health of clients. Peplau made it important and imperative for nurses to engage in interpersonal relationships with their patients in order to achieve the goal mentioned above (Chambers, 1998).

            Unfortunately, her theory also experienced a lot of criticism, mainly due to difficulty in quantifying its outcomes and the perceived lack of objectivity in its application, which are hindrances to the attainment of “scientific respectability” of the theory (Chambers, 1998).

            Moreover, lately it is reported that psychiatric-mental health  nursing is under attack by professionals from various countries, because they believe that  nurses should be removed from specific mental health care settings and that they should be replaced with “generic care workers (Barker, 1998).” The problem is believed to lie primarily in the limited exposure of nurses in the actual, firsthand, and everyday clinical practice to which Peplau’s theory referred (Barker, 1998). The different approach in the education of nurses, such that there is a developed threat in relation to the experience of relating with patients, leads nurses into employing models of nursing that could address their anxieties (Barker, 1998).

            In sum, Peplau’s theories had existed for decades, and remain a relevant part of nursing theories to date, despite the growing number of criticisms thrown upon it. This shows that her theory has shown utility in the great number of decades that it had been applied and had been the subject of many clinical studies. Her theory shall forever remain in the annals of nursing theory and practice, making her worthy of the moniker “mother of psychiatric nursing (Barker, 1998).”

References

Barker, P. (1998). The future of the Theory of Interpersonal Relations? A personal       reflection on Peplau’s legacy. Journal of Psychiatric and Mental Health Nursing 5,        213-220.

Beeber, L S. & Bourbonniere, M. (1998). The concept of interpersonal pattern in           Peplau’s Theory of Nursing. Journal of Psychiatric and Mental Health Nursing 5,          187-192.

Chambers, M. (1998). Interpersonal mental health nursing: research issues and          challenges. Journal of Psychiatric and Mental Health Nursing 5, 203-211.

Guest editorial – Interpersonal Theory in nursing practice: the Peplau legacy. (1998). Journal of Psychiatric and Mental Health Nursing 5, 165–166

LEGO S. (1998). The application of Peplau’s theory to group psychotherapy. Journal of         Psychiatric and Mental Health Nursing 5, 193–196.

Nystrom, M. (2007). A patient-oriented perspective in existential issues: a theoretical   argument for applying Peplau’s interpersonal relation model in healthcare         science and practice. Nordic College of Caring Science.

Peplau, H E. (1954). Utilizing Themes in Nursing Situations. The American Journal of            Nursing 54(3), 325-328.