INTERPERSONAL

RELATIONS
Hildegard E. Peplau
A Middle-Range Nursing Theory Analysis
“A Light in the Darkness”
By

Argi Virgona, S.Kp. M.Kep

GOALS OF THE THEORY

 She wanted “only to convey to the

nursing profession ideas [she] thought
were important to improve practice”
 Fokus Peplau adalah kualitas interaksi
nurse-patient dan nursing education

(O’Toole, 1989; Forchuk, 1993, p. 3)

Hilda in 1951
INTERPERSONAL RELATIONS THEORY
 BASIC ELEMENTS:
 the patient  INTERPERSONAL – Phenomena
 the nurse that occur between persons
 the interaction between them
 NURSE – The medium of the art of
nursing; a maturing force. “The
 DEFINITIONS: unique blend of ideals, values,
 CLIENT/PATIENT – orang, integrity, and commitment to the well-
pasangan, kelompok, komunitas being of others…”
layak mendapatkan asuhan
manusiawi dengan dignity, privacy,
ethics
 NURSING ROLES - to assist client
starting as stranger, then technical
expert, resource person, surrogate,
 ENVIRONMENT - Physiological, counselor, teacher and others
psychological & social yang
mempengaruhi sakit & sehat
(Forchuk, 1993; Peterson, 2009)
 HEALTH – Forward movement of
personality & human processes in the
direction of creative, constructive,
personal, and community living
RELATIONSHIPS HAVE FOUR PHASES
 ORIENTATION PHASE
 Preconceptions
 Parameter dibangun & diidentifikasi
 Tahapan awal trust dikembangkan
 Peran mulai dipahami

 IDENTIFICATION PHASE
 Klien mulai mengidentifikasi masalah
 Tujuan perawat : membantu pasien
mengenali his/her own
interdependent/participation role &
meningkatkan responsibility for self

(Belcher, 2002; Peterson, 2009)

RELATIONSHIP PHASES (CONT’D)
 EXPLOITATION PHASE
 Klien mempercayai perawat mampu
mengeksplorasi seluruh potensialnya
 Klien mengoptimalkan manfaat dari
asuhan keperawatan
 Memecahkan masalah dengan segera
 Mengidentifikasi & mengorientasikan
diri untuk pencapaian tujuan
 RESOLUTION PHASE
 Fase terakhir dari nurse-patient
relationship
 Rasa aman klien terpenuhi
 Klien meningkatkan kemampuannya
untuk mengatasi masalahnya
(Belcher, 2002; Peterson, 2009)
THE NURSE ASSISTS THROUGH ROLES
 ROLES of NURSE:
 Stranger (Orientation phase)
 Technical Expert & Authority Figure
 Surrogate for significant others
 Resource Person
 Change-Agent
 Researcher
 Counselor
 Teacher
 & More

 Specific roles bervariasi pada setiap Helping Patients

situasi nurse-client situation, terbatas
hanya pada imajinasi & keterampilan Help Themselves
perawat - - Rather than feeding them,
Teaching them “to fish” --
INFLUENCED PSYCHOBIOLOGICAL EXPERIENCES
 Setiap orang memiliki kebutuhan,
frustrasi, konflik, & kecemasan
yang saling mempengaruhi
 Setiap orang memiliki basic needs
& harapan dalam setiap hubungan
 Nurse’s own self-understanding 
merespon tensions & coping
mechanisms
 Nurse memandu pasien utk pulih;
tension and anxiety are converted
into purposeful action as the result
of the therapeutic relationship
(Peterson, 2009)
VISUAL MODEL OF MAJOR CONCEPTS

Peplau’s framework: Major Concepts and their Interrelationships

(Forchuk, 1993, p. 8)
THEORY INSIGHTS - PROFESSIONALISM
 Nurse memperoleh kompetensi dengan
memahami > lanjut ttg self, concepts,
roles & proses utk membantu pasien
tumbuh & pulih

 Peplau memperingatkan: danger of

‘social talk’ with patients – Perawat tdk
diperbolehkan utk berbicara dgn cra yg
sama pada px, kelg, atau kelompk.
Harus mengarah pada efek therapeutic –
promoting long-term well-being
 Kebutuhan emosional perawat tidak
boleh mempengaruhi pemberian askep
 Interpersonal Relations theory
membantu pasien untuk :
 Observe more intelligently Check your emotional baggage
 Intervene more sensitively at the door of patient care
(O’Toole, 1989)
EVALUATION OF THEORY
 ADEQUACY:  CLARITY:
 Contributes to the nursing  Clear and logical fashion
process  Definitions are readily
 Clearly consistent with understandable
nursing’s values and mission  Though concepts are at a high
 Limited in groups of people level of abstraction, they can be
 Fairly narrow set of cultural learned with practice
assumptions
(Meiers & Sheran, 2009)
 I disagree that it’s limited in
groups - Lego demonstrates it
has potential for group work
(Lego, 1998)
 It can be used in any specialty
area of nursing with patient
contact
 It is holistic in nature
EVALUATION OF THEORY
 CONSISTENCY:  LOGICAL
 Concepts and ideas are
parsimonious
 Worldview is
phenomenological in
nature and remains
consistent throughout the
theory
(Meiers & Sheran, 2009)
DEVELOPMENT:
 Logically inductively and
deductively based
 Many psychological
theorists’ works integrated
into development
 Nursing role promotes the
patient’s movement
through the steps of the
nursing process
(Meiers & Sheran, 2009)
EVALUATION OF THEORY
 LEVEL OF
DEVELOPMENT:
 Remains at the descriptive level
 Focusing on phases of
relationships and
interactional/inter- and
intrapersonal phenomena
 Not changed significantly since
Peplau’s original writings were
published over 50 years ago
 DISCRIMINATION:
 Peplau is clear about making
distinctions between the nursing
and the medical profession
 But theory can be used by all
helping professions in practically
all areas of the relationship arena
(Meiers & Sheran, 2009)
 The patients who have
overwhelming physiological
needs (or unconscious) are not
good candidates for this theory
application (Belcher, 2002)
 Use with family members would
be appropriate
EVALUATION OF THEORY
 COMPLEXITY:
 Theory has breadth, life and fluidity
 The basic core of the theory is
simple, but certain aspects of the
psychology in communication make
it more complex
(Meiers & Sheran, 2009)
 The concepts are at a fairly high level
of abstraction
 Both inductive and deductive
reasoning ability are part of this
theory
 Both quantitative and qualitative
research can take place
 REALITY CONVERGENCE:
 The basic tenants reality based,
particularly in nursing situations requiring
healing nurse-patient communication
 Real life Application: Nurses should be
treating patients in a holistic fashion, no
matter the context - It should be utilized
more than it is, for the patient’s sake
 It requires time & practice to master –
start with the basics: a continual process
improvement
 Considering the economy & managed
care, Jones reports (1996) “…the need to
provide cost-effective quantifiable care
may negate the value of Peplau’s theory”
 I disagree - This theory is valuable as
part of human development, maturity and
individual healing in many contexts
EVALUATION OF THEORY
 PRAGMATIC UTILITY:
 Nurses’ critical thinking, therapeutic-
intervention/communication - beyond
task oriented nursing
 Requires self-scrutiny of motives and
expectations by the nurse (maturity)
(Belcher, 2002)
 Requires understanding of inductive
reasoning skills
 It is the basis of higher levels of caring
 Directly affects interventions dealing
with communication
 The interactions with the patient spawn
deeper thinking in both the patient and
the nurse towards positive healthcare
outcomes
(Meiers & Sheran, 2009)
 Utility based on individual use by nurse
to invest energy and vision into
relationship understanding & healing
 SCOPE:
 Used in practice domains where
interpersonal or intrapersonal
difficulties are taking place – [all (?)]
 Uses are broad; not confined to only
psychiatric nursing, but other areas of
nursing as well
(Meiers & Sheran, 2009)
 Limited in realm of
physiological/medical issues – but
helpful to patients with concerns or
“issues” –most pts have these to some
degree
 Very useful in settings of nursing
education where focus on nurse-patient
relationship and communication are
discussed
EVALUATION OF THEORY
 SIGNIFICANCE/CONTAGIOUS
/CONTEMPORARY USE:
 Criterion for significance has been met for
the nursing discipline
(Meiers & Sheran, 2009)
 Continued references to the theory in
contemporary research and literature
attests to continued utility
 Many elements of the theory have become
public domain and integrated into nursing
practice without Peplau being credited
 Translated into multiple languages
 Use of the theory by psychiatric nurses
and advanced practice nurses is not
uncommon
 Documented as useful in many other
areas of nursing: health education,
palliative care, oncology, AIDS care,
quality of life and many others (Belcher,
2002)

 Theory has stood the test of time, though

only moderate and variable use for formal
research has occurred
(Belcher, 2002; Meiers & Sheran, 2009)

 Used internationally in Australia and

New Zealand, Belgium, Canada, the
UK, Ireland and the United States
PREVIOUS APPLICATION TO PRACTICE
 Used widely around the world –
nursing education
 Often integrated into policies
without credit to Peplau –
Public Domain
 Patient health education,
palliative care, oncology, AIDS
care, quality of life, private
practice, nurse practitioners,
home care & of course,
psychiatric nursing
 Nurse counseling of individuals
and groups
(Belcher, 2002; Lego, 1998; McNaughton, 2005; Beeber,
2001)
RECOMMENDED FOR NURSING PRACTICE
 ROUTINE  RESULTS: All interactions
INTEGRATION into within practice would be more
daily practice within any area of
clinical nursing, with multi-faceted mature and healing in a context of
effects caring, potentially improving peer
relations as well
 Nurses in private counseling practice
would increase  Near elimination of disrespect
between staff members with
 Theory requires the mature nurse to improved focus on the welfare of the
look deeply at own behavior, patient – better focused care plans
attitudes, motives, & actions during
daily practice & in relationships –
self-scrutiny
(Belcher, 2002)

 Invites the nurse to be less self-

gratifying, and more in tune to the
needs of the patient (and support
systems), as well as filtering into peer
and professional relationships
RECOMMENDED FOR NURSING PRACTICE
 Patients would perceive
being better understood
 Would comprehend instruction
with less anxiety
 Would give higher scores in
levels of satisfaction regarding
their nursing care

 Re-admissions would
decrease
 Increased comprehension of
teaching in patients
 Patient and staff increased
sense of responsibility for
selves
 Empowerment of both
patients & staff
 Improved health outcomes
 Success stories and patient
comments could be shared in staff
meetings and newsletters to
reinforce the new staff behaviors
 Role modeling by nursing &
management would give the
atmosphere of healing and caring –
less stressful environment
RECOMMENDED FUTURE RESEARCH

UPCOMING  Quantitative & qualitative research

demonstrating positive health-care
NURSING outcomes needs to take place (Jones, 1996)

RESEARCH  Focus on quantitative research would verify

the theory’s contemporary value, even with
today’s financial constraints
 It might require a blended effort of Psychology
and Nursing scholars
 Specifically, quantitative studies needed to
support the efficacy of the theory in relation
to patient outcomes
 Improved mental and physical health status
 Positive patient education results
 Favorable patient satisfaction
HAVE ANY QUESTIONS ???