The interpersonal theory was developed by psychiatric-mental health nurse Hildegard Peplau. The theory emphasizes the importance of nurse-patient communication. In this theory, nursing is perceived as a process that helps both the nurse and the patient become more mature and agree on the goals they pursue. The theory was used to develop the patient-centered care that is often engaged in clinics and hospitals today. The interpersonal theory is often used in psychiatry because of its focus on patients’ feelings, fears, and concerns. It is criticized for its inapplicability to patients who are not able to communicate.
Hildegard Peplau is the founder of the interpersonal theory that is often used in psychiatry. Peplau herself worked in a private psychiatric hospital. She developed the interpersonal theory while working with neo-Freudian analysts, and, later, during her work at hospitals when World War II began (D’antonio, Beeber, Sills, & Naegle, 2014). Her work on interpersonal nursing in psychiatry was often used by other professionals that worked in the same field (D’antonio et al., 2014).
Analysis of Basic Components and Relationships
According to Peplau, the ability to reflect on one’s actions, self-awareness, and individuality are the major concepts in nursing (D’antonio et al., 2014). The theorist emphasizes the importance of patient-centered approach, which implies that nurses’ aim is to help patients identify the health issues they have. Why did Peplau consider nursing as an interpersonal process? First, nursing was seen as an art of healing and assisting the individual (D’antonio et al., 2014).
Second, nurses engaged in interpersonal connection with their patients during treatment. Third, nurses and patients needed to work together to achieve the result. Fourth, nurses needed to pay attention to patients’ needs so that their personality, as well as personalities of nurses, could develop.
Peplau also advised nurses not to take patients’ behavior literally. According to her, not everything that patients said and did was the reflection of their actual needs (D’antonio et al., 2014). She suggests expanding the view on human behavior (D’antonio et al., 2014). This needs to be done not only to understand patients’ behavior but also to address such emotions like frustration and anger that are quite common for nurses. These feelings arise when nurses need to work with or block patients’ needs that often remain vague and unclear to patients themselves (D’antonio et al., 2014). Anxiety is perceived by her as a sign of changing and growing, both in patients and in nurses.
There are four main phases in the nurse-patient relationship: orientation phase, identification phase, exploitation phase, and resolution (termination) phase (Maghsoodi, Zarea, Haghighizadeh, & Dashtbozorgi, 2014). During the first phase, the nurse establishes fist contact with the patient, but her/his role is still the role of a stranger. Here, major questions and issues are discussed with the patient. During the second phase, the client begins working with the nurse on specific issues, expresses his/her fears and anxieties (Maghsoodi et al., 2014). The patient is expected to feel support in dealing with fears and frustration. During the third phase, the patient fully exploits the offered services, asks for assistance, expresses any concerns or needs, and feels like the part of the environment (Maghsoodi et al., 2014).
During the last phase, the professional relationship between the patient and the nurse ends. The patient is no more dependent on the services and the nurse, although some of them might still have a strong psychological connection to each other. As Maghsoodi et al. (2014) notice, patients’ emotions after discharge can be discussed during this phase.
As it can be seen, interpersonal theory highly relies on relationships between nurses and patients; nursing is, therefore, a process, not an aim with a definite ending (Aston & Coffey, 2012; D’antonio et al., 2014).
The interpersonal theory remains highly relevant, although not everyone might acknowledge it. First, the often-engaged patient-centered approach is based on this theory. Second, the interpersonal theory is often used in psychiatry. Research indicates it is not only the technological advancement that is important; valuing patients as human beings is also crucial for their recovery (Aston & Coffey, 2012).
The quality of relationship and collaboration between the nurse and the patient is essential for treatment, especially when working with mentally ill people (Aston & Coffey, 2012). It is a common problem that due to burnout and exhaustion nurses do not have emotional resources to provide patient-centered care, especially to those patients who might provide unclear or conflicting demands due to their condition. When using the interpersonal theory, nurses have the ability to address issues together with patients and see if they perceive the objectives of the treatment similarly. Unfortunately, nurses’ time is limited and often cannot be used for direct patient-nurse interactions (Aston & Coffey, 2012).
This adversely influences psychiatric treatment because patients and nurses cannot discuss their view of concepts crucial for the efficiency of treatment (e.g. recovery). As Aston and Coffey (2012) point out, nurses tend to see recovery as something they do to patients, while patients perceive recovering as a process that changes them. If interpersonal relationships were more valued, nurses and patients could possibly have more time to discuss what they expect from treatment and each other.
Thus, nursing practice relies on interpersonal communications. Furthermore, if undergraduate students are not introduced to the theories that emphasize interpersonal communication, there is a high chance that students will not “emulate empathic behaviors” (Ward, Cody, Schaal, & Hojat, 2012). It should be noted that empathy is a cognitive skill that helps nurses understand patients’ experiences and concerns (Ward et al., 2012). Therefore, the interpersonal theory can help nurses put empathy at the core of their encounters with patients: effective communication is capable of improving patients’ outcomes (Ward et al., 2012).
The theory’s major advantage is that it pays attention to patient-centered care, which has a direct impact on treatment and its efficiency. Empowerment of the patient is often not supported, although it can help nurses and physicians evaluate the efficiency of the treatment and its prognosis. Furthermore, the interpersonal theory is perfectly applicable to psychiatry, where therapy is used to establish professional relationships with patients and assess their issues. It is evident that some patients become dependent on their nurse or doctor, which is seen by the theory as a normal state of the nursing process. The model is also efficient for short-term interventions, where nurses need to evaluate patients’ needs quickly.
The main disadvantage of the theory is its focus on interpersonal relationships. Not all treatments imply patient-nurse communication, especially if the patient is not capable of communicating at all. Therefore, the theory is inapplicable to such situations because patients are not equal participants in the communication. In this case, another theory needs to be chosen for efficient nursing care.
Aston, V., & Coffey, M. (2012). Recovery: What mental health nurses and service users say about the concept of recovery. Journal of Psychiatric and Mental Health Nursing, 19(3), 257-263.
D’antonio, P., Beeber, L., Sills, G., & Naegle, M. (2014). The future in the past: Hildegard Peplau and interpersonal relations in nursing. Nursing Inquiry, 21(4), 311-317.
Maghsoodi, S., Zarea, K., Haghighizadeh, M. H., & Dashtbozorgi, B. (2014). The effect of using Peplau’s therapeutic relationship model on anxiety of coronary artery bypass graft surgery candidates. Jundishapur Journal of Chronic Disease Care, 3(3), 1-6.
Ward, J., Cody, J., Schaal, M., & Hojat, M. (2012). The empathy enigma: An empirical study of decline in empathy among undergraduate nursing students. Journal of Professional Nursing, 28(1), 34-40.