PEPLAUS INTERPERSONAL THEORY
INTRODUCTION
Hildegard peplau’s theory (1952) focuses on the individual, nurse and interactive process, the results is the nurse client relationship.
According to this theory the client is an individual with a felt need, and nursing is an interpersonal and the therapeutic process.
Nursing goal is to educate the client and family and to help the client reach mature personality development. Therefore, the nurse strives to develop a nurse client relationship in which the nurse serves as a resource person, counselor and surrogate.
Biographical sketch
Hildegard E. Peplau, B.A. M.A., Ed. D.
Born : 1 September 1909
1931 : Graduated from pottsteron, oennsylvania.
B.A. : In 1943 Interpersonal Psychology Bennington
M.A. : In 1947 Psychiatric nursing Columbia, New York
Ed. D : In 1953 Curriculum development Columbia, New York
1969 : Peplau become executive director of the ANA
Peplau has served with many organizations, including the world health organization, the national institute of mental health.
Fellow of the American Academy of Nursing
ASSUMPTIONS OF THEORY
Peplau identifies the following assumptions
1.The kind of nurse each person becomes make a substantial difference in what each client will learn as she or he is nursed throughout her or his experience with illness.
2.Fostering personality development in the direction of maturity is a function of nursing and nursing education. It requires the use of principles and methods that permits and guide the process of grapping with everyday interpersonal problems
3.Nursing can take as its unique focus the reactions of clients to the circumstances of their illness.
Since illness provides an opportunity for learning and growth, nursing can assist clients to gain intellectual and interpersonal competencies, beyond those that they have at the point of illness, by gearing nursing practices to evolving such competencies through nurse clients interactions.
Peplau defines his interpersonal theory in terms of 4 concepts
1.The person : As an organism that lives in an unstable equilibrium e.g. physiological, psychological and social fluidity and life is the process of striving in the direction of stable equilibrium.
Tension leads to behavior intended to reduce the tension and to meet the needs, the nurse is concerned with the health needs of "Sick and well individuals, groups, families and communities”.
2.Health
Implies forward movement of personality and other ongoing human processes in the direction of creative constructive, productive, personal and community living.
3.Environment
Physiological, psychological and social fluidity that may be illness maintaining or health promoting.
According to Peplau, health requires that physiological and personality needs have been met, and that the person is able to express his capabilities in a productive way.
4.Nursing : Nursing is an educative instrument, a maturing forces, that aims to promote forward movement of personality.
Nursing helps people to meet their present needs. When these needs are met, more mature needs can emerge and the personality moves forward.
In this model, the relationship between the nurse and the client, which takes place within the environment, is the critical aspect of the therapeutic process.
Initially, the two strangers have separate goals and interests.
However, as the relationship progresses, they develop a mutual understanding of health goals for the clients, leading to collaborative efforts to solve any health problems.
The relationship, then provides the means to resolve frustration, conflict or anxiety to meet the clients needs.

NURSE CLIENT RELATIONSHIP
Peplaus theory 1952 / 1991 is mainly concerned with the need for growth and development and with psychological needs. She views nursing as a force that promotes movement of the personality in becoming more creative and productive.
The physiological needs are secondary to the psychosocial needs and it is the psychological environment that needs to be safe and protective.
Peplau states that “The nursing process is educative and therapeutic when nurse and patient can come to know and to respect each others as persons who are alike and yet, different as persons who share in the solution of problems”.

The nurse client relationship has four overlapping phases : -
I.Orientation : The initial phase of the nurse client relationship is the orientation phase, where the nurse and the client come to know each other.
The client seeks help, and the nurse assists the clients to understand the problem and the extent of need for help.
The purpose of the orientation phase include
a.Introduction of nurse and client.
b.Elaboration of the clients need to recognize and understand both his difficulty and the extent of his need for help.
c.Acceptance of the clients need for assistance in recognizing and planning to use services that professional personnel can offer.
d.Agreement that the client will direct energies toward the mutal responsibility for defining, understanding and meeting productively the problem at hand.
e.Clarification of limitations and responsibilities in the delivery system environment.
f.When the nurse and the client validate understanding of the clients need for help and acceptance of resources to meet those needs, and they do so with feelings of shared responsibility and a sense of trust, they move into a new phase of the relationship.

II.Identification Phase :
In the identification sub phase the client the client begins to identify problems to be worked on within the relationship.
The client assumes a posture of dependence, interdependence or independence in relations to the nurse (relatedness).
The nurses focus is to assure the person that the nurse understands the interpersonal meaning of the patients situation
The purposes of the identification phase include
a.Provision of the opportunity for the client to respond to the helpers offer to assist.
b.Encouragement for the client to express what he feels to reorient his feelings and strengthen positive forces.
c.Provision of the opportunity for the nurse and the client to clearly understand each others preconceptions and expectations.

iii. Exploitation Phase MULLERNEWS
In this phase, the patient derives full value from what the nurse offers through the relationship. The patient uses available services on the basis of self interest and needs.
The purposes of the exploitation phase include
a.Full utilization of the nurse client relationship to mutually work on the solutions to problems and the changes needed to improve health.
b.Provision of opportunities for the client to explore earlier experiences and behaviors and to have emerging needs met.

IV. Resolution phase
This is a process in which the patient frees himself from identification with the nurse.
Old needs and goals are put aside and new ones adopted.
Once older needs are resolved newer and more mature ones emerge.
During the nurse patient relationship, nurses assume many roles.
1.Stranger
2.Resource
3.Teaching
4.Leader
5.Surrogate
6.Counselor
Today, Peplaus model continues to be used by clinicians when working with individuals who have psychologic problems.
Roles of the nurse
The nurse may act several roles with the client. The roles depend on the need of the client and the skills and creativity of the nurse. The possible roles will also be influenced by the nurses position and agency policies.
Peplau describes size different nursing roles that emerge in various phases of the nurse patient relationship :
1.Role of the stranger : The first role is the role of the stranger, because the nurse and patient are strangers to each other the nurse should not prejudge the patient, but accept him as he is.
During this non personal phase, the nurse should treat the patient as emotionally able, unless evidence indicates otherwise.
2.Role of the resource person
Here the nurse provides specific answers to questions, especially health information and interprets to the patient the treatment or medical plan of care. The nurse determines what type of response is appropriate for constructive learning either straightforward factual answers or providing counseling.
3.Teaching role : The teaching role is a combination of all roles and “Always proceeds from what the patient knows and develops around his interest in wanting and ability use information”.
Peplau separates teaching into two categories instructional, which consists largely of giving information and experiential which is using the experience of the learner as a basis from which learning products are developed.
Provides information to maintain health or to improve the health situation.
Technical expert : One who provides physical care by displaying clinical skills and has the ability to operate equipment in this care. e.g. provides basic care such as bathing feeding, protecting. Provides competent efficient and accurate technical care, such as monitoring vital signs, administering medications.
4.Surrogate role
One who takes the place of another.
The nurses attitudes and behaviors create feeling tones in the patient that reactivate feeling generated in a prior relationship.
The nurses function is to a prior relation ship. The nurses function is to assist the individual in recognizing similarities between herself and the person recalled by the patient.
She then helps the patient to see the differences in her role and that of the recalled person.
In this phase, both patient and nurse define areas of dependence, independence.
Provides basic care such as bathing, feeling protecting.
Surrogate acts as substitute figure that the client imagines the nurse to be
5.Leadership role : One who carries out the process of initiation and maintenance of group goals through interaction. The nurse helps the patient to meet the task at hand through a relationship of co-operation and active participation.
Gives direction during the present problem.
6.Counseling role
Peplau believes that counseling role has the greatest emphasis in psychiatric nursing.
Counseling functions in the nurse patient relationship by the way patient responds to patient demands.
Peplau says the purpose of interpersonal techniques is to help “The patient to remember and understand fully what is happening to him in the present situation, so that the experience can be integrated rather than dissociated from other experiences in life.
Nurse educator : Using peplau theory the nurse educator would be aware of how his or her relationship with students parallels the stages of therapeutic relationships.
Communication both verbal and non verbal would be viewed as an essential vehicle for the learning process.

CRITIQUE
Simplicity
1.It is simple because interpersonal relations between patient and nurse is easily understood.
2.The key concepts are defined sequentially describes four phases of the interpersonal process.
3.Roles of the nurse is clearly indicated.
4.Ideas are taken from the specific and applied to the general
5.Peplau is consistent with established theories and principles.
1.Generality
The quality of generality is not met since peplaus theory cannot be applied to all patients.
The one drawback to the theorys generality is that an interpersonal relationship must exist.
It is use is limited in working with comatose, senile or new born patient. Since the nurse patient relationship is often one sided.
2.Empirical precision
Peplau’s theory can be considered empirically precise. She provides us with a theory based on reality.
The relationship between the theory and empirical data allows for validation and verification of the theory by other scientists.
Peplaus operationally defines the four phases of the interpersonal process, the nurse with regard to her roles and the patient with regard to his state of dependence. With further research and development, the degree of precision will increase.
3.Derivable consequences : The evaluative criteria of derivable consequences are unquestionably met. Peplaus work, thoughts and ideas have touched many nurses. Her work can be considered pioneering in the nursing field, and her work has provided significant contribution to nursing knowledge base.
CONCLUSION
Peplaus emphasis on the interpersonal nature of nursing identifies the distinctive contribution that nursing can make to health care. It is in the relationship between people that the origins of many nursing problems lie, and it is in the interpersonal domain that interventions have to be made if people are to continue to develop.
Peplaus interpersonal theory of nursing identified the therapeutic nurse client relationship as the cruse of nursing. Her theory has been used extensively in nursing practice, particularly in mental health and psychiatric nursing. Peplaus theory allowed nursing to move away from “doing to” “to doing with” clients.
Bibliography
1.Julia B. George “Nursing Theories : The base for professional nursing practice”, 3rd edition, Appleton and Lange, 43-58.
2. Ann Marriner and Tomey, “Nursing Theorists and their work”, 4th edition Mosby 335-344.
3.Potter and Perry’s “Foundations in Nursing Theory and Practice”, 1995, 6,7.
4.Susan Leddy, Pepper J. Mac, “Conceptual Bases of professional nursing”, 3rd edition J.B. Lippincott company 165-167, 350-367.