Hildegard Peplau's interpersonal relations theory
- Fundamental
Peplau saw nursing as a therapeutic relationship between nurse and patient that moves through phases and helps the person grow.
What it is
Hildegard Peplau, a US psychiatric nurse, published Interpersonal Relations in Nursing in 1952. Building on Harry Stack Sullivan's interpersonal psychiatry, she described nursing as a therapeutic, interpersonal process: the relationship itself is a tool for care. The relationship moves through phases: orientation, identification, exploitation (the working phases) and resolution. Along the way the nurse takes on different roles, from stranger to counsellor. Anxiety is a central concept: in mild to moderate amounts it can drive learning, but when high it blocks it. It is usually classed as a middle-range theory and is the basis of therapeutic communication.
Key points
- Orientation: the person recognises a need for help; nurse and patient meet as strangers and set roles, trust and expectations.
- Identification: the person relates to the nurse who can help and expresses deeper concerns.
- Exploitation: the person makes full use of the help offered and practises new skills and ways of coping.
- Resolution: needs are met, the relationship ends and the person prepares to manage alone.
- Stranger role: the nurse offers the respect and positive interest due to someone not yet known.
- Surrogate role: the nurse may stand for another important person in the patient's life, which implies advocacy.
What it is for
- Strength: one of the few theories that explains how a nurse–patient relationship is formed and sustained.
- Strength: adaptable to psychiatric, emergency, community and long-stay settings.
- Limit: environment is not explicitly defined.
- Limit: it does not fully address the power imbalance between nurse and patient, and it was built for psychiatric nursing.
Step by step
- Introduce yourself, explain your role and agree on the purpose of your contact — this is orientation.
- Explore the person's view of the problem and their level of anxiety — high anxiety blocks learning.
- Choose the role the moment needs: resource, teacher, counsellor — the role changes with the phase.
- Plan goals together and let the person use the help actively — this is the exploitation phase.
- Prepare the ending early: review progress and plan for life after discharge — so resolution is not abrupt.
Peplau and the metaparadigm
| Concept | How Peplau sees it |
|---|---|
| Person | A developing individual, unique and with dignity, who tries to reduce anxiety from unmet needs |
| Environment | Not clearly defined; implied social, cultural and psychological forces, and the relationship itself |
| Health | A dynamic state of personal growth, not merely the absence of illness |
| Nursing | A significant, therapeutic, interpersonal process that helps the person grow |
In nursing practice
- Example: a young man admitted after a suicide attempt barely speaks. On day one, the nurse introduces herself and sets short, regular times to talk (orientation).
- Over the week he names his worries and practises asking for help (identification and exploitation). Before discharge, they review what he learned and who he will call (resolution).
- Peplau-based studies use her phases to plan teaching, anxiety management and discharge in many settings.
Common mistakes
- Skipping the introduction and the agreement on purpose.
- Giving advice before listening to the person's own view.
- Teaching when anxiety is high and the person cannot take it in.
- Ending the relationship abruptly at discharge, without a resolution phase.
Test yourself
Think of the answer, then tap the question to see it.
What are the phases of the nurse–patient relationship in Peplau's theory?
Orientation, identification, exploitation and resolution; identification and exploitation are often grouped as the working phase.
Why is anxiety central in Peplau's theory?
Mild to moderate anxiety can drive learning and coping, but high anxiety blocks them, so the nurse helps keep it manageable.
Which role does the nurse take when first meeting the patient, according to Peplau?
The stranger role: the nurse offers respect and positive interest, as to someone not yet known.
In which year did Peplau publish Interpersonal Relations in Nursing?
In 1952.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Applying Peplau's Interpersonal Relations Theory to Enhance Older Adults' Health Literacy Through Nursing Care: A Theory Analysis (Journal of Holistic Nursing (PubMed Central), 2025); Where and how does fundamental care fit within seminal nursing theories: A narrative review and synthesis of key nursing concepts (Journal of Clinical Nursing (PubMed Central), 2020); An anxiety management intervention for people with substance use disorders (ITASUD): An intervention mapping approach based on Peplau's theory (Frontiers in Public Health (PubMed Central), 2023).
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Representative model, for educational purposes only.