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# 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.

Updated Nov 12, 2026

## Key points

- 1952: Interpersonal Relations in Nursing; based on Sullivan's interpersonal theory.
- Phases: orientation, identification, exploitation and resolution (often grouped as orientation, working and termination).
- Nurse's roles: stranger, resource person, teacher, counsellor, surrogate, leader and technical expert.
- Anxiety is central: keep it mild to moderate so it can drive learning and coping.
- Health is a dynamic state of personal growth, not only the absence of illness.

## 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.

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## Connections

## Related 1

- [Therapeutic communication: techniques and barriers](https://durgical.com/en/nursing/therapeutic-communication-techniques-and-barriers/)

[← All of nursing](https://durgical.com/en/nursing/)

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](https://pmc.ncbi.nlm.nih.gov/articles/PMC13714210/) (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](https://pmc.ncbi.nlm.nih.gov/articles/PMC7540068/) (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](https://pmc.ncbi.nlm.nih.gov/articles/PMC9989484/) (Frontiers in Public Health (PubMed Central), 2023).

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