• Theorist –Hildegard. E. Peplau
• Born in Reading, Pennsylvania [1909], USA
• Diploma program in Pottstown, Pennsylvania in 1931.
• BA in interpersonal psychology – Bennington College in 1943.
• MA in psychiatric nursing from Colombia University New York in 1947.The middle‐range theory of nursing and interpersonal relations theory.
• EdD in curriculum development in 1953.
• Professor emeritus from Rutgers university
• Started first post baccalaureate program in nursing
• Published Interpersonal Relations in Nursing in 1952
• 1968 :interpersonal techniques-the crux of psychiatric nursing
• Worked as executive director and president of ANA.
• Worked with W.H.O, NIMH and Nurse Corps.
• Died in 1999.
• Theory of interpersonal relations is a middle range descriptive classification theory.
• The theory was influenced by Harry Stack Sullivan’s theory of inter personal relations (1953).The middle‐range theory of nursing and interpersonal relations theory.
• The theorist was also influenced by Percival Symonds, Abraham Maslow’s and Neal Elger Miller.
• Peplau’s theory is also refered as psychodynamic nursing, which is the understanding of ones own behavior.

MAJOR CONCEPTS

• The theory explains the purpose of nursing is to help others identify their felt difficulties.
• Nurses should apply principles of human relations to the problems that arise at all levels of experience.
• Peplau’s theory explains the phases of interpersonal process, roles in nursing situations and methods for studying nursing as an interpersonal process.The middle‐range theory of nursing and interpersonal relations theory.
• Nursing is therapeutic in that it is a healing art, assisting an individual who is sick or in need of health care.
• Nursing is an interpersonal process because it involves interaction between two or more individuals with a common goal.
• The attainment of goal is achieved through the use of a series of steps following a series of pattern.
• The nurse and patient work together so both become mature and knowledgeable in the process.The middle‐range theory of nursing and interpersonal relations theory.

• Person: A developing organism that tries to reduce anxiety caused by needs.
• Environment: Existing forces outside the organism and in the context of culture
• Health: A word symbol that implies forward movement of personality and other ongoing human processes in the direction of creative, constructive, productive, personal and community living.
• Nursing: A significant therapeutic interpersonal process. It functions cooperatively with other human process that make health possible for individuals in communities.The middle‐range theory of nursing and interpersonal relations theory.

• Stranger: receives the client in the same way one meets a stranger in other life situations provides an accepting climate that builds trust.
• Teacher: who imparts knowledge in reference to a need or interest
• Resource Person : one who provides a specific needed information that aids in the understanding of a problem or new situation
• Counselors : helps to understand and integrate the meaning of current life circumstances ,provides guidance and encouragement to make changes
• Surrogate: helps to clarify domains of dependence interdependence and independence and acts on clients behalf as an advocate.
• Leader : helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way The middle‐range theory of nursing and interpersonal relations theory.

• Problem defining phase
• Starts when client meets nurse as stranger
• Defining problem and deciding type of service needed
• Client seeks assistance ,conveys needs ,asks questions, shares preconceptions and expectations of past experiences
• Nurse responds, explains roles to client, helps to identify problems and to use available resources and services. The middle‐range theory of nursing and interpersonal relations theory.

• Selection of appropriate professional assistance
• Patient begins to have a feeling of belonging and a capability of dealing with the problem which decreases the feeling of helplessness and hopelessness. The middle‐range theory of nursing and interpersonal relations theory.

• Use of professional assistance for problem solving alternatives
• Advantages of services are used is based on the needs and interests of the patients
• Individual feels as an integral part of the helping environment
• They may make minor requests or attention getting techniques
• The principles of interview techniques must be used in order to explore, understand and adequately deal with the underlying problem
• Patient may fluctuates on independence
• Nurse must be aware about the various phases of communication
• Nurse aids the patient in exploiting all avenues of help and progress is made towards the final step

• Termination of professional relationship
• The patients needs have already been met by the collaborative effect of patient and nurse
• Now they need to terminate their therapeutic relationship and dissolve the links between them.
• Sometimes may be difficult for both as psychological dependence persists
• Patient drifts away and breaks bond with nurse and healthier emotional balance is demonstrated and both becomes mature individuals.The middle‐range theory of nursing and interpersonal relations theory.

• Both are sequential and focus on therapeutic relationship
• Both use problem solving techniques for the nurse and patient to collaborate on, with the end purpose of meeting the patients needs
• Both use  observation communication and recording as basic tools utilized by nursing

• Interrelation of concepts
  • Four phases interrelate the different components of each phase.
• Applicability
  • The nurse patient interaction can apply to the concepts of human being, health, environment and nursing.
• Theories must be logical in nature –
  • This theory provides a logical systematic way of viewing nursing situations
  • Key concepts such as anxiety, tension, goals, and frustration are indicated with explicit relationships among them and progressive phases. The middle‐range theory of nursing and interpersonal relations theory.
• Generalizability
  • This theory provides simplicity in regard to the natural progression of the NP relationship.
• Theories can be the bases for hypothesis that can be tested
  • Peplau’s theory has generated testable hypotheses.
• Theories can be utilized by practitioners to guide and improve their practice.
  • Peplau’s anxiety continuum is still used in anxiety patients
• Theories must be consistent with other validated theories, laws, and principles but will leave open unanswered questions that need to be investigated.
  • Peplau’s theory is consistent with various theories

• Personal space considerations and community social service resources are considered less.
• Health promotion and maintenance were less emphasized
• Cannot be used in a patient who doesn’t have a felt need eg. With drawn patients, unconscious patients
• Some areas are not specific enough to generate hypothesis

• Hays .D. (1961). Phases and steps of experimental teaching to patients of a concept of anxiety: Findings revealed that when taught by the experimental method, the patients were able to apply the concept of anxiety after the group was terminated. The middle‐range theory of nursing and interpersonal relations theory.
• Burd .S.F. Develop and test a nursing intervention framework for  working with anxious patients: Students developed competency in beginning interpersonal relationship.

Middle Range theory: Peplau’s Theory of Interpersonal Relations

Middle-Range theoretical frameworks continue to be more descriptive in emphasis and have more direct ties between Nursing Practice and Grand Nursing Theories. Such clinical research theories will also try to identify, justify or predict such phenomena (Covell, 2008). The middle-range concept of interpersonal relationships by Peplau can be extended to research.The middle‐range theory of nursing and interpersonal relations theory.

Assumptions

The assumptions are assertions that exclude the hypothesis of calculating or evaluating them in conceptual terms. They are ideas that are acknowledged as valid and could be debated intellectually, but they are not experimentally established (Franzoi et al., 2016). Peplau’s concept of interpersonal relationships stresses that the patient-nurse interaction is crucial in the wellbeing-illness phase since this connection helps the patient respond positively. Therefore therapeutic health interventions are carried out satisfactorily (Franzoi et al., 2016). In her thesis, Elizabeth Peplau offers two persuasive and one tacit assumption (Franzoi et al., 2016). The first clear statement notes that when providing patient care, the nurse’s preparation and attitude will affect the health of the patient. The second premise notes that the growth of personality in maturity is induced by a few of the nursing education and roles. The tacit presumption states that the medical profession is fully culpable to the patient for appropriate treatment and implications.The middle‐range theory of nursing and interpersonal relations theory.

Application in Research

The principle could be used to assess the healthcare experience of patients. People’s experience in healthcare facilities is a significant predictor of medical care efficiency (Hagerty et al., 2016). Patients’ experiences are characterized as their impressions of events and that they are the main or only type of evidence, like discharge planning performance or personal comfort. As an alternative parameter framework for patient experience information, Peplau’s concept of interpersonal relationships could be applied as an effective nursing theory in research since Peplau often recognized the significance of the patient’s perceptions of nursing healthcare. Peplau stressed patients’ perspectives in the context of interpersonal interactions in healthcare and the impact that patient-nurse associations have on such encounters. Peplau argued that patients, their preferences, and their expectations of the treatment they obtain from nurses should focus on clinical research in healthcare (Alligood, 2017).The middle‐range theory of nursing and interpersonal relations theory.