Why it mattered
Peplau's theory of interpersonal relations comes from Hildegard Peplau (1909–1999), whose book Interpersonal Relations in Nursing appeared in 1952. She finished the manuscript in 1948, but publishers balked at a nursing book without a physician co-author, so it sat for four years. During World War II she served in the Army Nurse Corps at a psychiatric hospital, and she drew heavily on psychiatrist Harry Stack Sullivan's interpersonal psychiatry.
Where care after Nightingale centered on the environment and procedures, Peplau argued that the encounter between nurse and patient is a treatment in its own right. It was one of the first attempts to define a body of knowledge that belonged to nursing rather than to medicine, and it earned her the title "mother of psychiatric nursing." In the early 1970s she served as executive director and then president of the American Nurses Association and championed advanced practice nursing.
Phases of the relationship
Peplau described four overlapping phases. In orientation, the patient seeks help and nurse and patient clarify the problem together. In identification, the patient responds selectively to people who can help and begins trading helplessness for a sense of control. In exploitation, the patient makes full use of the services and the relationship to move toward goals. In resolution, dependence fades, new goals emerge, and the relationship ends on healthy terms. Many educators now teach a three-phase version—orientation, working, termination—that folds identification and exploitation into one working phase.
Roles the nurse plays
Over the course of the relationship, the nurse moves among six roles: stranger (owed courtesy and respect), resource person, teacher, counselor, surrogate (standing in, in the patient's mind, for a parent or sibling), and leader who guides toward goals democratically. She also mentioned the technical expert, but her emphasis was squarely on relational roles.
Anxiety sits at the center of the model. Peplau described mild, moderate, severe, and panic levels: mild anxiety sharpens learning, but higher levels narrow perception, so the nurse has to read the level and adjust. That framework is still standard in psychiatric–mental health nursing courses.
In practice
Therapeutic communication training and talk-based interventions such as cognitive behavioral therapy or motivational interviewing all rest on Peplau's groundwork. For a newly admitted patient with schizophrenia, the nurse might build trust during orientation with a predictable schedule and short, clear explanations, practice symptom-management skills together in the working phase, and close by connecting the patient to community resources before discharge. Setting goals mutually was later formalized in King's theory of goal attainment.
Strengths and limitations
Peplau put relationship and communication at the heart of nursing and launched a whole family of interaction theories. Its limits: it assumes a verbal adult, so it's harder to apply to unconscious patients, newborns, or fast-moving emergencies, and it doesn't scale easily to families, groups, or communities.
See also
Nursing theory · King's theory of goal attainment · Watson's theory of human caring · Orem's self-care deficit theory
FAQ
- What's the difference between identification and exploitation?
- Identification is when the patient starts to feel "this person can help me" and responds to the relationship; exploitation is when the patient actively uses that relationship and the available services.
- What does the surrogate role mean?
- Patients sometimes transfer feelings about a parent or sibling onto the nurse. In the surrogate role, the nurse helps the patient recognize the difference.
Sources reviewed: 2026-10-26
References
- Peplau, H. E. (1952). Interpersonal Relations in Nursing. New York: G. P. Putnam's Sons.
- Peplau, H. E. (1997). Peplau's theory of interpersonal relations. Nursing Science Quarterly, 10(4), 162–167.
- Forchuk, C. (1993). Hildegard E. Peplau: Interpersonal Nursing Theory. Newbury Park, CA: Sage.
- Alligood, M. R. (Ed.). (2021). Nursing Theorists and Their Work (10th ed.). Elsevier.