peplau's theory of interpersonal relations a case study

Peplau's Theory of Interpersonal Relations: A Case Study

Affiliations.

• 1 School of Nursing and Midwifery, The Aga Khan University, Karachi, SD, Pakistan.
• 2 Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
• PMID: 34538167
• DOI: 10.1177/08943184211031573

Theoretical frameworks offer guiding principles to guide nursing practice on well-defined nursing knowledge. Peplau's theory of interpersonal relationship empowers nurses in their work for regaining health and well-being for people. Understanding the theory and the connectedness that arises from this theory provides a structure for nurse-patient relations, even working through a language barrier as evidenced by the case scenario detailed in this article.

Keywords: Peplau’s theory of interpersonal relations; language barriers; nurse-patient relationship; nursing theory.

• Interpersonal Relations
• Nurse-Patient Relations*
• Nursing Theory*

• Open access
• Published: 27 January 2024

The effect of multimodal care based on Peplau’s interpersonal relationship theory on postoperative recovery in lung cancer surgery: a retrospective analysis

• Xue-e Su 1 , 3 ,
• Shan-hu Wu 3 ,
• He-fan He 3 ,
• Cui-liu Lin 1 ,
• Shu Lin 1 , 2 &
• Pei-qing Weng 3  

BMC Pulmonary Medicine volume  24 , Article number:  59 ( 2024 ) Cite this article

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Lung cancer remains a major global health concern due to its high incidence and mortality rates. With advancements in medical treatments, an increasing number of early-stage lung cancer cases are being detected, making surgical treatment the primary option for such cases. However, this presents challenges to the physical and mental recovery of patients. Peplau known as the “mother of psychiatric associations” has formulated a theory of interpersonal relationships in nursing. Through effective communication between nurses and patients over four periods, she has established a good therapeutic nurse-patient relationship. Therefore, this study aimed to explore the effect of perioperative multimodal nursing based on Peplau’s interpersonal relationship theory on the rehabilitation of patients with surgical lung cancer.

We retrospectively analyzed 106 patients with non-small cell lung cancer who underwent thoracoscopic lobectomy at our department between June 2021 and April 2022. Patients were categorized into two groups according to the different nursing intervention techniques. The Peplau’s group comprised 53 patients who received targeted nursing interventions, and the control group comprised 53 patients who received conventional nursing care. We observed the patients’ illness uncertainty, quality of life, and clinical symptoms in both groups.

Patients in the Peplau’s group had significantly lower illness uncertainty scores and a significantly higher quality of recovery than those in the control group. However, there were no significant differences in length of post-anesthesia care unit stay, complication rates, and visual analog scores between both groups.

The multimodal perioperative nursing based on Peplau’s interpersonal relationship theory not only reduces the illness uncertainty of patients with lung cancer surgery and improves their QoR but also expands the application of this theory in clinical practice, guiding perioperative nursing of patients with lung cancer.

Implications

These findings provide practical information for standardized care in a hectic anesthetic care setting.

The assessed anesthesia nursing model helps reduce uncertainty and promote early recovery in patients with cancer at various stages of their disease, which expands the scope of therapeutic practice and existing theories. It also serves as a guide for care in the anesthesia recovery room.

Reporting method

We adhered to the relevant Equator guidelines and the checklist of items in the case–control study report.

Patient or public contribution

Patients cooperated with medical staff to complete relevant scales.

Global contribution

•Demand for nursing care from patients with NSCLC at various stages of the disease varies and changes over time.

•The anesthesia nursing model based on Peplau’s interpersonal relationship theory helps to reduce uncertainty and promote early recovery in patients with cancer.

•This model has some viability and efficacy, which expands the scope of therapeutic practice and existing theories. It also serves as a guide for care in the anesthesia recovery room.

Peer Review reports

According to the latest medical information, lung cancer continues to exhibit high incidence and mortality rates worldwide, posing a serious threat to human health [ 1 ]. However, with the rapid advancements in modern medical treatments, an increasing number of lung cancers are being detected at an early stage. Surgical treatment is considered the primary treatment option for early-stage non-small cell lung cancer (NSCLC) [ 2 ]. Although surgical intervention can be lifesaving, patients also face enormous physiological and psychological pressure during the perioperative period, necessitating optimal nursing care throughout the treatment process to improve patient outcomes.

While pertinent literature has contributed to the advancement of anesthesia care during the rapid development of modern anesthesia medicine in China, several anesthesia nursing procedures remained in the exploratory stage when rules and regulations were being established. Therefore, medical professionals should provide appropriate nursing care to assist patients throughout the treatment process and improve their prognosis.

Numerous studies have demonstrated that effective health intervention can lead to positive mood enhancement, reduced complication, and improved quality of life in patients with NSCLC [ 3 , 4 , 5 , 6 ]. However, compared to developed countries, anesthesia nursing started relatively late in China, and related anesthesia nursing service models were immature. Currently, the implementation of health nursing intervention measures still lacks anesthesia nurse-led care, particularly for patients undergoing surgical treatment. Thus, exploring related nursing models is essential for the development of continuous nursing. Additionally, traditional health education in China is disease-focused and frequently disregards the unique requirements of patients with varying stages of disease. This frequently results in prejudice while giving and receiving medical information, which partially lessens the efficiency of health education. The timing and content of pertinent health education materials are inconsistent with the current nursing needs of patients. Furthermore, health interventions for perioperative patients in China are relatively limited in scope, overly simplistic in form, and lack dynamic psychological assessment and intervention.

Hildegard E. Peplau, a renowned nursing theorist, proposed Peplau’s theory of interpersonal relationships [ 7 ]. It emphasizes the establishment of a harmonious, mutually understanding, and respectful nurse-patient relationship to gain a broader understanding of patient problems and proposes practical approaches, through the following four dynamic stages of nurse-patient communication: recognition, determination, progress, and resolution [ 8 ]. Although this theory has been widely applied to patients with chronic diseases and nursing education, its application in perioperative patients, particularly in anesthesia nurse-led care for lung surgery patients, remains scarce.

Therefore, based on the role of Peplau’s interpersonal relationship theory, the physiological and psychological rehabilitation needs of patients with surgical lung cancer during the perioperative period, and the background of anesthesia nursing work, we proposed the following scientific hypothesis: multimodal perioperative anesthesia nursing based on Peplau’s interpersonal relationship theory can promote the physiological and psychological rehabilitation of patients with lung cancer. To verify the above hypothesis, we conducted a retrospective study to observe the impact of multi-modal anesthesia nursing under the guidance of this theory on illness uncertainty, quality of recovery (QoR), and clinical symptoms in patients with lung cancer. This study holds great significance for the application of this theory in the field of anesthesia nursing and the rehabilitation of patients with lung cancer.

In this study, we adopted Peplau’s interpersonal theory as a framework to focus on the care needs of perioperative patients. We intended to understand the effectiveness of this care model on the health outcomes of these patients. Additionally, we aimed to improve the clinical outcomes of patients by reducing their illness uncertainty and enhancing early recovery while providing a theoretical and practical basis for the application of Peplau’s interpersonal theory in perioperative anesthesia care.

This study used a retrospective observational design involving a retrospective analysis of patients who underwent radical lung cancer resection.

Study setting and sampling

One hundred and six patients who underwent radical lung cancer resection at the Second Hospital of Fujian Medical University between June 1, 2021, and April 30, 2022, were retrospectively selected (Fig.  1 ). These patients were categorized into two groups due to the implementation nodes of multimodal perioperative nursing based on Peplau’s interpersonal relationship theory. The Peplau’s group (PG) comprised 53 patients who received multimodal care based on Peplau’s interpersonal relationship theory, while the control group (CG) comprised 53 individuals who received conventional nursing interventions. Specific intervention measures are detailed in Table  1 .

Flow chart of the included patients

Inclusion criteria

To be included in this study, patients had to meet the following criteria: confirmed diagnosis of NSCLC through pathological analysis, stages I–II (T 1 − 3 N 0 M 0 and T 1 − 2 N 1 M 0 ); age between 18 and 80 years; stable vital signs and complete baseline data; thoracoscopic lobectomy without prior treatment, chemotherapy, or other adjuvant medication; and normal cognitive function and verbal communication to understand and complete the assessment scale.

Exclusion criteria

The following patients were excluded from the study: those merged with other cancers; major systemic diseases affecting the heart, brain, kidney, or other organs; psychiatric and cognitive disorders; concurrent serious infectious diseases; and those who withdrew from the study for various reasons or were unable to cooperate.

Nursing care methods

In the CG, patients received the following routine nursing care: (1) active pre-operative conversation with the patient, explaining anesthetic instructions, and encouraging active participation in the procedure; (2) good preparation for anesthesia and regular intraoperative observation of changes in the patient’s vital signs; (3) administration of multimodal complex analgesia and continuous monitoring of the patient’s vital signs in the recovery area after anesthesia; and (4) follow-up visits to the ward to address the patient’s pain.

In the PG, patients received specialized care in four phases as follows:

Recognition: preoperative ward assessment

A day prior to the surgery, a nurse anesthetist visited the ward to conduct a pre-anesthetic examination. This bedside communication included a comprehensive assessment of the patient’s respiratory and cardiovascular system, enabling both nurses and patients to fully understand the risks associated with anesthesia [ 9 ]. Psychological care was provided to the patients and their families to further explain the general process of anesthesia and address matters related to cooperation. Successful cases were shared to alleviate psychological burdens, minimize uncertainty about the disease, build trust between patients and nurses, increase patient confidence, and promote positive cooperation. Additionally, clear instructions on coughing and deep breathing were provided to help patients recover quickly, which benefits both recovery from anesthesia and the disease. This period is the beginning stage of therapeutic nurse-patient relationships based on the Peplau theory, and nurses should focus on building trust relationships with patients.

Determination: evaluation of the anesthesia preparation room

The anesthetic preparation room serves as the setting where the anesthetist and the nurse prepare for anesthesia. Under the guidance of the anesthetist and considering the patient’s risk factors, the anesthetic nurses prepared drugs, performed venous and arterial punctures, and monitored vital signs. Nurses ensured that patients received reassurance and addressed their main concerns to alleviate any anxiety that may arise in an unfamiliar environment, which particularly emphasized that the nurse who conducted preoperative visits to the patient the day before reappeared to answer patient’s questions and alleviate their anxiety in unfamiliar environments.

Progression: nursing care in the postoperative anesthesia monitoring room

The recovery room, functioning as a central monitoring unit, plays a crucial role in perioperative patients care [ 10 ]. Despite continuous monitoring, there is a high potential for issues in patients during their stay in this area, mainly due to prior anesthesia and surgery. Therefore, nurses in the recovery room adjust the room temperature and provide thermal blankets and heaters to avoid complications, shivering, and awakening based on each patient’s preoperative vital signs, including temperature, pulse, respiration, blood pressure, and other factors such as the preoperative situation, particular anesthetic situation, and the current status of the operation. Additionally, as the primary caregivers during the immediate postoperative period, nurses pay close attention to the patient’s pain management and care of drainage tubes. Once the patient awakens and meets the discharge criteria based on modified Aldrete or Steward scoring(the scoring criteria used to evaluate the recovery status of patients undergoing general anesthesia surgery, including indicators such as consciousness, breathing, and circulation), the nurse accompanies the patient back to the ward and provides detailed explanations to both the patient and their family members, ensuring the continuity of nursing care. During this period, it is particularly emphasized that nurses carry out nursing based on the trust established during preoperative visits and preparation with patients, meet the needs of patients during anesthesia recovery, and further establish a sense of trust.

Resolution: postoperative ward visit

Postoperative visits are essential for implementing a multidisciplinary approach to comprehensive care. Although the reduction in the incidence of postoperative pain is significantly lower using multimodal analgesia, it remains a major concern for patients. Therefore, anesthetic nurses prioritize pain management during follow-up [ 11 ], including the interpretation and management of common complications, such as nausea and vomiting. Patients gradually recovered from surgery starting from the first day until their discharge from the hospital, allowing them to interact regularly with nurses. In the late 1990s the American Baptist Memorial Hospital pioneered the use of AIDET (A: acknowledge; I: introduce; D: duration; E: explicit; T: thank you) as a form of communication, which was later adopted in China for anesthetic pain management. This approach not only effectively controls pain but also enhances mutual trust between nurses and patients while increasing patients’ and doctors’ engagement in pain management [ 12 ]. Our anesthetic nurses used the AIDET standardized communication model for postoperative follow-up. They addressed individual patients’ concerns and focused on preventing complications and facilitating rehabilitation after discharge. During this period, the therapeutic nurse-patient relationship between nurses and patients tends to come to an end, and special emphasis should be placed on gratitude for patient cooperation, encouraging patients to actively recover and gradually return to normal life.

Outcome measures

Illness uncertainty scores.

Illness uncertainty refers to a person’s inability to comprehend events related to their illness and has been identified as a prevalent source of psychological stress in chronic diseases. According to illness uncertainty theory, patients may experience uncertainty when they are unable to categorize the significance of events linked to their condition, such as symptoms and treatment outcomes [ 13 ]. This outcome was measured using the Mishel Uncertainty in Illness Scale (MUIS) [ 14 ]. The MUIS comprises of 33 items categorized into four dimensions as follows: uncertainty regarding sickness status (13 items), complexity (7 items), lack of information (7 items), and unpredictable course and outcome of illness (5 items). Each item was scored on a 5-point Likert scale, with 1 indicating strong disagreement and 5 representing strong agreement. Higher scores reflected a higher level of disease uncertainty. The overall scores range from 32 to 160, categorized into low (32–74.7), moderate (74.8–117.4), and high (117.5–160) [ 15 ]. The scores were collected indicators from patients after surgery and the day before discharge.

Quality of recovery

Quality of recovery (QoR) is a fundamental concept in perioperative patient care. The QoR-15 is a questionnaire that evaluates QoR in five areas: pain, physical independence and comfort, psychological support, and emotional state. It has been validated for assessing inpatient and ambulatory anesthesia during the intermediate recovery period [ 16 , 17 ]. The QoR-15 score ranges from 0 to 150 representing poor to excellent recovery. The scores are categorized as excellent, medium, moderate, and poor recovery [ 18 ]. According to patients, clear communication, active participation in healthcare decisions, and compassion from healthcare professionals are considered important elements of the quality of their recovery. The scores were collected indicators from patients after surgery and the day before discharge.

Clinical outcomes

We recorded the length of post-anesthesia care unit (PACU) stay, length of hospital stay, visual analog scale (VAS) scores, and occurrence of PACU and postoperative complications. Early hypoxemia is the most frequent complication in the radical resection of lung cancer. Previous studies have shown that hypoxemia is more severe on post-operative days 1 and 3 [ 19 , 20 ]. Emergence agitation, characterized by inappropriate behavior during the awakening period from general anesthesia, is another common complication of anesthesia, reported in 11–51% of cases [ 21 , 22 ]. The VAS scores were collected from patients at 24, 48 and 72 h postoperatively.

Data collection and analysis

The data were analyzed using IBM SPSS Statistics for Windows, version 20.0 (IBM Corp., Armonk, N.Y., USA) to ensure accuracy. The Shapiro–Wilk test was applied to establish normal distribution. Descriptive statistics were presented using the median for non-normally distributed data, while the mean (X̄) ± standard deviation (SD) was used for variables with a normal distribution. Categorical variables were presented as numbers and percentages. The significance of the difference between the two means for the continuous variables was assessed in the PG and CG using the Student’s t -test, a parametric test for normally distributed values, and the Mann–Whitney U test for non-normally distributed data. The analysis of categorical variables employed Pearson’s chi-square test. Statistical significance was set at P  < 0.05.

Ethical considerations

This study was conducted in compliance with the principles of the Declaration of Helsinki. Owing to the retrospective nature of this study, the need for informed consent was waived by the Medical Ethics Committee of the Second Affiliated Hospital of Fujian Medical University, and the study design was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Fujian Medical University on January 7,2023 (No. 2,023,125).

Patients characteristics

The PG comprised patients aged 27–75 years, with an average of (53.62 ± 11.43) years, whereas the CG included those aged 28–80 years, with a mean age of (56.24 ± 12.28) years. The differences in mean age, body mass index, sex, Tumor Node Metastasis (TNM) stage, education, smoking history, family history, and alcohol consumption between the PG and CG were not significant (all P  > 0.05; Table  2 ).

Comparison of illness uncertainty scores after intervention in both the groups

Illness uncertainty was observed in both the groups. The results indicated that the post-operative scores were significantly lower in both groups, and disease uncertainty, complexity, lack of information, and unpredictability scores were significantly lower in the PG than those in the CG ( P  < 0.05; Table  3 ).

Comparison of the quality-of-life levels between both groups after the intervention

The rehabilitation levels of both groups were evaluated after the intervention. The results indicated that the QoR score was 97 (94–100) and 93 (92–97) in the PG and CG, respectively. The comparison showed that the QoR in the PG was significantly higher than that in the CG ( P  < 0.05; Table  4 ).

Clinical symptoms of patients in both groups after the intervention

Clinical symptoms were observed in both the groups. No significant differences were observed between the two groups in terms of the length of PACU stay, hospital stay, complication rate, and VAS scores (Table  5 ; Fig.  2 ).

Patient’s postoperative pain score

This retrospective study revealed that compared to patiens receiving routine care, those who received multimodal perioperative care based on Peplau’s interpersonal relationship theory exhibited significantly improved illness uncertainty and QoR in the subjects. However, the multimodal perioperative care based on Peplau’s interpersonal relationship theory was not statistically significance for the patient’s length of PACU stay, length of hospitalization, postoperative VAS score, PACU complications, and incidence of postoperative complications.

During the second half of the 19th century, anesthesia care flourished in the United States owing to a lack of qualified anesthesiologists [ 23 ]. China started anesthesia nursing relatively late and has recently released a detailed strategy to improve the standards of anesthetic care and ensure patient safety and comfort. Consequently, nursing anesthetists are receiving increasing attention, emphasizing the importance of creating and implementing targeted training and clinical practice [ 24 ]. Therefore, it is crucial to establish a standardized approach to anesthesia care to inform the anesthesia care profession and improve the consistency, quality, and efficiency of care.

An individual’s inability to explain disease-related events, known as illness uncertainty, has been identified as a common source of psychological stress in chronic diseases. Patients with lung cancer often face challenges related to higher levels of physical symptom distress, mental health and daily living challenges, and burdensome symptoms compared to patients with other types of cancer. This is due to the high morbidity and mortality associated with lung cancer during and after treatment [ 25 , 26 ]. All the respondents experienced frustration upon learning about their cancer diagnoses. It heralds the transition from a healthy person to a patient and to a time of perpetual change and difficulty. In addition, the extensive pre-operative testing that patients undergo upon hospital admission leads to increased levels of anxiety and stress. Most studies (65%) found that interventions targeting disease uncertainty management had favorable effects on uncertainty outcomes. Multicomponent therapies, which integrate informational and emotional support, appear to be the most successful approach to managing illness uncertainty in patients with cancer and their family caregivers [ 27 , 28 ]. Therefore, a new and effective intervention model for peripheral surgical anesthesia is urgently needed.

Peplau’s theory of interpersonal relationships is partly based on the relationships between interpersonal theories. It aims to help patients and caregivers build positive interpersonal relationships based on mutual respect and trust, assist patients in overcoming negative emotions, and break bonds of low self-esteem. By utilizing observational, empirical, and reflective approaches to structured and unstructured interactions, Peplau’s theory provides nurses with guidance in constructing strategic communication with patients. Anxiety plays a significant role in the interpersonal interaction process created by Peplau, and, if carefully addressed, can be the key to addressing a patient’s health issues [ 29 ]. Through the four stages of “recognition,” “determination,” “progression,” and “resolution,” dynamic communication can fill in the gaps in the patients’ knowledge about the disease, alleviate their concerns about upcoming anesthesia and surgery, and restore their confidence in their ability to overcome the illness. Nurses, especially nursing anesthetists assisting patients undergoing lung cancer surgery, play a critical role in the care of patients with lung cancer. They play a role in early task disclosure, patient care during surgery, escorting during wakefulness, post ward follow-up, and dynamic care that can readily address the patients’ first questions.

In summary, multimodal perioperative nursing based on Peplau’s interpersonal relationship theory may maintain a good nurse-patient relationship, dynamic communication, meet patient needs, reduce patient anxiety, and reduce disease uncertainty through comprehensive and personalized nursing between nurses and patients. A good psychological state of the patient will inevitably promote the physiological recovery of the body. Therefore, under this multimodal nursing plan, the postoperative rehabilitation quality indicators of patients in the PG patients also showed statistical significance. In addition to pain and physical comfort, physical comfort also demonstrated a good recovery trend. Previous studies have demonstrated that illness uncertainty is closely related to the patients’ quality of life [ 15 , 30 , 31 ]. These studies have found a negative correlation between illness uncertainty and quality of life, which can directly or indirectly affect the QoR of patients through perceived stress, depression, social support, and coping mechanisms. However, no significant difference was found in pain, length of PACU and hospital stay, and incidence of complications among patients. This could be attributed to the fact that the included patients were those with early-stage lung cancer, with relatively small surgical trauma and good rehabilitation effects. Additionally, the popularity of multimodal analgesia may be another reason, therefore, there was no statistically significant difference in pain scores between the two groups of patients.

This study had some limitations. Firstly, this is a retrospective study with a single center and small sample size. Due to non matching studies, there are many confounding factors, and the explanatory power of some observation indicators is insufficient. Secondly, a multimodal perioperative nursing observation based on Peplau’s interpersonal relationship theory was only carried out for a specific population of patients with surgical lung cancer. The population is limited, and the number of patients included in this study tends to be younger, which limits the generalizability and application of this nursing plan. Finally, implementing multimodal perioperative care based on Peplau’s interpersonal relationship theory may result in additional labor and time costs. Therefore, in the future, large sample, prospective, multicenter, randomized controlled studies are needed to confirm the effectiveness of this nursing model and evaluate its feasibility as a perioperative nursing plan.

Conclusions

The multimodal perioperative nursing based on Peplau’s interpersonal relationship theory not only reduces the illness uncertainty of patients with lung cancer surgery and improves their QoR but also expands the application of this theory in clinical practice, guiding perioperative nursing of patients with lung cancer. However, due to the limitations of single center, small sample, and retrospective studies, further research is needed to verify the widespread clinical application of a multimodal perioperative nursing plan based on this theory.

Data availability

The authors confirm that the data supporting the findings of this study are available within the article.

Abbreviations

Non-small cell lung cancer

Peplau’s group

Control group

Acknowledge; introduce; duration; explicit; thank you

Mishel uncertainty in illness scale

Visual analog scale

Emergence agitation

Standard deviation

Tumor Node Metastasis

Post-anesthesia care unit

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Acknowledgements

We would like to thank Editage ( www.editage.cn ) for English language editing.

This work was supported by the Nursery Fund Project of the Second Affiliated Hospital of Fujian Medical University (No. 2021MP25), the Fujian Provincial Clinical Key Specialty Construction Project (No. HLZDZK202307).

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Contributions

XES, HFH, SL and PQW contributed to study design. XES, SHW and CLL performed the searches and contributed to data collection and data analysis. Any disagreements were settled by a third author (SL or PQW). XES, HFH and CLL drafted the article. All authors approved the final report.

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Correspondence to Shu Lin or Pei-qing Weng .

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Owing to the retrospective nature of this study, the need for informed consent was waived by the Medical Ethics Committee of the Second Affiliated Hospital of Fujian Medical University, and the study design was approved by the Medical Ethics Committee of the Second Affiliated Hospital of Fujian Medical University on January 7,2023 (No. 2023125).

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Su, Xe., Wu, Sh., He, Hf. et al. The effect of multimodal care based on Peplau’s interpersonal relationship theory on postoperative recovery in lung cancer surgery: a retrospective analysis. BMC Pulm Med 24 , 59 (2024). https://doi.org/10.1186/s12890-024-02874-5

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DOI : https://doi.org/10.1186/s12890-024-02874-5

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Peplau’s Theory of Interpersonal Relations: A Case Study

Abstract: theoretical frameworks offer guiding principles to guide nursing practice on well-defined nursing knowledge. peplau’s theory of interpersonal relationship empowers nurses in their work for regaining health and well-being for people. understanding the theory and the connectedness that arises from this theory provides a structure for nurse-patient relations, even working through a language barrier as evidenced by the case scenario detailed in this article..

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References 2 publication s, the effect of professional nursing practice model training (mpkp) with the implementation of pillar iv nursing care delivery system (pillar iv ncds) at a hospital in kotamobagu, indonesia.

Background: Professional Nursing Practice Model Training (Model Praktik Keperawatan Profesional; MPKP) is one of the efforts to improve the quality of service in hospitals in nursing services to minimize errors or omissions that can occur. The training carried out is expected to be able to improve the implementation of pillar IV NCDS in hospitals. Aims: This study aimed to determine the effect of MPKP training with the application of pillar IV NCDS at the General Hospital of the Evangelical Masehi Church Bolaang Mongondow Monompia Kotamobagu. Methods: This research is a quantitative research type with a pre-experimental research design one group pre-test post-test design. This research was conducted in August 2022 as many as 52 nurse respondents working at the Monompia GMIBM Hospital Kotamobagu. Results: From the survey, it shows that the intervention will increase the number of nurses implementing the Pillar IV Nursing Care Delivery System (Pillar IV NCDs) including the assessment element (from 76.9% to 90.4%), nursing diagnosis (from 36.5% to 75.0%), planning (from 51.9% to 88.5%), action or measurement (from 84.6% and 92.3%), evaluation (from 46.2% to 90.4%), and nursing care notes (78.8% and 98.1%). There are differences in the implementation of pillar IV NCDS before and after being given MPKP training (p-value: <0.001). it is known that education level and the work experience of the nurses will significantly determine the success of the training, respectively with p value of <0.001 and 0.004. Conclusion: From the survey, we may note how the Professional Nursing Practice Model Training (MPKP) affecting the number of nursing implementing the Pillar IV NCDs. Data from the results can be used as recommendation to the hospitals’ human resources department in designing their program in order to increase the nurses’ competences.

Validación psicométrica de la «Escala de habilidades comunicacionales aplicada por paciente estandarizado» para la simulación clínica

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Advancing Nursing Practice Through Mentoring and Teaching-Learning

In the article that follows this introduction, there are insights into the importance of a theoretical framework for nursing practice. The authors detail the impact to nursing practice a theoretical framework provides by using a case study approach. The introductory thoughts in this article focus on inspiring mentoring models and teaching learning models within theoretically based nursing science and practice.

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• Hildegard Peplau: Interpersonal Relations Theory

Hildegard Peplau is a nurse theorist who created the Theory of Interpersonal Relations . Get to know Peplau’s theory and biography in this nursing theories study guide .

Table of Contents

Career and appointments of hildegard peplau, interpersonal relations theory, awards and honors, description, assumptions, society or environment, 1. orientation phase, 2. identification phase, 3. exploitation phase, 4. resolution phase, subconcepts of the interpersonal relations theory, four levels of anxiety, interpersonal theory and nursing process, recommended resources, external links, biography of hildegard e. peplau.

Hildegard Elizabeth Peplau (September 1, 1909 – March 17, 1999) was an American nurse who is the only one to serve the American Nurses Association (ANA) as Executive Director and later as President. She became the first published nursing theorist since Florence Nightingale .

Peplau was well-known for her Theory of Interpersonal Relations , which helped to revolutionize nurses’ scholarly work. Her achievements are valued by nurses worldwide and became known to many as the “Mother of Psychiatric Nursing” and the “Nurse of the Century.” 

Hildegard Peplau was born on September 1, 1909. She was raised in Reading, Pennsylvania, by her parents of German descent, Gustav and Otyllie Peplau. She was the second daughter, having two sisters and three brothers. Though illiterate, her father was persevering while her mother was a perfectionist and oppressive. With her young age, Peplau’s eagerness to grow beyond traditional women’s roles was precise. She considers nursing was one of few career choices for women during her time. In 1918, she witnessed the devastating flu epidemic that greatly influenced her understanding of the impact of illness and death on families.

When the autonomous, nursing-controlled, Nightingale era schools came to an end in the early 1900s, schools then were handled by hospitals, and the so-called formal “book learning ” was put down. Hospitals and physicians considered women in nursing as a source of free or inexpensive labor . Exploitation was widespread by nurse’s employers, physicians, and educational providers.

In 1931, she graduated from Pottstown, Pennsylvania School of Nursing. Peplau earned a Bachelor’s degree in interpersonal psychology in 1943 at Bennington College in Vermont. She studied psychological issues with Erich Fromm, Frieda Fromm-Reichmann, and Harry Stack Sullivan at Chestnut Lodge, a private psychiatric hospital in Maryland. Peplau held master’s and doctoral degrees from Teachers College, Columbia University, in 1947.

After graduating in Pennsylvania, Hildegard Peplau then worked as a staff nurse in her place and New York City. A summer position as a nurse for the New York University summer camp led to a recommendation for Peplau to become the school nurse at Bennington College in Vermont, where she earned a Bachelor’s degree in interpersonal psychology. Peplau’s lifelong work was largely focused on extending Sullivan’s interpersonal theory for use in nursing practice.

She served in the Army Nurse Corps and was assigned to the 312th Field Station Hospital from 1943-1945 in England, where the American School of Military Psychiatry was located. She met and worked with all the leading figures in British and American psychiatry. After the war, Peplau was at the table with many of these same men as they worked to reshape the mental health system in the United States through the passage of the National Mental Health Act of 1946.

“Nursing has made great progress from being an occupation to becoming a professional in the 20th. Century. As the 21st. Century approaches, further progress will be reported and recorded in Cyberspace – The Internet being one conduit for that. Linking nurses and their information and knowledge across borders – around the world – will surely advance the profession of nursing much more rapidly in the next century.” – Hildegard Peplau

Peplau was certified in psychoanalysis by the William Alanson White Institute of New York City. In the early 1950s, she developed and taught the first classes for graduate psychiatric nursing students at Teachers College. Peplau was a member of the College of Nursing faculty at Rutgers University from 1954 until her retirement in 1974. She was a professor emeritus at the said university.

At Rutgers University, she created the first graduate-level program to prepare clinical specialists in psychiatric nursing. She was a prolific writer and was equally well known for her presentations, speeches, and clinical training workshops. Peplau vigorously advocated that nurses should become further educated to provide truly therapeutic care to patients rather than the custodial care that was prevalent in the mental hospitals of that era.

During the 1950s and 1960s, she supervised summer workshops for nurses throughout the United States, mostly in state psychiatric hospitals. In these seminars, she taught interpersonal concepts and interviewing techniques and individual, family, and group therapy. Peplau was an advisor to the World Health Organization and was a visiting professor at universities in Africa, Latin America, Belgium, and throughout the United States. A strong advocate for graduate education and research in nursing, Peplau served as a consultant to the U.S. Surgeon General, the U.S. Air Force, and the National Institute of Mental Health. She participated in many government policy-making groups.

Peplau was devoted to nursing education at the full length of her career. After she retired from Rutgers, she served as a visiting professor at the University of Leuven in Belgium in 1975 and 1976. There she helped establish the first graduate nursing program in Europe.

She was the only nurse who served the ANA as executive director and later as president. She served two terms on the Board of the International Council of Nurses (ICN). And as a member of the New Jersey State Nurses Association, she actively contributed to the ANA by serving on various committees and task forces.

Her fifty-year career in nursing left an unforgettable mark on the field and the mentally challenged lives in the United States. During the peak of her career, she became the founder of modern psychiatric nursing, an innovative educator, advocate for the mentally ill, proponent of advanced education for nurses, Executive Director and then President of the ANA, and prolific author.

Like any other famous personalities, her life was often marked with controversy, which she faced with boldness, prowess, and conviction.

In 1952, Hildegard Peplau published her Theory of Interpersonal Relations influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller.  Her theory is discussed further below.

Some of Hildegard Peplau’s works include: Interpersonal Relations In Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing , Interpersonal Theory in Nursing Practice: Selected Works of Hildegard E. Peplau , Basic principles of patient counseling: Extracts from two clinical nursing workshops in psychiatric hospitals, A Glance Back in Time: An article from Nursing Forum, On Semantics (psychiatric nursing): An article from Perspectives in Psychiatric Care, The Psychiatric Nurse–Accountable? To Whom? For What?: An article from Perspectives in Psychiatric Care and Psychotherapeutic Strategies: An article from Perspectives in Psychiatric Care.

Her book on her conceptual framework, Interpersonal Relations in Nursing, was completed in 1948. Publication took four additional years because it was groundbreaking for a nurse to contribute this scholarly work without a co-authoring physician.

Peplau’s original book from 1952 has been translated into nine languages and in 1989 was reissued in Great Britain by Macmillan of London. In 1989, Springer published a volume of selected works of Peplau from previously unpublished papers. Her ideas have, indeed, stood the test of time. The archives of her work and life are housed at the Schlesinger Library at Harvard University.

Peplau was acknowledged with numerous awards and honors for her contributions to nursing and held 11 honorary degrees. She was awarded honorary doctoral degrees from universities including Alfred, Duke, Indiana, Ohio State, Rutgers, and the University of Ulster in Ireland.

She was named one of “50 Great Americans” in Who’s Who in 1995 by Marquis. She was also elected fellow of the American Academy of Nurse and Sigma Theta Tau, the national nursing honorary society.

In 1996, the American Academy of Nursing honored Peplau as a “Living Legend.” She received nursing’s highest honor, the “Christiane Reimann Prize,” at the ICN Quadrennial Congress in 1997. This award is given once every four years for outstanding national and international contributions to nursing and healthcare. And in 1998, the ANA inducted her into its Hall of Fame .

On March 17, 1999, Peplau died peacefully in her sleep at home in Sherman Oaks, California. She is survived by Dr. Leitia Anne Peplau and her husband, Dr. Steven Gordon, and their son, David Gordon of Sherman Oaks, CA; sister, Bertha Reppert (Byron), Mechanicsburg, PA; brother, John D. Forster (Dorothy), Reading, PA; niece, Dr. Carolynn Sears (Phillip) and children, Jessica and Jacob Sears, Pound Ridge, NY; niece Majorie Reppert, Jim Thorpe, PA; niece, Nancy Reppert, Mechanicsburg, PA; niece, Susanna Reppert (David Brill), Mechanicsburg, PA; niece, Karen Bently (William) and son, William, Sudbury, MA; and nephew, Carl Peplau, Hopewell Junction, NY.

The family requested that memorial contributions be made to the Peplau Research Fund through the American Nurses Foundation.

The need for a partnership between nurse and client is very substantial in nursing practice. This definitely helps nurses and healthcare providers develop more therapeutic interventions in the clinical setting. Through these, Hildegard E. Peplau developed her “Interpersonal Relations Theory” in 1952, mainly influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller.

According to Peplau (1952/1988), nursing is therapeutic because it is a healing art, assisting an individual who is sick or in need of health care. Nursing can be viewed as an interpersonal process because it involves interaction between two or more individuals with a common goal. In nursing, this common goal provides the incentive for the therapeutic process in which the nurse and patient respect each other as individuals, both of them learning and growing due to the interaction. An individual learns when she or he selects stimuli in the environment and then reacts to these stimuli.

Hildegard Peplau’s Interpersonal Relations Theory

Hildegard Peplau’s Interpersonal Relations Theory emphasized the nurse-client relationship as the foundation of nursing practice. It emphasized the give-and-take of nurse-client relationships that was seen by many as revolutionary. Peplau went on to form an interpersonal model emphasizing the need for a partnership between nurse and client as opposed to the client passively receiving treatment and the nurse passively acting out doctor’s orders.

The four components of the theory are person , which is a developing organism that tries to reduce anxiety caused by needs; environment , which consists of existing forces outside of the person and put in the context of culture; health , which is a word symbol that implies a forward movement of personality and nursing , which is a significant therapeutic interpersonal process that functions cooperatively with another human process that makes health possible for individuals in communities.

The nursing model identifies four sequential phases in the interpersonal relationship: orientation , identification , exploitation , and resolution .

It also includes seven nursing roles: Stranger role, Resource role, Teaching role, Counseling role, Surrogate role, Active leadership, and Technical expert role.

Hildegard E. Peplau’s theory defined Nursing as “An interpersonal process of therapeutic interactions between an individual who is sick or in need of health services and a nurse especially educated to recognize, respond to the need for help.” It is a “maturing force and an educative instrument” involving an interaction between two or more individuals with a common goal.

In nursing, this common goal provides the incentive for the therapeutic process in which the nurse and patient respect each other as individuals, both of them learning and growing due to the interaction. An individual learns when she or he selects stimuli in the environment and then reacts to these stimuli.

Hildegard Peplau’s Interpersonal Relations Theory’s assumptions are: (1) Nurse and the patient can interact. (2) Peplau emphasized that both the patient and nurse mature as the result of the therapeutic interaction. (3) Communication and interviewing skills remain fundamental nursing tools. And lastly, (4) Peplau believed that nurses must clearly understand themselves to promote their client’s growth and avoid limiting their choices to those that nurses value.

Major Concepts of the Interpersonal Relations Theory

The theory explains nursing’s purpose is to help others identify their felt difficulties and that nurses should apply principles of human relations to the problems that arise at all levels of experience.

Peplau defines man as an organism that “strives in its own way to reduce tension generated by needs.” The client is an individual with a felt need.

Health is defined as “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.”

Although Peplau does not directly address society/environment, she does encourage the nurse to consider the patient’s culture and mores when the patient adjusts to the hospital routine.

Hildegard Peplau considers nursing to be a “significant, therapeutic, interpersonal process.” She defines it as a “human relationship between an individual who is sick, or in need of health services, and a nurse specially educated to recognize and to respond to the need for help.”

Therapeutic nurse-client relationship

A professional and planned relationship between client and nurse focuses on the client’s needs, feelings, problems, and ideas. It involves interaction between two or more individuals with a common goal. The attainment of this goal, or any goal, is achieved through a series of steps following a sequential pattern.

Four Phases of the therapeutic nurse-patient relationship :

The nurse’s orientation phase involves engaging the client in treatment, providing explanations and information, and answering questions.

• Problem defining phase
• It starts when the client meets the nurse as a stranger.
• Defining the problem and deciding the type of service needed
• Client seeks assistance, conveys needs, asks questions, shares preconceptions and expectations of past experiences.
• Nurse responds, explains roles to the client, identifies problems, and uses available resources and services.

The identification phase begins when the client works interdependently with the nurse, expresses feelings, and begins to feel stronger.

• 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 .
• In the exploitation phase, the client makes full use of the services offered.
• Use of professional assistance for problem-solving alternatives
• Advantages of services are used based on the needs and interests of the patients.
• The individual feels like an integral part of the helping environment.
• They may make minor requests or attention-getting techniques.
• The principles of interview techniques must be used to explore, understand and adequately deal with the underlying problem.
• Patient may fluctuate on independence.
• Nurse must be aware of the various phases of communication.
• Nurse aids the patient in exploiting all avenues of help, and progress is made towards the final step.
• In the resolution phase, the client no longer needs professional services and gives up dependent behavior. The relationship ends.
• Termination of professional relationship
• The patient’s 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.
• The patient drifts away and breaks the nurse’s bond, and a healthier emotional balance is demonstrated, and both become mature individuals.

Peplau’s model has proved greatly used by later nurse theorists and clinicians in developing more sophisticated and therapeutic nursing interventions.

The following are the roles of the Nurse in the Therapeutic relationship identified by Peplau:

Stranger: offering the client the same acceptance and courtesy that the nurse would respond to any stranger

Resource person: providing specific answers to questions within a larger context

Teacher: helping the client to learn formally or informally

Leader: offering direction to the client or group

Surrogate: serving as a substitute for another such as a parent or a sibling

Counselor: promoting experiences leading to health for the client such as expression of feelings

Technical Expert: providing physical care for the patient and operates equipment

Peplau also believed that the nurse could take on many other roles, but these were not defined in detail. However, they were “left to the intelligence and imagination of the readers.” (Peplau, 1952)

Additional roles include:

• Technical expert
• Health teacher
• Socializing agent
• Safety agent
• Manager of environment
• Administrator
• Recorder observer

Anxiety was defined as the initial response to a psychic threat. There are four levels of anxiety described below.

Mild anxiety is a positive state of heightened awareness and sharpened senses, allowing the person to learn new behaviors and solve problems. The person can take in all available stimuli (perceptual field).

Moderate anxiety involves a decreased perceptual field (focus on the immediate task only); the person can learn a new behavior or solve problems only with assistance. Another person can redirect the person to the task.

Severe anxiety involves feelings of dread and terror. The person cannot be redirected to a task; he or she focuses only on scattered details and has physiologic symptoms of tachycardia, diaphoresis, and chest pain .

Panic anxiety can involve loss of rational thought, delusions, hallucinations , and complete physical immobility and muteness. The person may bolt and run aimlessly, often exposing himself or herself to injury .

Peplau’s Interpersonal Relations Theory and the Nursing Process are sequential and focus on the therapeutic relationship by using problem-solving techniques for the nurse and patient to collaborate on to meet the patient’s needs. Both use observation communication and recording as basic tools utilized by nursing.

Peplau conceptualized clear sets of nurse’s roles that every nurse can use with their practice. It implies that a nurse’s duty is not just to care, but the profession encompasses every activity that may affect the patient’s care.

The idea of a nurse-client interaction is limited to those individuals incapable of conversing, specifically those who are unconscious.

The concepts are highly applicable to the care of psychiatric patients considering Peplau’s background. But it is not limited to those sets of individuals. It can be applied to any person capable and has the will to communicate.

The phases of the therapeutic nurse-client are highly comparable to the nursing process , making it vastly applicable. Assessment coincides with the orientation phase; nursing diagnosis and planning with the identification phase, implementation as to the exploitation phase, and evaluation with the resolution phase.

Peplau’s theory helped later nursing theorists and clinicians develop more therapeutic interventions regarding the roles that show the dynamic character typical in clinical nursing.

Its phases provide simplicity regarding the nurse-patient relationship’s natural progression, which leads to adaptability in any nurse-patient interaction, thus providing generalizability.

Though Peplau stressed the nurse-client relationship as the foundation of nursing practice, health promotion and maintenance were less emphasized.

Also, the theory cannot be used in a patient who doesn’t have a felt need, such as with withdrawn patients.

Peplau’s theory has proved greatly used to later nurse theorists and clinicians in developing more sophisticated and therapeutic nursing interventions, including the seven nursing roles, which show the dynamic character roles typical in clinical nursing. It entails that a nurse’s duty is not just to care, but the profession also incorporates every activity that may affect the client’s health.

However, the idea of nurse-client cooperation is found narrow with those individuals who are unfit and powerless in conversing, specifically those who are unconscious and paralyzed.

Studying Peplau’s Interpersonal Relations Theory of Nursing can be very substantial, especially to aspiring to be part of the profession. Knowing the seven nursing roles, future nurses can apply for different roles in different situations, which will guarantee their patients acquire the best care possible and ultimately speed along with treatment and recovery.

Recommended books and resources to learn more about nursing theory:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

• Nursing Theorists and Their Work (10th Edition) by Alligood Nursing Theorists and Their Work, 10th Edition provides a clear, in-depth look at nursing theories of historical and international significance. Each chapter presents a key nursing theory or philosophy, showing how systematic theoretical evidence can enhance decision making, professionalism, and quality of care.
• Knowledge Development in Nursing: Theory and Process (11th Edition) Use the five patterns of knowing to help you develop sound clinical judgment. This edition reflects the latest thinking in nursing knowledge development and adds emphasis to real-world application. The content in this edition aligns with the new 2021 AACN Essentials for Nursing Education.
• Nursing Knowledge and Theory Innovation, Second Edition: Advancing the Science of Practice (2nd Edition) This text for graduate-level nursing students focuses on the science and philosophy of nursing knowledge development. It is distinguished by its focus on practical applications of theory for scholarly, evidence-based approaches. The second edition features important updates and a reorganization of information to better highlight the roles of theory and major philosophical perspectives.
• Nursing Theories and Nursing Practice (5th Edition) The only nursing research and theory book with primary works by the original theorists. Explore the historical and contemporary theories that are the foundation of nursing practice today. The 5th Edition, continues to meet the needs of today’s students with an expanded focus on the middle range theories and practice models.
• Strategies for Theory Construction in Nursing (6th Edition) The clearest, most useful introduction to theory development methods. Reflecting vast changes in nursing practice, it covers advances both in theory development and in strategies for concept, statement, and theory development. It also builds further connections between nursing theory and evidence-based practice.
• Middle Range Theory for Nursing (4th Edition) This nursing book’s ability to break down complex ideas is part of what made this book a three-time recipient of the AJN Book of the Year award. This edition includes five completely new chapters of content essential for nursing books. New exemplars linking middle range theory to advanced nursing practice make it even more useful and expand the content to make it better.
• Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice This book offers balanced coverage of both qualitative and quantitative research methodologies. This edition features new content on trending topics, including the Next-Generation NCLEX® Exam (NGN).
• Nursing Research (11th Edition) AJN award-winning authors Denise Polit and Cheryl Beck detail the latest methodologic innovations in nursing, medicine, and the social sciences. The updated 11th Edition adds two new chapters designed to help students ensure the accuracy and effectiveness of research methods. Extensively revised content throughout strengthens students’ ability to locate and rank clinical evidence.

Recommended site resources related to nursing theory:

• Nursing Theories and Theorists: The Definitive Guide for Nurses MUST READ! In this guide for nursing theories, we aim to help you understand what comprises a nursing theory and its importance, purpose, history, types or classifications, and give you an overview through summaries of selected nursing theories.

Other resources related to nursing theory:

• Betty Neuman: Neuman Systems Model
• Dorothea Orem: Self-Care Deficit Theory
• Dorothy Johnson: Behavioral System Model
• Faye Abdellah: 21 Nursing Problems Theory
• Florence Nightingale: Environmental Theory
• Ida Jean Orlando: Deliberative Nursing Process Theory
• Imogene King: Theory of Goal Attainment
• Jean Watson: Theory of Human Caring
• Lydia Hall: Care, Cure, Core Nursing Theory
• Madeleine Leininger: Transcultural Nursing Theory
• Martha Rogers: Science of Unitary Human Beings
• Myra Estrin Levine: The Conservation Model of Nursing
• Nola Pender: Health Promotion Model
• Sister Callista Roy: Adaptation Model of Nursing
• Virginia Henderson: Nursing Need Theory
• Hildegard Peplau (1909-1999) 1998 Inductee. (n.d.). . Retrieved July 1, 2014, from https://www.nursingworld.org/HildegardPeplau
• Sills, G. (n.d.). Hildegard Peplau.  Nursing Theorist Homepage . Retrieved January 3, 2014, from https://publish.uwo.ca/~cforchuk/peplau/obituary.html
• George B. Julia, Nursing Theories- The base for Professional Nursing Practice, 3rd ed. Norwalk, Appleton & Lange.
• Peplau, H. E. (1952). Interpersonal relations in nursing. In George, J. (Ed.).  Nursing theories: the base for professional nursing practice. Norwalk, Connecticut: Appleton & Lange.
• Peplau, H.E. (1988). The art and science of nursing: Similarities, differences, and relations. Nursing Science Quarterly, 1, 8-15. In George, J. (Ed.). Nursing theories: the base for professional nursing practice.  Norwalk, Connecticut: Appleton & Lange.
• Peplau Research Fund  – Supports research scholars in the ANF Nursing Research Grants Program.
• The Nurse Theorists – Hildegard Peplau Promo  – A video interview with Peplau
• Interpersonal Relations In Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing
• Interpersonal Theory in Nursing Practice: Selected Works of Hildegard E. Peplau

With contributions by Wayne, G., Ramirez, Q.

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Peplau's Theory of Interpersonal Relations

Peplau published her Theory of Interpersonal Relations in 1952, and in 1968, interpersonal techniques became the crux of  psychiatric nursing . The Theory of Interpersonal Relations is a middle-range descriptive classification theory. It was influenced by Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elger Miller.

The four components of the theory are: person, which is a developing organism that tries to reduce anxiety caused by needs; environment, which consists of existing forces outside of the person, and put in the context of culture; health, which is a word symbol that implies forward movement of personality and other other human processes toward creative, constructive, productive, personal, and community living.

The nursing model identifies four sequential phases in the interpersonal relationship: orientation, identification, exploitation, and resolution.

The orientation phase defines the problem. It starts when the nurse meets the patient, and the two are strangers. After defining the problem, the orientation phase identifies the type of service needed by the patient. The patient seeks assistance, tells the nurse what he or she needs, asks questions, and shares preconceptions and expectations based on past experiences. Essentially, the orientation phase is the nurse’s assessment of the patient’s health and situation.

The identification phase includes the selection of the appropriate assistance by a professional. In this phase, the patient begins to feel as if he or she belongs, and feels capable of dealing with the problem which decreases the feeling of helplessness and hopelessness. The identification phase is the development of a nursing care plan based on the patient’s situation and goals.

The exploitation phase uses professional assistance for problem-solving alternatives. The advantages of the professional services used are based on the needs and interests of the patients. In the exploitation phase, the patient feels like an integral part of the helping environment, and may make minor requests or use attention-getting techniques. When communicating with the patient, the nurse should use interview techniques to explore, understand, and adequately deal with the underlying problem. The nurse must also be aware of the various phases of communication since the patient’s independence is likely to fluctuate. The nurse should help the patient exploit all avenues of help as progress is made toward the final phase. This phase is the implementation of the nursing plan, taking actions toward meeting the goals set in the identification phase.

The final phase is the resolution phase. It is the termination of the professional relationship since the patient’s needs have been met through the collaboration of patient and nurse. They must sever their relationship and dissolve any ties between them. This can be difficult for both if psychological dependence still exists. The patient drifts away from the nurse and breaks the bond between them. A healthier emotional balance is achieved and both become mature individuals. This is the evaluation of the nursing process . The nurse and patient evaluate the situation based on the goals set and whether or not they were met.

The goal of psychodynamic nursing is to help understand one’s own behavior, help others identify felt difficulties, and apply principles of human relations to the problems that come up at all experience levels. Peplau explains that nursing is therapeutic because it is a healing art, assisting a patient who is sick or in need of health care. It is also an interpersonal process because of the interaction between two or more individuals who have a common goal. The nurse and patient work together so both become mature and knowledgeable in the care process.

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The nurse has a variety of roles in Hildegard Peplau’s nursing theory. The six main roles are: stranger, teacher, resource person, counselor, surrogate, and leader.

As a stranger, the nurse receives the patient in the same way the patient meets a stranger in other life situations. The nurse should create an environment that builds trust. As a teacher, the nurse imparts knowledge in reference to the needs or interests of the patient. In this way, the nurse is also a resource person, providing specific information needed by the patient that helps the patient understand a problem or situation. The nurse’s role as a counselor helps the patient understand and integrate the meaning of current life situations, as well as provide guidance and encouragement in order to make changes. As a surrogate, the nurse helps the patient clarify the domains of dependence, interdependence, and independence, and acts as an advocate for the patient. As a leader, the nurse helps the patient take on maximum responsibility for meeting his or her treatment goals. Additional roles of a nurse include technical expert, consultant, tutor, socializing and safety agent, environment manager, mediator, administrator, record observer, and researcher.

Some limitations of Peplau’s theory include the lack of emphasis on health promotion and maintenance; that intra-family dynamics, personal space considerations, and community social service resources are less considered; it can’t be used on a patient who is unable to express a need; and some areas are not specific enough to generate a hypothesis.

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Evidence and practice    

Open access empowering migrants during the resettlement process: applying peplau’s theory of interpersonal relations, irene nakasote ikafa lecturer in nursing, faculty of medicine and health, university of new england, new south wales, australia, colin adrian holmes adjunct professor, college of medicine and dentistry, james cook university, queensland, australia.

• To enhance your awareness of the issues that involuntary migrants commonly experience during the resettlement process

• To recognise the potential benefits of applying Peplau’s theory of interpersonal relations to support and empower involuntary migrants

• To understand the improvements to migrant support services that could be made

Background For many people, known as involuntary migrants, emigration is a last resort to escape armed conflict and persecution. Emigration may have positive outcomes for these people, but they may also experience several associated stressors that can have a negative effect on the resettlement process, particularly where there are significant lifestyle and cultural differences.

Aim To explore the issues affecting involuntary African migrants during their resettlement process in Western Australia and how Peplau’s theory of interpersonal relations could be used to inform how migrant support services could be improved to empower and support migrants.

Method An exploratory, qualitative research design was used. In-depth interviews were conducted with 30 involuntary migrants and five migrant support service providers. Thematic content analysis was used to identify themes from the data.

Findings Eight themes emerged from the data: reasons for migration; multiple losses; isolation and loneliness; employment issues; financial constraints; racial discrimination; migrants’ needs; and migrant support services.

Conclusion Migrant support services were often not easily accessible, culturally appropriate or sufficient for involuntary migrants. Peplau’s theory could be used to guide and empower migrants as they use support services and navigate the resettlement process.

Mental Health Practice . doi: 10.7748/mhp.2020.e1469

This article has been subject to external double-blind peer review and has been checked for plagiarism using automated software

[email protected]

None declared

Ikafa IN, Holmes CA (2020) Empowering migrants during the resettlement process: applying Peplau’s theory of interpersonal relations. Mental Health Practice. doi: 10.7748/mhp.2020.e1469

This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International licence (CC BY 4.0) (see https://creativecommons.org/licenses/by/4.0/ ), which permits others to copy and redistribute in any medium or format, remix, transform and build on this work, even commercially, provided appropriate credit is given and any changes made indicated.

Published online: 21 July 2020

black and minority ethnic - culture - discrimination - diversity - ethnicity - mental health - multiculturalism - nurse-patient relations - patients - patient empowerment - professional - racism - transcultural care

Migrants include voluntary and involuntary migrants who have no intention of going back to their homeland ( Muggah 2003 , International Organization for Migration 2015 ). Voluntary migrants choose to move to another country, for example to seek employment and better life opportunities. In contrast, involuntary migrants – also known as refugees or forced migrants – are forced to leave their countries to escape civil wars, armed conflict, persecution or other disasters, and cannot return because of a well-founded fear of persecution ( Toole and Waldman 1993 ). They may have experienced sudden unrest in their country and been forced to leave immediately amid chaos and uncertainty about the future ( Crowley 2009 ).

Involuntary migrants may consider themselves fortunate when they arrive in their host country and are often relieved to be in a comparatively safe environment ( Ward 2000 , Irfaeya 2006 ). However, their resettlement can quickly become stressful as they experience issues finding their way around their new city or town and are unsure of how to accomplish daily activities such as using public transport, purchasing goods and using household utilities, as well as other unfamiliar community services for example public swimming pools. According to Pittaway et al (2009) , involuntary African migrants have lived in refugee camps for long periods, with many of their children born and raised in these camps; they can experience issues in adjusting to their new circumstances ( Abkhezr et al 2018 ).

This article reports on a study to explore the issues affecting involuntary African migrants during their resettlement process in Western Australia, undertaken in response to the increasing numbers migrating to Australia ( Australian Bureau of Statistics 2011 ). Peplau’s (1952a , 1952b) theory of interpersonal relations was used as the theoretical framework for the study, in view of involuntary migrants’ need for interpersonal support. Although this theory is specific to mental health practice, it can be applied to all areas of care, and could empower and assist migrants with the resettlement process in their host country.

Literature review

Involuntary African migrants may experience language barriers, social isolation, racial discrimination and unemployment, all of which can have a detrimental effect on their resettlement ( Pittaway et al 2009 , Abur 2018 ). Language issues are a crucial factor for migrants to Australia from non-English speaking countries, and Pittaway et al (2009) found that lack of proficiency in the English language negatively affects the ability of involuntary African migrants to obtain employment.

The experience of social isolation and loneliness is also common among all migrants to new countries because of separation from their extended family members, friends and the loss of social networks ( Ward 2000 , Murray 2010 ). Ogunsiji et al (2012) found that West African women in Australia experienced issues in developing social networks and obtaining employment; this led to feelings of loneliness and isolation, which negatively affected their mental health.

Subsequently, involuntary migrants are often profoundly affected by homesickness. Although this is not well understood, many studies have found it to be a common consequence of transcontinental migration ( Eisenbruch 1991 , Redwood-Campbell et al 2008 , Rosbrook and Schweitzer 2010 ). For involuntary migrants, even those escaping conflict and persecution, homesickness can become so distressing that the only acceptable resolution is to return to their country of origin, regardless of the cost or dangers involved.

To compound these issues, experiences of racial discrimination are common among non-white migrants in countries such as Australia where the established population is predominantly white. African migrants can be subjected to clear discrimination ( Guilfoyle and Harryba 2009 , Guilfoyle and Taylor 2010 , Salleh-Hoddin and Pedersen 2012 ). Fozdar and Torezani (2008) found that involuntary migrants in Australia experienced high levels of discrimination, while Shakespeare-Finch and Wickham (2010) found that six out of 12 Sudanese refugees in their study experienced racial discrimination and verbal abuse. These experiences resulted in feelings of exclusion, fear and regression. Participants also stated that racial discrimination made it highly challenging for them to find employment in Australia.

Involuntary migrants need to be empowered when they arrive in a host country such as Australia because they can experience challenging situations. Solomon (1976) described an American programme in which empowerment is offered as part of a problem-solving strategy for stigmatised people such as refugees. Cochran and Dean (1991) asserted that local communities can have a significant role in the empowerment of migrants, for example providing interpreting services and assisting in the validation and recognition of overseas qualifications ( Spinks 2009 ).

There is no specific research on the importance of empowerment in the resettlement of involuntary migrants; therefore, this study aimed to address this gap by evaluating support services and using Peplau’s theory as a framework to support and empower involuntary migrants during their resettlement process.

Peplau’s theory of interpersonal relations

In Hildegard Peplau’s (1952a , 1952b) theory of interpersonal relations, the therapeutic relationship between the nurse and the client is central to mental health practice. Peplau’s theory aims to facilitate problem-solving and coping skills in the context of this relationship, to provide effective care and work towards resolving the client’s mental health issues. The relationship comprises three phases: orientation, working and termination ( Box 1 ).

Box 1.

Phases of peplau’s theory of interpersonal relations, orientation phase.

• The client identifies a need and seeks professional assistance and support

• The mental health nurse meets the client as a stranger, they exchange views and the nurse clarifies their role in the process

• The nurse develops rapport and trust with the client, establishing a therapeutic relationship with them

• In this phase, it is crucial that the nurse demonstrates interest in the welfare of the client, while encouraging them to ask questions and voice their needs

• The nurse recognises that the client has the power to address their issues, which will emerge from the therapeutic relationship

Working phase

Identification subphase

• The client identifies the nurse as someone who can assist them with their issues

• The mental health nurse undertakes the roles of counsellor, advocate and teacher, and identifies the client’s needs or issues to be addressed, such as anxiety, social isolation, low self-esteem and confusion

• The nurse introduces the client to available healthcare services and resources

Exploitation subphase

The mental health nurse undertakes the resource and leader roles, working with the client to plan, implement and evaluate their care. The client uses the therapeutic relationship and the resources being offeredThe mental health nurse educates the client about their condition, assists them to develop their problem-solving and coping skills, and facilitates the client’s goal settingAs the client becomes increasingly independent, the power shifts from the nurse towards the client

Termination phase

• The client begins to feel that their situation has improved, and starts planning and pursuing their goals

• Effective communication and interaction with other clients, nurses and non-clinical staff are maintained, while the client establishes alternative sources of support

• The nurse can undertake the leader and resource roles, encouraging social and physical activities to enable the client to achieve a normal, productive and fulfilling life. Progress can be satisfying for the client and the nurse

• There is a mutually agreed termination of the therapeutic relationship between the nurse and the client

( Peplau 1952a , 1952b , 1992 , 1997 , Forchuk 1994 , Fawcett and Desanto-Madeya 2013 , Senn 2013 )

Peplau’s theory also includes six therapeutic relationship roles that mental health nurses can undertake: stranger, advocate, counsellor, teacher, leader and resource roles. Mental health nurses are required to use various therapeutic skills, including being present, authentic, respectful, using active listening skills and demonstrating empathy to clients ( Dziopa and Ahern 2009 , Delaney and Ferguson 2011 , Moreno-Poyato et al 2016 ). This theory provides a framework that mental health nurses working with involuntary migrants can use for interpersonal support.

To explore the issues affecting involuntary African migrants during their resettlement process in Western Australia and how Peplau’s theory of interpersonal relations could be used to inform how migrant support services could be improved to empower and support migrants.

The study used an exploratory, interpretive, qualitative research design, which forms part of the PhD of the lead author (INI) about the resettlement experiences of African migrants in Australia and the support services available to them.

Participants

The participants included ethnic African migrants from sub-Saharan African countries living in Western Australia. Convenience and purposive sampling methods were used to recruit participants.

People were invited to participate in the study if they met the following inclusion criteria:

• Ethnic African migrant.

• Aged 18 years or older.

• Permanent resident or an Australian citizen.

The exclusion criteria were:

• Non-ethnic African migrant.

• Young people under 18 years.

• Temporary visa holders.

The five migrant support service providers who participated in the study were managers or senior officers working in organisations funded by the government ( Box 2 ).

Box 2.

Migrant support service providers who participated in this study.

• Provider 1 – the president of the African Community Association of Western Australia, which provides assistance and information about support services to African community leaders, who then disseminate it to their communities

• Provider 2 – worked for the Ethnic Communities Council of Western Australia, which provides information and support to various ethnic groups in Western Australia

• Provider 3 – worked for a migrant resource centre that provides long-term settlement services to support the integration of involuntary migrants into communities

• Provider 4 – worked for the Association for Services to Torture and Trauma Survivors, which provides a free confidential counselling service for survivors of trauma and torture

• Provider 5 – worked for Centrecare Migrant Services, which provides long-term settlement services to involuntary migrants

Participants were recruited using several approaches. Flyers describing the study were distributed and displayed in public places around the Perth metropolitan area. Participants were also recruited from the social networks of the lead author. A total sample of 30 involuntary African migrants and five migrant support service providers was obtained. Of the involuntary migrant participants, 19 were female and 11 were male. Eight participants were aged 21-30 years, four participants were aged 31-40 years, 13 participants were aged 41-50 years, and five participants were aged 51-60 years. All the participants came from war-affected countries, including Burundi, Democratic Republic of the Congo, Liberia, Somalia, Sudan, Sierra Leone and Zimbabwe.

Data collection and analysis

The qualitative data were collected using in-depth, face-to-face interviews with African migrants about their experiences of the resettlement process and their perspectives on migrant support services. Migrant support service providers were also interviewed about their perspectives of migrants’ needs and support services. The interviews took approximately 45-60 minutes to complete. Interviews were audiotaped with the participants’ permission, then transcribed for analysis.

The data were analysed using thematic content analysis with open coding, with each transcript being read and reread to ascertain the meaning of its content. Similarities and differences in the data were identified and colour-coded, and words capturing similar ideas were captured to create broad categories, which were then reduced to develop the final themes for analysis.

Ethical considerations

Approval to conduct the study was granted by the Human Research Ethics Committee of Murdoch University, Perth Campus, Western Australia. Informed consent was obtained from all participants. The participants were assured of complete confidentiality and anonymity, and that any response would be identified only by a number or pseudonym that could not be traced to any specific person.

Eight themes emerged from the data analysis:

• Reasons for migration.

• Multiple losses.

• Isolation and loneliness.

• Employment issues.

• Financial constraints.

• Racial discrimination.

• Migrants’ needs.

• Migrant support services.

Reasons for migration

Eleven participants stated that they escaped from civil war and persecution from their homeland and had lived in refugee camps in neighbouring countries before they were finally resettled in Australia with a refugee status:

‘It’s actually civil war which made me come to Australia. There was no peace in my country; we were running away from rebels that were fighting with the government soldiers, so we had to run for our lives, got to a neighbouring country and stayed in the refugee camp until we had the opportunity to come here’ (participant 13).

Multiple losses

Participants experienced multiple losses, including the loss of their culture, food, family, friends and social networks:

‘Oh, heaps [of losses] – your family and the support network. It’s not there – it takes a lot to build that up’ (participant 11).

Isolation and loneliness

Some participants felt isolated and lonely, missing the social and extended family support to which they were accustomed:

‘I started to distinguish things and I found that [Australians] are very secluded; they don’t like to mingle if they don’t know you. Like, we have neighbours who we have lived next to our house for several years, but we hardly say “hi” – we just pass each other… We give them their space and they give us our space’ (participant 12).

Employment issues

A significant cause of stress and frustration identified by ten participants was related to finding employment:

‘I would say, not finding work in my field that I studied, like I did my university degree [in Australia] but I haven’t got a job in line with my career, which is so distressing and frustrating’ (participant 7).

‘Though we may have education back in our homeland, we come [to Australia and] we struggle to have our qualifications recognised and, if they are recognised, the next battle is to find a job in your profession’ (participant 8).

‘I am a little confused because I thought by now I would be well settled [with a job] and be comfortable’ (participant 23).

‘It’s not easy to get job opportunities. When you come and you are new – they always look at your experience in Australia, so it’s very hard to find a job’ (participant 24).

Financial constraints

Many male participants identified their main concern as being associated with financial constraints. They reported that it was easier to find minor jobs than professional jobs (those that require specialised knowledge and advanced education or training):

‘Of course there are financial difficulties because, when we Africans come to Western countries like Australia, we have a financial handicap because of unemployment. There are barriers of stereotyping whereby, people look at you and assume certain things about you that can even affect you in a harmful way mentally when you are looking for jobs’ (participant 6).

Racial discrimination

Many participants reported that racial discrimination was present in the employment market, workplaces and community. More than half of the involuntary migrants ( n =18/30) who were interviewed reported that they or their family members had experienced racial discrimination:

‘I think racism [is] unfortunately grounded in the history of this country, so it is something that people will find very difficult to escape from and it is going to be around for a long time. I’m not talking about the racism where people call you names or where you walk on the street and someone says “go [back to your] home”, but silent racism… Especially when you go to institutions, you get that silent treatment – turning heads and treating you like you don’t exist. You’re standing right there, but you don’t exist’ (participant 18).

‘I would say one thing that still sticks to my mind for me is racism here – it is there, but it is subtle and many times people do not want to talk about it. About a year ago somebody came to my property and grafted it, and it had racial slur’ (participant 29).

Migrants’ needs

The five migrant support service providers identified some common needs among African migrants. They reported that it is important for people coming from refugee camps to be shown how to use basic household utilities, taught how to use common community infrastructure and orientated to the Australian cultural and legal system:

‘I suppose needs that we see amongst people – refugees – is getting used to a new culture, using ATMs [automated teller machines] and public transport. I suppose another need is linking people with their community, so that they can visit on a regular basis, like in the Mirrabooka area, there are so many Sudanese people and they feel comfortable living there’ (provider 3).

‘Coming from refugee camps to come to a big city like Perth can be overwhelming due to cultural shock. They need to learn a new system [in Australia]’ (provider 4).

‘We pick them from the airport, show them how to use household utilities, and straight away they start asking, “When are we going to school? When are we learning English?”’ (provider 5).

The migrant support service providers reported that they mainly supported refugees:

‘The refugees need high level of support. A lot more of our energy goes into just putting a lot more structured education in place such as educating them how to use household utilities. Effectively, for the first six weeks we answer any questions. “I want to enrol my children in school”, [so] we work out what schools are available, how they get there – it’s the real practical support’ (provider 3).

Migrant support services

Perspectives of migrants.

All involuntary migrants reported that they received migrant support from the Integrated Humanitarian Settlement Strategy when they arrived in Australia and were provided with initial intensive settlement support. Participants also reported that they were able to access other migrant support services provided by the government such as Centrelink, Medicare and public housing:

‘I did [receive support], like Centrelink and at the moment, I’m living in a Homeswest house – government [public] housing’ (participant 13).

‘Yes, just like everyone who comes here on a refugee visa, we get support. We come as permanent residents and get support from Centrelink’ (participant 22).

‘I was able to get migrant support services because we were brought here by the United Nations High Commission for Refugees, so there was that support’ (participant 26).

Most participants suggested that support services should be broader and culturally appropriate for migrants.

Perspectives of migrant support service providers

The five migrant support service providers reported that migrant support services were not easily accessible by African migrants and they were insufficient to meet their needs:

‘We only give emergency relief assistance to new migrants. For example, we give phone vouchers. We also give them Coles vouchers to assist them with their initial settlement’ (provider 1).

‘To be honest, I look at it in the grand scheme of things. My main reason for saying this is that I don’t think there’s enough [support for migrants]. There’s enough people providing services, but they don’t provide broad enough services for everyone [such as] individualised English language tuition’ (provider 3).

‘We assist them with many basic skills such as showing them how to use public transport and how to use ATMs to access banks and we introduce them to the legal system in Australia. Refugees are given three weeks to learn about the system, this is not enough’ (provider 4).

‘I don’t think there’s enough support and there’s not enough coordination of what goes on to people. It may be there, but people don’t know because of communication barriers’ (provider 5).

The migrant support service providers recommended several improvements to support services that could be made, such as consulting with migrants, adapting services to meet their needs and coordinating long-term services.

In this study, all the participants had escaped armed conflict and persecution from their countries. They reported that they had experienced multiple losses, isolation and loneliness, and were missing the social and extended family support to which they were accustomed. Perlman and Peplau (1981) stated that loneliness is a negative feeling that follows when people feel that their interpersonal relationships with others are not sustaining their emotional needs. Therefore, migrant support services need to explore and address involuntary migrants’ relational and emotional needs.

Several male participants identified financial constraints were an issue because they had difficulty finding employment in Australia. In addition, many of the participants in this study had experienced employment issues, particularly finding professional jobs, which was a significant cause of frustration. Similarly, Pittaway et al (2009) established that unemployment among African migrants in Australia has been heightened by racial discrimination and lack of work experience. The Refugee Council of Australia (2011) also reported that employment services were not effective in supporting this group of migrants to find work.

Most of the participants reported that they or their family members experienced racial discrimination, and that this was present in the employment market, workplaces and community. These findings are consistent with those of other studies. For example, in the UK, Hack-Polay and Mendy (2018) established that, irrespective of their qualifications, migrants were often rejected from employment opportunities. In the US, Heger Boyle and Ali (2010) also concluded that racial discrimination affected involuntary migrants’ ability to obtain formal employment, while Murray’s (2010) study of Sudanese migrants in Australia found that one third of participants experienced discrimination. Another Australian study by Fozdar and Torezani (2008) also found that refugees experienced high levels of perceived discrimination.

Applying Peplau’s theory to the resettlement process

During the orientation phase of Peplau’s (1992) theory of interpersonal relations, the nurse meets the client as a stranger, establishes a therapeutic relationship with them, and identifies their immediate needs. The Integrated Humanitarian Settlement Strategy is the first settlement and healthcare service agency with whom all involuntary migrants in Australia have contact. The mental health nurses, doctors and other professionals who work for this agency provide initial assessment of involuntary migrants’ needs and intense settlement support on their arrival.

The migrant support service providers in this study reported that they collected refugees from the airport, undertook orientation, showed them how to use household utilities, assisted them with shopping and answered any questions. They also ensured that migrants had access to support services that met their immediate needs such as Centrelink, Medicare and healthcare services. Mental health nurses working for the Integrated Humanitarian Settlement Strategy can also recognise issues such as homesickness, isolation, loneliness, anxiety and stress and refer them for counselling. It is essential that all those working with this group of migrants exercise interpersonal skills and communicate clearly to identify and address migrants’ immediate needs, which may differ from one person to another.

The working phase of Peplau’s theory comprises identification and exploitation subphases. During the identification subphase, healthcare professionals such as mental health nurses working for the Integrated Humanitarian Settlement Strategy can identify and assess involuntary migrants’ signs of trauma, anxiety and refer them to services such as the Association for Services to Torture and Trauma Survivors for free confidential counselling. Mental health nurses can also ensure that new arrivals have access to healthcare resources, teach them coping strategies and problem-solving skills and support them to set goals for their future. During the exploitation phase, involuntary migrants can be encouraged to use community services, such as public libraries and public swimming pools. Appropriate uptake of community services and facilities can result in greater community integration of migrants and promote their mental health.

The migrant support service providers in this study reported that people coming from refugee camps needed to be shown how to use common community infrastructures. They acted as resource experts, teachers and advocates for migrants, and educated them how to use ATMs, public transport, public libraries and swimming pools. They also enrolled their children into schools and encouraged migrants to undertake apprenticeships or further their education at technical and further education institutions or universities to increase their chances of finding employment.

The migrant support service providers reported that they provided a high level of support to involuntary migrants. During the termination phase of Peplau’s (1952b , 1997) theory, involuntary migrants begin to feel settled and work towards achieving their goals. They become self-reliant, independent and able to obtain employment. Shakespeare-Finch and Wickham (2010) identified support strategies such as the establishment of wider migrant support networks that can assist and empower involuntary African migrants and facilitate their integration into their new country and community. Once they are well integrated, involuntary migrants can successfully compete for employment and cease to depend on support services provided by their community and government. Migrant support service providers and mental health nurses can reassess involuntary migrants and ensure they remain settled, then mutually agree to terminate the relationship.

Limitations

Participants may have self-selected by being able to read recruitment flyers because no participant required assistance with reading or an interpreter. In addition, the participants were recruited from one state in different areas of the Perth metropolitan region in Western Australia, which limits the generalisability of the study findings.

This study explored the issues that may affect involuntary African migrants during their resettlement process in Australia. The participants reported that they used support services, but that these were often not sufficiently broad or culturally appropriate. Migrant support service providers identified that involuntary migrants required a high level of support and that the available support services were inadequate and not easily accessible. They recommended several improvements that could be made to these migrant support services, such as consulting with migrants, adapting services to meet their needs and coordinating long-term services.

This study appears to be the first to use Peplau’s theory of interpersonal relations to identify how migrant support services might be improved to ensure they offer effective support for involuntary migrants. Peplau’s theory can be used by mental health nurses and migrant support service providers to guide and empower involuntary migrants as they use these services to navigate the resettlement process.

Implications for practice

• Mental health nurses could use Peplau’s theory of interpersonal relations as the basis for working with migrants to empower and support them during the resettlement process

• Mental health nurses need to continuously update their knowledge and be aware of the services and resources available for migrants and ensure all migrants can access these services if necessary

• Migrant support services can be improved by consulting with migrants, adapting services to meet their needs and coordinating long-term services

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Clinical Practice

p-ISSN: 2326-1463    e-ISSN: 2326-1471

2017;  6(2): 33-36

doi:10.5923/j.cp.20170602.03

Case Management of Substance Induced Psychosis Using Peplau’s Theory of Interpersonal Relations

Isaac Machuki Ogoncho , Philip Sanga, Dabo Galgalo Halake

Department of Nursing Sciences, University of Kabianga, Kericho, Kenya

Copyright © 2017 Scientific & Academic Publishing. All Rights Reserved.

Substance induced psychosis is a form of psychosis that develops from the use of alcohol or other drugs. The symptoms for this form of psychosis can resolve within days or weeks though tendencies of relapsing occur with persistent use of the drugs. The purpose of this article was to examine Peplau’s theory of interpersonal relations as a framework to assist nurses in understanding and managing patients with substance induced psychosis. The theory involves a therapeutic process that is collaboratively undertaken by both the nurse and the patient towards resolving an identified health problem. The nurse-patient relationship evolves through three phases of orientation, working and termination. The nurse may function as a stranger, leader, teacher, resource person, surrogate and counsellor in helping the patient adopt a healthier behaviour. The nurse-patient relationship allows the patient to freely express their emotions, feelings and thoughts about a given health problem. This enhances understanding of the health problem and guides nurses to helping the patients meet their individual needs. Nursing practice should focus on strengthening interpersonal relationships with patients to improve health outcomes.

Keywords: Substance abuse, Psychosis, Peplau’s theory, Interpersonal relations

Cite this paper: Isaac Machuki Ogoncho, Philip Sanga, Dabo Galgalo Halake, Case Management of Substance Induced Psychosis Using Peplau’s Theory of Interpersonal Relations, Clinical Practice , Vol. 6 No. 2, 2017, pp. 33-36. doi: 10.5923/j.cp.20170602.03.

Article Outline

1. introduction, 2. hildegard peplau’s theory of interpersonal relations, 3. case summary, 4. application of the theory in managing a patient with substance induced psychosis, 5. conclusions.