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Date: 03/02/2026
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Project Status: completed
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Project Summary: Theory of Interpersonal Relations Hildegard Peplaus Theory of Interpersonal Relations emphasizes that an effective nurse-patient relationship goes through three different phases. The phases include orientation working and termination. The relationship that consists of the three phases should be therapeutic and both the patient and nurse are engaged. In this relationship the nurse takes on many roles including a stranger counselor and a teacher (Hildegard Peplau 2023). This theory helps the nurse tailor care that is unique to patient’s needs and preferences. In the orientation phase of the nurse-patient relationship the nurse and the patient meet. The patient acknowledges that they need help. The nurse creates trust in this phase by learning about the patient and their needs. In the working phase the patient addresses their problems with the assistance of the nurse. The nurse guides the patient to help address the issues they have while encouraging independence. In the termination phase the health of the patient has improved and the patient no longer requires the nursing care. Peplau emphasized that through these phases the nurse should maintain respect and empathy towards the patient (Hildegard Peplau 2023). Autonomy and Beneficence in the Nurse-Patient Relationship Peplau’s theory considers different ethical principles. Autonomy which involves the patient’s right to make their own decisions (Pursio et al. 2021) is addressed in the theory during the working and termination phase. In the working phase the nurse guides the patient in addressing the problems. Therefore in this stage the nurse is helping the patient increase their autonomy and reduce the need for nursing care. In the termination phase the patient gains the abilities and understanding to manage their condition independently which provides autonomy. Beneficence focuses on promoting good for others (American Nurses Association 2025). In nursing this entails making sure that the patient’s best interest is always a priority over the nurse’s views. Beneficence is relevant in the working phase of Peplau’s proposed nurse-patient relationship phases. In the working phase the nurse assists the patient with tasks they cannot perform independently thus promoting beneficence. Peplau’s Theory Presents Conflict for Patient Preferences Peplau’s theory focuses on developing the nurse-patient relationship based on three phases with every patient (Hildegard Peplau 2023). The theory assumes that the patient is a compliant patient and that the nurse-patient relationship will follow all three phases in order. However the theory can conflict with certain patient preferences. For example a psychiatric patient that does not want psychiatric medications would not complete the three phases of the patient-nurse relationship (orientation working and termination). A non-compliant patient may never build that trust in the nurse as Peplau’s theory explains in the orientation phase. Therefore if the patient does not build trust on the nurse the relationship cannot move to the working phase. Navigating the Ethical Dilemma While considering possible ethical dilemmas with Peplau’s theory the patient should remain the priority. While the nurse may have her/his own opinions patient’s autonomy should be preserved (American Nurses Association 2025). In psychiatry beneficence and autonomy are ethical principles that must be equalized. When there is a recommendation for certain interventions but the patient refuses to follow the recommendations then autonomy needs to be respected. However other issues come up such as ensuring the patient makes an informed decision. During the working phase of Peplau’s theory the nurse ensures that the patient has all the needed information to make an informed decision. The nurse should take different approaches with a non-compliant patient to preserve both beneficence and autonomy. The nurse should consider possible reasons why the patient is non-compliant. Possible reasons include lack of understanding cost or affordability (Chittenden 2022) and challenges with managing treatment plan. Once the possible challenges are identified then the nurse can provider further resources for the patient if applicable. Aligning the Theory with Ethical Practices Peplau’s theory assumes that patients will be compliant and that the phases will occur in order. However to align with ethical principles like autonomy the working phase could include following patient’s preferences and wishes. For example in the psychiatric patient that does not want medications perhaps the working phase could include educating the patient regarding recommended interventions and guiding the patient. During this phase the nurse should recognize that the patient may refuses a treatment plan. In a case like this the termination phase would include allowing that patient to have autonomy and make an informed decision to not take medications or follow the recommended treatment plan. Though the patient refused treatment the patient was provided autonomy by allowing them to make their own decisions and that would be considered a successful nurse-patient relationship.
