Hildegard Peplau has been coined the “Mother of Psychiatric Nursing” and the “Nurse of the Century”(Gonzalo, 2023). In 1952, Peplau published her Theory of Interpersonal Relations (Gonzalo, 2023). The concepts of the Interpersonal theory include the patient, environment, health, and nurse. Peplau’s interpersonal model pictures nursing as an interpersonal process between the nurse and patient working toward mutually agreed-on goals (Zaccagnini & Pechacek, 2021). Her emphasis on the interpersonal relationship between the nurse and patient was groundbreaking. Her model emphasized the partnership between patient and nurse as opposed to the patient passively receiving treatment and the nurse acting out the doctor’s orders. Peplau’s Theory of Interpersonal Relations transformed the nurse-patient relationship, especially within psychiatric nursing. She highlighted the importance of communication skills in nursing, mainly listening and empathizing. In psychiatric nursing, where patients might struggle with communication, this emphasis on empathetic listening and understanding was imperative for adequate care.

The assumptions that play a part in the theory’s assumptions are: (1) Nurse and the patient can interact. (2) Peplau emphasized that the patient and nurse mature due to the therapeutic interaction. (3) Communication and interviewing skills remain fundamental nursing tools. Lastly, (4) Peplau believed that nurses must clearly understand themselves to promote their clients’ growth and avoid limiting their choices to those that nurses value (Gonzalo, 2023).

Peplau’s theory is considered a theory-to-practice-to-theory strategy. A theorist who uses this strategy begins theorizing by selecting a theory to use in practice and then uses practice to refine the theory further (Meleis, 2018). Peplau’s theory exemplifies this method by establishing a theoretical base, promoting its implementation in real-world settings, and then iterating upon the theory based on practical insights and experiences.

The concepts taken to achieve the goals are (1) orientation, in which the patient’s problems are defined; (2) identification, in which the nurse and patient clarify expectations and figure out how to work together; (3) exploitation, in which the patient uses the services offered by the nurse that the patient finds useful; and (4) resolution, in which the patient’s needs have been met, and the patient moves towards independence (Zaccagnini & Pechacek, 2021).

The theory’s influence on nursing has been profound and continues to be so. Her theory drew inspiration from Henry Stack Sullivan, Percival Symonds, Abraham Maslow, and Neal Elgar Miller (Gonzalo, 2023). These men were psychologists, psychiatrists, and psychoanalysts. During the peak of her fifty-year career, she became the founder of modern psychiatric nursing, an innovative educator, an advocate for the mentally ill, an Executive Director, then President of the American Nurses Association, and a prolific author (Gonzalo, 2023).

The school of thought for Peplau’s theory would be interaction; it is best defined as a view of nursing supporting and promoting patient interactions (Meleis, 2018). This perspective in nursing is centered around the belief that therapeutic and meaningful interactions between the nurse and the patient are critical to the patient’s health and recovery.

REVIEW

I reviewed numerous scholarly articles that embody Peplau’s Interpersonal Relations Theory and showcase its practical efficacy in real-world nursing scenarios. Most of the literature I encountered was situated in clinical or in-patient environments. Of the 6,386 articles from 2018 to 2023 that I found, half of these articles highlighted mental health, chronic diseases, and less than half of the articles discussed loneliness. These sources do not typically address distinct cultural, population, or societal contexts. The articles I discovered encompassed a wide demographic, including various age groups and ethnicities, and they managed patients from all economic backgrounds. The articles I came across were all grounded in empirical research findings and centered around concepts about healthcare.

One study applied the theory to Diabetes Mellitus management, revealing improvements in patients’ self-care management post-intervention. Specifically, a notable increase in patients’ average knowledge, attitude, and practice scores, along with a decrease in fasting and post-prandial blood glucose levels, highlights the theory’s beneficial impact (Fernandes & Naidu, 2017).

In the context of oncology nursing, another article detailed the use of Peplau’s theory to support newly diagnosed breast cancer patients in rural areas, focusing on emotional distress. The study implemented a navigator intervention, measured by the Distress Thermometer, and recorded a significant reduction in distress levels among the participants after the intervention. This suggests the theory’s relevance and effectiveness in addressing psychological needs and promoting well-being in cancer patients (Johnson & Bongiorno, 2018).

Lastly, a study focused on HIV-infected women assessed Peplau’s theory in enhancing medication adherence among those facing challenges with their treatment regimen. The participants, primarily African-American women of low socioeconomic status from urban areas, showed positive health outcomes when the nurse-patient relationship was grounded in Peplau’s theoretical framework. The relationship fostered learning and goal-setting for better health outcomes, demonstrating the theory’s practical value in this context (Douglass et al., 2003).

EVALUATE

Peplau’s theory is considered to be highly adoptable in the field of nursing due to its practical framework and focus on the nurse-patient relationship. The theory promotes strong communication skills, which are essential in nursing practice.

Peplau’s theory does present certain limitations that may impact its application across the diverse landscape of patient care. It tends to overlook factors such as the significance of personal space and the availability of community social services. Additionally, there is a relatively minor focus on health promotion and maintenance. The theory does not apply to patients who do not recognize a need for help, such as those who are withdrawn or unconscious (Peplau’s Theory of Interpersonal Relations: Hildegard. E. Peplau, 2020). Moreover, certain aspects of the theory are too vague to facilitate the formulation of a specific hypothesis (Peplau’s Theory of Interpersonal Relations: Hildegard. E. Peplau, 2020).

CRITIQUE

One of the critiques of Peplau’s theory is its perceived lack of emphasis on health promotion and maintenance. Additionally, the theory doesn’t apply to patients who don’t express a felt need, such as those who are withdrawn (Gonzalo, 2023). When patients are withdrawn or struggle to express their needs because of severe mental health issues, cognitive impairments, or intense distress, the relevance of Peplau’s theory is limited. This theory also has limitations; it would not be suitable for quick-care or emergency room settings where patient interactions last only 15 to 20 minutes and may be the only interaction with the patient. Though Peplau’s theory is a significant landmark in psychiatric nursing literature, like any theory, its applicability varies based on context and might not be suitable for every nursing situation. These limitations suggest that while Peplau’s theory offers significant insights into the nurse-patient relationship, it may need to be adapted or supplemented with other theories.

APPLICATION

My DNP project will be focused on the Brief Adherence Rating Scale (BARS), which will enhance medication adherence in Schizophrenia patients. It has been estimated that as many as 60% of Schizophrenics stop medication use after 2–3 months and 80% after two years (Leijala et al., 2021). The BARS provides valid, reliable, sensitive, and specific estimates of antipsychotic medication adherence of outpatients with schizophrenia (Nakonezny et al., 2020). The BARS is a tool designed to provide a quick and reliable assessment of adherence to antipsychotic medications specifically for individuals with Schizophrenia. It typically involves both a clinician-rated scale and a patient self-report, aiming to capture a comprehensive picture of the patient’s adherence behaviors. 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 (Gonzalo, 2023).

As previously mentioned at the start of my paper, Peplau’s theory outlines phases that both the patient and nurse experience together. In the initial phase, when a patient seeks assistance, I will introduce them to the BARS, explaining its role and how it can help improve medication adherence. As we move to the identification phase, patients can visualize where they struggle with medication adherence. In the exploitation phase, the patient and I will collaboratively use the BARS to develop strategies to enhance medication adherence. Finally, the resolution phase is where the patient’s needs have been met. The plan is over time, as the patient becomes more compliant with his medication regimen, their dependence on the healthcare provider will diminish.

I intend to introduce the BARS questionnaire to my patients, informing them that their medication adherence will be re-evaluated during subsequent visits. I will administer the BARS questionnaire to half of my patients, while the other half will not receive any questionnaire. The selection of participants for the questionnaire will be entirely random. My independent variable would be implementing the BARS, and my dependent variable would include the medication adherence rate among schizophrenia patients. In doing so, I aim to discern whether this assessment tool is genuinely beneficial. I aim to help non-compliant patients by reviewing the BARS questionnaire, which might make them more aware of their medication adherence behaviors. This self-reflection could, in itself, lead to improved adherence.

I selected Peplau’s Interpersonal Model Theory because it provides a roadmap for the nurse-patient relationship, emphasizing collaboration, mutual understanding, and assessing medication adherence. It also ensures that interventions are patient-centered, tailored, and grounded in a therapeutic relationship.

Seven-step process

1	Name the specific aspect of practice being analyzed	Measurement of medication adherence in Schizophrenia patients using the Brief Adherence Rating Scale (BARS).
2	Identify the intended purposes of this aspect of practice	Patients will experience better health outcomes, fewer relapses, and fewer hospitalizations.
3	Uncover the assumptions that support these intended purposes	(1) Nurse and the patient can interact. (2) Patient and nurse mature due to the therapeutic interaction. (3) Communication and interviewing skills remain fundamental nursing tools. And lastly, (4) Nurses must clearly understand themselves to promote their client’s growth and avoid limiting their choices to those that nurses value (Gonzalo, 2023).
4	Identify who benefits	Patients will benefit from this the most. Mental health providers benefit from using a tool like BARS by clearly understanding their patients’ medication-taking behaviors, which can inform treatment decisions. Families can also benefit from the patient’s medication adherence because it can lead to a more stable condition with fewer relapses. Emergency Room services benefit, as improved medication adherence in patients can decrease the incidence of psychiatric crisis intervention.
5	Identify who is disadvantaged	Patients who suffer from low health literacy are at a disadvantage with BARS, as well as those who have limited resources, such as non-insured, homeless, and financial constraints.
6	Link these specific ideas to society-level patterns	To concentrate solely on individuals with schizophrenia, the project will strictly include patients diagnosed with this condition, excluding those with other mental disorders. Moreover, a critical inclusion criterion for this study is the ability of participants to afford their medication. Consequently, patients facing financial constraints regarding medication access will not be eligible for participation. This approach reflects a research design aimed at examining medication adherence within a specific subset of the schizophrenia population that does not encounter economic obstacles to treatment compliance.
7	Conceive alternatives that mitigate actual or potential harms	During this trial, several options could be considered, such as providing medication at no cost or a reduced rate. This would enable the inclusion of a more diverse patient population, mitigating any bias due to financial constraints. Additionally, the study could be broadened to encompass patients with various mental health conditions.