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Interpersonal Theory and the Nurse-Client Role

The Role of a Nurse

Peplau’s framework consists of four phases. On the orientation phase, the nurse provides essential information and guidance and establishes the communication channels. This phase is mostly one-directional and requires only a limited participation from the patient. The identification phase is where the patient involvement begins. The patients start to participate in the healthcare process, assuming a more active role. At the same time, they also assume greater responsibility for their health, which is associated with better outcomes (Brett et al., 2014). Once the patients fully recognize their involvement and actively participate in the process, the exploitation phase comes into effect, providing opportunities for them to independently manage the health issue with gradually decreasing participation of the nurse. Once the involvement becomes unnecessary, the patients turn into self-sustained individuals who are not dependent on the nursing practices. This is a resolution phase, where the relationship ends. Thus, the ultimate goal of the nurse-client relationships according to Peplau is to promote comprehension, understanding, and responsibility and minimize the dependence on professional help.

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The nurses can communicate the necessary information in several ways, termed roles by Peplau (D’Antonio, Beeber, Sills, & Naegle, 2014). The most recognized role includes providing specialized information regarding treatment and interpreting clinical data. It is known as resource role. The stranger role is responsible for creating a climate favorable for collaboration and decreases the possibility of tensions. The teaching role provides the patients with the information which expands their understanding and increases comprehension, minimizing their dependence on the professional establishments. At the same time, the counseling role empowers clients to utilize the gained knowledge and encourages them to participate and make decisions (Kitson, Marshall, Bassett, & Zeitz, 2013). The surrogate role eliminates any discrepancies and establishes the boundaries between the professional responsibilities of nursing practitioners and individual responsibilities of the patients. Similarly, the leadership role commutes the goals of the healthcare process to clients.

The process of establishing communication is known as the professional interpersonal alliance. The meaning of alliance, however, is not limited to the fact of communication. Rather, it starts with finding common ground which helps a nurse to set the common goal and share a vision of the process. In addition to the generalized concepts, the alliance is formed by finding shared views, comprehendible speech patterns, and individual points which can help to foster a meaningful participation. The alliance is not limited to the tangible categories. For instance, empathy – the ability of a nurse to perceive the reality through the patient’s perspective and adjust the communication accordingly – creates a strong emotional bond and eliminates the possible misunderstanding that may undermine the effectiveness of the alliance. The awareness of professional boundaries allows the nurse to eliminate the possibility of ethical violations, such as preferential treatment of certain clients or the breach of patients’ privacy. Placing the clients’ needs above those of the nurse is also strengthened by the shared decision-making model, which prioritizes the preferences of the patients and by extension emphasizes their responsibility.

The interactions in nursing profession are not limited to the client-nurse relationship. To ensure that the patients are receiving the appropriate care and that the healthcare activities are personalized for their needs, the nurses need to collaborate with clinicians. The collaboration can also be used to obtain the overlooked details relevant for fostering the alliance. Finally, the nursing staff is encouraged to create the meaningful communication channels aimed at sharing professional experience and thus strengthening the level of competence and obtaining the necessary skills.


Patient involvement is already recognized as a crucial factor in improving the health outcomes. The Peplau’s theory suggests the transformation of the patients’ role through communication initiated by nurses from fully dependent on the external counselor to fully independent and responsible for the decisions concerning their health. Thus, the role of nurse according to Peplau’s theory is that of a consultant, teacher, and leader, with the former gradually declining and the latter strengthening throughout the process.


Brett, J., Staniszewska, S., Mockford, C., Herron‐Marx, S., Hughes, J., Tysall, C., & Suleman, R. (2014). Mapping the impact of patient and public involvement on health and social care research: a systematic review. Health Expectations, 17(5), 637-650.

D’Antonio, P., Beeber, L., Sills, G., & Naegle, M. (2014). The future in the past: Hildegard Peplau and interpersonal relations in nursing. Nursing Inquiry, 21(4), 311-317.

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Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of patient‐centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing. Journal of Advanced Nursing, 69(1), 4-15.

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