Canadian Journal of Nursing Informatics

Peplau’s Theory of Interpersonal Relations: Application to Asynchronous Nursing Education

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by Laura Vogelsang RN, PhD(c)

Citation: Vogelsang, L. (2022). Peplau’s Theory of Interpersonal Relations: Application to Asynchronous Nursing Education. Canadian Journal of Nursing Informatics, 17(3-4).

Peplau’s Theory of Interpersonal Relations: Application to Asynchronous Nursing Education


The COVID-19 pandemic has changed the course of nursing education delivery in many ways. Although programs have resumed in-person classes for much of the curriculum some online delivery continues. Peplau’s Theory of Interpersonal Relations is summarized and suggested as a way to maintain interpersonal relationship with students in the online setting. Proposition of the new role of ‘innovator’ for the nurse and an expanded definition of communication which fits with the online context are suggested. Application to asynchronous nursing education with consideration of modern-day teaching methodologies are discussed.

Throughout the 21st century the use of technology as a tool for communication has exploded. Whether through telephone, social media, or instant message, individuals increasingly use digital means to stay connected. At the height of the pandemic entire nursing programs were delivered online and connecting synchronously and asynchronously though a virtual means became the norm. Relationships were formed between students and instructors without an in-person meeting ever occurring. As many nursing programs return to in-person delivery some of the advantages of virtual clinical were realized and many program continue to offer virtual components (Seah et al., 2020). Several existing nursing theories offer guidance for forming effective nurse-client relationships. However, these theories fail to address the ‘technology’ component of communication and the impact of the lack of physical presence.

Hildegard Peplau (1909-1999) was a pioneer of the nurse-client relationship. Her practice-based theory emphasized looking at using every interaction as an opportunity for empowerment. The aim of this paper is to critically examine the philosophical underpinnings of Peplau’s Theory of Interpersonal Relations and evaluate the potential contributions it makes for supporting nursing educators to deliver clinical in a virtual setting. The definition of communication will be redefined for use in the virtual clinical setting. Further the writer will suggest an additional role of the nurse, the innovator role. This theory can potentially contribute to effective nursing education when applied in a virtual educational setting.

Theory of Interpersonal Relations

Peplau’s Theory of Interpersonal Relations (1952) and her work on the professionalism of nursing was considered by some to be what awakened the nursing profession from relative silence since Florence Nightingale. Peplau is often regarded as the mother of psychiatric nursing, where her theory has its roots. However, as the literature shows, the Theory of Interpersonal Relations has been applied in many areas, including emergency and rural settings (Senn, 2013). The theory has been identified as grand, middle-range, and practice based, because it was initially developed to be applicable to psychiatric nurses. However, because of its relativity to all practicing nurses, and its representation of a partial view of reality with less abstract, more specific phenomena, it fits best as a middle-range theory (Fawcett, 2005).

The central theme of this theory is the nurse-patient relationship. The relationship can be separated into phases. In her initial work Peplau (1952) described these phases as: Orientation, identification, exploitation, and resolution. Later, Peplau (1997) reduced these to three phases: Orientation, working, and termination. At different phases the nurse fulfills various roles based on the needs of the patient: Stranger, resource person, teacher, leader, surrogate, and councillor (Peterson, 2013). It is through these roles the nurse begins to understand the various needs, frustrations, conflicts, and anxieties of the patient and a relationship that facilitates growth from both the nurse and patient happens (Peterson, 2013).

Each phase of the relationship can be experienced in every nursing situation. In the orientation phase, the nurse is a resource person, counsellor, and surrogate. The ultimate goal is helping the patient become oriented to their problem and understanding their sources of anxiety. For this to be effective the nurse must be an active listener and focus the needs on that of the patient not the nurse (Peplau, 1952). The identification phase can begin once the patient begins to understand his/her situation and identify sources of help, with the nurse acting as a leader to promote constructive learning by providing opportunities for the patient to develop skills that will enable them to respond independently of the nurse (Peplau, 1952). Exploitation is achieved when the patient is able to take full advantage of the services offered to them and begin to anticipate and set goals beyond the immediate problem, for example, planning for activities post-discharge (Peterson, 2013). Resolution happens when the patient no longer needs the nurse to meet their goals and the relationship may be terminated. Emphasized in Peplau’s work is that the patient’s needs are central. The nurse must communicate in a way that is professional and she cautions against ‘social talking’ (Peplau, 1952).

Epistemological Underpinnings

Beyond the usefulness of her theory for promoting an effective nurse-patient relationship Peplau’s work has also broadened the way health care professionals view knowledge and define evidence. At the time of her theory development, nurses were viewed as handmaidens to the physicians, gender discrimination was prevalent, and the idea of collaborative care was not acknowledged. Nursing was regarded more as a vocation than a profession and the interaction with the patients was limited. At this time empirical knowledge and objective, quantifiable data, were valued above all else. Peplau disagreed and felt that nursing could not be reduced to empirical science (Gastmans, 1998). Her view was a direct contrast to the positive regard for objective data. She valued the social, temporal, and situational context of knowledge and saw nursing as primarily concerned with health, well-being, and care, concepts that cannot easily be measured empirically (Gastmans, 1998). At a time when nursing was struggling to gain recognition as a profession with its own unique body of knowledge this way of thinking was revolutionary. If nursing was to establish itself as an autonomous profession, then nursing must be able to answer questions that other disciplines cannot answer. This emphasis on the centrality of the patient instead of the physician, and context specific inquiry separated nursing from medicine and created a lasting effect health care professionals still see today.

Proposition of New Concepts

As the role of the registered nurse has broadened far beyond that of servant to the physician or having the bedside as the only setting where interpersonal relationships are formed, so must Peplau’s theory expand.

Innovator Role

Within the orientation phase it is suggested that the nurse will “use technical expertise to attend to concerns of issues that require the use of professional devices” (Peterson, 2013, p.142). At the time of its conceptualization a professional device was likely a physical mobility aid or prosthesis. However, in today’s nursing education programs the idea of a professional device would be much broader and could include use of learning management systems, videoconferencing (i.e. Zoom), or smartphones.Therefore, it is suggested that the nurse educator must possess technological expertise to deliver the course. In this sense the nurse educator can no longer simply be competent in their area of expertise but must possess technological competencies as well. This role would be called the innovator role. From the literature innovation is understood to be the use of new methods or devices (McSherry & Douglas, 2011). Blakeney, et al., (2009) described innovation as “a process for inventing something new or improving on that which already exists” (p.1). With the new concept of the nurse as innovator the nurse considers relative technology as a means for education and facilitates the integration and normalization of the innovation into the curriculum. Where there is not a suitable innovation for the needs of the patient the nurse may engage in research to develop solutions. This role reflects that nurse educators are not only working to deliver curriculum but also active members of the research team. For example, during the identification phase the nurse in the role of leader in a traditional classroom setting may verbally involve a student cohort to establish norms and expectations. The nurse as innovator may use a new technology platform to reach the same outcome when they had to transition their course online. She creates and orientates the students to a live shared document where the students can type and brainstorm virtually asynchronously.

Communication Redefined

When her Theory of Interpersonal Relations was published Peplau likely could not fathom how nursing education would advance. Today we are still speculating what the future will bring to nursing education as we continue to adapt. To that end she likely did not envision a world in which nurse educators may facilitate an entire clinical course from their living room or that instant message and email would add a new dimension to communication where observation was removed entirely. For some it may feel like a paradox, the more we are connected, the more distant we have become. On the other hand, the ability to network and translate research findings has resulted in the diffusion of previously specialized medical knowledge to the masses. Today the nurse educator is no longer the traditional teacher who holds specialized information, but a facilitator, who encourages students to seek evidence-based sources and validates previous learning. The definition of communication will need to be clarified for the modern student. Communication today is more than Peplau’s (1991) definition of “spoken language, rational and non-rational expressions of wishes, needs, and desires, and body gesture” (p.289). The definition of communication should be elaborated to encompass the importance of both spoken and written language and body language when it is observable. To suggest that an interpersonal relationship can be formed only when the nurse is able to observe and hear the spoken language of the patient would limit the use of this theory in many areas of nursing today and negate the asynchronous nature by which much education is delivered.

Fit With Nursing Instruction Pedagogy

One area of nursing that will benefit from the updated definition of communication and addition of the role of the nurse as innovator is asynchronous nursing education. Peplau herself observed how students interacted with patients in the Interpersonal Relations model (Peterson, 2013). However, application of this theory to study the student and the nurse educator relationship has yet to be done. Peplau’s theory fits within a constructivist paradigm because the nature of the theory is that knowledge is generated through experience and interaction, reality would therefore be subjective. This is a common paradigm in nursing education where the instructor engages the student in experiential learning (Young & Maxwell, 2007).

The phases of the nurse-client relationship could be adapted to an asynchronous learning environment where the student first forms a relationship with the instructor through email or messenger and then is coached to realize their learning needs. As the relationship progresses into identification and exploitation students will begin to identify resources that will facilitate their success in the nursing course. With the nurse in the leadership role students will start generating their own knowledge and understanding and dependence on the instructor will lessen. At resolution the students will hopefully express satisfaction with their expectations for the asynchronous course and the relationship with the instructor will end. Throughout this process the instructor will keep the learning needs of the student as the central focus and the power will shift from the instructor as the expert, to the student as a seeker of knowledge, responsible for meeting their self-identified learning needs.

Testing of the New Theoretical Concepts

In asynchronous courses the instructor will need to remain accessible to students using technology. Communication with instructors was noted to be both essential and one of the major challenges during the COVID-19 pandemic when courses could not be offered face-to-face (Hargreaves, 20201; Tomietto et al., 2020). Students have expressed when they perceive their instructor to be less engaged in an online learning environment they experienced increased anxiety and resistance to online learning, and decreased motivation (Jowsey et al., 2020). Because the relationship of focus is that of student and instructor the type or nursing course could vary widely. Undergraduate nursing theory courses would be appropriate for testing of these new theoretical concepts. By studying how the student nurse-instructor relationship forms and progresses through the phases, educators could gain greater understanding of how this theory applies in an asynchronous educational context. The use of instant messenger, email, and online discussion boards as tools for communication would lend itself to a study potentially validating or rejecting the new definition of communication, where communication can take place in a context where observation and verbalization is removed. These previously mentioned means of communicating can be also classified as an innovation. The addition of the nurse’s role as innovator could be evaluated through a phenomenological study where experiences of the students who had an instructor facilitating their experience within the asynchronous course was explored.


By beginning to understand the interpersonal relationships which form without observation or dialogue, Peplau’s theory can be modified to a 21st century learning context. Testing of these new roles and contexts could serve as a catalyst to ongoing research including interventions to overcome the barriers discovered when there is no observation or dialogue and evaluation of various innovations. Peplau’s theory could be applied and tested within a variety of courses including theory, lab, and clinical courses.


Blakeney, B. A., Carleton, P. F., McCarthy, C., & Coakley, E. (2009). Unlocking the power of innovation. Online Journal of Issues in Nursing, 14(2), 4-4. 

Fawcett, J. (2005). Contemporary nursing knowledge: Analysis and evaluation  of nursing models and theories (2nd ed.). F.A. Davis.

Gastmans, C. (1998). Interpersonal relations in nursing: A philosophical-ethical analysis of the work of Hildegard E. Peplau. Journal of Advanced Nursing, 28(6), 1312-1319. doi:10.1046/j.1365-2648.1998.00840.x

Hargreaves, L., Zickgraf, P., Paniagua, N., Evans, T. L., & Radesi, L. (2021). COVID-19 Pandemic Impact on Nursing Student Education: Telenursing with Virtual Clinical Experiences. SAGE Open Nursing, 7, 23779608211044618.

Jowsey, T., Foster, G., Cooper-Ioelu, P., & Jacobs, S. (2020). Blended learning via distance in pre-registration nursing education: A scoping review. Nurse Education in Practice, 44, 102775.

McSherry, R., & Douglas, M. (2011). Innovation in nursing practice: A means to tackling the global challenges facing nurses, midwives and nurse leaders and managers in the future. Journal of Nursing Management, 19(2), 165-169. doi:10.1111/j.1365-2834.2011.01241.x

Peplau, H. E. (1952). Interpersonal relations in nursing. G. P. Putnam & Sons

Peplau, H. E. (1991). Interpersonal relations: A theoretical framework for application in nursing practice. Nursing Science Quarterly, 5(1), 13-18. doi:10.1177/089431849200500106

Peplau, H. E. (1997). Peplau’s theory of interpersonal relations. Nursing Science Quarterly, 10(4), 162-167. doi:10.1177/089431849701000407

Peterson, S. J. (2013). Interpersonal relations. In Peterson, S.J., & Bredow, T.S. (Eds.), Middle range theories: Application to nursing research (3rd ed., pp. 138-159). Wolters Kluwer/Lippincott, Williams & Wilkins

Seah, B., Ang, E., Liaw, S. Y., Lau, S. T., & Wang, W. (2021). Curriculum changes for pre-registration nursing education in times of COVID-19: For the better or worse? Nurse Education Today, 98, 104743.

Senn, J. (2013). Peplau’s theory of interpersonal relations: Application in emergency and rural nursing. Nursing Science Quarterly, 26(1), 31-35.

Tomietto, Comparcini, D., Simonetti, V., & Cicolini, G. (2020). Nursing education: Challenges and perspectives in a COVID-19 age. Professioni Infermieristiche (Consociazione Nazionale Associazioni Infermiere), 73(3), 131–132.

Young, L. E. & Maxwell, B. (2007). Student-centered teaching in nursing: From rote to active learning. In Young, L.E., & Paterson, B.L. (2007). Teaching Nursing: Developing a student-centred learning environment (pp.3-25). Lippincott Williams & Wilkins.

Author Bio

Laura Vogelsang RN, PhD(c), CMSN(C), CCCI(C), CCNE(C)

Laura is a registered nursing and Assistant Professor at the University of Lethbridge. She presently serves as the President of the Canadian Association of Medical Surgical Nurses. Her teaching and research interests include digital health and nursing education. Laura is also active on social media co-running the nursing education page @nurseitlikeyoumeanit on Instagram. Her other hobbies include gardening, reading, and golfing.

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