The theory of interpersonal relations, published in 1952 by Hildegard Peplau, defines nursing care as a structured relational process in four phases between the caregiver and the patient. This framework places human interaction at the center of practice, where previous models were limited to technical gestures and medical protocols.
Four phases of the relational process according to Peplau
The model is based on a progression that structures each caregiver-patient encounter. These phases are not mere administrative steps: they describe how the relationship evolves, from the first contact to the separation.
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The orientation phase corresponds to the moment when the patient expresses a need and seeks help. The nurse clarifies the request, identifies expectations, and lays the groundwork for a trusting relationship.
Next comes the identification phase: the patient begins to respond to those who provide help. They develop the ability to recognize available resources and rely on the relationship to make progress.
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The exploitation phase is when the patient fully utilizes the services and skills of the nurse. The relationship becomes an active therapeutic lever, not just a simple welcoming framework.
The final phase, resolution, marks the end of the professional relationship. The patient gradually disengages as their needs are met. It is a gradual process, not a sudden break.
To delve deeper into the theory of interpersonal relations according to Hildegard Peplau, one must also understand how these phases relate to the roles that the nurse adopts throughout the care process.
Nursing roles in Peplau’s model: from stranger to counselor
Peplau does not describe a single role for the nurse. She identifies several postures that succeed or coexist according to the phases of the relationship:
- The role of stranger, adopted during the first contact, where the nurse welcomes the patient without judgment or assumptions about their needs
- The role of resource person, who provides appropriate information and helps the patient understand their health situation
- The role of teacher, who imparts knowledge based on what the patient already knows and what they can integrate
- The role of counselor, who intervenes when the patient needs help making sense of their illness experience
These roles are not rigidly assigned. The nurse shifts from one role to another according to the patient’s evolution, which requires ongoing observation and adaptability.
This fluidity differentiates Peplau’s model from more mechanical approaches. The caregiver-patient relationship is not a protocol to be followed, but a living process that is built together.
Cultural and contextual limitations of Peplau’s theory
The model was designed in a North American context of the 1950s, focused on psychiatric care. Its application to other cultures or specialties raises concrete questions.
A qualitative study published in the Journal of Advanced Nursing (volume 82, April 2026) highlights that the linear phases of the model struggle to adapt to varied cultural norms. In some cultures, the trust relationship does not develop according to the same timeline. The orientation phase, as described by Peplau, assumes an explicit verbalization of the need, which does not align with all relational practices.
These field insights lead to hybrid adjustments. Some teams retain the four-phase structure as a framework for reflection while adapting the duration and content of each phase to local realities.
Peplau’s theory in emergencies: adapting deliberate phases to constrained time
The most concrete challenge for the model lies in contemporary emergency services, where care is dictated by technology and time constraints.
The orientation and identification phases assume a time for dialogue and observation that emergencies do not always allow. When a patient arrives in a critical situation, the relationship is built in a few minutes, not over several sessions.
The model remains applicable if the phases are compressed rather than eliminated. Orientation can be reduced to a targeted question about the felt need. Identification occurs through non-verbal signals picked up in seconds. Exploitation corresponds to the immediate technical gesture, and resolution to transfer to another service.
The HAS report (February 2026) on digital tools in nursing notes a marked preference among patients for human interactions over medical chatbots. This finding reinforces the relevance of Peplau’s framework: even in a technology-saturated environment, the quality of the interpersonal relationship remains a factor of satisfaction.
Compressing without distorting
The challenge for caregiving teams in an emergency context is not to abandon Peplau’s phases but to integrate them into micro-interactions. A glance, an open question posed during a technical gesture, a word of explanation at the moment of transfer: these elements are enough to maintain a relational structure.
WHO Europe, in its March 2026 report on person-centered care, recommends prioritizing interpersonal dynamics in mental health protocols. This direction aligns directly with Peplau’s model, which established the relationship as care itself, not as a complement to care, as early as 1952.
Peplau’s model does not prescribe a duration for each phase. It describes a relational logic. It is this logic that allows it to remain effective in contexts that its author did not anticipate, from high-tech emergencies to remote consultations.