Interpersonal/Caring Theories

Peplau’s Psychodynamic Nursing Theory

Peplau’s Psychodynamic Nursing Theory
Peplau’s Psychodynamic Nursing Theory

Hildegard Peplau is one of the first theorists since Nightingale to present a theory for nursing. She introduced her interpersonal concepts in 1952 and based them on available theories at the time: psychoanalytic theory, principles of social learning, and concepts of human motivation and personality development. Psychodynamic nursing is defined as understanding one’s own behavior to help others identify  felt difficulties and applying principles of human relations to problems arising during the experience.

Peplau views nursing as a maturing force that is realized as the personality develops through educational, therapeutic, and interpersonal process. Nurses enter into  a personal relationship with an individual when a felt need is present. This nurse-patient relationship evolves in four phases:

1. Orientation. During this phase, the patient seeks help and the nurse assists the patient to understand the problem and the extent of need for help.

2. Identification. During this phase, the patient assumes a posture of dependence, interdependence, or independence e in relation to the nurse (relatedness). The nurse’s focus is to assure the person that the nurse understands the interpersonal meaning of the patient’s situation.

3. Exploitaiton. In this phase, the patient derives full value from what the nurse offers through the relationship. The patient uses available services on the basis of self-interest and needs. Power shifts from the nurse to the patient.

4. Resolution. In this final phase, old needs and goals are put aside and new ones adopted. Once older needs are resolved, newer and more mature ones emerge.

During the nurse-patient relationship, nurses assumes many roles: stranger, teacher, resource person, surrogate, leader,  and counselor. Today Peplau’s model continues to be used by clinicians when working with individuals who have psychologic problems.


Kozier, Barbare et. al Fundamentals of Nursing 5th edition

Addison Wesley Publishing Company Inc p53


Dorothy E. Johnson

Dorothy E. Johnson
Dorothy E. Johnson

Behavioral System Model (1959,1968,1974,1980)


A behavioral system composed of seven subsystems: affiliative, achievement, dependence, aggressive, eliminative, ingestive, and sexual.


Consists of all factors that are not part of the individual’s behavioral system but that influence the system and some of which can be manipulated by the nurse to achieve the health goal of the client. The individual links to and interacts with the environment.


Health is an elusive, dynamic state of influenced by biologic, psychologic, and social factors. Health is reflected by the organization, interdependence, and integration of the subsystem. Human attempt to achieve a balance in this system; this balance leads to functional behavior. A lack of balance in the structural or functional requirements of the subsystem leads to a poor health.


An external regulatory force that acts to preserve the organization and integration of the client’s behavior at an optimal level under those conditions in which the behavior constitutes a threat to physical or social health or in which illness is found.


Johnson’s Behavioral System Model

Dorothy Johnson used her observations of behavior over many years to formulate a general theory of man as a behavioral system. The theory was originally presented orally in 1968 but was not published until 1980. Johnson defines a system as a whole that functions as a whole by virtue of the interdependence of its parts. Individuals strive to maintian stability and balance in these parts through adjustments and adaptations to the forces that impinge on them. A behavioral system is patterned, repetitive, and purposeful.

Johnson’s key concepts describe the individual  as a behavioral system composed of seven subsystems:

1. The attachment-affiliative subsystem provides survival and security. Its consequences are social inclusion, intimacy, and the formation and  maintenance of a strong social bond.

2. The dependency subsystem promotes helping behavior that calls for a nurturing response. Its consequences are approval, attention or recognition, and p[physical assistance.

3. The ingestive subsystem satisfies appetite. It is governed by social and psychologic considerations as well as biologic.

4. The eliminative subsystem excrete body wastes.

5. The sexual subsystem functions dually for procreation and gratification.

6. The achievement subsystem attempts to manipulate the environment. It controls or masters an aspect of the self or environment to some standard of excellence.

7. The aggressive subsystem protects and preserves the self and society within the limits imposed by society.

Each of the above subsystem has the same functional requirements: protection, nurturance, and stimulation. The subsystems’ responses are developed through motivation, experience, and learning and are influenced by biopsychosocial factors.

Other concepts associated with Johnson’s model are equilibrium, a stabilized more or less transitory resting state in which the individual is in harmony with the self and the environment; tension, a state of being stretched or strained; and stressors, internal or external stimuli that produce tension ans result in a degree of instability.



Kozier, Barbara Fundamental of Nursing 5th edition

Addison-Wesley Publishing Company, Inc 1998 p.49

Fundamentals Theorists

Virginia Henderson (1955, 1966, 1969, 1978)

Person/Client: A whole, complete, and independent being who has 14  fundamental needs to breathe, eat and drink, eliminate, move and maintain posture, sleep and rest, dress and undress, maintain body temperature, keep clean, avoid danger, communicate, worship, work, play and learn.

Environment: The aggregate of the external conditions and influences affecting the life and development of an organism

Health: Viewed in terms of the individuals ability to perform 14 components of nursing care unaided (eg, breathe normally, eat and drink adequately). Health is quality of life basic to human functioning and requires independence and interdependence.  It is the quality of health rather life itself that allows people to work most effectively and to teach their highest potential level of satisfaction in life. Individuals will achieve or maintain health if they have necessary strength, will, or knowledge.

Nursing: The unique function of the nurse is to assist clients, sick or well, in performing those activities contributing to health, its recovery, or peaceful death – activities that client would perform unaided if they had the necessary strength, will, or knowledge. Al;so, to do so in such a way as to help clients gain independence as rapidly as possible.

Henderson’s Definition of Nursing:

In 1955, Virginia Henderson formulated a definition of the unique function of nursing. This definition was a major stepping-stone in the emergence of nursing as a discipline separate from medicine. Basic to her definition are various assumptions about the individual: namely, that the individual (a) needs to maintain physiologic and emotional balance, (b) requires assistance to achieve health and independence or a peaceful; death, and (c) needs the necessary strength, will, or knowledge to achieve or maintain health. These needs give direction to the  nurse’s role.

Henderson cenceptualized the nurse’s role as assisting sick or well individuals in a supplementary or complementary way. The nurse needs to be a partner with the patient, a helper to the paitent, and, when necessary, a substitute for the patient. The nurse’s focus is to thelp individuals and families (which she viewed as a unit) to gain independence in meeting 14 fundamental needs (Henderson 1966):

1. Breathing normally.

2. Eating and drinking adequately.

3. Eliminaitng body wastes.

4. Moving and maintining a desirable position.

5. Sleeping and resting.

6. Selecting suitbale clothes.

7. maintianing body temperature within normal range by adjusting clothing and modifying the environamnet.

8. Keeping the body clean and well-groomed to protect the integument.

9. Avoiding dangers in the environment and avoiding inhuring others.

10. Coomunicating with others in expressing emotions, needs, fears, or oipinions.

11. worshiping according to one’s faith.

12. working in such a way that one feels a sense of accomplishment.

13. Playing or participating in various forms of recreations.

14. Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities.

Kozier, Barbara  Fundamentals of Nursing. 5th edition

Addison-Wesley Publishing company, Inc. 1998. p. 47