Contributor – Elouise Runnels Ford, RN, MSN, MHEd
Mental illness remains one of the most stigmatized health conditions worldwide, and stigma often extends into healthcare, including nursing (Ben Natan, Drori, & Hochman, 2024). Nurses play a critical role in supporting individuals with mental health challenges, yet unintentional biases can influence the care they provide and shape career choices in psychiatric–mental health nursing.
Nursing education is a critical site for addressing this challenge. One powerful approach comes from Peplau’s Theory of Interpersonal Relations, first introduced in 1952 and recognized on Nursology.net as foundational to relational nursing practice. Peplau transformed psychiatric nursing by emphasizing relationships over tasks. Rather than viewing nursing as the completion of medical duties, she framed it as a relational, patient-centered process in which the nurse–patient relationship itself becomes a therapeutic tool (Peplau, 1991/1952).
Bringing Theory to Life: A Hypothetical Approach
Imagine a nursing program committed to preparing students to provide compassionate, stigma-free care to individuals living with mental illness. Guided by Peplau’s Interpersonal Relations Theory, the program designs learning experiences that immerse students in the full trajectory of the nurse–patient relationship.
During the orientation phase, students practice establishing rapport and trust while reflecting on their own assumptions and biases. In the identification phase, they focus on understanding patients’ verbal and nonverbal communication, exploring expressed needs, emotions, and concerns. The exploitation (utilization) phase emphasizes collaboration, as students work with patients—real or simulated—to identify coping strategies, support systems, and resources that promote recovery. Finally, in the resolution phase, students guide patients toward closure, reinforce progress, and plan for ongoing well-being.
Within this framework, students engage in simulated clinical encounters, reflective journaling, and guided debriefings designed to deepen relational competence. Together, these strategies may reduce mental health stigma while strengthening students’ readiness for psychiatric–mental health nursing practice (Fernando et al., 2023; Kaddoura & Dyess, 2021).
Why This Matters
From a nursological perspective, embedding Peplau’s theory in nursing education does more than enhance communication skills—it shapes attitudes, fosters empathy, and challenges stigma at its roots (Giordano & Piazza, 2022; World Health Organization, 2021). By prioritizing relationships over tasks, nursing students learn to see the person beyond the diagnosis and to approach mental health care with dignity, curiosity, and compassion.
Integrating Peplau’s Interpersonal Relations Theory into nursing education invites a reimagining of how future nurses connect with patients. When students learn to engage with individuals experiencing mental illness through therapeutic presence and mutual respect, stigma becomes less likely to define clinical encounters. In Peplau’s theory, nurses have a professional responsibility to support patients’ understanding of illness and distress through therapeutic communication and purposeful interpersonal engagement (Peplau, 1991/1952). Because understanding and anxiety reduction are central to healing, this relational approach is not incidental but fundamental to nursing practice. Preparing future nurses to support understanding rather than judgment helps prevent patient experiences from being reduced to labels and positions nursing as a relational discipline capable of challenging stigma through everyday relationships.
Further Reading
Ben Natan, M., Drori, T., & Hochman, O. (2024). The relationship between nursing students’ attitudes toward mental illness and their intentions to work in mental health settings. Journal of Psychiatric and Mental Health Nursing, 31(2), e25279. https://doi.org/10.1111/jpm.13034
Fernando, A., Eg, J., McLafferty, I., & Rahim, A. (2023). Enhancing therapeutic communication skills through mental health simulation: A mixed-methods study. Nurse Education Today, 126, 105781. https://doi.org/10.1016/j.nedt.2023.105781
Giordano, A. L., & Piazza, N. J. (2022). Reducing mental health stigma through psychiatric simulation in undergraduate nursing education. Clinical Simulation in Nursing, 65, 25–32. https://doi.org/10.1016/j.ecns.2022.05.004
Kaddoura, M., & Dyess, S. (2021). Empathy development through standardized patient simulations in nursing students. Journal of Nursing Education, 60(12), 681–687. https://doi.org/10.3928/01484834-20211118-08
Peplau, H. E. (1991). Interpersonal relations in nursing: A conceptual frame of reference for psychodynamic nursing. Springer. (Original work published 1952).
World Health Organization. (2021). Comprehensive mental health action plan 2013–2030. https://www.who.int/publications/i/item/9789240031029
About Elouise Runnels Ford
Elouise Runnels Ford, RN, MSN, MHEd, is nursing faculty at Lee College and a doctoral student in the College of Nursing at Texas Woman’s University. Her scholarly interests include nursing education, mental health stigma, relational nursing practice, and the application of nursing theory to teaching and learning.
Reducing the stigma surrounding mental health in nursing education is not only necessary, it is urgent. Peplau’s theory reminds us that human connection, active listening, and empathetic understanding are the pillars of true care. Training nurses to recognize psychological suffering without prejudice means sowing a culture of respect, dignity, and deep accompaniment. Moreover, the growing number of Alzheimer’s and other dementia cases appearing at increasingly younger ages challenges us to prepare sensitive and competent professionals, capable of supporting not only patients but also their caregivers, in a context where mental health and comprehensive care become essential for the community. Thank you Elouise Runnels and nursology.net for sharing that important topic.
Thank you, Elouise, and nursology.net for highlighting Peplau’s Interpersonal Relations Theory in the setting of Nursing Education. Brava! Well done.
Elouise, I’m curious, can you imagine this nursology practice process in the setting of primary prevention? I would like to map the exploitation/utilization phase, with its emphasis on collaboration, to a framework that illustrates Collaborative Care as an Essential Health Benefit in health care delivery systems.
I’m curious, was it Peplau who described the process of interpersonal relations as a maturing force in which both the nurse and the patient/client were changed? Moreover, did she describe phases of the maturing personality: the ability to trust, to delay gratification, to define oneself and finally to participate in democracy.
Again, thank you! I am so grateful for your work.
Kathy,
Thank you so much for this thoughtful reflection—I am truly grateful for your commitment. I see Peplau’s practice process extending into primary prevention, particularly the exploitation (utilization) phase, in which individuals and families actively engage with available resources to support health before illness becomes entrenched. That phase aligns naturally with today’s collaborative and integrated care models, which emphasize shared decision-making, partnership, and team-based coordination as essential to whole-person care (Agency for Healthcare Research and Quality Integration Academy, 2024; Hernandez et al., 2024). Peplau’s view of the nurse–patient relationship as a maturing, mutually transformative process also remains strikingly contemporary, as nursing education continues to highlight relational practice, empathy, and professional identity formation (Alligood, 2022). Her emphasis on trust, self-definition, and democratic participation resonates strongly with current calls for people-centered, equitable systems of care (National Academies of Sciences, Engineering, and Medicine, 2021; World Health Organization, 2023). These connections underscore why Peplau’s theory remains not only relevant to nursing education and mental health practice but also foundational for equitable, relationship-centered, and prevention-focused care across the continuum.
Further Reading
AHRQ Integration Academy. (2024). What is integrated behavioral health?
https://integrationacademy.ahrq.gov/about/integrated-behavioral-health
Alligood, M. R. (2022). Nursing theorists and their work (10th ed.). Elsevier.
Hernandez, V., Nasser, L., Do, C., & Lee, W.-C. (2024). Healing the whole: An international review of the collaborative care model between primary care and psychiatry. International Journal of Integrated Care. https://doi.org/10.5334/ijic.7581
National Academies of Sciences, Engineering, and Medicine. (2021). Implementing high-quality primary care: Rebuilding the foundation of health care. National Academies Press. https://doi.org/10.17226/25983
World Health Organization. (2023). Operational framework for primary health care: Transforming vision into action. https://www.who.int/publications/i/item/9789240050082