Hildegard Peplau’s theory of interpersonal relations outlines four phases that a nurse-patient relationship moves through: orientation, identification, exploitation, and resolution. Peplau first published this framework in 1952, and it remains a foundational model in nursing education today. The four phases describe how a therapeutic relationship forms, deepens, and eventually ends as the patient moves toward independence.
One point worth noting upfront: later adaptations of Peplau’s work sometimes condense these into three phases (orientation, working, and termination), folding identification and exploitation together into a single “working” phase. But the original four-phase model is what most nursing programs teach and what you’re likely studying.
Phase 1: Orientation
The orientation phase begins when the nurse and patient first meet. The patient recognizes they need help and is trying to adjust to what may be an unfamiliar, stressful situation. During this phase, the nurse acts primarily in the role of a stranger, someone the patient doesn’t yet know or trust.
The goals here are practical and relational. The nurse gathers information about the patient’s condition, concerns, and history. The patient begins to understand what kind of help is available. Together, they start to define the problem and set initial expectations for care. Trust hasn’t been established yet, so the nurse’s job is to create a safe, welcoming space where the patient feels comfortable sharing honest information. This phase is typically brief, especially in hospital settings, but it sets the tone for everything that follows.
Phase 2: Identification
Once the patient feels somewhat oriented, the relationship shifts into the identification phase. Here, the patient begins to identify with the nurse and develops a sense of who can help them and how. The patient moves from feeling like a passive recipient of care to someone who is starting to engage with the process.
During identification, the patient may respond to their situation in several ways. Some patients become cooperative and actively participate. Others may become overly dependent on the nurse, while still others pull away and resist help entirely. The nurse’s role is to help the patient express their feelings, clarify their needs, and begin forming a working partnership. This is when the relationship starts to feel like a real collaboration rather than a one-sided encounter. The nurse may shift into roles like teacher or resource person, helping the patient understand their condition and what to expect from treatment.
Phase 3: Exploitation
The name of this phase is misleading by modern standards. “Exploitation” here simply means the patient is making full use of the services and support available to them. The plans developed during identification are now being put into action.
This is the most active, hands-on phase of the relationship. The patient draws on the nurse’s expertise, asks questions, tries new self-care behaviors, and works through the treatment plan. The nurse continuously assesses how things are going and adjusts the approach as new needs emerge. A key task during this phase is helping the patient find the right balance between dependence and independence. Early on, the patient may need significant support. As they gain confidence and skill, the nurse gradually steps back, encouraging the patient to take more ownership of their own care. In a diabetes education context, for example, this is when the patient would be actively learning to manage blood sugar, adjust their diet, and practice the skills they’ll need after discharge.
Phase 4: Resolution
Resolution is the final phase, where the therapeutic relationship comes to a planned, healthy end. The patient’s original needs have been met, or they’ve developed enough independence to continue managing on their own. In a hospital setting, this phase aligns closely with discharge planning.
Successful resolution doesn’t happen abruptly. The patient gradually lets go of the identification they’ve built with the nurse and shifts their focus toward life outside the care setting. Old dependencies are released, and the patient takes on a stronger sense of self-sufficiency. For the nurse, this phase involves summarizing progress, reinforcing what the patient has learned, and ensuring they have the resources to continue their care independently. When resolution goes well, the patient leaves the relationship stronger and more capable than when they entered it.
The Six Nursing Roles Across Phases
Peplau didn’t just describe what happens in each phase. She also identified six roles a nurse may take on as the relationship evolves: stranger, resource person, teacher, leader, surrogate, and counselor. These roles aren’t locked to specific phases. Instead, the nurse moves between them as the patient’s needs change.
In the orientation phase, the nurse is almost always in the stranger role, building rapport from scratch. As the relationship deepens through identification and exploitation, the nurse may become a teacher (explaining a condition or treatment), a resource person (directing the patient toward services), a counselor (helping them process emotions), or even a surrogate (standing in for another figure in the patient’s life, like a parent or authority figure). The leader role emerges when the nurse helps the patient take responsibility for meeting their own health goals. Recognizing which role fits the moment is one of the practical skills Peplau’s theory is designed to develop.
Why This Framework Still Matters
Peplau’s theory was groundbreaking because it reframed nursing as a relationship, not just a set of tasks. Before her work, nursing theory focused heavily on what nurses do to patients. Peplau argued that what happens between nurse and patient is itself therapeutic.
Modern research supports this. Studies on hospitalized older adults in cardiac intensive care units have found that applying Peplau’s communication framework increases patient satisfaction with nursing care. Research on elderly patients with diabetes has shown that strong interpersonal relationships in nursing care correlate with better adherence to dietary recommendations. A 2025 study used Peplau’s theory to design a self-care education program for older adults with diabetes, using the phases as a structure for teaching patients to participate actively in their own treatment. The four phases give nurses a concrete, repeatable way to build the kind of relationship that leads to better outcomes, whether the setting is psychiatric care, chronic disease management, or routine hospitalization.