Riza Fitri | Theory Concept of Hildegar E PeplauAos Nursing Model in Mental Nursing Care Journal Educational of Nursing (JEN) Vol.
8 No.
2 July Ae December 2025.
page 59-70 p-ISSN : 2655-2418.
e-ISSN : 2655-7630 journal homepage: https://ejournal.
DOI : 10.
37430/jen.
Article history:nyeri Received: November 26th 2025
Revised: December 03th 2025
Accepted: December 08th 2025
THEORY CONCEPT OF HILDEGAR E PEPLAUAoS NURSING
MODEL IN MENTAL NURSING CARE WITH THE RISK OF
VIOLENT BEHAVIOR IN THE KUTILANG WARD OF THE
PROVINCIAL MENTAL HOSPITAL BENGKULU IN 2025
Riza Fitri 1*.
Irna Nursanti 2 Master Of Nursing Study Program.
Faculty Of Nursing Muhammadiyah University Jakarta.
Indonesia Emai : izaizut99@gmail.
Abstract The risk of violet behavior is one of the main nursing problems in patients with schizophrenia, especially when the patient experiences threating auditory hallucinations.
High anxiety, inability to control impulses, and poor coping.
This condition can endanger the safety of oneself and others, thus requiring appropriate nursing care oriented towards a therapeutic relationship.
Hildegard E PeplauAos interpersonal relationship theory offers a humanistic approach that emphasizes the communication process, the formation of trust and the active involvement of patient recovery.
In its application, this theory forms a dynamic and continuous interpersonal relationship between nurses and patients.
This interpersonal relationship is divided into four phases of therapeutic relationship between nurses and patients, namely the orientation phase, the identification phase, the exploitation phase and the resolution phase.
Here we discuss the concept of PeplauAos theory and its application to psychiatric nursing care in the kutilang ward of the Bengkulu Provincial Mental Hospital for patient with medical diagnosis of schizophrenia who experiences auditory hallucination and is at risk of violent behavior.
The application of the theory focuses on therapeutic communication, assessing, triggers of aggression, establishing trusting relationships and developing adaptive coping through.
Structured interventions based on the SDKI-SLKI-SIKI.
The result of the application Show a decrease in improvement in patientAos self-esteem.
The theoretical analysis shows that the Peplau model has advantages in building effective interpersonal relationships and increasing patient involvement in the recovery process.
However, this theory has limitations in patients with severe psychosis who find it difficult to establish optimal therapeutic contact, and it underemphasizes the biological aspects often needed in the acute phase.
Overall.
PeplauAos theory has proven relevant and effective as humanistic, relationshiporiented approach to psychiatric nursing.
Keywords: Hildegard E Peplau.
Interpersonal Relationships.
Psychiatric Nursing.
Risk of Violent Behavior.
Schizophrenia.
Journal Educational of Nursing (JEN) Vol.
8 No.
Riza Fitri | Theory Concept of Hildegar E PeplauAos Nursing Model in Mental Nursing Care
INTRODUCTION
The history of nursing has continued to develop and develop over time, initially nursing practice focused solely on meeting physical needs and efficiently administering medical care, but later evolved into a holistic nursing practice, as advocated by leading nursing figure (Widuri, 2.
Hildegard E Peplau, a renowned nursing figure, is known for her work.
Auinterpersonal relations in nursing,Ay which she argued that the essence of nursing is the therapeutic relationship between nurse and patient, which is the foundation of Her work was recognized by pioneers of modern psychiatric nursing and received national and international awards for her contributions to nursing education and theory.
Her theories have since become widely used in nursing education, clinical practice, and nursing research worldwide.
Hildegard E Peplau made a significant difference in understanding that nurses are not merely medical practitioners but also therapeutic partners who play an active role in the patientAos healing process.
Her theory remains a key foundation for modern nursing practice, particularly in the in the areas of mental health nursing, therapeutic Theories relate to psychodynamic nursing are heavily influenced by the nursing is the ability to understanding a personAos behavior and thus identify the difficulties they are experiencing.
Therefore, achieving the goals of psychodynamic nursing requires the involvement and interaction of two or more individuals, based on a relationship therapeutic interpersonal.
(This theory was adapted from Hildegard E PeplauAos classic book, interpersonal relationships .
, as citied in Sulistiowati, 2.
This study is a theoretical literature review the application of PeplauAos theory in psychiatric nursing with patients experiencing auditory hallucinations with aggression that poses a risk of violent behavior.
In psychiatric nursing, which is one of the areas of nursing practice that emphasizes meeting the psychological, emotional and social needs of clients through a therapeutic One theory that provides a strong foundation in psychiatric nursing practice is the interpersonal relationship theory developed by Hildegard E Peplau, which emphasizes that nursing is an interpersonal process that occurs through a therapeutic relationship between nurses and clients.
This theory is one of the foundations for the development of client-oriented practice and emphasizes the active role of nurses in helping clients achieve optimal health.
Peplau explains that in the interpersonal relationships, dynamic and continuous interactions occur through for phases of therapeutic communication, including orientation, identification, exploitation and resolution.
These phases aim to foster communication, foster trust and enhance the clientAos adaptive Within this interpersonal relationship phase.
Peplau outline several nursing roles, including stranger, teacher, counselor, each with its own function.
This theoretical model is highly relevant in the context of psychiatric nursing services, including the management of clients with violent behavior problems.
Cases of psychiatric nursing violent behavior are one of the disorders frequently encountered in patients with This condition can take the form of verbal threats, physical aggression, or actions that have the Journal Educational of Nursing (JEN) Vol.
8 No.
Riza Fitri | Theory Concept of Hildegar E PeplauAos Nursing Model in Mental Nursing Care potential to harm oneself, others or the In psychiatric wards such as the Kutilang room at The Bengkulu Provincial Mental Hospital, cases of violent behavior are clinical problems that require prompt, appropriate and comprehensive treatment, particularly relationship between nurses and clients.
Nursing interventions provided must facilitate clients in recognizing triggers, controlling emotions and developing adaptive coping strategies.
this case study the treatment was conducted in the Kutilang room at the Bengkulu Provincial Mental Hospital, as this room specifically handles patients with severe mental disorders, particularly those with schizophrenia who frequently experience positive symptoms such as hallucinations and aggressive behavior.
The Kutilang room has its own characteristics.
Patient population with high risk of violent behavior, so it is in accordance with the focus of Mr.
HAos case who has a medical diagnosis of F20 .
aranoid accompanied by violent behavior.
Structure environment with close supervision, so as to allow for the therapeutic relationships according to PeplauAos interpersonal theory.
Competent nurses in the field of psychiatric nursing, who apply a therapeutic communication approach as a main part of case.
To serve as a space for behavior intervention and rehabilitation, thus implementation of all phases of the Peplau nurse-client .
rientation, exploitation, and resolutio.
To have multidisciplinary facilities and teams that support patient recovery through family involvement and other therapeutic programs.
With this Conditions, the Kutilang room is a relevant and appropriate location to study and apply Hildegard E PeplauAos interpersonal nursing model in managing client at risk of violent behavior such as in the case of Mr.
PeplauAos interpersonal relationship theory is an appropriate model for psychiatric nursing care for patients at risk for violent Through an interpersonal approach, nurses can guide client towards self-understanding, increased self-control and reduced risky behaviors.
This theory also reinforces the nurseAos role in providing emotional support, education and creating a safe therapeutic Violent behavior is a clinical treatment, particularly through an between nurse and client.
Nursing interventions should facilitate clients in emotions, and developing adaptive coping strategies.
PeplauAos interpersonal relationship theory is an appropriate model for application in psychiatric nursing care for patients at risk for violent behavior.
Through an interpersonal approach, nurses can guide clients to understand themselves, increase self-control and reduce potentially dangerous behavior.
This theory also reinforces the nurseAos role in providing emotional support, education and creating a safe therapeutic Journal Educational of Nursing (JEN) Vol.
8 No.
Riza Fitri | Theory Concept of Hildegar E PeplauAos Nursing Model in Mental Nursing Care
RESEARCH METHODOLOGY
The method used in this study was a case study with a nursing process approach based on Hildegard E.
PeplauAos Interpersonal Theory in the intervention of a patient with a risk of violent The implemented through a therapeutic nurseAepatient relationship encompassing the phases of orientation, identification, exploitation, and resolution Setting and Duration The intervention was conducted in the Kutilang Ward of Bengkulu Provincial Mental Hospital from September 24Ae29, 2025, over a six-day intervention period.
Participant The participant in this application was one patient diagnosed with Schizophrenia (F.
who exhibited a nursing problem of risk for violent The patient was selected using purposive sampling based on the following criteria:
In a mild to moderate acute phase Able to communicate verbally Not under full physical restraint Willing to participate with family consent obtained Instruments and Data Collection Data collection was carried out Interviews and observations of behavior and emotional responses Physical assessments and vital signs monitoring Daily nursing progress notes Measurement of risk for violent behavior using the Modified Overt Aggression Scale (MOAS) Documentation of the nursing process .
ssessment, diagnosis.
Intervention Procedure The intervention was delivered PeplauAos relationship phases:
Journal Educational of Nursing (JEN) Vol.
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Riza Fitri | Theory Concept of Hildegar E PeplauAos Nursing Model in Mental Nursing Care Table 1 Intervention Procedure Phase Objective Main Intervention Duration Orientation Establish trust and identify problems Rapport, therapeutic contract.
MOAS Day 1 Identify Assist patient in recognizing stressors and emotional coping Exploitation of emotional education Day 2-3 Exploitation Patient practices adaptive coping Relaxation techniques, assertive communication, anger Day 3-5 Resolution Planned termination of the therapeutic Goal review, reinforcement of Day 6 Analysis and Evaluation Evaluation was conducted at the end of each session and at the end of the intervention using the following Reduced MOAS score Reduced manifestations of aggressive behavior Improved self-control and coping The patientAos increased ability to express emotions adaptively The evaluation results were used to determine the effectiveness of the Peplau-based intervention in the context of mental health nursing.
RESULT AND DISCUSSION
The discussion in this case study analyzes the application of Hildegard E PeplauAos theory of interpersonal relation in psychiatric nursing care for patients at risk of violent behavior.
This theory emphasizes the importance of a therapeutic relationship between nurses and client as the foundation of the In the case of Mr.
H in Kutilang Ward of The Bengkulu Provincial Mental Hospital.
Peplau theoretical concept is systematically applied through four phases of interpersonal relations the Journal Educational of Nursing (JEN) Vol.
8 No.
Riza Fitri | Theory Concept of Hildegar E PeplauAos Nursing Model in Mental Nursing Care orientation phase, the identification phase, the exploitation phase and the resolution phase.
Hildegard E PeplauAos nursing interaction theory explains that nursing care, especially for mental patients, should be built on a therapeutic interpersonal relationship between the nurse and the client.
In this model nurses are not merely implementers of technical procedures, but partners in the recovery (Potter, 2.
In the patients at risk for violent hallucinations, emotional states and (Authreatening voicesA.
often trigger anxiety, fear, or feelings of threat which can lead to aggression or violence.
From PeplauAos perspective this aggression can be understood as maladaptive manifestation of effort to seek a sense of security Therefore, interventions must be able to build security and trust, as well as help clients restructure their perceptions and increase self-control.
Thus PeplauAos model is relevant because it provides a framework that bridges psychosocial, emotional and interpersonal aspects, not just biological aspects, in nursing care for patients at risk for violence.
the following analysis shows how each element of the theory is integrated into the nursing process.
Relevance Of PeplauAos Theory to The Condition of Patients at Risk of Violent The risk of violent behavior is a condition where a patient exhibits the potential to harm themselves, other or the environment as a maladaptive response to internal or external schizophrenia, such as Mr.
auditory hallucinations containing threats can trigger intense anxiety, feelings of insecurity and defensive impulses in the form of aggression.
(Stuart, 2.
This response can increase when the patient loses the ability to assess reality and is unable to control angry impulses.
In a theoretical context.
Peplau views behavior disorders not simply as clinical problems, but as products relationships and anxiety.
Therefore, the therapeutic relationship between the patient and caregiver becomes a primary intervention tool for reducing anxiety, increasing selfcontrol and achieving adaptive (Hagerty et all, 2.
The process of hallucinations becoming a risk factor for violent behavior begins with auditory hallucinations, a positive symptom of schizophrenia, often consisting of demeaning voices.
This condition affects the patientAos perception, emotions, and behavior.
The process of hallucinations developing into a risk factor for violence can be explained as follows:
Perceptual Distortion Patients hear voices that arenAot real but believe to be true.
This impairs their ability and assess reality, making it difficult for them to distinguish between internal and external stimuli.
Journal Educational of Nursing (JEN) Vol.
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Riza Fitri | Theory Concept of Hildegar E PeplauAos Nursing Model in Mental Nursing Care Cognitive Disorders and SelfControl Hallucinatory voices may give dangerous commands such as Aube ViolentAy.
Auhit himAy, or Authey want to kill youAy.
Patients feel compelled to comply with these commands to reduce anxiety or Negative Emotional Response Threatening hallucinatory content triggers intense emotions such as anger, suspicion, anxiety, or Unmanageable emotional tension increases impulsivity.
Protective and Aggressive Reactions: patients may interpret the environment as dangerous, leading to defensive behavior to perceived threats.
Violence then emerges as an expression anger or self-defense.
Lack of Coping Skills Inability to control or reject hallucinations leads to increased frequency and intensity of aggressive behavior.
(Sutini, 2.
When hallucinations, they will then Experiences perception, leading to fear and anger, aggressive impulses that lead to violent actions.
Nurses need to play a role in breaking this chain through hallucination management education, management education, emotional control techniques and increasing adaptive coping so that the risk of violence can be minimized.
Behavior patient at risk of violent behavior often experience emotional instability, agitation and difficulty controlling impulses.
In Mr.
HAos case, these conditions are influenced by threating auditory hallucinations, perceptual disturbances and chronic low self-esteem.
PeplauAos theory is relevant because:
Emphasize relationships as a means of creating a sense of security.
Using therapeutic communication to reduce anxiety and aggressive Focus and developing adaptive coping, which is greatly needed by patients with psychotic View nurses as agents of change, not just as implementers of medical procedures.
Thus.
PeplauAos theory provides a powerful clinical framework for addressing behavior and emotional problems comprehensively Analysis Of the Application of Interpersonal Relationship Phases in The Case of Mr.
Orientation Phase In this phase the nurse builds an initial relationship with Mr.
actions such as introducing oneself, actively listening and showing empathy have been carried out according to PeplauAos This approach is effective in reducing the patientAos anxiety, especially because Mr.
Risk assessment MOAS demonstrates the translation of theory into practice where nurses behavior is not just a symptom.
Journal Educational of Nursing (JEN) Vol.
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Riza Fitri | Theory Concept of Hildegar E PeplauAos Nursing Model in Mental Nursing Care but a response to anxiety and perceptual distortions Identification Phase In this phase the patient begins to rely on the nurse for a sense of Intervention such as exploring feelings, understanding self-perception, and identifying triggers for violence are direct PeplauAos understanding the interpersonal meaning behind the clientAos behavior, establishing a nursing diagnosis .
isk for violent, auditory hallucinations, selfesteem chronic lo.
indicates that the nurse successfully identified the patientAos emotional and psychological needs.
Exploitation Phase This phase becomes evident when patients begin to use the develop adaptive coping.
Actions such as practicing relaxation techniques, providing positive distractions align with their nurses to achieve therapeutic Family involvement also strengthens the nurseAos role as a leader and resource person, patientAos psychological in managing their Resolution Phase In final phase, the nurse and patient reflect on the change that Evaluations indicate increased self-control, decreased hallucination intensity, and improved self-concept.
This demonstrates the success of the PeplauAos theory, as the patient becomes more independent in managing their emotions.
Suitability Nursing Interventions with PeplauAos Theory Interventions Used during the nursing process are based on three major components of PeplauAos theory Therapeutic Communication used Build trust Validating feelings Reduce anxiety Reduce verbal/nonverbal Therapeutic communication has been shown to be a key strategy in preventing violence.
The role of nurses, nurses carry out all Peplau roles holistically Stranger Nurse introduce herself and builds initial trust Nurse teachers provide education about coping and emotional The nurse leader directs the patient in therapy activities Nurse resource person provide information about illnesses and The nurse counselor listens to the patientAos feeling and provides emotional support Surrogate nurse Provide a sense of security as a trusted substitute All of these roles are apparent in systematic daily interventions.
Development of adaptive coping Relaxation reinforcement, and structured activities are concrete forms of applying theory in helping Change Experienced by Patients and Their Relationship to Theory The clinical changes that occurred in Mr.
H indicate that the Peplau principles are effective in reducing Journal Educational of Nursing (JEN) Vol.
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Riza Fitri | Theory Concept of Hildegar E PeplauAos Nursing Model in Mental Nursing Care the risk of violence Decreased hallucinations are indicated by the patient being able to distinguish reality better Increased self-control is indicated by the patient being able to recognize anger triggers Self-esteem improves as indicated by the patient beginning to her/his More focused communication is shown by a stable relationship with the nurse This change is in line with PeplauAos primary goal of helping clients achieve a more adaptive level of Challenges In Applying PeplauAos Theory in The Case of Int Despite Patients with acute psychosis have difficulty forming a therapeutic relationship in the early phase Hallucinations that threaten and hinder the patientAos concentration Nurses need patience, consistency and high communication skills The confined environment of the hinders privacy in therapeutic However, these challenges do not reduce the effectiveness of the theory, but rather show the need for multidisciplinary collaboration and environmental support Implications of Mental Health Nursing Practice This case study Show that PeplauAos theory is very effective for patients at risk of violent Interpersonal approach not only reduces aggression, but also improves the patientAos quality of Therapeutic training for nurses should be a priority in psychiatric wards The use of MOAS.
SIKI SLKISDKI is very suitable as standardized system that supports the implementation of theory CONCLUSION Hildegard E PeplauAos theory of fundamental foundation in psychiatric nursing practice, particularly for patients at risk for violent behavior.
Through the four phases of the therapeutic relationship: orientation, indication, exploitation and resolution.
Nurse are able to create safe, empathetic and meaningful relationship that enable patients to understand themselves, control their emotions and enhance their adaptive abilities.
In case of patients at risk for violent behavior.
PeplauAos theory proves relevant because it emphasizes the importance of collaboration and patient empowerment.
This approach helps patients identify hallucinations and strengthen self-esteem through a process of developing interpersonal relationships.
Nurses also pay a role in facilitating positive coping mechanism, providing education and involving families in the recovery However, the application of PeplauAos theory requires high communication skills time, and patient conditions that Overall, however this theory makes a significant contribution to improving patient outcomes.
The quality of psychiatric nursing care, because it focuses on the patient as whole individual not just on the disease.
Journal Educational of Nursing (JEN) Vol.
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Riza Fitri | Theory Concept of Hildegar E PeplauAos Nursing Model in Mental Nursing Care
applying PeplauAos theory, nurses can provide more humanistic care that is focused on the emotional and psychosocial needs of patients and are able to reduce the risk of violent behavior
through constructive and professional therapeutic relationships REFERENCE