Application of Interpersonal Relationship Surrogacy Role

Application of Interpersonal Relationship Surrogacy Role

Hildegard Peplau, a nurse theorist, pioneered a philosophy of interpersonal relationships in healthcare in 1952 (Forchuk, 2021). She contended that the nurse-client interaction objective is to offer holistic nursing care that leads to health enhancement and sustenance. When delivering care within the nurse-client relationship, the nurse takes on one or more of six different roles: stranger, resource person, educator, leader, surrogate, and advisor (Forchuk, 2021).

A study by Wasaya et al. (2021) shows the nurse acts as an advocate or alternative for another person known to the patient, such as a mother, brother, relative, friend, or instructor, in the surrogate role. A client may unknowingly transfer behaviors or feelings associated with a significant other onto the nurse through this approach. The nurse responds to this emotion by assisting clients in recognizing the contrasts and commonalities between themselves and the other.

In certain cases, the nurse effectively becomes the patient’s family while the patient is in the nurse’s care. According to Chinn et al. (2021), the surrogate interaction, according to Peplau, contributes to “the building of rapport in the nurse-patient interaction.” This allows the patient to distinguish between the nurse and a representative family figure by moving the connection ahead, allowing the patient to transition from nursing dependency to independence.

The function of surrogacy is relevant to nursing practice. As a surrogate, the nurse assists the patient in clarifying the realms of dependence, interdependence, and independence and works as the patient’s advocate. According to contemporary nursing research, the nurse has the expertise to detect issues and begin to create solutions(Chinn et al., 2021). If the nurse’s existing care is not addressing a patient’s needs, the nurse acts as a surrogate in this scenario.

The Implementation phase of the nursing process entails putting the plan into action. This is akin to Peplau’s exploitation phase. A nurse would act as a surrogate for the patient throughout this period, procuring the resources required for good health (Farah et al., 2021). Because the patient relies on the nurse’s care, the surrogate role emerges as the patient projects emotions of former sentiments for family onto the nurse.

To minimize disappointment, the nurse assumes a motherly role in this scenario, and the client should be informed that this relationship is transient and not like the one with their family. It should be made clear which actions need the patient’s independence, dependency, or reliance on the nurse (Schlairet & Rubenstein, 2019). Montgomery (2019) shows patients in intensive care units or nursing homes may become dependent on nursing care, in which case a nurse serves as a surrogate.

Based on the examples of surrogacy applications provided above, the surrogate function described by Peplau is applicable to current nursing practice. The nurse’s encouragement of patient and family engagement in health care decision-making, including the adoption of advance directives that meet both patient preferences, is an essential surrogate role application (Parnell, 2019).

Advance directives are expressions of a patient’s preferences for medical treatment based on values and beliefs. In advance directives patient care, the surrogate role is used to identify someone who will represent the patient’s wishes in decision-making, such as durable powers of attorney for health care (Parnell, 2019). Advance directives, at their finest, represent talks between the patient’s family and the nurse as a surrogate.


Chinn, P. L., Kramer, M. K., & Sitzman, K. (2021). Knowledge development in nursing E-book: Theory and process (11th ed.). Elsevier.

Farah, W., Sumera, Z., Anila, F., Aga Khan University School of Nursing and Midwifery Karachi, Pakistan, Aga Khan University School of Nursing and Midwifery Karachi, Pakistan, & Aga Khan University School of Nursing and Midwifery Karachi, Pakistan. (2021). A comparison and integration of two nursing theories into clinical practice: Betty Neuman and Hildegard Peplau. I-Manager’s Journal on Nursing11(3), 48.

Forchuk, C. (2021). Overview of Peplau’s theory. In From Therapeutic Relationships to Transitional Care (1st Edition, pp. 3–15). Routledge.

Montgomery, S. (2019). The effects of nurse-to-patient ratios on patient outcomes in a variety of hospital settings. Scholars Week.

Parnell, E. R. (2019). Empowering individuals in the community: Let your wishes be known through advance healthcare planning.

Schlairet, M. C., & Rubenstein, C. (2019). Senior NCLEX-RN Coaching Model: Development and implementation. Nurse Educator44(5), 250–254.

Wasaya, F., Shah, Q., Shaheen, A., & Carroll, K. (2021). Peplau’s theory of interpersonal relations: A case study. Nursing Science Quarterly34(4), 368–371.

Application of Interpersonal Relationship Surrogacy Role Instructions

The surrogate role is not one that is frequently mentioned in recent nursing practice literature.  Is that role as defined by Peplau relevant to nursing practice as currently experienced.  If so, in what way.  If not, why?