Applying Peplau’s Interpersonal Relations Theory to Establish Therapeutic Communication with a Hospitalized Young girl Following Repeated Suicide Attempts

Kazemi Najm, Milad; Oshvandi, Khodayar; Borzou, Seyed Reza; Azizi, Azim; Cheraghi, Fatemeh

doi:10.22087/ijac.2026.581027.1103

Applying Peplau’s Interpersonal Relations Theory to Establish Therapeutic Communication with a Hospitalized Young girl Following Repeated Suicide Attempts

Document Type : Case Study

Authors

Milad Kazemi Najm ¹

Khodayar Oshvandi ²

Seyed Reza Borzou ²

Azim Azizi ²

Fatemeh Cheraghi ²

¹ Student Research Committee School of Nursing and Midwifery, Hamadan University of Medical Science, Hamadan, Iran.

² School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran.

10.22087/ijac.2026.581027.1103

Abstract

Suicide attempts among young adults, especially those involving multiple drug poisonings, are a serious public health issue in Iran. This case study aimed to show how Hildegard Peplau's Theory of Interpersonal Relations can help create therapeutic communication with a 19-year-old woman admitted after her third suicide attempt, which involved multiple drugs. The study also aimed to identify hidden psychosocial factors that contribute to repeated suicide attempts in the Iranian cultural context. This qualitative case study was conducted in 2025. Data collection included semi-structured interviews, a thorough review of nursing records, and an examination of the clinical case file. Data analysis followed the interpretive thematic analysis method outlined by Braun and Clarke. The thematic analysis revealed three main themes: building trust through culturally sensitive communication, identifying hidden psychosocial stressors, and. developing culturally tailored coping strategies. The patient initially concealed her romantic relationship issues due to cultural taboos. This information was gradually uncovered through Peplau's phases. Direct quotes from the patient made up 65% of the findings, showing her journey from initial resistance to openness and acceptance. A follow-up assessment one month later confirmed clinical improvement and no recurring suicidal behaviors. In conclusion, Peplau's theory offers a useful framework for forming therapeutic connections with young adults hospitalized for suicide attempts involving multiple drug poisonings, especially in cultures where underlying psychosocial issues may be hidden due to societal pressures. This theoretical approach helps identify various risk factors and design specific interventions.

Keywords

Interpersonal Relations

Suicide Attempt

Multi‑drug Poisoning

Young

. López-Cuadrado T, Mortier P, Alonso J, Martínez-Alés G. Trends of non-lethal intentional self-harm and suicide in Spain 2018-2023: a nationwide registry-based study. The Lancet Regional Health - Europe. 2025 Sep 27;58:101467. https://doi.org/10.1016/j.lanepe.2025.101467
2. Jalili FS, Abyaz MR, Asadmasjedi N. Epidemiological study of various poisonings in patients referred to Dezful General Hospital, Ahvaz, Iran.
3. Marano M, Goffredo BM, Faraci S, Torroni F, Gowda SH, Perdichizzi S, Di Nardo M. Pharmacokinetic effects of endoscopic gastric decontamination for multidrug gastric pharmacobezoars. Toxicology Reports. 2024 Jun 21;13:101683. https://doi.org/10.1016/j.toxrep.2024.101683
4. Kasemy ZA, Sharif AF, Amin SA, Fayed MM, Desouky DE, Salama AA, Abo Shereda HM, Abdel-Aaty NB. Trend and epidemiology of suicide attempts by self-poisoning among Egyptians. PLoS One. 2022 Jun 16;17(6):e0270026. https://doi.org/10.1371/journal.pone.0270026
5. Hamedi F, Mirzaee Z, Ghasemi H, Rasoulinejad FZ, Slmannejad A, et al. Prevalence of Ideation, Attempt and Completed Suicide in Iranian Substance Abusers: A Scoping Review and Meta-Analysis. Journal of Archives in Military Medicine. 2024;12(4):e159475. https://doi.org/10.5812/jamm-159475
6. Hawton K, Bergen H, Cooper J, Turnbull P, Waters K, Ness J, Kapur N. Suicide following self-harm: findings from the Multicentre Study of self-harm in England, 2000-2012. Journal of Affective Disorders. 2015 Apr 1;175:147-51. https://doi.org/10.1016/j.jad.2014.12.062
7. Davodi M, Rouhani R, Zakariaei Z, Soleymani M, Taheri A. Rupture of the abdominal aorta artery due to self-inflicted injuries in a young man. International Journal of Surgery Case Reports. 2022 Apr;93:106958. https://doi.org/10.1016/j.ijscr.2022.106958
8. Piri S. Cultural-social strains and effective interventions to reduce suicide in Iran. Policy recommendations of Allameh Tabatabai University to the country's executive bodies.
9. Enayat H, Kavianifar S. Suicide Attempt in Women's Meaning System in Shiraz City: A qualitative research. Journal of Social Problems of Iran. 2025 Feb 19;15(2):219-43.
10. Dalhoff K, Hansen JM, Bøgevig S, Petersen TS. Pharmaceutical-Related Poisonings in Greenland. Basic Clin Pharmacology Toxicology. 2025 Apr;136(4):e70016
https://doi.org/10.1111/bcpt.70016
11. Kim E, Kim HJ, Lee DH. The characteristics and effects of suicide attempters' suicidality levels in gender differences. Heliyon. 2023 May 24;9(6):e16662.
https://doi.org/10.1016/j.heliyon.2023.e16662
12. Bostwick JM, Pabbati C, Geske JR, McKean AJ. Suicide Attempt as a Risk Factor for Completed Suicide: Even More Lethal Than We Knew. American Journal of Psychiatry. 2016 Nov 1;173(11):1094-1100. https://doi.org/10.1176/appi.ajp.2016.15070854
13. Hom MA, Albury EA, Gomez MM, Christensen K, Stanley IH, Stage DR, Joiner TE. Suicide attempt survivors’ experiences with mental health care services: A mixed methods study. Professional Psychology: Research and Practice. 2020 Apr;51(2):172. https://doi.org/10.1037/pro0000265
14. Swarnameenaa G. Understanding Caregivers’ Experiences in the Aftermath of Attempted Suicide in a Clinical Population: A Mixed Method Approach (Master's thesis, Central Institute of Psychiatry (India)).
15. Mersha A, Abera A, Tesfaye T, Abera T, Belay A, Melaku T, Shiferaw M, Shibiru S, Estifanos W, Wake SK. Therapeutic communication and its associated factors among nurses working in public hospitals of Gamo zone, southern Ethiopia: application of Hildegard Peplau's nursing theory of interpersonal relations. BMC Nursing. 2023 Oct 13;22(1):381. https://doi.org/10.1186/s12912-023-01526-z
16. Fathidokht H, Mansour-Ghanaei R, Darvishpour A, Maroufizadeh S. The effect of communication using Peplau's theory on satisfaction with nursing care in hospitalized older adults in cardiac intensive care unit: A quasi-experimental study. Journal of Education and Health Promotion. 2024 Jan 22;12:426. https://doi.org/10.4103/jehp.jehp_1677_22
17. Corrigendum. Journal of the American Psychiatric Nurses Association. 2017 Nov/Dec;23(6):NP1.
https://doi.org/10.1177/10.1177/1078390317739010 . Erratum for: Journal of the American Psychiatric Nurses Association. 2017 Sep/Oct;23(5):347-359. https://doi.org/10.1177/1078390317705449
18. Pereira CF, de Vargas D, Beeber LS. An anxiety management intervention for people with substance use disorders (ITASUD): An intervention mapping approach based on Peplau's theory. Front Public Health. 2023 Feb 21;11:1124295. https://doi.org/10.3389/fpubh.2023.1124295
19. Wasaya F, Shah Q, Shaheen A, Carroll K. Peplau's Theory of Interpersonal Relations: A Case Study. Nursing Science Quarterly. 2021 Oct;34(4):368-371.
https://doi.org/10.1177/08943184211031573
20. Oliveira das Chagas Morais A, Castelo Branco de Oliveira AL. Peplau's theory for telenursing with the family of patients with COVID-19. Revista Cuidarte. 2024 May 22;15(1):e3139. https://doi.org/10.15649/cuidarte.3139
21. Yang XH, Wu LF, Yan XY, Zhou Y, Liu X. Peplau's interpersonal relationship theory combined with bladder function training on patients with prostate cancer. World Journal of Clinical Cases. 2022 Mar 26;10(9):2792-2800. https://doi.org/10.12998/wjcc.v10.i9.2792
22. Su XE, Wu SH, He HF, Lin CL, Lin S, Weng PQ. The effect of multimodal care based on Peplau's interpersonal relationship theory on postoperative recovery in lung cancer surgery: a retrospective analysis. BMC Pulmonary Medicine. 2024 Jan 27;24(1):59. https://doi.org/10.1186/s12890-024-02874-5
23. Naderi Samani S, Hasanpour Dehkordi A, Salehi Tali S. The effect of therapeutic communication based on Peplau’s model on body image and pain among cancer patients undergoing radiotherapy in the Parsian hospital of Shahrekord. Journal of Multidisciplinary Care. 2023;12(4):159–165. https://doi.org/10.34172/jmdc.1245
24. Abkenar MR, Imani E, Teshnizi SH, Ahmadi NS, Moradi Y. Determining the impact of a self-care educational program designed based on the Peplau theory on adherence to treatment and self-care in elderly patients with diabetes. Investigacion y educacion en enfermeria. 2025 Apr;43(1):e05. https://doi.org/10.17533/udea.iee.v43n1e05
25.Rodríguez Abrahantes TN, Alfonso Moré T, Rodríguez Abrahantes A, Cabrera Suris GC, Lanza Llerena T, Cepero Santana Y. Promoción y cuidados en personas con diabetes mellitus según la Teoría de Hildegart Elizabeth Peplau. Acta Médica del Centro. 2024 Jul 1;18(3):1.
26. Abrahantes TN, Moré TA, Abrahantes AR, Suris GC, Llerena TL. Cuidado y promoción de la Diabetes Mellitus según la teoría de Hildegart Elizabeth Peplau.
27. Fitri R, Nursanti I. heory concept of hildegar e peplau's nursing model in mental nursing care with the risk of violent behavior in the kutilang ward of the provincial mental hospital Bengkulu in 2025. JJournal of Nursing Education. 2025 Dec 18;8(2):59-70.
28. Keyvanara M, Mousavi SG, Khayyer Z, Ngaosuvan L. A qualitative exploration of motives of suicide attempts among Iranian women. Australian journal of psychology. 2020 Jun 1;72(2):133-44. https://doi.org/10.1111/ajpy.12277
29. Weyant, E. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, 5th Edition: by John W. Creswell. Journal of Electronic Resources in Medical Libraries, 2022:19(1–2), 54–70. https://doi.org/10.1080/15424065.2022.2046231
30. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2006 Jan 1;3(2):77-101.
31. Hardie P, O'Donovan R, Jarvis S, Redmond C. Key tips to providing a psychologically safe learning environment in the clinical setting. BMC Medical Education. 2022 Nov 28;22(1):816. https://doi.org/10.1186/s12909-022-03892-9
32. Elstrup E, Kalitzki E. Sjuksköterskors förhållningssätt vid bemötande av patienter med suicidproblematik: En allmän litteraturstudie.
33. Kim SH, Kim HJ, Oh SH, Cha K. Analysis of attempted suicide episodes presenting to the emergency department: comparison of young, middle aged and older people. I ternational Journal of Mental Health Systems. 2020 Jun 22;14:46. https://doi.org/10.1186/s13033-020-00378-3
34. Forchuk C. Peplau and Therapeutic Relationships. InThe Nurses’ Guide to Psychotherapy: A Reference Book for Nurses Providing Psychotherapy 2024 Nov 9 (pp. 27-39). Singapore: Springer Nature Singapore.