JOYCE TRAVELBEE (19261973) Human-to-Human Relationship Model A nurse does not only seek to alleviate physical pain or render

physical care she ministers to the whole person. The existence of the suffering whether physical, mental or spiritual is the proper concern of the nurse. - Joyce Travelbee Life Story A psychiatric nurse, educator and writer born in 1926. 1956, she completed her BSN degree at Louisiana State University 1959, she completed her Master of Science Degree in Nursing at Yale University Working Experiences: 1952, Psychiatric Nursing Instructor at Depaul Hospital Affilliate School, New Orleans. Also she taught at Charity Hospital School of Nursing in Louisiana State University, New York University and University of Mississippi. 1970, the Project Director of Graduate Education at Louisiana State University School of Nursing until her death. Publications: 1963, started to publish articles and journals in nursing. 1966 and 1971, publication of her first book entitled Interpersonal Aspects of Nursing. 1969, when she published her second book Intervention in Psychiatric Nursing: Process in the One-to-One Relationship. She started Doctoral program in Florida in 1973. Unfortunately, she was not able to finish it because she died later that year. She passed away at the prime age of 47 after a brief sickness. Theoretical Sources Catholic charity institutions Ida Jean Orlando, her instructorThe nurse is responsible for helping the patient avoid and alleviate the distress of unmet needs. The nurse and patient interrelate with each other. Viktor Frankl, a survivor of Auschwitz and other Nazi concentration campsproposed the theory of logotherapy in which a patient is actually confronted with and reoriented toward the meaning of his life.

Major Assumptions The nursepatient relationship is the essence of the purpose of nursing (Travelbee, 1966, p. 13). Human beings are rational, social, and unique beings and are more different than alike (1966, p. 29). All human beings undergo certain experiences and will search for meaning in them during the process of living. These experiences could be considered as coherent wholes and could be understood (e.g., illness, anxiety, joy, harm). Therefore, likeness and similarities between human beings are in the nature of their experiences (1966, p. 30). Labels tend to evoke stereotypical categories. Nurses should remember that patients are human beings who differ from other human beings only in requesting the assistance of other human beings believed capable of helping them solve health problems (1966, p. 34). Relationships are established when both partners perceive each others uniqueness. Then, such human relationships transcend roles and are true, meaningful, and effective relationships based on perceptions of uniqueness (1966, p. 36). Nursepatient relationships are based on perceiving the patient as an illness or nursing as a task. Illness is only understood in the context of perceptions of the patient and the nurse. Illness, suffering, and pain experiences could be self-actualizing if individuals find meaning in them. Human beings are motivated to search for and understand the meaning of all life experiences. Illness and suffering are not only physical encounters for human beings, they are emotional and spiritual encounters as well (1966, p. 69). Nursepatient interaction, when purposeful, fulfills the goals of nursing (1966, p. 93). Communication is a process that can enable the nurse to establish a nursepatient relationship and thereby fulfill the purpose of nursingnamely to assist individuals and families, to prevent and cope with the experience of illness and suffering and, if necessary, to assist them to find meaning in these experiences (1966, p. 94). Nurses are expected to ascertain the meaning of exchanged messages. Basic Concepts Suffering "An experience that varies in intensity, duration and depth ... a feeling of unease, ranging from mild, transient mental, physical or mental discomfort to extreme pain and extreme tortured ..." Meaning Meaning is the reason as oneself attributes Nursing is to help man to find meaning in the experience of illness and suffering. has a responsibility to help individuals and their families to find meaning. The nurses' spiritual and ethical choices, and perceptions of illness and suffering, is crucial to helping to find meaning.

Hope Nurse's job is to help the patient to maintain hope and avoid hopelessness. Hope is a faith that can and will be change that would bring something better with it. Hope's core lies in a fundamental trust the outside world, and a belief that others will help someone when you need it. Six important factors charecteristics of hope are: It is strongly associated with dependence on other people. It is future oriented. It is linked to elections from several alternatives or escape routes out of its situation. The desire to possess any object or condition, to complete a task or have an experience. Confidence that others will be there for one when you need them. The hoping person is in possession of courage to be able to acknowledge its shortcomings and fears and go forward towards its goal Communications "a strict necessity for good nursing care" Using himself therapeutic " one is able to use itself therapeutic." Self-awareness and self-understanding, understanding of human behavior, the ability to predict one's own and others' behavior are imporatnt in this process. Targeted intellectual approach Nurse must have a systematic intellectual approach to the patient's situation.

Nursing Metaparadigm Person - Person is defined as a human being. - Both the nurse and the patient are human beings. - A human being is a unique, irreplaceable individual who is in continuous process of becoming, evolving and changing. Health - Health is subjective and objective. - Subjective healthis an individually defined state of well being in accord with selfappraisal of physical-emotional-spiritual status. - Objective healthis an absence of discernible disease, disability of defect as measured by physical examination, laboratory tests and assessment by spiritual director or psychological counselor.

Environment - Environment is not clearly defined. - She defined human conditions and life experiences encountered by all men as sufferings, hope, pain and illness. Illness being unhealthy, but rather explored the human experience of illness Suffering is a feeling of displeasure which ranges from simple transitory mental, physical or spiritual discomfort to extreme anguish and to those phases beyond anguishthe malignant phase of dispairful not caring and apathetic indifference Pain is not observable. A unique experience. Pain is a lonely experience that is difficult to communicate fully to another individual. Hope the desire to gain an end or accomplish a goal combined with some degree of expectation that what is desired or sought is attainable Hopelessness being devoid of hope

Nursing - Nursing is an interpersonal process whereby the professional nurse practitioner assists an individual, family or community to prevent or cope with experience or illness and suffering, and if necessary to find meaning in these experiences. PARADIGMATIC ORIGIN (CONCEPTUAL FRAMEWORK) Travelbee based her theoretical formulation on existentialist philosophy. She used the concept of stages of development of the nurse-patient relationship, stages of suffereing, tasks to be mastered, constant change and development and the becoming nature. Nurse- patient undergo several stages to achieve the goal of nurse-patient relationship Phase of Original encounter Phase of Emerging identities Phase of Empathy Phase of Sympathy Phase of Rapport

Human-to-Human Relationship Model - humanistic revolution Interactional Phases of Human-to-Human Relationship Model: 1. Original Encounter - First impression by the nurse of the sick person and vice-versa. - Stereotyped or traditional roles 2. Emerging Identities - the time when relationship begins - the nurse and patient perceives each others uniqueness 3. Empathy - the ability to share in the persons experience 4. Sympathy - when the nurse wants to lessen the cause of patients suffering. - it goes beyond empathyWhen one sympathizes, one is involved but not incapacitated by the involvement. - therapeutic use of self 5. Rapport - Rapport is described as nursing interventions that lessens the patients suffering. - Relation as human being to human being

- A nurse is able to establish rapport because she possesses the necessary knowledge and skills required to assist ill persons and because she is able to perceive, respond to and appreciate the uniqueness of the ill human being. *phases are in consecutive and developmental process. APPLICATION OF THE NURSING PROCESS Nursing Process Human-to-human relationship theory Assessment Phase of the original encounter: Data collection and analysis Emotional knowledge colors impression and perceptions of both nurse patient during initial encounter. Nursing diagnosis Phase of emerging identities: Summary statement based on nurse Both the nurse and the patient begin to analysis with possible patient involvement. transcend their respective role and perceive uniqueness in other Outcome and Planning Phase of Empathy: Mutually set outcome and goal This phase involves anothers psychological state but standing apart and not sharing feeling Implementation Phase of Sympathy: Plans initiated the move toward Sharing feelings and experiencing what achievement of mutually set goals. May others are feeling and experiencing accomplished by patient health care accomplished. professional and patients family Evaluation Phase of Rapport: Based on mutually established expected All previous phase culminate in the rapport behavior. defined as those experiences, thoughts May lead termination of relationship or and attitudes that both nurse and patient initiation of new plans undergo and are able to perceive, share and communicate.

Logical Form - An inductive theory that uses specific nursing situations to create general ideas. Application Practice: Hospice self-actualizing life experience. Assumption of the sick role. Meaning of life and sickness and death. Education: Teaches nurses to understand the meaning of illness and suffering. Research: Applied in the theory of caring cancer patients.

Analysis Clarity Travelbees theory is clear because it only focuses on the relationship between the nurse and the patient. Simplicity The theory is simple to understand. The nurse and the patient needs to satisfy the stages in order for them to reach their goal. (establishing rapport) Generality The theory according to Travelbee is specially designed for psychiatric patient. However it could also be used for different patients in the hospital setting Empirical Precision Travelbee does not appear to develop her propositions using findings of research. Derivable Consequences The theory has the potential for use in practice within the limitation of the scope Only to individual patients who are ill and suffering Who are conscious Who are willing to invest in the development of rapport Who participate in finding meaning in and making decisions about care CASE SCENARIO PHASE OF ORIGINAL ENCOUNTER A patient was admitted to the hospital due to depression. A nurse was assigned to take care of the patient. Upon reading the chart and the history of the patient, the nurse visited the patient, for the first time the nurse saw the patient, vice versa. The nurse greeted the patient with enthusiasm but the patient was staring blank at the nurse with no sense of wanting to live anymore, this is according to the nurse assessment of the patient. PHASE OF EMERGING IDENTITIES Upon doing the assessment, the nurse identified that the patient is within the probability of having suicide. So the nurse formulated a nursing care plan regarding suicide precautions for the patient. Made an agreement for a non-suicidal contract. PHASE OF EMPATHY After such time that the nurse interacted with the patient, the patient finally shared something to the nurse. The nurse kept silent and listened to the patient attentively. The nurse showed concern to the patient by staying with the patient and listened to his concern.

PHASE OF SYMPATHY The patient is scheduled for an ECT. The nurse knowing that it will be a painful procedure to the patient, made a NCP regarding the care for post-ECT patients. The nurse remembered his brother who was also a depressed patient who undergone ECT last 2 yrs ago. The nurse felt sympathy for the patient that he didnt leave the patient till he recovers from ECT procedure. PHASE OF RAPPORT The nurse and the patient developed a special bonding that the patient quickly recovered from his state of depression. THEORY DERIVATIVES A young man trying to be perfect son to his father. His father is a wealthy man that owns a multibillion company that he will manage soon. All his life, his father was stern to him that led to proving himself all the time. One day his father accidentally read his diary knowing all the emotions that was inside of him all those years but didnt finish reading it because he arrived. (Phase of the original encounter), thats when the father realized that all those years hed been hard to his son and didnt really know him at all. He decided to get to know his son on a father-son relationship and vice versa. (Phase of emerging identities), thats the time when the son verbalized his feeling through those struggling years to make his father proud of him, how frustrated he was to be the perfect son to him. The father kept silent and listened to his son attentively with the act of care and compassion. (Phase of empathy), when they arrived home the father felt guilty and ashamed of himself for mistreating his son like that and sympathized for him. He then promised to himself that he will change the way he treat his son. (Phase of Sympathy), from the day onwards the father and the son solidify their bonding and making his son more active in their company and when the time comes that the father retires, his son will be able to manage the company with efficiency and precision with the help of his loving father beside him. (Phase of Rapport) References: Octaviano, E.F. & Balita, C.E. (2008). Theoretical Foundations of Nursing: The Philippine Perspective. Philippines: Ultimate Learning Series, 93-98. Tomey, A.M. & Alligood, M.R. (2002). Nursing Theorists and Their Work. 5th ed. Missouri: Mosby, 418-425. Meleis, A.I.. Theoretical Nursing: Development and Progress. 5th ed., 260-265.