JOYCE TRAVELBEE

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

JOYCE TRAVELBEE

Theorist Background

• She was born in New Orleans, Louisiana, United States.
• She earned her bachelor's degree in nursing in 1956 from Louisiana State University, and three years later she received a Master of Science in Nursing from Yale University.
• Her career was always focused on the psychiatric field, in which she was very interested.Her career was always focused on the psychiatric field, in which she was very interested.
• Her short life did not give much more, but there is no doubt that she left a deep mark in the field of nursing thanks to her theory published in 1961 in the book Interpersonal Aspects of Nursing,which was also translated into Spanish asAspects IInterpersonal Nursing.

Her works include:

• Travelbee's Intervention in Psychiatric Nursing: A One-to-one Relationship
• Interpersonal Aspects of Nursing
• Intervention in Psychiatric Nursing: Process in the One-to-One Relationship

HUMAN TO HUMAN RELATIONSHIP MODEL

-The Human to Human Relationship Model of Nursing deals with the interpersonal aspects of nursing, focusing especially on mental health. Joyce Travelbee, who developed the theory, explained that “human-to-human relationship is the means through which the purpose of nursing is fulfilled.” -Travelbee based the assumptions of her model on the concepts of existentialism by Kierkegaard and logotherapy by Frankl. Existentialism believes that humans constantly face choices and conflicts and are accountable to the choices they make in life. Logotherapy is meaning-centered psychotherapy based on the assumption that meaning fulfillment in life is the best protection against emotional instability.

Two different types of health:

1. Subjective health - a state of wellbeing that is determined by an individual's assessment of their physical, emotional, and spiritual well-being.
2. Objective health - the absence of any appreciable illness, impairment, or defect as determined by a medical examination, laboratory testing, and evaluation by a spiritual advisor or psychologist.

7 BASIC CONCEPTS: 1. Suffering - A sensation of unease that might range from minor, fleeting emotional, physical, or mental discomfort to extreme distress is described as suffering. According to Travelbee's philosophy, a nurse's job is to assist the patient in maintaining hope while also assisting them in finding meaning in their experience of pain2. Meaning - is the justification of one's own characteristics. This is the explanation given to an individual.3. Nursing - Assist man in making sense of his experience with illness and suffering. To assist individuals and their families in finding meaning. The nurse's moral and spiritual decisions, as well as how she views disease and suffering, that are essential in assisting patients in doing so.4. Hope - A belief that can and will bring about change that will bring about something better. Helping the patient maintain hope and prevent hopelessness is the nurse's responsibility.

* Six factors characteristics of Hope:

1. It is strongly associated with dependence on other people.
2. It is oriented with the future.
3. It is linked to elections from several alternatives or escape routes out of its situation.
4. The desire to possess any object or condition, to complete a task or have an experience.
5. Confidence that others will be there for one when you need them.
6. The hoping person is in possession of courage to be able to acknowledge its shortcomings and fears and go forward toward its goal.

5. Communications - “a strict necessity for good nursing care.” 6. Self-therapy - It is the capacity to intentionally and fully utilize one's own personality in an effort to create relatedness and organize nursing interventions. This speaks to the nurse's physical and psychological presence. 7. Targeted intellectual approach - the nurse's approach to the patient's circumstance. The nurse must take a methodical, analytical approach to the patient's situation.

Interpersonal Assumptions and Phases

Joyce Travelbee assumes that nursing is fulfilled by means of human-to-human relationships. She defined nursing as “an interpersonal process whereby the professional nurse practitioner assists an individual, family or community to prevent or cope with the experience of illness and suffering, and if necessary, to find meaning in these experiences”. Inspired by being a psychiatric nurse, she struggles for a “Humanistic Revolution” in nursing, with devotion to caring and compassion for patients. She expressed that achieving the goal of nursing necessitates a genuine human-to-human relationship, which can only be established by an interaction process, this process is further divided into five phases. The 5 interactional phases of Travelbee’s model are in consecutive order and developmentally achieved by the nurse and the patient as their relationship with each other goes deeper and more therapeutic. 1.The phase of the Original Encounter: -Emotional knowledge colors impressions and perceptions of both nurse and patient during initial encounters. The task is “to break the bond of categorization in order to perceive the human being in the patient” and vice versa. Patients are the same human beings as us and families; only, that they need other human beings specifically nurses and doctors for maintaining health. Health, which, Travelbee defines in two categories: subjective and objective. Subjective health is an individually defined state of well-being in accord with self-appraisal of physical-emotional-spiritual status. Objective health is an absence of discernable disease, disability of defect as measured by physical examination, laboratory tests, and assessment by the spiritual director or psychological counselor.2. The phase of Emerging Identities: -Tasks in the second phase (visibility of personal or emerging identities) include separating oneself and one’s experiences from others AND recognizing the different qualities that each possesses, transcending roles by separating self and experiences from one another – not using oneself to judge others. The nurse nor the patient is not to stereotype the other as having a particular vexatious characteristic as this is not facilitative to building a relationship. Tasks include and avoiding “using oneself as a yardstick” by which to evaluate others. Barriers to such tasks may be due to role envy, lack of interest in others, inability to transcend the self, or refusal to initiate emotional investment. This phase is described by the nurse and patient perceiving each other as unique individuals. At this time, the link of the relationship begins to form. 3. The phase of Empathy: -This phase involves sharing another’s psychological state but standing apart and not sharing feelings. It is characterized “by the ability to predict the behavior of another”. 4.The phase of Sympathy: -Sharing, feeling, and experiencing what others are feeling and experiencing is accomplished. This phase demonstrates emotional involvement and discredits objectivity as dehumanizing. The task of the nurse is to translate sympathy into helpful nursing actions. Sympathy happens when the nurse wants to lessen the cause of the patient’s suffering. It goes beyond empathy. “When one sympathizes, one is involved but not incapacitated by the involvement.” The nurse should use a disciplined intellectual approach together with the therapeutic use of self to make helpful nursing actions. 5. The phase of Rapport: -Rapport is described as nursing interventions that lessen the patient’s suffering. The nurse and the sick person are relating as human being to human being. The sick person shows trust and confidence in the nurse. “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.”

Joyce Travelbee’s Contribution to Nursing Theory: Human-to-Human Relationship Model

The theory was presented in her book,Interpersonal Aspects of Nursing, which was published in 1961. “The nurse is responsible for helping the patient avoid and alleviate the distress of unmet needs.” - Travelbee “human-to-human relationship is the means through which the purpose of nursing if fulfilled” Travelbee thought that nursing was performed through interpersonal interactions that start with the first meeting and go through phases of forming identities, growing empathy, and ultimately developing feelings of sympathy. In the last phase, the nurse and patient become friends. Attaining true human-to-human interactions is a requirement for achieving the aims of nursing. This connection can only be made through communication.

Five stages to developing a patient-nurse relationship:

• The initial meeting
• The visibility of one's own or one's developing identities
• Empathy
• Sympathy
• Development of mutual understanding and rapport.

NURSING METAPARADIGM

Central to the discipline of nursing are the four phenomena of interest: person, health, environment, and nursing—nursing’s metaparadigm. Joyce Travelbee’s Human-to-Human Theory is a conceptual framework belonging to the totality paradigm. Jacqueline Fawcett (1984) explained: "The metaparadigm of any discipline is a statement or group of statements identifying its relevant phenomena...No attempt is made to be specific or concrete at the metaparadigm level".

• Person is defined as being human. Nurse as well as patient, family, or community under the umbrella of illness is human. Doona (1979) relayed Travelbee’s thoughts that "A person is a contingent being to whom things happen which are beyond his control…The person suffers and chooses. Through this search for meaning he creates himself. Human beings are unique, irreplaceable, ever evolving, and interacting (Travelbee, 1971, 2013).
• Health is defined as being both subjective and objective. Human beings perceive and relate their own sense of health and illness. To be human is to experience illness. Travelbee (1971) wrote: "A basic assumption is that illness and suffering are spiritual encounters as well as emotional-physical experiences". Humans may see illness as having merit or as unavoidable. The presence of distress may not cause one to seek help (Travelbee, 1971, 2013).
• Environment is not well defined, which one might relate to the timing of Travelbee’s writing, the 1960s. Instead, Travelbee relates that the nurse must be observant of the patient in the place where the patient is present in order to ascertain that the patient is in need. She speaks of experiences encountered by all humans: suffering, pain, illness, and hope. Her work with psychiatric patients and community as well as hospitalized individuals encompass an awareness of differing environments (Travelbee, 1971, 2013; Doona, 1979).
• Nursing is better defined. Foremost, the assumption of nursing is to establish a human-to-human relationship. Doona (1979) explained: "A relationship is established only when each participant perceives the other as a unique human being". It is within the paradigm of nursing that the nurse/human facilitates the individual, family, or community to prevent or cope with illness and suffering. The nurse also assists with trying to find meaning in these experiences (Travelbee, 1971, 2013; Pokorny, 2010). All contact with ill persons helps fulfill the purpose of nursing. Travelbee (1971) insisted: "The final measure of nursing competency is always in terms of the extent to which individuals and families have been assisted with the problems of illness and suffering" .

One could debate that in an oncology setting, there would be no difference between treating cancers as chronic diseases than treating illness in a primary care setting, except the triggers of distress occur more often. For the individual or family facing a cancer diagnosis, even if the treatment is successful, there remain an ongoing evaluation through scans and a diagnostic workup, which encourage distress and suffering secondary to the anticipation of progression of disease. The concept of communication resonates through Travelbee’s model. Getting to know another human being is as important as performing procedures. As noted, the nurse must establish a rapport, otherwise he or she will not know the patient’s needs. Travelbee’s model is useful in this setting. Travelbee (1971) noted: "Nurses who know ill persons are more apt to be able to detect not only obvious changes in an individual’s condition but are enabled to recognize the more subtle changes that may be occurring". The AP in the oncology setting will be able to anticipate an individual or family member’s likelihood of distress.

IMPLICATIONS

Nursing Practice -Nursing practice has taught us that everything a nurse does or says while dealing with a patient in a human capacity helps fulfill nursing's purpose, which is how it connects to Joyce Travelbee's theory. Since the nurse and the patient are both real individuals, they might be able to connect. It demonstrated how the interaction between a nurse and patient takes place. It said that a nurse aids the patient, the family, or the community as a whole by helping a patient's, a family's, or a community's development in preventing or coping with sickness or suffering in ways that may lead to finding meaning in the experience. The theory also demonstrated how the nurse should educate the patient and provide options to assist themNursing Education - According to Travelbee's theory, nursing should be carried out through interpersonal interactions that start with the initial meeting, continue through the phases of forming identities, and ultimately result in the growth of empathy and sympathy. Successful patient care depends on the nurse-patient connection, which is built through a process of interaction. This paradigm produced understanding about how nursing should act, communicate, and manage relationships with patients. Nursing Research - Thanks to Travelbee's comprehensive theory of Human-to-Human Relationships, nurses now have the theoretical foundation they need to interact in therapeutic relationships with others. The assumptions about how nurses engage with patients who are in pain, are upset, or could potentially be in pain were addressed by this theory.