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Human-To-Human Relationship Model

Joyce Travelbee(1926-1973)

Introduction

Joyce Travelbee (1926-1973) developed the Human-to-Human Relationship Model presented in her bookInterpersonal Aspects of Nursing (1966, 1971).She dealt with the interpersonal aspects of nursing.She explains “human-to-human relationship is the means through which the purpose of nursing if fulfilled” 


“A nurse does not only seek to alleviate physical pain or render physical care – she ministers to the whole person. The existence of suffering, whether physical, mental or spiritual is the proper concern of the nurse.”
As nurses, we have the responsibility towards our patients. This responsibility does not only focus on the physical defects, difficulties or illness they experience but as well as their total being whether it may be emotionally, psychologically and spiritually. In being able to provide quality health care to our patients, we must be able to have a good interaction and working relationship with them. We must be able to gain their trust, respect and establish rapport as well. As care providers, we must be able to assess the person as a whole not just by mainly focusing in each problem that they verbalize, share or complain.
The theory of Joyce Travelbee indeed has a very great contribution not only to those who are in the Psychiatric Nursing field but in the whole nursing practice. Not only should we be able to assist them towards wellness but also to be able to find meaning in the situation or experiences they had been through whether it may be good or bad. This theory does not only focus on the patient but as well as with the nurse practitioner, both having a unique personality.
Autobiography of the Theorist:
Joyce Travelbee, born in 1926, was a psychiatric nurse, educator and writer. In 1956, she completed her Bachelor of Science degree in Nursing Education at Louisiana State University and her Master of Science Degree in Nursing from Yale University in 1959. She started a doctoral program in Florida in 1973. Unfortunately, she was not able to finish the program because she died later that year. She passed away at the prime age of 47 after a brief sickness.
In 1952, Travelbee started to be an instructor focusing in Psychiatric Nursing at Depaul Hospital Affiliate School, New Orleans, while working on her baccalaureate degree. Besides that, she also taught Psychiatric Nursing at Charity Hospital School of Nursing in Louisiana State University, New York University and University of Mississippi. In 1970, she was named Project Director at Hotel Dieu School of Nursing in New Orleans. Travelbee was the director of Graduate Education at Louisiana State University School of Nursing until her death.
In 1963, Travelbee started to publish various articles in nursing journals. Her first book entitled Interpersonal Aspects of Nursing was published in 1966 and 1971. In 1969, she had her second book published entitled: Intervention in Psychiatrics Nursing: Process in One-to-One Relationship.

Description of the Theory:
Human-to-Human Relationship Model
Travelbee’s formulation of her theory was greatly influenced by her experiences in nursing education and practice in Catholic charity institutions. She concluded that the nursing care rendered to patients in these institutions lacked compassion. She thought that nursing care needed a “humanistic revolution”- a return to focus on the caring functions towards the ill person.
Travelbee’s mentor, Ida Jean Orlando, is one of her influences in her theory. Orlando’s model has similarities to the model that Travelbee proposes. The similarities between the two models are shown in Travelbee’s statement: “the nurse and patient interrelate with each other and by her description of the purpose of Nursing.” She stated that the purpose of nursing is to “assist an individual, family or community to prevent or cope with the experience of illness or suffering, and if necessary, to find meaning in these experiences.”
In her human-to-human relationship model, the nurse and the patient undergoes the following series of interactional phases:
1. Original Encounter
This is described as the first impression by the nurse of the sick person and vice-versa. The nurse and patient see each other in stereotyped or traditional roles.
2. Emerging Identities
This phase is described by the nurse and patient perceiving each other as unique individuals. At this time, the link of relationship begins to form.

3. Empathy
Travelbee proposed that two qualities that enhance the empathy process are similarities of experience and the desire to understand another person. This phase is described as the ability to share in the person’s experience. The result of the emphatic process is the ability to expect the behavior of the individual whom he or she empathized.
4. Sympathy
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 therapeutic use of self to make helpful nursing actions.
5. Rapport
Rapport is described as nursing interventions that lessens 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.”
Note that the above stated interactional phases are in consecutive order and developmentally achieved by the nurse and the patient as their relationship with one another goes deeper and more therapeutic.

Nursing Metaparadigms

·        Person

o   Person is defined as a human being. 

o   Both the nurse and the patient are human beings.

·        Health

o   Health is subjective and objective. 

o   Subjective health is an individually defined state of well being in accord with self-appraisal of physical-emotional-spiritual status. 

o   Objective health is an absence of discernible disease, disability of defect as measured by physical examination, laboratory tests and assessment by spiritual director or psychological counselor.

·        Environment

o   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 anguish—the 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

o   "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.”



Assumptions underlying the one-to-one Relationship:
1. Establishing, maintaining and terminating a one-to-one relationship are activities which fall within the province of nursing practice.
The goals in nursing differ distinctly from those in other health disciplines. Members of various health disciplines share the major overall goal of relationship therapy, namely, to assist the ill person toward social recovery. However, the specific methodology used to accomplish these goals varies. It needs to be emphasized that the one-to-one relationship lies within the province of nursing and that the nurse does not require the permission of the psychiatrist to practice nursing any more than the psychiatrist needs the permission of the nurse to practice psychiatry. This is not only to deny the importance of professional collaboration, it stresses that only nurses are prepared to decide the purposes, roles, activities and functions of nurses.
Members of other health professions are qualified neither by education nor experience to direct nursing activities. This point is emphasized because the “handmaiden-to-the-physician” viewpoint still guides some nurses in the practice of their professional activities. Nurses have many independent functions but only one dependent function, namely, the execution of legal medical orders. Aside fro this one dependent function, a physician cannot “order” nursing care any more than a nurse can “order” medical care. Only professional nurses can, and should, decide and guide the destiny of nursing.
2. A relationship is established only when each participant perceives athe other as a unique human being.
Strictly speaking, a nurse and a patient cannot establish a relationship. It is only when the roles of nurse and patient are transcended, and each perceives the other as a unique human being, that relationship is possible.
3. Only qualified psychiatric nurses are prepared to supervise nurses in the practice of psychiatric nursing.
The nurse who begins interacting with a psychiatric patient for the purpose of establishing a one-to-one relationship should have at her disposal a qualified psychiatric nurse supervisor. By supervisor we mean an individual who holds at least a master’s degree in the field of psychiatric-mental health nursing, she may be a clinical specialist in psychiatric nursing or a prepared psychiatrics nurse faculty member. The supervisor is a resource person with whom the nurse shares data relevant to the one-to-one relationship. The supervisor guides the nurse in clarifying data regarding the relationship and holds regularly scheduled conferences with the practitioner.

4. The major learning experience provided in the psychiatric nursing course in to provide students with the opportunity to establish, maintain and terminate one-to-one relationships.
It is believed that group work skills should be taught on the graduate level. Psychiatric nursing is upper-division nursing course, The concepts used to explain psychiatric nursing intervention are ambiguous and abstract. Time is required for students to understand and apply these concepts meaningfully in a nurse-patient situation. It is recommended that the psychiatric nursing course, on an undergraduate level, extend over a semester. The maturity level of students is also important in determining the extent to which they will be able to establish relatedness with mentally-ill individuals. It is recommended that psychiatric nursing be the last clinical nursing course offered in the program of study. (Behavioral concepts of course should be taught in all clinical nursing courses, not just in psychiatric nursing.)
Students enrolled in a baccalaureate program should, prior to the psychiatric nursing course, possess a basic understanding of major concepts from the natural, physical, biological, medical, behavioral, and nursing sciences. Content related to psychiatric nursing is taught concurrently with field experience. Students, through the group reconstruction process, are taught to apply theory to practice.

5. Nurses need to know how to use library facilities and how to search the literature for needed information.
It may seem somewhat simplistic and self-evident to state that nurses need to know how to use library facilities and how to search the literature for needed information and data. It cannot be assumed, however, that nurses or faculty members know how to use library resources to find reference materials.

6. The knowledge, understanding and abilities needed to plan, structure, give and evaluate care during the one-to-one relationship are necessary prerequisites for developing competency in group work.
Some nurses object to learning skills required to establish a one-to-one relationship on the basis that most nurses in psychiatric settings are required to work with large group of patients, not with individuals. They maintain it is more “realistic” for psychiatric nurses to be prepared to work with groups of patients. However, it is believed that group work is best taught on the graduate, not the graduate, level. It is further believed that the abilities developed in learning to establish, maintain and terminate the one-to-one relationship can be readily transferred and applied to group work. It is more difficult to transfer the knowledge and abilities needed for group work to the one-to-one relationship.

Conclusion

·        Travelbee's theory has significantly influenced nursing and health care.

·        Travelbee's ideas have greatly influenced the hospice movement in the west.

References:

1.     Travelbee, J. (1963). Humor survives the test of time. Nursing Outlook, 11(2), 128.

2.     Travelbee, J. (1963). What do we mean by rapport? American Journal of Nursing, 63(2), 70-72.

3.     Travelbee, J. (1964). What's wrong with sympathy? American Journal of Nursing, 64(1), 68-71.

4.     Travelbee, J. (1966). Interpersonal aspects of nursing. Philadelphia: F.A. Davis.

5.     Travelbee, J. (1969). Intervention in psychiatric nursing: Process in the one-to-one relationship.Philadelphia: F.A. Davis.

6.     Travelbee, J. (1971). Interpersonal aspects of nursing (2nd ed.). Philadelphia: F.A. Davis.

7.     Travelbee, J., & Doona, M. E. (1979). Intervention in psychiatric nursing (2nd. ed). Philadelphia: F.A. Davis.

8.     Octaviano, E.F. & Balita, C.E. (2008). Theoretical Foundations of Nursing: The Philippine
Perspective. Philippines: Ultimate Learning Series, 93-98.

9.     Tomey, A.M. & Alligood, M.R. (2002). Nursing Theorists and Their Work. 5th ed. Missouri:
Mosby, 418-425.