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
About Joyce Travelbee (1926–1973)
- A psychiatric nurse, educator, and writer.
- 1956, she completed her BSN degree at Louisiana State University.
- 1959, she completed her Master of Science Degree in Nursing at Yale University.
- 1952, Psychiatric Nursing Instructor at Depaul Hospital Affiliate School, New Orleans. Later in Charity Hospital School of Nursing in Louisiana State University, New York University and the University of Mississippi. Travelbee died at age 47.
Publications:
- 1963, started to publish articles and journals in nursing.
- 1966 and 1971, the 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.
Joyce Travelbee started a 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 Foundations of Nursing
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.
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.
- 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.
- 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”.
- 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.
- 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.”
Description of the Interpersonal Theory
Travelbee believed nursing is accomplished through human-to-human relationships that begin with the original encounter and then progress through stages of emerging identities, developing feelings of empathy, and later feelings of sympathy. Travelbee’s ideas have greatly influenced the hospice movement in the west.
The nurse and patient attain a rapport in the final stage. For meeting the goals of nursing, it is a prerequisite to achieving genuine human-to-human relationships. This relationship can only be established by an interaction process. It has five phases:
- The inaugural meeting or original encounter
- Visibility of personal identities/ emerging identities.
- Empathy
- Sympathy
- Establishing mutual understanding and contact/ rapport
Basic Concepts & Definitions
- 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: 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 are crucial in helping to find meaning.
- Hope: The nurse’s job is to help the patient to maintain hope and avoid hopelessness. Hope is a faith that can and will change that would bring something better with it. Hope’s core lies in a fundamental trust in the outside world, and a belief that others will help someone when you need it. Six important factors characteristics 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 you when you need them.
- The hoping person is in possession of courage to be able to acknowledge their shortcomings and fears and go forward towards their goal
- Communications: “a strict necessity for good nursing care” and “one is able to use itself therapeutic.”
- Using “self” therapeutically”: Self-awareness and self-understanding, understanding of human behavior, the ability to predict one’s own and others’ behavior are important in this process.
- Targeted intellectual approach: nurses must have a systematic intellectual approach to the patient’s situation.
Nursing Metaparadigms
- Person: person is defined as a human being. Both the nurse and the patient are human beings.
- Health: Health is 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 discernible disease, disability, or defect as measured by physical examination, laboratory tests, and assessment by a spiritual director or psychological counselor. - Environment: NOT clearly defined.
- Nursing: “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.”
Additional Information & References
- Appraising Travelbee’s Human-to-Human Relationship Model
- An Outline of Concepts by Theories in Nursing
- See the above links
