- NURSING THEORIST

http://nursing-theory.org/nursing-theorists/Joyce-Travelbee.php

Biography and Career of Joyce Travelbee

Joyce Travelbee was born in 1926 and is known for her work as a nursing theorist. In 1956,
Travelbee earned her Bachelor of Science in Nursing degree from Louisiana State University.
She was given a Master of Science in Nursing degree in 1959 from Yale University. Her career
dealt predominantly with psychiatric nursing and education. She worked as a psychiatric nursing
instructor at the DePaul Hospital Affiliate School in New Orleans, Louisiana, and worked later in
the Charity Hospital School of Nursing in Louisiana State University, New York University, and
the University of Mississippi.
Travelbee died in 1973 at the age of 47.

Some of Joyce Travelbee’s 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
Joyce Travelbee’s Contribution to Nursing
Theory: Human-to-Human Relationship Model
Travelbee developed the Human-to-Human Relationship Model of Nursing. The theory was
presented in her book,Interpersonal Aspects of Nursing, which was published in 1961.
The assumptions of the model are based on Soren Kierkegaard’s philosophy of existentialism
and Viktor Frankl’s logotherapy. Existentialism places the accountability for people’s choices in
life on the people who make those choices. Logotherapy, which was first proposed in
Frankl’s Man’s Searching for Meaning (1963), is a form of psychotherapy that makes the
assumption that fulfillment is the best protection against emotional instability.
The main concepts of the nursing theory are suffering, meaning, nursing, hope, communications,
self-therapy, and a targeted intellectual approach. Each of these concepts is defined by Travelbee
to help nurses understand the model.

Suffering ranges from a feeling of unease to extreme torture, and varies in intensity, duration,
and depth. The role of nursing in Travelbee’s theory is to help the patient find meaning in the
experience of suffering, as well as help the patient maintain hope.

Hope is defined as a faith that can and will bring change that will bring something better with it.
It has six characteristics:
 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.
Travelbee believed nursing should be accomplished through human relationships that begin with
the original encounter, progress through the stages of emerging identities, and lead to the
development of empathy and sympathy. The nurse-patient relationship is essential to successful
patient care, and this relationship is established by an interaction process.

Building the patient-nurse relationship takes place in five phases: the original encounter, the
visibility of personal or emerging identities, empathy, sympathy, and the establishment of mutual
understanding and a rapport.

In this theory, health is both subjective and objective. Subjective health is an individually-
defined state of well being in accordance with self-appraisal of the physical-emotional-spiritual
status. Objective health, on the other hand, is the absence of any discernible disease, disability, or
defect as measured by physical examination, lab tests, and assessment by a spiritual director or
psychological counselor.

This theory has greatly influenced hospice nursing in that hospice nurses focus on the
relationships with their patients to improve quality of life.

 Journal List
 J Adv Pract Oncol

 v.7(6); Sep-Oct 2016

 PMC5866131

J Adv Pract Oncol. 2016 Sep-Oct; 7(6): 657–661.

Published online 2016 Sep 1.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866131/

PMCID: PMC5866131

PMID: 29588870

Appraising Travelbee’s Human-to-Human Relationship Model

Gary Shelton, DNP, NP, ANP-BC, AOCNP®, ACHPN

Author information Copyright and License information Disclaimer

Finding meaning in suffering could be one of life’s greatest quests. It is a universal question,
yet we all attribute its meaning personally. Joyce Travelbee, a nurse theorist of historical
significance, set about to provide the basis for such discovery. In her grand theory, the
Human-to-Human Relationship, Travelbee (1971) writes: "Every human being suffers
because he is a human being, and suffering is an intrinsic aspect of the human condition" (p
61).
To explicate the philosophic and theoretic assumptions of Travelbee’s model, and therefore
ascertain its usefulness as a foundation for research, it is imperative to critically appraise this
theory. An in-depth critique of the Human-to-Human Relationship Model allows an objective
and nonjudgmental exploration as well as provides judgments related to the theory’s
applicability (Fawcett, 2005). Through phases of her theory, including rapport, empathy, and
sympathy, one establishes ways to garner the meaning of suffering (Travelbee, 1963).
As a career professional in an oncology setting, a better understanding of Travelbee’s theory
should provide the advanced practice nurse (APN) an impetus and the scientific
underpinnings to further nursing theory, nursing research, and evidence-based practice. This
content could easily apply to all advanced practitioners as well.
 Go to:

THE HUMAN-TO-HUMAN RELATIONSHIP MODEL

Purpose
Joyce Travelbee believed that everything the nurse (as a human) said or did with an ill person
(as a human) helped to fulfill the purpose of nursing. The nurse and the patient are human
beings, relating to each other. The process is that of interaction. Nursing is an interpersonal
connection, whereby the nurse facilitates the progress of a patient, a family, or a community
in preventing or coping with an illness or with suffering in ways that could lead to finding
meaning with the experience. The nurse is responsible for educating and providing strategies
to assist the patient in avoiding or alleviating the distress of unmet needs (Pokorny,
2010; Travelbee, 1971).
Thus, the AP has an opportunity to promote human-to-human connections. This should
facilitate the attribution of meaning or at least a better understanding of humans’ symptom
burden and illness. By incorporating the concepts of Travelbee’s model, the AP fosters self-
reflection of his or her own humanness and how an individual human relates to another.
These concepts align well with the AP’s understanding of evidence-based practice and allow
for developing quality improvement (QI) and nursing research.
Concepts and Definitions
Travelbee expresses the importance for nurses to understand their concept of what is human,
for their relationship with another human being will be otherwise determined by that
concept. The human being is defined by Travelbee, 1971 as "a unique irreplaceable
individual—a one-time being in this world, like yet unlike any person who ever lived or ever
will live" (p 26). Human beings are evolving; they are ever in the present but becoming. As
we understand our own humanness, we grow and develop more humanness. The AP
promotes patient- (or human-) centered care, which acknowledges the individuality of each
human being.
Defining the concept of patient is a stereotype and category. Travelbee, 1971 impresses upon
nurses that "actually there are no patients. There are only individual human beings in need of
care, services and assistance of other human beings" (p 32). And since nurses are human
beings, Travelbee, 1971 notes: "All assumptions about being human therefore apply to every
human being categorized as nurse" (p 39).
Illness is a classification and category. An individual will react to illness depending on
culture, symptom burden, and whether there is a related significance to those symptoms.
Depending on the impairment of functioning as well as the health-care provider’s responses,
a human connection that fosters understanding of the illness is developed (Travelbee, 1971).
As noted, every human experiences suffering, as it is a part of being human. Travelbee
(1971) pointed out: "It is probable that the more an individual cares for, and about others, the
greater the possibilities of suffering" (p 64). Hope is future-oriented. Without hope, there is
no direction for lessening suffering. Travelbee (1971) continued: "It is the role of the nurse to
assist the ill person to experience hope in order to cope with the stress of illness and
suffering" (p 77).
Communication is a necessity for good nursing and a fundamental part of this theory.
Travelbee (1971) expresses striving to communicate "to know ill persons, to ascertain and
meet nursing needs and to achieve the purpose of nursing" (p 102). Thus, the AP promotes
the ever-evolving human-to-human connections that promote the understanding of illness
and suffering.
Relationships and Structure
Furthering Travelbee’s assertion that we are all human beings, to be a nurse, or to be ill, the
relationship is human to human. Human relationships become therapeutic as they pass
through expected steps or stages. Travelbee stated (as cited by Pokorny, 2010) that nursing is
accomplished beginning with "the original encounter, which progresses through stages of
emerging identities, developing feelings of empathy and later, sympathy, until the nurse and
the patient attain rapport" (p 61).
Mary Ellen Doona (1979) related: "A relationship is established only when each participant
perceives the other as a unique human being" (p 149). The Human-to-Human Relationship is
established as an interactive process. The inaugural meeting or encounter may immediately
establish a connection. Unfortunately, this connection may not be positive. Through the
emergence of various personal identities, both humans attempt to relate or find meaning in
their encounter. Through our existence, we find meaning that creates who we are. Our
uniqueness is defined by our perceptions of self and other.
As humans share in another’s experience, one can empathize or relate to the other’s
experience. Sympathy surfaces in response to a human’s desire to relieve or lessen another
human’s suffering (Travelbee, 2013). Travelbee (1964) explained: "Sympathy is not a phase
in the process of knowing...It is rather a predisposition, an attitude, a type of thinking and
feeling characterized by deep personal interest and concern" (p 70). Sister Callista Roy
(1988) noted: "Travelbee added the dimension that suffering is a common life experience and
that human relationships are what help people cope with suffering. Basically, nursing is a
relationship of human being to human being" (p 27).
The AP is keenly aware that suffering is not always blatant or acknowledged. As a human
who understands humanness, the AP anticipates human suffering, even in silence, and
promotes a therapeutic relationship that allows for the exploration of meaning. Rapport, the
final phase or layer of the relationship, is established secondary to the nurse/human’s
knowledge and skills necessary to facilitate lessening of another human’s suffering. The
nurse/human perceives, responds, and appreciates the uniqueness of the ill human being
(Travelbee, 2013, 1971, 1963; Rodin, Mackay, & Zimmerman, 2009; Pokorny, 2010).
Rapport is defined by Travelbee as "a process, a happening, an experience between two
persons. It may not be a mutual affair at first, but the sharing of the experience and
participation in it grow as each individual unfolds him or herself in the interpersonal
situation...Rapport is a dynamic, fluctuating affair and it will change as changes occur in the
interpersonal situation or relationship" (Travelbee, 1963, p 70).
Assumptions
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" (p 84).
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" (p 11). 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" (p 61). 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" (p 149). 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" (p 119).
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" (p 98). The AP in the oncology
setting will be able to anticipate an individual or family member’s likelihood of distress.
Go to:

The Critical Appraisal

Conceptual frameworks are constructs joined together as a basis to form a new theory. The
analysis and evaluation of theory involve objective descriptions and judgments about the
extent to which theories meet certain criteria (Fawcett, 1995, 2005). Since the understanding
of nursing theory changes as it is analyzed and tested, it is helpful to critically appraise
concepts and constructs, creating a framework upon which to further build. The explication
of theory is a critical and necessary process that is both empiric and aesthetic, thus allowing
for alternative opportunities to find scientific truth.
Clarity or Brilliance
Although complicated and layered in definitions, Travelbee’s theory clearly outlines the steps
to understanding her concepts. Various sources (Travelbee, 2013) report a vague
interpretation for defining her theory, but she clearly defines the concept of suffering, hope,
illness, and the steps or phases necessary to establish a rapport (Travelbee, 1971). The
challenge for nurses is to identify themselves as being individually human, as are their
patients, and therefore accept and understand each other’s perceptions of self and illness,
striving to know each other and meet each other’s needs.
Simplicity or Parsimony
If the Human-to-Human Relationship Theory were merely to account for nurses and patients
being both human, and therefore able to relate on an equal playing field, Travelbee’s theory
would appear simply stated and parsimonious. This is not the case. Multiple variables exist to
define our being human, thus separating us via the level of distress and suffering. How
humans define or accept their distress and suffering is multifaceted.
The AP is ever aware of an individual human’s culture, religion, ethnicity, family, and
community connections, or lack thereof, and should identify ways to connect human to
human. Although her theory’s simple goal is to establish a rapport with ill human beings,
there are several phases or stages to accomplish: encounter, identity, empathy, sympathy, and
rapport (Travelbee, 1971).
Generalizability
The Human-to-Human Relationship Theory has the potential for global use within nursing,
as we are all human, we all have distress, and we all suffer. However, the individual human,
family, or community must see his or her distress or illness as being in need of an
intervention if a relationship is to develop. Spiritual values may determine one’s perception
of illness or distress. Travelbee (1971) related: "The spiritual values of the nurse or her
philosophical beliefs about illness and suffering will determine the extent to which she will
be able to help" (p 16).
Accessibility
At quick glance, this theory defines concepts but does not have operational definitions for
empiric research. Travelbee’s language is existential and requires an understanding of one’s
perceptions of illness and suffering to find meaning. The descriptive structure of this theory
is more concrete than its process. Although Travelbee’s theory lacks simplicity, her language
and rhetoric can reach researchers and practitioners in human science, thus creating the
foundation for generating knowledge.
Importance
Travelbee provides nursing with the criteria for connecting to ill persons. She has created a
conceptual framework upon which to base therapeutic relationships with patients, families,
and communities in distress or having the potential for suffering. Her definitions of the
components of the metaparadigm of nursing’s phenomena of interest add to the social
significance and social utility of her theory (Roy, 1988). Travelbee’s model teaches nurses to
understand—or at least explore—the meaning of illness and suffering in themselves. It is
through this existential identification that one human being can relate to another human
being. The AP should promote self-reflection as human to help other humans connect.
Theory Applications
Travelbee’s Human-to-Human Relationship Theory that patients are seen as unique
individuals and as human beings is in keeping with the current guidelines and expectations
set forth by agencies such as the Institute of Medicine, the American Nurses Association, and
the Joint Commission for Hospital Accreditation. Care should be patient-centered. The
theory is applicable to and has been used in the hospice movement, helping terminally ill
individuals and their families find meaning in suffering and fostering hope, even at end of
life (Herth, 1990). Margaret Moses (1994) explored Travelbee’s concern over nursing care’s
lack of compassion: "An individual’s interpretation of caring affects the quality of care they
[sic] can provide" (p 202).
Go to:

Conclusion
Travelbee’s grand theory of Human-to-Human Relationships provides nurses with a
foundation necessary to connect therapeutically with other human beings. The assumptions
involve humans, who are nurses, relating to humans who are suffering, are in distress, or
have the potential to suffer. Travelbee stated (as cited in Reed, 1992): "Experiencing meaning
in illness, in particular, has long been identified as an important clinical phenomenon" (p
354). Because of the nurse’s knowledge and experience, he or she develops a rapport with ill
 humans. Nurses perceive and understand the uniqueness of every ill human being and
therefore facilitate their finding meaning in suffering (Travelbee, 2013). The AP has an
opportunity to promote human-to-human connections. This should facilitate the attribution of
meaning or at least a better understanding of humans’symptom burden and illness.

Monday, September 20, 2010

Human-to-Human Relationship Model by Joyce
Travelbee
http://mhayabninal.blogspot.com/2010/09/human-to-human-relationship-model-by.html

“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.”

Introduction
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.

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.

The Goals of the Nurse:

1. The nurse helps the ill person cope with present problems.

The nurse is concerned with “here-and-now” problems as perceived and defined by the ill person. She is not
concerned with uncovering unconscious content or with tracking present problems back through the patient’s
earliest formative years. This is not to deny that such information is useful (or interesting)-it does imply that the
nurse’s primary aim is to help the patient conceptualize his present problem. Knowledge of the ill person’s past
history as obtained from the chart, resource people and others is helpful insofar as what is learned guides the
nurse in structuring nursing intervention; however, the nurse does not probe or request this information from the
patient. If the patient reveals it, the nurse uses it’s knowledge to help her understand his present problem. It is well
to remember that there may be a discrepancy between problems as perceived and defined by the patient and the
patient’s problem as perceived and defined by nurses, psychiatrists and etc.

2. The nurse helps the ill person to conceptualize his problem.

As stated previously, one of the goals in the interactive process is to assist the ill person to identify or conceptualize
problems as he perceives them. This is the primary focus of inquiry throughout the series of interactions. Problems
identified by patients will and do change as relationship progresses.

3. The nurse assists the ill person to perceive his participation in an experience.

The nurse strives to assist the patient to see himself as an active participant in life and it’s events. The practitioner
strives to assist the patient to gain (or regain) a sense of immediacy- of aliveness- and an appreciation of the
uniqueness of his individuality. As the relationship progresses, it becomes easier for the patient to acknowledge
that he is an active participant in life experiences and that what he thinks, feels, and does elicits a response from
others. The patient begins to realize that he affects the behavior of those about him. The patient also learns that
the individuals he encounters will react toward him on the basis of his behavior toward them. This knowledge is
gained slowly and over a period of time as the patient begins to develop an appreciation of the cause-and-effect in
behavior.

4. The nurse assists the ill person to face emerging problems realistically.

Problems, as initially conceptualized by the patient, frequently undergo a change. The initial presentation by the
patient of a somewhat “superficial” problem gradually changes, and deeper problems begin to emerge as the
relationship progresses and the patient is able to perceive his participation in life experiences.

5. The nurse assists the ill person to envisage alternatives.

Many ill individuals resort to stereotyped means of solving problems. The nurse assists the ill person to consider
alternative means of solving problems in living. It may not occur to an ill person that choices are possible in relation
to his particular problem or, if choices do exist, he cannot picture himself acting any differently than he has is the
past. The ill person’s ability to envisage alternatives is a legitimate subject of inquiry.
6. The nurse assists the ill person to test new patterns of behavior.

Another general goal in interacting with ill persons is to assist them to test new patterns of behavior. A patient who
has difficulty conversing with others is helped by talking with the nurse. The nurse then assists the patient to
interact with another patient in the unit. A patient who has difficulty in approaching authority figures is helped by
the nurse to approach the psychiatrist. Nurse and patient together develop the plan and the patient tests the new
pattern of behavior. The extent to which the plan is successful is discussed during the nurse-patient interaction. The
aim of testing new behavioral skills to help the patient to gain confidence in himself as a person who can plan, test,
envisage alternatives and face the outcome of the testing. As the result of gaining this ability the patient gains a
deeper appreciation of himself as an active participant in life experiences.

7. The nurse assists the ill person to communicate

Mentally ill individuals generally have difficulty in sharing their thoughts and feelings with others. A general goal in
the nurse-patient relationship is to assist the patient to communicate logically and clearly with others and to
become aware of what he communicates.

8. The nurse assists the ill person to socialize.

Mentally ill individuals generally have difficulty in socializing with others. The term socialize means more than the
ability to talk with others. An individual who has the ability to socialize derives pleasure and enjoyment from
interacting with others and is attentive to the needs of others. Socialization is a reciprocal process.

9. The nurse assists the ill person to find meaning in illness.

The nurse assists mentally ill individuals to find meaning in their suffering and distress. “Meaning is the reason
given to particular life experiences by the individual undergoing the experience.” The term “meaning” is used in a
restricted sense and refers only to those meanings which enable the ill individual not only to submit to illness, but
to use it as an enabling life experience.

Metaparadigm in Nursing

1. Person

Person is defined as a human being. Both the nurse and patient are human beings. A human being is a unique,
irreplaceable individual who is in the continuous process of becoming, evolving and changing.

2. Health

Travelbee stated that health is measured by subjective and objective health. “ A person’s subjective health status is
an individually defined state of well-being in accord with self0appraisal of physical-emotional-spiritual status.”
Objective health is “an absence of discernible disease, disability, or defect as measured by physical examination,
laboratory tests, assessment by a spiritual director or psychological counselor.”

3. Environment

Environment was not clearly defined in Travelbee;s theory. She defined human conditions and life experiences
encountered by all men as sufferings, hope, pain and illness. These conditions are associated to the environment.
4. Nursing

As defined by Travelbee, Nursing is “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.”

She explained that nursing is an interpersonal process because it is an experience that occurs between the nurse
and an individual or group of individuals.

Acceptance by the Nursing Community

1. Nursing Practice

The hospice is one good example in which Travelbee’s theory is applied. The hospice nurse attempts to build
rapport or a working relationship with the patient, as well as with his significant others. She stated that
understanding illness and suffering enables the patient not only to accept the sickness, but also to use it as self-
actualizing life experience.

A sick person’s insight of worthlessness in his or her sickness leads to non-acceptance of his condition and the great
possibility to lose hope.

A hospice nurse believes that the dying person must find meaning in his or her death before he or she can ever
begin to accept the actuality of death, just as his or her loved one must find meaning in death before they can
complete the grieving process.

2. Nursing Education

Travelbee’s concepts served as better assistance for nurses who help individuals understand the meaning of illness
and suffering. Travelbee’s second book, Intervention in Psychiatric Nursing: Process in the One-to-One Relationship,
has been used in different nursing programs. According to Travelbee’s model, courses in philosophy and religion
would also be helpful in preparing nursing students to fulfill the purpose of nursing sufficiently.

3. Nursing Research

Numerous researches in research studies have cited some aspects of the one-to-one relationship projected by
Travelbee. One study by O’Connor, Wicker and Germino, which is nearly related to some of Travelbee’s ideas,
discovers how individuals who were recently diagnosed with cancer described their personal search for meaning.
The results of this study make known that the search for meaning seems to be both a spiritual and psychosocial
process. The researchers acknowledged nursing interventions that would support this process. No other theory of
Travelbee that would create further development is available.