Joyce Travelbee

1926 - 1973

“Human-to-Human
Relationship Model
of Nursing”

GROUP 10
Psalm Jamili
Simms Richard Palacio
Sheena Joyce Colegado
Objectives:
BIOGRAPHY OF JOYCE TRAVELBEE
OVERVIEW OF THE “HUMAN-TO-
HUMAN RELATIONSHIP MODEL”
THEORY
THEORETICAL SOURCES
ASSUMPTIONS
BASIC AND MAJOR CONCEPTS
INTERACTION PHASE
USE OF TRAVELBEE”S THEORY IN
PRACTICE
“Suffering ranges from a feeling of unease to
extreme torture, and varies in intensity,
duration, and depth. The role of nursing is
to help the patient find meaning in the
experience of suffering, as well as help the
patient maintain hope.”
(Travelbee, 1966)
 Biography
Joyce Travelbee (1926-1973) was born in 1926 and died in 1973 at the age
of 47. She 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 in New Orleans, Louisiana,
York University, and the University of Mississippi.
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
 Overview of Travelbee’s “Human-to-Human
Relationship Model of Nursing”
Nursing: It’s Definition
Nursing Is an Interpersonal Process...
Nursing is an “interpersonal process because it is always concerned with people
either directly or indirectly. The “people” nurses are concerned with include ill
and healthy individuals, their families, visitors, personnel and members of the
allied discipline.
Nursing is also a “process”, and by that we mean it is an “experience” or a
happening, or a series of happenings between a nurse, an individual, or a group
of individuals in need of the assistance a nurse can offer, Nursing viewed as a
process stresses the dynamic character inherent in every nursing situation.
Nursing situation, being experiences in time and space, are dynamic and fluid,
and are ever in the process of evolving or becoming.
To identify and be able to bring about a change in a purposeful, enlightened,
thoughtful manner in a nursing activity. A nurse is a change agent - indeed
he/she cannot be otherwise if the purpose of nursing is to be achieved. the
nurse labors to effect a change, i.e., to assist the individual, family, or
community in becoming cognizant of ways to prevent illness, disability and
suffering and to act in such a way as to maintain health at the highest possible
level.
 The Nurse is vitally concerned with change and, in a sense, it may be said that
she invariably wants to change or influence others. Nursing is, in a sense, a
service which is initiated for the express purpose of effecting a change in the
recipient of the service.
Assists an Individual, Family, or Community...
A nurse always assists others. Who is assisted? The individual or family in need
of the services of the nurse. This assisting function is held jointly by nurses and
members of the other health disciplines.
How does a nurse assist a community? The nurse can fulfill a variety of
functions. For example nurses can initiate, participate in, organize, and
evaluate programs designed to solve members of other disciplines in detecting
potential or actual health hazards in a community and in organizing
community members so that effective action can be taken. Anything which
does or could interfere with the health and well being of citizens of a
community is of legitimate concern of the nurse.

To Prevent Illness and Suffering...

Nurses are always concerned with illness and with health since both these
concepts are pivotal ones in nursing practice.
Concept: Health Travelbee proposed two different criteria of health: the
subjective and objective aspects of health. Subjective
Health is defined individually, i.e., in accord with each
person’s appraisal of his physical-emotional-spiritual
status as perceived by him. Thus subjective health is highly
individualistic. The appraisal of subjective health status
implies that a person is as healthy as he perceives himself
to be at any given time. For, example, an individual may
believe he is “healthy” if he can perform the daily activities
of living to his personal satisfaction. Some individuals
equate being able to work with being healthy. It is quite
possible for an individual to be diagnosed as being without
discernible pathology and yet perceive himself as ill. On
the other hand, it is possible for an individual to be
diagnosed as “ill” by a physician yet perceive himself as
healthy. Thus, subjective and objective appraisals of health
may differ.
Using an objective criterion, health would be defined as an
Concept: Health
absence of discernable, disease, disability, or defect, as
measured by physical examination, laboratory tests,
assessment by a spiritual director or psychological
counselor, When the physical-psychological-spiritual
acpects fall within what is considered a normal range in
our society, the individual is judged “healthy.” The person
making the judgement of “objective” health may be a
physician, psychiatrist, priest, rabbi, or minister.

The process of nursing, i.e., everything the nurse does for

and with the recipient, is designed to help the individual or
family in coping with or bearing the stress of illness and
suffering in the event the individual or family encounters
these experience.
 Theoretical Sources
Catholic charity institutions
Ida Jean Orlando, her instructor—“The nurse is responsible for helping the patient
avoid and alleviate the distress of unmet needs.” The nurse and patient interrelate with
each other.
Travelbee based the assumptions of her theory on the concepts of existentialism by
Soren Kierkegaard and logotherapy by Viktor Frankl.
Viktor Frankl, a survivor of Auschwitz and other Nazi concentration camps—first
proposed the theory of Logotherapy in his book Man's Search for Meaning (1963).
Logotherapy is founded upon the belief that striving to find meaning in one’s life is the
primary, most powerful motivating and driving force in humans and the best
protection against emotional instability. She felt nursing needed a "humanistic
revolution" and a renewed focus on caring as central to nursing--she warned that if this
didn't happen, consumers might seek a "new and different kind of health care worker."
 Theoretical Sources
Soren Kierkegaard (concept of existentialism) - Existential theory believes that that
humans constantly face choices and conflicts and is accountable to the choices we make
in life. Kierkegaard, considered to be the first existentialist philosopher, proposed that
each individual—not society or religion—is solely responsible for giving meaning to life
and living it passionately and sincerely. A central proposition of Existentialism is that
existence precedes essense, which means that the most important consideration for
individuals is that they are individuals- independently acting, and responsible,
conscious beings (“existence”) – rather than what labels, roles, stereotypes, definitions
or other preconceived categories the individuals fit (“essense”).
Assumptions
Joyce Travelbee assumes that nursing is fulfilled by means of human-to-
human relationship. She defined nursing as “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”. Inspired by being a
psychiatric nurse, she struggles for a “Humanistic Revolution” in nursing,
with devotion on 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.
Assumptions
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.
Assumptions
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 the
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.
Assumptions
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.
Assumptions
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.
Assumptions
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.
Assumptions
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.
Propositions
To know and understand perceptions of time and life experiences increases
the nurse’s abilities to meet the needs of patients.
“The nurse’s perception of patients is a major factor in determining the quality
and quantity of nursing care she will render each patient”
If nurses perceive patients as illnesses,tasks, or sets of stereotype
characteristics,their focus in care is (institutional) rather than person-centered.
As patients become a “chore and a task, the nurse withdraws and directs her
energy toward meeting institutional needs” and patients experience anger,
irritability, tension, restlessness, sadness, depression, hopelessness, apathy,
and transient somatic symptoms.
An individual’s socioeconomic status affects the level of dehumanization a
person is subjected to.
“The quality of nursing care given any patient is determined by the nurses’
beliefs about illness, suffering, and death”.
Propositions
“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 patients
find meaning (or no meaning) in these situations”.
Nurses are able to empathize with patients who are similar to themselves.
Experience of illness affects, to a varying degree, all those associated with the
patient, and subsequently affects the patient’s perception of the experience.
There is a direct relationship between caring and suffering; the more a person
cares and is attached to an object or a person, the more the person suffers
when that object or person is lost.
Responses to pain are influenced by cultural background of the person,
philosophical premises,spirituality, level of anxiety, and responses of others to
the person in pain.
Identify the properties of hope, determinants of hope and hopelessness.
There is a direct relationship between the extent to which the individual’s need
for cognitive clarity and security are met and the individual’s anxiety level.
 Basic Concepts
Suffering
which is "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...."

Meaning
which is the reason attributed to a person

Nursing
which helps a person find meaning in the experience of illness and suffering; has a
responsibility to help people and their families find meaning; and the nurse's spiritual and
ethical choices, and perceptions of illness and suffering, which are crucial to help patients find
meaning.
 Basic Concepts
Hope
which is a faith that can and will be a change that would bring something better with it. Six
important characteristics of hope are: dependence on other people, future orientation, escape
routes, the desire to complete a task or have an experience, confidence that others will be there
when needed, and the acknowledgment of fears and moving forward towards its goal.
Six characteristics of hope are:
1. It is strongly associated with dependence on other people.
2. It is future oriented.
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 towards its goal.
 Basic Concepts
Hope
Communication, which is "a strict necessity for good nursing care."
Self-therapy, which is the ability to use one's own personality consciously and in full
awareness in an attempt to establish relatedness and to structure nursing interventions.
This refers to the nurse's presence physically and psychologically.
Targeted intellectual approach by the nurse toward the patient's situation.
 Major Concepts
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 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 of defect as measured by
physical examination, laboratory tests and assessment by spiritual director or psychological
counselor.
 Major Concepts
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 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
 Major Concepts
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 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
 Major Concepts
Nursing
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.
 Major Concepts
Nursing
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.
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.
 Major Concepts
Nursing
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.
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.
 Major Concepts
Nursing
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.
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.
 Major Concepts
Nursing
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.
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.
 Major Concepts
Nursing
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.

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.
Interaction Phase
Joyce Travelbee assumes that nursing is fulfilled by means of human-to-human
relationship. She defined nursing as “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”. Inspired by being a psychiatric nurse, she struggles
for a “Humanistic Revolution” in nursing, with devotion on 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.
Interaction Phase
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 spiritual director or
psychological counselor.
Interaction Phase
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
differing qualities that each possess, 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 relationship begins to form.
Interaction Phase
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".
Interaction Phase
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 therapeutic use of self to make helpful
nursing actions.
Interaction Phase
Phase of 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.”
Interaction Phases and Application to the
Nursing Process -
Assessment Diagnosis
The Nurse forms a first The nurse has now
impression of the patient and experienced an emotional
the patient, in turn, forms a sense of the patient’s
first impression of the nurse. situation and has begun to
The nurse and the patient are consider interventions based
just beginning to get a mutual on his perspective.
sense of what the problems
are as the nurse collects
information about the patient
and the problems at hand.
Interaction Phases and Application to the
Nursing Process -
Implementation Evaluation
The nurse now actively wants The nurse and the patient
to alleviate the patient’s enjoy a close human-to-
suffering. The actions human relationship where
designed in the plan of care the nurse has opportunities,
during empathy are now along with the patient, to
implemented. evaluate the effectiveness of
the interventions. The
patient now demonstrates
trust and confidence in the
nurse and the actions being
implemented.
 Use of Travelbee’s Theory in Practice
Considering the following scenario that is typical in psychiatric care delivery. It deals with the issue of
depression and suicide. You are working on the afternoon shift as a nurse at the local mental health unit.
You have been informed that a new admission has just been triaged form the emergency department
and has been cleared for admission to the unit. You are assigned this person as part of your caseload.
You prepare the room as the patient is brought to the unit by the emergency department staff.

Applying Travelbee’s model you know that the original encounter will occur the moment you greet the
patient. You may have some preliminary information about the patient (54-year old Caucasian female
diagnosed with depression who is suicidal) and she may have some preliminary information about
nurses (are generally nice and caring). The patient arrives on the unit and you and the patient are now
alone in the room as you begin the admission assessment. You are now entering the emerging identities
phase. You are getting to know the patient as a human being and she is getting to know you as a human
being. You hear her story and the circumstances leading to her admission and you may begin to feel
something emotionally toward the patient. She, too, is mentally forming an impression of you, for
example, based on how you are asking the questions, the tone of your voice, your body posture and your
attitude. She is deciding if you are trustworthy, caring and competent.
 Use of Travelbee’s Theory in Practice
You skillfully navigate the sensitive issues around suicidality, which allows the patient to feel
comfortable enough to disclose information. Details of the emotional pain leading to her suicide attempt
have touched you and you recognize that you have now entered the empathy phase of the relationship.
You may actually experience a brief sense of your own mood shifting as you navigate this phase.
You return to the nursing station to document your assessment and begin the plan of care. As you put
the information together and start your work, you may next experience sympathy. Developing a plan of
care with goals of safety, restoration of internal control, reduction of depressive symptoms and
instillation of hope indicates that you desire to provide nursing interventions that alleviate the cause of
the patient’s illness and reduce her suffering. It may also occur to you that this patient was probably
experiencing at least prolonged extreme anguish or likely despairful not caring, as viewed by
Travelbee’s continuum of suffering.
As the days pass, you and the patient meet regularly during your shift. You have meaningful
conversations that allow her to express her feelings and explore solutions to the circumstances that led
to her admission. She uses her time with you productively and you have been able to relate to each
other, human being to human being. Subsequently, you have now established rapport. This is where the
bulk of the work and healing is done in the nurse-patient relationship.
 Other Applications
Nursing Pactrice
Her theory is often cited in support of the nurse's role in interpersonal relationships with patients
to understand their suffering, in exploring the definitions and meanings in the concept of "hope"
and in the therapeutic use of self. Her existentially based ideas about the interpersonal
relationship have alaso been used as providing a humane perspective in developing models for
electronic patient records or in strategies for treating adults with depression.
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.
 Other Applications
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.
Travelbee indicated that the University of Mississippi School of Nursing in Jackson was beginning
to modify its curriculum to use her theory.
 Other Applications
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.
Her ideas about hope, suffering, relationship and interpersonal rapport continue to inform the
writings of nurse researchers in different parts of the world.
 Strengths
and
Limitations
Travelbee’s theory is a hierarchical one, developed around the concepts of nurse–patient
relationship, suffering, and pain to explore the relationships among them. It is both a
concatenated theory, isolating and conceptualizing the central theory concepts, and a
hierarchical one, as it interprets the relationship among these variables. Travelbee used
the field approach in developing her theory, as is demonstrated in conceptualizing rapport
in terms of other phases leading to and incorporating rapport. It is a descriptive and
prescriptive microtheory that is also considered a single-___domain theory. The theory
addresses one of the major concepts in nursing—interaction—but is limited to interaction
surrounding illness. The theory focuses on those components of illness that are
considered of concern to nursing; these are suffering and pain. It adds mainly to
knowledge of the process of providing nursing care and provides significant existence
propositions (nurse–patient interactions proceed through phases) and relational
propositions (rapport increases patient’s acceptance of illness). Travelbee uses an
operational method to develop highly abstract relationships. She incorporates the nurses’
perceptions and acceptance with components of the nursing problem areas and nursing
therapeutics. The nurse perceives, understands, and assigns meaning to behavior and is
therefore part of the theory.
 The nurse’s communication is one of the nursing problems, and the self could be used as
the intervention through empathy and sympathy. An operational method of theory
development allows choices between alternate theories and actions. An example can be
seen in the alternatives that Travelbee provides to dealing with suffering. She proposes
using the direct method of confronting the patient with his suffering or the indirect
method of having the nurse sharing her own experiences to prompt mutuality in sharing.
Operational methods tend to be more acceptable to nurses because of their preferences
for well identified choices.The theory’s explanatory power is low (higher ratio of
assumptions to explicitly stated propositions) and is limited to knowledge of disorder
(suffering) and knowledge of process (relationships).Travelbee used a deductive approach
to develop her theory (Duffey and Muhlenkamp, 1974). Although she explicitly stated the
sources that influenced the theory deductively (existentialist philosophy), the inductive
approach is more assumed than explicit. It is assumed that she observed nurse–patient
relationships in acute and suffering incidents. Such observations are not an integral part
of her theory, and it is not clear whether she developed her theory based on an extent or
ought to be practiced. One can deduce that it was the former rather than the latter.
Thank You for
listening!