NCM 1001

MT 12:30pm-2pm

Joyce Travelbee and “Human to Human Relationship” Theory

I. ABOUT THE THEORIST

- Born in 1926, New Orleans, Louisiana, United States

- BSN in 1956 at Louisiana State University

- Master of Science degree in Nursing in 1959 at Yale University

- Her career mostly dealt with psychiatric nursing and education

- She worked as a psychiatric nursing instructor at DePaul Hospital Affiliate School in New

Orleans, Louisiana

- Later, Travelbee worked in the Charity Hospital School of Nursing in Louisiana State

University, New York University and University of Mississippi

i. Taught psychiatric nursing at Charity Hospital School of

Nursing

- died in 1973 (43 years old), right when she began her Doctoral program in Florida

- 1970, named Project Director at Hotel Dieu School of Nursing in New Orleans

- Director of Graduate Education at Louisiana State University School of Nursing (until her

death)

- Some of her works include: Interpersonal Aspects of Nursing (published in 1961),

Intervention in Psychiatric Nursing: Process in the One-to-One Relationship (published in 1969),

as well as several articles and journals

II. CONTENT OF THE THEORY

- The “Human to Human Relationship” Theory revolves around the interpersonal

approaches of nursing

- Influenced by her experiences in nursing education and practice in Catholic charity

institutions.

- Concluded that nursing care given to patients in those situations were lacking compassion.

- Thought that nursing care needed a “humanistic revolution”

- Her mentor, Ida Jean Orlando, is one of her influences of her theory

- Also credits Viktor Frankel and Rollo May as influences on her thinking

- The main focus being mental health and communication

- Assumptions of model are based on Soren Kierkegaard’s philosophy of existentialism and

Viktor Frankl’s logotherapy

- Theory model states that the patient and nurse undergo several interactional phases (5)

i. Original encounter

- The first impression by nurse of the patient (and/or vice versa)

- Nurse and patient view each other in stereotyped or traditional roles

ii. Emerging Identities

- Nurse and patient begin to see the other as unique individuals

- Link of relationship is established at this time

iii. Empathy

- Travelbee proposed two qualities to enhance the empathy process: similarities of

experience and desire to understand another human being

- Described as the ability to share the person’s experience

- Result: ability to expect behavior of the individual with whom he or she empathized

iv. Sympathy

- Occurs when nurse wants to minimize cause of suffering of patient

- Goes beyond empathy

- Nurse must use disciplined and intellectual approach along with therapeutic use of self to

make helpful nursing actions

v. Rapport

- Nurse’s interventions to minimize the suffering of the patient

- Nurse and patient are relating as human being to human being

- Patient (or sick person) displays a level of trust and confidence in the nurse

- Main concepts of the nursing theory: suffering, meaning, nursing, hope, communications,

self-therapy, and a targeted intellectual approach

i. Each concept is defined by Travelbee to help nurses

understand the model

ii. Suffering:

- ranges from feeling of unease to extreme torture

- varies in length of time, intensity, and depth

iii. nursing:

- role is to help patient find meaning in the experience of suffering, at the same time

maintaining hope

iv. hope

- a faith that can and will bring change to bring something better with it that change

- six characteristics of hope:

a. strongly associated with dependence on other people

b. oriented with the future

c. linked to elections from several alternatives or escape routes out of the situation

d. desire to possess any object or condition, to accomplish a task or have an experience

e. confidence that others will be there for one when you need them

f. hoping the person is in possession of courage to able to acknowledge its shortcomings and

fears and more forward

 v. communication

- “a strict necessity for good nursing care”

vi. Self-therapy

- Ability to use one’s own personality consciously with full awareness in attempt to establish

relatedness and to structure nursing interventions

- Refers to nurse’s presence physically and psychologically

vii. Targeted intellectual approach

- By the nurse toward the patient’s situation

III. METAPARADIGM OF THE THEORY

- Nursing

“The 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” (Travelbee)

i. Accomplished by the relationships created by the persons

starting with the initial meeting/encounter and progressively moving through stages of emerging

identities and establishing feelings of empathy and sympathy.

- Person

Defined as a “human being”

“…a unique, irreplaceable individual who is in the continuous process of

becoming, evolving, and changing.”

i. Being the nurse, the patient, the patient’s family, or the

community

- Health

i. Both subjective and objective

ii. Subjective: “state of well-being in accord with self-appraisal

of physical-emotional-spiritual status”
 iii. Objective: “absence of discernible disease, disability of

defect as measured by physical examination, laboratory tests and assessment by spiritual

director or psychological counselor”

- Environment

i. Not clearly/specifically defined

ii. Based on Travelbee’s writing, the “environment” can be the

human conditions or personal experiences of the patient and the present location may serve as

the environment

iii. Experiences encountered by humans: suffering, pain,

illness, and hope

- Model (Theoretical/Conceptual)

IV. ACCEPTANCE BY NURSING COMMUNITY

i. Practice

- Hospice

a. Nurse tries to build rapport or working relationship with patient and his/her significant other

ii. Education

- Concepts served as a better assistance for nurses who help individuals understand

meaning of sickness and suffering

- Her 2nd book was used in different nursing programs

iii. Research

- Several sources have cited some aspects of the one-to-one relationship

- Study by O’Connor, Wicker, and Germino discovered how individuals that were recently

diagnosed with cancer described their personal search for meaning

V. ANALYSIS TO EVALUATION

i. Clarity
- Not consistent in clarity and origin

- Some definitions of her theory are hers and some are adopted from standard sources

- Used different terms for the same definition

- Focuses more on adults that are sick and nurse’s role in helping them find meaning in their

sickness and suffering

ii. Simplicity

- Theory contains different variables

- Therefore, simplicity is not evident

- Intended to assist nurses appreciate and understand patient’s humanness and (his or) her

own

iii. Generality

- Wide scope of application

- Mainly developed from experiences with psychiatric patients

- Applicable whenever the nurse encounters patients in distress and life changing events

- Most effective with those chronically ill, going through long term rehabilitation, dying or

terminally ill

iv. Empirical Precision

- Appears to have a low measure of empirical soundness

a. Due to lack of simplicity

- Travelbee describes the concepts theoretically, but has no operational definitions

- Model has not been tested; no empirical support

v. Derivable Consequences

- Useful for the reason that it has the ability to describe, explain, predict and control

phenomena

- Explains some variables which may influence the establishment of a therapeutic

relationship between nurse and patient

- However, with the lack of empirical precision, there is a lack of usefulness

- Theory focuses on the development of quality of caring

- Can be useful due to the fact that caring is an important quality in a nurse

VI. APPLICATION OF THEORY

Joana, a 25 year-old woman, appeared at a psychiatric outpatient clinic requesting

therapy. She said, “Ayokong maging malapit sa ibang tao maliban sa pamilya ko.” She had a
happy childhood, loving parents and liked her sister. Her entire family is very active in religious
Catholic activities and even gained a lot of friends. She thought that her fear of closeness began
when she slept over with her friend’s house. During the night began to fondle her in a way that
she interpreted as sexual. She became very frightened and felt guilty. She told no one before
entering therapy. Although she attended college, she never dated and only participated in
superficial social contacts. She realized that this was not a healthy young adult behavior and
because the behavior continued into her twenties, Joana decided to seek help.
In response to her situation, the psychiatric nurse, Luz, who is the same age as Joana,
tried her best to get as much information that would help in Joana’s situation. Although Joana
was initially hesitant and shy, Luz built a positive feeling of security by genuinely dealing with
her as if they were real best friends. In the end, Luz noticed that Joana felt comfortable talking
with her and even shared more feelings and thoughts.

Original encounter- shows the first impression of nurse Luz and Joana with each other. Since
it is the first encounter, they are both not yet comfortable talking and expressing deep thoughts
and feelings.
Emerging Identities- the closeness of Luz and Joana is being established. There is a
consciousness awareness between the nurse and patient that both of them have different
thoughts and feelings. Luz must develop awareness and a valuing of uniqueness of others
Empathy- Depicts Joana’s experiences that are shared to Nurse Luz. Travelbee emphasized
that the similarities of experiences will help the nurse understand her client. Similarities between
the nurse and patient are their age and gender, which will help the relationship become more
therapeutic. This would help Luz better understand Joana’s behavior and establish a better
interaction.
Sympathy- Luz progresses further than empathy and has the intention of lessening Joana’s
distress. Luz, using a combination of intellectual approach as a psychiatric nurse and her
therapeutic self, will help Joana to cope and adapt with her undesirable experience.
Rapport- End goal of all the nursing endeavors. All actions that lessen Joana’s distress have
been implemented, thus result would be a good and trusting relationship and achievement of
the therapeutic goal by nurse Luz.

VII. REFERENCES

- Petlprin, Alice (2016). Travelbee’s Human to Human Relationship Model

(http://www.nursing-theory.org/theories-and-models/travelbee-human-to-human-model-of-
nursing.php)
- Petlprin, Alice (2016). Joyce Travelbee – Nursing Theorist (http://www.nursing-
theory.org/nursing-theorists/Joyce-Travelbee.php)
- Udan, Josie Quiambao (2011). Theoretical Foundations of Nursing, 32-34
- Octaviano, Eufemia F., Balita, Carl E. – Theoretical Foundations of Nursing: The Philippine
Perspective