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.
Basic Concepts
- 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
- Meaning is the reason as oneself attributes
- Nursing
- Hope
- 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 one when you need them.
- The hoping person is in possession of courage to be able to acknowledge its shortcomings and fears and go forward towards its goal.
- Communications
- Using himself therapeutic
- Targeted intellectual approach
- Nurse must have a systematic intellectual approach to the patient's situation.
- 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 to helping to find meaning.
- Nurse's job is to help the patient to maintain hope and avoid hopelessness.
- Hope is a faith that can and will be change that would bring something better with it.
- Hope's core lays in a fundamental trust the outside world, and a belief that others will help someone when you need it.
- Six important factors characteristics of hope are:
- "a strict necessity for good nursing care"
- “One is able to use itself therapeutic."
- Self-awareness and self-understanding, understanding of human behavior, the ability to predict one's own and others' behavior are important in this process.
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:
- 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. - 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.
Nurse
Patient
Environment
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.
2. A relationship is established only when each participant perceives the other as a unique human being.
- Only qualified psychiatric nurses are prepared to supervise nurses in the practice of psychiatric nursing.
- 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.
5. Nurses need to know how to use library facilities and how to search the literature for needed information. - 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.
THE GOALS OF THE NURSE:
- 1. The nurse helps the ill person cope with present problems.
The nurse helps the ill person to conceptualize his problem.
3. The nurse assists the ill person to perceive his participation in an experience. - The nurse assists the ill person to face emerging problems realistically.
- The nurse assists the ill person to envisage alternatives.
6. The nurse assists the ill person to test new patterns of behavior.
7. The nurse assists the ill person to communicate - The nurse assists the ill person to socialize
- The nurse assists the ill person to find meaning in illness.
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.
Conclusion
- Travelbee's theory has significantly influenced nursing and health care.
- Travelbee's ideas have greatly influenced the hospice movement in the west.
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