JOYCE TRAVELBEE: 1926 - 1973

“Human-To-Human Relationship Model”

● BIOGRAPHY:
○ American psychiatric nurse practitioner, educator and writer
○ Born: 1926 (New Orleans, Louisiana, US)
○ Died: 1973 (47 Y.O.)
○ American Psychiatric Nurse, Educator and Writer
● EDUCATION:
○ 1946 - Basic Nursing Preparation (Charity Hospital School of Nursing
in New Orleans)
○ 1956 - BSN (Louisiana State University)
○ 1959 - Master of Science Degree in Nursing (Yale University)
○ 1973 - Started a Doctoral Program (Florida)
● EXPERIENCES:
○ 1952 - Psychiatric Nursing Instructor (Depaul Hospital Affiliate School,
New Orleans)
○ 1970 - Project Director of Graduate Education at Louisiana State
University School of Nursing until her death
○ taught at Charity Hospital School of Nursing in Louisiana State
University, New York University and the University of Mississippi
● WORKS:
○ 1963 - started publishing various articles in nursing journals
○ 1966 & 1971 - Interpersonal Aspects of Nursing
○ 1969 - Intervention in Psychiatric Nursing: Process in One-to-One
Relationship
■ 1979, the book was edited by Doona
■ Published in the same year as Travelbee’s Intervention in
Psychiatric Nursing.
○ 1973 - Doctoral program in Florida; not able to finish it because she
died
● ASSUMPTIONS:
○ Existentialism (Soren Kierkegaard’s Philosophy) - places the
accountability for people’s choices in life on the people who make
those choices
○ Logotherapy (Viktor Frankl; Auschwitz Survivor) - first proposed in
Frankl’s Man’s Searching for Meaning (1963); form of psychotherapy
that makes the assumption that fulfillment is the best protection against
emotional instability.
● HUMAN - TO - HUMAN RELATIONSHIP MODEL:
○ Grand Theory; presented in her book, Interpersonal Aspects of
Nursing
○ based on the belief that nursing is accomplished by relationships
between humans through a series of interactions. It is primarily a series
of experiences between a nurse and the recipient of her care.In order
 to have a successful nursing relationship, it is essential to have honest
human-to-human interactions.
○ Central Theme: a sick person finding meaning in illness and suffering
and human-to-human relationship
○ Interactional Phases of Human-to-Human Relationship Model:
■ 1. Original Encounter
● First impressions by nurse and patient
○ Stereotyped or traditional roles
■ 2. Emerging Identities
● time when relationship / bond begins
● nurse and patient perceives each others uniqueness
■ 3. Empathy
● ability to share in the person’s experience
● enhance the empathy process are similarities of
experience and the desire to understand another person
● ability to expect the behaviour of the individual whom he
or she empathized
■ 4. Sympathy
● nurse wants to lessen the cause of patient’s suffering
● goes beyond empathy—“When one sympathizes, one is
involved but not incapacitated by the involvement.”
● therapeutic use of self
■ 5. Rapport
● nursing interventions that lessens the patient’s suffering
● Relation as a human being to human being
● “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
● THEORETICAL SOURCES
○ 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.
 ○ Ida Jean Orlando, Travelbee’s mentor is one of her influences in this
theory, wherein 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.”
● USE OF EMPIRICAL EVIDENCE
○ Katharine Taylor, a former student and colleague of Travelbee, proved
that Travelbee gave more importance on her cumulative nursing
experiences and her readings rather than the evidence of a particular
study.
○ Travelbee is a prolific reader whose office was often crammed with files
of bibliography cards.
● PURPOSE OF THE THEORY
○ Joyce Travelbee believed that everything the nurse (as a human) said
or did with an ill person (as a human) helps 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, by incorporating the concepts of Travelbee’s model, it
promoteshow an individual human relates to another.

● MAIN CONCEPTS:
○ Suffering - feeling of unease to extreme torture, and varies in intensity,
duration, and depth
■ May experience in intensity, and range from mild to extreme
■ "An experience that varies in intensity, duration and depth ... a
feeling of unease, ranging from mild, transient mental, physical
or mental discomfort to extreme pain and extreme tortured ..."
○ Meaning - reason as oneself attributes; patient’s reasons or purpose
○ Nursing
■ Role: help the patient find meaning in the experience of suffering
■ help the patient maintain hope
■ responsibility to help individuals and their families to find
meaning
 ● nurses' spiritual and ethical choices, and perceptions of
illness and suffering, is crucial to helping to find meaning
○ Hope - faith varying in degrees that can and will bring change that will
bring something better with it
■ core lies in a fundamental trust the outside world, and a belief
that others will help someone when you need it
● Nurse's job is to help the patient to maintain hope and
avoid hopelessness
■ 6 CHARACTERISTICS
● strongly associated with dependence on other people
● oriented with the future
● linked to elections from several alternatives or escape
routes out of its situation
● 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
● hoping person is in possession of courage to be able to
acknowledge its shortcomings and fears and go forward
toward its goal
○ Communications - a strict necessity for good nursing care enables the
nurse to establish a human-to-human relationship, and thereby fulfil the
purpose of nursing
○ Self Therapy - ability to use one’s own personality consciously and in
full awareness in an attempt to establish relatedness and to structure
nursing interventions; nurse’s presence physically and psychologically
■ Self-awareness and self-understanding, understanding of
human behavior, the ability to predict one's own and others'
behavior are imporatnt in this process
○ Targeted Intellectual Approach - by the nurse toward the patient’s
situation
■ Nurse must have a systematic intellectual approach to the
patient's situation
● NURSING METAPARADIGMS:
○ Person
■ Human Being
● Nurse and Patient
● unique, irreplaceable individual who is in continuous
process of becoming, evolving and changing
■ Patient
● 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.
 ● Nurses are human beings, Travelbee (1971) notes: “All
assumptions about being human therefore apply to every
human being categorized as nurse.”
○ Health
■ Subjective Health - individually defined state of well being in
accord with self-appraisal of physical-emotional-spiritual status
■ Objective Health - absence of discernible disease disability of
defect as measured by physical examination, laboratory tests
and assessment by spiritual director or psychological counselor.
○ Environment
■ 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; classification and category. An
individual will react to illness depending on culture,
symptom burden, and whether there is a related
significance to those symptoms.
● Suffering – feeling of displeasure which ranges from
simple transitory mental, physical or spiritual discomfort
to extreme anguish and to those phases beyond anguish
(malignant phase of despairful “not caring” and apathetic
indifference)
● Pain – not observable; unique experience; lonely
experience that is difficult to communicate fully to another
individual.
● Hope – future oriented; 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
● Interaction - any contact during which two individuals
have reciprocal influence on each other and
communicate verbally and/or nonverbally.
● Nursing-Patient Interaction - any contact between a
nurse and an ill person and is characterized by the fact
that both individuals perceive the other in stereotyped
manner.
○ Nursing
■ 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
■ accomplished through relationships between humans beginning
with an original encounter and then progressing through stages
 of emerging identities, developing feelings of empathy and
sympathy

According to the model, nursing is accomplished through relationships between

humans beginning with an original encounter and then progressing through stages of
emerging identities, developing feelings of empathy and sympathy.

The nurse and patient establish a rapport in the final stage. Meeting the nursing goals
requires the creation of a genuine human-to-human relationship, which can only be
established by an interaction process. This process has five phases: the initial meeting
or original encounter, the visibility of personal and emerging identities, empathy,
sympathy, and establishing mutual understanding and rapport.

LOGICAL FORM

Travelbee’sHuman-to-Human Relationship Theory is inductive as she used specific

nursing situations to create general ideas. Travelbee appears to follow a logical form
by first defining the labels in her theory, then listing the assumptions, and finally
establishing specific nursing goals.

APPLICATION

● Practice - This theory has greatly influenced hospice nursing, wherein hospice
nurses focus on the relationships with their patients to improve quality of life.
● Hospice – self-actualizing life experience. Assumption of the sick role. Meaning
of life, sickness and death.
● Education
○ o This theory teaches nurses to understand the meaning of illness and
suffering.
○ o It prepares nurses too address the emotional and spiritual needs of
patients.
○ o The focus of nursing education has changed from the disease entity
approach (signs, symptoms, and nursing interventions) to a more holistic
approach.
○ o Helpful in preparing nurses to fulfill the purpose of nursing.
● Research
○ Several sources in research studies have cited some aspects of the one-
to-one relationship proposed by Travelbee.
○ Applied in the theory of caring cancer patients.
○ Gregory used Travelbee’s model to study suffering inherent in the cancer
experience.
○ Bennett used the model in relation to immune deficiency.
○ Baker used the model to study schizophrenia.

FURTHER DEVELOPMENT
Travelbee’s theory could be used to justify the research data. However, this theory
does not currently contain the empirical precisions to support such research data. To
be more readily accepted, the theory’s major assumptions must be assigned
operational definitions. Then the theory could perhaps generate the data needed to
facilitate further acceptance.
CRITIQUE
Clarity or Brilliance

● Ø All concepts of Travelbee’s theory are defined, but the definitions are not
consistent with regard to origin and explicitness.
● Ø Some of the definitions are owned and adopted others from Webster’s
dictionary. She explicitly presents some of the definitions, but derives others
from contextual usage.
● Ø Travelbee uses different terms for the same definition, such as the rapport,
human-to-human relationship, and human-to-human relatedness all have the
same definition.
● Ø Focus more on adult individuals who are sick and the nurse’s role in helping
them to find meaning in their sickness and suffering.
● Ø Deals in families and their needs but not in the community.

Simplicity or Parsimony

● Ø Travelbee’s theory does not possess simplicity.

● Ø Contains different variables.

Generality

● Ø It has a wide scope of application but applicable only to those patients in

distress and life changing events.
● Ø Most useful when working with those who are chronically ill, those who are
undergoing long-term rehabilitation, or those who are terminally ill.

Empirical Precision

● Ø Appears to have a low measure of empirical soundness or validity.

● Ø Result of lack of simplicity.
● Ø Defines concepts theoretically but does not define them operationally.
● Ø The model has not been tested.

Derivable Consequences

● Ø Development of quality of caring.

● Ø It is useful because of its ability to describe, explain, predict and control a
phenomenon.
● Ø Explains the variables that affect the establishment of a therapeutic
relationship between nurses and patients.
● Ø Lack of empirical precision also creates lack of usefulness.

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.

CONCLUSION
Travelbee’s grand theory of Human-to-Human Relationships provides nurses with a
foundation necessary to connect therapeutically with other hu-man 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: “Experiencing
meaning in illness, in particular, has long been identified as an important clinical
phenomenon.” 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).