University of San Agustin

General Luna St., 5000 Iloilo City, Philippines

www.usa.edu.ph

COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS - DEPARTMENT OF NURSING

BERNABE JONES V. CABERO

BSN 1-J

Case Application: Read the situation and answer the questions (present your own ideas) in
relation to the application of the theories of Hildegard Peplau, Virginia Henderson and Joyce
Travelbee:
       Robert, 25 years old, has been taken to the emergency room of the hospital after sustaining
multiple injuries after a motorcycle accident. Multiple x-rays were taken which revealed
fractures on the left femur (thigh bone), 2nd and 3rd ribs, and a fractured right wrist. Surgery was
immediately done to correct some of the dislocated bones and to stitch some open wounds. He
was placed on several casts, and an external fixator (a device used to keep fractured bones
stabilized and in alignment), to support fractured bone, was attached on his left leg. which
limited his movement for weeks to months? His family frequented their visits and tried to raise
his confidence and assured him that all would be fine. 
       However, Robert appeared to manifest self-pity and lowered self-esteem when he said
"Wala na akong career! (As he is motorcycle racer) Baldado na ako wala nang kwenta an buhay
ko!" and after having failed to bathe or feed himself. Every morning, when his family tries to
bathe him, he will raise his voice and say he's not a paralytic. At times, he also directs his anger
to the nurses by shouting at them during the routine daily care.

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 University of San Agustin
General Luna St., 5000 Iloilo City, Philippines
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COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS - DEPARTMENT OF NURSING

1. Among the roles cited by Hildegard Peplau, choose at least 2 and give an example on
how this can be done based on the situation.

 Counselor-
The nurse’s role as a counselor helps the patient understand and integrate the meaning of current
life situations, as well as provide guidance and encouragement in order to make changes. As a
counselor, I will let Mr. Robert to verbalize his fears and concerns and find ways to solve or
reduce it. I will let him understand the situation and give him hope despite of his condition. I will
encourage him to exercise and do things slowly but surely.

 Resource-
The nurse is also a resource person, providing specific information needed by the patient that
helps the patient understand a problem or situation. In his (Mr. Robert) situation, I will provide
the information that he needs to know that can help him understand his condition, and that
there’s still hope notwithstanding of what he’d been through.

2. Cite at least 5 among the 14 Basic Human Needs of Virginia Henderson that was affected
in the case of Robert. 

 Move and maintain desirable postures.

 Work in such a way that there is a sense of accomplishment.
 Play or participate on various forms of recreation.
 Eliminate Body wastes.
 Select suitable clothes- dress and undress.
 Communicate with others in expressing emotions, needs, fears, or opinions.
 Eat and drink adequately
 Keep the body clean and well-groomed and protect the integument.

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 University of San Agustin
General Luna St., 5000 Iloilo City, Philippines
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COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS - DEPARTMENT OF NURSING

3. In the nurse-patient relationship describe by Henderson, in what instance can the nurse be
a substitute and a helper in this situation. 

According to Marriner-Tomey and Alligood (2006), Henderson’s work can be seen as a

philosophy of nursing. She clarifies her opinions and views of basic nursing care which is
published in 1991 of The Nature of Nursing: Reflections After 25 Years. She also describes the
nurse’s relationship to the patient in three levels where the nurse acts as a substitute, helper and
partner with the patient. Henderson states that the nurse must “get inside the skin of each of her
patients in order to know what he needs” (as cited in Marriner-Tomey & Alligood, 2006, p. 56).

In the Situation of Mr. Robert, the nurse can be a substitute and a helper in a way that he/will
take good care of the patient by talking to him and allowing him to verbalize the things that he
need. Assisting Mr. Robert to gain independence in relation to the performance of activities
contributing to health or his recovery. I will assist Mr. Recover until he recovers well in his
injury.

Email: cn@usa.edu.ph | Tel. No.: 0999-997-1485 | Fax No.: (033) 337-4403

 University of San Agustin
General Luna St., 5000 Iloilo City, Philippines
www.usa.edu.ph

COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS - DEPARTMENT OF NURSING

4. How can the nurse establish a good therapeutic relationship applying the Human-to-
Human Relationship Model of Joyce Travelbee? Describe what could probably transpire
in each phase of Travelbee's model.

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.

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.

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 University of San Agustin
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COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS - DEPARTMENT OF NURSING

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).

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 University of San Agustin
General Luna St., 5000 Iloilo City, Philippines
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COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS - DEPARTMENT OF NURSING

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.

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.

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.

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 University of San Agustin
General Luna St., 5000 Iloilo City, Philippines
www.usa.edu.ph

COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS - DEPARTMENT OF NURSING

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.

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.

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 University of San Agustin
General Luna St., 5000 Iloilo City, Philippines
www.usa.edu.ph

COLLEGE OF HEALTH AND ALLIED MEDICAL PROFESSIONS - DEPARTMENT OF NURSING

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”.

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.

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.”

Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866131/#A1
https://pmhealthnp.com/joyce-travelbee-interpersonal-theory-of-nursing/

Email: cn@usa.edu.ph | Tel. No.: 0999-997-1485 | Fax No.: (033) 337-4403