Theoretical Foundations in Nursing

Module #9 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Lesson title:
§ JOYCE TRAVELBEE’S HUMAN-TO-HUMAN
RELATIONSHIP MODEL OF NURSING
§ ERNESTINE WIEDENBACH’S HELPING ART OF Materials: Book, pen and notebook
CLINICAL NURSING THEORY
Learning Targets:
At the end of the module, students will be able to:
1. Acknowledge the background and credentials of these
nursing theorists;
2. Identify the major concepts with their definitions as utilized in
their respective theory;
3. List down their specific theoretical assertions or assumptions;
4. Highlight their major contributions in the nursing field;
5. Enumerate the major assumptions enclosed within their
theory;
6. Describe each of these theories in view of the four
metaparadigms;
7. Apply the significance of these theories in the nursing
education, research, and practice; and,
8. Recognize the application of these theories in nursing today
References:
Alligood, M. (2018). Nursing theories and their
and in the clinical setting.
work (9th ed.). Singapore: Elsevier.

A. LESSON REVIEW/PREVIEW
Let us have a review of what you have learned from the previous lesson. Kindly answer the following questions on the space
provided. You may use the back page of this sheet, if necessary. Have fun!

Instruction: Identify if the following statements are true or false. Write T if the statement is TRUE and F for FALSE. The
questions are derived from the analysis of theory (clarity, simplicity, generality, accessibility and importance).
1. The theory is relatively simple in relation to the number of concepts. Answer: _________
2. Accessibility is achieved by identifying empirical indicators for the abstract concepts of model. Answer: ________
3. The theory is potentially simple because there are a number of possible interrelationships among the behavioral
system, its subsystems, and the environment. _________
4. Johnson’s theory has been used extensively with people who are ill or face the threat of illness. Answer: _______
5. By focusing on biology rather than behavior, the theory clearly differentiates nursing from medicine.
Answer: _________

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 Theoretical Foundations in Nursing
Module #9 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

B. MAIN LESSON
You will study and read their book, if available, about this lesson.

JOYCE TRAVELBEE’S HUMAN-TO-HUMAN RELATIONSHIP MODEL OF NURSING

“…human-to-human relationship is the means through which the purpose of nursing is
fulfilled.”

Life Story:
✔ A psychiatric nurse, educator and writer born in 1926.
✔ 1956, she completed her BSN degree at Louisiana State University
✔ 1959, she completed her Master of Science Degree in Nursing at Yale University
✔ She started a Doctoral program in Florida in 1973. Unfortunately, she was not able
to finish it because she died later that year. She passed away at the prime age of 47 after a brief sickness.

Working Experience:
✔ 1952, Psychiatric Nursing Instructor at DePaul Hospital Affiliate School, New Orleans.
✔ Also, she taught at Charity Hospital School of Nursing in Louisiana State University, New York University and
University of Mississippi.
✔ 1970, the Project Director of Graduate Education at Louisiana State University School of Nursing until her death.

Publications:
✔ 1963, started to publish articles and journals in nursing.
✔ 1966 and 1971, publication of her first book entitled Interpersonal Aspects of Nursing.
✔ 1969, when she published her 2nd book Intervention in Psychiatric Nursing: Process in the One-to-One Relationship.

Theory Concepts:
✔ Travelbee believed the spiritual values a person holds will determine to a great extent, his perception of illness. The
spiritual values of the nurse or her philosophical beliefs about illness and suffering will determine the degree to
which he or she will be able to help ill persons find meaning, or no meaning, in these situations.
✔ Travelbee extended the interpersonal relationship theories of Peplau and Orlando, but greatly emphasized on the
therapeutic human relationship between the nurse and the patient.
✔ Her model emphasizes: empathy, sympathy, rapport, and emotional aspects of nursing. Sympathy and empathy
are both acts of feeling.
✔ The establishment of a nurse-patient relationship and the experience that rapport is the end of all nursing
endeavors.
✔ Travelbee’s other contributions to the nursing profession included her works on illness, suffering, pain, hope,
communication, interaction, empathy, sympathy, rapport, and therapeutic use of self.

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.
▪ Viktor Frankl, a survivor of Auschwitz and other Nazi concentration camps—proposed the theory of logotherapy in
which a patient is actually confronted with and reoriented toward the meaning of his life.

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 Theoretical Foundations in Nursing
Module #9 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Major Concepts & Definitions:

▪ Rapport
→ is experienced when nurse and patient has progresses through the four interlocking phases preceding
rapport (4 phases of experience):
1. Original encounter – first impressions
2. Emerging identities – perceiving each other’s uniqueness
3. Empathy – ability to share in the person’s experience; to emphasize is to gain an intellectual
understanding of the mental world & psychological state of another
4. Sympathy – when the nurse wants to lessen the cause of patient’s suffering; “When one
sympathizes, one is involved but not incapacitated by the involvement.”
→ “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.” | “A nurse does not only seek to alleviate physical pain or render physical care – she
ministers to the whole person. The existence of the suffering whether physical, mental or spiritual is the
proper concern of the nurse.”

▪ Therapeutic use of self

→ ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and
to structure nursing intervention

▪ Communication
→ the vehicle through which nurse-patient relationships are established
▪ Nurse-patient interaction
→ refers to any contact between a nurse and an ill person
→ an experience or series of experiences between nurse and patient
→ means thru which the purpose of nursing is accomplished

▪ Logical form
→ an inductive theory that uses specific nursing situations to create general ideas

Theory in View of Metaparadigms:

An interpersonal process whereby the professional nurse practitioner assists an individual, family, or
Nursing community to prevent or cope with the experience of illness and suffering and if necessary to find
meaning in these experiences.
✔ a unique irreplaceable individual - a one time being in this world- like yet unlike any person who has
ever lived or ever will live
Person ✔ a unique, irreplaceable individual who is in continuous process of becoming, evolving and changing
✔ patients are only individual human beings in need of care, services and assistance of other human
beings who can render the assistance that is needed
Subjective and objective
▪ Subjective health – an individually defined state of well-being in accord with self-appraisal of
Health physical-emotional-spiritual status
▪ Objective health – absence of discernible disease, disability or defect as measured by physical
examination, laboratory tests and assessment by spiritual director or psychological counselor
This can be indirectly equated to the environment. She defined human conditions and life experiences
Environment encountered by all men as illness, sufferings, pain and hope.
▪ Illness – being unhealthy, but rather explored the human experience of illness

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 Theoretical Foundations in Nursing
Module #9 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

▪ 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 disdainful “not caring” and apathetic indifference
▪ Pain – is not observable, unique experience; 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

Application to Nursing:
▪ Nursing Practice: Hospice – self-actualizing life experience. Assumption of the sick role. Meaning of life and
sickness and death.
▪ Nursing Education: Teaches nurses to understand the meaning of illness and suffering.
▪ Nursing Research: Applied in the theory of caring for cancer patients.

Analysis of the Theory:

is not consistent in clarity and origin

▪ definition of terms came from dictionaries and books etc.
▪ used different terms for the same definition
Clarity
▪ focus more on adult individuals who are sick and the nurse’s role in helping them to find
meaning in their sickness and suffering
▪ deals in families and their needs but not in the community
Simplicity not simple; contains different variables
Generality has wide scope of application but applicable only to those patients in distress and life changing events
low measures of empirical soundness
Empirical ▪ result of lack of simplicity
Precision ▪ defines concepts theoretically but does not define them operationally
▪ the model has not been tested
development of quality of caring
▪ it is useful because of its ability to describe, explain, predict and control a phenomenon
Importance ▪ explains the variables that affect the establishment of a therapeutic relationship between
nurses and patients
▪ lack of empirical precision also creates lack of usefulness

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 Theoretical Foundations in Nursing
Module #9 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

ERNESTINE WIEDENBACH’S HELPING ART OF CLINICAL NURSING THEORY

“Nursing is the art of nurturing or caring for someone in a motherly fashion.”

✔ Her contributions to the nursing profession reiterated the helping role of the nurse in
terms of providing direct care to patients needing help.
✔ Her definition of nursing is rooted in her experience in the field of maternity nursing.

4 Elements in the Art of Nursing:

1. Philosophy – is what motivates the nurse to act in a certain way.

o includes major concepts of her philosophy:
▪ patient – need for help
▪ nurse – purpose, philosophy, practice (knowledge, judgment, skills),
administration, validation, coordination (reporting, consulting,
conferring), art (stimulus, preconception, interpretation, actions, rational, reactionary, deliberative)
o the nurse’s philosophy is their attitude and belief about life and how that affected reality for them
o 3 essential components associated with nursing philosophy:
▪ Reverence for life
▪ Respect for the dignity, worth, autonomy and individuality of each human being.
▪ Resolution to act on personally and professionally held beliefs

2. Purpose – is that which the nurse wants to accomplish through what she does.
o It is all of the activities directed towards the overall good of the patient.

3. Practice – are those observable nursing actions that are affected by beliefs and feelings about meeting the patient’s
need for help.

4. Art – this includes:

o Understanding patient’s needs and concerns
o Developing goals and actions intended to enhance patients’ ability
o Directing activities related to the medical plan to improve patient’s condition

Ways to Identify Patients’ Need for Help:

▪ Observing behavior consistent or inconsistent with their comfort
▪ Exploring the meaning of their behavior
▪ Determining the cause of their discomfort or incapacity
▪ Determining whether they can resolve their problems or have a need-for-help

Major Concepts & Definitions:

▪ The patient
→ is any person who has entered the healthcare system and is receiving help of some kind, such as care,
teaching, or advice.
→ The patient need not be ill since someone receiving health-related education would qualify as a patient.

▪ Need-for-help
→ is defined as any measure desired by the patient that has the potential to restore or extend the ability to
cope with various life situations that affect health and wellness.

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 Theoretical Foundations in Nursing
Module #9 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

▪ Clinical judgment
→ represents the nurse’s likeliness to make sound decisions.

▪ Sound decisions
→ are based on differentiating fact from assumption and relating them to cause and effect. It is the result of
disciplined functioning of mind and emotions, and improves with expanded knowledge and increased clarity
of professional purpose.

▪ Nursing skills
→ are carried out to achieve a specific patient-centered purpose rather than completion of the skill itself being
the end goal.
▪ Skills
→ are made up of a variety of actions, and characterized by harmony of movement, precision, and effective
use of self.

Theory in View of Metaparadigms:

Orlando speaks of nursing as unique and independent in its concerns for an individual’s need for help
Nursing in an immediate situation. The efforts to meet the individual’s need for help are carried out in an
interactive situation and in a disciplined manner that requires proper training.
Orlando uses the concept of human as she emphasizes individuality and the dynamic nature of the
Person
nurse-patient relationship. For her, humans in need are the focus of nursing practice.
In Orlando’s theory, health is replaced by a sense of helplessness as the initiator of a necessity for
Health
nursing. She stated that nursing deals with individuals who require help.
Orlando completely disregarded the environment in her theory, only focusing on the patient’s
immediate need, chiefly the relationship and actions between the nurse and the patient (only an
Environment
individual in her theory; no families or groups were mentioned). The effect that the environment could
have on the patient was never mentioned in Orlando’s theory.

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not allowed.

1. Which nursing model was developed by Joyce Travelbee (1926-1973)?

a. Human-to-Human Relationship Model
b. Human becoming theory
c. The theory of health as expanding consciousness
d. From Novice to Expert
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

2. Joyce Travelbee made use of Hildegard Peplau and Ida Jean Orlando’s interpersonal relationship. What is the main
focus of Travelbee’s theory?
a. Spiritual aspect of care
b. Manipulation of the environment as a factor of facilitating the recovery of the patient from illness
c. To emphasize compliance to care as a means to increase life expectancy
d. Nursing is accomplished through therapeutic human relationship
ANSWER: ________

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 Theoretical Foundations in Nursing
Module #9 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

3. Travelbee proposed that nursing is accomplished through a meaningful therapeutic relationship though a series of
encounters leading to rapport. Which of the following is not included?
a. First impression by the nurse of the sick person and vice-versa
b. The time in which the nurse and patient perceives each other’s uniqueness
c. The moment wherein the nurse is unable to share in the person’s experience
d. When the nurse wants to lessen the cause of the patient's suffering.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

4. Travelbee’s theory defines health in two categories. What category is this wherein it is an individually defined state of
well-being in accord with self-appraisal of the physical-emotional-spiritual status?
a. Mental and physical health
b. Spiritual health
c. Subjective health
d. Objective health
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

5. Travelbee’s theory defines health in two categories. What category is health is identified as an absence of discernible
disease, disability of defect as measured by physical examination, laboratory tests and assessment by spiritual director
or psychological counselor.
a. Mental and physical health
b. Spiritual health
c. Subjective health
d. Objective health
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

6. A therapeutic nurse-patient relationship is defined as a helping relationship that's based on mutual trust and respect,
the nurturing of faith and hope. Which of the following is the vehicle through which nurse-patient relationships are
established?
a. Relationship
b. Communication
c. Sympathy
d. Empathy
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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 Theoretical Foundations in Nursing
Module #9 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

7. Which of the following statements is TRUE about sympathy?

a. Feeling sorry for the patient or pity them, but you don’t specifically understand what they’re feeling
b. The use of active listening by means of putting yourself in the other person’s position
c. Feeling the same amount of excitement, when the patient tells you they received their laboratory results
stating that they are now cured from cancer
d. Acknowledging how the patient feels
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

8. It refers to the initial interaction between the nurse and the patient.
a. Emerging identities
b. Original Encounter
c. Sympathy and Empathy
d. Rapport
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

9. According to Ernestine Wiedenbach’s theory, which of the following are not among the three essential components
associated with the nursing philosophy?
a. Reverence for life
b. Respect for the dignity, worth, autonomy and individuality of each human being
c. Resolution to personally and professionally held beliefs
d. Derision to life
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

10. Which of the following are known ways to identify the patient’s need for help? (Select all that apply)
a. observing behavior consistent or inconsistent with their misery
b. exploring the meaning of their behavior
c. determining the cause of their comfort or incapacity
d. determining whether they can resolve their problems or have a need-for-help
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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 Theoretical Foundations in Nursing
Module #9 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

C. LESSON WRAP-UP

AL Activity: CAT: MINUTE PAPER

This strategy provides feedback on whether or not you understand the lesson. Use the space provided in this activity sheet
to answer the following questions. Make sure to not miss a tiny detail!
Empathy helps build trust between the nurses and patients. How do you show empathy to patients?
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