JOYCE TRAVELBEE (19261973) Human-to-Human Relationship Model 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. - Joyce Travelbee

passed away at the prime age of 47 after a brief sickness.

Theoretical Sources Catholic charity institutions Ida Jean Orlando, her instructorThe 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 campsproposed the theory of logotherapy in which a patient is actually confronted with and reoriented toward the meaning of his life. Nursing Metaparadigm Person - Person is defined as a human being. - Both the nurse and the patient are human beings. - A human being is a unique, irreplaceable individual who is in continuous process of becoming, evolving and changing. Health - Health is subjective and objective. - Subjective healthis an individually defined state of well being in accord with self-appraisal of physical-emotional-spiritual status. - Objective healthis an absence of discernible disease, disability of defect as measured by physical examination, laboratory tests and assessment by spiritual director or psychological counselor.

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 Working Experiences:

1952, Psychiatric Nursing Instructor at Depaul Hospital Affilliate 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 second book Intervention in Psychiatric Nursing: Process in the One-to-One Relationship. She started Doctoral program in Florida in 1973. Unfortunately, she was not able to finish it because she died later that year. She

Environment - Environment is 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 Suffering is a feeling of displeasure which ranges from simple transitory mental, physical or spiritual discomfort to extreme anguish and to those phases beyond anguishthe malignant phase of dispairful not caring and apathetic indifference Pain is not observable. A unique experience. Pain 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

3. Empathy - the ability to share in the persons experience 4. Sympathy - when the nurse wants to lessen the cause of patients suffering. - it goes beyond empathyWhen one sympathizes, one is involved but not incapacitated by the involvement. - therapeutic use of self 5. Rapport - Rapport is described as nursing interventions that lessens the patients suffering. - Relation as 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. *phases are in consecutive and developmental process. Logical Form - An inductive theory that uses specific nursing situations to create general ideas. Application Practice: Hospice self-actualizing life experience. Assumption of the sick role. Meaning of life and sickness and death.

Nursing - Nursing is 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. Human-to-Human Relationship Model - humanistic revolution Interactional Phases of Human-to-Human Relationship Model: 1. Original Encounter - First impression by the nurse of the sick person and vice-versa. - Stereotyped or traditional roles 2. Emerging Identities - the time when relationship begins - the nurse and patient perceives each others uniqueness

Education: Teaches nurses to understand the meaning of illness and suffering. Research: Applied in the theory of caring cancer patients.

Analysis Clarity is not consistent in clarity and origin. 1. Definition of terms came from dictionaries and books etc. 2. Used different terms for the same definition. 3. Focus more on adult individuals who are sick and the nurses role in helping them to find meaning in their sickness and suffering. 4. Deals in families and their needs but not in the community Simplicity not simple. 1. Contains different variables. Generality has wide scope of application but applicable only to those patients in distress and life changing events. Empirical Precision low measures of empirical soundness. 1. Result of lack of simplicity. 2. Defines concepts theoretically but does not define them operationally. 3. The model has not been tested. Derivable Consequences development of quality of caring. 1. It is useful because of its ability to describe, explain, predict and control a phenomena. 2. Explains the variables that affect the establishment of a therapeutic relationship between nurses and patients. 3. Lack of empirical precision also creates lack of usefulness. The nurse is responsible for helping the patient avoid and alleviate the distress of unmet needs. - Travelbee Introduction Joyce Travelbee (1926-1973) developed the Human-to-Human Relationship Model

presented in her bookInterpersonal Aspects of Nursing (1966, 1971). She dealt with the interpersonal aspects of nursing. She explains human-to-human relationship is the means through which the purpose of nursing if fulfilled Abou the Theorist 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. 1952, Psychiatric Nursing Instructor at Depaul Hospital Affilliate School, New Orleans. Later in Charity Hospital School of Nursing in Louisiana State University, New York University and University of Mississippi. Travelbee died at age 47. Development of the Theory Travelbee based the assumptions of her theory on the concepts of existentialism by Soren Kierkegaard and logotherapy by Viktor Frankl. Existential theory believes that that humans are constantly faced choices and conflicts and is accountable to the choices we make in life Logotherapy theory was first proposed by Viktor Frankel, a survivor of Auschwitz, in his book Man's Search for Meaning (1963).

Logotherapy 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 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, is crucial to helping to find meaning. Hope 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 lies in a fundamental trust the outside world, and a belief that others will help someone when you need it. Six important factors charecteristics of hope are: 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 "a strict necessity for good nursing care" Using himself therapeutic " 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 imporatnt in this process. Targeted intellectual approach Nurse must have a systematic intellectual approach to the patient's situation. Nursing Metaparadigms Person Person is defined as a human being. Both the nurse and the patient are human beings.

Health Health is subjective and objective. Subjective health is an individually defined state of well being in accord with selfappraisal of physical-emotional-spiritual status. Objective health is an absence of discernible disease, disability of defect as measured by physical examination, laboratory tests and assessment by spiritual director or psychological counselor. Environment

The inaugural meeting or original encounter Visibility of personal identities/ emerging identities. Empathy Sympathy Establishing mutual understanding and contact/ rapport Travelbee's ideas have greatly influenced the hospice movement in the west. Conclusion

Environment is not clearly defined. Nursing "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. Description of the theory Travelbee believed nursing is accomplished through human-to-human relationships that begin with the original encounter and then progress through stages of emerging identities, developing feelings of empathy, and later feelings of sympathy. The nurse and patient attain a rapport in the final stage. For meeting the goals of nursing it is a prerequisite to achieving a genuine human-to-human relationships. This relationship can only be established by an interaction process. It has five phases. Travelbee's theory has significantly influenced nursing and health care. Travelbee's ideas have greatly influenced the hospice movement in the west.

INTRODUCTION Ernestine Wiedenbach was born in August 18, 1900, in Hamburg, Germany. Wiedenbach's conceptual model of nursing is called ' The Helping Art of Clinical Nursing". Education: B.A. from Wellesley College in 1922

R.N. from Johns Hopkins School of Nursing in 1925 M.A. from Teachers College, Columbia University in 1934 Certificate in nurse-midwifery from the Maternity Center Association School for Nurse-Midwives in New York in 1946.. Career: Wiedenbach joined the Yale faculty in 1952 as an instructor in maternity nursing. Assistant professor of obstetric nursing in 1954 and an associate professor in 1956. She wrote Family-Centered Maternity Nursing in 1958. She was influenced by Ida Orlando in her works on the framework. She died on March 8, 1998. CONCEPTS AND DEFINITIONS Wiedenbach defined key terms commonly used in nursing practice. The patient "Any individual who is recieving help of some kind, be it care, instruction or advice from a member of the health profession or from a worker in the field of health." 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. A need-for-help A 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.

It is crucial to nursing profession that a need-for-help be based on the individual perception of his own situation. Nurse The nurse is functioning human being. The nurse no only acts, but thinks and feels as well. Knowledge Knowledge encompasses all that has been percieved and grasped by the human mind. Knowledge may be : factual speculative or practical Judgment Clinical Judgment represents the nurses likeliness to make sound decisions. Sound decisions are based on differentiating fact from assumption and relating them to cause and effect. Sound Judgment is the result of disciplined functioning of mind and emotions, and improves with expanded knowledge and increased clarity of professional purpose. Nursing Skills 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. Person Each Person (whether nurse or patient), is endowed with a unique potential to develop self-sustaining resources. People generally tend towards independence and fulfillment of responsibilities. Self-awareness and self-acceptance are essential to personal integrity and selfworth.

Whatever an individual does at any given moment represents the best available judgment for that person at the time. KEY ELEMENTS Wiedenbach proposes 4 main elements to clinical nursing. a philosophy a purpose a practice and the art. The Philosophy The nurses' philosophy is their attitude and belief about life and how that effected reality for them. Wiedenbach believed that there were 3 essential components associated with a nursing philosophy: Reverence for life Respect for the dignity, worth, autonomy and individuality of each human being and resolution to act on personally and professionally held beliefs. The Purpose Nurses purpose is that which the nurse wants to accomplish through what she does. It is all of the activities directed towards the overall good of the patient. The Practice Practice are those observable nursing actions that are affected by beliefs and feelings about meeting the patients need for help. The Art The Art of nursing includes understanding patients needs and concerns developing goals and actions intended to enhance patients ability and directing the activities related to the medical plan to improve the patients condition. The nurses also focuses on prevention of complications related to reoccurrence or development of new concerns.

PRESCRIPTIVE THEORY Wiedenbach's prescriptive theory is based on three factors: The central purpose which the practitioner recognizes as essential to the particular discipline. The prescription for the fullfillment of central purpose. The realities in the immediate situation that influence the central purpose. Diagram

CONCLUSION Nursing is the practice of identification of a patients need for help through observation of presenting behaviors and symptoms exploration of the meaning of those symptoms with the patient determining the cause(s) of discomfort, and determining the patients ability to resolve the discomfort or if the patient has a need for help from the nurse or other healthcare professionals. Nursing primarily consists of identifying a patients need for help. Wiedenbach believed that there were 4 main elements to clinical nursing. They included: a philosophy, a purpose, a practice and the art. The nurses philosophy was their attitude and belief about life and how that effected reality for them. Philosophy is what motivates the nurse to act in a certain way (Tomey & Alligood, 2002). Wiedenbach also believed that there were 3 essential components associated with a nursing philosophy (George, J. 2002):

Reverence for life, Respect for the dignity, worth, autonomy and individuality of each human being and resolution to act on personally and professionally held beliefs. Nurses purpose is that which the nurse wants to accomplish through what she does. It is all of the activities directed towards the overall good of the patient (Tomey & Alligood 2002). Practice are those observable nursing actions that are affected by beliefs and feelings about meeting the patients need for help. The Art of nursing includes understanding patients needs and concerns, developing goals and actions intended to enhance patients ability and directing the activities related to the medical plan to improve the patients condition. The nurses also focuses on prevention of complications related to reoccurrence or development of new concerns. Wiedenbach defined key terms commonly used in nursing practice. These definitions themselves do not fully define the profession, however confusion over commonly used terms continues to plaque nursing even today as we see with the lack of a uniform nursing language and the difficulties in coding data and reimbursement issues. In specifically defining what each of these terms mean within the context of her theory, Wiedenbach imparts clarity and power to her work, and sets the stage for productive exploration and debate. She defined the following: 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.

A 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. [Clinical] Judgment represents the nurses likeliness to make sound decisions. Sound decisions are based on differentiating fact from assumption and relating them to cause and effect. Sound Judgment 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. Each Person (whether nurse or patient), is endowed with a unique potential to develop self-sustaining resources. People generally tend towards independence and fulfillment of responsibilities. Self-awareness and selfacceptance are essential to personal integrity and self-worth. Whatever an individual does at any given moment represents the best available judgment for that person at the time. Wiedenbach conceptualizes nursing as the practice of identification of a patients need for help through observation of presenting behaviors and symptoms, exploration of the meaning of those symptoms with the patient, determining the cause(s) of discomfort, and determining the patients ability to resolve the discomfort or if the patient has a need for help from the nurse or other healthcare professionals. Nursing primarily consists of identifying a patients need for help. If the need for help requires intervention, the nurse facilitates the medical plan of care and also creates and implements a nursing plan of

care based on needs and desires of the patient. In providing care, a nurse exercises sound judgment through deliberative, practiced, and educated recognition of symptoms. The patients perception of the situation is an important consideration to the nurse when providing competent care