JOYCE TRAVELBEE

-Human to Human Relationship Model-

“A Nurse does not seek alleviate physical pain or render physical care- She ministers to the whole person. The existence of suffering whether physical, mental, or spiritual is the proper concern of the Nurse.”

About the Theorist: A psychiatrist nurse, educator, and writer. Born in 1926. 1956- Completed the Bachelor of Science Degree in Nursing, Louisiana State University. 1959- Completed her Master of Science Degree in Nursing. 1973- Psychiatric Nursing instructor at Depaul Hospital. Died at the age of 47 years old.

Human to Human Relationship has 7 Basic concepts: Human to Human Relationship has 7 Basic concepts:

1. Suffering- An experience that varies in intensity, duration and depth.; feeling of unease ranging from mild to extreme pain.2. Meaning- Reason attributed to a person.3. Nursing- Help a person find meaning experience of illness and suffering.4. Hope- faith that can and will be a chance that would bring something better with it.5. Communication- “A strict necessity for good nursing care”.6. Self- Therapy- ability to use once own personality consciously and in full awareness; refers to the nurse presence physically

and psychologically.

Metaparadigm in Nursing:1. Person- defined as human being2. Health- is subjective and objective:

2.1 Subjective Health- individually defined state of will being in accord emotional- spiritual status.2.2 Objective- absence of discernible diseases measured by physical, laboratory tests; assessment by spiritual

or psychological counsellor.3. Environment- this is not clearly defined in the theory.

-Defined human conditions and life experiences encountered by all men as sufferings, hope, pain, illness.4. Nursing- interpersonal process whereby the professional nurse practitioner assist on individual, family or community to

prevent or cope with the experience of illness and suffering and if necessary to find meaning.

Human to Human Relationship Interactional phases:1. Original Encounter- first impression by the nurse of the sick person2. Emerging Identities- the time when relationship begins.3. Empathy- ability to share in the person’s experience.4. Sympathy- when the nurse wants to lessen the cause of patient’s suffering.5. Rapport- Relation as Human Being to Human Being.

Acceptance by the Nursing Community:Practice: Hospice nurse attempt to build rapport or working relationship with the client. Self-actualizing life experience Stated understanding illness and suffering enable & the patient to accept sickness.

Education: Served as a better assistance for nurses who help individuals understand the meaning of illness. Helpful in preparing nursing student to fulfil the purpose of nursing sufficiently.

Research: Researchers acknowledgment nursing intervention that world support and create further development.

Analysis:Clarity:

The theory are not consistent in clarity and origin, some of the definitions are adapted from standard source, like Webster’s dictionary.

Simplicity: It is intended to assist nurse appreciate and understanding not only the patient’s humanness, but also her own, theory

was not able to meet this criteria. It contains different variables

Generality: This theory was a wide scope of application. She mainly developed this from her experience or psychiatric patients. It is applicable whenever the nurse encounters patient distress and life changing events.

Emperical Precision: The theory has no empiral support: It appears to have a low measure of empiral soundness, and the model has not been

tested.

Derivable Consequences: Useful for the reason that it has ability to describe, explain predict, and control phenomena. Theory focuses on the

development of the quality of caring, than makes nurse should possess.

HILDEGARD PEPLAU

“The kind of person that the nurse becomes makes a substantial difference in what each patient will learn as he/she receives nursing care.”

-Nurse-patient Interpersonal Relationship-

About the Theorist:

“Psychiatric Nurse of the Century” Born on September 1, 1909 at Reading, Pennsylvania.

As a child, she witnessed the devastating flu epidemic of 1918. This personal experience greatly influenced her

understanding of the impact of illness and death on families. Graduated from Pottstown, Pennsylvania Hospital School of Nursing in 1931 1943-received a Bachelor of Arts in Interpersonal Psychology from Bennington College, Vermont. Become member of the Army Nurse Corps March 7, 1999- Died peacefully at age of 89.

Phases of Nurse- Patient Relationship:

1. Orientation- “initial reaction between the nurse and the patient.”2. Identification- “explore the experience and the needs of the patient”3. Exploitation- patient derives the full value of the relationship as he moves on from a dependant to an independent.4. Resolution- “Final stage, patient earns independence over his care.”

Metaparadigm in Nursing:

Person- a man who is an organism that lives in unstable balance Health- word that symbolizes movement of the personality and other on-going human processes that directs the person

towards creative and constructive. Environment- “forces outside the organism” Nursing- as a significant therapeutic interpersonal process.

The Interpersonal therapeutic Process: Often referred by Peplau “as Psychological Mothering”

Steps:

The PT is accepted unconditionally as a participant in a relationship that satisfied his needs. There is recognition of and response to the patient’s readiness for growth. Power in the relationship shifts to the patient.

Peplau's Seven Nursing Roles

1. Stranger role: Receives the client the same way one meets a stranger in other life situations; provides an accepting climate

that builds trust.

2. Resource role: Answers questions, interprets clinical treatment data, gives information.

3. Teaching role: Gives instructions and provides training; involves analysis and synthesis of the learner's experience.

4. Counseling role: Helps client understand and integrate the meaning of current life circumstances; provides guidance and

encouragement to make changes.

5. Surrogate role: Helps client clarify domains of dependence, interdependence, and independence and acts on clients behalf

as advocate.

6. Active leadership: Helps client assume maximum responsibility for meeting treatment goals in a mutually satisfying way.

7. Technical expert role: Provides physical care by displaying clinical skills; Operates equipment

Acceptance by the Nursing Community:

Practise: It brought new perspective, a new approach and a theoretical foundation of nursing practise.

Education: It helps graduate nurses and nursing students alike in creating a significant nurse-patient relationship.

Research: Influenced upcoming nursing leaders especially those in the graduate school of psychiatric nursing.

Analysis:

Simplicity: Theory’s basic assumptions and key concepts were clearly given, explained, broken down.

Generality: The use of model is limited / impossible in working senile, comatose, newborn patients.

Empirical Precision: Based on theory; could be tested and observed using pure observation.

Derivable Consequences: Widening the perception of nursing as a noble profession. Peplau’s work has provided a significant contribution to the profession.

EVELYN ADAM

“Nursing practice, education and research must be based on explicit frame or references specific to nurses.”

-Conceptual Model for Nursing-

About the Theorist: Born on April 9, 1929 in Lanak, Ontario, Canada Graduated from Hotel Dieu Hospital in Kingston, Ontario in 1950 with a diploma in nursing. Received a BS degree from the University of Montreal in 1966 and an MN degree from the University of California, Los

Angeles in 1971. She has been a visiting professor at several universities. 1983 to 1989, she was a member of the review board for Nursing Papers: Perspective in Nursing Faculty secretary from 1982 to 1989, at which time the university named her Professor Emeritus She has been the Who’s Who in the World in 1987/1988 Awarded honorary doctorate by Laval University Quebec City in 1992 “A conceptual model, for whatever discipline, is not reality; it is a mental image of reality or a waof conceptualizing reality.” “A conceptual model for nursing is therefore a conception of nursing.”

Through the nursing process, the abstraction that is the conceptual model is linked to the reality that is nursing practice.

The nurse must also establish, with the client, what will be perceived to a helping relationship. It is climate of empathy, warmth, mutual respect, caring and acceptance that determines the effectiveness of nursing

care.

Three Components Constitutes Nursing Practice:1. Client2. Nurse (with his or her conceptual model as a base for the nursing process)3. the relationship between the client and the nurse

Metaparadigm Person -portrayed as a complex whole, made up of 14 fundamental needs and the resources to satisfy them. Health- the goal of nursing is to maintain or to restore the client’s independence in satisfaction of his fundamental

needs. This goal, congruent with the goal common to the entire health team, makes clear the nurse’s specific contribution to the preservation and improvement of health.

Environment - addressed in only one fundamental need. However it is implicit in all fundamental needs because the sociocultural dimension is integral to each other.

Nursing-maintaining or restoring the client’s independence in the satisfaction of 14 fundamental needs.

Acceptance by the Nursing Community:

Practice: The nurse is seen in a complimentary-supplementary role and the goal is client independence in the satisfaction of

his or her needs. The practitioner in whatever setting, will assess in the independence of the client in need satisfaction. The nurse will identify the client’s specific needs; determine the source of difficulty; and plan the intervention to

compliment client strength, will or knowledge. The nurse “carries out the social mission of contributing to public’s improved health by working toward greater client

independence.”

Education: She stated, “Following Henderson’s concept of nursing. The nursing curriculum is planned to prepare a health worker

capable of maintaining and restoring the client’s independence in the satisfaction of his fundamental needs.” Subject matter derived from the conceptual model’s assumptions is:

The concepts of independence and dependenceThe concepts of universal and individual human needs, hierarchy of human needs, and need satisfactionThe concept of wholeness

The practical aspect of nursing content consists of technical procedures and clinical experiences. “The goal of clinical experiences is to provide the student with opportunities to help a client recover his independence

in the satisfaction of his basic needs.”

Research: Adam states that various clinical and educational setting in Canada are at varying stages of being nursing care and

teaching on Henderson’s model and that the research for a small number of master’s theses has been based on this model.

Doctoral students may use the concept of independence in need satisfaction as a basis for research for theory development.

Simplicity: The interrelatedness of the components necessary for the care of the whole client also adds to the complexity of the model.

Generality: The assumptions, values, and major units involved nursing and clients in all aspect of society. They are not limited to age, medical diagnosis, or healthcare setting.

Empirical Precision: Although testing of the model in unavailable at this time, it appears to have the potential for a high degree of empirical precision.

Derivable Consequences: The empirically based concepts and broad scope of the model make it potentially applicable to nursing practice, education and research.

PATRICIA BENNER • A Professor Emerita at the University of California, San Francisco

• BA in Nursing- Pasadena College/Point Loma College• Master’s Degree in Med/Surg. Nursing from UCSF• Achieved her Ph.D at UCSF and UC Berkeley in 1970 and,

and has done researches in the same university since 1979

• Published 9 books and numerous articles• Published “Novice to Expert Theory” 1982• Introduced the concept that expert nurses develop skills

and understanding of patient care over time through a sound educational base as well as a multitude of experience

• Proposed that one could gain knowledge and skills (“knowing how”) without ever learning the theory (“knowing that”)

• She conceptualizes in her writing about nursing skills as experience is a prerequisite for becoming an expert.

• Proposed that the development of knowledge in applied disciplines such as medicine and nursing is composed of the extension of practical knowledge (know how) through research and the characterization and understanding of the “know how” of clinical experience.

5 levels of nursing experience:1. Novice2. Advance Beginner3. Competent4. Proficient5. Expert

Novice• Beginner with no experience• Taught general rule to help perform tasks• Rules are: context-free, independent of specific cases and

applied universally• Rule-governed behavior is limited and inflexible• Eg: “Tell me what I need to do and I’ll do it”

Advance Beginner• Demonstrates acceptable performance• Has gained prior experience in actual situations to

recognize recurring meaningful components• Principles, based on experiences, begin to be formulated

to guide actions

Competent• Typically a nurse with 2-3 years experience on the job in

the same area or in similar day-to-day situations• More aware of long-term goals• Gains perspective from planning own actions based on

conscious, abstract and analytical thinking and helps to achieve greater efficiency and organization.

Proficient• Perceives and understands the situations as whole parts• More holistic understanding improves decision-making• Learns from experiences what to expect in certain

situations and how to modify plans• Have a 5-year experience

Expert • No longer relies in principles, rules or guidelines to

connect with situations and determine actions• Much more background of experience• Has intuitive grasp of clinical situations• Performance is now fluid, flexible and highly proficient

7 Domains of Nursing Practice1. Helping role

2. Teaching of coaching function3. Diagnostic client-monitoring function4. Effective management of rapidly changing situations5. Administering and monitoring therapeutic

interventions and regimens 6. Monitoring and ensuring quality of health care

practices7. Organizational and work-role competencies

METAPARADIGM Nursing - Benner described nursing as an “enabling

condition of connection and concern” which shows a high level of emotional involvement in the nurse-client relationship. She viewed nursing practice as the care and study of the lived experience of health, illness and disease and the relationships among these three elements.

Person - Benner stated that “a self-interpreting being, that is, the person does not come in to the world predefined but gets defined in the course of living a life. A person also has…an effortless and non-reflective understanding of the self in the world. The person is viewed as a participant in common meanings.” Benner conceptualized that major aspects of understanding that a person must deal with as:

1. The role of the situation.2. The role of the body.3. The role of personal concerns.4. The role of temporality.

Health – Benner focused “on the lived experience of being healthy and ill”. She defined health as what can be assessed, while well-being is the human experience of health of wholeness. Well-being and being ill are recognized as different ways of being in the world. Health is described as not just the absence of disease and illness. Also, a person may have a disease and not experience illness because illness is the human experience of loss or dysfunction, whereas disease is what can be assessed at the physical level.

Environment – instead of using the term “environment”, benner used the term “situation”, because it suggests a social environment with social definition and meaning. She used the phenomenological terms of being situated and situated meaning, which are defined by the person’s engaged interaction, interpretation and understanding of the situation.

ANALYSIS

SimplicityBenner’s model is comparatively simple about the

five stages of skill acquisition. It gives a relative guide for classifying levels of nursing practice, from individual nurse descriptions and observations to actual nursing practice. The interpretations are validated by agreement or by general acceptance.

Clinical knowledge is relational and deals with local, specific, historical issues. Benner uses narrative accounts of actual clinical situations and preserves that the model enablers the reader to recognize similar intents and meanings, although the objective circumstances may be quite different.

Generality

Benner’s model has universal characteristic for the reason that it is not restricted by age, illness, health, or location of nursing practice. However, the characteristic of theoretical universality involve properties of functionality for prediction that is not a part of this perspective.

The descriptive model of nursing practice has the potential for universal application as a framework; however the descriptions are limited by dependence on the actual clinical nursing situations from which they must be used. It depends on the understanding of the five levels of competency and the ability to identify the characteristic intentions and meanings intrinsic at each level of practice.

Empirical PrecisionIn terms of empirical precision, Benner’s model was

tested using qualitative methodologies. Succeeding researches suggest that the framework is applicable and useful in providing knowledge of the description of nursing practice. The strength of Benner’s model is that data-based research contributes to the science of nursing.

Derivable ConsequencesThe usefulness of Benner’s model gives a general

framework for identifying, defining and describing clinical nursing practice. She uses a phenomenological approach to express and obtain meaning and abilities from interactions in life situation. The implication of Benner’s research findings lies on her conclusion that “a nurse’s clinical knowledge is relevant to the extent to which its manifestation is nursing skill makes a difference in patient care and patient outcome.”

ACCEPTANCE BY THE NURSING COMMUNITYPractice

- The model has been used to aid in the development of clinical ladders of promotion, new graduate programs and clinical knowledge development seminars

Education- Nursing educators have realized that learning needs

at the early stages of clinical knowledge development are different from those required at later researches.

Research- Her researches have been used in studying the

impact of nursing and its seven domains in every aspect of the profession.

- Nurses have a clear vision of the competencies requires in order for them to climb up into the leadership ladder.

REFERENCES• Dracup and Bryan-Brown. From Novice to Expert to

Mentor Shaping the Future - American Journal of Critical Care. 2004;13: 448-450.

• Jane Corrigan Wandel. The Institute for Nursing Healthcare Leadership Conference: Reflections on the Impact of Patricia Benner's Work. Medscape Nurses. 2003;5(2). Accessed on 5-04-2010 fromhttp://www.medscape.com/viewarticle/462607

Prepared by: Jezrel Oberes