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 being
2. 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 person
2. Emerging Identities- the time when relationship begins.
3. Empathy- ability to share in the persons experience.
4. Sympathy- when the nurse wants to lessen the cause of patients 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
Websters dictionary.
Simplicity:
It is intended to assist nurse appreciate and understanding not only the patients 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 patients 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: Theorys 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. Peplaus 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 Whos 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. Client
2. 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 clients independence in satisfaction of his fundamental
needs. This goal, congruent with the goal common to the entire health team, makes clear the nurses 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 clients 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 clients 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 publics improved health by working toward greater client
independence.

Education:
She stated, Following Hendersons concept of nursing. The nursing curriculum is planned to prepare a health worker
capable of maintaining and restoring the clients independence in the satisfaction of his fundamental needs.
Subject matter derived from the conceptual models assumptions is:
The concepts of independence and dependence
The concepts of universal and individual human needs, hierarchy of human needs, and need
satisfaction
The 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 Hendersons model and that the research for a small number of masters 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
Masters 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. Novice
2. Advance Beginner
3. Competent
4. Proficient
5. 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 Ill 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 Practice
1. Helping role
2. Teaching of coaching function
3. Diagnostic client-monitoring function
4. Effective management of rapidly changing situations
5. Administering and monitoring therapeutic
interventions and regimens
6. Monitoring and ensuring quality of health care
practices
7. 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 hasan 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 persons
engaged interaction, interpretation and
understanding of the situation.

ANALYSIS

Simplicity
Benners 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
Benners 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 Precision
In terms of empirical precision, Benners 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 Benners model is that data-based
research contributes to the science of nursing.

Derivable Consequences
The usefulness of Benners 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 Benners research findings
lies on her conclusion that a nurses 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 COMMUNITY
Practice
- 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