JOYCE TRAVELBEE
- Health is subjective and objective.
(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
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 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
- 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.
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
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
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.

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.

SOURCE: slsu-coam.blogspot.com/2008/09/joyce-
travelbee-human-to-human.html
DOROTHY E. JOHNSON (August 21, 1919 February 1999) was one of the
greatest nursing theorists who developed the Behavioral System Model.
Her theory of nursing defines nursing as an external regulatory force which
acts to preserve the organization and integration of the patients behaviors
at an optimum level under those conditions in which the behavior
constitutes a threat to the physical or social health, or in which illness is
found. It also states that each individual has patterned, purposeful,
repetitive ways of acting that comprises a behavioral system specific to that
individual. Johnson was born in Savannah, Georgia. She was the youngest of
seven children. Her father was the superintendent of a shrimp and oyster
factory and her mother was very involved and enjoyed reading. In 1938, she
finished her associates degree in Armstrong Junior College in Savannah,
Georgia. Due to the Great Depression, she took a year off from school to be a
governess, or teacher, for two children in Miami, Florida. This is when she
began to realize her love for children, nursing and education. Johnsons
professional nursing career began in 1942 when she graduated from
Vanderbilt University School of Nursing in in Nashville, Tennessee. She was
the top student in her class and received the prestigious Vanderbilt
Founders Medal.
In 1948, she received her Masters in Public Health from Harvard University in
Boston, Massachusetts. Johnson died in February 1999 at the age of 80.
Before she died, she was pleased that her theory had been found useful in
furthering the development of a theoretical basis for nursing and was being
used as a model for nursing practice on an institution-wide basis, but she
reported that her greatest source of satisfaction came from following the
productive careers of her students.
Her Behavioral System Model, which was first proposed in 1968. Her model
was greatly influenced by Florence Nightingales book, Notes on Nursing. It
advocates the fostering of efficient and effective behavioral functioning in
the patient to prevent illness and stresses the importance of research-based
knowledge about the effect of nursing care on patients.
GOALS
Johnson began her work on the model with the premise that nursing was a
profession that made a distinctive contribution to the welfare of society.
Thus, nursing had an explicit goal of action in patient welfare.
The goals of nursing are fourfold, according to the Behavior System Model:
1. To assist the patient whose behavior is proportional to social
demands.
2. To assist the patient who is able to modify his behavior in ways
that it supports biological imperatives.
3. To assist the patient who is able to benefit to the fullest extent
during illness from the physicians knowledge and skill.
4. To assist the patient whose behavior does not give evidence of
unnecessary trauma as a consequence of illness.
ASSUMPTIONS
The assumptions made by Johnsons theory are in three
categories: assumptions about system, assumptions about structure,
and assumptions about functions.
Johnson identified several assumptions that are critical to understanding the
nature and operation of the person as a behavioral system:
1. There is organization, interaction, interdependency and
integration of the parts and elements of behaviors that go to
make up the system.
2. A system tends to achieve a balance among the various forces
operating within and upon it, and that man strive continually to
maintain a behavioral system balance and steady state by more
or less automatic adjustments and adaptations to the natural
forces occurring on him.
3. A behavioral system, which requires and results in some degree
of regularity and constancy in behavior, is essential to man. It is
functionally significant because it serves a useful purpose in
social life as well as for the individual. And (4) System balance
reflects adjustments and adaptations that are successful in some
way and to some degree.
The four assumptions about structure and function are that:
1. From the form the behavior takes and the consequences it
achieves can be inferred what drive has been stimulated or what
goal is being sought.
2. Each individual person has a predisposition to act with reference
to the goal, in certain ways rather than the other ways. This
predisposition is called a set.
3. Each subsystem has a repertoire of choices called a scope of
action.
4. The individual patients behavior produces an outcome that can
be observed.
And lastly, there are three functional requirements for the subsystems.:
1. The system must be protected from toxic influences with which
the system cannot cope.
2. Each system has to be nurtured through the input of appropriate
supplies from the environment.
3. The system must be stimulated for use to enhance growth and
prevent stagnation.
MAJOR CONCEPTS
Human
Johnson views human beings as having two major systems: the biological
system and the behavioral system. It is the role of medicine to focus on the
biological system, whereas nursings focus is the behavioral system.
The concept of human being was defined as a behavioral system that strives
to make continual adjustments to achieve, maintain, or regain balance to the
steady-state that is adaptation.
Environment
Environment is not directly defined, but it is implied to include all elements
of the surroundings of the human system and includes interior stressors.
Health
Health is seen as the opposite of illness, and Johnson defines it as some
degree of regularity and constancy in behavior, the behavioral system
reflects adjustments and adaptations that are successful in some way and to Instability
some degree adaptation is functionally efficient and effective.
State in which the system output of energy depletes the energy needed to
maintain stability.
Nursing

Nursing is seen as an external regulatory force which acts to preserve the
organization and integration of the patients behavior at an optimal level
under those conditions in which the behavior constitutes a threat to physical
or social health, or in which illness is found.
Set
The predisposition to act. It implies that despite having only a few
alternatives from which to select a behavioral response, the individual will
rank those options and choose the option considered most desirable.

Behavioral system
Function
Man is a system that indicates the state of the system through behaviors.
Consequences or purposes of action.

System
7 SUBSYSTEMS
That which functions as a whole by virtue of organized independent
interaction of its parts.

Subsystem

A mini system maintained in relationship to the entire system when it or the

environment is not disturbed.

SUBCONCEPTS

Structure

The parts of the system that make up the whole.

Johnsons Behavioral System Model

Variables
Johnson identifies seven subsystems in the Behavioral System Model. They
Factors outside the system that influence the systems behavior, but which are:
the system lacks power to change.

1. Attachment or affiliative subsystem

Boundaries
Attachment or affiliative subsystem is the social inclusion intimacy and the
The point that differentiates the interior of the system from the exterior. formation and attachment of a strong social bond. It is probably the most
critical because it forms the basis for all social organization. On a general
level, it provides survival and security. Its consequences are social inclusion,
Homeostasis
intimacy, and formation and maintenance of a strong social bond
Process of maintaining stability.
2. Dependency subsystem
Stability
Dependency subsystem is the approval, attention or recognition and
Balance or steady-state in maintaining balance of behavior within an physical assistance. In the broadest sense, it promotes helping behavior that
acceptable range. calls for a nurturing response. Its consequences are approval, attention
or recognition, and physical assistance. Developmentally, dependency
behavior evolves from almost total dependence on others to a greater
Stressor degree of dependence on self. A certain amount of interdependence is
essential for the survival of social groups.
A stimulus from the internal or external world that results in stress or
instability.
3. Ingestive subsystem

Tension Ingestive subsystem is the emphasis on the meaning and structures of the
social events surrounding the occasion when the food is eaten. It should not
The systems adjustment to demands, change or growth, or to actual be seen as the input and output mechanisms of the system. All subsystems
disruptions.
are distinct subsystems with their own input and output mechanisms. The
ingestive subsystem has to do with when, how, what, how much, and under
what conditions we eat.
4. Eliminative subsystem
Eliminative subsystem states that human cultures have defined different
socially acceptable behaviors for excretion of waste, but the existence of
such a pattern remains different from culture to culture. It addresses
when, how, and under what conditions we eliminate. As with the ingestive
subsystem, the social and psychological factors are viewed as influencing the
biological aspects of this subsystem and may be, at times, in conflict with the
eliminative subsystem.
5. Sexual subsystem
Sexual subsystem is both a biological and social factor that affects behavior.
It has the dual functions of procreation and gratification. Including, but not
limited to, courting and mating, this response system begins with the
development of gender role identity and includes the broad range of sex-role
behaviors.
6. Aggressive subsystem
Aggressive subsystem relates to the behaviors concerning protection and
self-preservation, generating a defense response when there is a threat to
life or territory. Its function is protection and preservation. Society demands
that limits be placed on modes of self-protection and that people and their
property be respected and protected.
7. Achievement subsystem
Achievement subsystem provokes behavior that tries to control the
environment. It attempts to manipulate the environment. Its function is
control or mastery of an aspect of self or environment to some standard of
excellence. Areas of achievement behavior include intellectual, physical,
creative, mechanical, and social skills.
BEHAVIORAL SYSTEM MODEL AND THE NURSING PROCESS
The nursing process of the Behavior System Model of Nursing begins with an
assessment and diagnosis of the patient. Once a diagnosis is made, the nurse
and other healthcare professionals develop a nursing care plan of
interventions and setting them in motion. The process ends with an
evaluation, which is based on the balance of the subsystems.
Johnsons Behavioral System Model is best applied in the evaluation phase,
during which time the nurse can determine whether or not there is balance
in the subsystems of the patient. If a nurse helps a patient maintain an
equilibrium of the behavioral system through an illness in the biological
system, he or she has been successful in the role.
STRENGTHS
Johnsons theory guides nursing practice, education, and research; generates
new ideas about nursing; and differentiates nursing from other health
professions.
It has been used in inpatient, outpatient, and community settings as well as
in nursing administration. It has always been useful to nursing education and
has been used in practice in educational institutions in different parts of the
world.
Another advantage of the theory is that Johnson provided a frame of
reference for nurses concerned with specific client behaviors. It can also be
generalized across the lifespan and across cultures.
The theory also has potential for continued utility in nursing to achieve
valued nursing goals.
WEAKNESSES
The theory is potentially complex because there are a number of possible
interrelationships among the behavioral system, its subsystems, and the
environment. Potential relationships have been explored, but more empirical
work is needed.
Johnsons work has been used extensively with people who are ill or face the
threat of illness. However, its use with families, groups, and communities is
limited.
Though the seven subsystems identified by Johnson are said to be open,
linked, and interrelated, there is a lack of clear definitions for the
interrelationships among them which makes it difficult to view the entire
behavioral system as an entity.
The problem involving the interrelationships among the concepts also
creates difficulty in following the logic of Johnsons work.
CONCLUSION
Johnsons Behavioral System Model describes the person as a behavioral
system with seven subsystems: the achievement, attachment-affiliative,
aggressive protective, dependency, ingestive, eliminative, and sexual
subsystems. Each subsystem is interrelated with the others and the
environment and specific structural elements and functions that help
maintain the integrity of the behavioral system.
Through these, the focus of her model is with what the behavior the person
is presenting making the concept more attuned with the psychological aspect
of care in.
When the behavioral system has balance and stability, the individuals
behaviors will be purposeful, organized, and
predictable. Imbalance and instability in the behavioral system occur when
tension and stressors affect the relationship of the subsystems or the
internal and external environments.
SOURCE: http://nurseslabs.com/dorothy-e-johnsons-
behavioral-system-model/
http://nurseslabs.com/dorothy-e-johnson/