Process in the One-to-One Relationship, Article Review Example

Introduction

In the assigned excerpts from her book, Intervention in Psychiatric Nursing: Process in the One-to-One Relationship, author Joyce Travelbee presents her carefully delineated set of goals for the nurse involved with mental health patients.  Part II of the excerpted chapter is, in fact, little more than a preamble; in this section, Travelbee merely recounts the ideology guiding what is to follow, and the philosophy is based upon both growth and communication.  There is a decidedly holistic, if not outright spiritual, aspect to this brief section, for Travelbee stresses the growth opportunities for the nurse within the relationship as emphatically as she does those for the patient.

As is plainly seen in Part III, wherein the nine goals for the nurse are laid out, “relationship” is the cornerstone of Travelbee’s approach.  Each step she details, in fact, only serves to reinforce what she perceives to be the exponentially evolving relationship between the caregiver and the patient.  If necessarily non-specific, Travelbee’s nine goals are thoroughly in keeping with modern practice.  Harmony between the nurse and the patient, based upon and demonstrating mutual understanding and respect, is essential; by evincing genuine caring and by not employing a judgmental attitude, the nurse invites this harmony to become a vital component in the relationship, and rapport is achieved (Boyd, 2008,  p. 143).  Travelbee might substitute “rapport” for “relationship” without sacrificing any meaning or intent.

Application

As I review the nine goals, I am prompted to conceive of a variety of situations in which the precepts may apply.  Travelbee does employ an example or two; in the third goal, wherein the patient is encouraged to view himself as an active participant in the process by means of identifying both problem and possible cause, she cites insomnia and offers a series of questions a nurse may ask to promote discovery on the patient’s part.   The goal is basic: “The nurse’s message is that the ill person is an active, not passive, participant in life experiences” (Travelbee, 1969,  p. 60).

However, this goal, as well as the others, compelled me to reflect on perhaps more challenging circumstances.  Insomnia is a rather tame example of what a psychiatric nurse will ordinarily confront, and Travelbee’s emphasis on mutual understanding and cooperation actually led me to speculate on something far more difficult, that of a mentally ill patient in complete denial in regard to his or her illness.  Such a circumstance, in fact, strikes me as an effective test of Travelbee’s principles.  A cooperative, healing relationship intrinsically demands a shared acceptance of what is occurring before any progress can be made; how, then, to engage the patient unable to accept the reality?

This would be particularly challenging in a case involving a patient suffering from severe agoraphobia.  That is, Travelbee’s seventh goal, that of assisting the patient in socialization, is rendered moot in an example of this wherein the patient does not admit to having a problem.  There is one recourse, and it relies on how the nurse expertly communicates.  Denial is typically a fear mechanism.  Consequently, by consistently and gradually developing a trust component within the relationship, I as the nurse could create an environment safe enough for the issue to be honestly addressed.  I would carefully minimize the stigma the patient must be feeling in regard to the fear of being with others, and encourage him or her to accept that the disorder is by no means an especially abnormal, or even shameful, thing.  Thus reassured, the patient may then feel comfortable enough to explore the sources of the extreme unease in social situations, and this of itself is remedial.

Questions

I believe that the timing of Travelbee’s work must be taken into consideration, if it is to be fairly evaluated and/or questioned.  Her book appeared in 1969, and vast research in psychiatric nursing has emerged since.  With a concession to the constraints of the date, then, certain issues nonetheless remain.

The first is, unfortunately, rather pragmatic.  Travelbee’s writing is marked by occasional mistakes in grammar, as in, “But who among us possess the wisdom to know beyond a shadow of a doubt that a patient will not recover?” (Travelbee,  p. 58).  This sentence also indicates another failing in the work, which goes to a generalized approach that is often repetitive.  Essentially, the reality is that several of the nine goals could be neatly incorporated within others, and there does not seem to be any valid reason for the extending of them.

Although the close of Part III refers to additional factors within the nurse/patient relationship, it seems that the nine goals of the nurse as outlined by Travelbee cannot be effectively considered without a full understanding of one, specific factor: cultural background.  Every culture has distinct ways of both dealing with anxiety and in communication (Videbeck, 2010,  p. 234).  That her book addresses this elsewhere is immaterial because the goals here refer to actual strategies, none of which may be successful without an initial acknowledgment of the importance of cultural modes of communicating.

Conclusion

Misgivings and shortcomings aside, I believe there is authentic value in Travelbee’s proposals.  Ironically, the weaknesses of her writing actually serve to underscore these, in that her sincerity and commitment are the more evident.

Beyond anything else, the work is important because it addresses how pivotal the nurse/patient relationship is in mental health.  It points to a fact often ignored, even today; the nurse is empowered, by the very virtue of his or her role as not being that of the physician, to better approach the patient and create a comfortable environment.  Then, Travelbee wisely compares this sort of relationship with all others, and the comparison is both valid and useful.  No relationship between individuals can be healthy without mutual understanding and regard.  With the psychiatric nurse and the patient, this essential rapport is given the acknowledgment it merits in Travelbee’s views.

References

Boyd, M. A. (2008.)  Psychiatric Nursing: Contemporary Practice.  Philadelphia, PA: Lippincott Williams & Wilkins Publishers.

Travelbee, J.  (1969.)   Intervention in Psychiatric Nursing: Process in the One-to-One Relationship. Philadelphia, PA: F. A. Davis Company.

Videbeck, S. L. (2010.)  Psychiatric-Mental Health Nursing.  Philadelphia, PA: Lippincott Williams & Wilkins Publishers.