Guest Contributor: Joana Margarida Martins Fernandes

“I’m tired of being alive”: these were the first words I heard leave Pedro’s lips (name changed). Pedro was found at home after committing self-harm with suicidal intent. The resident made the call for help in another room at the hostel where he lived. When I arrived, I told Pedro my name, that I was a nurse, where I worked, and that I was there to help. My interaction with Pedro can be interpreted according to Joyce Travelbee’s human-to-human relationships model. In Travelbee’s model, this relationship is made up of five stages, with each involving specific tasks that must be completed before the next stage is reached. These stages culminate with a final connection or rapport, the culmination of all the experiences, thoughts, feelings, and attitudes that both nurse and patient are able to understand, share, and communicate (Travelbee, 1966).

I was with Pedro for nearly two hours. The first was spent working to stem the active bleeding from selfinflicted wounds on his wrists and neck and warming him up. It was a cold night, and he was physically and spiritually bare: he had no clothes and no hope. Hope can be defined as a mental state characterized by the desire to achieve an objective, combined with some degree of expectation that this goal is achievable (Travelbee, 1966). Pedro had no such expectation; he was despairing, lacking any hope or orientation to the future.

I tried to establish an interaction with Pedro through both verbal and non-verbal communication. The term interaction refers to any contact in which two individuals influence each other and communicate with one another, either verbally or non-verbally (Travelbee, 1966). Communication is a process that enables the nurse to establish a human-to-human relationship and, as a result, achieve the purpose of nursing: helping individuals and their families to prevent and cope with the experience of illness and suffering and, if necessary, to help them to find meaning in these experiences (Travelbee, 1966).

For an hour, I tried calmly and sympathetically to establish a therapeutic relationship. Sympathy is the process through which one individual is able to understand the suffering of the other, is moved or touched by the suffering of the other, and wishes to alleviate the cause of that suffering; it enables shared feelings and the experience of compassion. Travelbee (1966) describes how the sympathetic nurse feels and is moved by the other person’s distress: “There is a warmth, an urge to action, in sympathy”; with this warmth and urge to act to relieve Pedro’s suffering, I tried to establish a therapeutic relationship.

For Joyce Travelbee, nursing is an interpersonal process between two humans in which one needs assistance due to the presence of a disease, and the other can provide this assistance. Travelbee argues that nurses should not fear becoming emotionally, interpersonally, or existentially involved with their patients because it is only through this involvement that empathy, sympathy, trust, and, eventually, rapport can be created. Based on Joyce Travelbee’s theory and the five stages with their corresponding tasks, I feel that Pedro and I gradually moved through the different stages. After the initial encounter and transcending each of our roles, we were able to perceive one another’s uniqueness. At this stage of my time with Pedro, we were entering the stage of empathy, in which each individual begins to share their psychological state with the other while maintaining a certain distance. Although Pedro didn’t respond verbally, I realized that he felt safe by my side; sometimes, a fleeting moment of eye contact is all it takes to think of a sense of harmony. The concept of harmony is described as a process, occurrence, experience, or series of experiences that are shared simultaneously by the nurse and the person they are caring for. It is made up of a series of interrelated thoughts and feelings (Travelbee, 1966).

It was during my second hour with Pedro, during his transfer to the hospital, that I heard his first words; until then, he had been silent. On our way to the hospital during that second hour, Pedro spoke with me, and he had a lot to say. He told me how he felt lonely and isolated, how he had no job, no family, no friends, and had lost the will to live for that very reason: LONELINESS. I understood that what Pedro needed the most at that moment was somebody to talk to. Somebody with whom he could share his victories, his distress, his fears. Pedro was experiencing an astonishing level of suffering. Suffering can range from “a transitory mental, physical or spiritual discomfort” to “extreme anguish and to those phases beyond anguish,” the so-called “malignant phase” (Travelbee, 1966). By now, I felt that Pedro and I were entering the sympathy phase, in which each of us shared, felt, and experienced the other’s feelings and experiences. I actively listened to Pedro for as long as he needed. He spoke with me, cried with me, and told me that while he was scared to die, he was even more afraid of continuing with this life of loneliness, which he perceived as being eternal. We talked about potential solutions, and Pedro showed an interest in speaking with a mental health professional and a social worker. He told me that he didn’t have enough to eat and about the poor living conditions at the hostel where he was staying. I entered a request for social support and requested that an appointment be made at Pedro’s local health center to ensure that his case would be followed up. I left Pedro at the hospital, where he received treatment for his wounds and was then referred to the psychiatry department.

Though I was only present in Pedro’s life for a short period, these were two intense hours for both of us. Looking back on Pedro’s case, considering all our interactions from our initial meeting to the final reflections we shared, the sensation of harmony, mutual respect, and understanding made me believe that we had established a rapport, the final phase described by Joyce Travelbee. Rapport is defined as the culmination of all the previous phases in the final stage of harmony and connection.

References

Afaf Ibrahim Meleis. (2012). Theoretical nursing: development and progress. Wolters Kluwer Health/Lippincott Williams & Wilkins.

Linard, A. G., Pagliuca, L. M. F., & Rodrigues, M. S. P. (2004). Aplicando o modelo de avaliação de Meleis à teoria de Travelbee. Revista Gaúcha de Enfermagem, 25(1), 9-16.

Parola, V., Coelho, A., Fernandes, O., & Apóstolo, J. (2020). Teoria de Travelbee: Modelo de Relação Pessoa-a-Pessoa – adequação à enfermagem em contexto de cuidados paliativos. Revista de Enfermagem Referência, 5(2), e20010. https://doi.org/10.12707/RV20010

Tomey, A.M. and Alligood, M.R. (2004) Nursing Theorists and Their Work: Models and Theories of Nursing. 5th Edition, Lusociência, Loures

Travelbee, J. (1963). What Do We Mean by Rapport? The American Journal of Nursing, 63(2), 70–72. https://doi.org/10.2307/3452595

Travelbee, J. (1966). Interpersonal aspects of nursing. Philadelphia: F.A. Davis

About Joana Margarida Martins Fernandes

My name is Joana, i work in the emergency department and as a prehospital nurse. I’ve been a nurse since 2017 and I’m currently attending a master in critical care nursing. This post was created in the curricular unit of Nursing Theories under the guidance of Professor Zaida Charepe (PhD., Associate Professor).