How Joyce Travelbee’s Human-to-Human Relationship Model

affects me as a Dialysis Nurse

I am a dialysis nurse for eight years now. In the hospital setting, the patients that I work with are mostly in the end-stage of their renal disease, where there has been no established cure and their only options are lifetime dialysis treatment whether peritoneal or hemodialysis and kidney transplantation, otherwise, they will suffer and eventually die. Other patients try the power of herbs but most of them stumble and comes back to dialysis with more complications that involves other organs like the liver and pancreas.

As an acute care dialysis nurse my initial role is to alleviate the patient’s suffering at the first encounter. Patients may come to the hospital complaining of chest discomfort, usually as a result of hyperkalemia; shortness of breath caused by fluid overload; severe hypotension due to cardiac complications, anemia or sepsis; fever and chills related to central catheter infections; access blockage, among other problems but significantly a portion of our patients suffer from depression either directly coming to the hospital or associated with the problems that I have mentioned above.

I may have been doing the human-to-human relationship before even learning about it, however, Travelbee has changed “the reason” why I would treat my patient in a humanistic way. Working in the renal dialysis unit, made me think that one day I may be in the same situation where I need to depend on others and I wanted to be treated well when that time comes. I was thinking that how I felt was the result of the mean nature of Saudi patients. They treat nurses as maids if not trash bins. Now is different as Travelbee taught me that to be able to build a friendly relationship or to be able to be treated as a human nurse, the patient should realize that he/she is treated as a human, and I have to believe that it is possible at least for those conscious and oriented patients.

At the initial phase of interaction, I start by giving my patients privacy, treating them with respect, especially in communicating with them, may bring back to them the human feeling, which may have been affected by a sense of uselessness or a burden to their families or significant others because their condition is in the end-stage. Privacy for Saudi patients especially the females’ faces is a great deal of respect.

I make myself known to the patient that I am a nurse, not a doctor, certainly not a maid. It is through empathy that I anticipate their needs and be able to predict their behavior. Predicting the behavior of a chronic patient with hyperkalemia for example, is different from predicting the behavior of an acute case patient. Chronic patients may have received enormous dietary education way back then compared with a newly developing kidney disease patient. It is so easy to tell the patient “you know you are not allowed to eat this and that!” but empathy will be the understanding what happened to the health education given to the patient. Did he/she really have health education? Did he understand the importance of diet in his condition? Does he know the reason behind all the restrictions? How is he applying the dietary restrictions? Does the family know about the dietary restrictions? Was there a party he attended? By understanding the reason/s that brought the patient to the hospital it would be easier to support the patient.

Sympathy will be the formulation of a good nursing care plan. How do I care for this patient? Now that I have identified his needs, I may be referring the patient to the dietician, include the family in treatment regimen; I should make a record of the foods he loves to eat and foods he should be restricting; be a diet expert to him; exert a noticeable effort and make them feel they are important beings so that they may have the hope to live further and make things better on their own disposition.

Objective health is almost impossible to achieve in my patients. Their disease will always be of concern and their laboratory values may always have abnormalities specifically with serum electrolytes. However, achieving their optimum objective health through dialysis and diet, and the appraisal of their physical-emotional-spiritual well-being status (subjective health) becomes my goal as a nurse and these could be achieved by a human by a therapeutic human-to-human relationship.