Strengths and Limitations

 

Travelbee’s theory is a hierarchical one, developed around the concepts of nurse–patient relationship, suffering, and pain to explore the relationships among them. It is both a concatenated theory, isolating and conceptualizing the central theory concepts, and a hierarchical one, as it interprets the relationship among these variables. Travelbee used the field approach in developing her theory, as is demonstrated in conceptualizing rapport in terms of other phases leading to and incorporating rapport. It is a descriptive and prescriptive microtheory that is also considered a single-domain theory. The theory addresses one of the major concepts in nursing—interaction—but is limited to interaction surrounding illness. The theory focuses on those components of illness that are considered of concern to nursing; these are suffering and pain. It adds mainly to knowledge of the process of providing nursing care and provides significant existence propositions (nurse–patient interactions proceed through phases) and relational propositions (rapport increases patient’s acceptance of illness). Travelbee uses an operational method to develop highly abstract relationships. She incorporates the nurses’ perceptions and acceptance with components of the nursing problem areas and nursing therapeutics. The nurse perceives, understands, and assigns meaning to behavior and is therefore part of the theory. The nurse’s communication is one of the nursing problems, and the self could be used as the intervention through empathy and sympathy. An operational method of theory development allows choices between alternate theories and actions. An example can be seen in the alternatives that Travelbee provides to dealing with suffering. She proposes using the direct method of confronting the patient with his suffering or the indirect method of having the nurse sharing her own experiences to prompt mutuality in sharing. Operational methods tend to be more acceptable to nurses because of their preferences for well identified choices.The theory’s explanatory power is low (higher ratio of assumptions to explicitly stated propositions) and is limited to knowledge of disorder (suffering) and knowledge of process (relationships).Travelbee used a deductive approach to develop her theory (Duffey and Muhlenkamp, 1974). Although she explicitly stated the sources that influenced the theory deductively (existentialist philosophy), the inductive approach is more assumed than explicit. It is assumed that she observed nurse–patient relationships in acute and suffering incidents. Such observations are not an integral part of her theory, and it is not clear whether she developed her theory based on an extent or ought to be practiced. One can deduce that it was the former rather than the latter.

 

Theoretical Nursing: Development and Progress 5th Edition by Afaf Ibrahim Meleis, PhD, FAAN