Tugas Caring

The document discusses the Transactive Relationship Theory of Nursing (TRETON). TRETON views nursing as a transactive engagement between the nurse, patient, and intelligent machines (HNRs). It acknowledges that nursing encounters can be human-to-human or human-to-machine. The theory was developed in response to the increasing use of technology in healthcare and the need for guiding nursing practice with machines. Key questions the theory addresses are what functionalities HNRs would need for compassionate relationships with patients, and what role nurses should play. The assumptions of TRETON are that nursing is a relationship between humans and machines, and that HNRs can enhance care through task delegation but not replace human nursing care.

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Tugas Caring

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Dina Trisnawati

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Transactive Relationship

Theory of Nursing
(TRETON)
By : Dina Trisnawati

STUDENT DOCTORAL IN NURSING

ST.PAUL UNIVERSITY PHILIPPINE
2023-2024
Precise nursing actions assure quality human health
care. However, such actions are often identified as
low-level health care work thereby delegated as tasks
that only need completion. As a health care practice
problem leading to labor shortages in health care
settings specifically among nurses and direct health
caregivers. Transactive relationships are necessary in
human Nurse-patient interactions. thereby
sanctioning human nurses’ focus on direct human
caring relationships. in transactive interactions were
described within the metaparadigms of person,
nursing, environment, and health. This situation has
expectedly become a serious social problem, leading
to labor shortages, particularly within health care
settings. these types of human- dependent activities
will, more importantly, allow human nurses to focus
on direct human caring relationships and nursing care
for these patients. Nevertheless, what is important to
understand is the apparent apathy that nursing
professionals have shown towards nurses, healthcare
or caring.

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Computerization and nursing
The overwhelming development of personal computers, the intranet
and the Internet is transforming the work methods of nurses,
physicians, and other healthcare staff members who work in
hospital settings. Two of the most distinctive technologies available
and used in current health care settings are the ordering systems and
the use of electric care cards. The functionalities of these
technologies are irreplaceable. For example, when a patient
undergoing an examination at an internal medicine clinic is given an

”
order for a prescription, the ordering system makes it possible to
send that data to each department instantly. By using electric cards,
clinical data and nursing data are recorded and shared with multiple
professionals

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Transactive reliably increased the speed of healthcare
operations particularly in hospital settings, supporting the
anticipation and realization that Transactive has a more
expansive future. Also important is the concern regarding
the relationship between nursing judgment and the use of
databases. By using nursing judgment in thirteen areas of
NANDA (North American Nursing Diagnosis Association),
NOC (Nursing Outcome Classification), and NIC (Nursing
Intervention Classification), a description of the manner
and kind of observations and care given is accounted for, so
that a necessary nursing plan can be made. This means that
the impersonal aspect of technology is perceived to de-
emphasize the need to know the patient and act as a
distraction from the nurse-patient relationship. In situations
such as these, nurses are torn between the human caring
model of nursing

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Revealed in this theory is a practical process of relationship
advanced as the transactive engagement between human persons
(patients) and caring, As such, the theory illustrates a unique and
emerging practice of nursing. The realization of human and
intelligent machine transactions in human health care has been
the impetus for the development of the Transactive Relationship
Theory of Nursing. As the demands and needs for quality health
care rise, particularly in environments poor in human resources
and among the older adult population, the use of human-
machine process requirements is intensified, and the realities
and consequences of transactive relationships have become
integral to assuring quality human health care “Transactive” is a
term that focuses on the transactional nature of things. As an
active process, it illuminates the main feature of the relationship
between human-to-human and human-to-intelligent machines
which is that it is always a transaction. The term delineates as
well as illuminates the relationship between HNRs and human
persons (patients). The TRETON is a theoretical transactive
engagement, and as such, the process of nursing is an ‘active’
engagement between the nurse and person being nurse.

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Some of the concerns, demands, and needs which have influenced the
development of this theory include:
•The functionality of HNRs as a requirement for assisting in human caring.
•The possibility that patients, especially older adults and those with dementia
can gain well-being from dialogues and conversations with HNRs.
•The need for theories guiding nursing practice with HNRs.
•Accordingly, the following questions are posited:
•If HNRs are developed and introduced into healthcare facilities for older
adults, should not the ethical issue of robotic practice engagements be
prioritized and fully discussed and addressed for realizable solutions?
•What functionalities may be required of HNRs to engage in a compassionate, Click icon to add picture
nurturing relationship within the demands of robot performance?
•Should nurses and other key health care personnel still provide the required
health care tasks and practices considering human- to-human relationships, and
between humans and HNRs?
•These questions advance the transactive relationship theory of nursing
(TRETON) as focused on the constant and “active” transactional engagement
between the nurse, the HNR, and patient triad.

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Theoretical assumptions
The Transactive Relationship Theory of Nursing (TRETON) is a
middle-range theory grounded in the general theory of Nursing as
Caring. It is a critical and much-needed theory from which is
derived a practical process of nursing as a transactive engagement
expressed as nursing transpiring between the nurse and nursed - the
shared engagement between human persons (patients) and
intelligent machines (HNRs). This engagement is an active
interaction between the nurse and nursed co-existing in a transactive
relationship. The theory acknowledges ways in which human-to-
human and human- to-intelligent machine nursing encounters are
expressed in nursing

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Nursing is a relationship between and among human beings
(human persons) and intelligent machines (HNRs)
Influences HNR functionality. AI is necessary in HNRs. In order to
express caring in nursing, HNRs are used to enhance the quality of
nursing care by the “delegation” of healthcare tasks to the robots—
not to solve the nursing care problem, nor meet the demands of task
completion because of shortage of nurses or other health caregivers.

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Nurses use technologies of care
for practice Nurses are adept at technologies that aid the practice of
nursing. However, an understanding of and intentionality with the
code of ethical practice for nurses guides the suitable use of AI in
hospitals and in other healthcare arenas. Nurses must always
exercise sensibility with AI-capable equipment. Transactive
relationships are guided by ethical use of technology in nursing

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Transactive relationships are guided by ethics in nursing
Regardless of the level of sophistication in physico-mechanical
functions and intelligence, HNRs are expected to have a
programmed response system that is guided by ethico-moral
sensibilities. The possible problem that may arise in possible
contradictory situations is the dependency that robots may
encounter in relationship situations, simply because it is dependent
on human coded programs.

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Personal knowing:

• In nursing, nurses make efforts to share experiences with care participants (human persons as patients) through
human connections. In doing so, nurses know and understand the other person. Personal knowing is to recognize
images, fingerprints, and the individual persons. They record information regarding conversations with their
patients and record these in databases such as the electronic medical/health care record. These recorded data can be
shared by those authorized to access these data, and sharing these with the patients and other health care personnel
enables them to know and understand their patients more fully as persons.
Empirical Knowing:

• Nurses should consider the participants’ biological, psychological, sociological, cultural, medical, and spiritual
conditions - including their psychological state - in order to create appropriate and accurate nursing care activities.
In nursing care institutions, nursing skills mean technological expertise such as measuring blood pressure, heart
rate, and body temperature, and also observing the patient’s physical situation. The data collected from these
processes are automatically transferred from the measuring equipment to the database.

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Aesthetic knowing:

• In order to communicate what the nurse knows about the patient through this or her knowing, the nurse needs to
express this knowledge in ways that others can appreciate. So that nurses realize the care recipient’s wishes, or help
them grow as caring persons as they meander through the maze of human health care, they need to reflect on the
caring process and consider how to provide even better, more convenient, and more responsive care.
• For example, for his purpose, the nurse asks the patient’s latest wish or current desire, and the patient takes time
deciding his desires, hopes, dreams and aspirations. Human nurses may be able to capture these essences and the
accumulated data can be stored in databases. Moreover, personal effects such as photographs, and laboratory
information can be stored and made available to family members when appropriate. Information related to past
experiences including those of their parents are inserted into the database as accessible information. In this sense, it is
important to program into the robots such an interactive relationship. Therefore, in order to have HNRs function
within the Transactive Relationship Model, it is necessary to develop a computerized interface communication
process between HNRs and healthcare practitioners.
Concluding Statements Emphasizing Nursing Practice Applications

• A theory-guided nursing practice is integral to meet healthcare demands. Attaining good quality healthcare
particularly in situations in which human beings, robots, and patients are involved may be the common healthcare
practice in the very near future. Nursing caring practices involving intelligent machines with highly sophisticated
robotic functions such as interactive capabilities may be the best option for the increasing demand of health care
labor. Engaging in activities that assure good health within the changing and evolving world of human caring is
essential for human healthcare
• When these are able to express themselves through human-like emotive behaviors, they will be able to convey
empathic understanding to the patients and their families. Therefore, within the Transactive Relationship Theory of
Nursing,
12 a nursing encounter where all nursing occurs encompasses
Presentation title the process of nursing as technological 20XX
engagement and mutual knowin
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Thank you