Midterm 1 Flashcards
What is relational inquiry?
is a highly reasoned, skilled action that involves:
a) a relational orientation
b) a thorough and sound knowledge base
c) sophisticated inquiry and observational and analytical skills
d) strong clinical skills including clinical judgement, decision-making skills, and clinical competencies
e) particular ways of being
What is a relational orientation?
It is a way of thinking and focusing your attention. Specifically, attention is focused on what is going on at and between the intrapersonal (within), interpersonal (between), and contextual levels of healthcare situations
What is inquiring action?
Action that enables you to look underneath and around the surfaces of what you are observing to ask what might be influencing, shaping, and/or determining what is transpiring and how best to intervene
What are reference points?
informal and unconscious rules or structures from which we work. It provides the framework that determine what you focus your attention on, the automatic rules from which you work, and the choices you consider.
How can one’s habits of knowing limit one’s nursing practice?
Habits of knowing are considered “taken for granted” truths that shape our practice. Without examining our habits, we may accidentally be practising in ways we do not intend (i.e., the medical model)
What does it mean to be an intentional theoretical practitioner in nursing?
All nursing is theoretical, knowledgeable and competent nursing practice is about “living” different theories in your practice. A conscious and intentional practitioner uses theories but also examines and critiques them.
Critique the use of an individualist lens and the benefits of a relational lens
The individualist approach focuses on the individual without considering the influences that shape their actions - nurses may see themselves as personally responsible for the care they deliver and this may lead to a “half-empty” view of nursing care that can be demoralizing and lead to depersonalizing clients.
Relational inquiry at its very core, it s practice of intention - of focusing attention and action in a more conscious and intentional manner. It is not about changing the RESULT, it is about changing the PROCESS and the EXPERIENCE.
How does relational inquiry contribute to patient/client/family/nurse well-being?
According to Doanne and Varcoe, relational inquiry encompasses empiral knowing, personal knowing, and socio-political knowing. This relational inquiry approach provides the structure and processes to understand the complexities of nursing practice. It enables the nurse to consider the interplay between and among factors that impact the client.
According to Bramley and Matiti, what is compassion and how can it be expressed by nurses?
Compassion was described by the patients to be “knowing me and giving me your time”. In this sense, compassion and caring are used almost interchangeably and small gestures can be as impactful as large gestures (i.e., touch) when time is limited. It is expressed through attitude and small actions from nurses. Patients also expressed an overwhelming desire for empathy, “how would I feel in their shoes?”
What are Watson’s 10 Carative Factors?
- Formation of a humanistic-altruistic system of values
- Instillation of faith-hope
- Cultivation of sensitivity to one’s self and to others
- Development of a helping-trusting, human caring relationship
- Promotion and acceptance of the expression of positive and negative feelings
- Systematic use of a creative problem-solving caring process
- Promotion of transpersonal teaching-learning
- Provision for a supportive, protective, and/or corrective mental, physical, societal, and spiritual environment
- Assistance with gratification of human needs
- Allowance for existential-phenomenological-spiritual forces
What is caring, according to Watson?
it is fundamental to nursing practice and serves as the unifying force of nursing. It is defined as “a conscious judgement that manifests itself in concrete acts interpersonally, verbally and nonverbally”
Define Watson’s Carative Factor 1: the formation of a humanistic-altruistic system of values
According to Watson, it is a philosphy that relates to satisfaction through giving an extending oneself. The formation of an altruistic system of values takes place through the process of values clarification. Through the process of forming an altruistic system of values, the nurse develops a “caring consciousness” where the values that support humanistic caring are freely chosen, cherished, and habituated.
Define Watson’s Carative factor 2: The instillation of faith-hope
This carative factor encompasses making possible a sustaining and deep belief system of hope. Even when there are no further medical options, nurses can foster patient’s faith and hope in their own potential, health regime, and in resources to carry them through. The nurse can use cognitive restructuring interventions to challenge patients “to change thought patterns and view self and world more realistically”
Define Watson’s Carative factor 3: The cultivation of sensitivity to one’s self and to other
According to Watson, nurses need to develop a recognition and acknowledgment of feelings, one’s own as well as the feelings of others. By being sensitive to other’s feelings, nurses show empathy, compassion, and understanding. Sensitivity is grounded in the awareness that what happens to one affects the other and this awareness transfers into actions. This can be achieved through “bearing witness”, which is turning toward the patient’s need and attesting to the authenticity of the individual’s experience through unconditional presence and therapeutic listening.
Define Watson’s Carative factor 4: The development of a helping-trusting relationship
According to Watson, to develop a helping-trusting relationship, the nurse must first know the person, such as the “person’s self, life, space, and phenomenological view of his or her own world”. This can be achieved through authentic presence which requires an open attitude and attention focused exclusively on the patient to be fully available to the patient.
Define Watson’s Carative factor 5: The promotion and acceptance of the expression of positive and negative feelings
This carative factor incorporates actions of being open to, nonjudgemental of, and supportive of the expression of positive and negative feelings from the patient. It involves active listening, which is attending closely to and attaching significance to a patient’s verbal and non-verbal messages.
Define Watson’s Carative factor 6: The systematic use of creative problem-solving process
According to Watson, creative problem-solving is implemented as nurses engage in the “artistry of caring-healing practices”. Nurses use knowledge from the affective, and psychomotor domains. Creativity involves generating fresh ideas, originality, and independent thought rather than relying on learned ways to solve problems. This may be witnessed through nursing advocacy.
Define Watson’s Carative factor 7: The promotion of interpersonal teaching-learning
Teaching-learning is interpersonal with the critical aspect being the way the nurse approaches patient learning rather than the mere act of providing information. Transpersonal teaching-learning engages the patient and the nurse and requires awareness of readiness to learn, respect for and use of pre-existing knowledge, concern for the patient, understanding of perceptions and feelings about the content, attentiveness to the patient’s preferred domain of learning, and health goals and desired outcomes. An example might be providing sensation information to the client prior to a procedure.
Define Watson’s Carative factor 8: The provision for supportive, protective, and /or corrective mental, physical, societal, and spiritual environment
Nurses provide caring actions by providing mental, physical, social, and spiritual environments. In each of these environments, actions are called for which potentiate beauty, comfort, dignity, and peace. The internal environment encompasses mental and spiritual well-being of the patient and includes values, attitudes, and beliefs about one’s way of life. the external environment includes the physical and social surroundings around the patient. In using a holistic model, the external and internal environments affect each other. In tending to the physical environment, the nurse provides a sacred place that soothes and heals the body, mind, and spirit. An example might be Milieu therapy.
Define Watson’s Carative factor 9: Assistance with the gratification of human needs
According to Watson, the gratification of both lower-order (physiological and safety) and higher-order (belonging, esteem, and actualization) needs is essential for the “protection, maintenance and enhancement of self”. Examples can include the use of purposeful touch.
Define Watson’s Carative factor 10: Allowing for existential-phenomenological-spiritual dimensions of caring.
According to Watson, this type of nursing care addresses the identity of each person, pulling out personal meaning in each situation. Nursing practice supports the subjective appreciation of the patient’s inner world. In the search, the nurse joins with the patient in finding meaning and wholeness in life.
Describe current threats to to caring in nursing
- Technological advances: increased workloads, higher acuity patients - may challenge ‘time’ to spend caring
- Emphasis on the medical model: focus is on the disease and not the person
What is the Shifting Perspectives Model?
It is a model that shows living with chronic illness is an on-going, continually shifting process in which people experience a complex dialectic between themselves and their “world”. The experience of chronic illness is depicted as ever-changing perspectives about the disease that enable people to make sense of their experience.
What is the illness-in-the-foreground perspective?
Part of the shifting perspectives model, it is characterized by a focus on the sickness, suffering, loss, and burden associated with living with a chronic illness; the chronic illness is viewed as destructive to self and others. People who assume this perspective tend to be absorbed in their illness experience and often have difficulty attending to the needs of their selves and others.
What is the wellness-in-the-foreground perspective?
Part of the shifting perspectives model, it is characterized by the appraisal of the chronic illness as an opportunity for meaningful change in relationships with the environment and others. The person attempts to create consonance between self-identity and the identity that is shaped by the disease, the construction of the illness by others, and by life events. In the wellness in the foreground perspective, the self, not the diseased body, becomes the source of identity.
According to Reed and Corner, what is illness trajectory?
It refers to the events over the course of illness which are shaped by the individual’s response to illness, interactions with those around them and interventions.
Define the pretrajectory phase of chronic illness
This phase might involve describing events before diagnosis such as reasons for the diagnosis and progression of the disease, as well as early treatment. Also includes the onset of symptoms.
Define the trajectory onset phase of chronic illness
This phase includes the onset of symptoms and communication of diagnoses as well as the adaptation to and assimilation of the diagnosis and seeking support.
Define the living with progressive disease phase of chronic illness
This phase includes enduring sequential treatments and dealing with symptom burden as well as relentless vigilance.
Define the downward phase of chronic illness
Is characterized by episodes of illness and crisis of increasing frequency.
