Relational Work

Question 1

Describe the difference between ‘I-it’ relationships vs. ‘I-thou’ relationships.

Answer 1

Martin Buber & C. Terry Warner Theory of Caring
(theme- objectification of pt w/in interpersonal relationships)
- I-IT (resistant) - detached, uninterested, see them as a patient not a person
- I-THOU (responsive relaitonship) - share humanity, authentically connect and facilitate healing

ex: avoid micro-objections - ask preference (brush teeth before/after eating)

Question 2

List and explain three key principles that inform the therapeutic relationship

Answer 2

1. A relationship where the focus is on meeting the needs of the person receiving care
2. The needs of the caregiver are met outside the therapeutic relationship
3. Characterized by principles of empathy, compassion, and caring

Question 3

How is the work of healing distinct from the work of curing?

Answer 3

• Cure: being disease free. May or may not be possible
• Healing: learning to cope, becoming a new person, becoming a whole person (getting ill/injured can distupt their identity), think of healing in terms of emotional, psychological and spiritually. Always possible, not matter of curing possibility

Question 4

How are patients objectified in hospital environments? Why does that happen?

Answer 4

• as soon as they get admitted, they change into a gown and become a patient (takes away identity)
• when people are treated less than human, can be many micro-objections like not caring about preferences.

WHY?

• high nurse:patient
• cost-cutting
• bed pressures
• health care is less about humanity, more about efficiency

Question 5

What is the cumulative impact of objectification on patients?

Answer 5

physical impact:

• incr. HR, BP, RR
• impaired sleep
• digestion issues
• elevated blood glucose
• increased pain

emotional impacts

• anxiety
• fear
• stress
• emotional distress

Question 6

What does being attuned to patients allow nurses to do within the context of the therapeutic relationship?

Answer 6

• Causes us to notice things
• Make us curious about people
• Draw us into rhythmic interactions
• Allows to see the impact that our own presence in the room has on our patients
• Help us align ourselves with others
• Allows us to see a person as a person
• Compels us to claim a stake in the welfare of the person we’re caring for
  → become attuned to another person when you get interested in getting to know them. It helps us notice things about the patient (body language, etc.)

Question 7

Describe the purpose of deep listening.

Answer 7

Listening is a clinical act, it is collecting data and is solution/intervention focused
Deep listening is honoring the person who is ill by providing the space for them to share their story so they can make sense of what’s happening and work through it
- when you see the other, listen to and hear the other with undivided attention

Question 8

How do objective and subjective forms of knowledge act synergistically in the pursuit of curing and/or healing the patient?

Answer 8

Understanding our patient in a clinical way (objective) is important, as is knowing our patient by understanding their story.

1. Subjective: contextually situated. About the lived experience of illness, that would be impossible to know, without an illness narrative (storytelling).
   - The subject is the expert of the illness. (monitoring bodily processes, distressed caused by it, ability to cope, daily life, new normal- unknowable until told)
2. Objective: logical, empirical - directed by hypothesis and evidence. - - Focus on cause/effect.
   - disease focused (vs. illness)
   - clinical recognition is limited to alteration in biological structures/functioning
   - clinician is expert
   (shields clinician from messiness of illness, distills it down and focuses on physiological processes and treatments. the personhood is secondary to the disease)

Question 9

Why does Arthur Kleinman suggest that we need to explore the meanings of our patient’s symptoms as they define them?

Answer 9

we all interpret changes in our body and describe it in deeply subjective ways. It is shaped by our identity, culture, and past experiences. The meaning we assign changes.
Ex: a woman says she has cramps, someone thinks it’s no big deal bc its just menstrual cramps. Maybe she has endometriosis, or a non-menstruating pain
EX2: Power of positivity with cancer - shared understanding if you are positive it will get better. ‘Just believe’.

Question 10

List three wondering questions you might ask a patient after they receive a diagnosis of a life threatening illness.

Answer 10

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Question 11

Describe the concept of comfort and identify two factors that have been found to influence patients’ comfort.

Answer 11

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