week 8 Relational Inquiry

Question 1

What is relational Inquiry according to Doan & Varcoe?

Answer 1

relational inquiry is an approach to nursing education and practice that will help you understand how to relate to people as a nurse.

Question 2

What is the difference between relational PRACTICE & relational INQUIRY?

Answer 2

Relational practice - the caring, interpersonal dimension of nursing
- this is often thought of when we use the word “Relational” and speak of a relational orientation

Relational Inquiry - a relational orientation goes beyond the interpersonal level (what happens between and among individuals) and includes an examination of the intrapersonal, interpersonal, and contextual dimension of client/patient situations.

Question 3

What is and is not relational Inquiry?

Answer 3

NOT…
- confined to the nurse-patient
- “soft” - confined to interpersonal communication
- not only about developing relationships

IT IS…
- An approach to nursing practice - helps you learn “how” to approach each and every nursing situation
- guides you to enter each nursing situation as an inquirer, inquiring into the experiences of people (including yourself)
- a way of focusing your attention
- helps you to see patients as human beings who are connected to families and friends; see how people are shaped by everyone and everything in their worlds
- includes how you are shaped by outside influences
- helps you determine effective action

Question 4

What are the 2 key components of relational inquiry?

Answer 4

1. Relational Orientation
2. Inquiring Action

Question 5

What is relational orientation?

Answer 5

• a way of thinking and focusing your action
• specifically, attention is focused on what is going on and between the intrapersonal, interpersonal, and contextual levels of health care situations

Question 6

What is Inquiring action

Answer 6

• determining effective action
• this offers a wider and deeper understanding of any situation
• it helps you determine what is most significant and identify other knowledge or info you may need to determine the most relevant action
• IMPORTANTLY, questioning your analysus of any situation on an ongoing basis

basically figuring out what is the most effective action in the situation by considering all factors after gathering significant info from the situation

Question 7

What does it mean by the Intrapersonal, interpersonal, and contextual aspects in the Relational Orientation?

Answer 7

intrapersonal - what is going on within all people involved

interpersonal - what is going on among and between people - how people are acting in the situation, what they are prioritizing, etc.

Contextual - what is going on around the people and the situation

Question 8

What is Uncertainty & Complexity

Answer 8

• this is when a nurse walks into a client’s room and needs to decide what to do first
• the situation is further complicated when clients cannot express their needs
• in these complex contexts, the nurse must grasp the meaning of the situation and determine what is relevant
• the process of GRASPIG involves determining the significance of what we see, hear, touch, and smell; this includes emotions, objects, gestures, and sounds

Question 9

What are some things to consider about Relational Orientation?

Answer 9

• their life
• their story
• what has brought them here to this moment
• who is with them
• who is not with them
• how were they talking to the last person in the room

basically considering what is occurring among people and their contexts

Question 10

What is a decontextualized View?

Answer 10

sees people decontextualized from their worlds
- sees people as a “person with a diagnosis”

Question 11

How does Context affect nursing?

Answer 11

• it helps consider what is shaping the lived experience within, between, and around the patient/family or health care situation
• Ex. many women experience going through treatment for breast cancer, but as unique beings that have lived different experiences particular to them, the meaning of the illness and the best treatment will vary

Question 12

What are the 3 most common distinct nursing identities found by Kelly, Fealy, & Watson?

Answer 12

1. the nurse as a skilled knower & bearer
2. The nurse as a sexual plaything
3. The nurse as a witless, incompetent individual

Question 13

What is the service provision model (McKnight)?

Answer 13

it claims that people with health problems require outsiders to meet their health needs; how health care is delivered.
- systems of health care are based on a service provision model
- many nurses relate to patients as people in need of a service
- dominant within practice and is most often the central point of reference from which health care providers act

Question 14

what did Self provision model within home care look like?

Answer 14

• only focusing on the “technical” biomedical service versus the patient
• nurses are allotted a certain amount of time to get in and get out of each household based on estimated time it take to complete the “required” medical task (ex. dressing change, IV line flush, etc.)

Question 15

What are reference points?

Answer 15

*Formed habits that we sometimes automatically fall back upon or default to.
*Relational inquiry involves understanding one’s past reference points and “shifting them to people and situations as they are” (Hartrick Doane & Varcoe, 2015, p. 326).
*Reference points are indicators that orient us in the world
*Reference points for nurses are often based on “providing a service” and are problem focused rather than client-centered and strengths based

Question 16

What is wrong with an emphasis on behavioural & technical skills within nursing? Are these skills the essence of nursing?

Answer 16

*They are not based on the health promotion approach you learned about last term
*It is not that the biomedical reference points are incorrect
*Eg. Woman presenting in ER with anxiety/difficulty breathing
*if your reference point is efficiency then getting Ativan prescribed to calm the woman will help her calm down and then send her on her way
*but if your reference point is health promotion (upstream), most likely this woman will be back again because the underlying cause of her anxiety has not been addressed.

Question 17

How does relational appraoch incorporate a strengths-based focus?

Answer 17

it encourages nurses to:
*question your priorities – patients or the institutional demands
*Prioritizes nursing care so relationships and people versus providing a service
*Focus on patient strengths versus deficits

Question 18

What are habits that support relational inquiry?

Answer 18

• Developing the habit of knowing/not knowing
• Developing the habit of humility
• Developing the habit of looking with fresh eyes

Question 19

What are the Five C’s (Nursing Capacities) of Relational Inquiry (Doane & Varcoe)?

Answer 19

• Be compassionate
• Be curious
• Be committed
• Be competent
• Correspond to what is

Question 20

What does it mean to “Be compassionate”?

Answer 20

to share suffering”
* “is being with and enduring with someone”
* To be able to relate human being to human being, to share something of ourselves and of what it is to be human.
* Requires very conscious intent and a particular way of being.
* Nursing programs and clinical experiences teach you to see your role as “fixing your patients’ discomfort” – we feel obligated to somehow alleviate patient’s pain & suffering

Question 21

What does it mean to “be curious”?

Answer 21

Being interested, inquisitive and open to uncertainty
* It is the capacity to work in between knowing and not knowing
* It is crucial that nurses learn to work in uncertainty, to be humble and to critically question the knowledge that is guiding us.
* Being confident and curious.

Question 22

What does it mean to “be committed”?

Answer 22

*to actively and intentionally identify the values and concerns that orient your work as a nurse and continually monitor how your actions are aligning with those commitments.
*Example: If you value patient-centered and/or family-centered care then you find time in your day to be with your patients and their families

Question 23

What does it mean to “be competent”?

Answer 23

*TRADITIONAL VIEW = Confident and safe practitioner who provides holistic care… competence lies within the individual nurse.
*RELATIONAL INQUIRY VIEW = competence is the nurse’s unique understanding of people/patients that is unique from one patient and situation to the next.
* Eg. two people in the Emergency Department. Both with leg lacerations. One is a frail older lady who is alone, and another is a 40-year- old lady. The 40-year-old arrived first and has their partner with them. The 40-year-old been waiting longer.
*Competence involves recognizing that the elderly lady is alone, appears tired, and has no one with her and making the decision to bring her in first.

Question 24

Correspond to what is…

Answer 24

*“Relating to people in a way that is meaningful to them”
*Nepo’s post-operative experience (from Doane & Varcoe)
*Nepo describes how, while “barely awake,” the “burly first nurse” pulled back his covers wanting him to walk. “‘I just looked at her,’ [and] she swung my legs to the edge of the bed”.
*In contrast, the second nurse “appeared with a washcloth for my forehead. She looked at me with compassion, took my hand and said in a firm whisper, ‘The rest of your life starts here.’ I started to weep. The rib that was removed the day before was now cooling in a jar in the lab while I, sore in every way, was straining to get out of bed . . . But she was right, and so, with much help, I put my feet to the floor and began”.