Week 3B: Relational Practice, Relational Inquiry

Relational Practice, Relational Inquiry Readings: pg 722-729 (part of CH 27) + 2 articles Relational Practice Competencies - Communicating in an authentic and responsive manner is fundamental to creating relational space and advancing the nurse-client relationship - Authenticity: In order to make meaningful connections with clients, you need to be true to yourself, actively present, and genuine in how you communicate and interact with clients - Being self-aware, reflecting, and analyzing the congruence between the values, beliefs, and attitudes you verbalize and demonstrate with those you actually use in practice will help you achieve authenticity in relational practice - Active Listening: Clients often become disillusioned with the healthcare team/system when they feel their voice has been silenced or their concerns are not heard or responded to. When engaged in active listening, the nurse is present both physically and emotionally, expresses genuine interest, takes the initiative to understand, and provides feedback to ensure the client feels heard - Although it is essential for nurses to truly listen to what the client is saying, it is equally important to listen to what he or she is not saying - SURETY: sit, uncross, relax, eye contact, touch, your intuition - Self-awareness: listen and watch others, self-disclosure, seek feedback etc. - Empathy: empathy is the ability to emotionally and cognitively understand and communicate the experiences and feelings from another’s point of view - Rapport: rapport is the primary influencing factor in the development of trust and understanding within the nurse-client relationship - Trust: trust is described as an evolutionary process and an attitude in which an individual relies with confidence on another - Good communication, knowledge, respect, honesty, confidence, self reliance, and commitment are essential elements of trust - Self-disclosure and confidentiality: self-disclosure on the part of the nurse should occur only if the information is deemed to be therapeutically beneficial to the client. Confidentiality is a moral obligation of non-disclosure and implies that the information a client chooses to disclose will not be shared without consent - Mutuality and Intentionality: mutuality can be defined as finding common ground in other’s experiences, goals, values, beliefs, thoughts, and feelings. Intentionality is a spectrum/continuum. - Reflective practice: reflective practice is a process of mentally reviewing, analyzing, and comprehending events, situations, and actions that occur in our everyday work and personal lives. The use of reflection ensures nurses are continually learning by assimilating theory into practice and developing self-awareness, all of which contributes to safe, competent, ethical care and communication https://journals.sagepub.com/doi/10.1177/0969733020912523 https://edelweisspublications.com/edelweiss/article/Relational-Practice-Nursing-Case-AnalysisNHC-16-102.pdf - - - - - - - Relational nursing practice is an understanding of patients’ health care needs within complicated contexts, in which patients experience health care and nurses deliver nursing care - Contextual factors include personal elements, such as gender, age and ability, and sociopolitical elements, such as economic, cultural, historical and geographical ones. From the perspective of relational practice, nurses examine how personal capacities and socioeconomic limitations impact on the live experience of patients, decision making, and management of their health care. Five relational capacities: - initiative, authenticity, and responsiveness; - mutuality and synchrony; - honoring complexity and ambiguity; - intentionality in relating; - and re-imagining. Teaching and learning in nursing education often focus on mechanical skills and technical interventions rather than social aspects of health care and effective advocation The nursing ethics codes and standards are valid when encouraging individual principles such as beneficence, nonmaleficence, autonomy, justice, and other caring aspects of nursing practice. However, the abstract principles of ethical codes are inadequate to address relational aspects of nursing practice, such as context, historical changes, cultural concerns, character and relationship - Relational ethics, which recognize the interpersonal and relational nature of nursing practice, encourage the partnership between nurses and patients, sharing power and knowledge Nurses have three obligations in their professional practice: - practicing reflexively, - providing relational space for difficulty, - and working at all levels to enhance the potential for health STORY: Mrs. X was diagnosed with diabetes at age 81 and was taught how to give insulin injections but told a nurse she won’t do it when she gets home. The nurse asked her about how she felt about needles and talked to - - - 1. 2. 3. 4. 5. 6. 7. the patient for a few minutes each day and developed a therapeutic relationship and she got oral diabetic medication instead. - Beliefs, values, and structural factors influenced the nurse not to communicate with relational practice to Mrs. X. - Reflective actions and questions allowed the nurse to open up and question her assumptions and biases and lead her to be more open to communicating - Both the concepts of cultural safety and relational practice require nurses to look beyond the surface of people, relationships and situation to recognize psychosocial context, cultural diversity and power imbalances relational practice should be initiated at the very beginning of patient contact. Authentic, interested and intentional inquiry about a patient’s experiences and needs is an obligation of nursing practice Second, I should have constantly reflected on how my personal assumptions, social location, and biased valued impact on my nursing care. Reflexivity is both a need of nursing practice and an obligation of professional nurses Finally, my relational practice should not stop at nurse-patient interpersonal contact level. Nurses have obligation to act at all levels to influence health care and clinical practice Relational practice requires nurses to look beyond the surface of people, situations and relationships to find out the contextual factors which are unseen or ignored but shaped our nurse-patient interaction. Nurses need to be aware of the socioeconomic and political issues in our society and recognize how these issues impact on people’s health care in Canada, a multicultural society, it is essential for nurses to understand the cultural issue and provide cultural safety in their practice Third, relational practice emphasizes the significant of respect in nursing care. Relational practice requires that nurses demonstrate respect for patients’ culture, age, sex, beliefs and values, health care decision and preference. relational practice renews the content of nursing ethics. In order to practice ethically, nurses need to not only follow codes and standards, but more importantly understand patient’s experiences contextually and act on their best. nursing management and leadership should be involved in relational practice. Nursing schools should consider to incorporate critical social theory into nursing curricula and to educate students about cultural diversity and other psychosocial health determinants. relational practice has important implications in nursing research. Critiquing the influence of liberalism on nursing science should be a focus of nursing research. https://journals.sagepub.com/doi/10.1177/0969733020912523 - This article cannot be accessed