NURS 3220S&O: Reflection on CaringPracticeRelational Practice

Andrea Gretchev, RN, BScN, MNWinter 2013

Learning Objectives

Learners will have the opportunity to:

1. Recognize “relational capacities” in self and others.

2. Identify challenges that interfere with relational caring practice.

3. Explore and understand the skills of relational nursing practice as outlined in the course pack reading.

Relational Practice

A relational approach recognizes that:

• Health, illness, and the meanings they hold for people are shaped by one's gender, age, ability, and social, cultural, family, historical, and geographical contexts.

• These contexts influence how nurses and other healthcare professionals view, relate, and work with patients and families.

• Nurses and other healthcare professionals must remain critically attuned to the significance of these contexts during the process of health assessment.

(Browne & Varcoe, 2009, p.37)

Relational Practice

When you think about your personal or clinical experiences, what characteristics do you think make a “good” nurse?

When you think about how the general population would perceive a “good” nurse, what do you think would influence whether or not their health care experience is a good one?

Relational Practice – Doane and Varcoe Reading

Letting Be

Listening

Self-Observation

Questioning beyond the surface

Intentionality

Interrupting Contextual Constraints

Reimagining

Relational Practice

Humanly involved process of…

RESPECTFUL

COMPASSIONATE

AUTHENTICALLY INTERESTED

INQUIRY

Relational Practice

Unlearn the habit of:

Looking for the master key or truth that will offer certainty in our practice.

Thinking that human experience is a problem to be solved.

Distancing ourselves and/or attempting to disconnect from people.

Decontextualizing people.

Letting Be

Being with people as they are

vs.

Our habitual practice of solving problems

Presencing and learning from others

Listening

“Listening is all the doing that is necessary to promote well

being” (Rogers)

Listening as opposed to waiting to speak/act

Listening using all our senses

Listening to come to know the client

Self-Observation

Conscious act of increasing self-awareness through self-reflection and intentional action.

“Conscious participation and self-knowing within the process of being in-relation” (Doane & Varcoe, 2005, p.204).

Questioning Beyond the Surface

Questioning assumptions and taken-for-granted knowledge.

Looking at all the variables that may influence a situation.

Considering families in context outside of health care encounter.

Noticing discrepancies and seeking further clarification.

Noticing patterns that signal something is being missed.

Posing questions and thinking critically using a broader perspective.

Intentionality

Possessing an awareness of values, beliefs, and theories that direct your knowing/being/doing

Choosing to follow values, knowledge, and behaviors or making a conscious effort to expand or change them.

Interrupting Contextual Constraints

Considering that the usual way of doing things may not always be the best way.

Questioning rationale for actions.

Voicing concerns.

Considering alternate points of view.

Advocating for change when warranted.

Refusing to participate in oppressive practices.

Reimagining

Looking at current situations, examining the contributing factors, and imagining how it can be

transformed (i.e. envisioning change).

Video

June Callwood and George Stroumboulopoulos

Reflect on how the interviewer uses the skills of relational practice

http://www.youtube.com/watch?v=Duif0tGZ4pc

Families and Relational Practice

We have examined families as a group of people with diverse variations in the composition of those groups.

Doane and Varcoe (2006) purport that characterizing families in this way is limiting as it still relies upon assumptions and sterotypes.

Family is dynamic and experiential – a process, rather than a static entity (p.11).

Viewing family as a relational experiences takes into account the influence of context, emotions, experience, environments, etc.

Families and Relational Practice

Hard spots – recognizing the differences between us and families and seeking the similarities.

Taking a stance of inquiry – investigating the experience of self and others.

Relational process - connecting across the differences.

Realizing that our way is not the only “right” way and meeting people where they are.

Honoring a family’s choices, boundaries, and right to decide when and how we enter their lives (through the screen door).

See the capacity and strength that lies within families.

Relational Practice and Technology

How does our dependence on technology influence our ability to engage in relational practice?

TED Talk

Sherry Turkle: Connected, but alone?

http://www.ted.com/talks/sherry_turkle_alone_together.html

References

Browne, A. & Varcoe, C. (2009). Cultural and social considerations in health assessment. In Jarvis, C., Brown, A.J. MacDonald-Jenkins, J. & Luctkar-Flude, M. (Eds.), Physical Examination and Health Assessment: First Canadian Edition (pp.35-39; 46-50). Toronto: Saunders Elsevier.

Doane, G.H. & Varcoe, C. (2005). Family nursing as relational inquiry (pp. 200-209). Philadelphia, PA: Lippincott, Williams & Wilkins.

Doane, G.H. & Varcoe, C. (2006). The “hard spots” of family nursing: Connecting across difference and diversity. Journal of Family Nursing, 12(1), 7-21. doi: 10.1177/1074840705284210

Thank you

douglascollege.ca