Exam One

Relational Inquiry Involves

1. Relational orientation

2. Strong knowledge base

3. Inquiry, observation, and analytical skills

4. Clinical judgment, decision-making, and clinical skills

5. Particular ways of being

Relational Inquiry Orientation

A way of thinking that focuses on what’s happening within and between the intrapersonal, interpersonal, and contextual levels.

Intrapersonal

Relationship within yourself. What’s going on inside a person. ex. what’s going on inside your patients head

Interpersonal

relationship between people (relational practice)

Contextual

What’s happening around the person, including the structures and forces influencing the situation and shaping personal and interpersonal responses.

Relational Inquiry vs Relational Practice

• Relational inquiry: Broad; examines intrapersonal, interpersonal, and contextual dimensions.

• Relational practice: Focuses mainly on the interpersonal level.

5 W’s of Conscious Inquiry

WHAT are you relating to?

WHO are you relating to?

WHY are you relating?
WHEN are you relating?

WHERE are you relating?

Marie Rollet Hébert

1588-1694.

Went against notion that the indigenous people needed saving, educated indigenous children

Jeanne Mance

1606-1673.

First lay nurse in north america, founder of the hospital hotel deux in montreal

Marguerite d’Youville

1701-1777.

Moved nursing care into the community and out of christian sanctuaries, “mother of the poor”, fought for/advocated for people of low social economic status/low income

Florence Nightingale

• founder of modern nursing

• “Lady of the Lamp”

• went around british war camp with a lamp to check on the injured soilders

• improved environment for soldiers and lowered the death rate by alot with her documenting

• improved sanitation, nutrition, hygiene, ventilation and she opened the first nursing school based on these principles

• she was a philanthropist, wealthy, educated, went against the norm, very racist, thought there was no place for men in nursing

Charlotte Edith Anderson Monture

• Mohawk First World War veteran and registered nurse (1890–1996)

• First Indigenous woman in Canada to become an RN

• First Indigenous woman to serve in the U.S. military

• Gained the right to vote federally in Canada through her wartime service

• Broke barriers for Indigenous women in nursing, the military, and voting rights

First Nursing School in the World

Nightingale Training School for Nurses in 1860 at St. Thomas’ Hospital in London, England.

Who was nursing school often pursued by in history?

Often pursued by women who were working class or part of a religious sisterhood

First Nursing School in Canada

Mack’s General.

Moto was: “I see, and I am silent”

Based in service and practical skills

Mary Anges Snivley

• saw deplorable conditions in hospitals for nursing students

• formed Canadian National Association of Trained Nurses in 1908 (became CNA in 1924)

Nursing Education in 1909

approx 70 hospital based schools established across Canada (remained prominent until 70s)

Nursing Education in 1919

first university program at UBC

Nursing Education in 1959

first masters in nursing at university of western

Nursing Education in 1970-80s

non university diploma programs moved from hospital schools of nursing to community colleges

Nursing Education in 1980s (mid)

collaborative partnerships between colleges and universities

Nursing Education in 1991

first doctoral program (university of alberta)

Factors Influencing Nursing Education and Practice in Canada

• social determinant of health

• Ageing population

• Chronic disease

• Mental health issues

• Poverty and homelessness

• Immigration and new Canadians

• First Nations, Inuit, and Metis people

• The environment

• Disease patterns

• Healthcare system change

• Nursing workforce changes

• MAiD

• Legalization of cannabis

• COVID-19

Concept

• An idea representing an aspect of human experience

• Building block of theory

• Helps nurses understand and describe situations/circumstances

Theory

• Uses multiple concepts to describe, explain, or predict a phenomenon

• Organizes knowledge and helps advance nursing practice

• Supported and refined through research

• Can be tested

• A model is a visual representation of a theory and shows relationships between concepts

Nightingales’s 4 Theoretical Assumptions about Nursing and Healthcare (Environmental Theory)

• Nurse-client relationship is important

• Environment directly affects client well-being

• Fresh air, clean water, cleanliness, and light promote health and recovery

• Poor environmental conditions can contribute to illness

• Nurses modify the environment to improve client outcomes

Use of Theory in Knowledge Development

• Nurses use theory in client care, education, administration, and research

• These areas of practice also help develop and improve nursing theories

Metaparadigm

• Broad framework for how a profession views the world

• Describes the main concepts important to a profession

• Acts like a lens for understanding the discipline

Nursing Metaparadigm

• Nursing

• Person

• Health

• Environment

Nursing Theories

• Knowledge used to describe and explain concepts in nursing practice

• Grand theories: broad theories (e.g., Nightingale, Watson)

• Mid-range theories: more focused (e.g., Pender’s Health Promotion Model)

• Practice theories: used in specific nursing care situations

Nursing Theorists

Hildegard Peplau (1909-1999)

Virginia Henderson (1897-1996)

Jean Watson (1940-)

Laurie Gottlieb

Barbara Carper

Hildegard Peplau

• Nursing Theorist

• 1909-1999

• Theory of interpersonal relationships

-therapeutic relationship, mental health settings

-highlighted the four phases of the nurse-patient relationship (identification, orientation, exploitation, termination)

Virginia Henderson

• Nursing Theorist

• 1897-1996

• Definition of Nursing (confusion of medicine and nursing at the time so he came up with a definition for nursing)

-nursing care based on 14 basic needs

Jean Watson

• Nursing Theorist

• 1940-

• Theory of Human Caring

-establishment of the caring relationship to treat the body, mind, and spirit

-a “caring moment”, connection/transformation

Laurie Gottlieb

• Nursing Theorist

• Strength Based Care

Barbara Carper

• Nursing Theorist

• Ways of Knowing

Patterson & Zderad’s Humanistic Nursing Theory

• Builds on Peplau’s interpersonal nursing work

• Nursing is an experience between people; focuses on “being,” not just “doing”

• Emphasizes presence, awareness, and nurse-patient connection

• Intersubjective: shared nurse-patient experience

• Promotes growth or “more-being”

• Focuses on being with/doing with, dialogue, and the here and now

Characteristics of Humanistic Nursing

1. nursing as being with and doing with

2. nursing as dialogue

3. nursing as here-and-now

4. nursing in situations

5. nursing all-at-once

6. nursing as complementary synthesis

How nursing theory supports a nursing standpoint

• Nursing knowledge improves patient/family, nurse, and system well-being

• Theory guides how nurses focus, inquire, interpret, and act in practice

The Fundamental Patterns of Knowing

• Empiric

• Ethical

• Aesthetic

• Personal

• Emancipatory

Personal Knowing

Understanding and reflecting on how your own feelings, values, attitudes, and experiences affect nursing care, relationships, and biases.

Ethical Knowing

Knowing what ought to be done by considering what is right, responsible, and important when making nursing decisions.

Aesthetic Knowing

The art of nursing—understanding the meaning of a patient’s unique experience and responding intuitively and appropriately in the moment. Not what you do but how you do it.

Empirical Knowing

The science of nursing—using observable, measurable, and verifiable evidence, testing, and logical reasoning to guide care.

Emancipatory Knowing

Understanding inequalities and taking action to reduce injustice and create change.

Self Concept

• sum of beliefs about self

• facilitated by self reflection

Temporal & Spatial Aspect of Self Concept

Temporal: How self-concept changes over time due to life experiences, positively or negatively.

Spatial: How the environment and surrounding factors influence self-concept, positively or negatively.

Self concept in yourself

Professional - who you are as a professional

Personal - who you are as a person

• pos in that one makes the other stronger

• neg in that they can leak into each other

self concept through early attachment and growth and development

• Erikson - how self concept is developed

-Infants and Children: how caregivers react to kids emotions impacts their concepts

-Adolescents and Young Adults: peer groups, they develop self identity

-Mature and Older Adults: ability to preserve ego (healthy, productive life, ability to deal with problems)

Bronfenbrenner’s Ecological Systems Approach

The way these systems interact impacts self concept

Self Esteem

How positively or negatively a person views their own worth, shaped by life experiences, parents, and interactions with others; low self-esteem may contribute to feelings like imposter syndrome.

Discouragement

Repeated failures can lead to frustration, anger, fear, depression, and diminished self-concept, especially when there is a gap between the ideal self and real self.

Realistic Encouragement

Positive, realistic messages help build self-esteem and confidence by promoting feelings of belonging, competence, and self-worth.

Individualism and Self Concept

• western view

• creates a measuring stick for self concept

• not universally shared (diff worldviews exist that promote connections with family, community, and environment instead of the individual)

Illness and Self Concpet

Illness can affect self-concept through physical or mental changes, changes in independence/functioning, appearance, and ability to perform roles.

developing personal knowing

A conscious and purposeful effort to understand yourself and connect self-awareness with your actions — “do what you know and know what you do.”

Authenticity of Self

• Being genuine and self-aware by practicing tolerance, reflecting on your feelings toward others, and using strategies like journaling or meditation to stay centered.

Strengths-Based Care

• requires one to be aware of personal strengths, vulnerabilities, and weaknesses

• 11 strengths are necessary to practice SBC and others and are developed over time

SBC requires 4 major categories of strengths:

• mindset

• knowledge and knowing

• relationship

• advocacy

Strengths of Mindset

Qualities that contribute to a set of attitudes, outlooks, philosophies, or values that affect one’s way of behaving.

Subcategories of Strengths of Mindset

• Mindfulness - being aware of and in tune with self

• Humility - understanding of own qualities and limitations

• Open-mindedness - willingness to seek out and be open to different ideas

• Nonjudgmental attitudes - tolerance for others beliefs, values, behaviours

Strengths of Knowledge and Knowing

Qualities needed to acquire and use information. ask “why” questions

Subcategories of Strengths of Knowledge and Knowing

• Curiosity – internal desire for experiences and knowledge

• Self-reflection – capacity to critically examine one’s own thoughts, emotions and actions, as well as others

Strengths of Relationships

Qualities needed to connect with others and create and maintain a collaborative partnership.

Subcategories of Strengths of Relationships

• Respect and Trust - cornerstone of any relationship

• Empathy - most essential thing for caring for another person

• Compassion and Kindness - fundamental ways of behaving toward another human, especially when dealing with suffering

Qualities of Empathy

- perspective taking

- non-judgmental

- recognizing emotion

- communication of that emotion

Strengths of Advocacy

Qualities that are needed to protect, stand up for, and defend another person and family

Subcategories of Strengths of Advocacy

• Courage - standing up for beliefs

• Self-efficacy - persons beleif that they can perform a behaviour and produce a desired outcome

Nursing must ensure their actions:

• promote health and healing

• are ethical and safe

Challenges in Determining Nursing Obligations

Ethical codes outline the values and principles nurses must follow but do not always explain what to do in specific situations or consider context, history, culture, character, and relationships.

Relational Inquiry and Nursing Obligations

Relational inquiry helps nurses understand and interpret their obligations by considering relationships and context, expanding their perspective and possible actions.

Proximal-Distal View

• Nurses consider both the immediate and long-term effects of their actions to determine the best response in complex situations.

The 5 C’s of Relational Inquiry (5 ontologic capacities)

• Compassionate

• Curious

• Committed

• Competent

• Corresponding

Compassion

A fundamental nursing capacity to “share suffering” through a human-to-human connection, joining clients in their vulnerability and strengths rather than trying to fix their suffering, while also practicing self-compassion.

Curiosity

• Being interested, open, and comfortable with not knowing, using questions and uncertainty to develop knowledgeable, humble, and compassionate nursing care.

Commitment

• Actively identifying your nursing values and ensuring your actions align with them, while using a proximal-distal lens to guide practice.

Competence

• Having the knowledge and skills to provide safe, confident, holistic, and person-centred care by using critical thinking, communication, caring, and professionalism.

Corresponding

Relating and communicating with people in ways that are meaningful to them, which also shapes our own experiences as nurses.

Beliefs

the convictions that we generally hold to be true usually without actual proof or evidence

Values

strong personal beliefs about the worth of a given idea, attitude, custom, or object that set standards that influence behaviour. reflect cultural and social influences, relationships and personal needs, schooling, religion, and governments

-consider right and wrong

-instilled in us as children

-evolved as we age

-decisions/behaviors reflect values

Value Formation

The ability to identify/act on strong feelings (acting on what you believe is right). Nurses must respect diverse client values.

Personal Values

• Beliefs about life, health, illness, and death that require self-awareness of your own values and biases, especially when they differ from a patient’s values.

Ethics and Morality

Ethics are societal ideas of right and wrong, while morality is an individual’s personal beliefs about right and wrong. Moral seamlessness occurs when your personal morals align with ethical expectations.

Moral Integrity

the sense of trustworthiness and of consistency between our convictions interactions

• Good moral character

• Moral mentors

• Attribute of being whole/complete

• Commit committed to a clear sense of value/beliefs

• Maintain consistency

Moral Autonomy

A subcategory of moral integrity involving keeping promises, being steadfast, and maintaining moral seamlessness between your values and actions.

Types of ethics

• Bioethics - the study of what's right and wrong in medical treatment

• Feminist ethics - power imbalance/inequities

• Nursing ethics - CNA code of ethics for RNs

Ethical theories

• Consequentialism (utilitarianism) - focus is only on the outcome

• Deontology - focus is only on the process, not the outcome/end result

• Principal - 4 principles that guide healthcare

-respect for autonomy (people have the right to make their own decisions)

-beneficence (aim to do good)

-non-malificence (do no harm)

-justice (people get what they need)

Codes of ethics

Provide a foundation for ethical practice by outlining professional standards, obligations, acceptable behaviours, and principles that guide nurses’ decisions and actions.

Nursing code of ethics

• Provide provides guidance for ethical relationships, responsibilities, behaviors, and decision-making

• Is to be used in conjunction with a professional standards laws and regulations that guide practice

Jurisprudence exam

• Assesses the applicants knowledge and understanding of the nursing profession in Ontario in terms of:

-nursing regulation

-scope of practice

-professional responsibility and accountability

-ethical practice

-the nurse client relationship

Consent

Nurses have ethical and legal responsibilities for obtaining consent. The Health Care Consent Act outlines when consent is required and who can provide it if the client is incapable.

Consent two major features of legislation

1. Healthcare consent act

-promote autonomy, facilitate communication

-seals with consent to treatment (treatment/intervention specific, ongoing process, emergency situations, assessing capacity), care facility, and personal assistance

2. Substitute decisions act

-deals with decision-making about personal care or property on behalf of incapable persons

-involves formal of a SDM through a power of attorney through the office of the public guardian and trustee or through a court appointment

Informed consent

• The person received the information about the treatment that a reasonable person in the same circumstances would require to make a decision

• The person received responses to his/her request for additional information about the treatment

-the information must include the nature of the treatment, expected benefits of the treatment, material risks, and side effects of the treatment, alternative course of action, likely consequences of not having the treatment

Steps to obtaining consent

1. Assess capacity

2. Provide emergency treatment or crisis administration

3. Informed the client that a SDM will make the decision

4. Identify SDM

5. Obtained consent from SDM

Hierarchy of substitute decision makers

1. Guardian

2. Someone who has been named an attorney for personal care

3. Someone appointed as a representative by the CCB

4. Spouse, partner or relative in this order:

• spouse or partner

• child if 16 or older

• parent who has only a right of access

• brother or sister

• other relative

5. PGT