PPN201 - Week 1 & 2 Relational inquiry & Caring/role of the nurse

What are habits of knowing

"taken for granted" truths & shape our practice
Without examination of habits, we may practice we dont intend
Habits= helpful/problematic
Nursing is about learning ones own habits and how it may constraint

Application of theories in Nursing

All nursing is theoretical
- Theories are instruments, not answers
- Competent practice = "living" different theories into practice
- knowledge is not app. of theories
- conscious practitioner uses theories
- Relational inquiry guides this

Limits of objective knowledge

Empirical knowledge is vital for competent healing
overreliance on empirical limits your capacites to understand/analyze and respond to any scenario

Carpers way of kowing

Empirical
Aesthetic
Personal
Ethical
Sociopolitical

Empirical knowing

Factual, undisputed and objective knowledge

Aesthetic knowing

what matters to people and/or what might be appropriate/comfortable

Personal knowing

perception and management of self feelings and prejudices

Ethical knowing

values and obligation

Sociopolitical knowing

contextual and political knowledge

Importance of personal knowing

We choose what knowledge we use
all knowledge is filtered thru our personal frameworks
self knowledge = reflexivity = moving beyond self-interest

Importance of sociopolitcal knowing

Nurses must consider context of care
- must examine taken for granted assumptions
- consider culture of client/family, their idea of health, disease
- e.g. Social Determinants

Relational inquiry approach to nursing

Provides structure/processes to undestand complexities of practice
- allows nurses to consider the interplay amongst factors that impact client

2 components of Relational inquiry

Relation orientation
Inquiring action

What is relational inquiry

Highly reasoned, skilled action that involves
- relational orientation
- sound knowledge base
- sophisticated inqury & observational/analytical skills
- clinical skills
- ways of being

Relational oreintation purpose

focusing attetnion on 3 dimensions, enables deeper understanding/knowledge + more responsibilty nursing action

3 dimensions of relational orientation

Intrapersonal (within the person)
Interpersonal (between people)
Contexual (around people)

Intrapersonal dimension

What is going on within the person
consider
- feelings, thoughts, experience of patients
- going what is going within the person
- which theoy/knowledge to help provide better
- values/beliefs/attributes are influenced

Interpersonal dimenson

focusing on what is going on among/between
- how clients/people acting
- what are they prioritizing, ignoring?

Contextual dimenson

consider the structures/forces that influences the situation and shaping intra/interpersonal responses (sociopolitical knowing)
- context of cair is shaping lived experience of client

Inquiring action

looking underneath/around the surfaces of what you are observing to ask whay may be influencing what is happening
- enter each situation as an iquierer, inquire into experinces and how it shapes each other

relational inquiry

guided by attention/intention
- way of orientating/responding to people, situations by being responsive/reponsible

relational inquiry leads us to

Look for ways in which people, situations, and contexts are connected
See how we are being present, responding, and relating to the situation
inform/form practice to responsive

Individualist/deontextualized nursing

Focus on the person w/o considering actions that shape their actions
Nurses see themselves as responsible for care, when ofter times system level constraints influence it
leads to an empty view of care, demoralizing /depersonalizing clients

aspects of relational inqury and wellbeing

Patient/family well being
Nurse wellbeing
System well being

Patient/Family wellbeing

Health is socio-relational experiences caused by contextual factors

Nurse wellbeing

Allieveates distress that builds up
Increase Q of care
Strategies that can aid in prevention of deleterious effects

System wellbeing

practice is mor effective
all can participate in conditions healthier for communities
identifies system level prejudices, interrupts normative

what is caring?

Part of being human, altruistic act of concern for another
being there for Pt and family when needed
Abstract concept yet "notoriously ambigous"

Perspectives on caring

Nightengale,Leninger, Rogers - Caring is essence of nursing
Watson - Caring should be in the metaparadigm of nursing
Nursing is an Art and Science

Caring as a noun

when nurses care for a Pt who is unable to care for themselves

Caring as an adjective

Nurses displas actions of compassion, kidness and concern
Nurse is genuine, authentic, honest, and acts with integrity

Challenge to caring - Adams 2006

argues that technological advancements in healthcare are sidelining caring, despite its fundamental role in nursing through trust, intimacy, and responsibility.

Threats to caring - Adams 2006

Tech advancements, increased workloads, higher acuity pt
Medical model, focus of disease> Person
removal of caring from sanctioned definition of nursing

Caring is devalued - Lazenby (2013)

Ascendency of nursing as a science devalues caring
Argues that the natural home of nurisng = Lived human experiences
Focus of nursing research on sciences seperates nursing from connection to lived experiences

"Silent Crisis" in Nursing - Lazenby 2013)

- argues that the increasing focus on positivistic research and evidence-based metrics in nursing has created a "silent crisis," - humanistic aspects of nursing—like compassionate care—are undervalued, leading to a diminished role for caring in nursing practice

Caring in nursing today

It will make a resurgence inspite of tech advancements, medical/financial pressure
benefits sick and compromised
research demonstrates effectiveness of caring

Solutions to Caring in nursing

Devloping a focused and unified statement about caring and nursing
Challenge nursing theorist
Consider nursing as an art and a science
Nursing/Nursing research needs to focus on the lived experience of pt

Caring framework #1 - Watson's caring science

Caring = conscious judgement that manifests itself in concrete acts interpersonally, non/verbally
Transpersonal Caring intervention (TCI) connects/embraces spirit/soul of other thru caring

Watson's Human Caring model

caring science embraces whole person, focuses on unity of mind/model
a Model of caring includes a call for both an art and science

Watson's 10 carative factors

Embrace (loving-kidness)
Inspire (faith-hope)
Trust (transpersonal)
Nurture (Relationship)
Forgive (all)
Deepen (creative self)
Balance (learning)
Cocreate (caritas field)
Minister (humanity)
Open (infinity)

Embrace (loving-kindness)

Sustaining humanistic-altruisitic values by practice of loving, kindness, compassion, and equanimity with self/others

Inspire (faith-hope)

Being authentically present, enabling faith, hope/belief system
honoring subjective inner, life-world of self/others

Trust (transpersonal)

Being sensitive to self and others by cultivating own spiritual practices; beyond ego self to transpersonal presence

Nuture (relationship)

Developing and sustaining loving, trusting-caring relationship

Forgive (all)

allowing for expression of positive and negative feelings

Deepen (creative self)

Creatively problem solving, soloution seeking thru caring process; full use of self and artistry of caring-healing practices via use of ways of kniwng

Balance (learning)

Engaging in transpersonal teaching and learning within context of caring relationship; staying within others frame of reference; shift toward coaching model for expanded health/wellness

Co-create (caritas field)

Creating a healing enviroment at all levels; subtle enviroment for energetic authentic dcaring experience

Minister (humanity)

assist with basic needs as scared acts, touching mind-body-spirit of other; sustaining human dignity

Open (inifnity)

Opening to spiritual, mystery, unknows-allowing for miracles

Caring framework #2: bramley/matiti Caring vs Compassion

Compassion can promote physical/mental health
Need to adress compassiion and how it can become part of nursing
Overlaps with empathy/caring
Compassionate care = entering into pts experinces and maintaining dignity/independence

Bramely/Matiti on Compassion

They way in which we relate to human beings
it can be nurtured/supported, involves noticing another persons vulnerability, experiencing an emotional reaction

What is compassion

Knowing me and giving me your time
-encouraging adversity and being available to be with individuals
-personalizing the experience to individual needs
-attending to patient-centered assessment and planning
-making time to listen to patients, despite pressures

Being more compassionate

essence of nursing and communication
- quality vs something that can be molded and taugh
- culture of "getting the job done"
- comms are the pillar of compassion

Understanding the impact of compassion

How would i feel in their shoes?
- being empatheic
- understanding how it feels to be them
- having understand for times when nurse do not show compassion