NURS- 1001 Relational Practice in Nursing

Communication

• Relationship building
• Advocacy
• Professionalism
• Essence of relational practice

Relational Practice

“Guided by conscious participation with clients using a number of relational skills including listening, questioning, empathy, mutuality, reciprocity, and self-observation, reflection and a sensitivity to emotional context”

Examples of Relational Practice Skills

• Trust
• Respect
• Mutality
• Rapport
• Active listening
• Confidentiality
• Empathy
• Self-awarness
• Intentionality
• Reflection

Relational Practice in Nursing

• A relational nurse:
  • Provides patient-centred care
  • Engages in effective communication
  • Builds patient trust
  • Demonstrates empathy and compassion
  • Provides continuity of care
  • Is culturally sesnsitve

Relational Capacities

• Gwen Hartrick RN,PhD
  • Initiative, authenticity and responsiveness
  • Mutuality and synchrony
  • Honouring complexity and ambiguity
  • Internality in relating
  • Re-imaging

Relational Education

• Psychosocial needs
• Interpersonal communication
• Critical reflection

In Class Activity

1. To build rapport with others, the nurse needs to be
2. Adaptable
3. Courteous
4. Genuinely interested
5. Efficient

2. True relational practice is the same as counselling

1. True
2. false

3. An Important aspect of relational practice is

1. Involving
2. Educating
3. Partnering
4. Advising

4. Relational practice is

1. A communication style
2. An approach to care
3. A synonym for interpersonal relationship
4. An authentic style

Relational Inquiry

Intrapersonal

• Occurring within the individual

Interpersonal

• Factors & people involved

Contextual

• Hidden factors influencing the situation

Case study

• What are the intrapersonal, interpersonal and contextual factors?

PATIENT:

Intrapersonal factors: the patient was fearful, and vulnerable but showed strength. Those feelings she needed to talk about

Interpersonal factors: her relationship with her daughter, and fear shell losing her independence

Contextual factors: living alone, hurt for two days. Tension between daughter and mother due to lack of communication. She having a moral struggle

NURSE

Interpersonal factors: minimize conversation

Contextual factors: ER is really busy, normal values ofthe healthcare system, short staffed, long wait times, ER building up

Reflexivity

• Self-awareness
• Self-examination
• Critical reflection
• Being self-aware both consciously and subconsciously
• Be aware of tone of voice, posture and body language
• Values and beliefs will not always align with patients
• Honour our differences

Is relational practice practical in today's healthcare?

• Can take lots of time to do
• One small change can really change patient care and satisfaction for the nurse

Regulatory Expectations

• College of Nurses of Ontario (CNO)
  • Therapeutic Nurse-Client Relationship
  • Introducing yourself to the patient with name and designation every time u meet them
  • Use communication to build the relationship
  • Use communication effectively and clearly

Therapeutic Relationship and Communication

Therapeutic Nurse-Patient Relationship

“A relationship a nurse establishes and maintains with a client, through the use of professional knowledge, skills and attitudes, to provide nursing care expected to contribute to the client’s well­ being” (Canadian Nurses Association, 2017).

• Relationship has a starting point and ending point (terminated at end of care)
• Build trust to eliminate patient fears

Therapeutic Communication

• Establishes therapeutic relationship
• Both participants equal partners
• Mutual respect for autonomy and values
• Demonstrates professionalism
• Tailor to meet patients diverse needs
• Verbal and nonverbal communication

Active Listening

• S
  • Sit and face the patient
• O
  • Open posture
• L
  • Lean toward the patient
• E
  • Establish eye contact
• R
  • Relax

Empathy

• “Ability to emotionally and intellectually understand another person’s reality, to accurately perceive unspoken feelings, and to communicate this understanding to the other person (Devito et al., 2015).

Sympathy

• “Sympathy is a feeling of concern, sorrow, sadness, or pity for the patient generated by personal identification with the patients needs” (Sinclair et al., 2018).

Ineffective Communication

• Asking personal questions
• Giving personal opinions
• False reassurance
• Passive aggressive responses
• Raising voice

Interprofessional Practice and Conflict Resolution

Interprofessional Care

• “Interprofessional care (IPC) occurs when a variety of health care providers work together with patients, families, and communities to provide integrated and comprehensive services of the highest quality across settings” (WHO, 2010).

Interprofessional Relational Practice

• Communication
• Teamwork
• Role Clarity
• Shared Goals

Conflict Resolution

• Ways nurses can prevent workplace conflict
  • Modelling professional behaviour, recognize personal stress that may be impacting professional relationships, reflect on personal values and attitudes that may be impacting professional conflict
• Ways to manage workplace conflict
  • Directly address conflict, rather than avoiding, focus on behaviours that led to the conflict rather than the colleague personally, validate assumptions and create open dialogue with peer, collaborate to identify underlying cause of the conflict

(College of Nurses of Ontario, 2018)

Conflict with Patients

• Factors that can lead to patient conflict
  • Patient is withdrawing from substances, being restrained, overstimulated, anxious, denied smoking privileges, told a challenging diagnosis
• Nurses reaction that can cause patient conflict
  • Judging or labelling patient, threatening, not listening to concern's, not respect patient values or beliefs
• Ways nurses can mitigate conflict
  • Seek to understand patient perspective, acknowledge patients concerns, avoid arguing, focus on patients’ behaviour rather than them as a person, ask for assistance, not tolerate abusive language and behaviours, leave the situation

Relational Practice in Learning

• Positive student-teacher relationship
• Increases student engagement
• Safe learning environment
• Promotes student growth

Relational Practice with Peer Students

• Social interactions and collaboration among peers to enhance learning experience
• Key aspects:
  • Peer support
  • Collaborative learning
  • Personal growth
  • Feedback and reflection
  • Community building
  • Peer accountability

Reflection

• Self-examination
  • Review actions, thoughts, feelings
• Critical thinking
  • Asses areas for improvement, effectiveness of interventions, alternate approaches to care
• Professional growth
  • Continuous learning and skill enhancement
    • Identify areas we need to lean more about
    • Compare with best pratcie standards
    • What am i do well? What can i improve on? Are there nay gaps on my knowledge?
    • Take note of the things we did wrong
    • Take note of things we did really well
    • self - examination
    • Question our actions

Modes of Reflection

Individually

• Within ones self
• Journaling
• Podcasts

Group

• Group discussion
• Peer sharing
• Organizational meeting

Quality Assurance Assessment

• CNO expectation of regulated nurses
  • Reflect after every shift
  • Randomly selected to submit reflection and learning plan
• Regulated Health Professionals Act 1991
  • Yearly learning plan

CNO Reflection Questions

• How did your experience this year impact your practice?
• What changed in how you do your work?
• What learning opportunities did you identify through your experiences that you can apply moving forward?
• Based on your reflection, what areas of your nursing knowledge, skill and judgement identify as needing professional development?

Summary

• Relational practice is a way to care for patients that looks beyond the patient, so see the complete picture. It involves engaging with the patient in a meaningful way to develop a nurse-patient relationship. This collaborative care promotes patient healing and job satisfaction for the nurse.