Nimra.

T
2022/08/30
PPN 201
Dr. Metersky

Week One (1): PPN 201 A Theoretical Orientation To Nursing Practical Relational Inquiry
Reading One: How To nurse: Relational Inquiry With Individuals And Families In Shifting
Contexts (Chapter One)

Learning Objective
1. What is a relational inquiry
2. The limitations of an individualist approach to nursing practice
3. The connections among patient/family well-being, nurse well-being, and the well-being of
the health care system
4. Relational conceptualizations of people, families, and communities
5. A pragmatic approach to knowledge development and its implications for learning how to
nurse as a relational inquirer

1. WHAT IS A RELATIONAL INQUIRY APPROACH TO NURSING PRACTICE

● Nursing is a profession built on FEELING; recall caspers ways of knowing
● To understand what it means to be a nurse in our complex world- a world that is
shaped by relationships, economics, history, politics, values, and normative
ideologies- and how our own well-being and the well-being of our patients,
families, communities, and health care system are integrally connected- we need
to explore that place where they are intricately interwoven-everyday nursing at
the point-of-care
● Relational inquiry approach to nursing practice, we provide structures and
processes to support the translation of nursing values, knowledge, skills, ideals,
and imperatives into effective action
● Relational inquiry is more than touching and emotional side of nursing→ it is also
the complex interplay of human life, the world, and nursing practice
● To be competent in relational inquiry we need to understand
a. Thorough and sound knowledge base
b. Sophisticated inquiry and observational and analytical skills
c. Strong clinical skills including CJ, decision making skills, and clinical
competencies
d. Ways of being

A RELATIONAL INQUIRY APPROACH HAS TWO MAIN COMPONENTS

COMPONENT ONE
1. RELATIONAL CONSCIOUSNESS
 ● Being conscious of the relationships in our work and understanding humans are
not just humans but relational beings who have social, cultural, political,
historical, etc components–? Being aware of this affects our understanding of
how we react on the intrapersonal, interpersonal, and contextual levels
- Intrapersonally you consider what is going on with ALL people involved
(such as family members as well, community, you, other people in the
interpersonal healthcare team)
- Focusing on the interpersonal you notice what is going on AMONG and
BETWEEN people- how people are acting in the situation, what do they
want, what are the emotions in the air
- A relational consciousness is like getting on in and around the room to
notice people, their attire, how are theta re moving, what kind of
experience they seem to be having, how they are interacting with each
other or not, the music that is playing, and how that music is shaping the
way they are dancing, how the surroundings contribute to what is
occurring, and so forth
Having a relational inquiry mindset helps sensitize to human behavior and the understanding
that humans beings are relational people
● Sensitizes us to the relational complexities that affect what happens at the point of care
● Directs attention toward the relational transactions that are occurring within and among
people and contexts
● Enables us to be very intentional and consciously choose how to act in response to
these complexities and transactions
● BEING MINDFULLY aware of what is going on around not only physically but socially
and emotionally and relationally.

2. COMPONENT TWO: INQUIRY AS A FORM OF ACTION

● Inquiry is the “HOW TO” of a relational consciousness
● As an inquirer we enter each nursing situation inquiring into the relational
experiences of people, contexts, knowledge, meaningful purposes, excellence of
practices, and effectiveness of outcomes
● Examining how things are interrelated- what effects do they have on each other-
how do they depend on each other

INTEGRATING THE TWO COMPONENTS

● RI (relational inquiry) is the way of relating to people, situations, and knowledge and is
guided by the overriding goal of being as responsive and responsible as possible
● RI is a practice of attention, of focusing attention and acting in a more conscious and
intentional manner

RI leads us to
a. Look for ways in which people, situations, contexts, environments, and processes are
integrally connected and shaping each other
 b. See how we ourselves are being present, responding, and relating within the situational
circumstances
c. Inform and form our practice responsively within the complexity of those relational
realities

WHY IS RI IMPORTANT IN NURSING PRACTICE

1. Enhances patient care and patient care outcomes
2. Helps give an understanding of the holistic view
3. Nursing is based on ways of knowing and the paradigm of nursing which are all
interconnected concepts health environment nursing person and social equality

Currently nursing is dominated by a individualist, contextualized approach

We want to change this nursing environment
- Individualist approach focuses on individuals without concerning the external and
internal influences
- This approach often leads nurses to be so focused on what they had been able to do or
change instead of what they had done- nurses may begin to see themselves as
inadequate this way
- This approach is not strong enough to understand all the complexities that are part and
parcel of most contemporary nursing situations
- Practical components are also impacted when we fail to consider RI
- Relational inquiry is aimed toward patient well-being, nurse well-being, and system
well-being, and it recognizes the way in which those elements are integrally connected
- An individualistic approach to nursing results in a normative pattern in which good care
and subsequently patient/family well-being is continually compromised, nurses are left
feeling like they have done all they can, but it is still not good enough, nurses lose sight
of the way in which they are making a difference and promoting well being
- Nurses feel powerless to change the system

A RI APPROACH INCREASES NURSES ABILITY TO AFFECT WELL-BEING

● A professional is a doer who shapes reality
● A doer is merely someone who attends to the cogs of reality to prescribed patterns
● To be a professional doer you need to be proactive in self selecting, self directing, and
self generating knowledge

3 elements of RI that are inherently (permanently /essential) related and dependent on one
another
1. patient/family well-being
● Recall health and WHO’S definition in which it is more than the absence of
disease/sickness
● Nurses focus on the preventing and treating disease with a behavioural model
that health is more than the absence of disease that includes physical and
emotional wellbeing- emphasis is given to secondary and primary prevention
 ● Ottawa Charter for Health Promotion marked a shift from strictly medical and
behavioural health determinants of health determinants in which psychological,
social, environmental, and political terms were defined
- This groundbreaking document shifted nursing from a
disease/behavioural perspective to a socio-environmental one,
emphasizing the that health is deeply rooted in human nature and societal
structures- health is considered a resource for living, a positive concept,
and need to change or cope with the changing environment
- Caspers 4 ways of knowing
- Emancipatory
- aesthetic
- nursing
- Empirical
Nursing practice is then geared toward enhancing the capacity and power
of people to live meaningful lives, involves treating and preventing
disease, modifying lifestyle factor

Page 14/36
2. Nurse Well-Being
● How nurses work amongst themselves and others
● RI practices includes particular skills and strategies and also offers a way of
navigating through the often conflicting and competing interests and values
inherent in contemporary settings

3. System Well-Being
● Globally health care has become oriented towards a “business model”, even in
countries where there is some level of public funding and for-profit health care
● Emphasis is put on EFFICIENCY, LIMITING THE USE OF RESOURCES AND
OPTIMIZING PROFIT, often without accompanying attention to the longer term
consequences for health of individuals and populations
● RI draws attention to the ways in which nursing practice and the well-being of
patients and populations are shaped by changing health care systems, including
the organizations and units within which nurses practice, and by wider social,
political, and economic trends
● Expediency (being convenient, an advantage, useful)

ENGAGING IN A RELATIONAL INQUIRY PROCESS

● Consider this question about RI: what would it mean to practice with the understanding
that you are affecting and being affected by everything that is happening around you, in
you, among you and others, and in the world?

CONCEPTUALIZING THROUGH A RELATIONAL LENS

● Look at the connections between ideas, theories, and situations
 ● Look at how people and systems are connected and shaping each other and how the
well-being of each is interdependent with the others

CONCEPTUALIZING INDIVIDUALS RELATIONALLY

● Do you believe that the context in which you grew up and or the context in which you
currently live has shaped you as a person?
● How have other people's contexts shaped who they are?
● Is it possible not to be affected by your contexts?
● Did you take into account the opinions of other important people in your life?
● In what ways were your own personal thoughts sparked and or influences by what you
had heard and learned in your relational world?
● What stereotypes about nursing did you balance in your decision making?
● Each person has a unique personal, socio historical location that affects and shapes that
person's identity, experience, interpretations, and way of being in the world.
● Values, knowledge, attitudes, practices, and structure that dominate the sociocultural
world within each person's lives are passed on through relational interactions.
● People's experiences, interpretations, and actions are understood as products of a
multitude of interactions occurring at the intrapersonal, interpersonal, and contextual
level.
● People are both shaped by and shape other people's responses, situations,
experiences, and contexts.
● Contextualizing peoples relationally is similar to taking what Kiefeel identifies as an
ecocentric view: everything is connected to everything else POV
● Relational view: people are not just individuals but they are continuous with their social,
economic, historical, political, and physical contexts
● How does this diagnoses affect their life, their relationships, their community, their
culture, their sociocultural aspects

CONCEPTUALIZING FAMILIES RELATIONALLY

● Family as a structure and function
● Offer a conceptualization of family as a configuration of people who are connected in
some way
● Who they are and the provide
● In conceptualizing family relationally we highlight how understanding family as a complex
process in which economics, emotion, context, and experience are interwoven and
multilayered
● Every moment of practice involves family nursing
CONCEPTUALIZING COMMUNITY RELATIONALLY
● Geographically
● Ethnicity
● Experience
● Diversity
● A relational view is required to understand individuals experience are shaped by and
shape their multiple communities
 ● Which communities are relevant to people at particular points in time
● When community is conceptualized relationally, nurses begin to understand the
significance of community to health, healing, and EOL experiences

ENGAGING AS A RELATIONAL INQUIRER

● Learning is not only merely an intellectual activity but a deeply embodied and personal
process that requires active and substantial engagement
● To become an intentional competent nurse you must bring intellectual understanding
● Certain attitudes and capacities will help you reap the most benefit from this book

RELATING WITH CURIOSITY

● Take a stance of not knowing willingly
● Open to question
● Open minded
● Brining an attitude of curiosity enables you to transverse that relational space between
knowing and not knowing

RELATING TO COMPLEXITY AND UNCERTAINTY

● Enter ambiguous and uncertain situations and develop effective ways of relating with
them
● Learning is risky business
● It is far less likely to carry on with the status quo and do things according to the dominant
norms in nursing and health care

RELATING TO VULNERABILITY
● You need to be willing to be uncomfortable and vulnerable
● To be willing to be perturbed and discover new things about yourself
● How vulnerabilities are being perpetuated
● Compassion offers a way of being and orienting relationally in the midst of discomfort
and angst

SCRUTINIZING AND DEVELOPING OUR HABITS OF PRACTICE

● Develop deeply ingrained ways of being, ways of knowing, and ways of doing that are
consistent with the values, ideals, and competencies of the nursing progression
● Provide the oopt for you to the develop the habit of not acting habitually

WE ARE OUR HABITS

● Taken for granted truths and ingrained actions that shape our practice
● Taken up in a nonreflective way these truths become bodily responses
● As patterns of activity these habits are constantly reproduced through us unconsciously
● People discipline and control their own bodies according to the social groups within
which they live and work
HABITS ARE HELPFUL
● Simply put we all operate with habits
● Dewwy 1922 contended that part of the reason habits become powerful is because they
all started out as helpful
● They provide an expertise and efficiency necessary for daily living
● As Dewey described, a sailor can be at home on the sea, a hunter in the forest, and a
scientist in the lab.
● Certain habits do all the recognizing, imagining, recalling, judging, conceiving, and
reasoning in such an efficiency way that energy and attention can be freed up for other
activities
● Driving example; becomes so habituated we may not even realize what we are doing
anymore, it becomes muscle memory
HABITS CAN SOMETIMES BE PROBLEMATIC
● With habit alone there is a machine like repetition, a duplicating recurrence of old acts
● Habits are too organized, too insistent, and too determinant
● Given that we all operate from habit and those habits can be helpful or constraining, the
more awareness we bring to that gap the more we can align our actions with our chosen
values and intentions

ORIENTING TO KNOWLEDGE AND KNOWLEDGE DEVELOPMENT

● Pragmatic view of knowledge assumes the existence of multiple truths and
interpretations and considers knowing to be a relational process
● Pragmatists contends that all knowledge is socially constructed by embedded embodied
people who are in relation with each other
● From a pragmatic perspective it is said that we can never rlly separate ourselves from
our experience, the knower is always central to the knowing process
3 FEATURES OF THE PRAGMATIC PROCESS
1. KNOWLEDGE IS LIMITED
- Impossible to separate human beings from human knowledge
- Socially embedded people bring selective interest to any experience and
situation
- Selective interest can cause us to notice certain things and not others
- Research always reflects selective interest no matter how hard it tries to by
objective

2. KNOWLEDGE IS ACTIVE
- Knowledge is the connection of knowledge, experience, and practice
- Pragmatists do not see a deep slit between theory practice and experience
- Knowing is an action and all so called theory is understood to arise from and be
grounded in experiences and practices

3. KNOWLEDGE IS USEFUL
- Value of knowledge lies in its pragmatic contribution
 - Knowledge is valued because it enables us to be more effective in the world
- Consider how conceptualizing people as bed blockers or limiting your theorizing
of family may limit responses

BECOMING PRAGMATIC
● The way to develop a more conscious intentional and responsive way of living
● Relational inquiry is guided by an ethic of social justice in which decisions and actions
are not only health promoting and or economically viable but also socially just
● Practise guided by an ethic of social justice continually asks wo what
● We view practice as a way of being as much as a form of action

CULTIVATING HABITS TO SUPPORT RELATIONAL INQUIRY

● 3 particular habits that we will be inviting you to develop throughout the book include
a. The habit of knowing and not knowing
b. The habit of humility
c. The habit of looking with fresh eyes in other words the habit of conscious inquiry

DEVELOPING THE HABIT OF KNOWING AND NOT KNOWING

● Being knowledgeable is seen as the foundation for safe competent care

DEVELOPING THE HABIT OF HUMILITY

● As professionals we are schooled to become experts and often inherent to that process
we are inadvertently schooled to be arrongalty confident in our professional knowledge
and perspectives of the people whom we care
● Being mindful of the limits of our knowledge is critical to high quality nursing limitations
● Developing the habit of humility as a knower requires confidence and clarity

DEVELOPING THE HABIT OF LOOKING WITH FRESH EYES

DEVELOPING YOUR RELATIONAL INQUIRY TOOLBOX