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Relational practice with Children and Families

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Kookii Jess

on 10 March 2014

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Transcript of Relational practice with Children and Families

Perspectives on

"Relational inquiry requires us to look beyond the tip of the iceberg... those elements shape the health and healing experience."
Relational practice with Children and Families
Reflecting on my values and beliefs...
Principles and Goals of Relational Nursing Practice
establishing trust
holistic care
family-centered care
nurse-patient collaboration
Reflecting on my goals...
Children's Contributions to Relational Practice
Reflection on Contribution of Children
Depiction of Relational Nursing Practice
Children and Families
California Autism Foundation. (2014). Take a closer look. Retrieved from http://www.calautism.org
WikiHow. (n.d.). Retrieved from http://www.wikihow.com
BritePro Solo. (2012). Frequently asked questions. Retrieved from http://www.briteprosolo.com
All Nursing Schools. (2014). Clinical nurse specialist (CNS) parent-child nurse. Retrieved from http://www.allnursingschools.com
Retrieved from http://www.woman.thenest.com
Retrieved from http://www.neonatalnursepractitioner.org
Villanova University. (2014). Retrieved from http://www.villanovau.com
Regis University. (2014). Retrieved from http://www.regis.edu
Gippsland Lakes Community Health. (2009). Retrieved from http://www.glch.org.au
John Muir Health. (2014). Retrieved from http://www.johnmuirhealth.com
Preston College. (2013). Retrieved from http://www.preston.ac.uk
North Shore Pediatric Therapy. (2011). Retrieved from http://www.nspt4kids.com
Retrieved from http://www.healthyfamilymatters.com
Retrieved from http://www.dailymail.co.uk
Retrieved from http://www.kidspot.com
What is relational practice?
To me, relational practice is...

nursing care that seeks to understand who the family is as a unit and as individuals, how situations and contextual factors affect health and life choices

being aware of how nurses are, in relation to children and families and how context can impact the relation between nurse-family, and how this impact can affect health

an approach that does not have specific assessment tool in the process of inquiry; instead, a range of theoretical frameworks are use to guide relationally responsive nursing practice

being aware of how the context of child and family's life can affect the child's voice, health experience, and relationship with the nurse

not having a "fix it" mentality, but instead done through presencing and being responsive to the patient
(Doane & Varcoe, 2006)
(McPherson & Thorne, 2000)
My personal beliefs surrounding family-centered practice coincide with the relational nursing approach. Not only is it important to establish a trusting relationship with children and families to promote health and healing, it is important to understand the significant impact family experience and context may have on health and healing.
(Doane & Varcoe, 2007)
Reflecting on my contributions...
In my nursing practice, I feel that I have had opportunities to experience some of the components of relational practice in the encounters I have had with children and their families. Through my interactions with these families, I feel that I have gained experience in building a connection and establishing rapport with the children and their family members. This was done successfuly by being aware of the verbal and non-verbal cues from children and utilizing this knowledge in my attempt to establish rapport. By first gaining the parent's trust, I am able to demonstrate trustworthiness to the child. Incorporating play into my nursing care gave me the opportunity to observe the child and in some cases, the child would feel comfortable expressing his or her thoughts and feelings. I also provided opportunities for the child to make choices. When speaking with the parents of children I cared for, I was able to identify several contextual factors that influenced the child and family's health experience (ie. difficulties with caring for child, education, home environment, etc.)
Reflecting on my challenges...
...Encounters with children and families...
As a student, I am normally very schedule- and task-oriented and tend to rely on structure and routine. The dynamic nature of family and health requires nurses to be relationally responsive in nursing practice. Thus, there is no set structure for nurses to follow and guide them when working with families (Doane & Varcoe, 2006). I have found it challenging at times to feel confident when there is no specific structure and I am required to rely on my own capacity to relate and respond to the child and family. Throughout the nursing program, I examine and
reflect on my personal values and on how my
personal experiences and context can impact my
nursing practice. I have also experienced how
patient acuity, workload, and other nurse's
personal experiences can affect presencing
with the patients.
Potential difficulties that may challenge relational practice...
language barriers
time constraints
lack of respect, trust
lack of experience in collaborating with children of different age groups and with families
possibility of parents overpowering child's "voice"
To continually reflect on my process of getting "in sync" with children and their families, by intentionally and consciously entering meaningful relationships that promote health. The key to achieving this is maintaining unconditional positive regard with those in-relation to me as a nurse.
(Doane & Varcoe, 2006)
It it easy for nurses to focus on "fixing" patients rather than focusing on inquiring about the patients' experience. As a nurse, I would focus on being in the moment and creating an open relational space with the patient.
(Doane & Varcoe, 2007)
When nurses begin to look at families and situations through a relational lense, they tend to experience uncertainty, suffering, and/or conflict (Doane & Varcoe, 2007). They may also experience intense emotional responses of the patients and families, as well as their own. I would like to be able to focus on and be aware of my own feelings and become comfortable with uncertainty, while also utilizing these experiences to be responsive in my care.
(Doane & Varcoe, 2007)
Through my interactions with children and families, it is important that I reflect on the context of the family members. Drawing on family and nursing knowledge will help in understanding who the family members are as a whole and as individuals, understanding what is meaningful and significant to the family, learning what the family's strengths and capacities are, and learning what adversities affect the family's abilities in health and healing.
(Doane & Varcoe, 2007)
Children are...
... leaders in collaboration with nurses
... leaders in interactions between nurses
Children contribute...
Children are partners in deciding...
... knowledge and expertise
... experiences, goals, and needs
Katherine Scott. (2011). Retrieved from http://katherinegscott.wordpress.com/
... the extent of nurse-patient partnership
... the choices and goals
A relational approach to nursing practice in pediatric nursing is important in achieving health promotion and ensuring safe and ethical care for children and their families. Children play a large role in their own health and healing but their "voices" may often go unheard (McPherson & Thorne, 2000). The child's contribution to the relational encounter with the nurse involves the child being the leader and decision-maker in how the nurse-patient relationship is formed, what information is disclosed and shared with the nurse, and how health promotion and goals are achieved. The notion of the child in taking a leadership role in their own care may potentially be challenging to incorporate into nursing practice, as this depends on the child's current developmental stage. It may be challenging to determine how a child's voice is to be heard and to create an environment that helps to facilitate the expression of the child's voice (McPherson & Thorne, 2000).
"By recognizing the inherent complexity in the concept of voice; searching for cues to the thoughts and feelings of the child; and accepting an openly reflective attitude toward procedures, rules, and policies; nurses can often begin to develop the conditions under which children in their care feel more valued, respected, and understood."
(McPherson & Thorne, 2000)
Michael Carino. (2011). Retrieved from http://www.michaelcarino.com
Rebecca Klinger. (2012). Retrieved from http://www.stateoffitnessblog.com
(Doane & Varcoe, 2007, p.199)
Contextual Factors
..that may impact the health of children and their families...
... as well as the relational encounter between nurses and the children and families...
Past Experiences
Stress, Anxiety, Coping
Education & Literacy
Social Support Systems
Beliefs, Experiences, Behaviours on health and illness
Relationships with family members, friends, health care providers
Gender, Genetics
Family Experience, Life Events
Socioeconomic Status, Financial Stability, Employment
Food, Housing, Transportation
Culture, Beliefs, Values
The Impact of Context
Nurses' Contribution
Children's Contribution
past experiences and life experiences
relations with child, family, other nurses and health care professionals
feelings, values, beliefs, culture
education - knowledge and awareness
relation with child and family
ability to hear child's voice
ability to respond in the moment
ability to collaborate and follow the child's lead
(Doane & Varcoe, 2007)
(McPherson & Thorne, 2000)
past experiences
relations with family members, caregivers
socioeconomic status of family
access to food
education level
feelings regarding hospitalization or health care
access to health care
culture, beliefs, values
relation with the nurse
child's voice
child's ability to lead and contribute
experience on health and illness
capacity, expertise, and knowledge for positive health
creates barriers and difficulties to positive health behaviours
(Doane & Varcoe, 2007)
(McPherson & Thorne, 2000)
Doane, G., & Varcoe, C. (2007). Relational practice and nursing obligations.
Advances in Nursing Science. 30
(3). 192-205.

Doane, G., & Varcoe, C. (2006).
Family as relational inquiry: Developing health promoting practices.
Philadelphia: Lippincott Williams & Wilkins.

McPherson, G., & Thorne, S. (2000). Children's voices:
Can we here them?
Journal of Pediatric Nursing,
(1), 22-29
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