Relational inquiry is “the complex interplay of human life, the world, and nursing practice” (Doane & Varcoe, 2015, p. 3). This means that individuals working in health environments must avoid viewing clients on a merely individual level (Doane & Varcoe, 2021).  Doane and Varcoe (2021), note that drawing upon relational inquiry involves the following elements of communication:

• Intrapersonal  — communicating with the client in a way that allows you to assess what is occurring within all people involved (the client, you, and others).
• Interpersonal — communicating with the client in a way that allows you to assess what is occurring among and between all people involved, examine how they behave in the situation, and identify their priorities.
• Contextual — communicating with the client in a way that allows you to assess what is occurring around the people and situation involved. This includes the “structures and forces influencing the situation and shaping the intrapersonal and interpersonal responses” (Doane & Varcoe, 2021, p. 3).

Relational inquiry is a lens you can use to perceive the world. In contrast to an individualist approach, which privileges the individual as accountable for their actions and behaviours, relational inquiry brings into focus the internal dialogue of the client, their social system, and the broader context that influences their actions and your actions as a healthcare provider (Doane & Varcoe, 2021). This approach to therapeutic communication is important because it can help you understand the client’s situation more fully, focus on what is important to them, and collaboratively work with the client to integrate this knowledge into care.

Case Study (An example of a relational-inquiry approach during an interview)

An 8-year-old client, who uses the pronouns he/him, attends a pre-operative day surgery unit for tonsillectomy (tonsil removal) with a parent present. The client has a history of six strep throat infections with antibiotic treatment in the past 18 months. The client has no previous history of surgery or anesthesia.

Health Professional: Hello, Peter Lin; my name is Ahsan Khan, and I am a health professional. I will care for you until you go into surgery; a surgical team member will take over your care. You can call me Ahsan. What name would you like me to call you?

Client: Peter.

Rationale: Introducing yourself using your first and last name and explaining your role promotes accountability. You explain the extent of the care being provided, including when it will end and who will take over care for the client at different stages of their procedure. This includes the client in the care plan and minimises uncertainty about care provision.

Health Professional: Okay, Peter. The information you share with me will only be shared with the healthcare team caring for you. Before we begin, who is with you today?

Client: It is my mum.

Rationale: Explaining confidentiality at a developmentally appropriate level for an 8-year-old. Asking, “Who is with you today” allows the client to identify their relationship to their caregiver in their own words.

Health Professional: [directed to mother] Hello, what would you me to call you?

Client’s mother: Please call me Wei. Rationale: This approach includes the mother in the care and acknowledges her participation. Some providers refer to the parent generically as “mum” or “dad” as this reinforces the client (child) as the recipient of care and is also convenient for the provider for easy reference. However, calling the parent by their preferred name builds trust and rapport, acknowledges their humanity, and identifies them in the care process.

Health Professional: Okay, Wei. [directed to both client and client’s mother] I will collect some information from you and then do a physical exam. It should take about 10 minutes. I can see in your chart here that you are scheduled for tonsil removal and that you have signed a consent form. Can I answer any questions you have before we proceed?

Rationale: Repeating the preferred name of the client’s mother helps you remember the name while acknowledging the mother’s request. Offering a timeline and plan helps them anticipate events. Inviting any questions before conducting the subjective data collection can alleviate concerns upfront.

Client and Client’s mother: Not really.

Health Professional: OK. Can you tell me how you are feeling today, Peter? Rationale: This question invites an intrapersonal response as it attends to the feelings and emotions of the client, acknowledging the importance of their thoughts and emotions as part of their care and allowing you to respond to any concerns.

Client: A little nervous. Will I be able to feel anything during surgery?

Health Professional: No, you will not feel anything during surgery. We will give you some medicine to put you into a deep sleep, and when you wake up, it will be over. We will also be giving you some medication for pain.

Rationale: Your response addresses the client’s concern by providing a definitive answer and anticipates the client’s concern for pain, as the concept may not be well understood at their developmental stage.

Health Professional: How are you feeling, Wei? Client’s mother: I am a little nervous about giving Peter pain medications.

Rationale: The question invites the mother to share intrapersonal concerns about the client’s surgery, offering a family-centred approach by also considering them as a care recipient. Health Professional: Tell me more about your concern.

Client’s mother: Well, you read so much nowadays about opioids and addiction problems caused by prescribed medications. I am worried about Peter. Rationale: This approach invites discussion without supposition.

Health Professional: I can understand your concern. The pain medications the anesthesiologist administers during the surgery are short-acting, only a few hours. The anesthesiologist will speak with you before the surgery, and you can ask more specific questions. After the surgery, the surgical team will ensure Peter is comfortable and likely give him medication for pain and swelling. You can continue this treatment when you are home with Peter. Paracetamol and ibuprofen are over-the-counter medications, not opioids, nor are they addictive. The surgical team will give you specific instructions about discharge care and a handout. If you do not get this information, feel free to ask.

Rationale: Responding directly to the mother’s concern about pain medication while anticipating the plan of care and other points of interface with the healthcare system offers reassurance about future opportunities to ask and clarify concerns. Additionally, it invites the mother to ask questions, validating her concerns and potentially alleviating others.

Client’s mother: Ok, that is reassuring. I have two kids home sick from school today with the flu. Will that be an issue for Peter?

Health Professional: It could be. If possible, hand-washing and keeping some space from each other will be important to minimize the spread of germs. Peter will be more susceptible to getting sick after surgery.

Rationale: This explanation responds directly to the mother’s question and offers strategies to reduce the risk of the spread of germs. The response is also in everyday language, free from professional jargon.

Client’s mother: Oh boy, I will try.

Health Professional: Tell me about your support system to help you manage at home.

Client’s mother: I have a good support system. My sister is helpful with the kids and is in town to give us a hand.

Rationale: In this case scenario, this question assesses interpersonal relations by asking about support systems for managing this situation.

Health Professional: That sounds like helpful support. Are there other resources that would be helpful to you?

Rationale: This question helps assess contextual relations by identifying resources and issues requiring attention in this scenario. It invites further discussion about factors to consider in Peter’s care and sheds light on the context of the dyad.

Client’s mother: Well, this has all been challenging. I am transitioning jobs, so money is tight right now. I do not have extra room in the budget for a sitter. I am glad my sister is coming, but I do not know how long she can stay. My parents could help in a pinch, but they are getting older, and the kids are a lot for them to manage. And poor Peter has been sick so much lately. On the one hand, I am glad Peter will be getting the surgery to prevent other cases of strep throat, but I also feel bad that this is happening at such a stressful time for everyone. I am worried about the recovery time.

Health Professional: I can see how that would be stressful. It is going to take a few days for Peter to recover. The important thing will be to avoid the spread of germs, as that could extend his recovery time. And you are right that this surgery should help reduce his risk of getting strep throat in the future. It sounds like you have some alternative ideas for support to help you manage the recovery.

Rationale: This response offers empathy and encouragement by acknowledging what the client’s mother and their support system have shared. It also offers strategies to minimize recovery time, which seems to be a concern identified by the mother.

Client’s mother: I do. Thanks.

Activity: Check Your Understanding