Nurse-client relationships are inherently valued in descriptions of the nature of public health practice and require consideration as intentional work that demands knowledge, skill, and personal engagement. They are also matters of place. In public health, they are largely taken-for-granted, particularly in the area of infectious diseases and the tuberculosis (TB) program specifically. TB nursing is structured within an explicit population focus, which challenges such relationship ideals as client-centered care, autonomy, and empowerment in everyday practice. This interpretive phenomenological study (Benner, 1994) of the relational work of TB nurses was undertaken to understand the nature of nurses’ relational work, wherever it happened, and how it was understood within the mix of assigned program tasks. Carried out in one of Canada’s largest TB programs, this study involved observing nine nurses and 24 clients in their respective visits over time, and interviewing 16 participants. Visits happened in homes and cars, and other assorted locations, highlighting how place shows up in these relationships and how nurses help clients to make sense of TB and broader life concerns shaping the experience of it. How they involve themselves interpersonally in these situations is the stuff that relational work is made of. Through the use of thematic analysis (Benner, 1994; Chesla, 1994), notes and transcripts were analyzed. The resulting interpretation of the nature of relational work is that of ‘welcome intrusions’, a notion that along with three key thematic dimensions: ‘getting through the door’, ‘doing TB but more than that’, and ‘beyond a professional’, addresses the central control-care tone of relational work. Together these themes identify key areas of knowledge and skill. That is, honesty and respect for privacy, ‘expertise’ in TB, dismantling the effects of stigma and displacement, and socializing-with-purpose. This emphasizes the value of articulating the everyday practices of nurses in population-focused programs that can contribute to successful treatment, and client healing and well-being. This relational work of TB nurses may be supported and enhanced when framed as the skill of involvement (Benner et al, 1996; Benner et al, 1999) and critically examined as part of providing comfort and enacting surveillance.
| Identifer | oai:union.ndltd.org:TORONTO/oai:tspace.library.utoronto.ca:1807/17728 |
| Date | 23 September 2009 |
| Creators | Bender, Amy Catherine |
| Contributors | Peter, Elizabeth Helen |
| Source Sets | University of Toronto |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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