The web of relationship: an exploration and description of the nature of the caring relationship in a nurse case management scheme of care

Abstract

This study explores and describes the nature of the client nurse relationship in which clients reveal their health circumstances. It is situated within a nurse case management [NCM] scheme of care. The nursing disciplinary focus is the unitary-transformative paradigm as outlined by Newman, Sime & Corcoran-Perry [1991]. The investigation commences with a theoretical perspective explicated from Newman theory of Health as Expanding Consciousness [1986], a reconceptualisation of this theory by Litchfield [1993] and the work of Litchfield et al [1994]. Research as practice and praxis oriented research form the methodological principles of the study. The study involved a two phase research-practice process with myself as practitioner-researcher. In phase one five clients were referred to the NCM scheme. The primary value of the practice was a relational ethic of care embodied in 'being with' the clients as they revealed and reflected on their health circumstances. I returned summaries of the client revelations after each meeting/interview and composed a narrative of our time together. These summaries were research-practice strategies for encouraging reflection and recognition of 'the pattern of the whole' for each client. Reflections sometimes led to actions in which researcher-practitioner support was available. Journalling of my personal reflections throughout the research also occurred. In addition the clients joined with me to reflect on the process of our engagement at the closure of phase one of the research-practice. Phase two consisted of the search for and the generation of meaning in all the material from phase one. The nature of the client nurse relationship in a NCM scheme of care in which clients reveal their health circumstances is generated within a model of 'the web of relationship'. The metaphor of the web symbolises the pattern of the relationship, the pattern of the whole inter-subjective experience of the client and the nurse throughout the time of engagement. The 'web of relationship' represents a pattern of the whole inter-subjective experience of the client and the nurse myself, the nurse, throughout the time of our engagement. It comprises four main interrelated and interwoven themes: constructing context, the art of speaking to one another, building up and moving on and changing and transforming. I returned the model to clients for their reflection seven to twelve months after completing phase one of the study. They found it interesting and made some minor changes. Included in the study is an update of their health circumstances at that time. A linking occurs of the personal knowledge generated in the web of relationship with knowledge developed by other nurse authors who have written on the client nurse relationship, nurse case management and caring in nursing. Discussion of this knowledge focuses on its application to nursing and nurse case management. Issues are raised relating to the web of relationship and a conjunction of the metaparadigmatic concepts of caring and health within the unitary-transformative paradigm of nursing.