Relational Inquiry Approach to Communication

Relational inquiry is defined as “the complex interplay of human life, the world, and [clinical] practice” (Doane & Varcoe, 2015, p. 3). This means that MRTs must avoid looking at the client on a merely individual level (Doane & Varcoe, 2015). As per Doane and Varcoe, 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.
• Contextual – communicating with the client in a way that allows you to assess what is occurring around the people and situation involved.

Relational inquiry is a kind of 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 MRT (Doane & Varcoe, 2015). 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 the care.

See Case Study 2 for an example of a relational inquiry approach to interviewing.

Case Study 2

An 8-year-old client, who uses the pronouns he/him, attends an imaging clinic for a soft tissue neck x-ray because of an inquiry of croup versus foreign body.

MRT: Hello Peter Lin, my name is Ahsan Khan, I am a Medical radiation Technologist. I will be taking an x-ray of your neck. You can call me Ahsan. What name would you like me to call you?

Client: Peter.

Rationale: You introduce yourself using first and last name – this action promotes accountability. You explain the extent of the diagnostic test being provided, including when it will end and who will report the images and who will get a copy of the report. This includes the client in the care plan and minimizes uncertainty about care provision.

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

Client: It’s my mom.

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

MRT: [directed to mother] Hello, what would you like 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 as mom 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.

MRT: Okay, Wei. [directed to both client and client’s mother] I will collect some information from you and then do the x-ray. It should take about 10 minutes. 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 also acknowledging the mother’s request. You offer the client and mother a timeline and plan to help them anticipate events. You invite any questions before conducting the subjective data collection. This can be a helpful tool for you to gauge the client and can also alleviate concerns up front.

Client: Not really.

Client’s mother: I’m little nervous about the radiation.

MRT: Tell me more about your concern.

Rationale: The question invites the mother to share intrapersonal concerns about the client’s test. This conveys to the mother a family-centred approach, whereby they are also a care recipient. This approach invites discussion without supposition.

Client’s mother: Well, you read so much nowadays all the different causes of cancer including radiation. I’m worried about Peter.

MRT: I can understand your concern. As an MRT my job is to make sure Peter receives the least amount of radiation as possible to acquire the diagnostic image of his neck to help the doctor with their diagnosis. We put lead in front of him to block out any scatter radiation to the most radio-sensitive anatomy. As well, did you know that there is six times more radiation absorbed by our bodies on a flight from Vancouver to Toronto than in one chest x-ray.

Rationale: In this case you respond directly to the mother’s concern about radiation while anticipating what we can do to minimize the absorption. This offers reassurance about future opportunities to ask and clarify concerns. Importantly, in addition to letting the mother know what to expect, you also invite the mother to ask questions. This validates the mother’s concern and also alleviates others in the event they do not provide information.

Client’s mother: Ok, that’s reassuring.

Summary

A relational care approach attends to the broader social context in which clients and their support systems are situated (Doane & Varcoe, 2015). Also, as the MRT should be aware of yourself and how you influence, and are integrally connected to, the client and the healthcare system (Doane & Varcoe, 2015). This approach is an especially helpful tool for family-centred care. It also requires skill and knowledge because it demands active listening and critical thinking. Unlike closed-ended checklists, you cannot predict how the conversation will unfold.