Exploring relational engagement practices in stroke rehabilitation using the Voice Centred Relational Approach

Abstract

While discussions on patient engagement commonly focus on patient behaviors, a small body of research highlights the patient-practitioner relationship as critical in engagement. Understanding this relationship might be facilitated through a relationally-oriented methodology. The Voice Centred Relational Approach is one such qualitative methodology. Within this paper, we present one turn in a long conversation about this methodology. Drawing on our longitudinal observational study of engagement practices in stroke rehabilitation in New Zealand, we explicate how a theoretical framework can inform how the Voice Centred Relational Approach is enacted in the research process, from entering the field to dissemination. We detail how we adapted the associated analytic techniques (the Listening Guide and i-poems) for use with multiple forms and sources of data. We propose that the underlying relational ontology and relational orientation of this methodology makes it a useful approach in researching relational practice in healthcare.

Keywords:

• Engagement
• therapeutic relationships
• Listening Guide
• qualitative
• rehabilitation

Acknowledgements

The authors thank Dr Barbara McKenzie-Green for her methodological advice during the study design process. They thank Dr Gareth Terry and the two anonymous reviews for their assistance in critiquing and revising the manuscript.

Notes

1. Voice refers to perspectives (Brown, Debold, Tappen, & Gilligan, 1991; Sorsoli & Tolman, 2008) or stories (Mauthner & Doucet, 1998) embedded within a person’s communication.

2. The terms ‘readings’ or ‘listenings’ are used interchangeably in the literature. Throughout this paper, We use the term ‘readings’, consistent with Mauthner and Doucet’s (1998) approach.

3. Whakawhanaungatanga is a Māori term, Māori being both the indigenous population and official language of New Zealand. The term reflects a depth and commitment to the process of relationship-building beyond the term ‘building relationship’, and is used in response to where the research was culturally located.

4. Talk-in-action refers to how the practitioner communicated (verbally or non-verbally) when interacting with the person experiencing communication disability.

5. Talk-about-action refers to how the practitioner spoke about their practice within interviews outside the 1:1 interaction with the patient. Talk-about-action represented the practitioner’s reported perceptions of, and reasoning about their practice.

6. The pronoun ‘I’ reflects the memo was written by one member of the research team (FB).

7. This memo incorporates a description of an interaction incorporating direct quotations from participants (indicated in quote marks) as well as the researcher’s perceptions and very early analysis of the interaction.

8. Reading one (reading for the story) is in bold. Reading two (reading for the self) is in italics.

Reading three (reading for the other) is in grey. Reading four (reading for the context) is in capitals.