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Writing ourselves: creating knowledge in a postmodern world.

In an attempt to encourage nurses and academics to write, there have been some recent journal papers that outline rules and guidelines for successful publication. This paper attempts to tackle the 'why' of writing rather than the 'how', and argues that writing is more than merely the representation of speech. Rather, writing is a creative act in which knowledge is produced as part of the process of writing itself, and at this level we might talk not merely of writing, but of writing. It is further argued that whereas the verb 'to write' always has an object (we write a book or an essay), the verb 'to write' is intransitive; it has no object. We do not write a paper, we merely write. We might, of course, choose to publish our writing, but it is done as an afterthought; we write for discovery, not for presentation. The act of writing is then compared to the act of teaching, and it is concluded that in order to teach, we must also write. Finally, this paper is offered as an example of writing (not an exemplar--there are as many ways to write as there are writers), and attempts to pull together material from a variety of sources including sociology, psychology, philosophy and literature as an act of discovery, of creating what I know about writing as I write.

Education, Nursing, Continuing↗

Dementia: sociological and philosophical constructions.

This analysis presents a challenge to the biomedical view of dementia as a disease. This view is critiqued from two perspectives: those of sociology and philosophy. Because these domains inform the creation of the medical discourse, their analysis provides an important refinement to the apprehension of the phenomenon of dementia. From the work of Foucault, and in particular his analysis of the historical origins of modern medicine, the sociological construction of dementia is considered. Following this, the philosophical question of Being is discussed, considering particularly the positions of Heidegger and Merleau-Ponty. Lastly aspects of dementia nursing that are damaging to those relatives forced to take on the role of primary carer are isolated, in the context of Kitwood's view that it is possible to maintain personhood at the extremes of this condition. It is suggested that this critique of sociological and philosophical foundations of dementia might offer a way of approaching the dismantling of the self and revise current conceptions of dementia care for the better.

Caregivers↗

Liminality: a major category of the experience of cancer illness.

Narrative analysis is well established as a means of examining the subjective experience of those who suffer chronic illness and cancer. In a study of perceptions of the outcomes of treatment of cancer of the colon, we have been struck by the consistency with which patients record three particular observations of their subjective experience: (1) the immediate impact of the cancer diagnosis and a persisting identification as a cancer patient, regardless of the time since treatment and of the presence or absence of persistent or recurrent disease; (2) a state of variable alienation from social familiars, expressed as an inability to communicate the nature of the experience of the illness, its diagnosis and treatment; and (3) a persistent sense of boundedness, an awareness of limits to space, empowerment and available time. These subjectivities were experienced in varying degree by all patients in our study. Individual responses to these experiences were complex and variable. The experiences are best understood under the rubric of a category we call "liminality". We believe that all cancer patients enter and experience liminality as a process which begins with the first manifestations of their malignancy. An initial acute phase of liminality is marked by disorientation, a sense of loss and of loss of control, and a sense of uncertainty. An adaptive, enduring phase of suspended liminality supervenes, in which each patient constructs and reconstructs meaning for their experience by means of narrative. This phase persists, probably for the rest of the cancer patient's life. The experience of liminality is firmly grounded in the changing and experiencing body that houses both the disease and the self. Insights into the nature of the experience can be gained from the Existentialist philosophers and from the history of attitudes to death. Understanding liminality helps us to understand what it is that patients with cancer (and other serious illnesses) seek from the system to which they turn for help. Its explication should therefore be important for those who provide health care, those who educate health care workers and those concerned to study and use outcomes as administrative and policy making instruments.

Adult↗

The practice of presencing.

OBJECTIVES: To understand philosophical foundations for this fundamental nursing intervention, and to review literature and expert nurses' experiences to describe how to be present to persons with cancer. DATA SOURCES: Author's qualitative research of nurses' experiences of presencing; theoretical and clinical nursing perspectives; books by theologian Martin Buber. CONCLUSION: Presencing requires deliberate focused attention, receptivity to the other person, and persistent awareness of the other's shared humanity. "Being there" provides comfort for both patient and nurse. IMPLICATIONS FOR NURSING PRACTICE: Literature reviewed offer the elements of presenting (eg, providing affirmation, communication of empathy, being without words). Identification of such elements can assist the reader to implement this intervention.

Empathy↗

Theoretical perspectives on narrative inquiry.

Narrative inquiry is gaining momentum in the field of nursing. As a research approach it does not have any single heritage of methodology and its practitioners draw upon diverse sources of influence. Central to all narrative inquiry however, is attention to the potential of stories to give meaning to people's lives, and the treatment of data as stories. This is the first of two papers on the topic and addresses the theoretical influences upon a particular narrative inquiry into nursing scholars and scholarship. The second paper, Conducting a narrative analysis, describes the actual narrative analysis as it was conducted in this same study. Together, the papers provide sufficient detail for others wishing to pursue a similar approach to do so, or to develop the ideas and procedures according to their own way of thinking. Within this first theoretical paper, perspectives from Jerome Bruner (1987) and Wade Roof (1993) are outlined. These relate especially to the notion of stories as 'imaginative constructions' and as 'cultural narratives' and as such, highlight the profound importance of stories as being individually and culturally meaningful. As well, perspectives on narrative inquiry from nursing literature are highlighted. Narrative inquiry in this instance lies within the broader context of phenomenology.

Attitude to Health↗

Hans Castorp's journey-to-knowledge of disease and health in Thomas Mann's The Magic Mountain.

The paper examines Thomas Mann's novel, The Magic Mountain, to show how imaginative literature can enhance our understanding of health in place. The story centers on the experiences of Hans Castorp, a young bourgeois German, at a tuberculosis sanatorium in the Swiss Alps. Three themes are examined: (1) how knowledge about illness and health, death and life, is gained; (2) how knowledge is arrived at through a dialectical process which reconciles seeming opposites; and(3) how new knowledge is gained through making transitions. Lessons for health geography are drawn from analysis of the three themes.

Adaptation, Psychological↗

Living with experiences following a myocardial infarction.

Coronary heart disease is a major cause of sudden death and morbidity in the developed world, as well as a cause of great suffering. Research within this area has primarily focused symptoms, risk factors and treatment. The aim of this paper was to explore women's experiences following a myocardial infarction (MI). Eight women were interviewed; the interviews were audiotaped and transcribed into text and analysed using a phenomenological approach. To explore the meaning that is experienced in the lived world of the patient a method of reflective lifeworld research, based upon phenomenological epistemology has been used. The results indicate that the body is vital for the women in their lifeworlds. After a MI the patient's natural and unreflective relationship with the body and the lived world is interrupted. Uncertainty about life and death as well as the body is experienced as a suffering in the women's lifeworlds. In relation to this, the women's existence is characterised by an uncertainty and a loss of context. It is through reconciliation with their bodies and their illnesses that the women can achieve a sense of well-being and harmony in life. In that process the women can re-establish a natural relationship with their bodies and lifeworlds.

Adaptation, Psychological↗

Hermeneutics and the philosophy of medicine: Hans-Georg Gadamer's platonic metaphor.

Taking as our starting point Plato's metaphor of the doctor as philosopher we reflect on some aspects of the epistemological status of medicine. The framework to this paper is the hermeneutics of Hans-Georg Gadamer which shows the paradoxical nature of Western medicine in choosing the body-object as its investigative starting point, while in actual fact dealing with subjects. Gadamer proposes a model of medicine as the art of understanding and dialogue, which is capable of bringing together its various constituent parts, i.e. knowledge, knowing how to do and knowing how to be, in medical practice and in the physician's training. The paper concludes with a brief discussion of the dyadic figure of the physician as Platonic "master of the living totality" and wounded healer, capable of activating the patient's self-healing capacity.

Art↗

The tacit-explicit connection: Polanyian integrative philosophy and a Neo-Polanyian medical epistemology.

The purpose of this paper is to introduce an approach to clinical practice aiming to resolve the dilemma of choosing between a mechanistic and a phenomenological model. The approach is an extension of Polanyi's epistemology. Michael Polanyi (1891-1976), devised an epistemology of science which overcomes the problem of detachment, inherent in the "mechanistic" approach, and resolves the problem of subjectivity troubling phenomenologists. His epistemology is known as Personal Knowledge. An extension of this epistemology, a Neo-Polanyian proposal, is offered as a more successful model for clinical practice than previous suggestions addressing the dilemma.

Ethics, Medical↗

Some philosophies can console: an old but forgotten message.

Thesis: Since Socrates, western philosophy has been concerned with the study of humankind, with a strong emphasis on how we ought to live and why. Philosophy, in its multiple forms and expressions, has enabled many to pursue their lives with greater depth, richness, and variety; yet it can also act as a therapeutic method for the achievement of a healthier life. Asking and answering philosophical questions such as 'How best ought I live?', 'What is the meaning of my life in relation to the whole?', 'Why should I live?', 'What constitutes a healthy life?' can act as therapeutic entryways, not only within the parameters of one's own mind or in a university classroom, but also within a health care/therapy context. Philosophy, both as subject and method, is a powerful, largely unrecognized, therapeutic instrument for social medicine, an instrument whose application in various health care settings could benefit those--patient and staff--in need of consolation and support when they need it most.

Existentialism↗

Prescriptions: autonomy, humanism and the purpose of health technology.

My purpose is to examine two of the foundations of medical ethics: the principle of autonomy and the concept of the human. I also investigate the extent to which health technology makes autonomy and humanness possible. I begin by underlining Illich's point that the same health technology designed to promote health and autonomy also is pathogenic. I proceed to analyse the Kantian concept of autonomy, a concept which is closely associated with health and which continues to determine current ethical thinking. In so doing, I uncover an unexpected ontological function of health technology, a function described in Heidegger's work on technology. Based on this discovery, I suggest that calls for Kantian autonomy may often be self-defeating or even sometimes harmful. I conclude by calling for continued ethical vigilance, but also for a questioning of the hitherto virtually unquestionable concepts of ethics and humanness which may themselves play a role in our era's greatest problems.

Ethics, Medical↗

A brief history of psychiatry: millennia past and present--part III.

Release of emotion through a variety of means has often been seen as healing. Throughout the centuries many cultures dealt with stress by bringing relief through methods like dancing, ritual, or confession. The idea of discovering not always conscious emotions and their release through talking became important in 19th-century psychological treatments. The 20th century has seen a flowering of psychoanalytical, behavioral, cognitive behavioral, and many other psychotherapies. These have been used in individual, group, or martial/family settings, inpatient and outpatient. There have been disagreements between and among the various schools of psychotherapy. As we approach the next century, therapists of all schools are discussing ways in which each therapy contributes to helping patients and are defining common threads that link all the approaches to psychotherapy.

Cognitive Behavioral Therapy↗

Empirical and hermeneutic approaches to phenomenological research in psychology: a comparison.

Empirical phenomenology and hermeneutic phenomenology, the 2 most common approaches to phenomenological research in psychology, are described, and their similarities and differences examined. A specific method associated with each form of phenomenological inquiry was used to analyze an interview transcript of a woman's experience of work-family role conflict. A considerable degree of similarity was found in the resulting descriptions. It is argued that such convergence in analyses is due to the human capacities of reflection and intuition and the presence of intersubjective meanings. The similarity in the analyses is also encouraging about researchers' ability to reveal meaning despite the use of different methods and the difficulties associated with interpreting meaning.

Adult↗