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PubMed2002

The lived experience of waiting-to-know: Ebola at Mbarara, Uganda--hoping for life, anticipating death.

PURPOSE PF THE STUDY: The purpose of the study was to describe the phenomenon of 'waiting to know'. It is a phenomenon uniquely experienced by persons who had been exposed to patients with Ebola Hemorrhagic Fever (Ebola) but who have not yet exhibited signs and symptoms of the disease. RESEARCH METHOD/ANALYSIS: The phenomenological human science approach was used using the four life worlds as guides for reflection. These are spatiality, corporeality, temporality, and relationality. PARTICIPANTS: Seven health care personnel were selected through professional networking. They were preferred because of their exposure to patients with Ebola during the epidemic at Mbarara, Uganda. RESULTS/FINDINGS: Written descriptions of the experience of 'waiting to know' whether exposure to patients with Ebola causes these participants to be infected, were obtained and analysed. Through immersion with the written descriptions, the following themes emerged: helplessness in anticipation and fear of dying or premature death; agonizing and languishing over losing relatives, friends, and loved ones; trusting no one, and; helplessness and hopelessness with the persistence of time.

Adaptation, Psychological↗
PubMed2002

Edwards, Benner and Wrubel on caring.

AIMS: To explain the difficult Heideggerian concept of the ontological difference and then use it as a context to explain the misperceptions of Benner and Wrubel's reply to Edwards' criticism of the differences between ontological and intentional care. BACKGROUND: Edwards' paper attempts to clarify what Benner and Wrubel actually mean by the category of ontological care. The latter's reply totally bypasses Edwards' criticisms because they have a misunderstanding of Heidegger's philosophy, which they use to support their arguments. CONCLUSION: Benner and Wrubel's claims that they are using Heidegger to underpin their arguments is wrong. This has the consequence that their category of ontological caring comes tumbling down and their philosophy is not as radical as they think it is.

Empathy↗
PubMed2002

Applying phenomenography in nursing research.

AIMS: This paper examines phenomenography, a research approach designed to answer certain questions about how people make sense of their experience. The research approach, developed within educational research, is a content-related approach investigating the different qualitative ways in which people make sense of the world around them. The outcomes of phenomenographic research are different content-related categories describing the differences in other people's ways of experiencing and conceiving their world. METHODS: The research approach is presented by describing the underlying ontological and epistemological assumptions, describing the research method in detail and providing some examples of phenomengraphic studies in health care and nursing research. The possibilities for applying the methodology to nursing research are discussed, illustrated by research examples. Finally, the future role of the approach within nursing research is discussed. CONCLUSION: The emphasis on differences in the phenomenographical research approach makes it distinct from other research approaches, and accordingly, it seems to be reasonable to incorporate knowledge of this kind in the professional education of health care personnel.

Adaptation, Psychological↗
PubMed1998

Evolution of the species 'expert nurse'. An examination of the practical knowledge held by expert nurses.

The aim of this study was to examine the knowledge that expert nurses use in practice and the factors that influence knowledge use and development. A combined ethnographic and phenomenological methodology was used. Data were collected by questionnaires, interviews, workshops, observation visits and critical incident technique. Knowledge and expertise were found to have developed in response to the 'world view' held by expert nurses. Four distinct types of experts holding different knowledge bases emerged from the data.

Attitude of Health Personnel↗
PubMed2001

Women's lived experience of breast biopsy: a phenomenological study.

This study aimed to explore Irish women's lived experience of breast biopsy with a view to gaining a deeper understanding of their individual experiences and the meanings that it holds for them. A phenomenological approach from a Heideggerian hermeneutical perspective was used. Study participants were eight women aged 22-54 years who had experienced a recent breast biopsy with benign diagnosis. Data were collected using in-depth interviewing. The work of Benner (1994), together with guidelines from Morse & Field (1996) and Burnard (1991) were used to guide the process of data analysis. Themes which emerged from the data were: 'Finding the lump', 'Waiting, not knowing', 'knowing', 'Getting back to normal' and 'Reflections'. Women's feelings of initial distress followed by relief permeate these themes.

Adaptation, Psychological↗
PubMed2004

Spirituality: the emperor's new clothes?

BACKGROUND: This paper explores the concept of 'spirituality' with reference to the Patients' Charter that stipulates that a person's religious, spiritual and cultural needs should be respected at all times. AIMS AND OBJECTIVES: The aim is to offer a critical analysis of what the word 'spirituality' may mean when used in the Patients' Charter and to explore the implications of this for clinical practice. DESIGN: A critical discussion based on a literature review, examining in particular methodological presuppositions. METHODS: The meaning of 'spirituality' in the Judaeo-Christian biblical traditions is explored. Some of the heuristic assumptions in contemporary research on 'spirituality' are examined. Philosophical (i.e. non-scientific) and scientific questions to do with 'spirituality' are disentangled. RESULTS AND CONCLUSIONS: The paper concludes that: (i) 'Spirituality' is an elastic term not capable of universal definition as each person's spirituality is an individual matter for them and (ii) tools that are being developed for identifying a person's spirituality run the risk of making wrong presuppositions about what comprises spirituality. RELEVANCE TO CLINICAL PRACTICE: It is unlikely that tools can be developed that are widely applicable for identifying and assessing spirituality.

Christianity↗
PubMed2001

The emancipation of nursing practice: applying anti-psychiatry to the therapeutic community.

This paper raises issues about the process and conduct of clinical relationships with people diagnosed as mentally ill who live in therapeutic communities. This clinical work is of particular importance in the late 1990s due to the changing socio-cultural climate of interaction with people living with mental illness. This climate has a focus of care on recovery in the community and not on long-term hospitalization. The paper takes the position of anti-psychiatry as a preferred model of intervention because it is person and not diagnosis oriented. The nature of the therapeutic community is explored in relation to its importance in the context of destigmatizing mental illness, its structure, and in its ability to empower the person from a philosophically driven and experiential perspective.

Attitude of Health Personnel↗
PubMed1998

The good, the bad and the relative, Part one: Conceptions of goodness in qualitative research.

This (part one) paper traces efforts to define 'goodness' in qualitative research within various fields, including nursing. At first closely aligned with the traditional tenets of quantitative research (reliability and validity), over time these are found to be increasingly problematic to uphold within a qualitative context. As alternative criteria more appropriate to qualitative approaches are developed, in many instances these also are wanting in that they continue to reflect a search for order and certainty that permeates the quantitative domain. In reviewing various sets of criteria of goodness, the concepts of reliability and validity in relation to qualitative research are conceived as being championed, translated, exiled, redeemed and surpassed. Part two of the paper addresses the topic of goodness of qualitative research within the philosophical 'problem of the criterion'. Discussion extends to how researchers might usefully juxtapose the rationality of a modern world with a mounting postmodern sensibility.

Ethics, Nursing↗
PubMed1999

The patient's perceived caring needs: measuring the unmeasurable.

The aim of this study is to elucidate the phenomenon of the caring need in the life-world of the patient and, on the basis of this, to compare patients' perceived caring needs with the six areas of need contained in a new instrument for patient classification, the Oulu Patient Classification (OPC). A total of 75 patients were interviewed and the data were analysed by means of a phenomenological-hermeneutical method. Seventeen perceived caring needs emerged from the process of interpretation. The patients experienced themselves as an indivisible unit that contained existential/spiritual needs and desires. The patients' caring needs are constituted from their problems, needs and desires, where human desire for life, love and meaningfulness may, express itself as bodily, psychical and existential/spiritual needs. A comparison between the patients' perceived caring needs and the OPC shows that patients' existential/spiritual needs do not emerge clearly enough and that the instrument should be supplemented by a caring perspective.

Activities of Daily Living↗
PubMed1999

Reading Heidegger and interpretive phenomenology: a response to the work of Michael Crotty.

In a recent paper in Nursing Inquiry and in his other work, Michael Crotty was severely critical of much interpretive nursing scholarship and especially of some nurse scholars' interpretations of the work of Martin Heidegger. In this paper we respond to Crotty's attempt to set out what Heidegger 'actually says' [sic] in relation to tradition, culture, destruction, das Man and everydayness. We suggest that Crotty took a narrow, existentialist view of Heidegger's work and that this view was often misguided and poorly informed. We show not only that an alternative understanding of Heidegger's work in these important areas is possible, but that this interpretation is strongly supported by a deeper and wider reading of Heidegger's own work and of the secondary literature of Heideggerian scholarship.

Attitude of Health Personnel↗
PubMed1999

Mad talk: attending to the language of distress.

This paper will examine how the narrative of one woman, Madeleine, can be constructed as symptomatic of the diagnosis of schizophrenia, and how it can also be read from other perspectives, particularly a poststructural feminist one. The readings are presented as possibilities for understanding the woman's experiences and the implications of this for mental health nursing practice. A poststructural feminist reading acknowledges the gendered experiences of subjectivity and how those experiences are constructed in language. The purpose of this paper is to identify for mental health nursing practice an approach which recognizes the figurative and literal characteristics of language in order to provide nursing care which positions the individual's experience of mental distress as central. This requires an acknowledgement of Madeleine's path into mental distress rather than simply a categorization of what is observed in a clinical setting. Intervention may need to include a range of strategies: medical and nonmedical, psychotherapeutic and social, physical and environmental. It may also require the provision of sanctuary and security whilst these options are explored.

Attitude to Health↗
PubMed1999

Being authentic and being a chameleon: nurse-patient interaction revisited.

This paper explores contradictory understandings of nurse-patient interaction arising through an exploration of 'being authentic' and 'being a chameleon'. The concepts arose during a critical praxis research study exploring nurse-patient relationships in the context of life-threatening or terminal illness. Being authentic can be understood as a dominant view in the nursing literature of the nurse-patient relationship, incorporating the value of being genuine. However, we argue that this concept offers only a partial and inadequate framework from which to understand nurse-patient interaction. The paper argues that nurse-patient relationships develop intersubjectively, with both the nurse and the patient choosing to reveal or conceal aspects of themselves in response to their interactions. Intersubjectivity as a concept provided the nurses in this study with a means for understanding how the nurse and the patient each contribute to interactions; nurse-patient relationships being understood as mutually constructed. These ideas are explored in this paper using examples from the nurses' stories, along with the implications raised for nursing practice.

Attitude of Health Personnel↗
PubMed2003

The meaning of being in ethically difficult care situations in paediatric care as narrated by female Registered Nurses.

Studies among physicians and nurses in paediatric care reveal experiences of loneliness and lack of open dialogue. The aim of this study was to illuminate the meaning of female Registered Nurses' lived experience of being in ethically difficult care situations in paediatric care. Twenty female Registered Nurses who had experienced being in ethically difficult care situations in paediatric care were interviewed as part of a comprehensive investigation into the narratives of male and female nurses and physicians about being in such situations. The transcribed interview texts were subjected to phenomenological-hermeneutic interpretation. The results showed that nurses appreciated social confirmation from their colleagues, patients and parents very much. This was a conditioned confirmation that was given when they performed the tasks expected from them. The nurses, however, felt that something was missing. They missed self-confirmation from their conscience. This gave them an identity problem. They were regarded as good care providers but at the same time, their conscience reminded them of not taking care of all the 'uninteresting' patients. This may be understood as ethics of memory where their conscience 'set them a test'. The emotional pain nurses felt was about remembering the children they overlooked, about bad conscience and lack of self-confirmation. Nurses felt lonely because of the lack of open dialogue about ethically difficulties, for example, between colleagues and about their feeling that the wrong things were prioritized in the clinics. In this study, problems arose when nurses complied with the unspoken rules and routines without discussing the ethical challenges in their caring culture. The rules and the routines of the caring culture represented structural barriers for creating open dialogue and an ethically justifiable practice, called inauthentic existence, blindness related to our own inauthentic understanding, which focuses on the routines, rules, theories and systems.

Adaptation, Psychological↗
PubMedDate not supplied

Spirituality, demographic and disease factors, and adjustment to cancer.

PURPOSE: The purpose of this study was to examine the relationship between demographic-disease variables, spirituality, and psychosocial adjustment in a heterogeneous sample of patients with cancer. DESCRIPTION OF STUDY: Participants (N = 83) accrued through the Rhode Island Hospital and the American Cancer Society completed questionnaires, and structural equation modeling was used to examine the relationships among disease and demographic factors, spirituality, and psychosocial adjustment to cancer. RESULTS: Of five models tested, a mediational model received the strongest support (chi-square(35)-66.61; P = .005; comparative fix index = .90; root mean square error of approximation = .09), explaining 64% of the variance in psychosocial adjustment. Being a woman, having a longer illness duration, and having a lower disease stage were related to greater levels of purpose in life and religious beliefs, which, in turn, were associated with higher levels of family and social adjustment and psychological health. CLINICAL IMPLICATIONS: The results indicate that spirituality can influence how patients with cancer adjust to their diagnosis and treatment and, thus, support the need for interventions that target spirituality to promote psychosocial adjustment in this population.

Adaptation, Psychological↗
PubMed2000

Learning ethics in nursing and genetics: narrative pedagogy and the grounding of values.

An approach to learning is proffered that simultaneously provides new ways of thinking about ethics and genetics. This approach, narrative pedagogy, looks toward the ground of ethics and values in nursing practice and genetics. The ground is presented here as the beginning of questioning rather than an end, that is, questioning as a horizon, out of which new understandings for ethics and genetics can emerge.

Attitude of Health Personnel↗
PubMed1999

A Heideggerian investigation into the lived experience of humour by nurses in an intensive care unit.

A literature search revealed no systematic enquiry into the experience of humour by nurses in the intensive care setting, suggesting that there was a need for such studies (Astedt-Kurki & Liukkonen 1994). This phenomenological study was undertaken using an interpretive human science approach of phenomenology grounded in the hermeneutics of Heidegger. The task was to investigate and describe the concept of humour in an intensive care unit (ICU) from an inductive-descriptive perspective, seeking to identify the essence of the phenomenon through an accurate description of the lived experience of humour. A sample of eight nurses with at least one year's intensive care experience was randomly selected. Semi-structured interviews were conducted, audiotaped, transcribed into text, checked for transcription errors, and returned to participants for checking to ensure reliability and validity. Main core themes were identified and categorized, then Colaizzi's seven steps were used for analysis. Themes and categories identified in the collected data were rich and varied, allowing for lengthy discussions on thoughts and experiences. The study revealed a rich experience of humour in the ICU, suggesting that humour is central to nursing, and therefore worthy of deeper analysis using the same methodology.

Adaptation, Psychological↗
PubMed2000

The nearest and dearest: a lifeline for ICU patients.

This study was designed to examine, describe and elucidate patients' experiences of the presence and visits of the nearest and their participation in the care process during their stay in the ICU. Five patients, three men and two women, were interviewed for about one hour each. A hermeneutic approach was used when the texts from the interviews were interpreted and analysed. The theoretical frame of interpretation was based on Tillich's theory concerning 'The courage to be' and Eriksson's theory on 'Suffering'. It was found that suffering from severe disease or injury results in not only a threat against the person as an individual, but also against the individual as a part in the world, with consequent feelings of estrangement and the fear of meaninglessness. The threat can, however, be neutralized by the nearests' presence and visits. These represent fellowship, togetherness and participation and thus can help to maintain the patient's identity and individuality. By experiencing this, patients as individuals may be able to affirm themselves and their 'courage to be' will be given strength and support.

Adaptation, Psychological↗
PubMed2006

[Suicide in the literary work of Walker Percy].

Suicidality is one of the most serious unsolved problems of modern psychiatry. The psychological analysis of the behavioral and meaning patterns of suicide in the work of W. Percy gives the opportunity to a better and wider understanding of this phenomenon. In the suicide discussion, Percy points out the primary human need of transcendence and symbolization and the meaning of the "experience on the border" with its sense inducing character.

Existentialism↗