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PubMed1997

Heideggerian phenomenology: an approach to understanding family caring for an older relative.

Recent research has found that family caregivers do not discuss their caregiving in terms of tasks but instead describe their care as shaped by concerns, commitments and goals. The purpose of this paper is to challenge the ways in which nurses approach the family caregiving process and to explore possibilities for evolving nursing knowledge by questioning existing practice in the light of developing insight into the ways in which being a family caregiver is meaningful. A critique of the philosophical orientations of rationalism and empiricism provides a platform to discuss the merits of a Heideggerian phenomenological approach in assisting nurses to better understand family caring experience. Such critique serves to support the notion of displacing the traditional scientific view as the prime means of disclosing truth, acknowledging alternative ways of knowing.

Aged↗
PubMed2005

Sustaining self: moving beyond the unexpected realities of teaching in practice.

Nurse educators who teach undergraduate students in clinical practice frequently encounter, or are thrown into situations that interrupt smooth activity, pausing to make sense of what is going on in order to respond in a manner that is consistent with their professional beliefs and values. In moving towards, within and beyond this interruption in smooth activity, identified within this research as an Unready-to-Hand immersion, these educators create a matrix of situational knowing and wisdom that surrounds propositional knowing. In striving to clarify the knowing that informs the clinical nurse educator's response to unexpected situations, I referred to philosophical literature on tacit knowledge, practice wisdom, smooth activity and the Unready-to-Hand mode of engagement. I carried out an interpretive research project involving reflections on personal experiences followed by two layers of interviewing with nurse educators teaching students in practice. The first layer of individual interviews was with eight nurse educators who in their role experienced Unready-to-Hand immersions. The second layer involved of three of these eight participants who chose to continue with more in-depth, unstructured interviews. One participant not involved in the original set of interviews approached me individually and asked to participate in the in-depth interviews, which they did. An interpretive analysis of these nurse educators' stories illuminated Unready-to-Hand as Adventure, highlighting the elements of attuning to difference, the domains of practice within Unready-to-Hand and three modes of unknowing. This paper focuses on one of the domains of practice: sustaining self.

Adaptation, Psychological↗
PubMed2005

Dwelling with stories that haunt us: building a meaningful nursing practice.

The purpose of this article is to reflect on pediatric critical care nurses' experience of grief by focusing on the meaning of the stories that haunt them. It is suggested that these stories are the nurses' attempt to find ways to journey through their grief and to live with the mystery of life and death. It is also the task of these stories to throw light on their experiences, a task that is never entirely finished. Dwelling with the stories that haunt them helps to provide nurses with a moral structure of critical care nursing practice. Their reflections upon the meaning of their experiences of grief can lead to a view of death that is not always perceived as an evil to flee, but is upheld as a source of value and revelation as critical care nurses strive to build who they are and how they practice the art of nursing.

Adaptation, Psychological↗
PubMed2005

Mediating the meaning of evidence through epistemological diversity.

Nursing's disciplinary recognition of 'multiple ways of knowing' reflects an epistemological diversity that supports nursing praxis. Nursing as praxis offers a conceptual way to explore what it is about the interface of practice, knowledge and evidence in nursing that distinguishes us as a discipline. I suggest that the relationship between evidence and knowledge is defined and mediated by the same epistemological diversity that supports nursing as praxis. Just as the meaning and truth-value of evidence is evaluated from within the body of existing disciplinary knowledge, new evidence may prompt an evaluation of the meaning and truth-value of extant nursing knowledge. Nursing practice that relies on scientific evidence as a singular basis of practice knowledge is susceptible to exploitation by the diverse agendas operating within an ideology of evidence-based practice and the healthcare system. Mediating the meaning of evidence for nursing practice through acknowledgement of the diverse epistemologies that underpin nursing knowledge will contribute to a disciplinary-specific definition of what constitutes evidence for nursing, and will better direct how evidence is integrated into a disciplinary body of knowledge.

Benchmarking↗
PubMed2005

Phenomenology as rhetoric.

The literature on 'nursing phenomenology' is driven by a range of ontological and epistemological considerations, intended to distance it from conventionally scientific approaches. However, this paper examines a series of discrepancies between phenomenological rhetoric and phenomenological practice. The rhetoric celebrates perceptions and experience; but the concluding moment of a research report almost always makes implicit claims about reality. The rhetoric insists on uniquely personal meanings; but the practice offers blank, anonymous abstractions. The rhetoric invites us to believe that knowing is subjective and involved, but at the same time it recommends a technique (bracketing) which can only represent a crude, and entirely misconceived, gesture towards objectivity. Finally, the rhetoric claims that generalisation is beside the point; but the majority of researchers generalise anyway. In quietly ignoring their own rhetoric, 'phenomenologists' appropriate scientific prerogatives illegitimately. For their methods do not entitle them to lay claim to anything resembling 'objectivity', or generalisability, or 'reality', or theoretical abstraction. Like other researchers, they want to talk in generalisable terms about reality; they want to be objective, they want to do theory. But they are saddled with a philosophy that is disabling, because it says they can only talk about perceptions, and meanings, and uniqueness.

Adaptation, Psychological↗
PubMed2006

To describe or prescribe: assumptions underlying a prescriptive nursing process approach to spiritual care.

Increasing attention is being paid to spirituality in nursing practice. Much of the literature on spiritual care uses the nursing process to describe this aspect of care. However, the use of the nursing process in the area of spirituality may be problematic, depending upon the understandings of the nature and intent of this process. Is it primarily a descriptive process meant to make visible the nursing actions to provide spiritual support, or is it a prescriptive process meant to guide nursing actions for intervening in the spirituality of patients? A prescriptive nursing process approach implies influencing, and in some cases reframing, the spirituality of patients and thereby extends beyond general notions of spiritual support. In this paper we discuss four problematic assumptions that form the basis for a prescriptive approach to spiritual care. We conclude that this approach extends the nursing role beyond appropriate professional boundaries, making it ethically problematic.

Attitude of Health Personnel↗
PubMed2006

Phenomenology as a paradigm of movement.

Phenomenology is a well-founded qualitative methodology that is frequently used by nurse researchers and considered of value when addressing research questions in nursing practice and nurse education. However, at present, nurse researchers using phenomenology tend to divide phenomenological methodology into the descriptive and interpretive formats. The nursing literature suggests that there is a deep divide between researchers following the methodological underpinnings and basic precepts pertaining to these two camps. If we are to reach a clearer understanding of the theory underlying phenomenological methods it would be more helpful if we started to recognise that there are also important associations between transcendental and interpretive phenomenology. One such association is that a paradigm of movement exists that is not unique to transcendental and interpretive phenomenology but is common to them, as well as being inherent within a variety of fields of study. If we consider the universality of such imagery, looking to examples through parallel texts, we can obtain insights into phenomenology and its transposition into a workable scientific method that can be of use to the nurse researcher.

Attitude to Health↗
PubMed2006

The art of professional development and caring in cancer nursing.

The impetus for this qualitative study was the premise expressed by lay people that nursing terminally ill cancer patients must be depressing and difficult to cope with. Its focus was nurses' stress and coping strategies, both secular and religious. Data was collected using a narrative life-story approach, and then Lazaruz and Folkman's coping theory and Pargament's theory on the psychology of religion were used during the analysis of the data. Several factors were identified, related to the individual and group levels, that influence a nurse's identity and professional development. A person's life orientation was suggested as a first concept for developing a professional paradigm that includes caritas as a main orienting factor. Directed by the nurse's secular and religious orientation, competence develops, making it possible to understand, analyze, manage, and appreciate the significance of the professional work of caring.

Adaptation, Psychological↗
PubMed2006

Treading lightly: spirituality issues in mental health nursing.

Spirituality has been recognized as an important part of nursing practice since its early beginnings. However, debate continues about whether and how nurses and other mental health professionals should include spirituality within their daily work. This paper aims to contribute to the discussion of spirituality within mental health nursing, through considering findings from a Heideggerian phenomenological study conducted with six people with mental illness living in regional Australia. This study aimed to provide a greater understanding of the phenomenon of spirituality by answering a primary research question, 'What does spirituality mean for people with a mental illness?' Participants were interviewed and data analysed using an iterative approach. Findings emerged through multiple readings and meanings were gradually constructed from the data into themes. The themes describe that spirituality is experienced uniquely for the participants, and that spirituality became vitally important to them when they became mentally unwell. In addition, issues of interest to mental health nurses were raised but not completely addressed by the study. The issues relate to potential interactions about spirituality between nurses and their patients. Although participants wanted to discuss their experiences of spirituality with others, they raised concerns about whether their mental health care providers would be accepting of their beliefs. Spirituality was deemed to be a highly individual phenomenon; it could be experienced as a journey and it was life-sustaining. For these reasons, it is proposed that mental health professionals must be prepared to discuss patients' spiritual needs in the context of their health concerns.

Adaptation, Psychological↗
PubMed2005

Through the lens of Merleau-Ponty: advancing the phenomenological approach to nursing research.

Phenomenology has proved to be a popular methodology for nursing research. I argue, however, that phenomenological nursing research could be strengthened by greater attention to its philosophical underpinnings. Many research reports devote more page space to procedure than to the philosophy that purportedly guided it. The philosophy of Maurice Merleau-Ponty is an excellent fit for nursing, although his work has received less attention than that of Husserl and Heidegger. In this paper, I examine the life and thought of Merleau-Ponty, with emphasis on concepts, such as perception, intentionality and embodiment, which have particular relevance to the discipline of nursing.

Emotions↗
PubMed2005

The production of the psychiatric subject: power, knowledge and Michel Foucault.

The issue of power has become increasingly important within psychiatry, psychotherapy and mental health nursing generally. This paper will suggest that the work of Michel Foucault, the French philosopher and historian, has much to contribute to the discussion about the nature, existence and exercise of power within contemporary mental health care. As well as examining his original and challenging account of power, Foucault's emphasis on the intimate relationship between power and knowledge will be explored within the context of psychiatry and mental health nursing. This is to say that the paper will investigate Foucault's account of how power and knowledge are central to the process by which human beings are 'made subjects' and therefore how 'psychiatric identities' are produced. In doing so, it will be suggested that Foucault's work can not only make a valuable contribution to contemporary discussions about power and knowledge, but can also provide a significant critique and reconceptualization of the theoretical foundations and associated diagnostic and therapeutic practices of psychiatry and mental health nursing.

Attitude of Health Personnel↗
PubMed2005

Knowing the nurse practitioner: dominant discourses shaping our horizons.

The purpose of this paper is to examine the various discourses, particularly the dominant instrumental and economic discourses that have brought the phenomena of the nurse practitioner (NP) into being. It is proposed that NPs have been constituted as an object of nature and therefore understood metaphorically as a tool or instrument within the health care system to be used efficiently and effectively. Heidegger's philosophical analysis of the question concerning technology is used to argue that our current ways of knowing the NP through these discourses, with their emphasis on calculative logic, have resulted from our modern view of the essence of technology. It is also argued that there is now a need to shape our horizons concerning the NP in new and different ways. There is a need to engage in dialogical forms of research in order to evoke the richness and depth of what it means to be an NP, that is, to reveal the other modes of expression by which we define ourselves, understand others and nursing.

Anthropology, Cultural↗
PubMed2005

Understanding end-of-life caring practices in the emergency department: developing Merleau-Ponty's notions of intentional arc and maximum grip through praxis and phronesis.

The emergency department (ED) is a fast-paced, highly stressful environment where clinicians function with little or suboptimal information and where time is measured in minutes and hours. In addition, death and dying are phenomena that are often experienced in the ED. Current end-of-life care models, based on chronic illness trajectories, may be difficult to apply in the ED. A philosophical approach examining end-of-life care may help us understand how core medical and nursing values are embodied as care practices and as ethical comportment. The integration of Aristotle's notions of phronesis and praxis with Merleau-Ponty's ontological notions of intentional arc and maximum grip in the context of the culture and practices of the ED offers a unique view of clinical and ethical practice at the end-of-life in the emergency setting. Caring for people at the end-of-life calls us to act virtuously based on previous experience, meanings and local practices. The maximum grip of the ultimate particulars of the situation combined with one's experiential and theoretical knowledge opens up situated possibilities for the expert clinician.

Adaptation, Psychological↗