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Ricoeur’s hermeneutic phenomenology: an implication for nursing research
Abstract
Researchers and educators are increasingly implementing qualitative research methods to investigate issues of concern and interest. Hermeneutics has risen as an option for the qualitative research paradigm particularly after the 1970s. The precedence of the sciences that have applied hermeneutics as their approach to investigation is provided with special reference to nursing. In the nursing science, hermeneutics have been used extensively as a qualitative research method to investigate a variety of issues, through the lived experiences of the participants. In this paper, we introduce important aspects of the philosophy of Paul Ricoeur and we discuss the reasons why we have applied this approach in our study titled ‘Quality Nursing Care: perspectives of patients with cancer and the nursing response’. The arguments that are presented here can be generalised to fit other areas of Nursing Science. Through this paper our aim is not only to familiarise the reader with Ricoeur’s work, but also to arrive at an appreciation of his philosophy as a methodological approach for future nursing research.
... A qualitative research design was used to conduct this study. The researchers of this study used the phenomenological hermeneutic approach [19]. This study was also based on the theory of interpretation and used socio-anthropological fieldwork [19,20]. ...
... The researchers of this study used the phenomenological hermeneutic approach [19]. This study was also based on the theory of interpretation and used socio-anthropological fieldwork [19,20]. This study is divided into two parts: 1) the participants' observations; 2) interviews with the participants. ...
... The data that were collected from the participants' observations were analyzed on three levels: naive reading, structural analysis, and critical interpretation [19,20]. ...
Background: The responsibilities of critical care nurses for mechanical ventilation (MV) management may differ among countries, particularly in the weaning process. Aim: To identify nurses' perceptions, roles, and challenges regarding the weaning process for patients in intensive care units (ICUs) in Denmark, Egypt, and the Kingdom of Saudi Arabia (KSA). Methods: This study was a qualitative study using a phenomenological-hermeneutic design. Results: Nurses in Egypt and the KSA were more likely to independently adjust ventilator settings. They used body language, facial expressions, and eye contact to communicate with patients. They prepared patients for the weaning process following physicians' orders. They provided routine nursing care with no specific nursing guidelines or protocols for the weaning process. In contrast, the nurses in Denmark checked the ventilator settings frequently, assessed the consistency of secretions, and frequently performed endotracheal suctioning. They used body language, facial expressions, and eye contact, and they used low technology devices (e.g. word or picture charts, alphabet boards and rewritable magnetic boards) and advanced technological devices (e.g. electronic voice output communication aids through a computer) to communicate with their patients. Moreover, the criteria for weaning and the protocol were used to wean patients from MV. Unfortunately, no protocol was applied for patients with long-term MV. Therefore, the weaning of these patients was conducted by consultation between the nurses and physicians. Conclusion: The use of weaning protocols in Danish settings is an excellent example of collaborative teamwork to apply the best practices in MV weaning processes. It is recommended that nurses in Arab countries apply this experience.
... A qualitative research design was used to conduct this study. The researchers of this study used the phenomenological hermeneutic approach [19]. This study was also based on the theory of interpretation and used socio-anthropological fieldwork [19,20]. ...
... The researchers of this study used the phenomenological hermeneutic approach [19]. This study was also based on the theory of interpretation and used socio-anthropological fieldwork [19,20]. This study is divided into two parts: 1) the participants' observations; 2) interviews with the participants. ...
... The data that were collected from the participants' observations were analyzed on three levels: naive reading, structural analysis, and critical interpretation [19,20]. ...
... Phenomenological researchers search to obtain a different world view in comparison to quantitative researchers (Salmon, 2012). The use of qualitative research helps researchers delve deep into the experiences and belief systems of people who are variable, unique, and individualized (Burns & Grove, 2011;Charalambous et al., 2008;Pratt, 2012). Pratt (2012) explained that interviewing is the most commonly used qualitative approach for examining the lived experiences of individuals. ...
... This form of philosophical research allows investigators to understand the life experiences, perceptions, and beliefs of others in relation to a specific phenomenon. This philosophical approach requires effort, commitment, and time to achieve (Charalambous et al., 2008;Ironside, 2001;Pratt, 2012). Using Breckenridge's (1997) (Burns & Grove, 2011;Charalambous et al., 2008;Groenewald, 2004). ...
... This philosophical approach requires effort, commitment, and time to achieve (Charalambous et al., 2008;Ironside, 2001;Pratt, 2012). Using Breckenridge's (1997) (Burns & Grove, 2011;Charalambous et al., 2008;Groenewald, 2004). ...
... Phenomenological researchers search to obtain a different world view in comparison to quantitative researchers (Salmon, 2012). The use of qualitative research helps researchers delve deep into the experiences and belief systems of people who are variable, unique, and individualized (Burns & Grove, 2011;Charalambous et al., 2008;Pratt, 2012). Pratt (2012) explained that interviewing is the most commonly used qualitative approach for examining the lived experiences of individuals. ...
... This form of philosophical research allows investigators to understand the life experiences, perceptions, and beliefs of others in relation to a specific phenomenon. This philosophical approach requires effort, commitment, and time to achieve (Charalambous et al., 2008;Ironside, 2001;Pratt, 2012). Using Breckenridge's (1997) (Burns & Grove, 2011;Charalambous et al., 2008;Groenewald, 2004). ...
... This philosophical approach requires effort, commitment, and time to achieve (Charalambous et al., 2008;Ironside, 2001;Pratt, 2012). Using Breckenridge's (1997) (Burns & Grove, 2011;Charalambous et al., 2008;Groenewald, 2004). ...
Student nurse perceptions of teaching strategies commonly used in nursing programs. Qualitative study using interviews.
... Ricoeur's theory of interpretation served as the inspiration for the method of interpreting the text notes (23)(24)(25). Data analysis focused on understanding people in context. We took both the experiences of the patients (what was said) and of the researcher (what was observed) into account and let the language of both sources speak to us about the lived experiences (25). ...
... Finally, critical interpretation has the goal of developing new understandings. The themes were recontextualised in the light of relevant literature (23,25). In presenting the findings, we use examples from specific go-alongs to support the research team's analyses and themes. ...
Aim: To investigate how patients admitted to single-room accommodation experience mealtime situations. Methods: The study employed an ethnographical phenomenological design using the go-along method. From April to September 2022, 40 hours of meal-related observations and informal conversations with ten patients were completed in a Danish cardiac medicine ward and a vascular surgery ward. Data were analysed using a Ricoeur-inspired method. Results: Admission to a single-room is not unequivocally excellent or wrong with respect to the patients’ experiences of the meal or their perceived appetite. Nevertheless, meals were often referred to as the highlights of the day. Patients were positive about their own influence on their food choices, but they needed to experience professionals talking to them about healthy nutrition. Privacy was greatly emphasised, and most patients chose to eat alone because of their condition. Therefore, eating in the common dining room was seldom chosen. The results are presented in two themes: 1) Beyond the tray: Understanding the significance of meals for patients in single-rooms, and 2) Alone – but not lonely. Conclusions: Single-rooms allow for privacy during illness and recovery and make it possible to have private conversations about adequate nutrition. Clear professional responsibility needs to be assigned for the meal in single-room accommodation. Relevance to clinical practice: Knowledge of patients’ perspectives may guide nurses’ approaches to communicating with patients about the importance of the meal. Keywords: Nursing; Nutrition; Hospital design; Single-room accommodation; Qualitative research
... Hermeneutics, traditionally understood as the study of biblical science, is an approach to understanding meaning through textual exegesis (Klecun-Dabrowska and Cornford 2000;Crotty 1998), although it can be applied to other human artifacts including objects, built spaces and works of art (Burrell and Morgan 1979;Crotty 1998;Yanow 2006). The purpose of hermeneutics is to bring human symbols or texts 'into understanding' (Geanellos 1998 p154), to retrieve, reconstruct and reveal meaning not readily accessible on the surface of human existence, a meaning that extends beyond both the author's own understanding and the pre-understanding of the reader (Yanow 2000;Charalambous et al. 2008). Such is the nature of hermeneutics that some postulate an association with Hermes, the fleet-footed messenger in Greek mythology who acted as a translator of the messages of the Gods, conferring their intended meaning to humans in the mortal underworld (Crotty 1998;Jahnke 2012). ...
... Hermeneutics can lead to the development of new understandings through an iterative process of engaging with the text as a whole and with its parts (Geanellos 2000); as Wagenaar (2011) points out, the 'part obtains meaning from the whole and …the whole is explained by the individual parts' (p47). Through this hermeneutic circle the matter of the text is exposed, although this matter is neither the intention of the author nor a representation of any true state of affairs (Charalambous et al. 2008). ...
Skill-mix change and task shifting among the healthcare workforce has become a key mechanism for the continued provision of effective public healthcare within funding constraints. However, decoupling the healthcare professions from their traditional professional work tasks is not straightforward. Previous research has shown that in some contexts jurisdictional boundaries remain resolute.
This thesis uses two case studies to explore the mechanism and effect of challenge to the physiotherapy-medical professional boundary, precipitated by policy to modernise the English National Health Service workforce. The first examines the socio-political events which accompanied the publication of a national clinical guideline that proposed a reconfiguration of healthcare professionals managing people with non-specific low back pain. The second investigates the practice of physiotherapist non-medical prescribing in a musculoskeletal outpatient service in a single NHS Trust in England. The methodology adopted is interpretive policy analysis, informed by Foucault’s writings about power/knowledge and governmentality.
Through the identification and analysis of policy-related symbolic languages, objects and acts holding meaning for the communities studied, and examination of the system of relations between them, the discursive and extra-discursive constituting and shaping the physiotherapy-medical boundary are revealed. A ‘grid of intelligibility’ is employed as a framework to discern the circuits of power and the technologies governing physiotherapy practice. ‘Medical professionalism’ – the pre-eminence of specialist physicians in this field of healthcare – emerged as a dominant discursive formation and the case studies show the significant professional and institutional work required to maintain this.
The findings of this thesis suggest that despite the strong policy rhetoric of workforce modernisation, medical professionalism at the physiotherapy-medical boundary continues to thwart jurisdictional change. The historically contingent discourses at the heart of this power struggle mean that both meso-level policies and local-level practice change, directed to workforce reconfiguration, have only limited impact.
... Ricoeur [26] claims that the methodological steps help to create a distance between the researcher and her/his pre-understanding. Such a distance cannot be realized completely [27,41] but becoming more aware of the situation through reflection helps to limit the bias [2]. The authors are all RNs working in the following fields: clinical ethical support for all groups of professionals in a County Council (AS); researching matters of conscience in healthcare (VD); and working in anaesthetic care for many years (CFG). ...
... This was based on the researchers' pre-understanding, naïve understanding, themes and sub-themes and was reflected on in relation to relevant literature. The authors first appropriated and interpreted the text individually, then discussed the interpretations made until agreement on the most credible interpretation was arrived at [27]. According to Ricoeur [26] the text is open to a variety of interpretations, one therefore has to choose the interpretations one can argue for. ...
This study is part of a major study about difficulties in communicating ethical problems within and among professional groups working in hemodialysis care. Describing experiences of ethically difficult situations that induce a troubled conscience may raise consciousness about ethical problems and thereby open the way to further reflection.The aim of this study was to illuminate the meanings of being in ethically difficult situations that led to the burden of a troubled conscience, as narrated by physicians working in dialysis care.
A phenomenological hermeneutic method was used to analyze the transcribed narrative interviews with five physicians who had varying lengths of experience in nephrology.
The analysis shows that physicians working in hemodialysis care suffered from a troubled conscience when they felt torn by conflicting demands and trapped in irresolution. They faced ethical dilemmas where they were forced to make crucial decisions about life or death, or to prioritize when squeezed between time restraints and professional and personal demands. In these ethical dilemmas the physicians avoided arousing conflicts, were afraid of using their authority, were burdened by moral responsibility and felt devalued and questioned about their way of handling the situation. The findings point to another way of encountering ethical dilemmas, being guided by their conscience. This mean sharing the agony of deciding how to act, being brave enough to bring up the crucial problem, feeling certain that better ways of acting have not been overlooked, being respected and confirmed regarding decisions made.
The meanings of being in ethically difficult situations that led to the burden of a troubled conscience in those working in hemodialysis care, indicate the importance of increasing the level of communication within and among various professional groups--to transform being burdened by a troubled conscience into using conscience as a guide--in situations where no way of solving the problem seems to be good.
... Ricoeur's hermeneutic approach focuses on both the person and the context (Charalambous et al., 2008;Ikkink & van Tilburg, 1998). This research context refers to Israel during the first and the second waves of the pandemic. ...
Little is known about experiences of physicians when deciding on initiating life support during medical crises of mass casualties and undersupply. We performed a qualitative analysis of interviews with 14 physicians about their decision-making experience when considering initiating mechanical ventilation in patients with severe COVID-19 during the early pandemic. Three themes were revealed: (a) The accumulating clinical experience with invasive ventilation, and the physicians' perception of ventilation as effective or futile in these patients; (b) Preferences of patients and their families regarding mechanical ventilation; and (c) Economic, logistic, and organizational considerations of the undersupplied healthcare system. The circumstances under which end-of-life decisions were made often caused moral injury to physicians, in particular when their personal ethical standpoints were not integrated in the decision-making process. Our findings explore the moral injury suffered by physicians and may help identify strategies to mitigate moral injury of healthcare staff in times of medical crisis.
... However, compared to this broader field, empirical phenomenological inquiry is a field of methodologies 1 based on phenomenological philosophy with analysis of phenomena. It is interesting that empirical phenomenological methodological debate was largely reported in the previous century (e.g., Baker et al., 1992;Koch, 1995) but it is following the millenium shift that we recognize methodological studies into specific empirical phenomenological methodologies (e.g., Charalambous et al., 2008;Thomas, 2005). Nevertheless, guidance on how to choose between different empirical phenomenological methodologies is sparse. ...
Empirical phenomenological inquiry and analyses are of high relevance and applicability for nursing and health care. Phenomenology has clear roots in philosophy, which needs to be brought into an empirical phenomenological inquiry. However, all study of phenomena and experience does not qualify as phenomenological inquiry. The aim of this article is to provide guidance for how to relate different empirical phenomenological methodologies that are in play in the broader field of healthcare research, and thus support healthcare researchers in navigating between these methodologies. For pedagogical purposes, we present commonalities and differences as related to descriptive and interpretive phenomenological inquiries throughout the research process. The merits and criticisms of empirical phenomenological inquiry are commented on.
... 109). Although distanciation is framed as objectifying the text, the interpretive hermeneutic ontology is maintained in that the "knower" is connected with the "known", within a process that seeks to allow broader interpretative scope to facilitate the "Refiguration" stage in Mimesis III (Geanellos, 2000;Russo, 2021;Charalambous et al., 2008). ...
The deprivation, adversity, and lack of protection for children on the streets of urban Uganda are well known; as is the reality that most of their support is facilitated by Western Missionary operated, non-government organisations (NGOs). However, their approach is problematised as ineffective, oppressive, and colonial. Yet there is a dearth of research from the children’s perspectives, capturing the meaning of such actors’ interventions within their lifeworld’s, and no such literature within the Ugandan context. Therefore, this case study focuses on the ‘Mzungu Phenomenon’, a theme unearthed from critical hermeneutic analyses of the life stories of 30 former street children within an orphanage in Kampala, Uganda. The Mzungu phenomenon refers to the meaning and influence of the Western Missionaries and volunteers that feature within the children’s experiences, captured within their narratives. Underpinned by Ricœur’s narrative philosophy, this study illuminates and problematises the way in which Western NGO actors feature within the children’s lifeworld’s, and the wider ramifications from postcolonial, and postcolonial feminist theoretical perspectives. This includes the perpetuation of colonial legacies, ideologies, and praxis, that contribute to disempowerment for children, their families, and their communities, and the dual oppression of women. Therefore, this piece argues that despite a need to enhance child protection measures in Uganda, the current approaches that do not align with national and international rights-based policies must be further critically examined, challenged, and reformed, to ensure the wellbeing of the children.
... 23 Ricoeur argues that the process of interpreting a text is not about the realization or understanding of the narrator, but an understanding of the meaning of the text itself. 21,24 To achieve this, dialectical movement between explanation and comprehension is crucial. We try to understand the text by following the movement from what it 'says' to what it 'talks' about and in this way we aim for the goal of revealing a new aspect of being-inthe-world. ...
Study rationale:
Amyotrophic lateral sclerosis is a progressive neurodegenerative disease which causes impairment of the motor functions in the upper and lower limbs and bulbar muscles with a median survival time is three years from the first appearance of symptoms. There is massive psychological impact on health professionals to persons with amyotrophic lateral sclerosis, hence the work leads to multiple challenges and stressful and demanding situations with high risk of experiencing diminished personal well-being including burnout, moral distress, and compassion fatigue.
Aim:
To investigate reflections and perspectives from health professionals working within palliative rehabilitation for elements of importance in relation to job satisfaction.
Methods and materials:
The design was qualitative and based on the phenomenological-hermeneutical methodology by Paul Ricoeur's interpretation theory. Data consisted of two semi-structured focus group interviews with a total of 12 specialized health professionals: Nurses, Psychologists, Physicians, Occupational Therapists, Physiotherapists, and Social workers, working within a hospital setting of specialized palliative rehabilitation for people with amyotrophic lateral sclerosis and their families.
Results:
The analysis revealed insight into four themes: fundamental drive, working conditions, value of collegiality and work-life balance. Fundamental drive was deeply rooted in the professionals' sense of having a meaningful job. Working conditions such as self-management were important for job satisfaction as were good collegial relations. Finally, a good balance between working life and private life was considered important for job satisfaction.
Conclusion:
Our study indicates that work within the field of palliative rehabilitation is experienced as enriching and beneficial under the right circumstances and in an appreciatory working environment. We found elements like autonomy, mastery, purpose, collegiality, and work-life balance to be of great importance. Our findings can help guide managements and health professionals in other palliative rehabilitation contexts to ensure satisfied employees and to optimize the quality of care.
... 728). Researchers use hermeneutic phenomenology to attend to an interconnected human experience rather than focusing solely on knowing a specific experience (Charalambous, Papadopoulos, & Beadsmoore, 2008;Heidegger, 1962;Lopez & Willis, 2004;Solomon, 1987). Furthermore, the "focus of a hermeneutic inquiry is on what humans experience rather that what they consciously know" (Lopez & Willis, 2004, p. 728). ...
Pediatric oncology nurses can develop hazardous feelings of burnout over decades of clinical practice (Boyle & Bush, 2018). Interventions that help decrease burnout and improve professional development are reflective practices (Caldwell & Grobbel, 2013). Currently, there is a paucity of information on pediatric oncology nurses with 10 or more years of experience and how they use self-reflection to cope with workplace stressors. The purpose of this study was to explore how expert-level pediatric oncology nurses describe their experiences using self-reflective practices in the clinical setting. An interview-based exploration of the lived experiences of participants was necessary to understand the unique self-reflective practices currently used among nurses. Descriptive phenomenological methods were used, and data were organized and analyzed using the modified Stevick-Colaizzi-Keen method (Moustakas, 1994). Convenience and snowball sampling procedures were used. Six nurses fit the inclusion criteria and consented to participate in this study. Each participant completed three interviews. Results of the study were arranged in two categories: (a) the experience of using self-reflective practices in the clinical setting and (b) the experience of using self-reflective practices away from the clinical setting. In the clinical setting, experienced pediatric oncology nurses used self-reflection to develop better ways of interacting with patients, families, and colleagues. Using self-reflection to cope with stress and burnout occurred less in the clinical setting and more when experienced nurses reflected with other nurses, had moments of solitude, or when they were driving home from work. These results have implications for current nursing educators and nurses looking to develop skillsets to help reduce the harmful effects of stress and burnout in the clinical setting and maintain a productive career.
... This included a naive reading where the researchers read the transcriptions followed by structural analysis, and finally interpretation of the whole, which involves understanding, and reflection of the findings (Streubert & Carpenter, 2011). As nurse researchers, this approach lends itself to describing the phenomenological experience and allows for taking a more active role in interpreting the lived experiences (Charalambous, Papadopoulos, & Beadsmoore, 2008). To gain deeper insight, the researchers' field notes and journaling notes were integrated into the data analysis and constant comparison with the data was performed. ...
Introduction: Breast cancer–related lymphedema (BCRL), a long-term side effect of treatment, can occur at any point in time. With the extensive physical and psychological effects of BCRL, few studies have focused on the lived experience. The purpose of this study was to examine the lived experience of Hispanic women dealing with BCRL, particularly women of Mexican descent or origin. Method: Using interpretive phenomenology, 13 Hispanic women with BCRL, 42 to 80 years, were individually interviewed. Data analysis was conducted using interpretive reading of field notes, journal entries, and transcribed interviews. Results: Three central themes emerged from the findings, “sense of loss,” “resignation to the new self,” and “not knowing.” Further subthemes highlight the physical, psychological, and spiritual aspects of living with BCRL. Discussion: Cultural awareness of the impact BCRL has on activities of daily living of Hispanic women should be part of a holistic plan of nursing care when caring for this population.
... According to Ricoeur (1976) a person's first-hand experience remains private, but its meaning becomes available to others through interpretation. In nursing science, the hermeneutic-phenomenological approach has been used extensively as a qualitative method to investigate multiple issues through the first-hand experiences of the participants (Charalambous, Papadopoulos, & Beadsmoore, 2008). ...
The authors’ aim in this study was to examine the experiences of women regarding vaginal examination (VE) performed during labor. This qualitative study is based on a hermeneutic–phenomenological approach. Fourteen women within the first 24 hours of the postpartum period following vaginal birth were enrolled in the study. We created six themes under the categories of “past experiences” and “future expectations”. It was revealed that women had many negative feelings during the VE such as pain, ache, embarrassment, and fear. We recommend that the health care providers should inform women about relaxation methods that will reduce pain and discomfort.
... This study considered doctors' experiences of supporting and communicating to different health literacy groups, and how their experiences influenced their clinical practice. [23]. ...
Background: Low health literacy is associated with adverse health outcomes and raised healthcare costs. General practitioners (GPs) are the first point of access to health care services and play a key role in building patients’ health literacy. This study aimed to explore: (1) GPs’ understandings of health literacy, (2) the perceived challenges to addressing health literacy, and (3) the strategies used to support people with health literacy difficulties. Method: A qualitative study in South Western Sydney, New South Wales, Australia. Semi-structured qualitative interviews were audio-recorded and transcribed verbatim. Interview data were analyzed using the Framework method, a matrix-based approach to thematic analysis. Results: Eighteen participants took part in the study. Four key themes were identified: (1) identifying patients with health literacy difficulties; (2) perceived consequences of low health literacy; (3) being sensitive to developing health literacy skills; and (4) strategies used to build health literacy. Intuitive skills were used to identify the patient’s health literacy skills through recurring encounters with patients over time. A range of communication techniques were used to build health literacy. The value of a long-term relationship with patients, and support from relatives, seem to be important in helping patients to build their health literacy skills. Conclusions: A number of barriers may hinder building patient health literacy in general practice. An increased focus on the significance of health literacy, educationally and clinically across the entire health system can be a solution to overcome these barriers. © 2018
... This process also illustrates how the data from the na€ ıve reading are compared to the interpreted data from the structural analysis-a way to open up to new ways of both understanding and trying to explain the themes in a summative critical interpretation. This is in line with the hermeneutic circle when the themes are validated (or invalidated) against the previous findings ( Charalambous, Papadopoulos, & Beadsmoore, 2008). ...
Aim and objective:
The aim of this study is to examine how hospitalised, surgical lung cancer patients experience talking to a former patient, and how the former patient experiences the role as supportive.
Background:
During hospitalisation, patients often create a community in which they can engage with fellow patients. The exchange of experiences with others in a similar situation might increase opportunities for support and complement nursing care, but there is a need for more evidence and understanding on the topic.
Design:
The methodological framework is based on the French philosopher Paul Ricoeur's text interpretation theory. Qualitative interviews were conducted with nine patients, including a peer informant, using a narrative structure. The analysis was conducted on three levels: i) naïve reading, ii) structural analysis, and iii) critical interpretation.
Results:
Four themes were developed from the analysis of the interviews: Exchanging emotional thoughts is easier with a peer; Talking to a peer reduces loneliness; Being ambiguous about a relationship with fellow patients; and Being the main person in the conversation with a peer. Sharing stories about having similar symptoms and undergoing similar journeys predominated, and the key feature of the contact between patients was the commonality of their stories.
Critical interpretation and conclusion:
Telling one's story to a former patient, and thereby creating a joint, common story, is the essence of this study. The support received in this process can be empowering because knowledge of the illness experience is shared and increased. This can help create new coping strategies. The contact with a former patient offered a way to confirm one's thoughts and to find a way out of the illness perspective, by seeing how the former patient had recovered.
Relevance to clinical practice:
The nursing field faces challenges in the relational aspect of caring because of ever greater efficient and shortened hospital stays; therefore, the peer support concept among patients is becoming increasingly relevant. Patient peers offer each other their own perspectives, and it is important to raise awareness of the value of this and incorporate it into patient stays in hospital. This article is protected by copyright. All rights reserved.
... In their literature review on the use of Ricoeur's theory and hermeneutics in general in a medical setting, Charalambous et al. (2008) conclude: ''Reflecting on the research questions, the aims and objectives, the desired data, the literature review and the methods of research as a whole, hermeneutic phenomenology integrates all the necessary elements for conducting a successful qualitative study based on the lived experiences of the participants. The philosophical approach proposed by Ricoeur is considered to offer a deep, interpretive understanding of human experience''. ...
Victims of disaster suffer, not only at the very moment of the disaster, but also years after the disaster has taken place, they are still in an emotional journey. While many moral perspectives focus on the moment of the disaster itself, a lot of work is to be done years after the disaster. How do people go through their suffering and how can we take care of them? Research on human suffering after a major catastrophe, using an ethics of care perspective, is scarce. People suffering from disasters are often called to be in distress and their emotional difficulties 'medicalised'. This brings them often into a situation of long term use of medication, and one can wonder if medication is of help to them in the long run. In our paper, we will explore another moral perspective, focusing on the importance of the victims' narrative and their lived experiences. We will use Paul Ricoeur's phenomenological reflections from 'Suffering is not the same as pain' for conceptualizing human suffering and how to apply it to victims of disaster. Ricoeur suggests that suffering is not a quantity that can be measured, but a characteristic that should be studied qualitatively in interpersonal and narrative contexts. Above all, the perspective of care and listening could offer an opportunity to reconcile people from their loss and suffering.
... Informed by the principles of the hermeneutic circle, the constructed themes were reflected on to ascertain whether or not they validated or invalidated the na€ ıve understanding (Charalambous, Papadopoulos, & Beadsmoore, 2008b). In this study, the themes and sub-themes verified the first interpreting reflections of the na€ ıve reading. ...
Cancer patients receiving targeted therapies often develop persistent cutaneous adverse effects, such as papulopustular eruption (rash), xerosis cutis (dry skin), pruritus (itch), and hair and nail changes. These can be dose-limiting or a cause for therapy discontinuation but also can be wearing on patients, negatively influencing their self-image and relationships with others. In a Ricoeurian hermeneutic phenomenological study, we aimed to explore the lived experiences of colorectal, pancreatic, and non-small cell lung cancer patients living with cutaneous toxicities following treatment with targeted agents. Narratives were used to elicit the experiences of 22 cancer patients. Data were analyzed in three steps informed by Ricoeur's interpretation theory: naïve understanding, structural analyses, and comprehensive understanding. Three themes were identified: "Ashamed of what I have become," "Surrender to cancer," and "Mourning for the loss of my body," with nine sub-themes revealing the multidimensional impact of the adverse effects on the patients' lives. The comprehensive understanding produced in analysis revealed a new contextualized interpretation of being in the world while living with cutaneous toxicities. Treatment-induced cutaneous toxicities distorted patients' daily living in ways that led to negative manifestations and effects on their self-image, social engagement, and intimate relationships. Although the dose-limiting and treatment-interrupting effects of these toxicities have been reported, this study sheds light on their existential impact, touching on physical, psychological, and social issues. © 2016 Wiley Periodicals, Inc.
... Utilizing phenomenology research methods in this study, the researcher explored the experiences of individuals who had bariatric surgery to learn more about the process of change and stability, regarding their individual self and aspects of their intimate relationships. As a research method, phenomenology has been widely used in the nursing field and incorporated in several studies regarding medical patients (Charalambous, Papodopoulos, & Beadsmoore, 2008) and in the field of marriage and family therapy (Sprenkle & Piercy, 2005). Phenomenology is built on the epistemological premise that knowledge is socially constructed and based on interpretation. ...
This study explores the experiences of 20 men who have had bariatric surgery, focusing on their couple or marital relationships. The researcher concentrates on men's perspectives regarding relationship satisfaction, sexual intimacy, and social support after surgical intervention. Phenomenology and family systems theory were used to guide the study from which emerged three themes: (a) Unintended consequences (unpredicted problems occurring within intimate relationships); (b) Intimacy as bittersweet (experiencing increasing levels of intimacy, while still desiring more); and (c) Inconsistent social support (experiencing instances where social support is provided, while simultaneously experiencing other areas where social support is not provided). The study includes a rich description of the data, critical analysis, and discussion of clinical implications for therapists and other healthcare professionals.
... Qualitative methods are progressively being implemented by researchers for the exploration within healthcare (Charalambous, Papadopoulos, & Beadsmoore, 2008). Researchers have been reported to have utilised qualitative research methodologies since the 1960s, however, it was in the 1980s that a broad acceptance of phenomenology as a research method was evident with further development in the 1990s (Todres & Wheeler, 2001). ...
Since antiquity, the trauma of a severe burn has beset humankind with poor outcomes and survival rates. However, over the last two decades there has been substantial progress in the management of acute burns that has resulted in life expectancy similar to the general population. Despite these advancements in the management of severe burns, the physical, psychosocial and economic implications following a severe burn injury are variable with a lack of substantial progress in the area of burn rehabilitation. Consequently, the rehabilitation of those with severe burns remains a lengthy process with significant associated physical and psychosocial problems. A crucial point raised by burn professionals internationally, is that burn rehabilitation needs to be recognised as a continuum of active care rather than a separate isolated phase, with rehabilitation commencing on the day of injury. The immediate commencement of therapy is a key factor in the management of burns with the initial focus directed towards life support, wound closure, infection control and aggressive metabolic support. However, at some point, patients’ rehabilitation needs exceeds those that can be provided by burn units necessitating the transfer to a rehabilitation facility. Therefore, it is the experiences of these patients rehabilitating from severe burns that are the focus of this study. This thesis reports on a research undertaking that explores patients’ ‘lived experience’ of rehabilitation after a severe burn injury. The study utilised a descriptive phenomenological methodology approach. Purposeful sampling was utilised to select participants who sustained severe burns that required intensive rehabilitation across three Australian states. The researcher interviewed 21 burn survivors utilising semi structured interviews that were digitally audio recorded. The interviews were transcribed verbatim then analysed using Colaizzi’s method of data analysis. From the data analysis, 25 cluster themes developed from the participants’ experiences which were further merged into seven emergent themes that structured the ‘lived experience’ of burn survivors’ rehabilitation journey forming the basis of the findings reported. The essence of these experiences is reflected in these themes: Vital supports, Spatial environment, Endurance, Acceptance, Impact, Challenges and Progression. These emergent themes incorporate both the physical and psychosocial impact after a severe burn injury. Central to burn rehabilitation is the notion of social support that has a significant influence on burn survivors’ psychosocial rehabilitation. Fundamental to burn rehabilitation are the development of coping strategies and the means of adjusting and adapting. Patient centred goals provided the necessary motivation and tenacity to progress through the lengthy rehabilitation journey that besets those with severe burns. Acceptance of an altered selfimage and body image is a slow and challenging experience for those with severe burns. Key to burn rehabilitation is the appropriate timing and delivery of burn therapy and education that facilitates patients’ adherence to burn care and therapy. The process of transition and reintegration after a severe burn injury is a significant event in the rehabilitation of burn survivors. Access to ongoing rehabilitation services remains a challenging experience because of the lack of burn expertise in the community setting. This study has unearthed fundamental aspects of burn rehabilitation that span across a diverse and multidisciplinary sector of healthcare. In essence, these findings may provide for the further development of health policy in relation to management of severe burn injury; principles and guidelines for best practice; and both survivor and health professional education so as to improve outcomes for burn survivors, their families and the community .
... In any hermeneutic phenomenological study of a phenomenon, there is perhaps a question that repeatedly comes up, that of the generalisability of the findings and their applicability to similar contexts [37]. This has been discussed earlier in the paper, however a notion introduced and discussed by Ricoeur also needs to be acknowledged here. ...
The care of patients suffering from cancer and especially those facing the death trajectory appears to be complex and demanding not only for student nurses but for professional nurses as well. The educational models often used in nursing require students to face challenging care scenarios, sometimes with minimal or no supervision and guidance. These "worst case scenarios" can be traumatic experiences that can leave the student hopeless and disappointed of themselves and in many cases can "scar" their subsequent professional career. The literature demonstrates that this can be the result of the students' ill-preparation to care for cancer patients and deal with death and dying. The purpose of this study was to interpret the students' experiences of coming face-to-face with cancer care during their clinical placements.
This is a hermeneutic phenomenological study influenced by the ideas of the French Philosopher Paul Ricoeur. Based on this philosophical enquiry the interpretation process included three stages: 1) naïve reading, 2) structural analysis and 3) comprehensive understanding. Data were collected through reflective/narrative diaries from the 4th grade undergraduate (pre-registration) nursing students practicing at oncology, hematology, pediatric oncology departments and hospices. Diaries of twelve students met the inclusion criteria and were included in the interpretation process. The study took place during January and May 2011.
The interpretation yielded the following themes: a) Being part of the center's life, b) Being sympathetic, c) Being confronted by others, d) Being self-reflective, e) Being trapped in the system, f) Being caring towards the family and g) Being better in clinical practice.
The students emphasized the need for appropriate preparation both at a theoretical and at a clinical level, as to better confront situations involving death and dying as well as learning techniques for crisis management. The students perceived the importance of adopting a policy that is both patient and family-centered in order to provide better care.
À luz da dificuldade que pesquisadores interessados em avaliar políticas públicas de segurança e combate à criminalidade esbarram, em virtude da escassez de dados, o presente trabalho se propõe a fornecer subsídios metodológicos para a utilização do método qualitativo de estudo de caso como alternativa viável, confiável e rigorosa para tal avaliação. Assim, a literatura especializada concernente ao tema foi analisada com base no método hermenêutico, a fim de interpretar e explicar a utilização do estudo de caso. Como resultados, verifica-se que o método sugerido possui grande potencial para fomentar a literatura de segurança pública, sobretudo no contexto da América Latina, que apresenta as maiores taxas de criminalidade do mundo e escassas publicações de avaliações das políticas de segurança que foram implementadas. O estudo de caso, ao promover uma construção horizontal do conhecimento, tem potencial para esclarecer o motivo pelos quais algumas políticas fracassam e outras logram êxito.
Narrating or storytelling is a fundamental practice for human survival and a means for finding meaning in experiences and for enhancing self-understanding. The use of story has been present in nursing since its origins. Biographical narrative has rarely been used as a research method in nursing, and there are no examples conceptualizing biographical narrative research methods within a unitary science perspective. The purpose of this paper is to describe one specific narrative methodological approach—the biographical narrative research method—and to link the method to the science of unitary human beings as a means of creating a unitary understanding of the storied nature of human-health experiences.
Background:
Supporting spirituality is an essential aspect of the holistic nursing care of older people living with dementia. Spirituality is defined as a search for answers to questions about the meaning and purpose of life and the individual's relationship with the sacred or transcendent. This relationship may or may not involve an affiliation with a specific religion.
Objective:
To understand how older people living with dementia and their family members experience spirituality and its support in nursing care.
Design:
A qualitative study informed by the principles of Ricoeurian hermeneutic phenomenology.
Settings:
We conducted the study in home care and long-term care settings in Southern Finland.
Participants:
We collected data between 2017-2020 from a purposive sample of 10 older people living with dementia and their 9 family members (n = 19).
Methods:
We used interviews to collect data and adapted and used Ricoeur's theory of interpretation as a method for analysis.
Results:
The findings of this study show that older people living with dementia need spiritual support in nursing care based on their personal understanding of spirituality. The four elements of this spirituality that emerged were: religion, meaningful relationships, nature, and art. The participants addressed some challenges to spiritual support in the nursing care of older people living with dementia including: the competence and abilities of nursing, time available, presence and experience.
Conclusions:
Older people living with dementia and their family members consider spiritual support an important aspect of nursing care. To support the spirituality of these older people, the elements of spirituality need to be understood as these are central to each person's spiritual position. Additionally, spiritual support requires understanding knowledge, experience, time and presence, to manage all four elements with individuals.
After a rather long journey through the philosophy of medical practice and the phenomenology of health we have now reached a crucial point of our investigation: the subject of hermeneutics. I have found it strategically, if not logically, necessary to proceed in the manner I have done in this work in order to make the questions considering the essence of modern medicine more relevant and understandable. The history of medical practice surveyed in Chap. 1 and the philosophy of health and illness surveyed in Chaps. 2 and 3 were needed in order to provide a framework for the contemporary activity in the clinic that I will explore in this chapter. Philosophical questions are indeed always raised at specific moments in history, and in answering them we must pay close attention to our own historical situation and to the past history out of which they have evolved. .
The purpose of this article was to examine the historical contribution of Wilhelm Dilthey's approach to the philosophy and methodology of hermeneutics in the demarcated context of nursing science. Dilthey's work made a fundamentally significant, yet ancillary, contribution to nursing science. Organically born from a need to deduce Biblical texts, hermeneutics later developed as a means to understand the truth of another's experience, in literal German language referred to as verstehen. A German-born empiricist and devout hermeneutic scholar, Dilthey extended the philosophy of hermeneutics to a methodological approach as a way to recapture expressed meaning of human experiences. His directive work paved a procedural pathway to probe the science of human nature while bound to the appropriate sociohistorical context. Hermeneutic methodology provides a phenomenological-like way to more keenly understand and interpret the whole person. This methodological approach steers a truth-seeking strategy fixed in meticulous and rigorous inquiry. Dilthey transparently recognized the humble fact that there is no true way to wholly grasp another's experience, an inherent limitation of our human abilities. The current paper posits that hermeneutical understanding verstehen can be paralleled to the concept of empathy in nursing. Understanding and empathy are foundational components to the field of nursing as a caring science. The complex yet invaluable philosophy and methodology of Wilhelm Dilthey's hermeneutics is notably relevant and applicable to nursing science as we strive to care for, treat, and heal patients as whole beings.
“Patient-centred care” is the recent response to the malaise produced in the field of health care from the point of view both of a technical mentality and the paternalistic model. The interest in the story-telling approach shown by both the humanities and the social sciences has favoured a “narrative turn” in medicine too, where the new ethics of therapeutic relationship consider the hermeneutic method a means by which to integrate evidence and subjectivity, scientific data and patient experience. The aim of this paper is to show how Ricoeur’s theory of “threefold mimesis” makes a conceptual contribution to the use of narrative interviews in nursing and also be successfully transferred into and applied in the field of healthcare in general. First, the paper examines how this narrative approach might open up new possibilities for the acquisition of in-depth knowledge of patients’ life experiences, a condition indispensable for the improvement of the quality of care. Secondly, it highlights how this Ricoeurian method seems capable of provide an opportunity for healthcare professionals to review their own understanding of the caregiver-patient therapeutic relationship, beginning with their confrontation with the patient’s world as revealed by the narrative they provide.
Purpose
To understand the phenomenon of communication related to knowing diagnosis and prognosis, by exploring the perspectives of patients with advanced cancer and those of their caregivers, physicians and nurses.
Methods
Drawing upon a multi-perspective design, a total of 27 semi-structured interviews involving four different groups of stakeholders (7 patients, 7 caregivers, 6 physicians, and 7 nurses) ―who were linked by a carer-cared relationship―were conducted in two Oncology Departments of two Italian hospitals. Interpretative Phenomenological Analysis was used to interpret the participants’ narratives.
Results
Two overarching themes were identified: The first theme “the «what is it?» and the «what will happen to me?»” illustrates the two different paths of communication of diagnosis and prognosis. The second theme “Matching and mismatching in identifying the others as speakers” shows that not each of the four parties recognizes the others as reciprocal speakers on topics related to diagnosis and prognosis, although all of them display reciprocal communication interactions.
Conclusions
Communication related to diagnosis and prognosis is often handled by health professionals without a comprehensive and integrated understanding of the communication approach. There is a correspondence between the nurses’ perception of their extraneousness to the diagnosis and the prognosis related communication, and the descriptions and perceptions of the nurse's role reported by the other participants.
Relevance to clinical practice. Understanding how the different groups of stakeholders reciprocally interact and influence each other, can help to identify potential positive resources and detect hindrance in the implementation of an effective patient-centered approach, while avoiding silo cultures.
Aims:
This study is aimed at exploring experiences of, and practices related to, mealtime challenges in patients with COPD.
Background:
Nutritional status is a significant indicator of prognosis and outcome in patients with COPD. Preventing unintended weight loss and helping patients regain weight are important nursing tasks. Dietary supplements have been effective in treating underweight in cases of stable COPD. However, compliance with long-term interventions is quite low. Improving nutritional intake through knowledge of meal-related challenges is the key to making further progress in preventing unintended weight loss.
Design:
This study employed an ethnographic design using the go-along method.
Methods:
From September 2018 to June 2019, 34 hours of meal-related observations and informal conversations with purposefully selected patients (n=15) were completed at a Danish respiratory medicine ward and in patients' homes. We analysed the empirical data using a Ricoeur-inspired method. Reporting adheres to the COREQ Checklist.
Findings:
In this study, we identified the absence of professional responsibility as a main challenge. Mealtimes appeared to be relegated to a matter of nutrition, and common practices surrounding mealtimes were no longer observed. Patients became dependent individuals who had to settle for the food available. In addition, physiological challenges often resulted in patients re-evaluating the benefits of eating, concluding that it was not worth the effort and therefore not eating. Furthermore, patients were hesitant to communicate their needs, which left a number of non-verbalised challenges unattended.
Conclusions:
Overall, meal-related challenges pose a risk of unintended weight loss, and the health professionals' work with mealtimes lacks a coordinated, systematic approach. Further research is needed to develop or implement interventions that can accommodate mealtimes.
The teaching context is complex and any reflection on policies regarding the out-of-field phenomenon needs to be anchored to a strong theoretical foundation—a framing that directs policies to mirror the contexts they seek to uphold. Noticing the consequences of the out-of-field teaching phenomenon in classrooms and schools can then undergird improvement and management strategies. A context-conscious theoretical reasoning displays the consequences of the out-of-field phenomenon for specific learning contexts by acknowledging its multilayered teaching and learning characteristics, and supplies this knowledge for the creation of fit-for-context management in different learning spaces.
A child's emotional and social development depends on the parents' provision of optimal support. Many parents with perinatal distress experience difficulties in mastering parenthood and seek help from professionals within primary healthcare. A clinical project was launched in Stockholm, where psychodynamic psychotherapists provided short-term consultations at Child Health Centers. This study qualitatively explored parents' experiences of perinatal distress and of receiving help by nurses and therapists in the project. Thirteen parents were interviewed, and their responses were analyzed with a hermeneutical method. Three main themes crystallized; accessibility of psychological help and detection of emotional problems; experiences of therapy at the Child Health Center; and the therapists' technique. Parents were also clustered into three so-called ideal types: the insecure; parents in crisis; and parents with lifelong psychological problems. Parents experienced obstacles in accessing psychological care within primary healthcare. Psychotherapists with a holistic family perspective and who managed to oscillate between insight-promoting and supportive interventions were especially appreciated. Patient categories who benefitted from insight promotion and support, respectively, were identified.
© 2019 Michigan Association for Infant Mental Health.
In-depth knowledge of what it means to patients to receive health care services is crucial to the development of adequate protocols for nursing. Qualitative research allows us to gain important insight into what is experienced by and meaningful to patients. The French philosopher Paul Ricoeur’s thoughts have inspired qualitative researchers to conduct various forms of analysis and interpretation that increase our knowledge of ways of being-in-the-world. This article describes and discusses how a specific approach to derive in-depth knowledge of patients’ lived experiences can be taken. A combination of participant observations and interviews was used to generate data. Field notes and transcribed interviews were gathered as one collective text and analyzed and interpreted with inspiration from Ricoeur’s thoughts on narratives and interpretation. This approach is argued to be a significant way of developing in-depth knowledge of patients’ lived experiences. Such knowledge is important within nursing science.
Research findings in occupational science and occupational therapy education can be mutually informing, yet this mutual benefit is seldom explored. A secondary analysis of data from a study of how occupation is addressed in US occupational therapy curricula explored this question: what latent meanings within education research data are pertinent to occupational science? Data were selected that richly described the tandem occupations of teaching and learning where the focus was occupation-related content. Three processes adopted from Ricœurian hermeneutic interpretive analysis—explanation, understanding, and appropriation—revealed the occupational experiences of doing, being, becoming and belonging as a dynamic web among instructors and students who participated in the study and the researchers. Further, the analytic process united the occupational experiences of research participants and researchers, and prompted researchers to reflect on and engage emotionally with their teaching and other occupations, facilitating appropriation of the research for their classroom practices.
Purpose: The study seeks to address the research question: “How can Gadamerian and Ricoeurian hermeneutics be operationalized in an interpretive accounting research project”? The aims are to: (1) review the key hermeneutic concepts of philosophers Gadamer and Ricoeur, and (2) to share insights from the researcher’s experience of applying Gadamerian and Ricoeurian hermeneutics to an interpretive accounting research project.
Methodology: The paper draws on the extant literature and the researcher’s own experience using hermeneutics theory in an interpretive accounting research project involving in-depth interviews with organisational managers.
Findings: The process of interpretation is described using the core concept of the hermeneutic circle where the reader and the text engage in dialogue. The readers’ pre-understandings play a key role in this dialogue and assist in drawing meaning from the text. However, it is necessary for the reader to adopt a critically reflexive approach remaining alert for both unproductive pre-understandings and hidden power structures and ideologies in the text being interpreted. Each reading of a text involves the completion of one cycle of the hermeneutic circle in which the reader transitions from pre-configuration to configuration and ultimately re-configuration, concluding with the reader acquiring new horizons of understanding. The researcher’s experience of applying hermeneutic theory to an interpretive accounting research project are reflected on and nine lessons are offered.
Originality: These insights will prove valuable to interpretive researchers within the social sciences, including accounting and management studies, as well as those working in the natural sciences.
Objective: Adopting new attitude toward patients with skin diseases taken into consideration their lifeworld which enable understanding and effective communication. Second aim is to evaluate the impact of Melasma on patient lifeworld and quality of life in a sample of Iraqi women.
Methods: This study was conducted at my private clinic in the period between April 20114 and March 2015. DLQI is administered & all women answered questions on a 0-3 scale based on their experience during the previous 7 days. The scores are then tabulated and expressed as a number from 0 to 30 or, alternatively, as a percentage of the maximum score, with higher values indicative of poorer outcomes. A maximum score of 30 means that the quality of life of the sufferer is greatly affected. A descriptive analysis of the score was performed. In addition we use interpretative phenomenology (lifeworld approach) which is a qualitative research method that describes the meaning of a lived experience from the perspective of the patient. Phenomenology seeks to achieve a deep understanding of the phenomenon being studied through a rigorous, systematic examination of it from inside perspective. Its aim is to describe the essences of lived experiences.
The aim of this chapter is to introduce the use of interpretative phenomenological analysis (IPA) in relation to understanding the subjective realities of individuals with chronic low back pain (CLBP). The chapter will begin with an overview of how phenomenological approaches may be of particular value in understanding how pain appears to a patient and ultimately the embodied nature of patients’ pain experiences. This will be followed by an introduction to IPA, its theoretical background and ontological and epistemological claims. The rationale for exploring subjective experiences of people with CLBP will be expounded and the main findings discussed in relation to clinical practice. The chapter will conclude by exploring the ways in which findings from an IPA study may contribute towards a First-Person Neuroscience of Pain.
Background:
In November 2013, the Haiyan typhoon hit parts of the Philippines. The typhoon caused severe damage to the medical facilities and many injuries and deaths. Health professionals have a crucial role in the immediate disaster response system, but knowledge of their experiences of working during and in the immediate aftermath of a natural disaster is limited. Aim The aim of this study was to explore health professionals' experiences of working during and in the immediate aftermath of a natural disaster.
Method:
Eight health professionals were interviewed five months after the disaster. The interviews were analyzed using phenomenological hermeneutic methods.
Results:
The main theme, being professional and survivor, described both positive and negative emotions and experiences from being both a helper, as part of the responding organization, and a victim, as part of the surviving but severely affected community. Sub-themes described feelings of strength and confidence, feelings of adjustment and acceptance, feelings of satisfaction, feelings of powerless and fear, feelings of guilt and shame, and feelings of loneliness.
Conclusion:
Being a health professional during a natural disaster was a multi-faceted, powerful, and ambiguous experience of being part of the response system at the same time as being a survivor of the disaster. Personal values and altruistic motives as well as social aspects and stress-coping strategies to reach a balance between acceptance and control were important elements of the experience. Based on these findings, implications for disaster training and response strategies are suggested. Hugelius K , Adolfsson A , Örtenwall P , Gifford M . Being both helpers and victims: health professionals' experiences of working during a natural disaster. Prehosp Disaster Med. 2017;32(2):1-7.
Background: Melasma, also called chloasma, is a common symmetric,
Nursing presence, although it involves action at times, is a humanitarian quality of relating to a patient that is known to have powerful and positive implications for both nurse and patient. However, this phenomenon has not been well understood. Three theories, drawn from the work of Paul Ricoeur and Hans-Georg Gadamer, served as the boundaries for both data collection and analysis. The theories were narrative identity, play and solicitude. This study follows a critical hermeneutic approach to field research and data analysis. Literature regarding nursing presence is reviewed and discussed, and in-depth conversations with eleven participants are recorded. Examining the phenomenon of nursing presence through the hermeneutic lenses of narrative identity, play and solicitude has elucidated the role of ethical orientation, creativity and connection with the human experience through exploration of self and other. This more nuanced and complex understanding adds depth to the conversation and offers new possibilities to the effort to encourage and support presence in nursing practice.
Diabetes continuously disrupts a patient's well-being and quality of life. Successful self-care could potentially decrease overall costs and rates of mortality and morbidity. Patients' experiences could be used to elucidate what they believe about illness and its management. The overall aim of this study was to illuminate the meaning of self-care among diabetic patients in Southeast of Iran.
Sixteen diabetic patients with a mean age of 34 and 10 years' experience in self-care for their disease were interviewed. The interviews were recorded, transcribed verbatim, and analyzed with a Ricoeur's phenomenological hermeneutic method.
The meaning of self- care was comprehensively understood as being empowered. This can be divided into four themes: seeking information, being independent, being optimistic or pessimistic and trust in God.
The results in this study suggest that cultural and religious components could affect diabetic patients' self-care. Nurses might use patients' religious beliefs to relieve their stress, help them to retain a sense of control, maintain hope and sense of meaning and purpose in their life.
Qualitative methods are progressively being implemented by researchers for exploration within healthcare. However, there has been a longstanding and wide-ranging debate concerning the relative merits of qualitative research within the health care literature. This integrative review aimed to exam the contribution of qualitative research in burns care and subsequent rehabilitation. Studies were identified using an electronic search strategy using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Excerpta Medica database (EMBASE) and Scopus of peer reviewed primary research in English between 2009 to April 2014 using Whittemore and Knafl's integrative review method as a guide for analysis. From the 298 papers identified, 26 research papers met the inclusion criteria. Across all studies there was an average of 22 participants involved in each study with a range of 6-53 participants conducted across 12 nations that focussed on burns prevention, paediatric burns, appropriate acquisition and delivery of burns care, pain and psychosocial implications of burns trauma. Careful and rigorous application of qualitative methodologies promotes and enriches the development of burns knowledge. In particular, the key elements in qualitative methodological process and its publication are critical in disseminating credible and methodologically sound qualitative research.
Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.
The article focuses on the relationship between people and places from the perspective of a participant observer. We use examples of assisting living facilities in the mental health field, and demonstrate how the process of understanding a research setting as Language and text, may allow for new perspectives to emerge. Mainly by introducing the Norwegian architect Christian Norberg-Schulz’s phenomenology of place, and complementing it with the French philosopher Paul Ricoeur’s theory of interpretation; we demonstrate how
these understandings help us to include the physical environment. Norberg-Schultz describes places by following characteristics: a) The place's basic language, b) The place's material language and c) The history of the place. Inspired by Ricoeur, a place becomes a text which has d) emancipated itself from its origin and e) is living its own life. The discussion relates to how, by taking the material surroundings into account, the researcher becomes able to better understand the way people live. The conclusions show the importance
of the role of the researchers’ personal experiences and emotions when being present together with the participants in the same physical environment.
Paul Ricoeur's hermeneutic phenomenology has proved to be very helpful in guiding nursing researchers' qualitative analysis of interview transcripts. Modifying Ricoeur's philosophy, a number of nursing researchers have developed their own interpretive methods and shared them, along with their experience, with research community. Major contributors who published papers directly presenting their modifications of Ricoeur's theory include Rene Geanellos (2000), Lena Wiklund, Lisbet Lindholm and Unni Å. Lindström (2002), Anders Lindseth and Astrid Norberg (2004) and Pia Sander Dreyer and Birthe D Pedersen (2009). The aim of this article was to delineate differences among these methods. Descriptive presentation of each method side by side makes clear the differences among them. In addition, Ricoeur's hermeneutic theory is portrayed and compared with the modifications. It is believed that differences that are found can stimulate further thoughts on how to apply Ricoeur's theory in qualitative research in nursing.
© 2015 John Wiley & Sons Ltd.
Background:
Significant advances have been made in the surgical treatment of lung cancer while patient experiences with diagnosis, treatment, and rehabilitation remain only sparsely researched.
Objective:
The objective of this study was to investigate how the diagnosis affects the daily lives of patients with operable lung cancer in order to identify their needs for care interventions from the point of diagnosis to hospitalization.
Methods:
We investigated patients' lived experiences from a longitudinal perspective at 4 critical time points during the treatment trajectory; we present here the findings from the first time point, diagnosis. Data were collected through interviews conducted 7 to 10 days following diagnosis of lung cancer. Data from 19 patients are included, and the analysis is based on Ricoeur's interpretation theory. The study framework is inspired by Schutz's phenomenological sociology.
Results:
The findings are presented as themes that summarize and express the ways in which a diagnosis affects patients' daily lives: the cancer diagnosis comes as a shock, it changes everyday awareness; it presents the patient with an unfamiliar body, disturbs social relationships, forces the patient to face a new life situation, and demands one-on-one supportive care.
Conclusions:
Diagnosis is the first critical point for patients with operable lung cancer and disrupts their daily life. Patients need psychosocial support during the period from diagnosis to surgical intervention and patient-tailored one-on-one information.
Implications for practice:
This article contributes to the knowledge base of support needs of lung cancer patients. Interventions aimed at supportive care during the period between diagnosis and surgical intervention should be researched.
The purpose of this article is to broaden the understandinfg of the hermeneutic reading of classic texts. The aim is to show how the choice of a specific scientific tradition in conjunction with a methodological approach creates the foundation that clarifies the actual realization of the reading. This hermeneutic reading of classic texts is inspired by Gadamer's notion that it is the researcher's own research tradition and a clearly formulated theoretical fundamental order that shape the researcher's attitude towards texts and create the starting point that guides all reading, uncovering and interpretation. The researcher's ethical position originates in a will to openness towards what is different in the text and which constantly sets the researcher's preunderstanding and research tradition in movement. It is the researcher's attitude towards the text that allows the text to address, touch and arouse wonder. Through a flexible, lingering and repeated reading of classic texts, what is different emerges with a timeless value. The reading of classic texts is an act that may rediscover and create understanding for essential dimensions and of human beings' reality on a deeper level. The hermeneutic reading of classic texts thus brings to light constantly new possibilities of uncovering for a new envisioning and interpretation for a new understanding of the essential concepts and phenomena within caring science.
Although relatively rare, encapsulating peritoneal sclerosis (EPS) is nonetheless a major concern within the renal community. Risk of developing EPS is associated with long-term peritoneal dialysis (PD). High mortality was previously reported, although surgery has since improved outcomes. Research into EPS focuses on imaging and early detection methods, genetics, biomarkers and preventive strategies. No previous studies have examined patients' experiences of EPS. Aims: The aim of the present study was to explore the experience of patients who have undergone surgery for EPS in one center in the North of England.
A qualitative phenomenological approach, involving in-depth interviews, was adopted. Nine participants were recruited out of a total of 18 eligible. Most participants were interviewed twice over a 12-month period (October 2009 to October 2010). Analysis: Interpretive data analysis was conducted, following the philosophical tradition of hermeneutics, to draw out themes from the data. Data collection and analysis took place concurrently and participants were sent a summary of their first interview to allow a period of reflection prior to the subsequent interview.
EPS presented the most serious challenge participants had faced since developing chronic kidney disease (CKD). Three major themes were identified, each with subcategories. The key issues for patients were related to identification of early symptoms and lack of understanding. The patients' sense of 'not being heard' by health care professionals led to a loss of trust and enhanced their feelings of uncertainty. The enormity of the surgery, the suffering, and what they had to endure had an enormous impact, but an overriding aspect of this experience was also the loss they felt for their independence and for the PD therapy over which they had control.
The findings of this study highlight a number of important issues relevant to clinical practice, including lack of information and understanding of EPS, particularly its early symptoms At the time patients transfer from peritoneal to hemodialysis, the provision of adequate information about the risks and potential early signs of EPS may not only improve their experiences, but may also assist in early detection.
This article questions the aptness of ‘discourse analysis’ as a label for our field, and prefers the less reductionist concept of ‘Discourse Interpretation’. It does this through drawing on ideas from the field of philosophical hermeneutics – the theory and practice of interpreting texts. It operationalizes and adapts the construct of the Interpretive Arc from the philosophy of Paul Ricoeur in order to address issues that are central to discourse work, including that of how we warrant the validity of our textual interpretations. The Interpretive Arc consists of six inter-linked phases, which the article presents and exemplifies through discussion of a single text – the story of Babel. Phase 1 of the arc defines readers as being in a state of Estrangement before the text because of the distancing created by its written or technological form. Phase 2 is that of Pre-view, the state of opinion or knowledge that readers bring to a text. At phase 3, a first reading forms readers’ Proto-understanding, their initial ‘guess’ at what the text means. Then processes of Analysis (phase 4) test and evidence the validity of alternative readings, limiting the interpretations which can plausibly be taken from a text. Three byways of interpretive analysis are challenged and discarded: the dominance of author intention, structuralist analysis and limitless polysemy. Analysis then leads into 5, the phase of informed Understanding of the matter or injunction of the text, of what is disclosed or unfolded before the text. The Interpretive Arc is completed in phase 6, Ownership. Here, through processes of critique of their own and the text’s ideologies and of fresh listening, readers are led to a new self formed by the matter of the text. There is a dialectic amongst Analysis, Understanding and Ownership, with each informing and modifying the other. The approach emphasizes interpretation as the heart of discourse work. The 3000-year-old narrative of Babel is a subject as well as an object here. It contributes to the matter of the article and its interpretation is interwoven with the theoretical substance. The story is shown to be an integrated narrative abounding in sophisticated linguistic techniques which show a delight in language. The traditional Christian and Western interpretation of Babel – as an affront to God which results in the curse of multilingualism – is challenged. A re-constructed interpretation informed by intertextual evidence reads the fault of Babel to be the people’s refusal to spread through the earth. Babel can be interpreted as a manifesto against the monolingual and monocultural impetus of empires ancient and contemporary. The multilingual outcome is a positive affirmation of sociocultural and linguistic diversity.
This article presents the findings from a hermeneutic-phenomenological study looking at the meanings of ''quality nursing care'' through the experiences of patients with cancer, their advocates and their nurses. Twenty-five patients were interviewed from which fifteen also participated in two focus groups. Six patients' advocates participated in a focus group and twenty nurses were individually interviewed. The informants came from the three major hospitals in Cyprus which provide in-patient cancer care. Patients' advocates came from the two major cancer associations in Cyprus. Having analysed the data, seven major themes were identified: receiving care in easily accessible cancer care services, being cared for by nurses who effectively communicate with them and their families and provide emotional support, being empowered by nurses through information giving, being cared for by clinically competent nurses, nurses addressing their religious and spiritual needs, being cared for in a nursing environment which promotes shared decision-making, and patients being with and involving the family in the care. These findings stress the need to integrate these aspects in the care of patients with cancer. In doing so, nurses will need support and adequate training in order to acquire the relevant skills towards better caring for the patients.
Scand J Caring Sci; 2011; 25; 253–261
Health–illness transition among persons using advanced medical technology at home
This study aimed to elucidate meanings of health–illness transition experiences among adult persons using advanced medical technology at home. As an increasing number of persons perform self‐care while using different sorts of advanced medical technology at home, knowledge about health–illness transition experiences in this situation may be useful to caregivers in supporting these patients. A qualitative design was used. Five women and five men, all of whom performed self‐care at home, either using long‐term oxygen therapy from a ventilator or oxygen cylinder, or performing peritoneal or haemodialysis, were interviewed. Ethics committee approval was obtained. Informed consent was received from all participants, and ethical issues concerning their rights in research were raised. The interviews were analysed using a phenomenological hermeneutical methodology, including both an inductive and a deductive structural analysis. This method offers possibilities to obtain an increased understanding by uncovering a deeper meaning of lived experiences through interviews transcribed as texts. The health–illness transition for adult persons in this context was found to mean a learning process of accepting, managing, adjusting and improving daily life with technology, facilitated by realizing the gain from technology at home. Further, the meaning of the health–illness transition experience was interpreted as contentment with being part of the active and conscious process towards transcending into a new state of living, in which the individual and the technology were in tune. The healthy transition experience was characterized by human growth and becoming. This study elucidates one meaning of health–illness transition experiences in relation to the use of advanced medical technology on a more generic level, independent of the specific type of technology used. A positive attitude towards technology at home facilitates the transition.
Burn unit nurses work in an emotionally exhausting environment and are frequently exposed to emotional trauma. Emotion is a difficult concept to define. This study used a hermeneutic-phenomenological approach to establish the experiences of nurses working on a burn unit to find out how they deal with their emotions. The findings suggest that nurses have little or no time to deal with their emotional experiences. This study has shown that current support services might be ineffective. Nurses realize that they have emotions. They also recognize the need to address these emotions. Recommendations for nursing practice are made as a result of these findings.
Researchers have ethical and professional obligations to produce research of a high standard. The constituents of quality in research appear to differ between authors, leaving readers unsure about which pathway to follow. This can reflect inadequate consideration of the theoretical framework guiding the study. Many papers fail to consider the theoretical underpinnings of the methodology chosen and the link between these and the methods employed. These need to be accessible to readers in order to assess the trustworthiness of the research.
This paper discusses the development of trustworthiness in hermeneutic phenomenological research.
Referring to a study on lived experience of Chronic Fatigue Syndrome/myalgic encephalitis, I describe the decision trail and discuss the strengths and limitations of the choices made throughout the study.
The methodology focused my approach more fully on the importance of recognizing the influences that I brought to the study and the impact of these in generating the data. It highlighted the fact that the process of setting out my horizon can never be complete, the importance of analysing the data at a macro and micro level, acknowledging the evolution of the data over time, and ensuring that analysis does not move beyond the data and out of the hermeneutic circle. In seeking to make the decision trail clear to others, researchers must distill the philosophical principles of the methodology and set these out in a way that is accessible and open to scrutiny.
There have been at least four major movements in twentieth-century Continental ethics: value realism; intersubjectivity theories; personal transformation theories; and “anti-morality, creative-response theories.” Value realism emerged from phenomenological investigations of the experience of value; it highlights the relationships among emotions and value. Its central figures include Brentano, Scheler, and Hartmann. Intersubjectivity theories are rooted in theories of recognition in Fichte and Hegel; they suggest that an entirely new ethical dimension emerges from the interweave of human reciprocity. Major exponents include Buber, Levinas, and Habermas. Personal transformation theories elaborate and refine self-realization approaches that are central to Hegel, Marx, and Nietzsche; they ground ethics in the analysis of the human condition. Paradigm contributors include Sartre and Foucault. Finally, anti-morality theories develop Nietzsche's harsh critique of morality – narrowly conceived, while creative response theories attempt to ground ethics in fidelity to specific, developing, significant events. Exemplary figures include Bergson and Badiou. All four movements provide grounds for ethics that differ from traditional emphases on consequences and/or duties. Below I explore some reasons for this tradition's rejection of those standard approaches.
This collection brings together twenty-two essays by Paul Ricoeur under the topics of structuralism, psychoanalysis, hermeneutics, and religion. In dramatic conciseness, the essays illuminate the work of one of the leading philosophers of the day. Those interested in Ricoeur's development of the philosophy of language will find rich and suggestive reading. But the diversity of essays also speaks beyond the confines of philosophy to linguists, theologians, psychologists, and psychoanalysts.
provide a brief summary of a grounded hermeneutic approach to research, give examples of such research, list the central aspects of grounded hermeneutic research, describe the step-by-step research practices I employed in a grounded hermeneutic investigation of individuals becoming family physicians, outline the account I generated, and offer some helpful standards for evaluating qualitative research (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Abstract Understanding each patient's situation or lived experience evolves from a nurse's sincere communication with the patient. Through rhetoric, the nurse's use of competent language and expressions is more likely to engage the patient in a dialogical discussion that brings forth an open, honest display of feelings and emotions. Through hermeneutics, the nurse gains an accurate understanding and interpretation of a patient's beliefs, values, and situations that supports explanations of meaning. Thus, with rhetoric being the words or expressions that give rise to hermeneutics or the interpretation, the blending of the two creates a rhetorical–hermeneutical relationship that provides accurate understanding of a patient's true lived experience. Consequently, knowing the patient depends upon the nurse's rhetorical competence and accurate assessment of each patient's authentic self. Nurses should seek to interpret and understand the lived experiences of patients in order to limit or prevent misunderstandings and inaccuracies in communication. The truth that emerges from the expressed rhetorical–hermeneutical interrelationship will enhance nurses’ sensitivity to patient matters, produce relationship outcomes that emerge from a consistent and effectively applied set of interpersonal principles, and more importantly, successfully influence nurses’ lives and those of their patients with meaning that ultimately improves the human condition. Thus, nurses’ communication and perceptive understanding of each patient's world or lived experience becomes an integral and necessary component to effectively carrying out the practice role of caregiving.
This study describes a phenomenological hermeneutical method for interpreting interview texts inspired by the theory of interpretation presented by Paul Ricoeur. Narrative interviews are transcribed. A naïve understanding of the text is formulated from an initial reading. The text is then divided into meaning units that are condensed and abstracted to form sub-themes, themes and possibly main themes, which are compared with the naïve understanding for validation. Lastly the text is again read as a whole, the naïve understanding and the themes are reflected on in relation to the literature about the meaning of lived experience and a comprehensive understanding is formulated. The comprehensive understanding discloses new possibilities for being in the world. This world can be described as the prefigured life world of the interviewees as configured in the interview and refigured first in the researcher's interpretation and second in the interpretation of the readers of the research report. This may help the readers refigure their own life.
The patient’s perceived caring needs as a message of suffering¶The aim of the study was to arrive at a deeper understanding of the patient’s experience of caring needs, that is, of problems, needs and desires, by investigating and explaining how these will be expressed and shaped in the caring relation and to illuminate its implications for caring. The target population consisted of 38 patients in a medical ward and 37 patients in a surgical ward in a central hospital in Western Finland. The patients were interviewed in the wards and asked about perceived caring needs. By means of a hermeneutical process of interpretation a pattern emerged which was interpreted as pictures of themselves and of the nurses. These types of patients fell into three groups: the satisfied, the complaining and satisfied, and the complaining and dissatisfied patients. The types of nurses were divided into the competent and friendly, the competent and contact-creating and the competent and courageous. The patients’ caring needs can be interpreted and understood from the standpoint of their experience of suffering, but also in relation to their experience of pleasure and comfort. The most conspicuous caring needs were experiencing confidence in the competence of the nurses, comfort, guidance, dialogue and closeness, which the patients expressed as problems, needs and desires. The patients’ caring needs can contain new possibilities of growth and development. The nurse can relieve patients’ suffering by promoting their experience of comfort. If the nurses’ view of the limits of reality are extended to comprise the existential/spiritual dimension of human beings as well, new possibilities will emerge of interpreting and understanding patients’ caring needs as a message of suffering.
Reconceptualising rigour: the case for reflexivity This paper is a critical review of recent discussions of rigour in nursing research. We will argue that ‘borrowing’ evaluation criteria from one paradigm of inquiry and applying them to another is problematic. We attempt to map the ‘rigour’ field and add a dimension to the existing debate about rigour and qualitative research through inclusion of reflexivity guided by philosophical hermeneutics. We describe reflexivity and appeal to writers to incorporate a reflexive account into their research product by signposting to readers ‘what is going on’ while researching. We contend that researchers bring to the research product, data generated, a range of literature, a positioning of this literature, a positioning of oneself, and moral socio-political contexts. We suggest that reflexive research is characterized by ongoing self-critique and self-appraisal and that the research product can be given shape by the politics of location and positioning. We emphasize that in the creation of a text (the research product) it is desirable that the researcher be a skilled writer. Finally we claim that if the research product is well signposted, the readers will be able to travel easily through the worlds of the participants and makers of the text (the researchers) and decide for themselves whether the text is believable or plausible (our terms for rigour).
In volume 1 of this three-volume work, Paul Ricoeur examined the relations between time and narrative in historical writing. Now, in volume 2, he examines these relations in fiction and theories of literature. Ricoeur treats the question of just how far the Aristotelian concept of "plot" in narrative fiction can be expanded and whether there is a point at which narrative fiction as a literary form not only blurs at the edges but ceases to exist at all. Though some semiotic theorists have proposed all fiction can be reduced to an atemporal structure, Ricoeur argues that fiction depends on the reader's understanding of narrative traditions, which do evolve but necessarily include a temporal dimension. He looks at how time is actually expressed in narrative fiction, particularly through use of tenses, point of view, and voice. He applies this approach to three books that are, in a sense, tales about time: Virgina Woolf's Mrs. Dalloway; Thomas Mann's Magic Mountain; and Marcel Proust's Remembrance of Things Past. "Ricoeur writes the best kind of philosophyâcritical, economical, and clear."âEugen Weber, New York Times Book Review "A major work of literary theory and criticism under the aegis of philosophical hermenutics. I believe that . . . it will come to have an impact greater than that of Gadamer's Truth and Methodâa work it both supplements and transcends in its contribution to our understanding of the meaning of texts and their relationship to the world."âRobert Detweiler, Religion and Literature "One cannot fail to be impressed by Ricoeur's encyclopedic knowledge of the subject under consideration. . . . To students of rhetoric, the importance of Time and Narrative . . . is all too evident to require extensive elaboration."âDilip Parameshwar Gaonkar, Quarterly Journal of Speech
Since the publication of Being and Time (1927), Martin Heidegger has remained one of the most influential figures in contemporary thought. Until now, however, there has been no clear introduction to his crucial work on art, language and poetry for students of literary and cultural studies. This guidebook provides an ideal entry-point for readers new to Heidegger, touching upon such issues and concepts as:
*The limits of 'theory'
*The history of being
*The origin of the work of art
*Language
*The literary work
*Poetry and the political.
The author also introduces the recent controversy of Heidegger's involvement with Nazism.
Heidegger is not an 'easy' thinker. However, he is a crucial thinker. This accessible volume transforms the daunting task of reading Heidegger into an exciting and necessary challenge.
Phenomenological approaches to research have gained popularity in nursing research over past years, in particular the use of critical incident technique. Phenomenology can be traced back to existentialist philosophy where it is expounded in the work of Husserl and Heidegger. One of the most notable examples of phenomenological research in nursing has been the work of Benner who has used this approach to examine expertise in nursing. This paper is an account of a study which attempted to adapt phenomenological methods to the investigation of expertise in nurses working in long-term care settings, which was curtailed by the apparent inability of nurses in the study to identify any significant incidents. The paper examines this problem in the light of existentialist philosophy and suggests that the apparent lack of expertise identified in the nurses might be due more to a tendency of phenomenological studies to focus more on articulation than on attunement or potential, the other elements of dasein. The paper concludes that attention to these elements is required when phenomenology is used.
This paper presents a comparison of the phenomenologies of Edmund Husserl and Martin Heidegger with the aim of highlighting some of the critical distinctions between these two 'schools' of phenomenology concerning the methodological implications of each approach for nursing research. Specifically, the paper examines: the implications of epistemology versus ontology; issues relating to validity; the involvement of the researcher, and aspects relating to interpretation.
The thesis of this paper is that researchers working in interpretive traditions need to address three central issues: philosophy, rigour and representation. This paper discusses the process of an hermeneutic inquiry as a research methodology used in seeking to understand the experiences of older patients admitted to an acute hospital. The methodology includes the philosophical framework and assumptions underpinning the research. Philosophical hermeneutics guides the inquiry as a reflection of the research process. Three issues concerning legitimation of the hermeneutic research process arise: the philosophical underpinnings of the methodology, representation, or the participation of the researcher in making data, and rigour, or the way in which trustworthiness of hermeneutic research can be established. I recommend that Gadamer's primacy of application to the understanding of texts can also be applied to understanding of health environments. I conclude that Gadamer's post-modern sensibility regarding text and the framework of Guba & Lincoln's fourth generation evaluation are compatible within a hermeneutic inquiry.
Developing a method that is pragmatic yet theoretically consistent with the philosophies of hermeneutics and phenomenology is a constant hurdle for any researcher endeavouring to engage their inquiry in this manner, particularly when its proponents refute the credence of hermeneutics as a research method. This paper discusses how Van Manen's six research activities can act as a framework, that when modified to suit the particular needs of the research project, can promote a process of inquiry that works with these philosophies towards an unfoldment of new understandings of the human experience in illness.
The meaning of learning in critical care nursing: a hermeneutic study
Many critical care nurses choose to undertake further, specialist education and have an expectation that the curriculum will reflect their common learning requirements. Although previous studies have addressed education‐related issues, few have explored fundamental learning needs as expressed by the students themselves. This paper summarizes a study which aimed to explore the meaning of learning to 10 intensive care/coronary care nurses who had recently undertaken specialist post‐registration study. Utilizing an interpretative human science approach (Heideggerian hermeneutic phenomenology) the study identified three major themes: learning as focusing, learning as questioning and learning as technological mastery. One theme, learning as technological mastery, was revealed to be a particular feature of critical care nursing and was subsequently identified as the constitutive pattern. An alternative view of the relationship between nursing and technology is presented from the perspective of Heideggerian hermeneutic phenomenology. As a phenomenological account, this study does not claim to be representative of the larger population of critical care learners; however, it is suggested that unique human experiences may also be shared by others with similar backgrounds.
Fibromyalgia (FM) is a common chronic pain syndrome with an obscure etiology, which mostly afflicts middle-aged women. In this study, 14 women with FM were interviewed about the meaning of living with the illness. A phenomenological-hermeneutic method was used to analyze and interpret the interview texts. The findings show that being a woman with FM means living a life greatly influenced by the illness in various ways. The women's experiences of living with FM were presented in three major interlaced themes: loss of freedom, threat to integrity, and a struggle to achieve relief and understanding. This study highlights the importance of meeting people suffering in illness with respect for their human dignity. The care of women with FM must empower the women to bring to bear their own resources so that they can manage to live with the illness.
Hermeneutic-phenomenology: providing living knowledge for nursing practice
The phenomenological approach has gained popularity among nurse researchers as an alternative investigative method to those used in the natural sciences. As more nurse scholars and nurse researchers utilize phenomenology as a research approach, it becomes critical to examine the implications this may have for nursing knowledge development and for the utilization of that knowledge in practice. In this paper, an examination of the results of phenomenological inquiry is presented and compared with the types of knowledge considered important for nursing by Carper and White. It is clear that phenomenology contributes to empirical, moral, aesthetic, personal, and socio-political knowledge development. Its contribution is not in developing predictive and prescriptive theory, but in revealing the nature of human experience. Although interpretive inquiry, such as hermeneutic phenomenology, does not prescribe action for use in clinical practice, it does influence a thoughtful reflective attentive practice by its revealing of the meanings of human experience.
Exploring Ricoeur’s hermeneutic theory of interpretation as a method of analysing research texts
Increasingly, researchers use hermeneutic philosophy to inform the conduct of interpretive research. Congruence between the philosophical foundations of a study, and the methodological processes through which study findings are actualised, obliges hermeneutic researchers to use (or develop) hermeneutic approaches to research interviewing and textual analysis. Paul Ricoeur’s theory of interpretation provides one approach through which researchers using hermeneutics can achieve congruence between philosophy, methodology and method.
Ricoeur’s theory of interpretation acknowledges the interrelationship between epistemology (interpretation) and ontology (interpreter). Also, Ricoeur notes the way interpretation moves forward from naive understanding, where the interpreter has a superficial grasp of the whole of the text, to deeper understanding, where the interpreter understands the parts of the text in relation to the whole and the whole of the text in relation to its parts (the hermeneutic circle). In this way, Ricoeur’s theory of interpretation provides researchers with a method of developing intersubjective knowledge.
Through exposition of the concepts of Ricoeur’s theory, which include distanciation, appropriation, explanation and understanding, guess, and validation, a hermeneutic approach to textual analysis is presented, discussed and critiqued. Examples from nursing research are also used to demonstrate points under discussion. It is suggested that, in conjunction with Gadamer’s hermeneutic of understanding, Ricoeur’s theory of interpretation warrants consideration as a method of textual analysis.
The purpose of this article is to introduce practicing nurses to qualitative research. Qualitative research terms are defined, philosophy of science is briefly discussed, and several types of qualitative research studies are described. A hermeneutic phenomenological study of infant colic is described as an example of qualitative research useful in gastroenterology nursing. Finally, suggested criteria for evaluating a qualitative study are introduced.
It is generally agreed in the nursing literature that the maintenance of patient dignity is an important element of nursing care that is highly valued by patients. Despite this, dignity is seldom defined and there are few guidelines that nurses may use in their practice to safeguard individual patients' dignity. This phenomenological study aimed to uncover patients' and nurses' perceptions of dignity, formulate a definition of dignity based on the experience of patients and nurses, and identify nursing practices that maintain or compromise patient dignity. The study found that the characteristics nurses associated with dignity were many and varied. Important elements in the meaning the nurses ascribed to the notion of patient dignity were the elements of respect, privacy, control, advocacy and time. The themes which emerged from the patient interviews were similar to those which emerged from the interviews with nurses. The characteristics that patients attributed to dignity and its maintenance included respect, privacy, control, choice, humour and matter-of-factness.
Hermeneutics and narration: a way to deal with qualitative data
This article focuses a hermeneutic approach on the interpretation of narratives. It is based on the French philosopher Paul Ricoeur's theory of interpretation but modified and used within a caring science paradigm. The article begins with a presentation of the theoretical underpinnings of hermeneutic philosophy and narration, as well as Ricoeur's theory of interpretation, before going on to describe the interpretation process as modified by the authors. The interpretation process, which consists of several stages, is exemplified and discussed using a single case from a larger study on suffering. The results of that study indicate that the struggle of suffering is perceived as a struggle formed between shame and dignity, and that nurses must engage in the process of preserving and restoring the dignity of their suffering patients. The authors suggest that Ricoeur's theory of interpretation is useful when trying to understand narrative data if the researcher realises that the process of distanciation, although central in Ricoeur's thinking, is not the goal of the process but rather a means to deal with the researcher's pre-understandings. According to Ricoeur, distanciation is accomplished by putting the context aside and dealing with the text ‘as text’ and thereby explaining its meaning. Explanation thus becomes the dialectic counterpart to understanding in the interpretation process. The researchers further argue that distanciation must be followed by reflection, where the interpretations are linked back to the empirical context.
The experience of mental ill health is fundamentally disempowering. The processes of psychiatric hospital care and treatment may also add to the personal feeling of disempowerment. This disempowerment is partly due to the failure of others to afford a proper hearing to the person's story of his/her experiences and problems in life. Hence, there is a need to investigate patients' experiences of being mentally ill with psychosis and being helped in a psychiatric hospital.
This paper describes the application of a phenomenological method of analysis derived from Amadeo Giorgi to an investigation of psychiatric patients' experiences about being mentally ill with psychosis and being helped in a psychiatric hospital ward in Northern Finland.
This phenomenological study was conducted with nine voluntary adult patients recovering from psychosis. In 1998, patients were interviewed regarding their experiences of psychosis and being helped. The verbatim transcripts of these interviews were analysed using Giorgi's phenomenological method. Giorgi's method of analysis aims to uncover the meaning of a phenomenon as experienced by a human through the identification of essential themes. Patients' experiences of psychosis and being helped were clustered into a specific description of situated structure and a general description of situated structure.
The Giorgian method of phenomenological analysis was a clear-cut process, which gave a structure to the analyses and justified the decisions made while analysing the data. A phenomenological study of this kind encourages psychiatric nurses to focus on patients' experiences.
Phenomenological study and Giorgi's method of analysis are applicable while investigating psychiatric patients' experiences and give new knowledge of the experiences of patients and new views of how to meet patients' needs.
This study contributes to an understanding of the art of nursing by defining and focusing on the nurse's experience in achieving the object of nursing art. Nursing art is conceptualized as a transition that the nurse helps facilitate with a patient who has become "stuck" in some way. The request posed to participants was: "Tell me of your experience in helping a patient turn a corner in his or her illness and come to see his or her situation in a new way." This research resulted in three sets of findings; only those relevant to transitions are presented here.
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