Some thoughts on phenomenology and medicine

Narrative Medicine Theory and Practice: the Double Helix Model

The genesis of the medical humanities as a discrete academic discipline engendered a need for a theoretical framework, a function taken on by the growing narrative medicine movement. More recently, scholars have begun to develop a critical medical humanities, an analytical movement that emphasises the fundamental enmeshment of the sciences and humanities. Building on Helene Scott-Fordsmand's work on reversing the medical humanities, this paper develops an alternative to the current version of narrative medicine. We propose a new interpretive heuristic, the Double Helix Model, and place it in critical dialogue with the Columbia School's close reading based-approach. Through this new conceptual frame, we suggest that critical narrative medicine may empower clinicians to contribute to the reorientation of the roles of the sciences and humanities, benefiting providers, scholars and patients.

Physical Restraint Experience of Patients with Mental Disorders in Mainland China: A Qualitative Study

Introduction

The use of physical restraint (PR) is considered a controversial practice and research in Western countries has demonstrated negative physical and psychological consequences for patients, as well as staff, family members/carers, organisations and society as a whole. However, there are few research reports on restraint experiences of patients with mental disorders in non-Western countries, especially in mainland China.

Aim

This study aims to explore the subjective experiences and perceptions of patients with psychiatric disorders who have experienced PR in mainland China.

Methods

Semi-structured interviews were conducted with 8 inpatients with mental disorders in convalescence at a specialized mental health hospital in Shanghai. Interviews were recorded on audiotape and transcribed verbatim. Transcripts were analyzed using thematic analysis.

Results

Five themes emerged: "perception and understanding of PR", "response to PR", "negative physical and psychological experiences", "unmet care needs during PR" and "changes after PR", which together characterize patients' perceptions, experiences, feelings, and needs in PR.

Conclusion

The use of PR involves ethical issues and brings negative experiences to patients with mental disorders that cannot be ignored and should be used as a last resort. Different patients have different attitudes and reactions to PR. During PR, patients' physical and psychological needs are not adequately met. Medical staff should give more attention to patients in PR, meet their physical and psychological needs, and actively seek PR alternatives and reduction options based on evidence-based resources on restraint reduction available in the West and the national context and culture of China.

The patient's perspective of diabetic foot ulceration: A phenomenological exploration of causes, detection and care seeking

AIMS

Diabetic foot ulceration can contribute to lowered life expectancy and quality of life for people with diabetes, and yet, scant attention has been given to improving preventive and educational measures. This article uses a phenomenological approach to explore individuals' lived experiences of diabetic foot ulcerations to explore factors that can be harnessed to achieve improved outcomes.

DESIGN

This was a qualitative study using semi-structured interviews grounded in a phenomenological framework to explore how patients perceive and understand their foot problems.

METHODS

Study participants were recruited from February 2020 to February 2021 from a tertiary referral centre that treats foot problems in persons with diabetes. A total of 15 Hispanic, Native American and White patients participated in the study. We conducted in-depth semi-structured interviews which were audio recorded with the participant's consent. Interview data were transcribed and analysed with Dedoose data management software.

RESULTS

Analysis revealed findings in two primary domains: (1) how patients perceive foot ulceration, with themes around limited understandings of foot ulceration, close sensory observation of foot problems and barriers to ulcer perception and (2) how patients experience the timing of foot ulceration, with themes on how time perceptions shifted as foot problems became more serious, which correlated closely to how patients responded to their foot problems.

CONCLUSION

Despite the close sensory observation of their feet, people with diabetes face an array of barriers to recognizing and understanding the implications of diabetic foot ulceration, which can lead to delayed care seeking. Nurses can play a critical role in promoting patient education and improving patient self-management of foot ulcers.

IMPACT

This phenomenological study offers important lessons to guide nurses and other providers in enhancing patient self-management of DFUs and improving care outcomes by expanding an understanding of DFU early warning signs, the imperative to seek medical care quickly, and addressing possible barriers.

A New Perspective on Human Rights in the Use of Physical Restraint on Psychiatric Patients-Based on Merleau-Ponty's Phenomenology of the Body

(1) Background: Physical restraint in psychiatric settings must be determined by health care professionals for ensuring their patients’ safety. However, when a patient cannot participate in the process of deciding what occurs in their own body, can they even be considered as a personal self who lives in and experiences the lifeworld? The purpose of this study is to review the existential capability of the body from Merleau-Ponty’s phenomenology to explore ways of promoting human rights in physical restraint. (2) Methods: A philosophical reflection was contemplated regarding notions of the body’s phenomenology. (3) Results: Merleau-Ponty’s body phenomenology can explain bodily phenomena as a source of the personal subject, who perceives and acts in the world, and not as a body alienated from the subject in health and illness. Patients, when they are physically restrained, cannot be the self as a subject because their body loses its subjecthood. They are entirely objectified, becoming objects of diagnosis, protection, and control, according to the treatment principles of health care professionals. (4) Conclusions: The foundation of human rights, human being’s dignity lies in the health professionals’ genuine understanding and response to the existential crisis of the patient’s body in relation to its surrounding environment.

"Finding oneself after critical illness": voices from the remission society

The number of people who survive critical illness is increasing. In parallel, a growing body of literature reveals a broad range of side-effects following intensive care treatment. Today, more attention is needed to improve the quality of survival. Based on nine individual stories of illness experiences given by participants in two focus groups and one individual interview, this paper elaborates how former critically ill patients craft and recraft their personal stories throughout their illness trajectory. The analysis was conducted from a phenomenological perspective and led to the meaning structure; a quest to find oneself after critical illness. In this structure, illness represented a breakdown of the participants' lives, forcing them to develop a new understanding of themselves. Despite acute illness, they felt safe in hospital. Coming home, however, meant a constant balancing between health and illness, and being either in or out of control. To gain a deeper understanding of the participants' narratives of survival, the meaning structure was developed from a phenomenological life world perspective, Heidegger's concept of homelikeness and Arthur Frank's typologies of illness narratives. In conclusion listening to and acknowledging the patients' lived experiences of critical illness may support the patient efforts to establish the newly defined self and hence be vital for recovery. Phenomenology is one approach facilitating care tailored to the patients' lived experience of critical illness and its aftermaths.

Phenomenology and its relevance to medical humanities: the example of Hermann Schmitz's theory of feelings as half-things

One leitmotif that medical humanities shares with phenomenology and most contemporary medical ethics is emphasising the importance of appreciating the patient as a whole person and not merely as an object. With this also comes a focus on marginalisation and invisibility. However, it is not entirely clear what exactly patient-centred care means. What both phenomenology and medical humanities contribute to a 'more humane health-care encounter' (Goldenberg 2010, p 44) is offering not only a first-person perspective, but a dialogue between the third-person perspective and evidence-based medicine. Therefore, one main aim of medical humanities and phenomenology is to pay attention to the lived body (Leib) while adding this to the science of the objective body (Körper). In this study, I will discuss this connection through the lens of Hermann Schmitz's phenomenology. Finally, in light of this dialogue between phenomenology and medical humanities some proposals for medical practice shall be suggested.

Culture-bound syndromes in migratory contexts: the case of Bolivian immigrants

Objective:

to describe the culture-bound syndromes maintained by Bolivian immigrants in the new migratory context and analyze the care processes of these health problems.

Method:

qualitative research with an ethnographic methodological approach. Sample: 27 Bolivian immigrants. In-depth interviews and participatory observation were the strategies used for data collection. Data were classified and categorized into logical schemes manually and using the ATLAS-ti program v.5.

Results:

susto, “wayras”, amartelo, pasmo de sol, pasmo de luna and pasmo de sereno are some of the folk illnesses that affect the Bolivian immigrants and that they have to treat in the new migratory context.

Conclusions:

in the new environment, the group under study preserves culture-bound syndromes that are common in their country of origin. The care strategies used for these health problems are adapted to the resources of the new context and based on interactions with the domestic environment, biomedicine and traditional medicine. It was observed the need for the health professionals to realize that the efficacy of certain therapies occurs within the scope of cultural beliefs and not in that of the scientific evidence.