Understanding the life of illness: learning through the art of Frida Kahlo

Embodied relational research: How can researchers' competences in exploring existential aspects be enhanced?

BACKGROUND

This methodological essay discusses the following question: How can researchers' competences in exploring existential aspects related to healthcare be enhanced? Exploring this novel perspective on caring practice may help us better understand and communicate about experiences and issues that matter to others (e.g. patients/users). Two things are needed: firstly, a vocabulary mirroring an "aesthetic-holistic" research approach allowing us to capture the essence of "what it is like" and secondly, the development of skills and competences allowing us to understand complex aspects of caring that are embodied, ethically sensitive and sustainable.

AIM

To identify personal competences and approaches underpinning research exploring "what it is like"-understanding human existence.

DISCUSSION

The discussion addresses three questions: (A) What does human science exploring human existence search for? (B) Which researcher competences are required? (C) Which theoretical and practical approaches and dimensions may enhance the researchers' competences? We argue that we should find "ourselves" not only grasped through language and a qualitative research-methodological approach but also in what is reflected in the relation between self, language (dialogue) and the other. It is crucial to listen to the world in an ontological way. Emotions, feelings and bodily sensed understandings can, in some situations, bar us from stepping further into meta-physical listening and from adopting a being-in-the-world stance. In this relational perspective, the researcher may adopt an attentive pace and aesthetical attunement that transcend what cannot be reached through the language of logical, rigorous, precise and rational words, tuning into the ontological mood that exists as the tacit backdrop of our existence. This approach we dub "Embodied Relational Research."

CONCLUSION

Researchers who explore humanity may benefit from cultivating awareness, sensitivity and understanding while displaying openness towards the other (the patients' or users' experiences). In this context, contemplative and creative dimensions are important to apply.

Could Frida Kahlo have had antiphospholipid syndrome?

Frida Kahlo's medical history shows sequelae of polio, a severe traumatic event that caused multiple fractures and a penetrating pelvic injury, as well as a history of countless surgeries. In her biographical accounts and her works, chronic disabling pain always appears for long periods. Besides, a chronic foot ulcer, gangrene that required amputation of the right leg, a history of abortions, and a positive Wasserman reaction suggest that the artist could have suffered from antiphospholipid antibody syndrome (APS).

Could Frida Kahlo Have Had Antiphospholipid Syndrome?

Frida Kahlo's medical history shows sequelae of polio, a severe traumatic event that caused multiple fractures and a penetrating pelvic injury, as well as a history of countless surgeries. In her biographical accounts and her works, chronic disabling pain always appears for long periods. Besides, a chronic foot ulcer, gangrene that required amputation of the right leg, a history of abortions, and a positive Wasserman reaction suggest that the artist could have suffered from antiphospholipid antibody syndrome (APS).

Art, anatomy, and medicine: Is there a place for art in medical education?

For many years art, anatomy and medicine have shared a close relationship, as demonstrated by Leonardo da Vinci's anatomical drawings and Andreas Vesalius' groundbreaking illustrated anatomical textbook from the 16th century. However, in the modern day, can art truly play an important role in medical education? Studies have suggested that art can be utilized to teach observational skills in medical students, a skill that is integral to patient examination but seldom taught directly within medical curricula. This article is a subjective survey that evaluates a student selected component (SSC) that explored the uses of art in medicine and investigates student perception on the relationship between the two. It also investigates whether these medical students believe that art can play a role in medical education, and more specifically whether analyzing art can play a role in developing observational skills in clinicians. An "Art in Medicine" 8-week course was delivered to first year medical students at Brighton and Sussex Medical School. The use of art to improve observational skills was a core theme throughout. Feedback from the students suggests that they believe a strong association between art and medicine exists. It also showed a strong perception that art could play a role in medical education, and more specifically through analyzing art to positively develop clinical observational skills. The results of this subjective study, together with those from research from elsewhere, suggest that an art-based approach to teaching observational skills may be worth serious consideration for inclusion in medical and other healthcare curricula.

Images of Loneliness: Using Art as an Educational Method in Professional Training

BACKGROUND

An educational program using art was created to prepare healthcare professionals to work with older adults by deepening their knowledge of loneliness and promoting self-reflection.

METHOD

Participants viewed art exploring themes of loneliness and discussed their perceptions. Semi-structured feedback questionnaires were used to evaluate evidence of learning.

RESULTS

Training enhanced ethical knowing, aesthetic knowing, and empathy. Healthcare professionals also reported increased self-knowledge and skills to use art in group interventions. They gained deeper understanding of loneliness through viewing works of art.

CONCLUSION

Viewing art and discussing perceptions of loneliness or suffering was an effective method to help healthcare professionals develop empathy.

On being dependent on home mechanical ventilation: depictions of patients' experiences over time

In this study, the authors describe the meanings of experiences of being dependent on a ventilator (HMV) and living at home as narrated by 13 people who had been using a ventilator via a mask or tracheostomy for half a year. The analyses revealed various movements across time toward the goal of using the ventilator successfully, and some narratives depicted suffering caused by care. The analyses also yielded different representations of embodiment. These findings were abstracted into two contrasting meanings of the experience of using HMV over time: a closing in or an opening up of the lived body, oneself, to other people and to the world. The authors illustrate this interpretation with two images. Ignorance and negative attitudes on the part of professionals working and/or managing care in the patients' homes are interpreted as causing suffering and intensifying a closed-in mode of being.

Art as measure: nursing as safeguarding

In this paper I explore the possibilities of nursing as safeguarding through a phenomenological description of a small sculpture by the German artist Käthe Kollwitz. My discussion will be grounded in Heidegger's understanding of technicity as a pervasive systematizing and aggressive challenging-out. The method is grounded in Merleau-Ponty's and Heidegger's contention that strong artworks are truth-disclosing and show up our precognitive contact with the world. Bringing nursing concerns to an encounter with single strong artworks can help us cultivate a more receptive openness to our patients.

Using the arts and humanities to support learning about loss, suffering and death

In this article, the benefits of using the arts and humanities as teaching and learning strategies are explored. Their contribution to undergraduate nursing curricula, as a means of promoting a deeper understanding of the experiences of loss, suffering and death, cannot be undervalued. They need to be present equally alongside the physical and social sciences in nursing curricula. More than ever, is the need for all undergraduate nursing students to participate in self-reflection of these experiences, in order that they may meet the needs of their patients and families adequately, in a range of healthcare settings.

Werna Naloo -'We Us Together': the birth of a midwifery education consortium

AIM

The metaphor of a journey will be used to describe the process covering 2 years of development of a Bachelor of Midwifery curriculum shared between a consortium of three universities in Victoria, Australia.

BACKGROUND

The landscape or background against which this journey took place is described, providing a context for understanding the political and pragmatic steps necessary to achieve common vision and processes. This journey has necessitated a convergence of our thinking about what constitutes the living theory and philosophy of the new midwifery in the Australian context, and how this fits with international trends.

PROCESS

The journey took midwife academics from one paradigm to another, forging partnerships between universities to develop an innovative undergraduate midwifery curriculum that shares academic expertise and resources. Consultation between a multitude of competing interests and voices became one of our biggest challenges, but this process itself has helped to change the very landscape in which we travel. In the end, we had to examine our baggage, and much that was excess had to be abandoned. In particular, our emphasis on language and the politics of the midwifery partnership with women became the subject of much debate and contention, and reflects the competing philosophies developing in the midwifery profession. Despite this, there were many who suggested that we had left behind too much, and others who would have us pack even more. Compromises were inevitable if we were to proceed and set up the next stage of a journey that would open a new and challenging frontier to working with Australian childbearing women.

A introdução das artes nos currículos médicos

A capacitação profissional apropriada no campo da infecção pelo HIV/Aids prevê que tratamento e cuidados sejam oferecidos de maneira adequada, ética e humanizada. A preocupação com esta capacitação tem acentuado a discussão sobre como a formação médica pode integrar a aquisição de excelência técnica e traços humanistas. Assim, a Educação Médica passa a incorporar o desafio de adequar-se, para providenciar aos médicos, produtos finais de seus currículos, uma formação humanista e humanizadora. As Humanidades, em específico as Artes, são disciplinas que classicamente cumprem esta função. Postula-se e discute-se que elas sejam introduzidas nos currículos médicos, seja pelo seu valor intrínseco, fonte de experiência estética e conhecimento, seja para facilitar a execução de objetivos mais amplos dentro desses currículos.

Masterworks of art and chronic illness experiences in the elderly

AIM

This article presents findings of a qualitative study, conducted between 1997 and 2000, to investigate the plausibility of integrating masterworks of art with care of the chronically ill elderly, and to analyse perceptions about chronic illness among three groups: registered nurses, nursing students, and the elderly.

BACKGROUND AND SIGNIFICANCE

Statistically the incidence of chronic illness increases in the elderly. Although pathophysiology of chronic illness is increasingly understood, few studies explore the experience of living with chronicity from the perspective of the elderly. Understanding and intervening appropriately for the elderly with chronic illness may contribute significantly to improving quality of life for this growing population.

ETHICAL ISSUES AND APPROVAL

The study was approved through an Institutional Review Board. Facility permission and participant informed consent were obtained. Anonymity and confidentiality were protected.

DESIGN

Using hermeneutic phenomenology and masterworks of art as a centre point for dialogue, the investigators explored the perceptions of nurses, students, and the elderly about living with a chronic illness. A purposive sample of 65 participants made up seven focus groups with which group interviews were conducted. Themes were explicated and analysed from audiotaped interviews until data saturation was reached.

FINDINGS

Content analysis of focus group interviews revealed themes of social isolation, inevitable role change, and inertia-movement. Only the elderly acknowledged hope and a steadfast refusal to give up, while nurses and students viewed chronicity more negatively. Themes of social isolation and role change are consistent with other studies of the elderly. A paradox of inertia-movement in the chronically ill elderly has not been reported in the nursing literature.

CONCLUSIONS

Paradoxical tension of inertia-movement in the chronically ill elderly appears to be linked to the broader concept of energy in nursing science, and to Parse's theory of human becoming. Masterworks of art can generate energy exchange between the elderly and caregivers, providing a plausible catalyst for meaningful interventions that transcend age and practice settings.

Speaking unavoidable truths: understanding early childhood sexual and physical violence among women in prison

Women in prison have often suffered physical and sexual abuse as children which substantively contributes to their substance abuse, violence, and criminal behaviors. To understand women's offending, and subsequent health issues, it is helpful to understand their own victimization. In this participative action research, women used poetry as both a process and a product to confront the truths of their lives in terms of what was done to them and what they have done to others and themselves. As the women learned to speak their own truths, those same truths became unavoidable to themselves. This rise into consciousness is demonstrated through excerpts from the participants' writings.

Integrating the creative arts into a midwifery curriculum: a teaching innovation report

The practice of midwifery has long been recognized as both art and science. However, educational programmes for midwifery are most often undertaken within an academic health sciences environment, and tend to be based on knowledge derived from the sciences (e.g. life sciences, biomedical sciences, behavioural sciences and social sciences). These scientific perspectives, while essential to the preparatory and on-going education of midwives, do not necessarily fully prepare midwives to fulfil their practice roles. This paper reports a teaching innovation aimed at facilitating student exploration of fundamental, complex and ethereal concepts which are essential to the effective and skillful practice of midwifery. Through the exploration of the arts and humanities, students were encouraged to engage with concepts such as 'caring', 'empathy', 'suffering', 'motherhood', 'pain', 'love', 'attachment', 'health' and 'illness'. Students were also encouraged to explore cultural and social symbols pertaining to parenthood and family life. Evaluation revealed that students valued the course, and that they gained insights which assisted them to develop understanding of key concepts. Implications for practice and education are drawn from this paper.

Reclaiming 'Big Nurse': a feminist critique of Ken Kesey's portrayal of Nurse Ratched in One Flew Over the Cuckoo's Nest

Nurse Ratched or 'Big Nurse' in Ken Kesey's counter-culture novel One Flew Over the Cuckoo's Nest is one of popular culture's most arresting and memorable images of the nurse. She is, however, deemed to be remarkable primarily for her malice and authoritarianism. This paper argues that such a purely realist reading fails to fully appreciate the significance of the character of Nurse Ratched. A feminist critique of the novel contends that the importance of 'Big Nurse' is less related to how realistic/unrealistic or good/bad she is as a nurse. Nurse Ratched is important because she exemplifies all that traditional masculinity abhors in women, and particularly in strong women in positions of power and influence. This paper explores the stereotype of 'Big Nurse' and argues that Kesey's vision of her ultimate 'conquest' is not a progressive allegory of 'individual freedom', but a reactionary misogyny which would deny women any function other than that of sexual trophy.

Lessons From Literature: Caring, Interpretation, and Dialogue

There can be little doubt that nursing, like other arts and sciences, is experiencing an "interpretive turn" (Hiley, Bohman, & Shusterman, 1991). As part of this more global "turn," the curriculum revolution has spurred nurse educators to critically examine their schools, curricula, and everyday practices as teachers and propose alternative pedagogies where appropriate. I argue that what is now being developed as nursing humanities is a valuable approach to interpretive pedagogy which challenges, stimulates, integrates, and develops students' thinking and understanding of the lived experience of patients/clients in ways that more traditional scientific and behaviorist approaches to nursing education are unable to do. In creating courses or learning experiences using nursing humanities, it is essential to attend to both content and pedagogical approach as being inseparable. Ignoring the former will produce no more than a pleasant chat, while ignoring the latter will result in mere "metaphor counting" or rote learning of "what the book, story, or poem means." Nurse educators have used literature to help illuminate health and illness issues in the past, but unfortunately, this has been viewed as an essentially marginal approach. While novels, stories, poems, and other literature can certainly be used in almost any nursing class, I believe that nursing humanities is such a rich seam of pedagogical and critical possibility that it merits development of specific courses and options within all of our nursing courses and programs.