Meaningfulness as an epistemologic concept for explicating the researcher's constitutive part in phenomenologic research

Korean Nursing Students’ Ethical Problems and Ethical Decision Making

This Korean study replicated a previously published American study. The conceptual framework and method combined ethical enquiry and phenomenology. The research questions were: (1) What is nursing students’ experience of ethical problems involving nursing practice? and, (2) What is nursing students’ experience of using an ethical decision-making model? The participants were 97 senior baccalaureate nursing students, each of whom described one ethical problem and chose to use one of five ethical decision-making models. From 97 ethical problems, five content categories emerged, the largest being health professionals (69%). The basic nature of the ethical problems was the students’ experience of conflict, resolution and rationale. Using an ethical decision-making model helped 94% of the students. A comparison of the Korean and American results yields important implications for nursing ethics education, practice and research.

Travelling along a road with obstacles: experiences of managing life to feel well while living with migraine

Living a life with migraine can impair one's sense of feeling well, and migraine is a disorder that is associated with substantial disability. Earlier research on how people manage their migraine has given important insight into these people's preventive actions and how they handle their attacks, but there is still a lack of knowledge of how persons with migraine manage their lives to feel well from a more holistic viewpoint. Therefore, the aim of this study was to explore lived experiences of managing life to feel well while living with migraine. Nineteen persons with migraine were interviewed. A hermeneutic-phenomenological approach was used to explore their lived experiences. The findings reveal that persons with migraine not only used preventive strategies to abort and ease the consequences of migraine but also tried to amplify the good in life through increasing their energy and joy and through reaching peace with being afflicted with migraine. The findings of this study can encourage healthcare providers, as well as persons with migraine, to consider channeling their efforts into strategies aiming to amplify the good in life, including reaching peace of mind despite being afflicted.

Professional tools and a personal touch - experiences of physical therapy of persons with migraine

Purpose:

The aim was to explore the lived experience of physical therapy of persons with migraine.

Method:

Data were collected by conducting narrative interviews with 11 persons with migraine. Inspired by van Manen, a hermeneutic phenomenological method was used to analyse the experiences of physical therapy which these persons had.

Results:

Physical therapy for persons with migraine meant making an effort in terms of time and energy to improve their health by meeting a person who was utilising his or her knowledge and skill to help. Being respected and treated as an individual and having confidence in the physical therapist were highlighted aspects. The analysis revealed a main theme, “meeting a physical therapist with professional tools and a personal touch”. The main theme included four sub-themes, “investing time and energy to feel better”, “relying on the competence of the physical therapist”, “wanting to be treated and to become involved as an individual” and “being respected in a trustful relationship”.

Conclusions:

The therapeutic relationship with the physical therapist is important and the findings of this study can increase awareness about relational aspects of physical therapy and encourage thoughtfulness among physical therapists and other healthcare professionals interacting with persons with migraine.

The extra burdens patients in denial impose on their family caregivers

Objective:

The purpose of this study was to explore the impact of advanced cancer patients' denial on their family caregivers and how they cope, in order to enable clinicians to better support them and their caregiving.

Method:

As the objective was to obtain clinically useful findings, an interpretive descriptive design was used. Data consisted of prospective semi-structured interviews with 16 family caregivers of advanced cancer patients in denial, field notes, reflexive journals, and memos during the analysis.

Results:

Caregivers experienced extra burdens with the patient's denial. Feeling bound to preserve the denial, which they perceived as immutable, they were prevented from seeking information to manage the patient's care. Additionally, those caring for noncompliant patients felt disenfranchised from their role, resulting in feelings of powerlessness and guilt, and felt burdened by managing medical situations that arose from noncompliance. Caregivers described the ambivalence of feeling frustrated and burdened by the denial while recognizing it as a long-standing coping pattern for the patient. The denial prevented them from acknowledging their own needs to the patients or seeking informal support. They therefore developed solitary coping strategies, sought professional psychosocial support, and/or employed denial themselves.

Significance of results:

Caregivers of patients in denial experience added burdens, which they must bear without most of the usual sources of support. The burden is accentuated when patients are noncompliant with care, placing themselves in dangerous situations. Healthcare providers should identify patients in denial and support their caregivers in meeting both their caregiving and their own needs. Evidence-based strategies to accomplish this should be developed and implemented.

Migraine--more than a headache: women's experiences of living with migraine

PURPOSE

In this qualitative study the aim was to explore the meaning of living with migraine.

METHODS

In-depth interviews were conducted with ten women about their experience of living with migraine. Halfway through the interview, the women drew a picture of what living with migraine is like, and the interview continued with the conversation being guided by the picture. The interviews were analyzed using a hermeneutic phenomenological method inspired by van Manen.

RESULTS

The analysis revealed an essence "Being obliged to endure a life accompanied by an unpredictable and invisible disorder" and three themes "Being besieged by an attack", "Struggling in a life characterized by uncertainty" and "Living with an invisible disorder."

CONCLUSIONS

Migraine is a debilitating disorder which accompanies life in the sense that it or the threat of its return is always present, and yet invisible to others. The struggle of enduring life with migraine is worsened by the feeling of having an invisible disorder and of being doubted. There is a need to increase the knowledge among healthcare professionals about what it means to live with migraine, something this qualitative study offers.

A method for historicizing lived experience

The purpose of this article is to describe a method used to historicize the lived experience of nurse caring by the culture of white Northern women during the American Civil War. Primary sources included unpublished and published Civil War letters, journals, diaries, memoirs, reminiscences, narratives, and records from 1861 through 1911. The phenomenological description was created using van Manen's approach for hermeneutic phenomenology and Drew's method for examining the researcher's preunderstanding of a phenomenon. The phenomenological description was historicized using Scott's concept of historicizing and Leininger's Sunrise Model as a framework. The method used to historicize the lived experience of American Civil War nurse caring provides a foundation for examining American nurse caring in other time periods in order to reveal the phenomenon of nurse caring during these periods as well as the cultural and social forces that have shaped American Nursing.

Cultural Competence in Qualitative Interview Methods with Asian Immigrants

The growth in Asian immigration and a diversity of Asian populations living in Western English-speaking societies pose many opportunities for qualitative research. Cultural competence is essential to credible qualitative nursing research employing interview data. The purpose of this article is to describe culturally competent qualitative research with Asian immigrants, especially in the design, interview phases, and analysis. Strategies to achieve cultural competence are synthesized within the model of cultural competence, integrating the literature review and data exemplars. Strategies for successful conduct of qualitative research in Asian immigrant populations, including preparation of the research team, techniques for the conduct of research interviews with Asian immigrants, and contextual meanings and timing of translation are offered. The article concludes with a summary of implications for future research.

Experiences of women with bulimia nervosa in a mindfulness-based eating disorder treatment group

The experience of 6 college-age women with bulimia nervosa was examined after they participated in an 8-week mindfulness-based eating disorder treatment group. This phenomenological study used individual interview and pre- and post-treatment self-portraits. Participants described their experience of transformation from emotional and behavioral extremes, disembodiment, and self-loathing to the cultivation of an inner connection with themselves resulting in greater self-awareness, acceptance, and compassion. They reported less emotional distress and improved abilities to manage stress. This treatment may help the 40% of women who do not improve with current therapies and might be useful to prevent symptoms in younger women.

Patients' experiences of recurrent depression

This study explores the lived experiences of individuals who are suffering from recurrent depression. Open interviews were conducted in Sweden with ten participants aged 19-67. Guided by the phenomenological method of Giorgi, data were analyzed within a Reflective Lifeworld Approach. The findings revealed a pattern of meaning, described as being alienated from oneself and others. Depression is described as an insidious disorder and participants described their experiences variously as elusive, extensive, complex, contradictory, paradoxical and stated that depression pervaded the person's whole lifeworld, involved both body and soul, and affected relationships with others. Relationships with others could be the reason for both wanting to live or to die. How best to confirm this form of suffering is something of a challenge to mental health care professionals.

Bridging the distance between the objectivism of research and the subjectivity of the researcher

A phenomenological study of researchers' experience of their work is presented. The disparity between researchers' subjective experience and the inherent objectivism of science and research is discussed. Bridging the distance between the immediate experience of research and the positivistic/objectivistic nature of research is proposed as a way to keep the research community cognizant of values and beliefs that may get pushed aside in the clamor for factual information and material gain. A synthesis of intentionality is discussed as a method for disclosing a researcher's constitutive part in phenomenological research. Expanding the traditional format for research reports to include a brief biographical account of the inception of the research is proposed and an example included.

Phenomenology as rhetoric

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

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

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

A midwifery model of care for childbearing women at high risk: genuine caring in caring for the genuine

According to this paper's synthesis of research, three constituents of ideal midwifery care emerge. First, a dignity-protective action takes place in a midwife's caring relationship with a childbearing woman at high risk and includes mutuality, trust, ongoing dialogue, enduring presence, and shared responsibility. Secondly, the midwife's embodied knowledge is based on genuineness to oneself and consists of theoretical, practical, intuitive, and reflective knowledge. Finally, nurse-midwives have a special responsibility to balance the natural and medical perspectives in the care of childbearing women at high risk, especially by promoting the woman's inborn capacity to be a mother and to give birth in a natural manner. This midwifery model of care is labeled "Genuine Caring in Caring for the Genuine." Here, the word genuine expresses the nature of midwifery care, as well as the nature of each pregnant woman being cared for as a unique individual.

Creating a synthesis of intentionality: the role of the bracketing facilitator

The role of a bracketing facilitator during the analysis phase of phenomenological research is discussed. As a research colleague, a bracketing facilitator plays an important part in a fellow researcher's task of uncovering his or her constitutive relationship with the research phenomenon. The primary task of a bracketing facilitator is providing assistance for a colleague in moving away from the usual cognitive mode of thinking during data analysis and into a state of emotional sensitivity to personal history and experience of the phenomenon. A step-by-step approach to the search for personal connections is presented, including an example of the process of facilitating this search. A table of guidelines that includes specific points for the act of bracketing as well as the content to be bracketed is intended as a tool for the development of phenomenological description.

Living with bodily strangeness: women's experiences of their changing and unpredictable body following a stroke

The authors' aim in this phenomenologial and feminist study was to gain a deeper understanding of how female stroke survivors experienced their body after a stroke. They recruited 25 women in a rural area in eastern Norway who had suffered a first-time stroke and interviewed them in depth three times each during the first 1 1/2 to 2 years following the stroke. The data analysis was inspired by phenomenological method. The stroke survivors' experiences of their bodies were characterized by profound, disturbing, and, in part, unintelligible changes during the onset and the process of recovery from the stroke. Their experiences can be summarized under three major themes: The Unpredictable Body, The Demanding Body, and The Extended Body.

Gaining access to the life-world of women suffering from stroke: methodological issues in empirical phenomenological studies

AIM

First to give a brief introduction to some dimensions of phenomenology as philosophy, and then to discuss some problems related to empirical research. The objectives of the discussion are: (1) to show what is involved in investigating changes in the life-world caused by illness and (2) to show what must be taken into consideration to obtain adequate descriptions of the changes.

RATIONALE

To discuss some of the methodological requirements and challenges that phenomenological studies are expected to meet, particularly focusing on the data collection phase.

METHODS

This is primarily a theoretical analysis supplemented by illustrations drawn from an ongoing study of women who have had suffered stroke.

FINDINGS

Openness is essential in the whole research process. It is a precondition for conversation with the informants. In interview-based investigations two forms of openness are at issue - the informant's openness in describing his/her life-world, and the sensitivity of the researcher as regards seeing and hearing what is conveyed in the situation. Both forms of openness can be influenced positively or negatively by many factors, including the physical and mental health of the informants, the researcher's theoretical insight, her ability to communicate, and not least the relationship between the informant and the researcher. A relationship of power, for example, might reinforce gender differences, differences in cultural background, education and social status.

CONCLUSION

Openness on the part of the researcher is a prerequisite in order to gain access to the informant's life-world.

Caring as a slave morality: Nietzschean themes in nursing ethics

BACKGROUND

Sceptical arguments about 'caring' can be divided into three categories. First, it is suggested that, while caring is no doubt an admirable thing in itself, it is just one ideal among others. Secondly, it is claimed that caring is not really a virtue at all, and that it should be regarded as more of a vice, because it promotes favouritism, injustice, and self-deception. Thirdly, there is a worry that caring is not politically realistic, and that its advocates underestimate the powerful organizational and social structures which conspire to subvert nursing.

AIM

This paper outlines a fourth, and more radical, type of scepticism, which explains why caring is subject to these drawbacks. In doing so, it considers the relation between caring, phenomenology and holism in nursing discourse, and the way in which all three fit together to form the 'caring paradigm'.

METHODS

The paper adopts a genealogical approach, borrowed directly from Nietzsche's Genealogy of Morality. That book argues that the values associated with caring are the expression of a profound resentment, harboured by the slaves (weak, powerless, timorous) against the nobles (strong, powerful, self-confident). Caring represents an inversion, a sort of 'fantasy revenge', in which the nobles can be portrayed as 'evil', while the slaves portray their own weakness as 'good'. Taking its cue from Nietzsche, the paper shows that the Genealogy narrative can be transposed into a modern health care context, with nurses as the 'slaves' and the medical profession as the 'nobles'.

CONCLUSIONS

The ideology of caring is, in the Genealogy's terms, a slave morality. It represents an attack on the 'medical-scientific model', motivated by resentment, and designed to establish nursing's superiority. Its effects have been debilitating, and it has prevented nursing from becoming a 'noble' (that is, a properly scientific) discipline.

Older persons' ethical problems involving their health

Although older persons (aged 65 years and older) experience stressful ethical problems involving their health, research is lacking about this phenomenon. The purpose of this study was to describe and examine the content and basic nature of older persons' ethical problems concerning their health. The conceptual framework and method combined ethical enquiry and phenomenology. The participants were 18 older persons and 12 of their children or grandchildren (for contextual understanding). The 19 women and 11 men, 73% of whom were Caucasian, described 184 ethical problems, from which emerged 10 content categories. The basic nature of the ethical problems consisted of conflict, resolution and rationale. The results could assist health professionals to promote older persons' ethical decision making, quality of life, and good death.

Heart failure and its impact on older women's lives

AIM OF THE STUDY

This phenomenological study sought to examine and describe the experience of living with heart failure (HF) from the perspective of five women who live with Stage II HF.

BACKGROUND

Research has shown that women are affected by HF differently than men, having different risk factors, a higher increase in mortality per decade, and longer survival after diagnosis. Women have also been greatly under-represented in studies of HF. A search of the literature revealed only one Swedish study examining the overall impact of HF on women's conceptions of their own lives.

RESEARCH METHODS

Four 1-hour semi-structured interviews were held with each participant. Colaizzi's steps were used to analyse the verbatim transcripts of the interviews, drawing meanings from the participants' words.

FINDINGS

Four main themes emerged from the data: 'Acknowledging Losses in Their Lives', 'Accepting the Losses', 'Changing Their Lives' and 'Deepening Relationships'. Additionally, each theme contained several subthemes.

CONCLUSION

Findings from this study indicate that no aspect of women's lives escapes the impact of HF. It causes immense losses in many areas of life, and requires tremendous changes in many aspects of daily living. Yet, drawing on inner resources of great strength and courage, these women learn to find contentment in their lives. They discover ways to create productive lives and deeply meaningful relationships, within the boundaries imposed by HF.

Hands-on: the persistent metaphor in nursing

The metaphor "hands-on" has been used throughout the history of nursing, highlighting internal conflict and reflecting the centrality of patient care. Connection with the intent to heal suggests the deeper meaning of the metaphor. Nurses have struggled to maintain a holistic approach to patient care while reflecting larger social values. Some nurses have moved from holistic care of the client to a holistic use of self as healer. This unified approach of head, heart, and hands is exemplified in healers using touch therapies. Head and heart unite with the action of the hand with intent to heal.