Medicine is incorporating genetic services into all avenues of health‐care, ranging from the rarest to the most common diseases. Cognitive theories of decision‐making still dominate professionals’ understanding of patient decision‐making about how to use genetic information and whether to have testing. I discovered a conceptual model of decision‐making while carrying out a phenomenological‐hermeneutic descriptive study of a convenience sample of 12 couples who were interviewed while deciding whether to undergo prenatal genetic testing.Thirty‐two interviews were conducted with 12 men and 12 (...) women separately. Interviews were transcribed verbatim and all data were analyzed using three levels of coding that were sorted into 30 categories and then abstracted into three emergent meta‐themes that described men's and women's attempts to make sense and find meaning in how to best use prenatal genetic technology. Their descriptions of how they thought about, communicated, and coped with their decision were so detailed it was possible to discern nine different types of thinking they engaged in while deciding to accept or decline testing.They believed that decision‐making is a process of working through your own personal style of thinking. This might include only one or any combination of the following types of thinking: analytical, ethical, moral, reflective, practical, hypothetical, judgmental, scary, and second sight, as described in detail by these 12 couples. (shrink)

Nurses’ bodywork: is there a body of work? The work that many nurses do involves the use of their own body as one of the tools of their occupation. Being a nurse, in many cases, means controlled, purposeful use of her or his own body oriented to the patient. This paper discusses some of the ways in which nurses’ bodies and the work that those bodies do are represented in professional and academic research accounts and made relevant in literature. Using (...) instances of bodies and bodily activity mentioned in a variety of literature, the paper discusses three categories of accounts of nursing bodywork: those which are problematised and where the nurse's body is seen as a topic for investigation, and those which are unproblematised either explicitly discussing bodily activity (for example, touch) or implicitly dealing with bodywork (for example, taking blood pressure). Four ways in which nurses’ bodies are made relevant in accounts are proposed: relational, corporate, instrumental and human.The paper discusses the prominence (or not) nurses’ bodies are given in professional and academic accounts, as a contribution to preliminary work of generating a topic for investigation and concludes with some suggestions as to how this investigative project might be taken forward, focusing primarily on an examination of methodic practices, or how bodywork is brought off and executed as a skilled but taken‐for‐granted activity. (shrink)

The ethics of care, adopted in much of the nursing literature, is usually framed in opposition to the Kantian ethics of principle. Irrespective of whether the ethics of care is grounded in gender, as with Gilligan and Noddings, or inscribed on Heidegger's ontology, as with Benner, Kant remains the philosophical adversary, honouring reason rather than emotion, universality rather than context, and individual autonomy rather than interdependence. During the past decade, however, a great deal of Kantian scholarship – including feminist scholarship (...) – has rendered this series of oppositions questionable, challenging the view that an ethics of care and Kant's moral law are irreconcilable. This paper therefore re‐examines Kant's writings, drawing on recent scholarship, and argues both that they provide the care ethicists with everything they require, and that they offer something beyond an ethics of care, something that repairs the deficits in philosophies of caring. It concludes by suggesting that a Kantian ethics of care has significant implications for the construction of nursing knowledge. (shrink)

We propose a new conceptualization of pain by incorporating advancements made by phenomenologists and cognitive scientists. The biomedical understanding of pain is problematic as it inaccurately endorses a linear relationship between noxious stimuli and pain, and is often dualist or reductionist. From a Cartesian dualist perspective, pain occurs in an immaterial mind. From a reductionist perspective, pain is often considered to be “in the brain.” The biopsychosocial conceptualization of pain has been adopted to combat these problematic views. However, when considering (...) pain research advancements, paired with the work of phenomenologists’ and cognitive scientists’ advanced understanding of perception, the biopsychosocial model is inadequate in many ways. The boundaries between the biological, psychological, and social are artificial, and the model is often applied in a fragmented manner. The model has a limited theoretical foundation, resulting in the perpetuation of dualistic and reductionist beliefs. A new framework may serve to better understand and treat pain. In this paper, we conceptualize pain as a 5E process, arguing that it is: Embodied, Embedded, Enacted, Emotive, and Extended. This perspective is applied using back pain as an exemplar and we explore potential clinical applications. With enactivism at the core of this approach, pain does not reside in a mysterious immaterial mind, nor is it an entity to be found in the blood, brain, or other bodily tissues. Instead, pain is a relational and emergent process of sense-making through a lived body that is inseparable from the world that we shape and that shapes us. (shrink)

This discussion is grounded in Aristotelian–Thomistic realism and takes the position that nursing is a practical science. As an exposition of the title statement, distinctions are made between opinion and truth, and the speculative, productive and practical sciences. Sources of opinion and truth are described and a discussion follows that truth can be achieved through knowing principles and causes of the natural kind behind phenomena. It is proposed that humans are the natural kind behind nursing phenomena. Thus, human nature provides (...) proper principles (the truth) of nursing practice. (shrink)

Hermeneutics, also referred to as interpretive phenomenology, has led to important contributions to nursing research. The philosophy of Charles Taylor has been a major source in the development of contemporary hermeneutics, through his ontological and epistemological articulations of the human sciences. The aim of this paper is to demonstrate that Taylor's ideas can further enrich hermeneutic inquiry in nursing research, particularly for investigations of ethical concerns. The paper begins with an outline of Taylor's hermeneutical framework, followed by a review of (...) his key ideas relevant for ethics research. The paper ends with a discussion of my empirical research with critically ill children in Canada and France in relation to Taylor's ideas, chiefly Social Imaginaries. I argue that Taylor's hermeneutics provides a substantive moral framework as well as a methodology for examining ethical concerns. (shrink)

This discussion is grounded in Aristotelian–Thomistic realism and takes the position that nursing is a practical science. As an exposition of the title statement, distinctions are made between opinion and truth, and the speculative, productive and practical sciences. Sources of opinion and truth are described and a discussion follows that truth can be achieved through knowing principles and causes of the natural kind behind phenomena. It is proposed that humans are the natural kind behind nursing phenomena. Thus, human nature provides (...) proper principles (the truth) of nursing practice. (shrink)

Recently the relevance of the philosophy of Martin Heidegger has been critiqued in nursing literature. However, this critique is based primarily upon an appropriation of Heidegger that does not reflect an understanding of meaning as grounded in temporality. Therefore, this paper aims to (1) explicate Heidegger's grounding of meaning, (2) briefly contrast Heidegger's and Husserl's notions of the origin of meaning, (3) describe how Heidegger was first introduced to nursing, and (4) illustrate through examples from a research study how the (...) philosophy of Heidegger might inform the phenomenological researcher. (shrink)

The modern West has vigorously sought to overcome death, or at the very least minimize the suffering that it entails. Whereas the former has been predominantly pursued through modern scientific medicine, the minimization of the adversity of death and dying has been sought through ‘death technologies’. This technologization of death is analyzed in light of Martin Heidegger’s phenomenological philosophy. The analysis begins with an outline of the fundamental tenets of Heidegger’s ‘philosophy of Being’. In turn, his philosophical framework is utilized (...) to highlight the manner in which the technologization of dying serves to conceal the central existential questions about being and finitude that dying gives rise to. The paper concludes with a discussion of how Heidegger’s work can inspire a more authentic stance toward dying. Leo Tolstoy’s The Death of Ivan Ilych is referred to in order to illustrate Heidegger’s construal of this existential struggle toward dying. (shrink)

Nursing philosophy is fundamentally based on an ethos of holistic care. However, spiritual aspects of care are often neglected. There are questions about how spirituality is currently approached and to what extent student nurses feel competent in assessing and delivering spiritual care in practice. A literature review was performed, using a systematic approach. From the themes identified in the literature review, five major knowledge and practice gaps were noted in nurse education. These were: lack of ontological integration; lack in phenomenological (...) understanding; lack of support and environmental constraints; curriculum structure and unprepared Faculty. Developing competency to deal with spiritual issues in nursing education is still a challenge. Issues of conceptual clarity and articulation around the ontological and phenomenological aspects of nursing must be addressed to prepare nurses to provide truly holistic care, including spiritual and existential issues. Adequate preparation, environmental support for both nursing educators and students, and explicit representation of spirituality in the nursing curriculum will facilitate this. An emphasis on the philosophical underpinnings of nursing care is needed to rebalance existing nursing education to embrace caring for spiritual needs as part of holistic care. (shrink)

An ontogenetically-informed epistemology is necessary to understandings of apprenticeship learning. The methodology required in this enterprise is a constructive phenomenology, a phenomenology that takes into account the fact that as infants, we were apprentices of our own bodies: we all learned our bodies and learned to move ourselves. The major focus of this essay is on infant social relationships that develop on the ground of our original corporeal-kinetic apprenticeship. It shows how joint attention, imitation, and turn-taking - all richly examined (...) areas in infant social development - are the foundation of apprenticeship learning in later adult life. The relationship between each infant capacity and later apprenticeship learning is demonstrated in examples from present-day research, specifically, research in the areas of medicine, sport, music, and tailoring, and research carried out by philosophers on apprenticeship learning. (shrink)

This article is a critical methodological reflection on the use of interpretive phenomenological analysis (IPA) initiated in the context of a qualitative research project on the experience of seclusion in a psychiatric setting. It addresses an explicit gap in the IPA literature to explore the ways that Merleau-Ponty’s phenomenology can extend the remit of IPA for noncognitivist qualitative research projects beyond the field of health psychology. In particular, the article develops Merleau-Ponty’s understanding of the lived-body, language, and embodied speech, with (...) specific attention to the ethical implications of body and place. It concludes with a discussion on phenomenological reflexivity and prompts a reconsideration of phenomenological methods across a wide range of qualitative research projects concerned with subjectivity and ethical practice, including critical health studies, critical bioethics, and cultural studies that employ a qualitative empirical research design. (shrink)

It is argued that philosophical realism is well suited to serve as a perspective from which to understand nursing, and that it should be considered as an alternative to positivist, interpretivist, hermeneutical and phenomenological approaches. However, existing forms of realism, including theory and entity realism are shown to be faced with serious problems. In response, an alternative form ‘constraint realism’ is outlined, and shown to be apposite for illuminating the rule or convention governed behaviour characteristic of human beings. A brief (...) sketch is offered of its application to the social practice of nursing. (shrink)

Abstract“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. (shrink)

The lived body has structures of ability built up over time through habit. Serious illness, injury, and incapacity can disrupt these capacities, and thereby, one’s relationship to the body, and to time itself. This paper focuses attention on a series of healing strategies individuals then employ on the “chessboard” of possibilities intrinsic to lived embodiment. This can include restoring past abilities (pointing to the future to recreate the past); and/or transforming one’s bodily structure or use-patterns, or the external environment, to (...) compensate. With many conditions, including progressive aging, no full rehabilitation is possible. Nevertheless, one can also seek consolation, richness, or hope by remembering the past; anticipating the future; or presencing, that is, living fully in the now. Insofar as past, present, and future are interwoven in one’s life experience, many also meet adversity by a life-story revision, constructing a new narrative to render events meaningful. Some also access a sense of transpersonal timelessness, whether through anticipation of an afterlife, or a sense of the eternal present. There is a literature on the adaptive coping mechanism used by the chronically ill, but with its diverse patient populations, methodologies, and categories, it has proved difficult to systematize. This article suggests that the structures of lived embodiment, as explored by phenomenology, provide a way to understand the modes of wholeness individuals access over time, and in relation to time—what is here termed chronic healing. (shrink)

Increasingly, nurses use the philosophy of hermeneutics, especially Heideggerian and Gadamerian hermeneutics, to inform interpretive research. However, application of the work of these philosophers to interpretive nursing research has proved problematic as it fails to recognise, or act upon, obligations inherent in their work. Through a review of hermeneutically informed nursing research, methodological implications regarding the use of hermeneutic philosophy are examined in relation to: (i) the need to address forestructures and pre-understandings; (ii) checking interpretations with research participants; (iii) seeking (...) objectivity, consensus and accuracy in textual interpretation; (iv) evaluating interpretations; and (v) gaining entry into the hermeneutic circle. This review suggests that despite obligations inherent in Heideggerian and Gadamerian hermeneutic philosophy, nurses fail to actualise these obligations in their research. In following Heidegger, nurses need to make the scientific theme secure by working out their forestructures in terms of the phenomenon under investigation. Those following Gadamer need to accept that interpretation seeks to manifest textual meanings rather than individual ones. And, whether following Heidegger or Gadamer, the way to make manifest textual meanings is to engage with the text within the hermeneutic circle by continuing to address forestructures and pre-understandings and by considering their influences upon the research. (shrink)

This paper explores some of the ways in which phenomenological approaches have been linked to contemporary social science inquiry into human ways of knowing and learning in the fields of education and nursing research. It then looks at four contemporary approaches which draw on phenomenology namely: distinguishing imaginal from rational/logical knowing as an alternative and complementary mode of knowing; using ‘arts based’ or ‘expressive’ approaches to inquiry; developing hermeneutic text making to present research findings and using heuristics in a cyclical (...) approach to understanding forms of human experience. The suggestion is that these approaches could be enriched and deepened by a more explicit exploration of phenomenological approaches and that conversely, some of forms of phenomenological research might be enriched by the use of these approaches. Indo-Pacific Journal of Phenomenology , Volume 4, Edition 1 July 2004. (shrink)

In exploring phenomenological literature, it is evident that the term ‘phenomenology’ holds rather different meanings depending upon the context. Phenomenology has been described as both a philosophical movement and an approach to human science research. The phenomenology of Husserl, Heidegger, Gadamer, and Merleau-Ponty was philosophical in nature and not intended to provide rules or procedures for conducting research. The Canadian social scientist, van Manen, however, introduced specific guidelines for conducting human science research, which is rooted in hermeneutic phenomenology and this (...) particular method has been employed in professional disciplines such as education, nursing, clinical psychology, and law. The purpose of this paper is to explore the difference between the phenomenological method as described by van Manen and that of other philosophers such as Husserl, Heidegger, Gadamer, and Merleau-Ponty. In so doing, the author aims to address the blurred boundaries of phenomenology as a research method and as a philosophical movement and highlight the influence of these blurred boundaries on nursing knowledge development. (shrink)

This methodological article explores issues related to having the ontological ground for phenomenological empirical research present throughout the research process. We discuss how ontology needs to be taken into consideration regarding the phenomena to be studied and how ontological aspects of phenomena need to be highlighted during various data collection and analysis procedures. Here, we discuss how philosophical works can be used in the context of specific research projects. In illustrating our statements, we present four empirical examples connected to the (...) themes of life changes and learning processes with the purpose of exemplifying and discussing how general lifeworld ontology can be integrated as an active resource in empirical phenomenological research. (shrink)

Phenomenology informs a number of contemporary attempts to give more weight to the lived experience of patients and overcome the limitations of a one-sidedly biomedical understanding of illness. Susan Bredlau has recently presented a reading of Plato’s dialogue Charmides, which portrays Socrates as a pioneer of the phenomenological approach to illness. I use a critical discussion of Bredlau’s interpretation of the Charmides to show that the phenomenology of illness also has its shortcomings and needs to be complemented by still other (...) approaches. While Bredlau does make a number of highly apt and relevant suggestions as to how a narrow biomedical approach to illness may be corrected, some of which are related to phenomenology, the attribution to Plato’s Socrates of a phenomenological approach is mistaken. Characteristically, Socrates shows little interest in the personal experience of a patient. He is more concerned with the patient’s lifestyle and conduct and so suggests an alternative or complementary perspective, stressing the importance of education and prevention to health care. (shrink)

This paper compares Heidegger’s “dasein-centric” existential hermeneutic to Levinas’s primacy of the Other and the importance the latter places on the ethical relationship. Invoking the concepts of totality and infinity, the paper discusses the ways in which one encounters the Other and how signification arises from the ethical relationship. This is followed by a discussion of how Levinas’s ethics might influence existential phenomenological research methodology, pointing to the ethical demands described by Levinas as seeming to have priority over the praxis (...) of research insofar as the Other calls us beyond the methodological framework. Finally, the paper considers the extent to which the ethical demands of Levinas’s phenomenology are met by the special place of the research participant and the attitude of empathic presence prescribed within the Heideggerian framework. Indo-Pacific Journal of Phenomenology, Volume 10, Edition 2, October 2010: 11-22. (shrink)

Western thought has dominated scientific development for a long time, and nursing has not escaped the influence of such ideology. Nurse scholars, in an attempt to fit the dominant scientific ideology, typically have had to struggle with non-empirical elements of nursing. This orientation in science, however, may have contributed inadvertently to a form of scientific ethnocentrism in the culture of inquiry in nursing as in other fields. The result has been a narrow view of science and knowledge and failure to (...) recognize the potential significance of Eastern philosophy in nursing knowledge development. Recently, intensive cultural exchanges between the East and the West have contributed to Western scientists becoming aware of the limits of Western linear thinking and concomitant efforts to explore the mysteries of Eastern philosophy. In this article, we explore Buddhism as one example of such philosophies that have great potential to enrich nursing as it continues to strive for definition and identity. (shrink)

The claim that, in some nontrivial sense, nursing can be identified with caring has prompted a search for the philosophical foundations of care in the nursing literature. Although the ethics of care was initially associated with Gilligan's ‘different voice’, there has more recently been an attempt – led principally by Benner – to displace the gender perspective with a Heideggerian one, even if Kant is the figure to whom both Gilligan and Benner appear most irretrievably opposed. This paper represents the (...) first half of a double-edged project: initially, to point out that Heidegger explicitly disowns any ethical implications for his ontological thinking, and to argue that no ethical theory (including an ethics of care) can be derived from Being and Time; and then to argue that Kant's categorical imperative is not only compatible with the ethics of care but actively entails it. In this, Heideggerian, part of the argument, I consider three attempts to wrest an ethics from Being and Time– those of Benner, Olafson and Guignon – suggesting that, for different reasons, they all fail. Benner systematically confuses the ontological with the ontic, not recognizing that care, concern and solicitude have ‘deficient’ modes as well as positive ones, and that Heidegger's ontology retrieves the possibility of an ethics-in-general without at any point implying an ethics-in-particular (whether of care or justice). Olafson does recognize this, and to that extent admits his failure, but his efforts to amplify Heidegger's thought in such a way as to generate an ethical theory involve both the importing of Kantian premises, and an appeal to some rather doubtful empirical observations. Guignon resorts to Heidegger's discussion of authenticity, and the idea that authentic Dasein ‘may choose its hero’, suggesting a morally reassuring list of heroes who might fit the bill. However, there is nothing in Heidegger's account of this choice that justifies his confidence, and I conclude by proposing that we should take Heidegger at his word when he says that ontology has ‘no result, no effect’. (shrink)

Bioethics has made a compelling case for the role of experience and empirical research in ethics. This may explain why the movement for empirical ethics has such a firm grounding in bioethics. However, the theoretical framework according to which empirical research contributes to ethics—and the specific role it can or should play—remains manifold and unclear. In this paper, we build from pragmatic theory stressing the importance of experience and outcomes in establishing the meaning of ethics concepts. We then propose three (...) methodological steps according to which the meaning of ethics concepts can be refined based on experience and empirical research: function identification, function enrichment, and function testing. These steps are explained and situated within the broader commitment of pragmatic ethics to a perspective of moral growth and human flourishing. We hope that this proposal will give specific direction to the bridging of theoretical and empirical research in ethics and thus support stronger actualization of ethics concepts. (shrink)

While the richness of Heideggerian philosophy is attractive as a healthcare research framework, its density means authors rarely utilise its fullest possibilities as an hermeneutic analytic structure. This article aims to clarify Heideggerian hermeneutic analysis by taking one discrete element of Heideggerian philosophy (Being-towards-death), and using it’s clearly defined structure to conduct a meta-synthesis of Heideggerian phenomenological studies on the experience of living with a potentially life-limiting illness. The findings richly illustrate Heidegger’s philosophy that there is either an inauthentic positioning (...) towards death, or an authentic positioning towards death with a proposition that (1) death is certain; (2) death is indefinite; (3) death is non-relational; and (4) death is not-to-be-outstripped. None of the 29 included studies on the experience of a confrontation with death fully utilised this framework, despite claiming a grounding in Heideggerian thought. This demonstrates the value in modelling how Heideggerian existential structures can be used proactively as analytical ‘hooks’ for data in research claiming a basis in this philosophy and/or method. By modelling the potential application of an important Heideggerian philosophical construct to published qualitative data, this meta-synthesis has revealed new domains and more nuanced understandings of the temporal structure of Being-towards-death. Such an approach helps to more fully unveil the existential concerns of people at the core of interpretative phenomenological enquiry and may provide a blueprint to map either primary or synthesised data to other key ontological existentials. (shrink)

The aim of this paper is to clarify what “phenomenological” means in the phenomenological researches of nursing and what “method” is or should beadopted in phenomenological researches of nursing. The essay first defines a traditional classification of the phenomenological researches of nursing by Cohen and Omery, and then gives a new attempt to classify the phenomenological approaches in the theories of nursing. On this basis, the essay reviews some representative “phenomenological” researches of nursing today and addresses critical comments to them. (...) Finally, the essay will make clear what “phenomenological” should mean in the phenomenological research of nursing and what kind of “method” should be adopted in those researches. (shrink)

The paper begins with an overview of the historical roots of philosophical hermeneutics grounded in the work of Husserl and Heidegger. It goes on to explore the philosophical hermeneutics of Hans Georg Gadamer as a philosophy useful to nursing research. The four concepts of prejudice, the fusion of horizons, the hermeneutic circle and play are discussed, as are the implications these concepts have for nursing research. These concepts have been utilized in the author's own research and examples from this research (...) are given to illuminate how these concepts can be shaped to the purposes of nursing research. While the concepts discussed stem from the work of Gadamer, the ways they have been utilized by the author do not represent a Gadamerian method. Gadamer's project is purely philosophical. (shrink)

Communication between medical professionals and patients is an important aspect of therapy and patient satisfaction. Common barriers that get in the way of effective communication in this sphere include: (1) gender, age, and cultural differences; (2) physical or psychological discomfort or pain; (3) medical literacy; and (4) distraction due to technological factors or simply being overworked. The author examines these communicative barriers from a philosophical lens and then utilizes Martin Heidegger’s phenomenology and hermeneutics to provide guidance for medical professional–patient interactions. (...) The phenomenological approach espoused emphasizes the particular, contextual nature of such interactions, and thus is opposed to abstract, theoretical principles. Heidegger’s hermeneutics provides a philosophical approach to communication that may guide the back-and-forth interpretation that should happen between medical professionals and patients to achieve effective communication. (shrink)

This paper is concerned with the popularity of phenomenologies and the tensions that arise from their use as research methodologies in nursing. Among these tensions are: the troublesome issues of adapting a fundamentally philosophical means of understanding human being(s) for use as a more pragmatic and robust research approach in a practice discipline; the various types of phenomenology and the confusions that surround these and other interpretive methodologies, particularly within different intellectual and cultural traditions; and the need for nursing to (...) find a space in which it can give voice to aspects of its practice that are silenced in less existentially oriented methodologies. Although phenomenologies are currently popular and possibly fashionable in nursing, there are important issues in relation to their use in a methodological sense that remain to be addressed. (shrink)

HLDING A‐G and HEGGDAL K. Nursing Inquiry 2012; 19: 345–356 Patients’ experiences of health transitions in pulmonary rehabilitationPeople who live with chronic obstructive pulmonary disease (COPD) experience major changes in health. Coping with the illness and caring for themselves places extensive demands on them. Thus, pulmonary rehabilitation (PR) is recommended as a means to facilitate healthy transitions in everyday life with COPD. This study explores the experience of patients with COPD in terms of their transitions in health during and after (...) PR. The research was inspired by interpretive phenomenology. Thirty‐three individual qualitative interviews were conducted with eighteen patients recruited from Norwegian PR units. A thematic analysis of the interviews was performed. The interviewees described participation in PR as a time of increasing awareness of opportunities for health and well‐being with strengthened hope. The year following PR was dominated by their ongoing challenge to acknowledge limitations and explore opportunities in everyday life. Continuation of healthy transitions was facilitated by peer and professional support. The study highlights the personal resources that patients with COPD have access to in order to promote their own health. The study also highlights their vulnerability during illness and rehabilitation. The findings critique time‐limited PR and support the current trends towards patient‐centred rehabilitation efforts that incorporate user involvement and self‐management education. (shrink)

When is it ethically acceptable to use artificial agents in health care? This article articulates some criteria for good care and then discusses whether machines as artificial agents that take over care tasks meet these criteria. Particular attention is paid to intuitions about the meaning of ‘care’, ‘agency’, and ‘taking over’, but also to the care process as a labour process in a modern organizational and financial-economic context. It is argued that while there is in principle no objection to using (...) machines in medicine and health care, the idea of them functioning and appearing as ‘artificial agents’ is problematic and attends us to problems in human care which were already present before visions of machine care entered the stage. It is recommended that the discussion about care machines be connected to a broader discussion about the impact of technology on human relations in the context of modernity. (shrink)

Learning to work as a relational caring professional in healthcare and social welfare, is foremost a process of transformative learning, of Building, of professional subjectification. In this article we contribute to the design of such a process of formation by presenting a structured map of five domains of formational goals. It is mainly informed by many years of care-ethical research and training of professionals in healthcare and social work. The five formational domains are:Relational Caring Approach,Perception,Knowledge,Interpretation, andPractical Wisdom. The formation process, (...) described as the recurring detour of a continuing practice, requires ‘exposure’, in-depth learning and learning communities. Relational caring—care consequently resulting from and structured by relational thinking, exploring, and steering—requires ‘inquiry’ as a continuous learning process in practice. The process is ultimately aimed at fostering mature, competent, and practically wise professional caregivers who are able to relationally connect with and attune to care receivers, and adequately navigate existential, moral, and political-institutional tensions in relational caring in complex organizations in Late-Modern society. (shrink)

Although the positive outcomes achieved in home‐visiting interventions targeting young, disadvantaged mothers are partly credited to therapeutic relationships, researchers rarely offer philosophical or theoretical explanations for these relationships. This omission is a conspicuous oversight as nurse–family relationships have figured prominently in public health nursing practice since its inception. In this study, I suggest that the contribution of therapeutic relationships to positive outcomes will remain theoretically undeveloped as long as clinical trials and nursing practice models follow the logic of techne. After (...) describing how a scientific–clinical gaze misrepresents teen mothers and contributes to a rational–technical model of clinical practice, I draw on contemporary hermeneutics to describe how dialog and understanding are indispensable for clinical judgment and the judicious use of scientific knowledge. This hermeneutic corrective calls attention to the dialogical nature of truth and the relational skills that disclose meaning, preserve personhood, and support possibilities available in the life‐world. Dialogical understanding also disrupts the scientific–clinical gaze by disclosing the social disparities that are implicated in early childbearing and teen mothers’ long‐term prospects. The implications of this thought for legitimating and supporting the flexibility and clinical know‐how that ‘strays’ from protocol‐driven care is addressed. (shrink)

Nurse researchers are increasingly adopting qualitative methodologies for research practice and theory development. These approaches to research are, in many cases, more appropriate for die field of nursing inquiry than the previously dominant techno‐rational methods. However, there remains the issue of adapting methodologies developed in other academic disciplines to the nursing research context. This paper draws upon my own experience with interpretive research to raise questions about the issue of nursing research within a social science research framework. The paper argues (...) that by integrating the characteristics of nursing practice with the characteristics of research practice, the researcher can develop a ‘nursing lens’, an approach to qualitative research that brings an added dimension to social science methodologies in the nursing research context. Attention is drawn to the unique nature of the nurse‐patient relationship, and the ways in which this aspect of nursing practice can enhance nursing research. Examples are given from interview transcripts to support this position. (shrink)

This paper describes the first phase of an ongoing education and research project guided by three main intentions: (1) to create opportunities for phronesis in the classroom; (2) to develop new understandings about phronesis as it relates to nursing care generally and to caring for specific groups, like formerly incarcerated adults; and (3) to provide an opportunity for formerly incarcerated adults and graduate nursing students to participate in a dialectical conversation about ethical knowing. Gadamer's writings on practical philosophy, phronesis, and (...) the Socratic dialectic provide the philosophical foundation and framework for the project. The first phase in the project was a 4‐h class within a graduate‐level health promotion course during which 30 nursing students and three formerly incarcerated panelists engaged in a dialectic conversation about what it means to care for formerly incarcerated adults in a meaningful way. After the class, two focus groups were conducted, one with the students and one with the formerly incarcerated panelists. Findings articulated participants' prejudices and assumptions prior to the class, expanded sense of phronesis, and ability to consider nursing practice within a larger ethical framework. Panelists and students left the class with a deeper understanding of one another and expressed an openness towards continued dialectic conversations together. Use of the Socratic dialectic within nursing curricula reflects a current and critical trend in nursing education to bring non‐epistemologic forms of knowledge into the classroom. (shrink)

In this study the awake patient's intraoperative situation and experiences during regional anaesthetics and surgery are reflected upon by using the work of the French philosopher Maurice Merleau‐Ponty. Merleau‐Ponty's phenomenological idea of the body as being at the centre of the world highlights the patient's embodied position and bestows significance onto the body as a whole, as a lived body. A case, based on the findings from a previous interview study, is presented as a contextual starting point where a patient (...) goes from having a familiar body recognized as her own to having a partially anaesthetized body experienced as an unknown object. The intraoperative caring space is described in this context as the mutual ground where the awake patient and the nurse anaesthetist (NA) can interact to create meaning. The NA can act as the patient's bodily extension to bridge the gap between the patient's experiences and the situation. This calls for the NA's proximity and genuine presence in order to meet and understand the patient's awake experiences. Learning from the patient's situatedness gives information that is valuable for NAs to share with patients who are less experienced with this contextual situation. The challenge for the NA is not to perform routine‐based care, but to acknowledge every patient's lifeworld and uniqueness thus enabling the patient to move easily along the mind–body–world continuum. The core of intraoperative care is to provide support and promote well‐being of awake patients in the intraoperative environment. The use of a philosophical perspective is relevant for nurses who work in an intraoperative setting where patients undergo regional anaesthetics. This study shows how nursing research using phenomenological philosophy can help uncover new meanings known only to the patients living the experience. (shrink)

An alternative to objectifying approaches to understanding Post-traumatic Stress Disorder grounded in hermeneutic phenomenology is presented. Nurses who provided care for soldiers injured in the Iraq and Afghanistan wars, and sixty-seven wounded male servicemen in the rehabilitation phase of their recovery were interviewed. PTSD is the one major psychiatric diagnosis where social causation is established, yet PTSD is predominantly viewed in terms of the usual neuro-physiological causal models with traumatic social events viewed as pathogens with dose related effects. Biologic models (...) of causation are applied reductively to both predisposing personal vulnerabilities and strengths that prevent PTSD, such as resiliency. However, framing PTSD as an objective disease state separates it from narrative historical details of the trauma. Personal stories and cultural meanings of the traumatic events are seen as epiphenomenal, unrelated to the understanding of, and ultimately, the therapeutic treatment of PTSD. Most wounded service members described classic symptoms of PTSD: flashbacks, insomnia, anxiety etc. All experienced disturbance in their sense of time and place. Rather than see the occurrence of these symptoms as decontextualized mechanistic reverberations of war, we consider how these symptoms meaningfully reflect actual war experiences and sense of displacement experienced by service members. (shrink)

Research Question: What are patients’ experiences of technology in adult intensive care? Research Objectives: -To explore patients’ perceptions of receiving care in a technological environment -To explore patients’ perceptions of how technology has influenced their experience of care Background: Technology is fundamental to the physical recovery of critically ill patients in intensive care (ICU), however, there is a suggestion in the literature that its presence may dehumanise patient care and distract the nurse from attending to patients’ psychosocial needs. Little attention (...) has been paid to patients’ perceptions of receiving care in a technological environment. The purpose of this research, therefore, was to explore patients’ experiences of technology and care within ICU. Methods: This study was informed by Heideggerian phenomenology. The research took place in a university hospital in England. Nineteen participants who had been a patient in ICU were interviewed using a semi-structured approach. Interviews were transcribed verbatim and analysed utilising Van Manen’s framework. Findings: Resulting themes were ‘My Useless Body’ which describes how participants experienced their body as dysfunctional, disconnected and invaded by technology, ‘Making Sense of It’, which describes how participants rationalised their experiences by constructing a story, and ‘Technology and Care’, which describes how and why participants endured technologies in ICU. Conclusions: The disintegrated body is central to the critically ill’s experiences in ICU. Families play an important role in helping patients make sense of their experiences by filling in gaps in memory and helping them to sort the real from unreal memories. Families therefore require support and information resources in fulfilling this role. Patients experience technology and care as a series of paradoxical relationships: alienating yet reassuring, uncomfortable yet comforting, impersonal yet personal. Nurses maintaining a close and supportive presence and providing personal comfort and care may minimise the invasive and isolating potential of technology. (shrink)