In this article, an attempt is made to analyse important implications of the hermeneutic approach in qualitative studies. The article discusses the hermeneutic circle with regard to reasoning contexts, on which the researcher's interpretation is based. Problems in connection with achievement of ‘proper’ understanding in an interpretative process are discussed in light of Gadamer's hermeneutic philosophy. Some features of qualitative studies are addressed. This is concerned with arguments in the presentation of findings in qualitative studies using the hermeneutic approach. The (...) essence of the article is there are grounds for reasonable understanding, even though it cannot be absolute in the hermeneutic. (shrink)

The aim of this article is to investigate how life in Norwegian nursing homes may affect experiences of dignity among persons with dementia. The study had a qualitative design and used a phenomenological and hermeneutic approach. Participant observation in two nursing home units was combined with qualitative interviews with five residents living in these units. The study took place between March and December 2010. The residents feel that their freedom is restricted, and they describe feelings of homesickness. They also experience (...) that they are not being seen and heard as individual autonomous persons. This lack of freedom, experiences of homesickness and feelings of not being confirmed and respected as individual autonomous persons may be a threat to their personal dignity. In order to protect and enforce the dignity of persons with dementia living in nursing home, we should confirm them as whole and as individual persons, and we should try to make the nursing homes less institutional and more home like. (shrink)

Human dignity is one of the key concepts of our ethical evaluations, in politics, in biomedicine, as well as in everyday life. In moral philosophy, however, human dignity is a source of intractable trouble. It has a number of characteristic features which apparently do not fit into one coherent ethical concept. Hence, philosophers tend to ignore or circumvent the concept. There is hope for a philosophically attractive conception of human dignity, however, given that one takes three crucial turns. The negative (...) turn: to start the inquiry with violations of human dignity. The inductive turn: to consider the whole range of applications of the concept of human dignity in different areas of ethics. And finally, the historical turn: to take into account the historical bonds between human dignity and traditional conceptions of dignity. Taken together they point in the direction of an understanding of human dignity as universal nobility. (shrink)

Background: The concept of dignity can be divided into two main attributes: absolute dignity that calls for recognition of an inner worth of persons and social dignity that can be changeable and can be lost as a result of different social factors and moral behaviours. In this light, the nursing profession has a professional dignity that is to be continually constructed and re-constructed and involves both main attributes of dignity. Objectives: The purpose of this study was to determine how nurses (...) described nursing’s professional dignity in internal medicine and surgery departments in hospital settings. Research design: The research design was qualitative. Ethical considerations: This study was approved by the ethics committees of the healthcare organizations involved. All the participants were provided with information about the purpose and the nature of the study. Participants: A total of 124 nurses participated in this study. Method: The data were collected using 20 focus group sessions in different parts of Italy. The data were analysed by means of a conventional inductive content analysis starting from the information retrieved in order to extract meaning units and sorting the arising phenomena into conceptually meaningful categories and themes. Results: Nursing’s professional dignity was deeply embedded in the innermost part of individuals. Regarding the social part of dignity, a great importance was put on the values that compose nursing’s professional identity, the socio-historical background and the evolution of nursing in the area considered. The social part of dignity was also linked to collaboration with physicians and with healthcare assistants who were thought to have a central role in easing work strain. Equally important, though, was the relationship with peers and senior nurses. Conclusion: The organizational environments under scrutiny with their low staffing levels, overload of work and hierarchical interactions did not promote respect for the dignity of nurses. To understand these professional values, it is pivotal to comprehend the role of different health professions in their cultural milieu and the evolution of the nursing profession in diverse countries. (shrink)

In the context of the end of life, many authors point out how the experience of identity is crucial for the well-being of patients with advanced disease. They define this identity in terms of autonomy, control, or dependence, associating these concepts with the sense of personal dignity. From the perspective of the phenomenology of embodiment, Kay Toombs and other authors have investigated the ways disease can impact on the subjective world of patients and have stressed that a consideration of this (...) personal world can promote understanding and recognition of their experience. Based on the findings of qualitative studies of the perception of dignity and autonomy in patients at the end of life, this analysis assesses concepts such as being-in-the-world in illness, embodiment, lived body versus objective body or the gaze of the other from a Toombsian phenomenological perspective. (shrink)

In 1991 the United Nations General Assembly adopted the Principles for Older Persons as a framework for international policy responses to population ageing. These principles promote independence, participation, care, self-fulfilment and dignity as legitimate entitlements of all older people. Although these principles, or variations of them, are embedded in standards of best-practice in residential aged care facilities, the literature shows that in reality institutional care can deny older people opportunities to exercise some of these entitlements. More specifically, residential aged care (...) facilities can deprive older people of access and support to pursue opportunities for the full development of their potential, i.e. their entitlement to self-fulfilment. This discussion article explores the influence of institutional care on older people’s ability to exercise their entitlement to self-fulfilment. We identify the characteristics of a ‘good life’ in institutional care, according to aged care residents themselves. The Eden Alternative™ is presented as a model of aged care that aims to create the conditions for a ‘good life’ and self-fulfilment for aged care residents. (shrink)

The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents’ dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in (...) this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: ‘A feeling of being abandoned’. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life. (shrink)

The concept of social structure is ill defined in the literature despite the perennial problem and ongoing discussion about the relationship between agency and structure. In this paper I will provide an outline of what the term social structure means, but my main focus will be on emphasizing the value of the concept for nursing research and demonstrate how its erasure in some research negatively effects on our understanding of the nurses' role in clinical practice. For example, qualitative research in (...) nursing has largely focused on agency through such theories as phenomenology, hermeneutics, and symbolic interactionism. The result is that social structure may be erased or seen as epiphenomena of agency. My purpose is to provide a theoretical discussion of social structure and how such a discussion can help us to understand how nurses live and experience clinical practice. While not denying the importance of agency, I will argue that the thinned out approach to social structure places limits on our understanding of the constraints nurses experience in their working lives. The result is that nurses' attitudes and clinical failings are individualized, resulting in ever more calls for improved education, when a more thorough examination of structural issues may elucidate more fundamental problems. (shrink)

Nursing models of care show promise in addressing the needs of older adults facing serious illness through supporting inner strength. However, previous conceptual and theoretical models of inner strength are limited. This concept analysis used dimensional analysis methods to explore inner strength in people ageing with serious illness to address limitations by defining a pragmatic, data‐driven model. This study analyzed published literature of adults with serious illness that describes inner strength. Thirty articles were selected after review. The result was an (...) explanatory matrix that describes inner strength from the perspective of where have I been, where am I going? within the context of being a person who is living and dies and you have a serious illness. The conditions spotlighting by actors around me and taking stock of others and ideas lead to processes of looking in/looking out and seeing me as I’m seen. The final consequence of this process is meeting me. This updated concept analysis of inner strength improves upon previous models by providing a clinically relevant situation‐specific model of inner strength for people with serious illness. Implications for nursing scholarship and practice are described including exploration of person‐centered care, relational practice, and health communication. (shrink)

Background:Protecting the dignity of elderly residents of facilities and providing dignified care can be difficult. Although attempts have been made from several aspects, dignity is considered an area in which less real impact has been made in both theory and practice.Objective:The objective of this study is to characterize the concept of dignity in care for elderly subjects in residential facilities from a practical perspective through concept synthesis.Research design:This study includes in-depth interviews with residents of elderly facilities and a literature review.Participants (...) and research context:A total of 12 residents of seven facilities in three prefectures in Japan were recruited via purposive sampling, and 27 interviews were conducted. Each digitally recorded interview was transcribed verbatim. The interview data were analyzed based on hermeneutic phenomenological research. The literature was searched using PubMed, CINAHL, and Web of Science with combinations of terms such as dignity, elderly, and residential facilities and then selected according to the predefined inclusion criteria. The descriptions about dignity in the included studies were divided into codes and compared with the results of the interviews.Ethical considerations:This study was approved by the institutional review board of Nagoya University’s Graduate School of Medicine.Findings and discussion:There were 1728 data codes for the interviews from which four themes were generated. In the literature review, 3716 titles were searched, and 28 articles were selected. Combining these results, five following themes and a conceptual matrix were obtained: individual dignity not affected by others; dignified care in a narrow sense; elements of the staff side; dignity in relation to family members, friends, society, and other residents; and dignity in relation to nursing care facilities and the nursing care system.Conclusion:According to the established matrix, we must consider the role of the care system, facility, family, and society in providing care with dignity and the individual dignity to residents and dignity in daily care. (shrink)

The purpose of this study was to explore situations experienced by 12 health-care providers working in two nursing homes. Individual interviews, using a narrative approach, were conducted. A phenomenological–hermeneutical method, developed for researching life experiences, was applied in the analysis. The findings showed that good care situations are experienced when the time culture is flexible, the carers act in a sovereign time rhythm, not mentioning clock time or time as a stress factor. The results are discussed in terms of anthropological (...) and sociological theory: time as event and action and flexible time cultures. Care settings for persons with dementia represent many challenges, such as a heavy workload and time strain. Time ethics is a construction, understanding time used in caring for persons suffering from dementia, which involves a mature, responsible and flexible nursing approach to these patients. (shrink)

Ethics support is called for to improve the quality of care in elderly institutions. Various forms of ethics support are presented, but the needs for ethics support remain unknown. Using a mixed-methods design, this article systematically investigates the specific needs for ethics support in elderly care. The findings of two surveys, two focus groups and 17 interviews demonstrate that the availability of ethics support is limited. There is a need for ethics support, albeit not unconditionally. Advice-based forms of ethics support (...) are less appropriate as they are removed from practice. Ethics support should be tailored to the often mundane and easily overlooked moral issues that arise in long-term care. Attention should also be given to the learning styles of nurses who favour experiential learning. Raising awareness and developing a climate of openness and dialogue are the most suitable ways to deal with the mundane moral issues in elderly care. (shrink)

Continence is a key moment of care that can tell us about the wider care of people living with dementia within acute hospital wards. The spotlight is currently on the quality of hospital care of older people across the UK, yet concerns persist about their poor treatment, neglect, abuse, and discrimination within this setting. Thus, within hospitals, the care of people living with dementia is both a welfare issue and a human rights issue. The challenge of continence care for people (...) living with dementia can be seen as the ‘canary in the coal mine’ for the unravelling of dignity within the acute setting. This paper draws on an ethnographic study within five hospitals in England and Wales, selected to represent a range of hospital types, geographies and socio‐economic catchments. Observational fieldwork was carried out over 154 days in acute hospitals known to admit large numbers of people living with dementia. This paper starts to fill the gap between theory and data by providing an in‐depth ethnographic analysis examining the ways in which treatment as a person is negotiated, achieved or threatened. We examine how the twin assaults on agency of a diagnosis of dementia and of incontinence threaten personhood. The acute threats to this patient group may then act to magnify perils to treatment as a person. Our findings suggest that personal dignity and the social construction of moral personhood are both threatened and maintained in such a setting. We show how empirical ethnographic data can lend weight to, and add detail to, theoretical accounts of moral personhood and dignity. (shrink)