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Title. Expert nursing practice: a mathematical explanation of Benner’s 5th stage of practice development. Aim. This paper is a theoretical discussion of a mathematical explanation for Benner’s theory of practice development. Background. Benner’s practice development theory demonstrates how a nurse moves from a beginning, rule-based practice through to expert care. Her notion of expert practice as intuitive has not been well-accepted or understood in nursing. A new description of expert practice includes three types of intuitive practice (cognitive, transitional and embodied), the development of which are dependent on knowledge, experience and reflective time. Data sources. This paper is based on phenomenological research conducted in 2000–2003 and Benner’s publications, as well as recent discussions about the relationship between mathematics and phenomenology. Discussion. The mathematical explanation for Benner’s theory of practice development relates reflective time and knowledge to the mathematical power of experience and links the unique components of intuitive practice to expert care. On reaching expert practice, the three types of intuition include previously identified themes (knowledge, experience, connection, feeling, syncretism and trust) as differentials along the reflective time axis. When graphically represented, expert practice becomes a three-dimensional figure as practice becomes more complex, rather than a two-dimensional one as seen in previous stages. Conclusion. Having the intuitive component of expert practice further clarified from Benner’s first vision confirms it as a valid component of practice. It is important to recognize that experience is a powerful component of practice and that it is essential to the development of expertise. Although this discussion has been nested within nursing practice, it has wide implications for medical, psychological and educational practice. [ABSTRACT FROM AUTHOR]

whitehead l. (2004) Journal of Advanced Nursing 45(5), 512–518 Enhancing the quality of hermeneutic research: decision trail Researchers have ethical and professional obligations to produce research of a high standard. The constituents of quality in research appear to differ between authors, leaving readers unsure about which pathway to follow. This can reflect inadequate consideration of the theoretical framework guiding the study. Many papers fail to consider the theoretical underpinnings of the methodology chosen and the link between these and the methods employed. These need to be accessible to readers in order to assess the trustworthiness of the research. This paper discusses the development of trustworthiness in hermeneutic phenomenological research. Referring to a study on lived experience of Chronic Fatigue Syndrome/myalgic encephalitis, I describe the decision trail and discuss the strengths and limitations of the choices made throughout the study. The methodology focused my approach more fully on the importance of recognizing the influences that I brought to the study and the impact of these in generating the data. It highlighted the fact that the process of setting out my horizon can never be complete, the importance of analysing the data at a macro and micro level, acknowledging the evolution of the data over time, and ensuring that analysis does not move beyond the data and out of the hermeneutic circle. In seeking to make the decision trail clear to others, researchers must distill the philosophical principles of the methodology and set these out in a way that is accessible and open to scrutiny. [ABSTRACT FROM AUTHOR]

Arguments for ‘British Pluralism’ in qualitative health research Aims of the study. This paper examines the argument that certain qualitative research methods can be used in ‘pure’ forms. Whilst rigid adherence to particular published procedures might be possible, we argue that in many cases this is neither necessary nor more likely to increase the validity of the research outcome. Methodological purity. In examining the works of well-known claimants to particular research approaches such as grounded theory and phenomenology we show that purity of method is uncommon. In particular it is possible to demonstrate that all published qualitative methods are subject to their own underlying relativist philosophy. The implication of this is that all are social constructions and that their execution will necessarily be negotiated in time and context. Conclusion. We conclude that analysis of varied examples of qualitative research shows methods to be more flexible than is often admitted. What we describe as ‘British Pluralism’ is an attempt to accept this reality whilst maintaining rigour through integrity, clear accounts, reflexivity and constructive critique of one’s own work and that of others. [ABSTRACT FROM AUTHOR]

Phenomenological approaches to research have gained popularity in nursing research over past years, in particular the use of critical incident technique. Phenomenology can be traced back to existentialist philosophy where it is expounded in the work of Husserl and Heidegger. One of the most notable examples of phenomenological research in nursing has been the work of Benner who has used this approach to examine expertise in nursing. This paper is an account of a study which attempted to adapt phenomenological methods to the investigation of expertise in nurses working in long-term care settings, which was curtailed by the apparent inability of nurses in the study to identify any significant incidents. The paper examines this problem in the light of existentialist philosophy and suggests that the apparent lack of expertise identified in the nurses might be due more to a tendency of phenomenological studies to focus more on articulation than on attunement or potential, the other elements of dasein. The paper concludes that attention to these elements is required when phenomenology is used. [ABSTRACT FROM AUTHOR]

Aim. In this paper we explore the congruence of focus group interviews within a phenomenological framework. Background. Focus groups as a research method are popular in nursing. Similarly, phenomenology is a dominant methodology for nurse researchers globally. A number of nurse researchers have combined focus groups and phenomenology, but there are others who argue that they are incompatible. Discussion. The argument against using focus groups in phenomenological research is that phenomenology seeks essential characteristics or 'essences' of phenomena in a manner that requires an individual to describe their experiences in an 'uncontaminated' way. We recognize that traditionally most phenomenological interviews are conducted with only one interviewer and one respondent, but we question whether this needs to continue. We suggest means by which individual lived experience can be preserved within a group context. We draw on our own experience and the phenomenological literature to argue that focus groups are congruent with phenomenological research and extend this argument further by proposing that group interviews in phenomenology are actually beneficial because they stimulate discussion and open up new perspectives. Our observation is that some researchers who combine focus groups and phenomenology appear to do so uncritically and we argue that this is unacceptable. Conclusions. It is important for nurse researchers to develop critical awareness of the research methodologies and methods they employ. We argue that the phenomenological focus group is not an oxymoron. Rather, the use of focus groups can provide a greater understanding of the phenomenon under study. [ABSTRACT FROM AUTHOR]

Title. Against the odds: experiences of nurse leaders in Clinical Development Units (Nursing) in Australia Aim. This paper is a report of a longitudinal study to develop an understanding of the phenomena of Clinical Development Unit (Nursing) leadership by exploring the experiences of the nurse leaders of nine Australian units as they attempted to develop their existing wards or units into recognized centres of nursing excellence. Background. The concept of Clinical Development Unit (Nursing) in Australia originated in the British Nursing Development Unit movement, which has been widely credited with introducing innovative approaches to developing nurses and nursing. A network of nine Clinical Development Units (Nursing) was set up in a suburban area health service in Australia. The aim was to develop existing wards or units into centres of excellence by disseminating a new vision for Australian nurses that was based on the pioneering work of the British Nursing Development Unit movement. Methodology. Principles of Heideggerian hermeneutic phenomenology provided a framework for the study. Nine Clinical Development Unit (Nursing) leaders participated in qualitative interviews from 1998 to 2002. These interviews were transcribed into text and thematically analysed. Findings. Despite attempts to implement a variety of measures to nurture these Clinical Development Units (Nursing) until they had become well established, the new Clinical Development Unit (Nursing) leaders were unable to maintain the Clinical Development Unit (Nursing) vision with which they had been entrusted. This paper discusses their reactions to the problems they faced and the new understandings they developed of their Clinical Development Unit (Nursing) role over time. Conclusion. The findings illuminate the difficulties involved in maintaining the commitment of all levels of staff and management when attempting to introduce new nursing projects. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study to demonstrate how the scientific understanding of the concept of uncertainty was advanced through a phenomenological study of living with uncertainty. BACKGROUND: Techniques for concept analysis have evolved to subsume strategies for advancing a concept towards greater clarity and utility for research and practice. Recently, it has been argued that a clear delineation of techniques for concept analysis as separate and distinct from techniques of concept advancement is warranted. This article applies such delineated processes to demonstrate the advancement of the concept of uncertainty. METHOD: Concept analysis was used to establish an integrated understanding of the state of the science. Gaps in understanding were carefully analysed, resulting in the research question guiding the next phase of concept advancement: what is the nature of the lived experience of uncertainty? A phenomenological investigation of the experience of uncertainty among family caregivers was conducted. Then, using methods of template comparison, the conceptual attributes identified through the phenomenological study were compared and contrasted with the theoretical definition derived through concept analysis. Finally, a new conceptual definition of higher order abstraction, with greater pragmatic utility, was derived. FINDINGS: Uncertainty is rooted in the individual's perception of outcomes or meaning of a situation. Such perceptions challenge one's sense of confidence and/or control to yield varied types and modes of uncertainty. Uncertainty is present oriented. Both cognitive and precognitive ways of knowing are influential in ascribing meaning, anticipating outcomes and adapting strategies. CONCLUSIONS: One's sense of confidence and sense of control are primary essences that determine the nature of the experience of uncertainty. The experience of living with uncertainty is dynamic, with fluctuations in the types and modes of uncertainty in response to precognitive and cognitive ways of knowing. Probabilistic paradigms preclude existential and situational modes of uncertainty for which probabilities cannot be appreciated. [ABSTRACT FROM AUTHOR]

BACKGROUND: With the emerging focus on home-based care, there is an increasing demand on spouses to look after their chronically ill partners at home. The theoretical aspects of caring have been much discussed in the literature, but the pragmatic aspects have received less attention. Carer stress has been explored, but little has been written about the meaning of caring to informal carers. AIM: The aim of this paper is to report one of the major themes that emerged from a study conducted between 1998 and 1999 to explicate the meaning of caring from the perspective of spousal carers for people with multiple sclerosis in order to shed light on and understand the challenges and demands these carers encountered. METHODOLOGY: An interpretive phenomenological approach was used to describe spousal carers' experiences of caring for their partner. Ten spousal carers of people with multiple sclerosis participated. Data were collected through unstructured in-depth interviews and analysed by the method of hermeneutic analysis. FINDINGS: This paper presents one of the major themes identified: 'caring as worrying'. While the meaning of caring that emerged from this theme supports many of the philosophical understandings of caring as discussed in the literature, worrying as a care responsibility provides a further insight. Caring as worrying describes caring as a complex emotional relationship of responsibility in these participants. They worried about their partners, their relationships with their partners and their future. They also worried about their own health, institutional care, and lack of government support. CONCLUSION: Spousal carers' worries have significant implications for health care professionals. The findings provide insight into the concerns and worries the carers of people with multiple sclerosis face when caring for their chronically ill partners at home. [ABSTRACT FROM AUTHOR]

This paper provides a detailed account of two methodological approaches commonly used in qualitative research: ethnography and interpretive phenomenology. It traces both methodologies through the various stages of a research study--data collection, analysis and validation, before considering the most appropriate methods of reconstructing the participant experience for the given audience. The author puts forward a case for the combination of methodological approaches through the triangulation of data, suggesting that this can enhance our understanding of nursing. In the case of ethnographic and phenomenological data, triangulation may enable the researcher to highlight their interpretation of the phenomenon under review, whilst at the same time considering that phenomenon in terms of the participant group, their cultural background and day-to-day experiences. [ABSTRACT FROM AUTHOR]

Phenomenology attempts to get beyond the surface structure of experience to examine the underlying meaning of the realities of everyday life. In this paper, the writer attempts to answer the question, what is it like to give an injection? The paper is based on essays and interviews with ten experienced nurses, ten undergraduate nursing students and four diabetic patients who administered their own insulin. The author explores the meaning of the language used relating to an injection, the meaning that giving an injection has for the nurse, the feelings involved in preparing and giving the injection, and the meaning of the patient's response to the nurse. Two particular client groups create additional feelings for the nurse; the child and the unconscious patient. The phenomenologist never reaches a conclusion. The essay should challenge the reader to respond by saying, 'Yes, it is like this,' or 'No, I don't believe it is like that.' In responding, further understanding is developed. The aim of the author is to stimulate readers so they better understand the anxiety nursing students feel about giving an injection. [ABSTRACT FROM AUTHOR]

Nursing today, with its individualistic approach to care, shares many of its underlying beliefs and values with the school of philosophical thought known as phenomenology. The research method derived from phenomenology considers that the true meaning of phenomena can only be explored through the experience of them as described by the individual. This paper explores the features of phenomenology as a research method in relation to its relevance for nursing by first discussing the philosophical underpinnings of the method, and then proceeding to an examination of the features of the method with relation to research design, and data analysis. The specific issues of validity and generalizability are developed further, with reference to the criticisms levelled at the phenomenological method from the alternative quantitative paradigm. Finally, the author discusses the relevance of phenomenology for nursing, and concludes that, as a research method within the qualitative paradigm, it has a great deal to offer nursing as a humanistic discipline. [ABSTRACT FROM AUTHOR]

Title. Comfort as a basic need in hospitalized patients in Iran: a hermeneutic phenomenology study.Aim. This paper is a report of a study conducted to explore the comfort experiences of hospitalized patients during their admission to medical-surgical wards in an Iranian hospital.Background. Comfort has various definitions, ranging from a basic human need, to a process, function or an outcome of nursing. As comfort is a substantive need throughout life in health and illness, providing comfort is a major function and challenge for holistic nursing care.Method. This hermeneutic phenomenological study was conducted between July 2006 and April 2007 in six medical-surgical wards of one of a university hospital in Iran. Data were generated with 22 participants (16 hospitalized patients and six nurses), using in-depth interviews to capture their detailed experiences of comfort. Analysis based on the framework of Diekelmann enabled data interpretation and elaboration of shared themes.Findings. One constitutive pattern, 'Comfort: a need of hospitalized patients' and four related themes - A friend in hospital, Relief of suffering within a calm environment, Seeking God, and Presence among family - were identified in the data.Conclusion. These findings offer unique insight for planning and implementing appropriate clinical practices in Iran, especially in caring for Muslim patients. Two major implications are to: (1) consider comfort criteria during nursing assessment and planning of care during a patient's hospitalization and (2) note that Shiite people in particular are more comfortable and feel better when they are able to follow their religious principles. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore the changes experienced by the person living in a body with chronic obstructive pulmonary disease. Background. Chronic obstructive pulmonary disease is the world's fourth leading cause of death, and the World Health Organisation predicts further increases in prevalence and mortality. Despite a growing body of associated knowledge, there remains much to learn about patient and family-driven goals for medical and surgical treatment to guide nursing practice, to support self-management strategies, and to provide a context for therapeutic outcomes. Methods. Merleau-Ponty's philosophy of the body provided a framework for this Heideggerian phenomenological inquiry with 15 people with emphysema and 14 of their family members. The participants were drawn from three Australian teaching hospitals. Hermeneutic analysis was used to interpret 58 in-depth interviews conducted between 2003 and 2005. Findings. People with severe emphysema experience a shrinking life-world shaped by breathlessness. This diminishes the predictability and automatic nature of their bodies and their perceived effectiveness as a person. They develop a number of strategies of c onscious body management to facilitate breathing, mobility and task completion. Conclusion. Understanding of the person's changed body and the resulting expertise that those living with chronic illness bring into care and assessing and facilitating this expertise are central to planning sensitive and appropriate care and evaluating outcomes for medical or surgical therapies that are perceived as meaningful to the person. [ABSTRACT FROM AUTHOR]

Title. Explicating Benner’s concept of expert practice: intuition in emergency nursing. Aim. This paper is a report of a study exploring the experience of intuition in emergency nursing in relation to Benner’s fifth stage of practice development, ‘the expert practitioner.’ Background. Expert nurses anecdotally report actions and thoughts that present in their consciousness and have an impact on the care given. Benner used the term ‘intuition’ for the fifth stage of practice development. However, Paley has criticized Benner’s model for its lack of clarity about the nature of an expert practitioner. This criticism is further justified by Benner’s inadequate explanation of expert. Method. A hermeneutic phenomenological study was conducted using van Manen’s approach and a Gadamerian analysis. Fourteen expert emergency nurses in Australia were interviewed between January 2000 and December 2003. Findings. The analysis resulted in the reconstruction of Benner’s expert stage into three distinct phases: cognitive intuition, where assessment is processed subconsciously and can be rationalized in hindsight; transitional intuition, where a physical sensation and other behaviours enter the nurse’s awareness; and embodied intuition, when the nurse trusts the intuitive thoughts. Conclusion. The findings validate the use of intuitive decision-making as a construct in explaining expert clinical decision-making practices. The validity of intuitive practice should be recognized. It is essential to recognize the conditions that support practice development, and in the prenovice stage (during their university course) factors such as reflection, research (in its broadest sense) and clinical curiosity should be fostered. [ABSTRACT FROM AUTHOR]

Title. Women’s stories of their experiences as overweight patients. Aim. This paper is a report of a study to illuminate the meaning of women’s experiences as overweight patients in their encounters with healthcare services and healthcare providers. Background. Overweight and obesity are increasingly important issues for women’s health internationally. Overweight or obese women may delay or avoid health care if care providers have previously reacted negatively to them based on weight. However, studies focusing on the meaning of women’s experiences as overweight patients and as recipients of healthcare services are lacking. Method. A hermeneutic phenomenological approach was used. Face-to-face interviews were conducted in the United States of America in 2007 with eight women volunteers who self-identified as being overweight patients. The framework of van Manen’s lifeworld existentials of lived space, lived body, lived time and lived relation-guided reflection for data analysis. Findings. The essence of women’s experiences was a battle to fit into the world of healthcare services. Four major themes were identified. ‘ Struggling to fit in ’ consisted of trying to fit into limited physical space (examination rooms, equipment), limited time, and limited satisfaction and support in relationships with healthcare providers. ‘ Being dismissed ’ consisted of demeaning and embarrassing interactions with providers. ‘ Feeling not quite human ’ involved the stigma of being different because of body size. ‘ Refusing to give up ’ consisted of persistence in seeking support and advice from professionals despite negative past experiences. Conclusion. Awareness of these findings could reform understanding of women’s experiences as overweight patients and raise the consciousness of nurses worldwide to develop sensitive communication strategies and healthcare environments that support holistic care. [ABSTRACT FROM AUTHOR]

Title. 'Making the best of it': Chinese women's experiences of adjusting to breast cancer diagnosis and treatment. Aim. This paper is a report of a study to describe Chinese women’s experiences of adjusting to breast cancer diagnosis and treatment. Background. Breast cancer is the most common cancer in women, and its diagnosis and treatment are pivotal life-changing events that prompt women to make immediate adjustments. Adjustment to breast cancer has been studied as a way of coping with a stressful event and adapting to chronic illness. Adequate adjustment through coping and adaptation leads to successful completion of treatment and improved quality of life. Method. A descriptive phenomenological method was used, and 22 Chinese women were interviewed at a large cancer centre in Beijing, China, in 2004–2005. Findings. Facing breast cancer, Chinese women tried to ‘make the best of it’. The essences of Chinese women’s experiences were: facing the reality of cancer diagnosis, taking an active part in the cancer treatment, sustaining an optimistic spirit, sustaining physically, lessening the impact of cancer on others, and reflecting and moving on. Chinese women had similar perceptions of breast cancer to women in western countries as a fearful, stressful, life-threatening and life-changing event, and some of their intentions and actions were also similar to western women’s coping strategies. However, their experiences of adjusting to breast cancer also reflected Chinese historical, social and cultural influences. Conclusions. Our findings have implications for healthcare professionals also in countries with Chinese migrants, and could be used as a basis for information and emotional and social support interventions as these can be effective in promoting adjustment to breast cancer. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to explore the meaning of assisted feeding through the experiences of people with high cervical spinal cord injury. Background. Eating difficulties are known to affect a person's self-image and transform social lives. Little is known about the experience of assisted feeding as a permanent situation. METHOD: Sixteen people with high cervical spinal cord injury were interviewed twice within a period of 18 months in 2005-2006. The second interview was combined with observation. Transcriptions of interviews and notes from the observations were analysed using the phenomenological guidelines by Dahlberg and colleagues. FINDINGS: The essence of the phenomenon assisted feeding was described as a constructed pattern based on coordinated attention between the person with high cervical spinal cord injury and the helper. The constituents of the essence were: paralysis as a condition of life, facing the altered meal, reconciling with diminished bodily anchoring, sensitive cooperation between self and helper, realization of own values around meals, balanced use of meal-related devices and negotiating relationship with helpers. CONCLUSION: Assisted feeding should be adjusted to each individual person. Fixed procedures or routines should be avoided and assistive devices used with care. We recommend that continuity in the cooperation between the parties involved in assisted feeding is given priority, and that personal standard and social norms around meals are acknowledged. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to describe the essential structure of the lived experience of living with severe chronic obstructive pulmonary disease (COPD) during the palliative phase of the disease. BACKGROUND: Chronic obstructive pulmonary disease is one of the most common diseases throughout the world. Shortness of breath, fatigue and cough are the most troublesome symptoms, and living with COPD often imposes limitations on daily living. The disease has a great impact on quality of life and affects the extent to which people can be active in daily life. METHODS: We conducted qualitative interviews of eight people with COPD and collected data over a 2-month period in 2003. Our patients were recruited from two pulmonary disease clinics in West Sweden. We used a phenomenological methodology to analyse the interviews. FINDINGS: Daily life for people with COPD is affected in several different ways. The patients described how their physical limitations forced them to refrain from meaningful activities in everyday life and led to social isolation. Everyday emotions vacillated between viewing life as meaningful and meaningless. A sense of involvement and the belief that life was meaningful gave the individual the energy and the desire to continue living and to envision a future. CONCLUSION: Nursing care should include support and facilitation, so that patients can live rather than exist to the end of their lives. It is important to learn from patients and tailor activities to their social, existential and physical priorities, where appropriate family-centred support may be most effective. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study to increase understanding of patients' experience of rehabilitation and their self-reported needs in that context. BACKGROUND: Nurses need to be able to recognize patient needs to plan effective and individualized care. Needs-led nursing care is emphasized in the nursing literature, but few studies in rehabilitation have explored needs from the patient's perspective. METHOD: The sample of this phenomenological study was purposively selected and the data consisted of 16 in-depth interviews with 12 people aged between 26 and 85 years. The data were collected in 2005. FINDINGS: The findings showed that being a patient in rehabilitation involves existential struggling, as the reason behind patients' rehabilitation, accident or illness usually leads to trying to cope with existential changes while needing to adapt to new characteristics of life and self. This makes patients vulnerable and their self-reported needs include individualized caring and emotional support from family, peers and staff. Participants also reported a need for a sense of security in a stable and homelike environment, with assistance, help and presence. Finally, they reported needing goal-oriented and progressive care in which realistic and achievable goals were established. Individualized patient education enhanced their independence and empowered them towards a new and progressive lifestyle. CONCLUSION: A new emphasis is needed in rehabilitation nursing, involving assessment of existential well-being of patients by means of skilful interpersonal relationship based on individualized caring and emotional support and recognition of each patient's own hierarchy of needs. [ABSTRACT FROM AUTHOR]

Title. Health promotion and health education practice: nurses’ perceptions Aim. This paper is a report of a study to explore nurses’ perceptions of health promotion and health education practice in a Chinese provincial hospital. Background. Health promotion and health education practices are based on universal constructs. Therefore, such practices should share common principles. To date, most nursing-related studies have been conducted in Europe or in North America. Method. A Husserlian phenomenological approach was adopted. Interviews were conducted in 2006 with a sample of eight nursing students and eight senior nurses. The interviews were audio-recorded and transcribed from Mandarin to English. Data analysis adhered to the framework developed by Giorgi. Results. Reported health education and health promotion-related practices showed results similar to those reported in Europe and North America. Hospital-based nurses were often aware of what health promotion is, but did not have the scope or opportunity to implement it in practice. Instead, they were likely to conduct more limited forms of health education. Actual understanding of health promotion and health education constructs was high with most participants, underpinned by active clinical-based educational support. Some participants were able to conduct broader health promotion activities on a voluntary basis in their own communities. Conclusion. Health education and health promotion are universal health-related constructs. Thus, there is an expectation that all nurses will implement these in a similar fashion. Where possible, hospital-based nurses should strive to improve their health education practices and further embrace wider perspectives of health promotion practice. [ABSTRACT FROM AUTHOR]

Title. Quality of life for caregivers of people with Alzheimer’s disease Aim. This paper is a report of a study to describe the meaning of quality of life for caregivers of patients with Alzheimer’s disease and to identify factors that affect their quality of life. Background. The burden for informal caregivers and change in their quality of life can lead to patients being placed in nursing homes. Factors found to worsen caregivers’ quality of life include strained finances, poor family functioning, difficult patient behaviour, financial burdens and the amount of time caregivers spend caring for family members with Alzheimer’s disease. Method. A hermeneutic phenomenological design was used to study 32 informal caregivers of patients with Alzheimer’s disease. Data were collected using interviews between November 2004 and June 2005. Findings. Caregivers associated good quality of life with serenity, tranquility, psychological well-being, freedom, general well-being, good health and good financial status. Factors that caregivers said improved their quality of life were good health of the patient, independence from the patient, and more help in caregiving. Factors that worsened their quality of life were worries about the future and progression of the patient’s illness and stress. Conclusion. Our findings may help healthcare professionals have a deeper understanding of the meaning caregivers give to quality of life and thereby aid in the design of strategies to maintain or improve quality of life. Intervention research is needed for caregivers in countries where this has not yet been performed. Researchers should also investigate whether different types of caregivers (spouse, adult child and friend) have different needs or problems. [ABSTRACT FROM AUTHOR]

Title. Vulnerable and strong – lesbian women encountering maternity care Aim. This paper is a report of a study to describe the maternity care experiences narrated by a sample of lesbian couples. Background. Pregnant and labouring women are dependent on the professional skill and caring ability of the healthcare provider. Studies show that lesbian women who reveal their sexual identity are exposed to homophobic prejudice and discrimination in midwifery care. Method. A phenomenological hermeneutical study inspired by the French philosopher Paul Ricoeur was conducted. Six lesbian couples were recruited in Norway by a snowball method, reporting a total of eight children conceived by donor insemination. Joint interviews were performed in January 2006, and the participants were encouraged to share narratives about important events in their maternity care experiences. Findings. The fundamental life conditions of vulnerability, responsibility and caring permeated the narratives, and were related with the couples’ decisions to be open about their sexual identity. Being exposed, they experienced under- and over-focusing on sexuality. They felt responsible for having the right attitude in interactions, which meant being open, but not over-assertive. They described genuinely caring situations as well as being content with less genuine care, and demonstrated that in addition to receiving care, they provided care in the encounters. Conclusion. Lesbian women are a vulnerable group when encountering maternity care. They took responsibility in caring situations because of healthcare providers’ uncertainty and anxiety. Existential needs, such as being seen, being cared for and communicated with, should be considered equally important for lesbian women and heterosexual women in labour. [ABSTRACT FROM AUTHOR]

Title. Families’ lived experience one year after a child was diagnosed with type 1 diabetes Aim. This paper is a report of a study to elucidate families’ lived experience of diabetes one year after a child was diagnosed with type 1 diabetes. Background. The incidence of type 1 diabetes is rapidly increasing worldwide, with a shift towards younger age groups. This illness is treated by means of an intensive management regimen that often disrupts the child’s usual activities and requires disease-focused behaviours from the child and his or her family. However, research elucidating families’ lived experience from the perspective of all its members is sparse. Method. A hermeneutic phenomenological study was carried out in 2004, based on interviews one year after diagnosis with 11 consecutively chosen Swedish-speaking family members with children aged between 9 and 14 years. Findings. The families described their one year of lived experience as living an ordinary yet different life. They experienced their lives to be neither particularly difficult nor as easy as they had been before the child was diagnosed with diabetes. Related themes were ‘feeling acceptance yet frustration’, ‘being healthy yet invisibly ill’, ‘feeling independent yet supervised’ and ‘feeling confident yet insecure’. Conclusion. It may be helpful if healthcare professionals make use of the knowledge and experience of families living with the illness to meet their specific needs, especially when the affected child is experiencing fluctuating blood sugar levels. Thus, health-promoting collaboration should be tailor-made for every individual and proceed from each family’s everyday life. [ABSTRACT FROM AUTHOR]

Title. Women’s experience of internal radiation treatment for uterine cervical cancer Aim. This paper is a report of a study to explore the experiences of women undergoing internal radiation for cervical cancer. Background. Cervical cancer continues to be one of the most common cancers and one of the leading causes of cancer deaths globally. Women’s experiences of undergoing internal radiation for cervical cancer remain relatively unexplored, in particular in Hong Kong. Better understanding of the experiences of this specific group could inform the provision of supportive care services and provide useful information to be included in education programmes for them. Method. A phenomenological approach was adopted and unstructured telephone interviews were carried out with eight participants between July and October 2004. The interviews were audio-taped and analysed using the procedures described by Giorgi, 1985 . Findings. Three themes were identified from the data: (1) isolation versus social intercourse, (2) unbearable symptom distress versus endurance and coping and (3) growth from the experience. The most distressing aspects of undergoing internal cervical irradiation reported by the patients were the experience of isolation and various physical and psychological symptoms. Specific provisions in the physical environment, psychological support provided by healthcare professionals, family and fellow patients and a positive attitude helped them to cope. They also felt that they became stronger through their hardship and suffering. Conclusion. The findings highlight the importance of adequate preparation of patients, carers and friends before the procedure, more sensitive support during the procedure and debriefing afterwards. There might also be benefits in delivering therapy to two women in adjacent beds to enable them to support each other. [ABSTRACT FROM AUTHOR]

Title. Maternal-newborn nurses’ experiences of inconsistent professional breastfeeding support Aim. This paper is a report of a study to describe the meaning and significance of common, essential elements of inconsistent professional breastfeeding support as revealed through the experiences of maternal-newborn nurses in a hospital. Background. Professional breastfeeding support has been found to have a beneficial effect on breastfeeding, although mothers also report that inconsistent professional breastfeeding support has a negative influence on their breastfeeding efforts. Method. An existential-phenomenological approach was used, and interviews were conducted with 12 maternal-newborn nurses between October 2005 and January 2006. Interview transcripts were subjected to thematic analysis. Findings. Inconsistency in professional breastfeeding support was directly related to the fact that ‘supporting’ breastfeeding is a dynamic, multidimensional process with relational, contextual and situational components. Eight themes were identified: Inconsistencies still exist but things are changing; A need for ‘buy in’; There is no escaping personal experience; What works for one does not work for all; Time impacts recommendations; We have a privileged vantage point; ‘My job’: what it is and what it is not and After all, breastfeeding is a maternal ‘choice’. Conclusion. Addressing inconsistent professional breastfeeding support involves understanding the multiple institutional and personal factors that influence this phenomenon. Because multiple practitioners assist each mother-infant dyad in learning to breastfeed, fostering strong collaborative relationships within this support team is essential. Regular opportunities for all team members to dialogue and actively participate in the updating of breastfeeding policies may increase ‘buy in’, promote greater collaboration and decrease both conflict and inconsistencies. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to elucidate the meaning of close relatives for people who have been critically ill and received care in an intensive care unit. Background. Falling critically ill can bring about a difficult change in life. In previous reports such events are described as frightening experiences, and close relatives are described as an important source of support in this difficult situation. Method. A purposive sample of 10 adults, eight men and two women, narrated how they experienced their close relatives during and after the time they were critically ill. The data were collected in 2004. The interview texts were transcribed and interpreted using a phenomenological hermeneutic approach influenced by the philosophy of Ricoeur. Findings. One major theme was identified, experiencing confirmation, with six subthemes: receiving explanations; a feeling of being understood; a feeling of safety; gaining strength and will-power; having possibilities and realizing their value. Close relatives served as tools for the person who was ill, facilitating better communication and an increased ability to do various things. Simultaneously, feelings of dependence on the close relatives were expressed. There were descriptions of loneliness and fear in the absence of close relatives and, in order to feel safe, the participants wanted their close relatives to stay near them. Conclusion. Close relatives are vital, as they are the ill person's motivation to stay alive and to continue the struggle. Their presence is of great importance for the ill person and must be facilitated by staff. [ABSTRACT FROM AUTHOR]

Title. Developing cultural sensitivity: nursing students’ experiences of a study abroad programme Aim. This paper is a report of a study to explore whether having an international learning experience as part of a nursing education programme promoted cultural sensitivity in nursing students. Background. Many countries are becoming culturally diverse, but healthcare systems and nursing education often remain mono-cultural and focused on the norms and needs of the majority culture. To meet the needs of all members of multicultural societies, nurses need to develop cultural sensitivity and incorporate this into caregiving. Method. A Gadamerian hermeneutic phenomenological approach was adopted. Data were collected in 2004 by using in-depth conversational interviews and analysed using the Turner method. Findings. Developing cultural sensitivity involves a complex interplay between becoming comfortable with the experience of making a transition from one culture to another, making adjustments to cultural differences, and growing personally. Central to this process was the students’ experience of studying in an unfamiliar environment, experiencing stress and varying degrees of culture shock, and making a decision to take on the ways of the host culture. These actions led to an understanding that being sensitive to another culture required being open to its dynamics, acknowledging social and political structures, and incorporating other people's beliefs about health and illness. Conclusion. The findings suggest that study abroad is a useful strategy for bridging the theory–practice divide. However, further research is needed with larger and more diverse students to test the generalizability of the findings. Longitudinal research is also needed to assess the impact of study abroad programmes on the deliver of culturally sensitive care. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to explore the experiences of 'almost old' women as they grow older while living with a chronic condition. Background. Little is known about the contextual effects of ageing and how it shapes and is shaped by a woman's chronic illness experience. Nurses' understanding of this phenomenon can have positive effects on how their client accesses and responds to healthcare. Method. Seven women aged between 50 and 58 years participated in this interpretive descriptive study that explored the issues of ageing with a chronic condition. Three focus groups were held between March 2003 and March 2004. Transcriptions were analyzed after each focus group. Participants were given the opportunity to respond to the findings as the analysis progressed. Findings. The experience of living with a chronic illness foreshadowed what was to come with ageing and embodied the ageing process: it was just part of their lives. Alongside this, the women now felt less out of place. Their peers were catching up and beginning to experience aspects of participants' everyday reality. The women, however, experienced double jeopardy because ageing amplified the ongoing vulnerabilities of living with a chronic condition. Conclusion. Nurses who recognize the resourcefulness and expertise of women who live with a chronic condition can effectively be co-strategists in their helping them to age well. [ABSTRACT FROM AUTHOR]

Aim. This paper reports an exploratory study of nurses’ experiences of caring for families who have relatives in adult intensive care units. Background. The admission of a critically ill patient into adult intensive care is universally accepted as a crisis for both patients and their families. Family members of critically ill people may experience emotional turmoil and therefore have many needs throughout the course of the relative’s illness. It has been identified that nurses are best placed to meet families’ needs. Whilst there is a substantial evidence base associated with family needs, little is known about nurses’ experiences of caring for these families. Method. Interviews, informed by Heideggerian philosophy, were conducted with a purposive sample of 12 Registered Nurses working in an adult intensive care unit. Interview transcripts were analysed using Colaizzi's framework. The data were collected in Autumn 2005. Findings. Participants’ experiences were categorized into the following themes: defining the nurse's role, role expectations and role conflict. Participants reported lack of confidence, doubts about their professional competence and conflicts between their professional and personal self. These experiences were linked to participants’ expectations and self-imposed standards. Conclusion. Registered Nurses caring for families who have relatives in adult intensive care units face a fundamental conflict both between role expectations and patient care and between professional ideals and being a human. This not only highlights a disparity between nurses everyday family care practice and the underpinning theories but also may contribute to occupational stress. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study to describe meanings that couples mutually assign to, and practices they develop, after the onset of cardiac disease and to understand the impact of the illness on the couples’ relationships in everyday life. Background. Patients as well as partners are affected by the onset of cardiovascular disease. Social support within intimate relationships has been shown to be important for patient survival and well-being, and couples’ coping strategies are pivotal for well-being and adjustment to the chronic condition in both patients with cardiovascular disease and their partners. Method. Twenty-four couples participated in this phenomenological study. Data were collected during 2003. Participants were interviewed after having been hospitalized due to an acute event and having participated in a rehabilitation programme. Three in-depth interviews were obtained for each dyad: one couple interview and two individual interviews with each partner of the dyad. Paradigm cases were sought and thematic analyses conducted. Findings. All couples experienced a ‘brush with death’ at the onset of heart disease, which called for changes in lifestyle. Three distinct patterns of dealing with the illness emerged. The first revealed that some couples assess the illness as a positive, transformative experience in their lives, bringing them closer together. The second showed that a proportion of couples experience the illness as a threat which imposes fear on both partners. The challenges are faced as mutual tasks and new routines are developed. The third pattern revealed couples who experience a missed opportunity to change. These couples are disenchanted about each other but return to life as usual. Conclusions. Nurses can use the information gained from this study to support couples in their attempts to come to terms with the illness, and can enhance their supportive role in rehabilitation efforts. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study illuminating meanings of being in the physical environment of an oncology centre as narrated by patients, significant others and staff. Background. The physical environment of hospitals can convey different messages. For example, landscape pictures, plants and comfortable chairs can convey positive messages, while sparsely decorated and run-down environments can convey negative values. Traditional healthcare environments may be experienced as unfamiliar, strange and alienating, fostering feelings of stress and vulnerability. The majority of research on care environments has employed experimental designs to test different environmental variables, for example sound, colour and architecture, in relation to patient outcomes such as recovery, pain and blood pressure. There is, however, little research-based understanding of the meanings of being in these environments. Methods. A phenomenological hermeneutic approach was applied to analyse 17 interviews with patients, significant others and staff carried out during the spring of 2004 at an oncology centre in Sweden. Findings. The physical environment was found to influence experiences of care in four ways: first, by being a symbol expressing messages of death and dying, danger, shame and stigma, less social value and worth; second by containing symbols expressing messages of caring and uncaring, life and death; third, by influencing interaction and the balance between being involved and finding privacy; and fourth, by containing objects that could facilitate a shift of focus away from the self: being able to escape the world of cancer, and finding light in the midst of darkness. The comprehensive understanding illuminates the physical environment as not merely a place for caring, but as an important part of caring that needs to be accounted for in nursing care. Conclusion. To promote well-being among patients, we need to ask ourselves if the environment imposes rather than eases suffering. Our findings also suggest the importance of not limiting our conceptions of nursing to nurse–patient relationships, but of using the therapeutic potential of the total environment in nursing care. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a study of the perceptions of patients and nurses of palliative care and, in particular, the concept of the expert palliative nurse. Background. Palliative care is a growing speciality and is practised globally. There is, however, limited information on patients’ views about palliative care. While the idea of expertise in nursing is not new, few studies have explored the concept of the expert nurse in palliative care. Some evidence exists on palliative nurses’ perceptions of their care, that it is supportive and involves maintaining therapeutic relationships with patients. Facing a terminal illness has been identified as a stressful and fearful experience that affects all aspects of life. It has also been revealed that dying patients may have unmet care needs, mainly in the areas of pain and symptom control, emotional support, and spending time alone. Methods. A phenomenological study was carried out, using in-depth interviews and thematic content analysis. A convenience sample of 22 Registered Nurses and 22 dying patients was interviewed in 1996–1997. Findings. Dying patients had a desire to maintain independence and remain in control. Palliative care nurses experienced both effective and ineffective interpersonal communication, the building of therapeutic relationships with dying patients and attempting to control patients’ pain and distressing symptoms. Patients and nurses agreed that the two most important characteristics of an expert palliative nurse were interpersonal skills and qualities such as kindness, warmth, compassion and genuineness. Conclusion. Although the study was conducted in the United Kingdom, the findings have relevance for palliative care practice globally in terms of dependence, issues of patient choice, nurses being interpersonally skilled and building therapeutic relationships with patients. [ABSTRACT FROM AUTHOR]

Aim. The aim of this paper is to present a hermeneutic phenomenological study illuminating patients’ existential situation prior to colorectal surgery. The intention was also to explore the value of the encounter between patient and nurse. Background. Patients waiting for major surgery experience multifarious reactions. Emotions of anxiety, fears of the unknown, anaesthesia, cancer diagnosis and death can arise. Several earlier studies have reported the importance of information, coping strategies and the need to reduce anxiety and stress in relation to surgery. However, there is a lack of studies focusing on patients’ existential situation in the preoperative phase. Methods. Conversational interviews were conducted with 28 patients 1 week before their surgery during autumn 2002. Analysis of the data was influenced by van Manen's existential themes: lived space/spatiality, lived body/corporeality, lived time/temporality and lived relation/relationality. Findings. Participants expressed either hope of increased spatiality or fear of restricted spatiality, according to whether they had a benign or malign diagnosis. Statements about lived time were also related to the diagnosis. Patients waiting for surgery for a benign diagnosis could use the time to relax and gather energy, while malignancy gave them high levels of anxiety and stress. Lived body experiences showed the ambivalence felt in entrusting one's body to professionals. Statements about lived relations drew attention to the need for considerate caregivers to enhance feelings of security and continuity. Conclusion. The existential situation of patients in a preoperative context was shown to be a state of uncertainty with regard to lived space, body, time and relation. The significance of meeting and talking to the nurse did not appear in the statements. The nurse was invisible. If nurses were to employ the existential themes proposed by van Manen in preoperative encounter with patients, their need for care might be more clearly identified and affirmed. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study that investigated the experiences of a group of critical care Jordanian nurses concerning verbal communication with critically ill patients. BACKGROUND: There is evidence that communication in critical care settings is not sufficiently implemented in practice. Inadequate nurse-patient communication results in increased levels of stress and anxiety. Verbal communication can help patients preserve their self-identity and self-esteem, which in turn will enhance their well-being and optimism. METHOD: The study was guided by the phenomenological hermeneutics of Heidegger. Data were generated in 2002 from in-depth interviews and overt participant observation, and analysed qualitatively. FINDINGS: Unconscious patients received less verbal communication and interaction than verbally responsive patients. CONCLUSION: Communication with sedated or unconscious patients in intensive care units should not be viewed as only an interactive process. Rather, it should be perceived as the means to give the information and support that such patients need. [ABSTRACT FROM AUTHOR]

weiskopf c.s. (2005) Journal of Advanced Nursing49(4), 336–343Nurses’ experience of caring for inmate patientsThe aim of this paper is to report the findings of a study of the experience of caring for prisoners through examining the everyday experience of nurses’ delivering health care to inmate patients in a correctional setting.Prisons are most often viewed as places for punishment, while the goals of health and healing, and prevention of diseases in correctional facilities are often neglected. Nurses who deliver health care to prisoners are challenged to do so in a caring relationship that will facilitate their health and healing. The literature on the nature of prison nursing indicates that delivering health care to inmates must be carefully balanced against the need for security, and is affected by factors such as custody staff values, staff education, nursing management, and organizational practices.In-depth interviews were carried out with nine Registered Nurses who had been employed in a variety of correctional institutions throughout their careers, and analysed thematically using Colaizzi's phenomenological method.Nurses’ caring was experienced as an attempt to negotiate the boundaries between the cultures of custody and caring. Facing complex challenges and a number of limitations on the nurse–patient relationship, nurses strived to find a way to care for their inmate patients. Environmental risk meant that caution and vigilance were essential and these nurses demonstrated courage and persevered for the sake of their inmate patients.The findings make clear the challenging and frustrating experience of nurses’ caring for inmate patients in restrictive settings. As a result, there are implications for nursing practice, education, and research to assure the best possible health outcomes for inmate patients, the integrity of caring nursing practice, and the safety of both nurses and patients. [ABSTRACT FROM AUTHOR]

AIMS: This paper reports a study whose aim was to describe the misunderstandings that Swedish patients with type 2 diabetes have about their illness and treatment. BACKGROUND: It is well known that patients with type 2 diabetes need extensive support and education to learn to manage and live with their illness. However, a Swedish survey has shown that only 34% of these patients had good metabolic control. Despite intensive education and support, misunderstandings about both the illness and treatment seem to be common. Furthermore, patients are currently complaining that health care services sometimes obstruct rather than support self-care and learning. METHODS: We videotaped 18 authentic encounters between a patient with diabetes and a physician, or a diabetes nurse. Patients then viewed the video and reflected on what took place during the consultation. Video-recordings and transcribed reflections were analysed thematically. RESULTS: Five themes emerged from the analysis: (a) Type 2 diabetes is not 'real diabetes'; (b) Complications - horror visions or suppression; (c) Self-monitoring of blood glucose and medication is a routine, not a learning tool; (d) Diet - the important thing is to reduce fat and (e) 'Physical exercise is good, they tell us'. Four of the 18 patients showed no misunderstandings. Misunderstandings of diabetes and its treatment were thus common and numerous, despite regular checkups and good access to care. The patients adhered to prescribed regimens but did not know why they performed many routines or how they could benefit from them. CONCLUSION: The results show that misunderstandings of illness and treatment were common. We suggest that diabetes educators should base their education on this variation of understanding, using a phenomenological approach to learning. Reflecting on this kind of varied experiences can be a powerful tool to help people to move from 'novice to expert' and apply basic routines to new situations. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study to illuminate the complex interaction between person and their life world during the burnout development period. BACKGROUND: Burnout is a construct describing the psychological state resulting from ineffective strategies for coping with enduring stress in both client and non-client work. Role conflict and role ambiguity, or long-term stress and frustration caused by strain in daily life, promote or exacerbate burnout, indicating that the person's entire life world is involved. There is still a lack of description of lived experiences of the time preceding manifest burnout. METHOD: Data were collected from interviews with eight people suffering from burnout and analysed using a phenomenological method. FINDINGS: The essential meaning of the phenomenon of burnout is understood as being trapped with stimulating challenges as a self-nourishing drive on one side and with responsibilities and demands on the other. This essence can be illuminated by its eight constituents: inner incentive, feeling responsible, threatened self-image, cutting off, bodily manifestations, psychological manifestations, fatigue and reaching the bottom line. CONCLUSIONS: The lived experiences of the time preceding manifest burnout are an ambiguous struggle. Cutting off is understood as a mean to shelter the threatened self-image in a state of vulnerability and weakened strength. Accordingly, a better understanding of how to reach behind the defence of 'cutting off' and thus help to open up for consolation and self-acceptance is an essential skill for nurses, health care professionals and others encountering the burnout sufferers. Furthermore this study illuminates early signs of burnout and an important issue is how to strengthen the individuals' ability to shelter their need for recovery and restitution. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a study to interpret and understand bulimia nervosa as women experience it. BACKGROUND: Research into bulimia nervosa has focused on prevalence rates, health complications, comorbidity, neurochemical dysregulation, and cultural influences. Despite a multitude of investigations, little published research appraised bulimic women's personal experiences and understanding of this disorder. Such an understanding would assist health care professionals in providing sensitive, empathetic care. METHOD: The principles of Heideggerian phenomenology guided the study. Participants were 13 actively bulimic women, aged 18-36 years, with lengths of illness from 1 to 23 years. Data were obtained through interviews, personal diaries, and demographic questionnaires. FINDINGS: Participants' narratives revealed four themes that characterized the experience of living with bulimia: isolating self, living in fear, being at war with the mind, and pacifying the brain. The practices bulimic women engage in are carried out in secret, and hence participants experienced isolation. Binge eating and self-induced vomiting are considered abnormal behaviours; therefore, participants believed that they were subjected to negative public perceptions, which led to the experience of living in fear. The women feared being judged if others knew about the disorder. Several feared living without bulimia because it had become a significant part of their identity. In addition, these women were terrified of gaining weight or becoming fat. They experienced an internal struggle with the mind. In order to pacify the inner voice, many fed the compulsion to eat, and this resulted in guilt. The women subsequently balanced the experience by getting rid of fullness and erasing guilt, which was primarily achieved through self-induced vomiting. CONCLUSIONS: Understanding the experience of bulimia for women who suffer from this disorder is important. Bulimia often presents as a chronic and potentially lifelong health issue. Awareness of bulimic women's perspectives could promote a comprehensive appreciation of bulimia, its aetiology, and directions for treatment alternatives. [ABSTRACT FROM AUTHOR]

Background. The experience of mental ill health is fundamentally disempowering. The processes of psychiatric hospital care and treatment may also add to the personal feeling of disempowerment. This disempowerment is partly due to the failure of others to afford a proper hearing to the person's story of his/her experiences and problems in life. Hence, there is a need to investigate patients' experiences of being mentally ill with psychosis and being helped in a psychiatric hospital. Aim. This paper describes the application of a phenomenological method of analysis derived from Amadeo Giorgi to an investigation of psychiatric patients' experiences about being mentally ill with psychosis and being helped in a psychiatric hospital ward in Northern Finland. Method. This phenomenological study was conducted with nine voluntary adult patients recovering from psychosis. In 1998, patients were interviewed regarding their experiences of psychosis and being helped. The verbatim transcripts of these interviews were analysed using Giorgi's phenomenological method. Giorgi's method of analysis aims to uncover the meaning of a phenomenon as experienced by a human through the identification of essential themes. Patients' experiences of psychosis and being helped were clustered into a specific description of situated structure and a general description of situated structure. Findings. The Giorgian method of phenomenological analysis was a clear-cut process, which gave a structure to the analyses and justified the decisions made while analysing the data. A phenomenological study of this kind encourages psychiatric nurses to focus on patients' experiences. Conclusion. Phenomenological study and Giorgi's method of analysis are applicable while investigating psychiatric patients' experiences and give new knowledge of the experiences of patients and new views of how to meet patients' needs. [ABSTRACT FROM AUTHOR]

The phenomenological approach has gained popularity among nurse researchers as an alternative investigative method to those used in the natural sciences. As more nurse scholars and nurse researchers utilize phenomenology as a research approach, it becomes critical to examine the implications this may have for nursing knowledge development and for the utilization of that knowledge in practice. In this paper, an examination of the results of phenomenological inquiry is presented and compared with the types of knowledge considered important for nursing by Carper and White. It is clear that phenomenology contributes to empirical, moral, aesthetic, personal, and socio-political knowledge development. Its contribution is not in developing predictive and prescriptive theory, but in revealing the nature of human experience. Although interpretive inquiry, such as hermeneutic phenomenology, does not prescribe action for use in clinical practice, it does influence a thoughtful reflective attentive practice by its revealing of the meanings of human experience. [ABSTRACT FROM AUTHOR]

Developing a method that is pragmatic yet theoretically consistent with the philosophies of hermeneutics and phenomenology is a constant hurdle for any researcher endeavouring to engage their inquiry in this manner, particularly when its proponents refute the credence of hermeneutics as a research method. This paper discusses how Van Manen's six research activities can act as a framework, that when modified to suit the particular needs of the research project, can promote a process of inquiry that works with these philosophies towards an unfoldment of new understandings of the human experience in illness. [ABSTRACT FROM AUTHOR]

Discussions of phenomenological research in nursing consistently appeal to either Husserl or Heidegger in justifying the technical and conceptual resources they deploy. This paper focuses on Husserl, and examines the relationship between his phenomenology and the accounts of it that are to be found in the nursing literature. Three central ideas are given particular attention: the phenomenological reduction, phenomena, and essence. It is argued that nurse researchers largely misunderstand these concepts and that, as a result, their version of Husserl's philosophy bears little resemblance to the original. A further consequence is that the project of identifying the 'essential structure' of a phenomenon, typically adopted by the nurse researchers who cite Husserl as an authority, comes close to being unintelligible. It is suggested that, while the methods used in 'phenomenological' nursing research may still have some legitimacy, they cannot achieve what they are alleged to achieve, and they should be detached from the framework of Husserlian ideas and terminology which is supposed to justify them. [ABSTRACT FROM AUTHOR]

This paper challenges those nurses who champion Heideggerian phenomenology, by outlining some of the possible political consequences of that philosophy. Some relationships between phenomenology and fascism are discussed, with special reference to anti-humanism and authenticity. Heidegger's commitment to Nazism is affirmed and, following the lead of other recent contributions to the debate, it is suggested that this was the likely, if not inevitable, result of his phenomenological philosophy. It is concluded that, because of its immanent fascism, Heideggerian phenomenology is at odds with the general value orientation publicly espoused by the nursing profession, and that this may render it not only unsuitable as a means of understanding and elaborating nursing knowledge, but also actively counter-productive to the conventional aspirations of nurses. [ABSTRACT FROM AUTHOR]

The increasing credibility of qualitative approaches for research in nursing has opened up new debates about methodology and rigour. Traditionally, qualitative methods have been scrutinized using some criteria that are more pertinent for quantitative research. The transition to a more subjective, reflexive approach to nursing research may be painful, but brings benefits. With the loss of scientific rigour comes the gain of eliciting true meaning, by recreating the experiences of others through co-operative enquiry. An openly subjective approach allows the researcher to be a real partner with informants, and to openly use her own experiences and reflections in order to uncover valuable meaning and to find a different type of objectivity. This paper explores some of the issues that are of concern and some of the benefits that may result from an openly subjective approach in qualitative nursing research. [ABSTRACT FROM AUTHOR]

Increasingly, qualitative research methods are being embraced by nurse researchers because these approaches allow exploration of human experience. Failure to explicate qualitative methodologies is resulting in a body of nursing research that is either mislabelled or is classified broadly as qualitative and subject to charges that qualitative research lacks rigour. In this paper, the authors discuss the importance of specificity in methodology and distinguish between phenomenology and grounded theory, two frequently misused terms in the description of qualitative methodology. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a phenomenological study of caring from the perspective of nurses working on surgical wards. Background. While care and caring are complex foundational nursing concepts which have received considerable and ongoing attention from theorists, researchers and clinicians, there has been little research into caring on surgical units. Method. A convenience sample of ten nurses working on surgical units in a public teaching hospital in Canada was interviewed using van Manen's phenomenological approach. Data were collected during 2001 using semi-structured interviews. Findings. The major theme of lamentation and loss was identified from the data. Participants revealed a dichotomous tension between what caring should be and what actually occurs. This tension was pervasive and generated lament - an expression of grief and mourning for the loss of caring. The essential structures supporting this theme included lack of time, lack of caring support, tasking, increased acuity, lack of continuity of care, emotional divestment and not caring for each other. Loss and sadness were articulated and participants lamented and grieved about the loss of care in contemporary practice. Conclusion. The forces and influences described by participants undermined caring in the new practice milieu. If this is a glimpse of the future, then the values of the nursing profession may be under siege. Caring as the central core, the essence or unifying concept of nursing may be subject to marginalization in contemporary practice. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a phenomenological study whose aim was to gain an understanding of what it was like to be an adolescent living with depression. Background. Depression is a significant mental health problem among adolescents. Identifying the meanings that adolescents assign to their experiences with depression is needed in order to develop interventions that will improve their care and quality of life. Method. The study took place in a city in Western Canada. Fourteen adolescents (13·5 to 18 years) diagnosed with depression participated in individual open-ended interviews and focus group interviews between July 2001 and June 2002. Field notes were recorded. Thematic statements that were representative of the adolescents’ lived experience were isolated from the interviews and field notes. Using all the phrases, sentence clusters and field notes, the data were then reduced until essential and incidental themes emerged. Findings. ‘Living in the shadow of fear’ emerged as the essence of the adolescents’ experiences and ultimately defined what it was like to live with depression. The shadow of fear was associated not only with fear of a return of the ‘bad’ feelings related to their depression, but also to fear of not getting help, not surviving the ‘bad’ feelings, and fear of having to do all the ‘hard work’ in overcoming the ‘bad’ feelings. This essence was supported by four themes: ‘containing the shadow of fear’, ‘keeping the self alive’, ‘maintaining a sense of belonging in the world’ and ‘feeling valued as a human being’. Conclusions. Adolescents with depression need adequate resources and support throughout the illness trajectory, including those periods when their depression is under control. [ABSTRACT FROM AUTHOR]