Interpretation/analysis methods in hermeneutic interpretive phenomenology

Recognizing the Two Faces of Gambling: The Lived Experiences of Korean Women Gamblers

PURPOSE

The aim of this study was to explore the lived experiences of women problem gamblers, focusing on the meaning of gambling to them, how and why these women continue to gamble or stop gambling, and their needs and concerns. In order to effectively help women problem gamblers, practical in-depth knowledge is necessary to develop intervention programs for prevention, treatment, and recovery among women problem gamblers.

METHODS

The hermeneutic phenomenology approach was used to guide in-depth interviews and team interpretation of data. Sixteen women gamblers who chose to live in the casino area were recruited through snowball sampling with help from a counseling center. Participants were individually interviewed from February to April 2013 and asked to tell their stories of gambling. Transcribed interviews provided data for interpretive analysis.

RESULTS

In the study analysis one constitutive pattern was identified: moving beyond addiction by recognizing the two faces of gambling in their life. Four related themes emerged in the analysis-gambling as alluring; gambling as 'ugly'; living in contradictions; and moving beyond.

CONCLUSION

Loneliness and isolation play a critical role in gambling experiences of women gamblers in Korea. In other words, they are motivated to gamble in order to escape from loneliness, to stop gambling for fear of being lonely as they get older, and to stay in the casnio area so as not to be alone. The need for acceptance is one fo the important factors that should be considered in developing intervention program for women.

Qualitative Methods in Patient-Centered Outcomes Research

The Patient-Centered Outcomes Research Institute (PCORI), created to fund research guided by patients, caregivers, and the broader health care community, offers a new research venue. Many (41 of 50) first funded projects involved qualitative research methods. This study was completed to examine the current state of the science of qualitative methodologies used in PCORI-funded research. Principal investigators participated in phenomenological interviews to learn (a) how do researchers using qualitative methods experience seeking funding for, implementing and disseminating their work; and (b) how may qualitative methods advance the quality and relevance of evidence for patients? Results showed the experience of doing qualitative research in the current research climate as "Being a bona fide qualitative researcher: Staying true to research aims while negotiating challenges," with overlapping patterns: (a) researching the elemental, (b) expecting surprise, and (c) pushing boundaries. The nature of qualitative work today was explicitly described and is rendered in this article.

Rapid Repeat Birth: Intersections Between Meaning-Making and Situational Support Among Multiparous Adolescent Mothers

This study examined interpretations of motherhood among adolescents who have experienced rapid repeat births (second births within 24 months of the primiparous birth). Analyses of participants’ descriptions of their transitions to motherhood indicate four modal narratives that vary along two axes: the adoption of a motherhood identity, and the nature (or stability) of relational support available. By using subjective perceptions of motivation, stability, and feelings of competence, this study linked intrapersonal meaning-making with situational sources of support to describe various pathways through repeat adolescent childbearing in a way that both confirms and enriches extant literature. The implications of this study instruct home visiting programs and other interventions designed to forestall repeat pregnancies by elucidating pathways of reinforcement or increased risk inherent in some maternal trajectories. Following this logic, interventions directed at improving outcomes for young mothers and their children would do well to consider the interplay between internal meaning-making, relational support, and the transformative power of adopting the mother identity.

Fathers’ Experience After the Death of Their Child (Aged 1–17 Years)

The death of a child is traumatic for parents. The grief of bereaved fathers is inadequately understood since most studies on this subject have focused primarily on mothers. The goal of this phenomenological study was to understand fathers’ experiences following the death of their child. Interviews were conducted with 13 fathers whose child (aged 1–17 years) had died at least 1 and up to 6 years earlier, either from a life-limiting illness or unexpectedly in an intensive care unit in a pediatric hospital in Eastern Canada. The analysis indicates that fathers’ experience deep suffering after the death of their child and feel torn between the past and the future. Three major themes were identified: needing to push forward in order to avoid breakdown, keeping the child present in everyday life, and finding meaning in their experience of grief. Clinical implications for professionals working with this population are discussed.

Cultural safety and midwifery care for Aboriginal women - A phenomenological study

BACKGROUND

Aboriginal and Torres Strait islander(1) women face considerable health disparity in relation to their maternity health outcomes when compared to non-Aboriginal women. Culture and culturally appropriate care can contribute to positive health outcomes for Aboriginal women. How midwives provide culturally appropriate care and how the care is experienced by the women is central to this study.

AIM

To explore the lived experiences of midwives providing care in the standard hospital care system to Aboriginal women at a large tertiary teaching hospital.

METHODS

An interpretive Heideggerian phenomenological approach was used. Semi-structured interviews were conducted with thirteen volunteer midwives which were transcribed, analysed and presented informed by van Manen's approach.

FINDINGS

Thematic analysis revealed six main themes: "Finding ways to connect with the women", "building support networks - supporting with and through Aboriginal cultural knowledge", "managing the perceived barriers to effective care", "perceived equity is treating women the same", "understanding culture" and "assessing cultural needs - urban versus rural/remote Aboriginal cultural needs".

CONCLUSION

The midwives in this study have shared their stories of caring for Aboriginal women. They have identified communication and building support with Aboriginal health workers and families as important. They have identified perceived barriers to the provision of care, and misunderstanding around the interpretation of cultural safety in practice was found. Suggestions are made to support midwives in their practice and improve the experiences for Aboriginal women.

An Interpretation of Nurse-Patient Relationships in Inpatient Psychiatry: Understanding the Mindful Approach

Nurses who work in acute inpatient psychiatry, where lengths of stay are increasingly shortened, struggle to establish therapeutic nurse–patient relationships. The purpose of this inquiry was to illuminate the nature of relationships between inpatient psychiatric mental health (PMH) nurses and their patients. The author used semistructured interviews and nonparticipant observation in an interpretive phenomenological inquiry. The data consisted of texts that were transcribed from narratives and observations. The meanings that were generated led to the uncovering of patterns of commonality, or themes. Of the themes uncovered, the theme of mindful approach highlighted PMH nurses as engaging with patients in distress, strategically creating encounters to establish a basis for ongoing therapeutic work. The PMH nurse–patient relationship in acute inpatient psychiatry continues to be under pressure, but nurses still carefully construct relational approaches in response to patient distress, and patients in these settings experience these approaches as meaningful to their recovery.

Caring for a Person With Amnestic Mild Cognitive Impairment

While much of the literature on caregiver burden has focused on caregiving for people living with Alzheimer's disease (AD) there is little information on the experience of caring for a loved one living with amnestic Mild Cognitive Impairment (aMCI), the group most likely to convert to AD. A hermeneutic phenomenological approach was used to understand the organizing principles that give experiences of being form and meaning in the lifeworld. Study findings highlight the precarious nature of caregiver role acquisition and the heterogeneity that is present among informal care providers. Specifically, the findings suggest that the wearing of multiple situational masks is required by the carer to cope with accumulated progressive losses suffered as they continually adjust to their new and evolving carer identity. Support groups specific to the carers of those living with aMCI are needed in an effort to remove these masks and to validate this unique caregiving experience.

The Immediacy of Illness and Existential Crisis: Patients' lived experience of under-going allogeneic stem cell transplantation for haematological malignancy. A phenomenological study

PURPOSE

This paper reports a study exploring the lived experience of fifteen men and women treated with allogeneic stem cell transplant (SCT) for haematological malignancy.

METHOD

The study followed an interpretive phenomenological methodology using semi-structured interviews. Participants aged between 22 and 68 years were purposively recruited from two specialist treatment centres and were interviewed within three months to one year post SCT between April and September 2013. Data were then analysed using interpretive phenomenological analysis.

RESULTS

An overarching theme that emerged from the data was: The Immediacy of Illness and Existential Crisis. The Immediacy of Illness and Existential Crisis developed from participants' experiences of critical events accompanied by enduring uncertainty continuing into the recovery period. Participants suffer major disruption to their lives physically, psychosocially and emotionally, including facing their own mortality, without a sense of when they may resume the normality of their former lives.

CONCLUSIONS

Ambiguity and uncertainty characterise the experiences of those with haematological malignancy. Whilst participants have access to specialist teams, there are opportunities for health and social care professionals to provide more support for individuals to come to terms with the critical events they have faced and to prepare them for their return home and to continue former lives and aspirations following prolonged hospitalisation.

Using a Qualitative Vignette to Explore a Complex Public Health Issue

This article discusses how qualitative vignettes were combined with interviews to explore a complex public health issue; that is, promoting unhealthy foods and beverages to children and adolescents. It outlines how the technique was applied in practice and the combination of vignette-based interviews with a broader approach involving Gadamerian hermeneutics. Twenty-one participants from the public health community and the marketing and food and beverage industries took part in vignette-based interviews between March and September 2012. Overall, the qualitative vignette method afforded an efficient, generally well-received technique that effectively explored the issue of promoting unhealthy foods and beverages to children and adolescents. The vignette provided structure to interviews but allowed certain responses to be investigated in greater depth. Through this research, we argue that qualitative vignettes allow researchers to explore complex public health issues. This article also provides a valuable resource for researchers seeking to explore this technique.

Understanding advocacy in action: A qualitative study

Introduction

Occupational therapists advocate with/for people with disabilities. In the occupational therapy literature, advocacy is mentioned within the context of specific populations or practice settings and thus there is no consistent way of describing advocacy itself. The objective of this article is to describe advocacy in action for occupational therapists who report engaging in advocacy with/for people with disabilities.

Method

In this hermeneutic phenomenological study, 13 occupational therapists were interviewed about their advocacy experiences. Data analysis was completed using a Gadamerian-based approach.

Findings

Advocacy is complex given that the specific tasks, the third party to whom advocacy is directed and the individual(s) advocating with the therapist vary greatly. Many skills used for advocacy are already part of the therapist’s practice, such as defining the problem, acquiring information, communicating and providing education. In this study, occupational therapists describe advocating as assisting clients who are struggling with access to equipment, services or funding. Also, they advocate by fostering the development of self-advocacy, rather than representing people with disabilities on an ongoing basis.

Conclusion

While these findings provide some insights about how advocacy is currently practiced, a detailed framework is needed to further guide therapists through this complex area of practice.

The Meanings African American Caregivers Ascribe to Dementia-Related Changes: The Paradox of Hanging on to Loss

PURPOSE OF THE STUDY

Using an interpretive phenomenological approach, this study explored the meaning African American (AA) caregivers ascribed to the dementia-related changes in their care-recipients.

DESIGN AND METHODS

Data were gathered in this qualitative study with 22 in-depth interviews. Eleven AA caregivers for persons with dementia, living in the Pacific Northwestern United States, were interviewed twice. Four caregivers participated in an optional observation session.

RESULTS

Analysis based on the hermeneutic circle revealed that, for these caregivers, the dementia-related changes meant that they had to hang on to the care-recipients for as long as possible. Caregivers recognized that the valued care-recipients were changed, but still here and worthy of respect and compassion. Ancestral family values, shaped by historical oppression, appeared to influence these meanings.

IMPLICATIONS

The results from this study suggest that AA caregivers tend to focus on the aspects of the care-recipients' personalities that remain, rather than grieve the dementia-related losses. These findings have the potential to deepen gerontologists' understanding of the AA caregiver experience. This, in turn, can facilitate effective caregiver decision making and coping.

The experiences of patients and carers in the daily management of care at the end of life

BACKGROUND

Home is the preferred location for most people with an advanced disease and at the end of life. A variety of care professionals work in community settings to provide support to this population. Patients and their spouses, who also care for them (spouse-carers), are rarely accompanied by these sources of support at all times, and have to manage independently between their contact with care professionals.

AIM

To explore how patients and spouse-carers manage their involvement with care professionals in the community setting. METHOD Interpretive phenomenology informs the design of the research, whereby 16 interviews were conducted with the patients and spouse-carers. Interviews were recorded and transcribed verbatim. Data were analysed using phenomenological techniques including template analysis.

FINDINGS

Patients and spouse-carers were interdependent and both parties played a role in co-ordinating care and managing relationships with professional care providers. The patients and spouse-carers actively made choices about how to manage their situation, and develop and modify managing strategies based on their experiences.

CONCLUSIONS

When daily management is effective and care professionals acknowledge the dyadic nature of the patient and spouse-carer relationship, people have confidence in living with advanced disease.

Releasing the flood: a qualitative case study of one high-risk father's journey through the labor unit and neonatal intensive care unit

Fatherhood is a turning point in the life of many men, but for fathers from fragile backgrounds, the birth of a premature child may be the catalyst for a fresh start. This case study details the experience of a young black man from a high-risk background during the pregnancy, birth, and hospitalization of his premature son. Fathers from backgrounds marked by violence and chaos may find the stability they crave in a hospital environment that provides comfort, familial cohesion, and an empowering sense of purpose. Fathers who lack male role models in their lives may benefit from mentoring relationships formed with male nurses in the neonatal intensive care unit. Longstanding neglected needs for available presence and guidance can be met by caring healthcare professionals who take the time to listen to these fathers and share personal experiences. While the struggle to break patterns of the past is complicated by low self-worth, healthcare providers can reinforce a sense of personal value both by providing a specific role for fathers and by engaging them in meaningful conversation. Findings provide valuable information on the lifeworld of black fathers from socially compromised urban neighborhoods and implications for healthcare practitioners working with this population.

How does mental-physical multimorbidity express itself in lived time and space? A phenomenological analysis of encounters with depression and chronic physical illness

Mental-physical multimorbidity (the co-existence of mental and physical ill health) is highly prevalent and associated with significant impairments and high healthcare costs. While the sociology of chronic illness has developed a mature discourse on coping with long term physical illness the impact of mental and physical health have remained analytically separated, highlighting the need for a better understanding of the day-to-day complexities encountered by people living with mental-physical multimorbidity. We used the phenomenological paradigm of the lived body to elucidate how the experience of mental-physical multimorbidity shapes people's lifeworlds. Nineteen people with chronic obstructive pulmonary disease (COPD) and depression (defined as a score ≥8 on depression scale of Hospital Anxiety and Depression Scale) were recruited from secondary NHS care and interviewed at their homes. Data were analysed phenomenologically using van Manen's lifeworld existential framework of the lived body, lived time, lived space, lived relations. Additionally, we re-analysed data (using the same framework) collected from 13 people recruited from secondary NHS care with either COPD, rheumatoid arthritis, heart disease, or type 1 or type 2 diabetes and depression. The phenomenology of mental-physical multimorbidity was articulated through embodied and emotional encounters with day-to-day life in four ways: [a] participants' perception of lived time and lived space contracted; [b] time and [c] space were experienced as liminal categories, enforcing negative mood and temporal and spatial contraction; and [d] time and space could also be customised to reinstate agency and self-determination. Mental-physical multimorbidity negatively impacts on individuals' perceptions of lived time and lived space, leading to a loss of agency, heightened uncertainty, and poor well-being. Harnessing people's capacity to modify their experience of time and space may be a novel way to support people with mental-physical multimorbidity to live well with illness.

Infected Lives: Lived Experiences of Young African American HIV-Positive Women

This hermeneutic phenomenological study explored the lived experiences of young African American HIV-infected women. Eleven women between the ages of 21 and 35 participated. One pattern, Infected Lives, and three themes--Living Alone With HIV, Living With Unresolved Conflicts, and Living With Multiple Layers of Betrayal--emerged. The pattern and themes portray the very complex and challenging experiences faced by these young women living with HIV infection. They have experienced isolation, abandonment, betrayal, and discrimination in their interpersonal and social systems. They often dealt with conflicts of hope and anguish in the relationships with their children, and portraying strength, while feeling fragile. These complexities negatively influence the ability to fully engage in self-care activities. Implications for future research include further investigation about the experiences of psychological distress experienced post-diagnosis, development and evaluation of holistic nursing interventions, and evaluative research on mass media educational campaigns to reduce HIV-related stigma.

Living with difference: exploring the social self of adolescents with chronic pain

BACKGROUND

Chronic pain negatively affects an adolescent's life; however, little is known about the social impact of chronic pain for adolescents. More is known about the general peer relationships of adolescents with chronic pain than their close friendships. Close friendships begin to take on more importance during adolescence as these relationships facilitate the development of an adolescent's sense of personal identity and increasing independence from family influences. Thus, chronic pain may create friendship challenges for adolescents beyond those typically experienced during this developmental trajectory, which may negatively impact their abilities to secure social support.

OBJECTIVES

To better understand the challenges adolescents with chronic pain face with regard to their friendships.

METHODS

An interpretative phenomenological study using individual interviews was conducted.

RESULTS

Two themes emerged. 'Rethinking the self with pain' describes the intrusive nature of chronic pain, challenging the participants to rethink the way they view themselves and their place within their social network. 'Rethinking friendships' describes the interpretation of their friends' reactions to their chronic pain condition, which led to these adolescents spending more time by themselves, and feeling misunderstood and unsupported.

CONCLUSIONS

The impact of chronic pain on the adolescent as an individual as well as the responses of close friends and others within their social network resulted in the development of new friendship needs. However, the adolescents were not always able to secure these new friendship needs. Their experiences suggest factors within friendships that may be ameliorated by interventions, thus maintaining and strengthening their close friendships.

Clinical mentorship to improve pediatric quality of care at the health centers in rural Rwanda: a qualitative study of perceptions and acceptability of health care workers

BACKGROUND

Despite evidence supporting Integrated Management of Childhood Illness (IMCI) as a strategy to improve pediatric care in countries with high child mortality, its implementation faces challenges related to lack of or poor post-didactic training supervision and gaps in necessary supporting systems. These constraints lead to health care workers' inability to consistently translate IMCI knowledge and skills into practice. A program providing mentoring and enhanced supervision at health centers (MESH), focusing on clinical and systems improvement was implemented in rural Rwanda as a strategy to address these issues, with the ultimate goal of improving the quality of pediatric care at rural health centers. We explored perceptions of MESH from the perspective of IMCI clinical mentors, mentees, and district clinical leadership.

METHODS

We conducted focus group discussions with 40 health care workers from 21 MESH-supported health centers. Two FGDs in each district were carried out, including one for nurses and one for director of health centers. District medical directors and clinical mentors had individual in-depth interviews. We performed a hermeneutic analysis using Atlas.ti v5.2.

RESULTS

Study participants highlighted program components in five key areas that contributed to acceptability and impact, including: 1) Interactive, collaborative capacity-building, 2) active listening and relationships, 3) supporting not policing, 4) systems improvement, and 5) real-time feedback. Staff turn-over, stock-outs, and other facility/systems gaps were identified as barriers to MESH and IMCI implementation.

CONCLUSION

Health care workers reported high acceptance and positive perceptions of the MESH model as an effective strategy to build their capacity, bridge the gap between knowledge and practice in pediatric care, and address facility and systems issues. This approach also improved relationships between the district supervisory team and health center-based care providers. Despite some challenges, many perceived a strong benefit on clinical performance and outcomes. This study can inform program implementers and policy makers of key components needed for developing similar health facility-based mentorship interventions and potential barriers and resistance which can be proactively addressed to ensure success.

The experiences of rural and remote families involved in an inter-hospital transfer to a tertiary ICU: a hermeneutic study

BACKGROUND

Inter-hospital transfers are necessary for critically ill patients to improve their chance of survival. Rural and remote families experience significant disruption to family life when critically ill patients are required to undergo a transfer to a tertiary hospital. What is not known is how ICU staff can assist these families who are involved in an inter-hospital transfer to a tertiary ICU.

PURPOSE

To gain an understanding of rural and remote critical care families' experiences during an inter-hospital transfer to a tertiary ICU.

METHOD

A hermeneutic phenomenological approach was adopted informed by the philosophical world views of Heidegger and Gadamer. Data collection occurred by in-depth conversational interviews from a purposeful sample of seven family members. Interview transcripts, field notes and diary entries formed the text which underwent hermeneutic analysis.

FINDINGS

Being confused, being engaged, being vulnerable and being resilient emerged as significant aspects of the rural and remote family members' experience during a transfer event.

CONCLUSION

A better understanding of the experiences of rural and remote families during an inter-hospital transfer journey can inform the practice of ICU nurses. This study highlights the specific experiences of rural and remote families during an inter-hospital transfer journey to a tertiary ICU. It also informs nurses of the meaningful ways in which they can support these families with the uncertainty and chaos experienced as part of this journey.

The Possibilities of Phenomenology for Organizational Research

Qualitative researchers have developed and employed a variety of phenomenological methodologies to examine individuals’ experiences. However, there is little guidance to help researchers choose between these variations to meet the specific needs of their studies. The purpose of this article is to illuminate the scope and value of phenomenology by developing a typology that classifies and contrasts five popular phenomenological methodologies. By explicating each methodology’s differing assumptions, aims, and analytical steps, the article generates a series of guidelines to inform researchers’ selections. Subsequent sections distinguish the family of phenomenological methodologies from other qualitative methodologies, such as narrative analysis and autoethnography. The article then identifies institutional work and organizational identity as topical bodies of research with particular research needs that phenomenology could address.

Living with diabetes in the 4-fold World of the Coeur d' Alene tribe

Despite national initiatives, diabetes disproportionately affects Native Americans. Although many studies have focused on the needs of Native Americans for culturally relevant diabetes programs, few have focused on Northwest tribes. This article presents the results of a phenomenological study exploring the experience of Coeur d'Alene tribal members living with type 2 diabetes. The main theme to emerge was perseverance while balancing tensions between burdens and strengths in 4 areas: valuing tribal traditions, being inattentively caring, struggling with disease burdens, and experiencing patient-provider tensions. This article provides new understanding about barriers and supports for diabetes self-management in one Native American tribe.

Goal Setting With Type 2 Diabetes

Purpose

The purpose of this study was to explicate and interpret common experiences of diabetes educators (DEs) with patient goal setting for patients with type 2 diabetes in diabetes education.

Methods

Transcripts (n = 10) from semi-structured interviews were analyzed using a hermeneutic phenomenological approach to more deeply explore the accounts of DEs’ goal setting with patients with type 2 diabetes.

Results

The overarching pattern that emerged was “Striking a Balance,” which subsumed 4 subthemes: Applying Theoretical-Practical Principles When Setting Goals, Identifying Idealistic-Realistic Expectations, Creating Patient-Educator–Centered Plans, and Readying-Living With Goal Setting. The pattern, “Striking a Balance,” revealed a common meaning of DEs as experiences requiring balance and nuance in goal setting with patients.

Implications

The results of this study combined with the tenets of the self-determination theory can provide the DEs with real-life exemplars and a theoretical framework to encourage their patients to self-manage, increase intrinsic motivation, and improve adherence related to their lifestyle changes and glycemic control. DEs, as facilitators of change, can implement these changes with flexible and reciprocal activities with their patients. The DEs owned these activities and they are: “building the bond,” “sharing the session,” “readying for change,” “sending them home,” and “bringing them back.”

Failing a student nurse: a new horizon of moral courage

The factors preventing registered nurses from failing students in practice are multifaceted and have attracted much debate over recent years. However, writers rarely focus on what is needed to fail an incompetent pre-registration nursing student in their final placement. This hermeneutic study explored the mentor experience of failing a pre-registration nursing student in their final placement. A total of 19 mentors were recruited from 7 different healthcare organisations in both inner city and rural locations in the southeast of England. Participants took part in individual reflective interviews about their experience of failing a pre-registration nursing student in their final placement. These experiences were interpreted through a hermeneutic discovery of meaning. The new horizon of understanding which developed as a result of this research is framed within the context of moral stress, moral integrity and moral residue with the overall synthesis being that these mentors' stories presented a new horizon of moral courage.

Understanding the Journey Through Homelessness: A Hermeneutic Study of Women Without Children

This study explored the meaning of the experience of homelessness and exiting homelessness among women without children. Convenience and snowball sampling techniques were used to recruit 12 women in an urban centre in Canada. Texts resulting from audiotaped interviews, participant observations, and reflective journal entries constituted data for analysis. Gadamerian hermeneutics informed the interpretive method used for analysis. The analysis yielded 5 subthemes that described the journey: (a) loss of self at home: the trigger; (b) non-feeling of “at-homeness”: dissociation; (c) disconnection and aloneness: homelessness; (d) simulating home: transitional shelter living; and (e) finding oneself: hopefulness. Findings suggest that exiting homelessness for women was a journey in search of hope, and reconnection with the self and others. This perspective suggests a new approach for policy and practice.

Group mentoring: a story of transition for undergraduate baccalaureate nursing students

BACKGROUND

Group mentoring has been endorsed as an effective method of supporting novice professionals across disciplines. In one university, faculty revised the undergraduate nursing curriculum to include a group mentoring course as a requirement of students during the four semesters they are enrolled in the nursing program.

OBJECTIVES

The purpose of this study was to explore the lived experience of undergraduate nursing students participating in a group mentoring course.

DESIGN

This study used a hermeneutic interpretive phenomenological method.

SETTING AND PARTICIPANTS

Data were collected from 22 undergraduate nursing students enrolled in group mentoring courses at a private Midwestern university in the United States.

METHODS

At the end of each semester of mentoring, students provided written responses to five open-ended questions about their experiences of participating in the mentoring courses.

RESULTS

Four themes emerged: conversation, communication, connection, and cohesion.

CONCLUSION

Group mentoring was an effective way to support nursing students as they transitioned from undergraduate student to novice professional nurse.

From Death to Life

Experiences of 17 female Iraq War veterans were explored to understand the challenges of reintegrating into civilian life and the impact on mental health. All respondents completed preliminary electronic surveys and participated in one of two focus groups. High levels of distress exist among veterans who are caught between military and civilian cultures, coping with war experiences, feeling alienated from family and friends, and attempting to negotiate gender and identity. Narrative is identified as a means of resolution. Recommendations include development of social support and transition groups; military cultural competence training for therapists, social workers, and college counselors; and further research to identify appropriate military response and paths to successful reintegration into society.

Active-learning diabetes simulation in an advanced pharmacy practice experience to develop patient empathy

OBJECTIVE

To develop and integrate an active-learning diabetes simulation into an advanced pharmacy practice experience to improve pharmacy students' empathy toward patients with diabetes mellitus.

DESIGN

Students simulated the experience of having diabetes mellitus by conducting activities commonly prescribed to those with this disease state for 7 days, after which they submitted a standardized diabetes log and narrative reflection. Interpretive phenomenology design with thematic analysis was used to determine the impact of this experience on the students.

ASSESSMENT

As shown in student reflections, 95% developed empathy, 97% found the experience beneficial, and 67% improved their ability to relate to and counsel patients. Most (95%) found difficulty adhering to the regimen. On average, students consumed 179 grams of carbohydrates per day and exercised 5 days or 215 minutes per week. Additionally, 69% decided to modify their personal habits to become healthier.

CONCLUSIONS

Inclusion of the 7-day active-learning exercise greatly impacted student pharmacists' self-reported empathy toward and ability to relate to patients with diabetes mellitus. Completion of this experience may result in long-lasting personal behavior modifications.

Experiences living with fatigue in Iranian veterans chemically injured by sulfur mustard gas: a phenomenological study

PURPOSE

Fatigue affects the quality of life. Evidence shows that the phenomenon of fatigue is experienced differently depending on the type of disease and its consequences. The aim of the study was to explicate the meanings of the experience of living with fatigue in chemically injured veterans.

METHODS

The hermeneutic phenomenology approach was used in this study, with an emphasis on Van Mennen's viewpoint and approach. According to Van Mennen, six overlapping dynamic activities are recommended to conduct a phenomenological study. During unstructured interviews, the participants were asked to describe their daily living experiences with fatigue. The participants were individuals who were chemically injured due to exposure to mustard gas. After examining every statement in the interview text, extractions of the meaning units, clustering, and themes were performed.

RESULTS

The data explication was based on the third to sixth stages of Van Mennen's approach. The experience living with fatigue was classified into four essential themes: fatigue as a chronic condition, as an unstable and affected situation, as a physical condition of the entire individual, and as a mental condition of the entire individual.

CONCLUSION

Due to unique social interactions and pathogenicity, victims of mustard gas experience fatigue differently than patients with other chronic diseases.

An interpretive phenomenological study of Chinese mothers' experiences of constant vigilance in caring for a hospitalized sick child

AIM

To examine Chinese mothers' experience of caring for their hospitalized sick child.

BACKGROUND

Engaging the mother in providing care for a hospitalized sick child is considered one of the key elements for high-quality care in advanced paediatric nursing. There is evidence that a mother's belief in her capacity to manage stressful situations could improve the nurse-parent relationship because they might play an important role in protecting mothers against heightened stress during crisis situation.

DESIGN

An interpretive phenomenological approach involving semi-structured interview and thematic analysis was used.

METHOD

Fifteen interviews were conducted in Hong Kong, China from April 2009-January 2010, with 15 mothers caring for their hospitalized sick children with acute injury or illness. Crist and Tanner's circular process of hermeneutic interpretive phenomenology was chosen to guide the data analysis.

FINDINGS

The prevailing concept identified through analysis was the 'constant vigilance' that mothers developed. Interpretation of data resulted in the identification of four key themes: 'being sensitive to others', 'providing helping hands', 'monitoring health conditions', and 'maintaining dialogues'. The findings highlight Chinese mothers' desire for participation in caring for their hospitalized child, their unexpressed needs for communication, and concern about being uncared by the busy health professionals, which affect their care for the child's health outcomes.

CONCLUSION

The findings facilitate the development of family-centred care focuses on partnership of care between the nurse and family to enhance the Chinese family's active and participatory role.

"Being-in-the-world-of-care": the lived experiences of older people receiving community aged care packages in Queensland

The lived experiences of older people living in Queensland who were receiving a Community Aged Care Package (CACP) were explored using Heidegger's interpretive hermeneutical phenomenological approach. A number of key themes were identified including the importance these older people placed on personal autonomy and the central significance of relationships. The comprehensive understanding developed revealed that the meanings of care experiences can significantly alter the older person's lived experiences and personal identity. This understanding can enhance the development of care practices that are more likely to support the older person's active participation in care and their own life choices.

The weather-stains of care: interpreting the meaning of bad weather for front-line health care workers in rural long-term care

This paper addresses the gap in health services and policy research about the implications of everyday weather for health care work. Building on previous research on the weather-related challenges of caregiving in homes and communities, it examines the experiences of 'seasonal bad weather' for health care workers in long-term care institutions. It features a hermeneutic phenomenology analysis of six transcripts from interviews with nurses and personal support workers from a qualitative study of institutional long-term care work in rural Canada. Focussing on van Manen's existential themes of lived experience (body, relations, space, time), the analysis reveals important contradictions between the lived experiences of health care workers coping with bad weather and long-term care policies and practices that mitigate weather-related risk and vulnerability. The findings contribute to the growing concern for rural health issues particularly the neglected experiences of rural health providers and, in doing so, offer insight into the recent call for greater attention to the geographies of health care work.

Caregivers' deepest feelings in living with Alzheimer's disease: a Ricoeurian interpretation of family caregivers' journals

Caring for a person with Alzheimer's disease (AD) challenges family caregivers with existential questions about what is the right thing to do for themselves and their care recipient. This study extracted themes spontaneously occurring in self-disclosure through expressive writing and sheds phenomenological insight into the deepest feelings revealed by caregivers of loved ones with AD. The personal journals of 24 caregivers were analyzed in the framework of Ricoeur's philosophy of ethics based on the concept of personal identity. Caregivers reflected on themes in friendship, self-esteem, authenticity, and capacity to act with the ethical intention to stay present while the care recipient is disappearing. Engaging the text within Ricoeur's ethically sensitive philosophy and methodology illuminated the benefit of writing interventions that allow caregivers to speak about conflicted states regarding their own humanity in the caregiver experience.

The experiences of medically fragile adolescents who require respiratory assistance

AIMS

To report a study of the experiences of medically fragile adolescents who require respiratory assistance.

BACKGROUND

The population of medically fragile adolescents has grown in recent decades because of the sequelae of prematurity, injuries and chronic or terminal illnesses. Medically fragile adolescents who require respiratory assistance are part of this unique population, yet as nurses, we know little about their experiences and the best approaches to use in caring for them.

DESIGN

A qualitative design, interpretive phenomenology was used in this study.

METHODS

Interpretive phenomenology was used to describe and interpret the experience of 11 medically fragile adolescents (ages 13-18 years old) who required respiratory assistances of tracheostomies, ventilator support and Bi-level positive airway pressure. Between April 2010-September 2010, audiotaped semi-structured interviews were conducted with the adolescents. Data analysis was completed using a stepped approach to identify themes.

FINDINGS

Five themes were identified from the interviews with the adolescents: 'Get to know me', 'Allow me to be myself', 'Being there for me', 'No matter what, technology helps' and 'I am an independent person'.

CONCLUSIONS

Medically fragile adolescents have a clear view of who they are as a person. They want nurses to view them as a person, not just a patient. The adolescents said that friends were there for them when they needed support. Technology had meanings that enhanced daily living and existed as a part of their day, not their whole day. The adolescents were actively engaging in activities and strategies to achieve their goals of independence.

Children and adolescents living with atopic eczema: an interpretive phenomenological study with Chinese mothers

AIM

This article is a report on a phenomenological study of Chinese mothers' experiences of caring for their children who were living with atopic eczema.

BACKGROUND

A mother's attitude and personality may have a direct influence on her child's adherence to treatment for atopic eczema. Thus, good communication between healthcare professionals and the mother is essential. Treatment and care should also be culturally appropriate.

METHODS

Using an interpretive phenomenological method, 14 interviews were conducted in Hong Kong, China from September 2007 to August 2008, with nine mothers caring for their children who were living with atopic eczema. Crist and Tanner's circular process of hermeneutic interpretive phenomenology was chosen to guide the data analysis.

FINDINGS

Mothers' coping patterns involved persistently dealing with enduring demands and seeking alternative therapies that were aimed at curing the disease. Four themes finally emerged from the data: (1) dealing with extra mothering, (2) giving up their life, (3) becoming an expert and (4) living with blame and worry. Mothers' coping patterns involved persistently finding ways to relieve their children's suffering with the aim of curing the disease and dealing with their own emotions related to the frustration resulting from giving up their life and living with blame and worry.

CONCLUSION

The study findings provide nurses with an empathic insight into mothers' feelings and the enduring demands of caring for children with atopic eczema, and help nurses to develop culturally sensitive interventions, reinforce positive coping strategies, increase family function and improve health outcomes.

A hermeneutic phenomenological study of Belgian midwives' views on ideal and actual maternity care

OBJECTIVE

to explore midwives' views on ideal and actual maternity care.

DESIGN

a qualitative hermeneutic phenomenological study based on the method of van Manen (1997) using individual in-depth interviews to gather data.

SETTING

Flanders, Belgium.

PARTICIPANTS

12 purposively sampled midwives, of whom nine from three different non-university hospitals and three independent midwives conducting home births.

FINDINGS

five major themes were identified: 'woman-centred care', 'cultural change', 'support', 'midwife and obstetrician as equal partners' and 'inter-collegial harmony'. In this paper 'woman-centred care', 'cultural change' and 'support' are discussed along with their subthemes. Midwives thought ideal maternity care should be woman-centred in which there were no unnecessary interventions, women were able to make an informed choice and there was continuity of care. Furthermore, ideal maternity care should be supported by midwifery education and an adequate staffing level. Also, a cultural change was wanted as actual maternity care was perceived to be highly medicalised. Barriers to achieving woman-centred care and possible strategies to overcome these were described.

CONCLUSIONS

findings from this study were consistent with those of other studies on midwives' experience with obstetric-led care. Despite the medicalised care, midwives still held a woman-centred ideology. In order to be able to work according to their ideology, different barriers need to be addressed. Although midwives suggested strategies to overcome these barriers, some were considered to be very difficult to overcome.