Interpretation/analysis methods in hermeneutic interpretive phenomenology

'The patient is my space': hermeneutic investigation of the nurse-patient relationship in critical care

BACKGROUND

The nurse-patient relationship has been postulated to lie at the core of nursing care. However, it is unclear how this concept applies in critical care, as a great majority of critically ill patients are unable to communicate.

AIMS

Through a phenomenological hermeneutical perspective, we aimed to explore intensive care nurses' perceptions and meanings regarding their interpersonal relationship with critically ill individuals.

METHODS

A Heideggerian hermeneutical approach was used to design the study and analyse the data, which were collected through repetitive interviews with 12 intensive care nurses.

RESULTS

Critical care nurses report to experience deep relationships with patients, which seem to be mediated by the ongoing contact with patients' bodies. These relationships evoke intense feelings of love, empathy and care and affect how nurses perceive and make sense of their role and their world. The identified core theme of their experience is entitled 'syncytium', which describes a network of closely connected cells. According to participants' perceptions, nurse and patient affect each other reciprocally and are mutually dependent upon each other. In Heideggerian terms patients provide nurses with opportunities to experience 'authentic care' and they participate in their 'being-in-the-world', thus they are central in nurses' meanings about their role and existence. Other elicited themes that account for the perceived nurse-patient relationship include the spatiality/temporality of the relationship, nurses' perceptions and meanings attributed to their role and nurses' perceptions of death.

CONCLUSIONS

Critical care nurses appear to experience their relationships with patients intensely. These relationships are invested with meanings and elicit powerful feelings over a shared course with patients. Patients are central in nurses' meaning-making process and role perception.

RELEVANCE TO CLINICAL PRACTICE

These findings have implications for the educational preparation of critical care nurses and their psychological support.

Women's experience of becoming caregivers to their ill partners: Gadamerian hermeneutics

The recent morbidity trends in Australia indicate a steep rise in the number of individuals living with chronic illness who rely on the assistance of mostly women carers. Consequently, supporting and promoting carers' health should be a priority to sustain their health, and ensure their ability to provide care to a significant other. This interpretive hermeneutic study explored the lived experience of women during the transition of becoming carers to their male partners with various health conditions. Gadamerian hermeneutics were used to research participants' experiences allowing for interpretations that incorporated understandings of both worlds, those of the researcher and the participants. This negotiation of understandings made it possible to create mutual and new knowledge. The phenomenon 'entering transition' revealed itself as a precarious balance between a sense of loss and coping with the life changing situation. Yearning to preserve that equilibrium, the women did not wish to be considered as carers to their partners but expressed a need for maintaining the cohesiveness of their identity as part of a couple. One of the recommendations arising out of this study is that a different approach is needed to assist nurses and other health professionals to support this specific population of women carers in the community and in hospital settings.

Mixed messages: hospital practices that serve as disincentives for associate degree-prepared nurses to return to school

Nearly 80% of associate's degree-prepared nurses do not return to school for a more advanced degree in nursing, which is an issue of concern to many nursing leaders. This interpretive phenomenological study investigates what influences associate's degree-prepared nurses to refrain from continuing their professional education and obtain a baccalaureate or higher-level degree. Although these nurses generally wished they had a higher degree, they did not feel pursuing one was necessary. They did not perceive that their standard of patient care would change with further professional training involved in obtaining a higher educational degree. Furthermore, they did not perceive any distinctions in professional ability between themselves and colleagues with more advanced nursing degrees. The culture of service health care organizations in which associate's degree-prepared nurses are employed, as well as other factors, are likely directly responsible for the practicing nurses' lack of appreciation for the relevancy and rewards of returning to school.

Expanding the notion of researcher distress: the cumulative effects of coding

Qualitative researchers who explore the individual's experience of health, illness, death, and dying often experience emotional stress in their work. In this article, we describe the emotional stress we experienced while coding semistructured, after-death interviews conducted with 38 next of kin of deceased veterans. Coding sensitive topic data required an unexpected level of emotional labor, the impact of which has not been addressed in the literature. In writing this discussion article, we stepped back from our roles as interviewers/coders and reflected on how our work affected us individually and as a team, and how a sequence of exposures could exert a cumulative effect for researchers in such a dual role. Through this article, we hope to generate an expanded discourse on how qualitative inquiry impacts the emotional well-being of researchers.

Views of Iranian patients on life with cancer: a phenomenological study

Cancer is one of the major causes of death worldwide. The diagnosis of this disease can cause significant stress, which destroys the patient's hopes, dreams and expectations. The aim of this qualitative phenomenological study was to explore the perceptions of 23 Iranian patients about life with cancer using in-depth and semi-structured interviews as the method of data collection. The data were analyzed using Benner's interpretive thematic analysis method. Four main themes were clarified by studying the patients' experiences of life with cancer: (i) cancer as a kind of divine test; (ii) a very bitter and debilitating experience; (iii) chemotherapy as the most difficult experience of cancer; and (iv) a continuous struggle. Life with cancer is full of suffering, stress and bitterness. Fear and hope are intertwined; this phase can be successfully endured by patience, tolerance and stability. It is also helpful if close relatives can raise the patient's morale. Certainly, in this process, religious beliefs, faith and culture-oriented interventions can significantly help patients deal with cancer.

Fatherhood and children with complex healthcare needs: qualitative study of fathering, caring and parenting

BACKGROUND

Fathers are increasingly providing substantial amounts of technical and nursing care to growing numbers of children with complex healthcare needs. This exploratory study reports some of the first in-depth evidence of fathers' experiences and presents a research agenda in this critically under-researched area.

METHODS

We conducted in-depth qualitative interviews with 8 fathers who provided a substantial amount of complex technical and nursing care for their child at home. The aim was to describe their experiences of fathering, parenting and caring. Interviews were recorded, transcribed and analysed using Burnard's approach, which has commonalities with phenomenological and content analysis.

RESULTS AND DISCUSSION

Fathers enjoyed their caring role and found it rewarding and at times stressful. They instituted structured regimes, which focused on the father/child/family. Performing intimate care posed specific challenges for which there is no guidance. Children's community nursing was highly valued. Fathers generally rejected the need for specific father-focussed services, as such provision would induce guilt feelings. Fathers reported positive relationships with their children and partners.

CONCLUSIONS

Key areas for future exploration include gaining a better understanding of fathers' motivations and styles of caring, developing interventions to support fathers' caring role, developing guidance on intimate care, and delivering tailored services to fathers in a family context. There is little understanding of fathering and caring by non-resident, teenage and step-fathers. Finally, knowing more about resilience and coping of fathers in strong relationships with partners and children may help inform interventions to support fathers who do not feel able to stay with their family.

Perceptions of cardiac risk factors and risk-reduction behavior in women with known coronary heart disease

BACKGROUND

Risk factor reduction has been linked to personal perceptions of risk, yet few data exist about women's personal perceptions of coronary heart disease (CHD) risk, especially women who have experienced a cardiac event or intervention.

OBJECTIVE

The purpose of this study was to explore perceptions of risk for CHD and to examine perceptions of risk-reducing behaviors in women with known CHD.

METHODS

Because women's attitudes are conceptualized to be embedded in their everyday practices, an interpretative qualitative approach was chosen to reveal this phenomenon. The purposive sample consisted of 7 women with CHD. Interviews were conducted and transcribed verbatim. Data collection continued until saturation occurred. Efforts were made to increase trustworthiness through participant review of transcripts, peer debriefing, and using field notes.

RESULTS

Three major themes emerged from the data: "out of sight, out of mind," "why doesn't he talk to me like that?" and "it's scary." The women indicated their CHD was currently not a major problem because they were asymptomatic or did not "feel sick," which led to decreased focus on their CHD, including risk factor reduction. They expressed the desire to return to normal, rather than focus on the chronicity of CHD. Participants felt that physicians treated them differently because they were women and that their concerns were taken less seriously. They perceived that the patient-physician relationship lacked open dialogue. Fear was experienced by all women, and many feared the unknown, especially not knowing when something was wrong with their heart.

CONCLUSIONS

Data indicated that, during stable periods in the CHD trajectory, women may not understand the chronicity of their disease and may not recognize the importance of reducing their risk for future cardiac events. Helping women understand CHD chronicity even when they may not feel sick may assist them in engaging in risk-reducing behaviors.

Exploring lived experiences of persons with severe mental illness: a review of the literature

This paper describes a literature review concerning the use of phenomenology to explore the experiences of persons with severe mental illness. Data from 35 publications were abstracted and summarized. The congruence between philosophical underpinnings and methods are critiqued. Findings of individual studies are summarized and reveal desires for normalcy, social relationships, meaningful activities, and opportunities for involvement and participation in treatment. The experience of suffering demonstrated the grave effect of severe mental illness on the individual's life experience. Utilization of phenomenology as a philosophy and methodology can guide the development of interventions that honor individual experience and meaning.

Perceptions of the effects of exercise on joint health in rheumatoid arthritis patients

OBJECTIVES

Exercise is important in RA management. However, RA patients are less active than the general population. This qualitative study explores the perceptions of patients regarding the effects of exercise on joint health.

METHODS

A purposive sample of 12 female and 6 male RA outpatients [age: 23-76 years; disease duration: 2.5 months to 33 years; HAQ score: 0-2.13] participated in four moderated focus groups. The main questions addressed were: (i) How do you feel exercise affects your joints?; and (ii) What affects your exercise behaviour? Transcriptions were independently analysed with 455 meaning units identified. An inductive, thematic analysis was conducted using established techniques. Discussion with a third analyst contributed to consensus validation.

RESULTS

Sixteen constructs emerged, clustering into five themes, reflecting the issues relating to exercise and joint health in RA patients. Emergent themes were: 'health professionals showing a lack of exercise knowledge', 'not knowing what exercise should be done', 'worry about causing harm to joints', 'not wanting to exercise as joints hurt' and 'having to exercise because it is helpful'.

CONCLUSIONS

RA patients demonstrated awareness of the advantages of exercise for their joints, both experientially and through education. However, they perceived that health professionals lacked certainty and clarity regarding specific exercise recommendations and the occurrence of joint damage. Thus, to enhance patient-centred exercise prescription in the RA population, uncertainties surrounding joint health, pain symptoms and exercise specificity need to be addressed, alongside continual emphasis of exercise benefits.

Stress and perceived faculty support among foreign-born baccalaureate nursing students

Using the triangulation approach at the method level, this study explored and described the essence of stress and perceived faculty support as identified by foreign-born students (N = 10) enrolled in a generic baccalaureate degree nursing program. Philosophical principles outlined by Heidegger served as the core component guiding this study. Quantitative data from a larger study examining nursing students' stress and perceptions of faculty support served as the supplementary component. Results uncovered an overarching theme of the foreign-born nursing students wanting to be valued and accepted by the nursing faculty, their classmates, and the educational institution leading to patterns of stress, strain, and cultural ignorance. Language issues, stereotyping, discrimination, cultural incompetence, financial issues, and lack of accommodation as an international student were stressors that were not captured by the quantitative measures.

Teaching thoughtful practice: narrative pedagogy in addictions education

Preparing practitioners for this rapidly changing and demanding health care environment is challenging. A surge in knowledge development and scientific advancement has placed a priority on technical skill and a focus on content driven educational processes that prepare students for evidence-based practice. However, the most difficult health care scenarios require thinking-in-action and thoughtfulness as well as didactic knowledge. It is our contention that interpretive educational methods, like narrative pedagogy, will promote judgment-based practice that includes use of evidence and delivery of thoughtful care. In this article, we describe and interpret a narrative approach to addictions content and teaching thoughtful practice. We present our pedagogical process, including observations and field notes, to show how interpretive pedagogies can be introduced into nursing curricula. By presenting this process, the reader is invited to consider interpretive methods as a way to inspire and habituate thoughtful practice and judgment-based care.

Challenges and struggles: lived experiences of individuals with co-occurring disorders

Approximately 20 million people have substance abuse disorder in a given year, and approximately 7-10 million of them will have co-occurring disorders (CODs) of both mental illness and substance abuse. Individuals with COD have higher rates of other chronic health problems (i.e., diabetes) and multiple rehospitalizations and overutilize emergent services. Despite their elevated risk for physical morbidities, there is a dearth of literature that focuses on the impact for those with COD of having multiple physical health disorders. The purpose of this interpretive study was to understand, describe, and illustrate the social and structural barriers that individuals with COD of mental illness, substance abuse, and general medical conditions encounter in regard to their health care. A purposive sampling of 20 individuals with COD (11 men and 9 women; 65% African American) were recruited from community treatment centers and supportive housing sites. Social and structural barriers to managing medical health conditions while living with COD were identified in three realms: (a) in having interpersonal relationships with health care providers, (b) in negotiating an arduous health care "system," and (c) in trying to manage health conditions while living in unstable shelter.

School Nurse Resilience

This qualitative descriptive study explored the experiences of school nurses in coastal Louisiana, who were affected by Hurricanes Gustav and Ike in 2008 and who had also been in the path of destruction caused by Hurricanes Katrina and Rita in 2005. The purpose of the study was to describe the experiences of school nurses affected by repeated natural disasters in relation to their professional practice. The researchers conducted interviews with five school nurses, using the constant comparative method of data analysis to analyze transcripts for recurrent themes. Findings revealed a common process of developing resilience among participants. As a result of their experiences, participants described the ability to recover and adapt in the face of adversity. Various factors affected this resilience, including preparedness, support from others, both personally and professionally, and commitment to the communities in which they live.

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.

See my suffering: women with alcohol use disorders and their primary care experiences

Despite global initiatives to improve the primary care of 2.5 million US women meeting criteria for alcohol use disorders (AUD), many women with serious problems are unseen, misunderstood, misdiagnosed, or ignored. This interpretive phenomenological study explored the meaning of the primary care experience for a small group of women with self-identified AUD. Interviews uncovered suffering. Subsuming themes of Presenting My Damaged Self and Being Silenced/Being Heard revealed potential interventions for primary care practitioners. Analyzed alongside extant literature on suffering, these findings complement and enhance recent important research in the area of diagnosis of and intervention for AUD in primary care.

Caregiving burden, acculturation, familism, and Mexican American elders' use of home care services

Caregiving burden has been shown to predict use of home care services among Anglo Americans. In a previous study, only one of two dimensions of caregiving burden predicted such use among Mexican American caregivers. Because acculturation and familism may affect burden, we conducted analyses to test three hypotheses: increased acculturation decreases familism; decreased familism increases burden; and increased burden increases use of home care services. Among 140 Mexican American family caregivers, acculturation was positively correlated with familism; familism was not significantly correlated with burden; objective burden was positively correlated with use of home care services, and objective and subjective burden significantly interacted in their effect on the use of home care services. Targeted interventions may be needed to increase use of home care services and preserve the well-being of Mexican American elders and caregivers.

Penetrating the dark silence

This study articulates women's lifeworld experience of unexplained and unexpected fatigue. Interpretive phenomenology situated within the perspective of Maurice Merleau-Ponty provides the study framework. Using purposive sampling, the study investigated the unexplained fatigue of 12 women in a southeastern state. Data analysis of interviews revealed a lost voice within the phenomenon of fatigue, providing new insights into this diffuse and dehumanizing experience. Ethical considerations are addressed for recognizing, hearing, and caring for women living with disabling fatigue to extend the goals of Healthy People 2010 by addressing new ethical priorities for quality of life over the next decade.

Enhancing intellectual empathy: the lived experience of voice simulation

PURPOSE

This study aimed to understand the lived experience of voice simulation with the novice nurse and to describe the impact on the nurse's empathy and desire to develop a therapeutic relationship.

DESIGN AND METHODS

Twenty-eight women and men participated in a detailed narrative investigation of reflective writing of the lived experience of hearing voices through a voice simulation experience.

FINDINGS

A sense of insight was developed, and participants felt they could empathize with this type of suffering. The ability to change attitudes to focus on the development of therapeutic relationships was enhanced.

PRACTICE IMPLICATION

Voice simulation assists the novice nurse in developing intellectual empathy.

Gaining ground from a family and cultural legacy: a teen mother's story of repairing the world

A multigenerational longitudinal study of teen mothering provided prospective data on the intergenerational continuities and discontinuities in parenting traditions and caregiving legacies. Families that included a teen mother were first interviewed intensively in 1988-1989 and were reinterviewed in 1993, 1997, 2001, and 2005. All studies in the series were based on the phenomenology of everyday practices and the assumption that the self is constituted by practical, historical, and embodied understandings. Data were analyzed using the hermeneutic approach.

Chinese female nurses' perceptions of male genitalia-related care--Part 1

AIMS

To explore Chinese female nurses' experiences of male genitalia-related care.

BACKGROUND

Male patients who require male genitalia-related care may have psychosocial and sexual concerns and needs. Nurses' attitudes and conduct in the provision of male genitalia-related care, if negative, may obviate meeting these needs. Previous research indicates that limited studies have been conducted focusing on nurses' perceptions, responses and attitudes towards male genitalia-related care. There is a dearth of knowledge about the practice of Chinese female nurses delivering male genitalia-related care, particularly given that physical contact between Chinese adults of different genders outside marriage is traditionally prohibited.

DESIGN

This study is an exploratory qualitative study.

METHODS

Through purposive sampling, eight subjects were approached and semi-structured interviews were conducted. Digitally recorded interviews were transcribed verbatim and thematic analysis was conducted. The strategies of long engagement, member checking, peer debriefing and journal writing were used to establish trustworthiness.

RESULTS

Two themes emerged from interviews: 'association with sexuality' and 'consequences'. The theme 'association with sexuality' comprised the sub-themes of 'being sexual', 'impact on intimate relationship' and 'emotional responses'. The theme 'consequences' was constituted by the sub-themes of 'care with preconditions', 'unavoidable responsibilities' and 'limited involvement with implicit approval'.

CONCLUSIONS

This study suggests that Chinese female nurses' perceptions, responses and attitudes towards male genitalia-related care may be negative, with the consequence that the quality of male genitalia-related care might be compromised. The Chinese culture of sexual conservativeness may play a critical role.

RELEVANCE TO CLINICAL PRACTICE

Risks may be embedded in the practice of male genitalia-related care by Chinese female nurses. Particular attention, therefore, should be drawn to the possibility of adverse effects of Chinese female nurses delivering male genitalia-related care on them and their patients.

Professional resilience in baccalaureate-prepared acute care nurses: first steps

New nurses typically begin their practice in acute care settings in hospitals, where their work is characterized by time constraints, high safety risks for patients, and layers of complexity and difficult problems. Retention of experienced nurses is an issue central to patient safety. The purpose of this qualitative study was to explore the nature of professional resilience in new baccalaureate-prepared nurses in acute care settings and to extrapolate pedagogical strategies that can be developed to support resilience and career longevity. Findings revealed a common process of evolving resilience among participants. New nurses spend a significant amount of time learning their place in the social structure. With positive experiences, they begin to feel more competent with skills and relationships and become increasingly aware of discrepancies between their ideas of professional nursing and their actual experiences in the work setting. The risk of new nurses leaving their practice is constantly present during these struggles. Acceptable compromises yield a reconciliation of the current crisis, typically occurring long after formal precepting has ended. Personal growth is evident by the evolving clarity of professional identity, an edifying sense of purpose, and energy resources to move forward. For new nurses, professional resilience yields the capacity for self-protection, risk taking, and moving forward with reflective knowledge of self.

A qualitative study into the lived experience of post-CABG patients during mechanical ventilator weaning

AIM

Research into mechanical ventilator weaning has predominantly been devoted to analysis and evaluation of predictors of weaning success. Few studies have examined the patient experience of weaning. The aim of this study was to provide a contemporary description of the patient experience of weaning, in order to up-date this aspect of knowledge in the context of newer modalities of mechanical ventilation and sedation.

METHODOLOGY

The study had a descriptive qualitative design focusing on the lived experience of post-CABG (coronary artery bypass graft) patients ventilated > or = 24h (n=10). Data were generated using semi-structured depth interviews conducted 2-5 months after hospital discharge. A hermeneutic phenomenological approach was used to analyze the data.

RESULTS

The article presents selected themes that emerged during the process of analysis. The main findings relate to general phenomena such as discomfort and impaired communication, psychological phenomena such as loss of control and loneliness, and existential phenomena such as temporality and human interaction.

CONCLUSION

Newer modalities of sedation and mechanical ventilation have not entirely eliminated the discomforts of critical illness; the human aspects of suffering remain. In order to address some of the general, psychological, and existential patient experiences, care should be taken to acknowledge the patient and to respect the patient domain and individual time frames. In nurse-patient communication, it is recommended that caregivers give accurate and unambiguous information.

The lived experience of mothering after prison: the preliminary study

The purpose of this interpretive phenomenological preliminary study was to gain a better understanding of the experience of mothering after prison. In-depth interviewing was conducted with two participants for a period of 4 months after their release from prison. All interviews were focused on the research question, "What has been your experience of mothering since your release from prison?" Data were analyzed using thematic analysis. The following four themes emerged: "always the mother,""separation anxiety,""new demands: divided loyalties," and "the honeymoon is over."

Critical appraisal of rigour in interpretive phenomenological nursing research

AIM

This paper reports a critical review of published nursing research for expressions of rigour in interpretive phenomenology, and a new framework of rigour specific to this methodology is proposed.

BACKGROUND

The rigour of interpretive phenomenology is an important nursing research methods issue that has direct implications for the legitimacy of nursing science. The use of a generic set of qualitative criteria of rigour for interpretive phenomenological studies is problematic because it is philosophically inconsistent with the methodology and creates obstacles to full expression of rigour in such studies.

METHODS

A critical review was conducted of the published theoretical interpretive phenomenological nursing literature from 1994 to 2004 and the expressions of rigour in this literature identified. We used three sources to inform the derivation of a proposed framework of expressions of rigour for interpretive phenomenology: the phenomenological scholar van Manen, the theoretical interpretive phenomenological nursing literature, and Madison's criteria of rigour for hermeneutic phenomenology.

FINDINGS

The nursing literature reveals a broad range of criteria for judging the rigour of interpretive phenomenological research. The proposed framework for evaluating rigour in this kind of research contains the following five expressions: balanced integration, openness, concreteness, resonance, and actualization. Balanced integration refers to the intertwining of philosophical concepts in the study methods and findings and a balance between the voices of study participants and the philosophical explanation. Openness is related to a systematic, explicit process of accounting for the multiple decisions made throughout the study process. Concreteness relates to usefulness for practice of study findings. Resonance encompasses the experiential or felt effect of reading study findings upon the reader. Finally, actualization refers to the future realization of the resonance of study findings.

CONCLUSION

Adoption of this or similar frameworks of expressions of rigour could help to preserve the integrity and legitimacy of interpretive phenomenological nursing research.

Family legacies in shaping teen mothers' caregiving practices over 12 years

In this article, the author focuses on the theme of family legacies. The research is based on a qualitative study of family caregiving practices in a cohort of teenage mothers and their families. Families were first interviewed in 1988-1989 and reinterviewed in 1993, 1997, and 2001. The author explored continuities and turning points in caregiving practices over the 12-year period. Eleven families participated at Time 4, including 9 mothers, 3 of their partners, 6 first-born children, and 9 grandparents of the children (N = 27). At each time period, family caregiving legacies emerged as a salient theme as the mothers and partners described their concerns, accomplishments, and the resources for or impediments to becoming the parents they wanted to be. Four cases are presented to highlight how family legacies were refined, rejected, or modified over time. The author also describes implications of the findings for clinical practice and future research.

Using narrative pedagogy: learning and practising interpretive thinking

AIM

This paper reports a hermeneutic study undertaken to explicate students' experiences in educational courses in which teachers enact Narrative Pedagogy.

BACKGROUND

International interest in developing and implementing discipline-specific pedagogies is becoming commonplace as teachers respond to the challenges of preparing students for contemporary practice. Lifeworld Pedagogy, developed in Scandinavia, and Narrative Pedagogy, developed in the United States of America, Canada and New Zealand, are two approaches developed from nursing research for nursing education that provide teachers with research-based alternatives to conventional pedagogy. Further research is needed, however, that addresses how new pedagogies are experienced in schools of nursing.

METHOD

Teachers and students from 22 schools of nursing in the United States of America were interviewed over a 4-year period between 2002 and 2005. Using interpretive phenomenology as the philosophical background and Heideggerian hermeneutics as the method, accounts from 52 participants were analysed by a research team.

FINDINGS

The theme Learning and Practising Interpretive Thinking reveals how reform is occurring in schools of nursing that use Narrative Pedagogy. It documents how Narrative Pedagogy helps students challenge their assumptions and think through and interpret situations they encounter from multiple perspectives. Findings suggest that by focusing teachers' and students' attention on thinking and interpreting as communal experiences, interpretive pedagogies such as Narrative Pedagogy engage teachers and students in pooling their wisdom, challenging their preconceptions, envisioning new possibilities for providing care and engaging with others to ensure patient-centred care and safety.

CONCLUSION

By documenting students' experiences in courses in which Narrative Pedagogy is used, this study provides teachers with research-based evidence to guide their pedagogical decisions. It extends international efforts to develop discipline-specific pedagogies and offers a practical, student-centred approach teachers can use to enhance students' thinking.

Families' experiences of support provided by resource-oriented family professionals in Finland

This study describes the support provided by resource-oriented family workers in Finland and the prerequisites for such support. Family workers consisted of professionals such as public health nurses, nurses, social educators, psychologists, kindergarten teachers, and social workers. The overall research project consisted of four separate studies carried out within the Families With Children Project. The findings of the four studies were aggregated and submitted to a secondary analysis. Interview data from 51 parents across 44 families with young children were included in the analysis. The families reported that they received emotional, cognitive, instrumental, and community and network support from the family workers. The work of resource-oriented family professionals was facilitated by the arrangements and orientation of the service model and by the quality of interaction between the family worker and the family. The families' experiences of support underlined the multiple dimensions of the cooperative relationship and the usefulness of the supportive interaction. The findings extend the understanding of resource-oriented family work from the perspective of families and offer important implications for the caring of families with young children.

The meaning for elders of receiving family care

AIMS

This paper reports a study undertaken to broaden nurse clinicians', policy-makers', and researchers' understandings of what it means to elders to receive family care.

BACKGROUND

The number of older people receiving assistance at home will increase tremendously in coming decades in proportion to the rapidly increasing aged population. Seventy to 80% of the care received by elders is provided by family members. As more elders with fewer family carers are predicted, nursing's insight into the family care phenomenon becomes even more important. The literature contains reports of specific aspects of family care. Most results include reports of elders dreading giving up their independence in the context of Euro-American United States society's highly valued cultural norm of independence. No studies have explored elders' views of the meaning of receiving family care.

METHODS

Hermeneutic interpretive phenomenology was chosen, and a sample of nine elders (five women and four men) was interviewed. Participants were asked for descriptions of their day-to-day experiences of receiving family care in two to five interviews, and were observed interacting with their family carers in naturalistic settings.

FINDINGS

Elders living at home were found to incorporate help from family members comfortably into their lives. They viewed themselves as autonomous and able to maintain balance between autonomy and dependence on loved ones.

CONCLUSIONS

Receiving family care may have positive meaning for elders, especially when the care is provided within the context of positive relationships with family carers. These findings are in contrast to previous reports. If validated in further research, they could be used to inform practice and policy in health care systems involved in collaborating with families to develop care arrangements for community-living elders.

Qualitative research and family psychology

Qualitative approaches have much to offer family psychology. Among the uses for qualitative methods are theory building, model and hypothesis testing, descriptions of lived experiences, typologies, items for surveys and measurement tools, and case examples that answer questions that surveys cannot. Despite the usefulness of these products, issues related to generalizability, subjectivity, and language, among others, block some researchers from appreciating the contributions that qualitative methods can make. This article provides descriptions of procedures that lead to these useful products and discusses alternative ways of understanding aspects of qualitative approaches that some researchers view as problematic.

Enhancing the quality of hermeneutic research: decision trail

BACKGROUND

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.

AIM

This paper discusses the development of trustworthiness in hermeneutic phenomenological research.

DISCUSSION

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.

CONCLUSION

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.