Hermeneutics as a methodology for textual analysis

Mothers' perspectives on the lived experience of children with intellectual disability and challenging behaviour

Children with intellectual disability and behavioural needs (challenging behaviour) are vulnerable to exclusion from services and communities. The situation is exacerbated by difficulties in accessing appropriate support and services to effectively meet the needs of children and carers. Family perspectives on the 'lived experience' of children can provide insight into how behavioural needs can affect their ability to access everyday experiences. Semi-structured interviews were conducted with mothers of children with intellectual disabilities and challenging behaviours. Phenomenological thematic analysis provided four key themes: finding our way; square services, round needs; behaviour touches everything and belonging. Experience of inclusion and exclusion was a central tenet of the lived experience. Recommendations call for timely proactive and bespoke interventions to identify and support children at risk of exclusion from communities. Early intervention and effective local provision will avoid increased burdens placed on families and services, in supporting children whose needs are currently unmet within child-centred provision.

A review of Gadamerian and Ricoeurian hermeneutics and its application to interpretive accounting research

Purpose

The study seeks to address the research question: “How can Gadamerian and Ricoeurian hermeneutics be operationalized in an interpretive accounting research project”? The purpose of this paper is twofold: first, to review the key hermeneutic concepts of philosophers Gadamer and Ricoeur; and second, to share insights from the researcher’s experience of applying Gadamerian and Ricoeurian hermeneutics to an interpretive accounting research project.

Design/methodology/approach

The paper draws on the extant literature and the researcher’s own experience using hermeneutics theory in an interpretive accounting research project involving in-depth interviews with organisational managers.

Findings

The process of interpretation is described using the core concept of the hermeneutic circle where the reader and the text engage in dialogue. The readers’ pre-understandings play a key role in this dialogue and assist in drawing meaning from the text. However, it is necessary for the reader to adopt a critically reflexive approach remaining alert for both unproductive pre-understandings and hidden power structures and ideologies in the text being interpreted. Each reading of a text involves the completion of one cycle of the hermeneutic circle in which the reader transitions from pre-configuration to configuration and ultimately re-configuration concluding with the reader acquiring new horizons of understanding. The researcher’s experience of applying hermeneutic theory to an interpretive accounting research project are reflected on and nine lessons are offered.

Originality/value

These insights will prove valuable to interpretive researchers within the social sciences, including accounting and management studies, as well as those working in the natural sciences.

Exploring NursEs lived Experience of Discussions about Sexual health, with kidney patients in Devon (NEEDS)

AIM

The aim of the study is to gain a better understanding about the complexities of discussing sexuality with patients.

DESIGN

The study will explore how nurses understand the phenomenon by using an Interpretive Phenomenological Approach; the technique encourages deep reflection and rich descriptions about lived experience.

METHODS

Six nurses will be interviewed using iterative, open-ended questions with prompts to illicit rich data.

PREDICTED RESULTS

Understand the support required to enable nurses to engage in deeper, more fulfilling conversations with patients about sexuality.

Ethics support for GPs: what should it look like?

INTRODUCTION Ethics support services for hospital clinicians have become increasingly common globally but not as yet in New Zealand. However, an initiative to change this is gathering momentum. Its slogan 'Clinical ethics is everyone's business' indicates that the aim is to encompass all of health care, not just the hospital sector. General Practitioners (GPs) deal with ethical issues on a daily basis. These issues are often quite different from ethical issues in hospitals. To make future ethics support relevant for primary care, local GPs were interviewed to find out how they might envisage ethics support services that could be useful to them. METHODS A focus group interview with six GPs and semi-structured individual interviews with three GPs were conducted. Questions included how they made decisions on ethical issues at present, what they perceived as obstacles to ethical reflection and decision-making, and what support might be helpful. FINDINGS Three areas of ethics support were considered potentially useful: Formal ethics education during GP training, access to an ethicist for assistance with analysing an ethical issue, and professional guidance with structured ethics conversations in peer groups. CONCLUSION The complex nature of general practice requires GPs to be well educated and supported for handling ethical issues. The findings from this study could serve as input to the development of ethics support services. KEYWORDS General practice; primary care; ethics; support; education.

Heroin shortage in Coastal Kenya: A rapid assessment and qualitative analysis of heroin users' experiences

INTRODUCTION

While relatively rare events, abrupt disruptions in heroin availability have a significant impact on morbidity and mortality risk among those who are heroin dependent. A heroin shortage occurred in Coast Province, Kenya from December 2010 to March 2011. This qualitative analysis describes the shortage events and consequences from the perspective of heroin users, along with implications for health and other public sectors.

METHODS

As part of a rapid assessment, 66 key informant interviews and 15 focus groups among heroin users in Coast Province, Kenya were conducted. A qualitative thematic analysis was undertaken in Atlas.ti. to identify salient themes related to the shortage.

RESULTS

Overall, participant accounts were rooted in a theme of desperation and uncertainty, with emphasis on six sub-themes: (1) withdrawal and strategies for alleviating withdrawal, including use of medical intervention and other detoxification attempts; (2) challenges of dealing with unpredictable drug availability, cost, and purity; (3) changes in drug use patterns, and actions taken to procure heroin and other drugs; (4) modifications in drug user relationship dynamics and networks, including introduction of risky group-level injection practices; (5) family and community response; and (6) new challenges with the heroin market resurgence.

CONCLUSIONS

The heroin shortage led to a series of consequences for drug users, including increased risk of morbidity, mortality and disenfranchisement at social and structural levels. Availability of evidence-based services for drug users and emergency preparedness plans could have mitigated this impact.

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.

Accepting Pain Management or Seeking Pain Cure: An Exploration of Patients’ Attitudes to Chronic Pain

This article explores the differing attitudes of patients toward chronic pain. Because pain is a subjective experience, individuals react to living with chronic pain in varying ways. Some patients successfully manage their chronic pain, whereas others continue to seek a pain cure. A convenience sample (n = 8) was generated from a district general hospital's nurse-led pain clinic. The sample was subdivided by an expert panel rating procedure into two groups: those accepting pain management and those seeking a pain cure. The study used a multimethod approach comprising extended, highly focused interviews coupled with patients' diaries and drawing on a phenomenologic theoretical framework. Initial hermeneutic data analysis provided emerging themes: "rules for living," "pain = life," and "acceptance" for the pain management group, and "pillar to post," "self-fulfilling prophecy," and "mood" for those seeking a cure. Thematic content common to both groups were "family" and "coping strategies." These themes illustrate some differences and similarities between those who manage pain compared with those who seek a pain cure. Phenomenologically based research findings can rarely be generalized, but they enlighten and highlight the need for further research to generate detailed understanding of why some patients with chronic pain can accept pain management and others relentlessly seek a cure that is frequently not possible.

'It's not like the wards'. Experiences of nurses new to critical care: a qualitative study

BACKGROUND

Critical care is both emotionally and intellectually challenging, yet little is currently known about the experience of nurses' new to this environment.

AIMS

The aims of the study were to: 1. Explore the experience of nurses' new to critical care. 2. Identify what factors influence the nurses' experiences during this time. 3. Evaluate methods used to facilitate nurses' development such as education and preceptorship.

METHODS AND PARTICIPANTS

This longitudinal qualitative study was undertaken using hermeneutic phenomenology and involved all nurses (n=14) recruited to the unit during two cohort intakes in 2002. Data collection was by means of semi-structured interviews at one, three and six months. All interviews were tape recorded, transcribed, and analysed for emerging themes and concepts.

FINDINGS

Participants described a variety of unique experiences throughout the interviews, many of these related to four key themes: support, knowledge and skills, socialisation and moving on. There were also a number of key factors influencing these experiences including foundation programme, support, preceptors, staff and pre-requisites. Although strategies such as education and preceptorship were positively evaluated, areas for improvement were also identified.

CONCLUSION

This study captures the unique experiences of nurses new to critical care and demonstrates the complexity of socialisation to the critical care milieu.