The value to nursing research of Gadamer's hermeneutic philosophy

A qualitative hermeneutical understanding of spiritual care in old age when living in a nursing home: The residents' voices

AIM

To explore and gain a broader understanding of residents' viewpoints and experiences of spiritual care when living in a nursing home.

DESIGN

A qualitative hermeneutical interview study inspired by Gadamer's philosophical hermeneutics.

METHODS

Thirty-eight individual interviews of 14 male and 24 female residents; of these, 24 had a dementia diagnosis. The setting was one large Norwegian nursing home providing long-term care. FACIT-Sp-12 was used as a guide for the interview, in addition to two open-ended questions about thriving and spiritual care.

FINDINGS

The older residents' voices portray a broad and diverse understanding of spiritual care, and four themes emerged: (1) Spiritual at-homeness, (2) Spiritual awareness, (3) Philosophy of life and (4) Interconnectedness.

CONCLUSION

Accepting one's life situation in a nursing home can foster a feeling of belonging, leading to feeling more at-home. Spiritual well-being, including finding purpose, spiritual awareness and beliefs, was found to be interconnected with spiritual at-homeness in the nursing home.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study provides insights into older nursing home residents' viewpoints on spiritual care, including persons living with dementia.

IMPACT

The study addressed the limited evidence regarding how older residents themselves experience and express spiritual care. Listening to older nursing home residents' voices provides a unique contribution to the research field. As several individuals with dementia contributed to the findings, this study mirrors the current population of residents in nursing homes. The findings may inform healthcare provision and policymakers and impact upon spiritual care in the field of older people nursing and dementia care services.

REPORTING METHOD

The COREQ guideline.

PATIENT OR PUBLIC CONTRIBUTION

Participation through interviews of nursing home residents.

A Trisonance: Identities of Women Whose Mothers Were Murdered by Their Fathers

The current qualitative study aimed to examine the narrative identities of women bereaved to intimate partner femicide. Eleven adult Israeli female offspring whose biological mothers were murdered by their biological fathers were interviewed for the purpose of this study. Due to the uniqueness of their loss experience and circumstances, participants' identity is narrated as a "trisonance": They are not like their fathers, their mothers, nor as society perceives them. This very particular route for identity reconstruction as a means of psychological survival is discussed in light of the literature on identity construction and bereavement and derives recommendations for practice.

Mothers' Continuing Bond With the Baby: The Case of Feticide

The nature of the ongoing bond maintained by the bereaved with the deceased has attracted considerable attention, but studies have generally ignored postdeath relationships when loss occurs in utero. The goal of this research was to reach an interpretive understanding of the continuing bond experience among Israeli mothers who underwent feticide, examining the strategies they use in maintaining a postdeath relationship with a child they did not know, whose death they chose and witnessed, within a social context that ignores their loss and forces them to silence their grief. The results highlight two themes: (a) strategies for relinquishing connection with the baby and (b) strategies for maintaining a postdeath relationship. These processes partially correspond with two theoretical views that shed light on interpretation of the results: the dual process of coping with bereavement and relational dialectic theory. Implications of the results to the practice of health providers are outlined.

Emotional labour and compassionate care: what's the relationship?

BACKGROUND

Malawi is one of the countries in the Sub-Saharan region of Africa severely affected by the HIV pandemic. This being the case, student nurses' clinical encounters include caring for patients with HIV and AIDS.

OBJECTIVES

The study explored the clinical learning experience of undergraduate nursing students in Malawi, with the aim of understanding the nature of their experience.

DESIGN

This was a hermeneutic phenomenological study.

SETTING

The study took place at a university nursing college in Malawi.

PARTICIPANTS

Thirty undergraduate nursing students were purposively selected.

METHODS

Conversational interviews were conducted and a framework developed by modifying Colaizzi's procedural steps guided the phenomenological analysis.

RESULTS

The participants reported their experience during the early years of their studies and their current experience at the time of the study, depicting them as novice and senior students respectively. The study findings demonstrated an overt fear of contracting HIV infection among novice nursing students. Such fear led students to deliberately avoid taking care of HIV positive patients and develop a sense of legitimate emotional detachment. However, as students progressed in their studies, and their knowledge and experiences increased, they realised that HIV and AIDS patients needed support and empathy. The learning trajectory demonstrate a gradual change from emotional detachment based on fear to a sense of emotional engagement built on knowledge, experiential insights and the notion of emotions management that led to the provision of care driven by compassion as opposed to anxiety.

CONCLUSION

The findings illustrate that nursing students need to work on their emotions to provide compassionate care. This is consistent with the concept of emotional labour and the paper argues that undertaking emotional labour is essential in promoting compassionate care.

Configurations of Time in Bereaved Parents' Narratives

In this study, we examined the configurations of time within narratives of bereaved Israeli parents, employing Gadamer's hermeneutic philosophy as the research methodology. Our results reveal that following a sudden violent loss, parents experienced a change in their sense of time. Three nonexclusive time possibilities were evident in the participants' narratives: time stopped, time moved forward, and time moved backward. Although most of the social science literature highlights the importance of linear temporal configuration to enhance the coherence of text, based on our study we call for other forms of temporal ordering, as varied time configurations were used by the bereaved and were perceived to have beneficial outcomes. Finally, we outline implications for mental health professionals.

'I sang Amazing Grace for about 3 hours that day': understanding Indigenous Australians' experience of seclusion

Research shows that Indigenous Australians' suspicion and fear of being 'locked up' may influence mental health service avoidance. Given this, the aim of this study was to explore, by qualitative analysis of in-depth interviews (n = 3), how three Indigenous people experienced the controversial practice of seclusion. Hans-Georg Gadamer's phenomenology guided analysis of the material, and allowed narrated experiences to be understood within their cultural and historical context. Participants viewed seclusion negatively: police involvement in psychiatric care; perceptions of being punished and powerless; occasions of extreme use of force; and lack of care were prominent themes throughout the interviews. While power imbalances inherent in seclusion are problematic for all mental health clients, the distinguishing factor in the Indigenous clients' experience is that seclusion is continuous with the discriminatory and degrading treatment by governments, police, and health services that many Indigenous people have experienced since colonization. The participants' experiences echoed Goffman's findings that institutional practices act to degrade and dehumanize clients whose resulting conformity eases the work of nursing staff. While some nurses perceive that seclusion reduces clients' agitation, one must ask at what cost to clients' dignity, humanity, and basic human rights.

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.

Students' views of enquiry-based learning in a continuing professional development module

The purpose of this study was to explore whether qualified nurses who had undertaken a continuing professional development module at a UK university, which utilised enquiry-based learning (EBL) as the educational strategy, believed that their nursing practice had been influenced by this educational approach. This study was underpinned by the assumptions of Gadamerian hermeneutic phenomenology; semi-structured interviews were conducted with eight nurses who had undertaken a continuing education module utilising an EBL approach. The responses in this study indicate that participants believed that their practice of nursing had been positively influenced by engaging in EBL. They felt that by becoming self-directed, critical, reflective practitioners, they were better able to deliver evidence-based practice/care. Self reports of practice change attributed to engaging in EBL were provided, with the patient identified as the principal beneficiary, echoing the espoused aims of continuing professional development. EBL was credited with being a motivating, energizing and enjoyable way of learning but participants were critical of the lack of preparedness of both the students and facilitators. Consideration needs to given as to whether EBL is viewed as a philosophy of learning or as a facilitative strategy used alongside other educational methods.

Nursing care and understanding the experiences of others: a Gadamerian perspective

A personal and professional issue that confronts all nurses is that of attempting to understand the experiences of our patients or clients. The position taken here is that understanding another person as a human being is much more than being able to explain their experience according to a particular model of ill-health. Rather, it is an issue of human dignity and respectfulness. Gadamerian hermeneutics has been used in nursing research to articulate the process of understanding and to develop interpretations of particular experiences. Gadamer's exposition of understanding shows that we need to be aware that our understanding of other people is developed through a fusion of our own history, language and culture with that of the other person. This occurs through a hermeneutic question-answer dialogue in which we put our ideas at risk of being modified or rejected in the process. Understanding then, is a perceptual and conceptual process in which we fully participate. In this way, the experience of understanding those we nurse increases our understanding of ourselves as well as enhancing our ability to further understand others.

Clinical application research: a hermeneutical approach to the appropriation of caring science

Clinical caring science researchers contribute, by means of various participatory research efforts, to bring clinical practice closer to the ideals of caring. These research efforts have in the main been developed from classical action research rooted in critical theory. In this article, the authors launch an alternative research approach called clinical application research, the basis of which can be traced to the interpretative paradigm, or hermeneutics. The basic cornerstones of this research approach are ontology, context, and appropriation as well as understanding, interpretation, and application. Using an example from ongoing clinical research, the authors demonstrate the utility of this approach. Their aim in this article is to contribute to the development of methods within clinical research.

'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.

Use of hermeneutic research in understanding the meaning of desire for euthanasia

The philosophy of palliative care is holistic, paying attention to the multidimensional needs of the terminally ill in promoting quality of life and relieving suffering. These needs have to be viewed within their cultural, temporal and social contexts. Thus in conducting patient need-based research, the patients' perspectives are vital data in providing intimate insight into the core issues of any phenomenon under study. This paper aims to illustrate the usefulness of hermeneutic philosophy in palliative care research, as demonstrated in a study to understand the meaning of desire for euthanasia directly from the terminally ill. Two particular aspects of the study are emphasized, namely the research methodology and research process, rather than its findings regarding the meaning of desire for euthanasia. Hermeneutic philosophy parallels that of palliative care, as it also values human experience and social contexts. This approach allows in-depth understanding into a phenomenon in a humane and holistic manner, with adherence to methodological and scientific rigour. The process of hermeneutic interpretation can also promote evidence-based reflective practice. The adoption of a hermeneutic attitude in clinical practice can refine professional self-development in the art of communication and caring.