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

" Being mutually involved in recovery". A hermeneutic exploration of nurses' experiences of patient participation in psychiatric care

Purpose

This study aims at exploring how psychiatric nurses’ experiences of patient participation could be understood from a caring science perspective.

Methods

The design was inspired by clinical application research., which is a hermeneutic approach developed within caring science research. . In this study data were co-created during four reflective group dialogues where five participants’ experiences of patient participation were reflected on in the light of caring science theory and research. The transcribed dialogues were subjected to a thematic, hermeneutic interpretation.

Results

The interpretation gave rise to three themes; giving room for the patient to find his/her own pathway, strengthening personhood, and being in a balanced communion. From these themes an underlying pattern of the meaning of participation as being mutually involved in the patients’ process of recovery arose.

Conclusion

From a caring science perspective the meaning of psychiatric nurses experiences of patient participation could be understood as an interpersonal process reflecting the reciprocity in human relationships. This means a shift in understanding of patient participation from procedures related to the planning of nursing care, to understanding participation as a process focusing on the mutual involvement of patients and nurses in the patients’ process of recovery.

Love and Responsibility: A New Understanding of Leadership

The purpose of the study is to investigate the importance of substance for the disclosure of ontological evidence. The methodology is inspired by Gadamer's hermeneutic philosophy and involves clinical application research using a deductive approach. This means that leaders in a clinical context were taught and participated in a discussion about a theoretical model of leadership with caring science and ontological substance. The result shows that the leaders' attention and focus were primarily directed toward administration, finances, and outer structures. Caring science and ontological substance contributed toward disclosing ontological evidence, and leadership emerged as caring, love, inner responsibility, guilt, and vulnerability. In this study, substance has been combined with teaching and group discussion as a methodical approach. Substance is the guiding issue and has been shown to lead to truth. The method is in a true sense nothing without substance.

Clinical application research through reflection, interpretation and new understanding - a hermeneutic design

The implementation of theoretical knowledge in clinical practice and the implementation of good clinical practice into theory have been of interest in caring science for the last 30 years. The aim of this article was to elaborate and discuss a methodology named clinical application research. The method is grounded in a hermeneutical design inspired by Gadamer's philosophy. The methodology, clinical application research, has been used in a research project A life in dignity and experiences from the researchers forms the bases for the elaboration and discussion. The project was performed in collaboration with residents, family caregivers and healthcare providers at six nursing homes in Scandinavia. The material for this article is based on the previous research, that is the results from 10 different articles showing the meaning of dignity and indignity in daily life in nursing homes. Data were generated from 56 individual interviews and 18 focus-group interviews with a total of 40 staff members with five to eight participants at every interview session. By reflection, interpretation and new understanding our results provide knowledge about dignity and how to preserve dignity for older people in an appropriate ethical way. The methodology was relevant for the research project A life in dignity and relevant to caring practice in nursing homes as it opens new possibilities and new ways of thinking when performing dignified care to older people.

Fostering dignity in the care of nursing home residents through slow caring

Background:

Physical impairment and dependency on others may be a threat to dignity.

Research questions:

The purpose of this study was to explore dignity as a core concept in caring, and how healthcare personnel focus on and foster dignity in nursing home residents.

Research design:

This study has a hermeneutic design.

Participants and research context:

In all, 40 healthcare personnel from six nursing homes in Scandinavia participated in focus group interviews in this study.

Ethical considerations:

This study has been evaluated and approved by the Regional Ethical Committees and the Social Science Data Services in the respective Scandinavian countries.

Findings:

Two main themes emerged: dignity as distinction (I), and dignity as influence and participation (II).

Discussion:

A common understanding was that stress and business was a daily challenge.

Conclusion:

Therefore, and according to the health personnel, maintaining human dignity requires slow caring in nursing homes, as an essential approach.

Using qualitative methods to access the pain experience

Qualitative methods provide us with techniques to access the pain experience of patients in ways that provide explanation for apparent contradictions and idiosyncrasies that are difficult to access. In this article, I review three such strategies and the application of qualitative research to practice: (1) the analysis of the ways participants speak about agonizing pain using narrative inquiry, (2) comparisons of childbirth pain in two cultural groups using ethnography and (3) present a qualitative theory, the Praxis Theory of Suffering. This theory provides a theoretical explanation for behaviours that presently confound the understanding of distress using the Distress Thermometer. An alternative approach, 'reading' patients' behavioural manifestations of distress, is recommended.

The multifaceted vigilance - nurses' experiences of caring encounters with patients suffering from substance use disorder

BACKGROUND

Nursing care is guided by a value base focusing on promoting dignity and health by means of the caring relationship. However, previous research has revealed that negative attitudes towards 'addicted' patients, as well as these patients' behaviour, can give rise to negative emotions such as frustration and disappointment among nurses. This can contribute to a judgmental and controlling attitude towards patients. To preserve order, nursing interventions focusing on creating structure and stability could be applied in a way that challenges caring values.

AIMS AND OBJECTIVES

This study aimed to describe how nurses' working in inpatient psychiatric care experience caring encounters with patients suffering from substance use disorder (SUD).

DESIGN

This qualitative study is part of a clinical application project focusing on value-based care of patients suffering from SUD. Data were obtained during four reflective group dialogues with six nurses in a psychiatric hospital.

METHODS

The transcribed dialogues were subjected to latent qualitative content analysis.

RESULTS

The analysis facilitated the organisation of the findings into a coherent pattern. A common thread of meaning was conceptualised as a theme labelled 'the multifaceted vigilance', describing how nurses strived to deliver good care, while at the same time being vigilant towards patients' behaviour as well as their own reactions to it. Within that theme, four categories described experiences related to different challenges nurses face in caring encounters.

CONCLUSION

We suggest that this perhaps unavoidable aspect of caring encounters can be an asset. Thus, if acknowledged and subject to reflection, being vigilant could be understood as a strength enabling nurses to safeguard caring values, and to use their authority to promote patients' health and alleviate suffering.

Ethical challenges in care for older patients who resist help

Background:

Situations where patients resist necessary help can be professionally and ethically challenging for health professionals, and the risk of paternalism, abuse and coercion are present.

Research question:

The purpose of this study was to examine ethical challenges in situations where the patient resists healthcare.

Research design:

The method used was clinical application research. Academic staff and clinical co-researchers collaborated in a hermeneutical process to shed light on situations and create a basis for new action.

Participants and research context:

Four research groups were established. Each group consisted of six to eight clinical co-researchers, all employees with different health profession backgrounds and from different parts of the municipal healthcare services, and two scientific researchers.

Ethical considerations:

The study was conducted in compliance with ethical guidelines and principles. Participants were informed that participation was voluntary and that confidentiality would be maintained. They signed a consent form.

Findings:

The findings showed that the situations where patients opposed help related to personal hygiene, detention in an institution and medication associated with dental treatment. The situations were perceived as demanding and emotionally stressful for the clinicians.

Discussion:

The situations can be described as everyday ethics and are more characterised by moral uncertainty and moral distress than by being classic ethical dilemmas.

Conclusion:

Norwegian legislation governing the use of force seems to provide decision guidance with the potential to reduce uncertainty and moral stress if the clinicians’ legal competence had been greater.

Being altered by the unexpected: understanding the perioperative patient's experience: a case study

The present paper focuses on the process of understanding the patient in the context of perioperative caring and reports a story narrated by a perioperative nurse as well as her emerging understanding of the patient prior to surgery at an operating department. This qualitative case study had a dual purpose; firstly, to describe how the perioperative nurse's understanding of the patient emerged and, secondly, to establish how the researcher interpreted the situation. As a perioperative nurse and researcher, the author is both the narrator and interpreter. To date we have rarely discussed the fact that, in a perioperative context, the patient might feel ashamed of his/her body, even before arriving at the operating department. This new understanding emerged from the hermeneutical dialogue in the present study.

Aspects of indignity in nursing home residences as experienced by family caregivers

The overall purpose of this cross-country Nordic study was to gain further knowledge about maintaining and promoting dignity in nursing home residents. The purpose of this article is to present results pertaining to the following question: How is nursing home residents’ dignity maintained, promoted or deprived from the perspective of family caregivers? In this article, we focus only on indignity in care. This study took place at six different nursing home residences in Sweden, Denmark and Norway. Data collection methods in this part of this study consisted of individual research interviews. Altogether, the sample consisted of 28 family caregivers of nursing home residents. The empirical material was interpreted using a hermeneutical approach. The overall theme that emerged was as follows: ‘A feeling of being abandoned’. The sub-themes are designated as follows: deprived of the feeling of belonging, deprived of dignity due to acts of omission, deprived of confirmation, deprived of dignity due to physical humiliation, deprived of dignity due to psychological humiliation and deprived of parts of life.

Exploring the development of a cultural care framework for European caring science

The aim of this paper is to discuss the development of a cultural care framework that seeks to inform and embrace the philosophical ideals of caring science. Following a review of the literature that identified a lack of evidence of an explicit relationship between caring science and cultural care, a number of well-established transcultural care frameworks were reviewed. Our purpose was to select one that would resonate with underpinning philosophical values of caring science and that drew on criteria generated by the European Academy of Caring Science members. A modified framework based on the work of Giger and Davidhizar was developed as it embraced many of the values such as humanism that are core to caring science practice. The proposed caring science framework integrates determinants of cultural lifeworld-led care and seeks to provide clear directions for humanizing the care of individuals. The framework is offered to open up debate and act as a platform for further academic enquiry.

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.

Uncovering the Ethics of Suffering Using a Narrative Approach

The purpose of this article is to portray the ethics of suffering based on the published literature. Narrative use has become common in the fields of nursing education and curriculum development and in the determination of practice competencies. Understanding the ethics of suffering implies a hermeneutic movement between alienation and dedication. To understand the ethical significance of human suffering, the scene of suffering is described through the concepts of: to endure, to struggle, to sacrifice life and health, and to become. To respond, to discover, to approach, to touch and to shape patients' different patterns of life implies responsibility: to see, to affirm their dignity by being, and to express this in ethical words. Narration plays a crucial role in transforming suffering, that is, reformulating patients' stories. It is vital that educators should create a learning environment where students can find the courage and intention to be present and listen to patients' narratives.