Providing end of life care in the emergency department: A hermeneutic phenomenological study

BACKGROUND

Registered nurses report the experience of delivering end of life care in emergency departments as challenging. The study aim was to understand what it is like to be a registered nurse providing end of life care to an older person in the emergency department.

METHODS

A hermeneutic phenomenological study was conducted in 2021, using semi-structured interviews with seven registered nurses across two hospital emergency departments in Queensland, Australia. Thematic analysis of participants' narratives was undertaken.

FINDINGS

Seven registered nurses were interviewed; six of whom were women. Participant's experience working in the emergency department setting ranged from 2.5-20 years. Two themes were developed through analysis: (i) Presenting the patient as a dying person; and (ii) Mentalising death in the context of the emergency department.

CONCLUSIONS

Nurses providing end of life care in the emergency department draw upon their personal and aesthetic knowing to present the dying patient as a person. The way death is mentalised suggests the need to develop empirical knowing about ageing and supportive medical care and ethical knowing to assist with the transition from resuscitation to end of life care. Shared clinical reflection on death in the emergency department, facilitated by experts in ageing and end of life care is recommended.

Promoting dignity in nursing education - How educators manoeuvre to promote dignity

BACKGROUND

Dignity is a core value in nursing. One of the objectives in nursing education is to promote dignity and contribute to the students' discovery of this value. Research shows that dignity in nursing education is threatened, due to lack of attention and an increasing problem with incivility.

PURPOSE

The study aims to explore how nursing educators experience their contribution in promoting dignity in nursing education.

METHOD

Five focus group conversations were conducted with nursing educators, and Gadamer's philosophical hermeneutics was chosen as the study's scientific theoretical approach.

FINDINGS

The educators experienced that they promoted dignity by safeguarding the dignity in the nursing profession in general, by promoting the dignity of the nursing students in particular, and through promoting dignity in challenging situations.

CONCLUSION

The study emphasizes the importance of promoting dignity in nursing education. It found that the nursing educators promoted dignity by safeguarding the dignity of both the nursing profession and the nursing students, and by manoeuvring judiciously between these two when there was disharmony between them. By manoeuvring challenging situations using discretion, the ethical demand will be given room. Dignity can then be fulfilled between people in harmony with professional, social and cultural norms, and in that way promote dignity in nursing education.

Anthropology and history in the early Dilthey

Dilthey frequently recognizes anthropology as a foundational science of human nature and as a cornerstone in the system of the human sciences. While much has been written about Dilthey's "philosophical anthropology," relatively little attention has been paid to his views on the emerging empirical science of anthropology. This paper examines Dilthey's relation to the new discipline by focusing on his reception of its leading German representatives. Using his book reviews, essays, and drafts for Introduction to the Human Sciences from the 1860s-70s, it highlights the influence of the new anthropology on his earliest attempts to elaborate the foundations of the Geisteswissenschaften. It argues that anthropology was a key source for some of the naturalistic features of Dilthey's philosophy, and that it pulled him in a direction contrary to the historicist hermeneutics of his teachers.

Psychological and social aspects of people with epilepsy expressed through drawing: Pilot study

INTRODUCTION

Frequently, the psychological and social aspects of PWE go unnoticed in medical consultations. Even in spite of having seizure control, some people can experience a poor quality of life. The objective of the study was to determine if drawing facilitates the expression of the psychological and social difficulties of PWE.

METHODS

Hermeneutic, qualitative, situated knowledge study located in the city of Medellín, Colombia. The participants were asked to make one or several drawings under the question "what it is like to live with epilepsy". The drawings were analyzed with criteria of Gestalt psychology, semiotics, image-word relationship and context.

RESULTS

Sixteen drawings of ten participants were obtained. The drawings revealed the construction of an identity of otherness and negative emotionality due to epilepsy. The social concepts of restriction, prohibition, dependency, and exclusion appear in the drawings. The authors expose the ways to face adversity.

CONCLUSION

Drawing can expose and facilitate the expression of the psychological and social difficulties of PWE, which often go unnoticed in the medical office. Free drawing is an easy-to-use global tool that has been underused in the medical field.

["In God alone my soul can find rest" (Ps 62:2) : Silence and pain in the Psalms and their narrativizations in Taizé]

BACKGROUND

A theological perspective on dealing with crises that focuses on modes of endurance and gestalt, is supported by interdisciplinary resilience research.

OBJECTIVE

How can silence contribute to a productive coping with crises and pain?

MATERIAL AND METHODS

Texts and practices of the Christian tradition are discussed with respect to their ways of dealing with critical and painful situations, namely a) the Psalm texts of the Old Testament, which are examined by means of exegetical methods for historical and cultural aspects of meaning and b) the practice of silence in the prayers of the Taizé community, which are examined from a narrative hermeneutical perspective.

RESULTS

By understanding silence as an ambiguous and ambivalent phenomenon, it can contribute to a productive way of dealing with pain that enables perception, confrontation and acceptance. It is crucial not to regard the silence of a sufferer as a mere endurance, but also to have an eye on the creative potentials. Cultural and religious narratives and practices can help to locate oneself in a "space of silence" in such a way that a resilient way of dealing with experiences of pain becomes possible.

CONCLUSION

In order for silence to promote resilience, it is necessary to keep an eye on productive as well as destructive processes of silence as an ambivalent phenomenon: These processes occur in an uncontrollable way and are shaped by implicit normative assumptions. Silence can be experienced as loneliness, isolation and the loss of quality of life, or silence can become a place of encounter, of arrival, of security, and in prayer of trust in God.

Exploring the intersection of hermeneutics and implementation: a scoping review

BACKGROUND

An enduring challenge remains about how to effectively implement programs, services, or practices. Too often, implementation does not achieve its intended effectiveness, fidelity, and sustainability, even when frameworks or theories determine implementation strategies and actions. A different approach is needed. This scoping review joined two markedly different bodies of literature: implementation and hermeneutics. Implementation is usually depicted as focused, direct, and somewhat linear, while hermeneutics attends to the messiness of everyday experience and human interaction. Both, however, are concerned with practical solutions to real-life problems. The purpose of the scoping review was to summarize existing knowledge on how a hermeneutic approach has informed the process of implementing health programs, services, or practices.

METHODS

We completed a scoping review by taking a Gadamerian hermeneutic approach to the JBI scoping review method. Following a pilot search, we searched eight health-related electronic databases using broadly stated terms such as implementation and hermeneutics. A diverse research team that included a patient and healthcare leader, working in pairs, independently screened titles/abstracts and full-text articles. Through the use of inclusion criteria and full-team dialogue, we selected the final articles and identified their characteristics, hermeneutic features, and implementation components.

RESULTS

Electronic searches resulted in 2871 unique studies. After full-text screening, we retained six articles that addressed both hermeneutics and implementing a program, service, or practice. The studies varied widely in location, topic, implementation strategies, and hermeneutic approach. All addressed assumptions underpinning implementation, the human dimensions of implementing, power differentials, and knowledge creation during implementation. All studies addressed issues foundational to implementing such as cross-cultural communication and surfacing and addressing tensions during processes of change. The studies showed how creating conceptual knowledge was a precursor to concrete, instrumental knowledge for action and behavioral change. Finally, each study demonstrated how the hermeneutic process of the fusion of horizons created new understandings needed for implementation.

CONCLUSIONS

Hermeneutics and implementation have rarely been combined. The studies reveal important features that can contribute to implementation success. Implementers and implementation research may benefit from understanding, articulating, and communicating hermeneutic approaches that foster the relational and contextual foundations necessary for successful implementation.

TRIAL REGISTRATION

The protocol was registered at the Centre for Open Science on September 10, 2019. MacLeod M, Snadden D, McCaffrey G, Zimmer L, Wilson E, Graham I, et al. A hermeneutic approach to advancing implementation science: a scoping review protocol 2019. Accessed at osf.io/eac37.

Exploring the business skills, experiences and preparedness of UK-based private physiotherapists when establishing and developing a physiotherapy business: A hermeneutic phenomenological study

AIM

To explore the business skills, experiences and preparedness of UK-based private physiotherapists when establishing and developing a physiotherapy business.

DESIGN

A hermeneutic phenomenological approach.

PARTICIPANTS

Six UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling.

METHODS

In-depth, semi-structured video interviews (n = 12) were audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, and small sections of data and all emerging codes were independently reviewed.

RESULTS

Knowledge acquisition: participants acquired business knowledge from training, external help, and trial-and-error approaches. Improved physiotherapy-related business training was requested. Business skills: Business plans were generally organic or lapsed with time. Success and timing of marketing strategies varied widely. The altruistic nature of many physiotherapists creates difficulties in requesting payments for services. Clinical policies: Lone working risks appeared more weighted towards protecting staff from physical abuse rather than allegations.

CONCLUSIONS

Improved physiotherapy-related business support and guidance may be beneficial. Focusing on word-of-mouth, website marketing, and establishing support networks may benefit practice owners. Greater consideration of the potentially negative implications of lone working, particularly accusations of inappropriate sexual behaviour, is recommended.

The body's dignity in integrative understanding of health in IBD - A hermeneutic approach to holistic care

BACKGROUND AND PURPOSE

This article will convey a new understanding of health and disease as a coherent dimension where the whole body interacts with its natural environment. This understanding is linked to a theoretical framework and illustrated by reference to research with patient experiences with inflammatory bowel disease (IBD), with the disorders Crohn's disease and ulcerative colitis. Creating ecological sustainability towards a greener health service where the body has a higher intrinsic value is a growing concern.

MATERIAL AND METHODS

The methodological approach is hermeneutic, whereby the results of one's own research are interpreted and reconceived through reflection towards a new understanding. Themes from patients' experiences are interpreted in light of the theoretical frame of reference of this article in order to achieve a new understanding.

RESULTS

The further interpretation of the state-of-the-art article and empirical articles resulted in the following themes: 1. The lived body is understood as a coherent whole and a place of inner freedom. 2. The body in a lowered state of stress helps the patient to experience dignity and vitality. 3. An integrative understanding of health in terms of IBD brings dignity and wholeness to the body.

CONCLUSION

This article sheds light on the connections between body knowledge, nutrition, dignity, and integrative understanding of health in acute and chronic IBD. In clinical practice, the connections may happen when giving the patient the opportunity for recovery by learning to listen to the body. Dignity is linked to both coping and expert help from clinically competent health professionals.

Finding meaning in medical education - how the hermeneutic window can help primary care educators

We have published a model in which biomedical and humanistic elements of the consultation are seen as complementary and where hermeneutics, the discovery and creation of meaning, plays an integral role in enriching conversations both between clinicians and patients and also between teachers and learners. We have also proposed that hermeneutics can be particularly powerful in exploring and making explicit elements of the hidden curriculum. In this article, we consider how hermeneutics can be applied in primary care training and supervision, in order to enhance the experience for both teacher and learner.

Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team

OBJECTIVE

To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units.

METHODOLOGY

Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle.

RESULTS

Four significant themes emerged from the analysis: (1) delirium prevention, (2) pharmacological treatment, (3) non-pharmacological treatment, and (4) barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team.

CONCLUSIONS

The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.

"We know what they're struggling with": student peer mentors' embodied perceptions of teaching in a health professional education mentorship program

This paper reports on a study of student peer mentorship in the context of nursing education in a higher education program in Canada. The study used an embodied hermeneutic phenomenological methodology to investigate student peer mentors' perceptions of teaching during peer mentorship. The data were collected over one calendar year (2019) and involved analysis of 10 participants' interview data and their 'body maps,' produced in response to guided questions. Through the data analysis a core theme of 'commitment to mentee growth' was identified, along with seven interrelated themes: sharing responsibility for learning, moderating stress, mediating power relations, navigating unknown processes, valuing creative approaches, offering generous acceptance, and facilitating confidence. Student peer mentorship has the potential to contribute to health professions education in a number of unique ways including through embodied attunement, trusting intersubjective relations, and dialogic education. This study is innovative in its purposeful design and aim to investigate both cognitive and embodied perceptions of student peer mentors. The findings point to the promise of student peer mentorship for advancing health sciences education. Implications for peer mentorship program development in health professions education are discussed.

Understanding the experience of living well, beyond the age of 85 years: a qualitative analysis using themes from a meta-ethnography

BACKGROUND

Increase in life-expectancy is not necessarily matched by an increase in quality of life.

OBJECTIVE

(1) To explore the quality of life of patients over the age of 85 in the second decade following unicompartmental knee replacement surgery (2) To understand the usefulness of a priori themes from an evidence synthesis as a framework for primary qualitative analysis.

DESIGN

Qualitative Research. A hermeneutic phenomenological approach, using a priori themes as sensitising concepts.

PARTICIPANTS

Adults over the age of 85 who were part of an outcomes study in the second decade following unicompartmental knee joint replacement.

METHODS

Semi-structured interviews in people's homes. Transcripts were coded and data sorted using a priori themes as sensitising concepts. Data that did not fit these themes, or that added nuance, were analysed thematically through constant comparison.

RESULTS

We interviewed seven white women and five white men, aged 85-100. Data resonated with a priori themes and supported additional themes that help us to understand older peoples' experience: (1) losing our autonomy can be challenging, so be kind; (2) we must take care of our own bodies and the NHS; (3) I am more afraid of not dying.

CONCLUSIONS

Findings indicate that health outcomes for older people should incorporate measures of participation and well-being; they highlight the importance of kindness in healthcare; they indicate that older people do not want to place additional burden on the NHS, and this can act as a barrier to care; they support the need for open conversations about dying well.

The meaning of nursing practice for nurses who are retired yet continue to work in a rural or remote community

BACKGROUND

Although much research has focused on nurses' retirement intentions, little is known about nurses who formally retire yet continue to practice, particularly in rural and remote settings where mobilization of all nurses is needed to assure essential health services. To optimize practice and sustain the workforce stretched thin by the COVID-19 pandemic, it is necessary to understand what it means for retired registered nurses (RNs) and licensed practical nurses (LPNs) to work after retirement. This study explored what nursing practice means for RNs and LPNs who have formally retired but continue to practice in rural and remote communities.

METHODS

A pan-Canadian cross-sectional survey conducted in 2014-2015 of nurses in rural and remote Canada provided data for analysis. Textual responses from 82 RNs and 19 LPNs who indicated they had retired but were occasionally employed in nursing were interpreted hermeneutically.

RESULTS

Retired nurses who continued to practice took on new challenges as well as sought opportunities to continue to learn, grow, and give back. Worklife flexibility was important, including having control over working hours. Nurses' everyday practice was inextricably tied up with their lives in rural and remote communities, with RNs emphasizing serving their communities and LPNs appreciating community recognition and the family-like character of their work settings.

CONCLUSIONS

Retired nurses who continue to work in nursing see retirement as the next phase in their profession and a vital way of engaging with their rural and remote communities. This study counters the conventional view of retaining retired nurses only to combat nursing shortages and alleviate a knowledge drain from the workplace. Rural and remote nurses who retire and continue working contribute to their workplaces and communities in important and innovative ways. They can be characterized as dedicated, independent, and resilient. Transitioning to retirement in rural and remote practice can be re-imagined in ways that involve both the community and the workplace. Supporting work flexibility for retired nurses while facilitating their practice, technological acumen, and professional development, can allow retired nurses to contribute their joy of being a nurse along with their extensive knowledge and in-depth experience of nursing and the community.

From Value to Valuation: Pragmatist and Hermeneutic Orientations for Assessing Science on the International Space Station

Based on a study of the International Space Station (ISS), this paper argues that - as a set of orientations for sociological inquiry - pragmatism and hermeneutics are confluent frameworks to examine valuation as a social process. This confluence is grounded on their common attunement to valuing as a problematic and relational process, their equally common updates with theories of institutions, and a further conceptual development regarding the temporalities of valuation. I advance the argument in four steps. First, looking at how the question about the "scientific value" of the ISS is far from settled, I show how valuation is always about something considered problematic and indeterminate. Second, characterizing the ISS at the intersection of different criteria of assessment, I stress the nature of valuation as a fundamentally perspectival and interpretive process, and show how a hermeneutic approach can complement some of the limitations of pragmatism in this regard. Third, I look at the question of institutions considering how some modes of assessment sediment more successfully than others. Fourth, I argue that, while providing insights towards it, pragmatist and hermeneutic approaches to valuation have not fully grasped its temporal nature as a process, and outline ways to open this line of inquiry. I conclude with some ideas for studies in sociology of science to re-entangle detailed case studies of scientific practice with the study of how institutions make claims of worth about the nature of science, I propose ways to extend these arguments to other studies of what I call iridescent institutions, and I make some considerations about our stance as sociologists in these valuation disputes.

The Ethics Laboratory: A Dialogical Practice for Interdisciplinary Moral Deliberation

Recent advancements in therapeutic and diagnostic medicine, along with the creation of large biobanks and methods for monitoring health technologies, have improved the prospects for preventing, treating, and curing illness. These same advancements, however, give rise to a plethora of ethical questions concerning good decision-making and best action. These ethical questions engage policymakers, practitioners, scientists, and researchers from a variety of fields in different ways. Collaborations between professionals in the medical and health sciences and the social sciences and humanities often take an asymmetrical form, as when social scientists use ethnographic approaches to study the moral issues and practices of physicians. The ethics laboratory described in this article is a cross-sectoral and inter-disciplinary forum for collaborative investigation on important moral topics. It offers an experimental way of unpacking implied assumptions, underlying values, and comparable notions from different professional healthcare fields. The aim of this article is to present the ethics laboratory's methodology. The article offers a model and a hermeneutical framework that rests on a dialogical approach to ethical questions. The model and the framework derive from a Danish research project, Personalized Medicine in the Welfare State. This article uses personalized medicine as a point of reference, though it offers an argument for the applicability of the model more broadly.

[Cancer narrative and hermeneutical analysis]

An existential analysis of the story that patients make related to the experience of suffering from cancer is presented. The objective of the study was to observe, describe and understand the way in which suffering reveals the temper of anguish and with it, the possibility of an authentic existence. Although this study only analyzes the report of two patients, the complete sample consists of 25 patients, all adults, of both sexes, aged between 40 and 70 years. The type of cancer varied, but in all cases it was treated with surgery, chemotherapy, and radiation therapy. Participation was voluntary and with consent. The interpretation and analysis was done by confronting the hermeneutical theories with the life stories of the patients.

Ricoeur's hermeneutic arc and the "narrative turn" in the ethics of care

"Patient-centred care" is the recent response to the malaise produced in the field of health care from the point of view both of a technical mentality and the paternalistic model. The interest in the story-telling approach shown by both the humanities and the social sciences has favoured a "narrative turn" in medicine too, where the new ethics of therapeutic relationship consider the hermeneutic method a means by which to integrate evidence and subjectivity, scientific data and patient experience. The aim of this paper is to show how Ricoeur's theory of "threefold mimesis" makes a conceptual contribution to the use of narrative interviews in nursing and also be successfully transferred into and applied in the field of healthcare in general. First, the paper examines how this narrative approach might open up new possibilities for the acquisition of in-depth knowledge of patients' life experiences, a condition indispensable for the improvement of the quality of care. Secondly, it highlights how this Ricoeurian method seems capable of provide an opportunity for healthcare professionals to review their own understanding of the caregiver-patient therapeutic relationship, beginning with their confrontation with the patient's world as revealed by the narrative they provide.

Prevention and treatment of delirium in intensive care: Hermeneutics of experiences of the nursing team

OBJECTIVE

To understand the experiences in nursing care in the prevention and treatment of delirium in people hospitalized in intensive care units.

METHODOLOGY

Hermeneutic phenomenological qualitative study. The selection of participants was by intentional sampling: seven nursing assistants and eight nurses. Theoretical saturation was achieved. The phenomenological interview was applied to collect data from a central question and the analysis was carried out following the approaches of Heidegger's hermeneutical circle.

RESULTS

Four significant themes emerged from the analysis: 1) Delirium prevention, 2) Pharmacological treatment, 3) Non-pharmacological treatment, and 4) Barriers to non-pharmacological treatment. These themes were accompanied by 35 interrelated units of meaning: in the first theme, the most repetitive units were communication, orientation, and family bonding; in the second was the use of pharmacological treatment only in the acute phase; in the third was the modification of the environment according to the patient's preference (where the family is a priority and strategies that provide cognitive and social stimulation can be reinforced), and in the fourth was the work overload for the nursing team.

CONCLUSIONS

The experiences of the nursing team in the prevention and treatment of delirium in critically ill patients highlight that communication allows an approach to the patient as a human being immersed in a reality, with a personal history, needs and preferences. Therefore, family members must be involved in these scenarios, as they can complement and support nursing care.

Participation amongst people ageing with neuromuscular disease: a qualitative study of lived experiences

Aim

To explore the lived experiences of participation in everyday life ageing with neuromuscular disease (NMD).

Design

A qualitative study using a phenomenological‐hermeneutic approach.

Methods

Data were gathered through interviews with 15 persons living with NMD in 2018. A three‐levelled analysis and interpretation influenced by Paul Ricoeur's philosophy were conducted.

The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used from May 2018 to December 2018.

Results

Three themes were identified: “Endless adaptations change the fundamentals of everyday life ageing with NMD,” “The ‘swamp’ of deterioration” is traversed through experiences of belonging and relationship,” “Being disabled by a professional knowledge gap and stereotypical images.” In these themes, the experience of participation in everyday life ageing with NMD appeared to depend on the ability to adapt constantly. Through participation, a sense of belonging and purpose was maintained. Lack of knowledge amongst professionals may negatively affect the ongoing participation of people ageing with NMD.

Images of the emptied society. Alicante (Spain), local and global example of the consequences of the coronavirus

The starting hypothesis of this article is that the confinement suffered by the Spanish population during COVID-19 has brought at least three important consequences. The first, that the cities -Alicante, between them- and the Spanish towns were deserted, so that, in a certain sense, society was also emptied. The second, that the shelterdwellings expanded their traditional functions and assumed new ones, becoming “World-Homes”. And, third, that individualism and “communitas” have been reinforced, along with fear of Society, Nature and History.

This starting hypothesis is confirmed, with nuances, by the content analysis of 14 photographs selected from hundreds, which the photojournalist, Rafa Arjones, from the newspaper Información, carried out during the confinement of Alicante (in phase 0, which lasted from March 14 to May 18, 2020). This city of 330,000 inhabitants is the capital of a dynamic province, located in the southeast of Spain. And, for this, we will use hermeneutics, concretized by linking three methods of image analysis: Panofsky's iconological analysis, K. Mannheim's documentary method and Visual Framing from Communication. In addition, these images will be contrasted with other 17 published in various media in Spain and the world, so that Alicante represents a local and, at the same time, global case of the impact of the pandemic on society.

Feeling understood for the first time: experiences of participation in rehabilitation after out-of-hospital sudden cardiac arrest

AIMS

Survivors of out-of-hospital sudden cardiac arrest (SCA) may suffer from long-term cognitive, psychological, or physical post-arrest consequences impacting and disrupting daily life. To adjust to and manage daily life is critical, and therefore a tailored rehabiliation programme was introduced to the participants. The study aimed to explore the lived experience among cardiac arrest survivors.

METHODS AND RESULTS

Data were gathered through six focus group interviews during a cardiac arrest rehabilitation programme. Thirty-three out-of-hospital SCA survivors (8 women and 25 men) participated. Time since cardiac arrest was on average 12-57 months. An exploratory qualitative design inspired by Ricoeur's phenomenological hermeneutics was applied. Two main themes emerged from the analysis and interpretation: (i) a lack of support from the health system in the transition from hospital to daily life; and (ii) feeling understood for the first time. The findings revealed that out-of-hospital SCA survivors experience a knowledge gap struggling for support. Attending the programme, gaining knowledge and experiencing peer support was described as a revelation for them.

CONCLUSION

The findings suggest that out-of-hospital SCA survivors felt understood for the first time when attending a cardiac arrest rehabilitation programme. A post-arrest pathway is needed led by a coordinating cardiac arrest specialist nursing service together with allied healthcare professionals. Focus on hypoxic brain injuries, emotional burdens, and supportive strategies are essential in the transition to daily life. Facilitated peer support is warranted.

The path of compassion in forensic psychiatry

We aimed to deepen our understanding of the concept of compassion in caring for patients with mental illness in forensic psychiatric inpatient care settings. Qualitative analysis was used to illuminate themes from interviews conducted with 13 nurses in a prior study. The audiotaped interviews, which had been transcribed verbatim, were analyzed following a hermeneutic approach. Results revealed the main theme of "being compassionate in forensic psychiatry is an emotional journey" and three themes. Overall, compassion was seen as a changeable asset, but also an obstacle when absent; sensitivity to one's own vulnerability is necessary to overcome that obstacle.

Illuminating Meanings of Thriving for Persons Living in Nursing Homes

Background and Objectives

Thriving has been described as a multidimensional concept that can be used to explore place-related well-being; however, there has been limited research into the meaning of thriving in aged care. This study aimed to illuminate meanings of thriving as narrated by persons living in nursing homes.

Research Design and Methods

Narrative interviews were conducted with 21 persons residing in a rural Australian nursing home. The interviews were audio-recorded, transcribed, and interpreted using a phenomenological hermeneutic approach.

Results

Meanings of thriving could be understood as: Striving toward acceptance of being in a nursing home while maintaining a positive outlook; Feeling supported and cared for while maintaining a sense of independence; Balancing opportunities for solitude and company while living with others; and, Feeling a sense of home while residing in an institutional environment. The meanings of thriving, as presented through the interpretive lens of Gaston Bachelard’s “Poetics of Space,” encompassed having access to literal, metaphorical, and symbolic doors, as well as having the freedom to open, close, and use these doors however the person wishes.

Discussion

Exploring meanings of thriving in nursing homes could contribute towards understanding and implementing positive life-world constructs in research and practice. These findings could be used to inform and enhance person-centered care practices by maximizing opportunities for persons residing in nursing homes to have options and choices, and the agency to make decisions where possible, in relation to their everyday care and living environment.

Patient involvement in micro-decisions in intensive care

OBJECTIVE

The objective of this study was to explore how bedside micro-decisions were made between conscious patients on mechanical ventilation in intensive care and their healthcare providers.

METHODS

Using video recordings to collect data, we explored micro-decisions between 10 mechanically ventilated patients and 60 providers in interactions at the bedside. We first identified the types of micro-decisions before using an interpretative approach to analyze the decision-making processes and create prominent themes.

RESULTS

We identified six types of bedside micro-decisions; non-invited, substituted, guided, invited, shared and self-determined decisions. Three themes were identified in the decision-making processes: 1) being an observer versus a participant in treatment and care, 2) negotiating decisions about individualized care (such as tracheal suctioning or medication),and 3) balancing empowering activities with the need for energy restoration.

CONCLUSION

This study revealed that bedside decision-making processes in intensive care were characterized by a high degree of variability between and within patients. Communication barriers influenced patients' ability to express their preferences. An increased understanding of how micro-decisions occur with non-vocal patients is needed to strengthen patient participation.

PRACTICE IMPLICATIONS

We advise providers to make an effort to solicit patients' preferences when caring for critically ill patients.

Going against patients' will? A qualitative study of how palliative health-care professionals handle competing considerations when children are excluded from parental illness and death

PURPOSE

The Norwegian Health Personnel Act (HPA §10a) obliges health professionals to contribute to meeting minor children's need for information about their parents' illness and prognosis. Previous research has shown that many parents withhold information about illness and anticipated death from their children. This study explored main considerations for palliative health-care professionals in these situations, and how they negotiate conflicting considerations of confidentiality and child involvement.

METHOD

This qualitative exploratory study involved semi-structured interviews with 11 palliative health-care professionals. Hermeneutics informed the data analysis.

RESULTS

The health professionals' main considerations were sustaining patients' hope and building trust in the professional-patient relationship. Both concerns were grounded in respect for patient autonomy. The health professionals negotiated patient autonomy and child involvement in different ways, defined in the present analysis on a continuum ranging from granting full patient autonomy to going directly against patients' will.

CONCLUSIONS

The professional-patient relationship is the primary consideration in the health care context, and decision making on the degree of children's involvement happens in a dialogical process between health professionals and patients. Close professional-patient relationships might increase the emotional impacts on health professionals, who consequently might give greater relative weight to patients' will. We propose that procedures for initiating collaboration with professionals in the child's everyday life context help health professionals involving the child without threatening trust.

Meaning of Success: perception of medical students, and faculty-A Qualitative Study from a medical school in Mauritius

Background

The objective of this study was to find what undergraduate medical students and teaching faculty perceive success to be.

Methods

A descriptive phenomenological qualitative study was designed and conducted on faculty and medical students in Sir Seewoosagur Ramgoolam Medical College, Mauritius. NVivo 12 (Windows) Plus software was implemented for data analysis and thematic analysis was performed.

Results

The codes/nodes namely being: Satisfaction, Accomplishment, Actions, Motivations, Extrinsic Factors and Intrinsic Factors were identified in the transcribed data. Satisfaction was described as the positive emotions and notions intimately related as well as synonymously associated with success. Accomplishment as the attainment and fulfilment of any physical, mental, emotional, social, occupational, personal goal or desire by an individual. Actions was the arsenal of physical processes, acts of planning, goal setting or forethinking exercised by the individual. Motivations was the drive to attain the preset goal or notion be it positive or negative. This applies to factors that enable a subject to strive forwards. Extrinsic Factors were the external determinants and definition of success perceived by the subject. Intrinsic Factors were the subject's internal organic, comprehension and definition of success. The themes generated were: Products of Success, Mechanisms of Success and Concepts of success.

Conclusion

A tangible demarcation is noticeable between the preconceived general impression of success and the vast multifactorial cohort of intrinsic and extrinsic factors coupled to the highly emotional aspects which were brought forth.

Expanding hermeneutics to the world of technology

In this essay, I first analyze the extension of hermeneutical interpretation in the Heideggerian sense to products of contemporary technology which are components of our "lifeworld". Products of technology, such as airplanes, laptops, cellular phones, washing machines, or vacuum cleaners might be compared with what Heidegger calls the "Ready-to-hand" (das Zuhandene) with regard to utilitarian objects such as a hammer, planer, needle and door handle in Being and Time. Our life with our equipment, which represents the "Ready-to-hand" in Heidegger's sense of the word, is determined by temporalization (Zeitigung) which cannot be separated and isolated from the wholeness of things in the world. In the second part of my paper, I explore the positive achievement of material hermeneutics (Don Ihde) with regard to its extension to technoscience and the discussion of how such hermeneutics can contribute to the preservation of our threatened lifeworld, but also to explore the possibilities of how technical inventions, medical innovations could improve our way of life.

Theory and practice of integrative clinical ethics support: a joint experience within gender affirmative care

BACKGROUND

Clinical ethics support (CES) aims to support health care professionals in dealing with ethical issues in clinical practice. Although the prevalence of CES is increasing, it does meet challenges and pressing questions regarding implementation and organization. In this paper we present a specific way of organizing CES, which we have called integrative CES, and argue that this approach meets some of the challenges regarding implementation and organization.

METHODS

This integrative approach was developed in an iterative process, combining actual experiences in a case study in which we offered CES to a team that provides transgender health care and reflecting on the theoretical underpinnings of our work stemming from pragmatism, hermeneutics and organizational and educational sciences.

RESULTS

In this paper we describe five key characteristics of an integrative approach to CES; 1. Positioning CES more within care practices, 2. Involving new perspectives, 3. Creating co-ownership of CES, 4. Paying attention to follow up, and 5. Developing innovative CES activities through an emerging design.

CONCLUSIONS

In the discussion we compare this approach to the integrated approach to CES developed in the US and the hub and spokes strategy developed in Canada. Furthermore, we reflect on how an integrative approach to CES can help to handle some of the challenges of current CES.

Critical care nurses' lived experiences of interhospital intensive care unit-to-unit transfers: A phenomenological hermeneutical study

OBJECTIVE

To explore critical care nurses' lived experiences of transferring intensive care patients between hospitals.

METHODS

A phenomenological hermeneutic approach using data generated through individual interviews with 11 critical care registered nurses.

SETTING

Two general intensive care units in Sweden.

FINDINGS

Five themes were identified: it depends on me; your care makes a difference; being exposed; depending on interprofessional relationships; and sensing professional growth. These themes were synthesised into a comprehensive understanding showing how transferring intensive care patients between hospitals meant being on an ambivalent journey together with the patient but also on a journey within yourself in your own development and growth, where you, as a nurse, constantly are torn between contradictory feelings and experiences.

CONCLUSION

Interhospital intensive care unit-to-unit transfers can be a challenging task for critical care nurses but also an important opportunity for professional growth. During the transfer, nurses become responsible for the patient, their colleagues and the entire transfer process. In a time of an increasing number of interhospital intensive care unit-to-unit transfers, this study illuminates the risk for missed nursing care, showing that the critical care nurse has an important role in protecting the patient from harm and safeguarding dignified care.

Being active 1½ years after hip fracture: a qualitative interview study of aged adults' experiences of meaningfulness

Background

Being active is vital and a source of well-being. However, 18 months after hip fracture (HF), progress seems to have come to a halt. Aged adults may feel vulnerable, experiencing ongoing dependency and limited possibilities for socializing. How they experience the meaningfulness of being active during these circumstances is unknown. The aim of this study was to explore experiences of the meaningfulness of being active for aged adults 18 months after HF.

Methods

A phenomenological-hermeneutic methodology based on the philosophies of Heidegger and Gadamer was applied. Data were collected using individual interviews conducted in participants’ homes. The study was part of a longitudinal study, and three former interviews helped build trusting relationships with participants and focus the semi-structured interview guide. An existential theory of well-being and suffering considering health to be a balancing of mobility and dwelling was applied.

Participants were nine aged adults 65 years or older with pre-fracture dependency included in the study 18 months earlier while still in hospital after HF. The interpretation was a process of analyzing data by moving between the parts and the whole as a means of gaining a deeper understanding and continuously testing pre-understandings. The analysis followed five steps: a) getting a sense of the whole b) delineating and condensing meaning units, c) interpreting meaning units, d) relating to study purpose, and e) developing themes and sub-themes.

Results

Two main themes emerged. The main-theme “Feeling the continuity of life “had four sub-themes: “Gratitude for present possibilities, ““Connected with earlier life-experience, ““Thoughtfully managing vulnerability, “and “Belonging with other people. “The main-theme “Feeling vulnerable “had two sub-themes: “Thwarted “and “Sad and regretting lost continuity in life.“.

Conclusions

Eighteen months after HF, aged adults seem to be struggling on their own to be active in meaningful ways. To maintain hope, relieve the strain in everyday life, and maintain a sense of safety and self-confidence, they may need help. However, to avoid suffering, there is a need to balance additional training and a struggle for progress with well-being experiences in terms of feeling gratitude, restoring a sense of normality, and feeling kinship with other people.

A Narrative Approach to Spirituality and Spiritual Care in Health Care

Recent approaches to spirituality in health care suggest spirituality and meaning making are intimately connected. However, not much has been done to explore the hermeneutic and existential implications of this perspective. This article delves into these hermeneutic and existential questions, suggesting that narrative is a comprehensive phenomenon through which spirituality can be described and understood. This leads to a systematic description of spirituality, which is both defined and described herein. This article ends with a reflection on the clinical implications of this model, drawing upon both practical literature and impressions from the author's own spiritual care clinical practice.

Emotional universe of intensive care unit nurses from Spain and the United Kingdom: A hermeneutic approach

AIM

To acquire an understanding of the emotional universe of intensive care unit nurses, working in Spain and the United Kingdom.

METHODOLOGY

The study used a hermeneutic study design and was set in an academic environment. Participants included nurses with clinical experience in intensive care units. Data were collected from seven in-depth interviews, four in Spanish and three in English. The analysis followed Ricoeur's Theory of Interpretation. The affective taxonomy Universe of Emotions, served to establish starting categories in it.

FINDINGS

Six themes were identified: 1) Critical patient care, critical context; 2) Intensive care… for whom?; 3) Nursing a dying patient; 4) In the company of others; 5) But… is it worth it? and 6) Emotional labour is crucial. These all describe different, multifaceted nurses' affective journeys, through categories such as: So little time-so much to do, Relatives, Young death vs. elderly death, Poorly-valued work and I'm in the profession I want to be.

CONCLUSION

The sociocultural context shared by the Spanish and English nurses working in intensive care units generates a complex emotional universe, with opposing affective experiences, such as those related to fear, anxiety, sadness, anger, shame, love, surprise and happiness.

"Worrying About Getting Sick in the Future": Lived Experience of Health Seeking and Healthcare Utilization Among Korean Immigrant Nail Salon Workers

To understand the health and safety concerns of Korean immigrant women nail salon workers in the Greater New York City area and their experiences of health seeking and health service utilization, 20 semi-structured interviews were conducted and analyzed using interpretive hermeneutic phenomenology. Most worried about working in nail salons and experienced work-related health symptoms. However, they were disinclined toward personal protective device use because of discomfort and inconvenience. Major barriers to healthcare utilization limited their healthcare use to times when they had intolerable symptoms, preventing opportunities for regular screening tests. To overcome these limitations, workers actively sought available resources and health-related information online and through personal networks, the latter facilitated by living in a Korean community. Despite efforts to maintain their health and manage their symptoms, Korean nail salon workers worried about getting sick as they got older due to prolonged occupational chemical exposure and limited healthcare access. Appropriate education and intervention should aim to resolve current barriers to personal protective device use and healthcare use and provide a source of care for uninsured workers.

What do geriatric patients experience during an episode of delirium in acute care hospitals? : A qualitative study

BACKGROUND

Predispositions and triggers for delirium, such as noxious agents are known and behavior can be monitored; however, there is little to no information available regarding the experience of patients during delirium episodes. Not much is known about a person's world of experiences, which therefore mostly remains as a sort of black box.

OBJECTIVE

This study was motivated by the following question: "What do (Austrian) geriatric patients experience during an episode of delirium in an acute care hospital?" The main objective of this article is to present little snippets from the experiences and to allow geriatric patients to speak for themselves.

PATIENTS AND METHODS

From 2013 to 2016 interviews were carried out within the framework of a qualitative investigation. For data collection narrative interviews according to Fritz Schütze were employed and 10 interviews were conducted in a hospital setting with German-speaking Austrian patients aged between 75 and 90 years (mean age 80.2 years; 7 female and 3 male). The individual interviews lasted between 60 and 120 min. Primary data in the form of individual interpretation and interpretation groups from interview transcripts were marked and coded according to Mayring.

RESULTS

All patients who participated in the interviews subjectively recognized delirium as a negative experience. The data analysis led to three main categories with subcategories: changes in sensory perception, extraordinarily strong emotions and memories. It is important to differentiate between two very different types of memories: firstly, personal fate or life changes and secondly, those regarding experiences of war.

CONCLUSION

Scandinavian and Anglo-American literature describe different categories, such as a change in reality, strong emotions and dramatic episodes in the experience of delirium, which can be transferred to Austria. Others consider the biography of each individual patient in context with the sociocultural history of Austria, especially following developments after 1940.

Patients' perceptions of an intensive care unit diary written by relatives: A hermeneutic phenomenological study

OBJECTIVE

To explore patients' perceptions of an intensive care unit diary written by relatives including pictures added by staff.

DESIGN

Ten patients were interviewed 3-6 and 8-16 months after discharge from the intensive care unit. Most patients were interviewed with a relative present. Interviews were analysed using Ricoeur's theory of interpretation.

SETTING

Interviews took place in participants' homes.

FINDINGS

Patients found the diary written by relatives with photos taken by staff to be valuable providing information that helped them understand their time in the intensive care unit. The diary text gave patients insight into relatives' experiences and suffering. Patients were touched by the love and care conveyed in the diary, however, the diaries could overwhelm the patients when they were confronted with the grief and agony endured by their relatives.

CONCLUSION

Although diaries kept by relatives confront patients with consequences beyond their own suffering, they are informative and promote understanding of what patient and family experienced during critical illness. The diaries expressed how much the relatives cared for the patient thus paving the way for mutual support and understanding. Diaries authored by relatives represent a new element to ICU diaries that have evolved from a nursing intervention toward family participation.

Does the Diabetes Specialist Nursing workforce impact the experiences and outcomes of people with diabetes? A hermeneutic review of the evidence

OBJECTIVES

The aim of the hermeneutic review was to identify and clarify the mechanisms by which the Diabetes Specialist Nursing workforce affect the outcomes of diabetes patients, with a focus on those in the United Kingdom. A clarification of diabetes specialist nurses' work is necessary in understanding and improving diabetes inpatient care.

DESIGN

The design is a hermeneutic evidence review and was part of a wider evaluation of Diabetes Inpatient Specialist Nurses for which the evidence was sourced. The literature search was limited to specialist nursing workforce caring for adults with diabetes. In order to gain global understanding of the impact of specialist nursing in diabetes, worldwide literature was included.

METHODS

A hermeneutic literature review of 45 publications was carried out, which included citation analysis. Relevant literature was identified from 1990 to 2018.

RESULTS

Evidence suggests that Diabetes Specialist Nurses educate patients and other healthcare professionals as well as delivering direct care. The outcomes of these actions include a reduced patient length of stay in hospital, reduced inpatient harms and complications, and improved patient satisfaction. Additionally, they are cost-effective.

CONCLUSIONS

The Diabetes Specialist Nursing workforce is essential in diabetes care, particularly in hospital settings. They improve patient experience and outcomes.

Reading Heidegger

Heidegger's philosophy is a significant contribution to understanding the meaning of lived experience. Recognizing this, nurses and other health professionals have taken on the research approach of Heideggerian hermeneutic phenomenology. This requires reading the writing of Heidegger. Philosophers themselves acknowledge this writing is dense, difficult to grasp, uses language for which there is no easy translation, and leaves the reader with more questions than answers. Drawing on commentary from philosophers who seek to read Heidegger and from a research study which interviewed doctoral students who were "reading Heidegger," we seek to show the nature of the experience of pursuing such a challenging quest.

"We live as good a life as we can, in the situation we're in" - the significance of the home as perceived by persons with dementia

BACKGROUND

The coming years will see more persons with dementia living longer at home. However, "the home" is a complex concept with a multitude of meanings, varying among individuals and raising ethical and practical dilemmas in the support provided for this group. This study aims to increase the understanding of experiences and attitudes among persons with dementia related to living at home.

METHODS

Qualitative interviews were conducted with 12 persons, 69 to 89 years old, with a dementia diagnosis and living at home. Using a hermeneutical approach, the interviews were analysed as single texts, as parts of a set of texts and as a whole single text. The writings of care philosopher Kari Martinsen on "The home" were chosen as a framework for the theoretical interpretation of the findings.

RESULTS

The participants experienced a vital interconnectedness between the home and their lives, placing their home as a core foundation for life. Through stories of persisting love, they illuminated how their lived lives functioned as a foundation for their homes. Further, they described how progressing dementia disturbed rhythms of life at home, forcing them to adapt and change their routines and rhythms in life. Finally, in the hope of an enhanced future home the participants showed an acceptance of, but also a reluctance to, the prospect of having to move out of their homes at some future point.

CONCLUSION

The study suggests that the participants' home generated existential meaning for the participating persons with dementia. Their experience of being at home was based on a variety of individual factors working together in various ways. These findings imply a need to understand what factors are important for the individual, as well as how these factors interact in order to provide support for this group of people.

Rethinking the doctor-patient relationship: toward a hermeneutically-informed epistemology of medical practice

Although typically implicit, clinicians face an inherent conflict between their roles as medical healers and as providers of technical biomedicine (Scott et al. in Philos Ethics Humanit Med 4:11, 2009). This conflict arises from the tension between the physicalist model which still predominates in medical training and practice and the extra-physicalist dimensions of medical practice as epitomised in the concept of patient-centred care. More specifically, the problem is that, as grounded in a "borrowed" physicalist philosophy, the dominant "applied scientist" model exhibits a number of limitations which severely restrict its ability to underwrite the effective practice of care. Moreover, being structural in character, these problems cannot be resolved by piecemeal modifications of the existing model, nor by an appeal to evidence-based medicine (Miles in J Eval Clin Pract 15(6):887-890, 2009; Miles in Folia Med 55(1):5-24, 2013; Miles et al. in J Eval Clin Pract 14(5):621-649, 2008). Hence, the need for medical theorists to "partner with experts in the humanities to build a sui generis philosophy of medicine" (Whatley in J Eval Clin Pract 20(6):961-964, 2014, p. 961). In response, the present paper seeks to vindicate the merits of hermeneutically-informed template in providing the requisite grounding. While capable of correcting for the limitations of the applied scientist model, a hermeneutically-informed template is a "both/and" approach, which seeks to complement rather than exclude the physicalist dimension, and thereby aspires to reconcile technical mastery with patient-centred care, rather than eschew one in favour of the other. As such, it can provide a cogent philosophical template for current best practice, which does justice to the art as well as the science of medical care.

The concept of vulnerability in medical ethics and philosophy

BACKGROUND

Healthcare is permeated by phenomena of vulnerability and their ethical significance. Nonetheless, application of this concept in healthcare ethics today is largely confined to clinical research. Approaches that further elaborate the concept in order to make it suitable for healthcare as a whole thus deserve renewed attention.

METHODS

Conceptual analysis.

RESULTS

Taking up the task to make the concept of vulnerability suitable for healthcare ethics as a whole involves two challenges. Firstly, starting from the concept as it used in research ethics, a more detailed characterization and systematization of the different realms of human abilities and the various ways in which these realms contain vulnerability is to be established. Secondly, at the same time, the sought-after concept of vulnerability should avoid picturing the relation between healthcare recipient and provider as a relation between a dependent individual in need and another individual capable of providing all the help necessary. An adequate concept of vulnerability should enable one to understand when and in which respects care providers may be vulnerable as well. Philosophical accounts of vulnerability can help to meet both of these challenges.

CONCLUSIONS

Philosophical accounts of vulnerability can help to make the concept of vulnerability suitable for healthcare ethics as a whole. They come with a price, though. While the ethical role of vulnerability in medical ethics usually is to signify states of affairs that are to be diminished or overcome, philosophical accounts introduce forms of vulnerability that are regarded as valuable. Further analyzing and systematizing forms and degrees of vulnerability thus comprises the task to distinguish between amounts and types of vulnerability that can count as valuable, and amounts and types of vulnerability that are to be alleviated.

The acute stroke unit as a meaningful space: The lived experience of healthcare practitioners

This hermeneutic phenomenological study was undertaken in response to the recent re-organization of stroke unit provision in the United Kingdom. Through the analysis of four acute stroke unit practitioners' subjective accounts, the acute stroke unit emerged as a dynamic, meaningful space, where they experienced authenticity and belonging. The findings showed how these practitioners navigated their way through the space, thriving, and/or surviving its' associated vulnerabilities. They offer a different gaze on which to attend to the complexity and challenge that is interwoven with health professionals' flourishing, the spatiality of healthcare practice, and perhaps other demanding places of work.

Maternal emotions during the first three postnatal months: Gaining an hermeneutic understanding

BACKGROUND

Maternal emotions in the first three postnatal months are rarely explored yet in the German context despite it is known that they play an important role in the complexity of maternal health and well-being.

AIM

Gaining understanding of maternal emotions and how the developmental process of the infant circadian rhythm influences them during the first three months of the postnatal period.

METHODS

A Gadamerian-based research method was used to explore the experiences of 15 mothers in Germany.

FINDINGS

'Being needed' and 'being in need' emerged as the first two themes and were further explored hermeneutically. This resulted in the findings of 'emotional balance and conflicting emotions' as underlying maternal emotions during the first three months following birth.

DISCUSSION

Understanding maternal emotions during the first three months of the postnatal period has the potential of opening new pathways for improving maternal health and well-being.

CONCLUSION

A spectrum of maternal emotions, maternal uncertainties and maternal needs exists in the first three months of the postnatal period.

Interpretation and use of patient-reported outcome measures through a philosophical lens

PURPOSE

As patient-reported outcome measures (PROMs) increasingly become key outcome indicators in health care, there has been growing concern about the potential negative consequences that could result when interpretations are being made to inform clinical and policy decisions. Therefore, we explored theoretical issues, assumptions, and consequences of using PROMs from a philosophical point of view.

METHODS

Our analysis of the literature was informed by Gadamerian hermeneutics, which emphasizes the dialectical processes that occur during interpretation, to provide insights as to how different users interpret and use standardized questions about health and quality of life.

RESULTS

We structured our consideration according to three tenets of using PROMs: (1) the use of PROMs involves the interpretation of contextual elements; (2) interpretation of PROMs is an ongoing dialectical interaction; and (3) the use of PROMs involves openness and reflexivity. These findings suggest that hermeneutics provides a useful approach to examining the complexities of measuring patient-reported outcomes by attending to the perspectives of different users (e.g., patients, clinicians, administrators, and policy-makers) at the micro-, meso-, and macro-levels and the broader socio-historical and economic situation.

CONCLUSION

Because PROMs can have different meanings and are used for different purposes, we propose that hermeneutics be used as a lens to ask reflexive questions about the problems of measurement and open a pluralistic dialogue with respect to the way we use PROMs and the interpretations we make of the findings that derive from our studies.

The emotional universe of women affected by hepatitis C: A hermeneutic approach

OBJECTIVES

Understanding the emotional universe of women from Cordoba affected by hepatitis C.

METHOD

Hermeneutic qualitative study. Participants met the criteria of being adult women with a current diagnosis of hepatitis C and belonging to the Plataforma de Afectad@s por la Hepatitis C of Cordoba. The intentional sampling was nominated and followed a criterion of intensity. Data collection was conducted through in-depth interviews. The analysis took place in 3levels: Explanation, naïve understanding and in-depth understanding. In the second level, the metaphor universe of emotions was incorporated, which is a taxonomy that organizes emotions into clusters of galaxies to facilitate understanding of affective phenomena.

RESULTS

Four participants were included. Seven themes roam the galaxies in the emotional universe of women. «Damned disease» explores their disgust, sadness and shame. «Intimate affections» focuses on happiness and love as well as sadness. «Friendship-platform» focuses on understanding, welfare and affection. «Physicians» deal with distrust and disappointment regarding new treatment, and with «curing» sadness, fear, anxiety and hope. «State of ill-being» focuses on anxiety. And «universal access now» explores anger.

CONCLUSIONS

Despite the presence of love in the complex emotional universe of women with hepatitis C, anger, sadness and anxiety are highlighted. Hermeneutics of their emotions facilitates nursing care and nursing research humanization.

A hermeneutic study of integrating psychotherapist competence in postnatal child health care: nurses' perspectives

Background

There is a considerable prevalence of and an increasing attention to emotional problems in families with infants. Yet, knowledge is scant of how to create efficient and accessible mental health services for this population. The study qualitatively explored public health nurses' conceptions of a clinical project, in which psychotherapists provided short-term consultations and supervisions for nurses at Child Health Centres in Stockholm.

Methods

In-depth interviews with fifteen nurses. The guideline of the interviews contained open-ended questions that were analysed applying a hermeneutical approach.

Results

Four main themes crystallized; The nurses' conceptions of their psychosocial work, Trespassing on another professional role, Interprofessional collaboration at the Child Health Centre, and The nurses' conceptions of the psychotherapist's function. In a second step, an analysis that clustered the nurses' attitudes towards handling mental health problems yielded one last theme with three "Ideal types"; nurses who expressed "I don't want to", "I want to but I cannot", and "I want to and I can" (take care of families' emotional problems at the CHC).

Conclusion

The nurses appreciated the easy referral and accessibility to the psychotherapists, and the possibilities of learning more about perinatal mental illness and parent-infant interactions. For a successful cooperation with the nurses, the therapist should be a team member, be transparent about his/her work, and give feedback about cases in treatment. The study also shows how the organization needs to clarify its guidelines and competence to improve psychological child health care. The paper suggests improvements for an integrated perinatal mental health care.

Heidegger, communication, and healthcare

Communication between medical professionals and patients is an important aspect of therapy and patient satisfaction. Common barriers that get in the way of effective communication in this sphere include: (1) gender, age, and cultural differences; (2) physical or psychological discomfort or pain; (3) medical literacy; and (4) distraction due to technological factors or simply being overworked. The author examines these communicative barriers from a philosophical lens and then utilizes Martin Heidegger's phenomenology and hermeneutics to provide guidance for medical professional-patient interactions. The phenomenological approach espoused emphasizes the particular, contextual nature of such interactions, and thus is opposed to abstract, theoretical principles. Heidegger's hermeneutics provides a philosophical approach to communication that may guide the back-and-forth interpretation that should happen between medical professionals and patients to achieve effective communication.

Medicine and technology. Remarks on the notion of responsibility in the technology-assisted health care

The introduction of the modern diagnostic and therapeutic procedures to the medical practice provided a new challenge for the medicine. The art of medicine, with its default purpose of acting for the benefit of health, is therefore required to derive from technological progress effectively and rationally. As a result, the medical ethics has been engaged with the rules of economy and management of deficit medical procedures as well as their rational and fair distribution. The above suggests, that medics, given these recourses, should approach each patient with a consideration to their therapeutic rights. However, the physicians cannot just concentrate on the good of one particular patient, but must take into account joint responsibility for the good of a potential patient. This makes medical ethical dilemmas similar to the ethical issues of business. The notion of responsibility is the key for discriminating these two kinds of ethics.

"When illness dictates who I am": A hermeneutic approach to older adults with heart disease

BACKGROUND AND PURPOSE

Heart failure (HF) is increasing in prevalence and will continue to do so with an aging population. Few studies describe, from a lifeworld perspective, the experiences of elderly people who are very ill and living with advanced HF, and how meaning about personal dignity in daily life is created.

METHODS

Data were collected by in-depth interviews with 12 Portuguese older people with advanced HF. The transcribed texts from the interviews were analyzed using the phenomenological hermeneutical method.

FINDINGS

The results demonstrate two main themes: the perspective of oneself as vulnerable and as a significant person.

CONCLUSION

Findings demonstrate the need for health care professionals to find an approach that ensures both quality medical care and, at the same time, acknowledges the uniqueness of each subject. From the elderly people's stories, it is clear that in order to retain a sense of dignity people need to be seen and respected for who they are. The information about life stories is often used to make possible biographical oriented care.

From "The Depleted Self" to "The Will to Believe": Excavating the Hermeneutics of Donald Capps

The concept of "reframing" lies at the heart of the pastoral psychology of Donald Capps. In previous articles I have argued that the process of reframing follows a circular hermeneutics. An excavation of Capps' hermeneutics reveals foundations in the fields of philosophy and psychology. This article focuses on the legacy of Johann Gottfried von Herder, Friedrich Schleiermacher, William James and Paul Ricoeur. It explores the differences and commonalities between William James and Friedrich Schleiermacher's understanding of religious experience as well as Paul Ricoeur's understanding of narrativity and traces these strains to Capps' pastoral psychology. As illustration of his pastoral approach to healing and wholeness the problem of "the depleted self," so prevalent in "our narcissistic age," encounters the healing narrative of Jesus that appeals to "the will to believe."