Caring Science Perspective Research Articles

Semantic analysis according to Peep Koort – a substance‐oriented research methodology

The aim of this article is to describe the hermeneutic semantic analysis created by professor Peep Koort (1920-1977) and to discuss it as a methodology for research within caring science. The methodology is developed with a hermeneutic approach that differs from the traditions of semantic analysis in philosophy or linguistics. The research objects are core concepts and theoretical constructs (originally within the academic discipline of education science, later on within the academic discipline of caring science), focusing deeper understanding of essential meaning content when developing a discipline. The qualitative methodology of hermeneutic semantic analysis is described step by step as created by Koort, interpreted and developed by the authors. An etymological investigation and an analysis of synonymy between related concepts within a conceptual family guides the researcher to understand and discriminate conceptual dimensions of meaning content connected to the word studied, thus giving opportunities to summarise it in a theoretical definition, a discovery that can be tested in varying contexts. From a caring science perspective, we find the hermeneutic methodology of semantic analysis fruitful and suitable for researchers developing their understanding of core concepts and theoretical constructs connected to the development of the academic discipline.

Out of the wave: the meaning of suffering and relieved suffering for survivors of the tsunami catastrophe. An hermeneutic-phenomenological study of TV-interviews one year after the tsunami catastrophe, 2004

The tsunami catastrophe, 26th December 2004, is one of a number of catastrophes that has stricken mankind. Climate reports forecast that natural disasters will increase in number in the future. Research on human suffering after a major catastrophe, using a caring science perspective, is scarce. The aim of the study was to explore the meaning of suffering and relieved suffering of survivors of the tsunami catastrophe, 26th December 2004. An explorative study design, inspired by the French philosopher Paul Ricoeur's hermeneutic-phenomenology, was used. Interviews made by the Swedish Television (SVT) in connection with the 1 year anniversary were carried out on site in the disaster area and in Sweden. The text analysis revealed four main themes: 'An incomprehensible event', 'A heavy burden', 'Help that helps', and to 'Being changed in a changed life situation'. The findings were mainly interpreted in light of Paul Ricoeur's thinking on suffering, quilt, forgiveness, time and narrative. The first year after the loss of loved ones in the tsunami catastrophe, 2004, was like starting an inner as well as an outer journey. This journey was experienced as living with the heavy burden of an incomprehensible event. Help that helped was mediated by consolers who endured the suffering of the other. An 'enduring courage' is a key moral virtue to encounter the alienation of the sufferer and how it in turn alienates from the sufferer. It is also important to recognize that the complexity of the world of those who have lost loved ones in major catastrophes includes possibilities for reconciliation with the loss. The reconciliation creates hope that opens up for being changed in a changed life situation.

Breastfeeding: An existential challenge—women's lived experiences of initiating breastfeeding within the context of early home discharge in Sweden

For most Swedish women, breastfeeding is an essential part of the childbearing period. Yet, the meaning of breastfeeding from women's perspective is scantily explored. Therefore, the aim of this study is to describe women's lived experiences of initiating breastfeeding within the context of early home discharge. Eight women, two primiparous, and six multiparous were interviewed within 2 months after birth. A reflective lifeworld research design based on phenomenological philosophy was used during the data gathering and data analysis. The results show that the phenomenon, initiating breastfeeding, in spite of good conditions, i.e., early home discharge, is complex and entails an existential challenge. The essential meaning of the phenomenon is conceptualized as, “A movement from a bodily performance to an embodied relation with the infant and oneself as a mother.” This pattern is further described in its five constituents: “Fascination in the first encounter,” “Balancing the unknown,” “Devoting oneself and enduring the situation,” “Seeking confirmation in the unique,” and “Having the entire responsibility.” Caring for women initiating breastfeeding entails, from a caring science perspective, to help the mother meet insecurity and strengthen confidence to trust her ability to breastfeed the newborn infant. According to these findings, it is suggested in the discussion that it is time for health care professionals to reject the idea of breastfeeding merely as meals or eating for the infant. Instead, they ought to embrace its origin, namely as a way to closeness between mother and infant.

Janice Morse' Theory of Suffering — a Discussion in a Caring Science Perspective

This article is based on a literature study. The purpose of the article is to discuss Janice Morse' theory of suffering in a caring science perspective, and thereby contribute to increased understanding of suffering from both a nursing science and a caring science perspective. The interpretive framework includes Katie Eriksson's theory of suffering and the fundamental ontological assumptions forming the basis of the caring science perspective. The following research questions are posed with regard to the text: What are the most important elements of the theory? What is the theory's field? What is the theory's image of reality? A hermeneutic approach is used as method. The discussion illustrates differences between Morse and Eriksson's theories of suffering with regard to both content and structure. Morse has carried out an extensive scientific work on suffering in the contextual area, while Eriksson has her focus on the ontological area. Each in their own fashion gives us a unique contribution to the discussion and development of knowledge about the phenomenon of suffering.

Anthroposophic health care – different and home‐like

Anthroposophic health care is rooted in the work of Steiner and Wegman in Switzerland during the 1920s. The Swedish hospital in this study offers integrated conventional and anthroposophic health care therapies which are conceptualized as an extended and integrative variant of health care and not as CAM. In anthroposophic care, health is viewed as a matter of body, soul and spirit in balance. Therapeutic resources include nursing care, therapeutic conduct (art and body therapies) and medicines based on natural remedies. This study aims to deepen the understanding of what constitutes good care from a patient's perspective to alleviate patients' suffering and to identify clinical markers for good care. As anthroposophic care is associated with theory and holistic ideas, this study aims at exploring whether or not anthroposophic care has a beneficial effect. A qualitative method was used, and the analysis was conducted with a phenomenological hermeneutic approach. Sixteen former patients, of whom nine were diagnosed with various kinds of cancer and seven with burnout syndrome, were interviewed regarding their experience of anthroposophic care. Patients especially noted the benefits of the holistic caring environment; the empathetic approach and true caring offered, as well as the peaceful atmosphere and rest. A turning point or shift in perspectives, implying a home coming in relation to inner aspects was discussed as an outcome. Although patients in general were overwhelmingly impressed and positive they were also ambivalent. One interpretation is that there is a gap between the anthroposophic and conventional paradigm that affects patients negatively. As mutual scepticism still prevents any real integration between integrative and conventional care, the onus appears to be on the patient to take the risk and act as bridge-builder. From a caring science perspective, the study shows that appropriation of specific values and theory makes it possible to create a true caring culture.

The Tune of Confirmation in Guiding Nurse Students

The purpose of the article is to provide a deeper understanding of the guidance of nursing students from a caring science perspective. The methodological approach is Gadamerian (2004) hermeneutics. Interviews are used in sampling and analyzing data (Kvale, 1996). The main findings were confirmation, reflection, and authority. This article focuses on the phenomenon of confirmation only. The main aspects of confirmation are that it includes genuine interest and care, makes nursing students feel secure and is a key to development, strengthens the relationship in a group and between individuals, and is a good base for reflection.

A student-centered clinical educational unit – Description of a reflective learning model

This article describes a model of a student-centered Clinical Education Unit (CEU) within an undergraduate nursing education programme. The model comprises three various levels of learning in the nursing education programme at School of Health Sciences, University College of Borås, Sweden. The three levels of learning correspond to the first, second and third programme years of the nursing education. Each level of learning is represented by clinical training in three different hospital care settings. The educational model was developed through a co-operation between hospital representatives and nurse educators at the university college. The model is built on a human caring science perspective and knowledge that focuses on patients' lived experience of their care and illness. The model emphasises collaboration in communion between students, hospital and faculty members as an alternative to bridge the gap between theory and practice in nursing. Reflection and critical thinking are the vital components in a clinical learning environment.

Support as experienced by men living with heart failure in middle age: A phenomenological study

Background Men living with heart failure (HF) in middle-age experience restrictions limiting their work capacity and/or social activities. To adjust to the life-situation they need support. The meaning of the phenomenon of support is not well known. Thus, formal carers may find it problematic to know how to support patients. Aim The aim of the current study was to uncover and describe the meaning of the phenomenon of support as experienced by men living with HF in middle age. Design The study used a caring science perspective and a reflective lifeworld approach based on phenomenological philosophy. Participants and settings Nine men, aged 49–64 years and diagnosed with HF, were recruited from two outpatient HF clinics in Sweden. Methods Interviews were used for data gathering. Data were analyzed by means of reflective lifeworld research. Findings The essence of support as experienced by men living with HF in middle age can be understood as security, and a sense of having control over body and situation. Support is realized in the men's relations to other people; there is however tension between what is supportive and what is not, meaning that even though intentions are good, intended support involves limitations, uncertainties or insecurity. The essence is illuminated by the following meaning constitutes: Support—a tenuous security; Medications—a support for life; Conditional support within the context of formal care; and, Information and knowledge. Conclusions The meaning of support as experienced by men living with HF in middle age is multi-dimensional, qualitative and contextual. When the men are supported they gain a sense of security and control, giving them strength to handle their life-situation. A lifeworld-led approach in the context of formal care can help formal carers support men living with HF in middle age.

Family suffering related to war experiences: an interpretative synopsis review of the literature from a caring science perspective

The aim of this study was to conduct a synopsis review of findings from families' experiences related to combat and war events and to interpret these findings from the perspective of theories of suffering. The method used in the study was a synopsis review of 12 articles dealing with family suffering related to war or combat experiences and an interpretation of the articles from a caring science perspective. Findings from the synopsis review were that the dominant part of the articles viewed suffering in general and post-traumatic stress disorders (PTSD) in particular from a medical, psychiatric or psychologically behaviouristic perspective. PTSD and other distress-related conditions were mainly described in terms of their symptoms and dealt with in terms of pathology. The interpretation of the articles from a caring science perspective generated three significant themes: first, interdependence as a spiritual dimension of dependence, secondly, familial communion as sharing moral and spiritual values and thirdly, familial suffering visualized by compassion. The study's conclusion is that, from a caring science perspective, the appearance of family suffering should be comprehended in terms of expressed compassion and that any disturbance within familial communion is likely to have an emotional impact on all of the family members, as a result of their interdependence.

Power as Authority—Concept Determination from a Christian and a Caring Science Perspective

The aim was to deepen the understanding and the knowledge of the concepts and phenomena of power and authority from the standpoint of caring science. An ontological determination of the character of the concepts is carried out where a hermeneutic interpretation is made of texts in the Old and the New Testaments in the Bible. The findings show how a human being’s power is the authority to hold every living thing in trust, to tend to and care for life. Serving one’s fellow-being is the purpose for anyone using this authority.

Empowerment and Authorization – Who Provides and Who Receives? A Qualitative Meta-Study of Empowerment in Nursing Research: A Caring Science Perspective

The findings show how different conceptions of power occur within nursing science, differences that can be interpreted as different views of human beings and ethics. Among the advocates of empowerment in caring, there is a desire to eliminate the difference in power between nurse and patient. The relationship between nurse and patient becomes mutual through the patient’s participation in and responsibility for his/her own care. But from a caring science perspective, a caring relationship is not mutual since nurse and patient cannot change places due to being on different levels nor can responsibility be delegated from nurse to patient.

Caritative leadership. Ministering to the patients.

A theory of ontological nature in caring administration has been developed from a Caring science perspective. Caritative leadership is named according to the motive, human love, and mercy, and its main idea is ministering to the patients. It consists of 5 theses in relation to the view of the human being: the caritas motive, dignity, measurement and meaning in health care, and the relationships in the caring culture. Without a clear vision of what care of the patients could be, there is the risk that ministering to the patient is lost in the demands of different stakeholders. The connection between caring and administration is the suffering patient with implications for caring administration.

Professional Assessment of Optimal Nursing Care Intensity Level

In the article a new method is presented for allocation of staff resources, 'Professional Assessment of Optimal Nursing Care Intensity Level' (PAONCIL). This method is presented as an alternative to classical time study, which has traditionally been considered to belong to systems for patient classification. By means of this method the optimal nursing care intensity level for individual wards can be established. The study comprised 8 wards, and the nurses working in these wards provided a total of 8,458 professional assessments of optimal nursing care intensity levels. The material was analysed by means of simple linear regression analysis. The nursing care intensity scores per nurse in a single ward were used as independent variables and the average PAONCIL score for the same calendar day was used as a dependent variable. The average determination coefficient for different wards were 0.37; the PAONCIL instrument thus explained 37% of the nursing care intensity/nurse variation. This corresponded to a linear correlation of 0.60. In five out of six wards for adults the optimal nursing care intensity/nurse scores were close to each other, ranging from 3.0 to 3.6. The advantage of the PAONCIL method is that it can be easily implemented in a ward, can be used time and again, is advantageous and is based on quality aspects. The PAONCIL method has been developed on the basis of a caring science perspective and can be seen as an administrative method for the nurse manager, with whose help 'good care' can become possible.

The importance of ethics in the clinical supervision of nursing students.

This article investigates whether or not an ethical attitude manifests itself in the clinical supervision of nursing students. The data consist of 57 narratives written by nursing students, which were subjected to latent content analysis. The interpretation represents a caring science perspective based on Eriksson's 'caring ethics'. The results showed that some students received good supervision, while others felt hurt and humiliated. The students were of the opinion that they should feel welcome, be allowed to take responsibility and be treated as individuals by their supervisors. Supervision can take a form such that the ethical element comes to the fore in the conduct of the students as well as of their supervisor. Both the students' and the supervisor's disposition permeates all the questions, actions and reflections that form part of supervision, which could help to bring students' ethical sense to maturity.

Measuring the unmeasurable: a caring science perspective on patient classification.

To give a short historical survey of patient classification and its motives, to analyse patient classification and especially the instrument, The Oulu Patient Classification more closely from a caring science perspective. A survey of topical literature and research on patient classification show that economic and administrative justifications predominate and the caring science connection is weak, almost non-existent. Topical literature and research on patient classification and the instrument, The Oulu Patient Classification. Topical literature and research were evaluated from a caring science perspective in accordance with Eriksson's theory of caring and the basic concept of man as an entity of body, soul and spirit. Patient classification is used in staff planning and is also justified from the viewpoint of content, that is, as a method of guaranteeing good quality in the care of patients and as an expression of the prevalent caring ideology. The concept of man is reduced in current literature and research on patient classification. The Oulu Patient Classification is based on a humanistic view of man, but man's spiritual and existential needs do not emerge clearly from the manual of the instrument. It is essential for patient classification to start from a caring perspective. Correctly dimensioned staffing based on patient classification is a prerequisite for good care. This should be combined with a caring culture that considers the whole complexity of man in order to make good care possible.