Phenomenological Hermeneutic Method Research Articles

Health Is Belonging: Lived Experiences during Recovery after Pancreaticoduodenectomy.

The aim of this study was to explore the lived experience of the symptoms, health, and illness reported by patients recovering after pancreaticoduodenectomy ad modum Whipple due to pancreatic or periampullary cancer. Thirteen patients with pancreatic or periampullary cancer who underwent pancreaticoduodenectomy ad modum Whipple between 2006 and 2008 were interviewed during postoperative recovery. Data were analysed using the phenomenological-hermeneutic method. The structural analysis of patient experiences revealed that recovery after pancreaticoduodenectomy was described as recapturing everyday life, being healthy, and looking to the future. Participants experienced symptoms but did not dwell on them, instead they stated that their general health was good. They strived to regain their former precancer selves and be a part of as well as contribute to the social context. Overall, the participants' view of the future was positive, and improvement in their health generated further confidence and encouragement. This study suggests that persons recovering from pancreaticoduodenectomy ad modum Whipple due to a pancreatic or periampullary tumour experience health despite postoperative symptoms. They manage their symptoms by means of different strategies and express a positive view of the future. Nurses working with such patients should adopt a person-centred approach focusing on patient perspectives, participation, and possibilities.

Living an unstable everyday life while attempting to perform normality – the meaning of living as an alcohol‐dependent woman

To illuminate the meaning of living with alcohol dependency as a woman. The number of women suffering from alcohol dependency is increasing. Today there are shortcomings in knowledge about the lived experiences of being a woman with alcohol dependency; knowledge which might be of importance for meeting these women's specific needs of care. The study has a qualitative design. Fourteen women with alcohol dependency participated in open in-depth interviews. Data were analysed according to a phenomenological-hermeneutic method, and interpreted by help from gender and caring perspectives as well as results from previous research of alcohol dependency. In relation to the women's senses of well-being, four main gender formations were found; An unstable self involving continual and rapid swings between emotional and bodily reactions. Ambivalence - meaning ambiguous feelings towards themselves as human beings and how they lead their lives. Introspectiveness - involving reflections, pondering and being introverted. Attempts to perform normality - covering - dealing with life through various strategies and facades to live up to the expectations of how to behave as a woman. Living with alcohol dependency as a woman constitutes of a rapid shifting everyday life resulting in senses of alienation as well as private introspection leading to self-degradation, and to a lesser extent meaningfulness and hope. It also constitutes of managing to perform normality. When supporting women with alcohol dependency towards wellbeing, professionals need to work towards approaching the woman's inner thoughts, share them and reflect over them together. To support these women to find balance in life, caregivers need to cooperate with the women to find out how best to live a life adjusted to the woman's abilities and wishes.

The experience of being a female carrier of haemophilia and the mother of a haemophilic child

Limited research has been conducted on how the female carrier experiences her life with a haemophilic child, and earlier studies are mostly questionnaire-based. No previous qualitative study on the female carrier's situation has been conducted in Sweden. The aim of the study was to describe the lived experience of being a carrier of severe or moderate haemophilia and of being the mother of a haemophilic child. The study was conducted via qualitative interviews and analysed by means of a phenomenological hermeneutic method; a total of 13 haemophilia carriers were interviewed in 2010. Being a carrier of haemophilia and having a haemophilic child was life changing. The women moved from a state of sad, guilty chaos to reconciling themselves with the new situation. Our analysis revealed three acts in which phenomena appeared: the time after diagnosis, the turning point and reconciliation with a changing life. Emerging as crucial to the process of reconciliation with a changing life was a sense of being fully informed and supported. The Haemophilia Treatment Centre (HTC) should create an environment that encourages learning, and the team should invite and encourage the woman's partner to be actively involved in the child's care. Moreover, the results indicate that it would be beneficial to invite female carriers to receive patient education at the HTC before they plan to start a family. During this visit, the woman may gain a greater understanding of her carriership to prepare her for future decisions concerning prenatal diagnosis, for example.

Tactile massage and healing touch –caring touch for patients in emergency care – a qualitative study

Abstract Aim This study aimed to explore the patient's lived experience of receiving caring touch after sustaining an acute illness or disease while being cared for in a short-term emergency ward. Background Admissions to short-term emergency ward for an acute illness or disease is often associated with increased stress, anxiety and pain. The caring touch in focus in this study is tactile massage and healing touch. A complementary treatment of tactile massage or healing touch was offered to patients to complement their routine nursing care. Methods This study has a qualitative interpretive design that explored two complementary approaches. Twenty-five patients (16 women and 9 men) admitted to the short-term emergency ward for acute conditions agreed to participate in the study and were individually interviewed. Data were collected from between January and May 2011. Data was analysed using a phenomenological-hermeneutical method. Results The patients’ lived experience indicated that caring touch resulted in an existential togetherness characterised by a nonverbal peacefulness, trust, consolation, safety, and a restoration of what it means to be a being human. However, some patients also expressed ambivalence towards caring touch. There also seemed to be a fine line between feelings of intimacy, sensuality, and sexuality, especially among the male patients. Conclusion In the presence of an acute illness or disease, caring touch may provide trust and consolation for the patient's body and soul which may help to restore his or her integrity. The complexity of intimacy is an aspect that needs further study.

Time ethics for persons with dementia in care homes

The purpose of this study was to explore situations experienced by 12 health-care providers working in two nursing homes. Individual interviews, using a narrative approach, were conducted. A phenomenological-hermeneutical method, developed for researching life experiences, was applied in the analysis. The findings showed that good care situations are experienced when the time culture is flexible, the carers act in a sovereign time rhythm, not mentioning clock time or time as a stress factor. The results are discussed in terms of anthropological and sociological theory: time as event and action and flexible time cultures. Care settings for persons with dementia represent many challenges, such as a heavy workload and time strain. Time ethics is a construction, understanding time used in caring for persons suffering from dementia, which involves a mature, responsible and flexible nursing approach to these patients.

Older people’s dependence on caregivers’ help in their own homes and their lived experiences of their opportunity to make independent decisions

The aim of this study was to illuminate the meaning of older people's dependence on caregivers' help, and of their opportunity to make independent decisions. Throughout the world, the older population is growing, and in Sweden, the system of care for older people is currently undergoing change. Older people in the need of care are expected to live at home for as long as possible. A qualitative and life world approach was used. Audio-taped interviews were conducted with twelve older persons living at home, dependent on daily municipal home help service. A phenomenological hermeneutic method was utilised to disclose the meanings of lived experiences. The findings revealed three themes: being facilitated to make one's own decisions, being hindered from making one's own decisions, struggling for vs. resigning oneself to losing the opportunity to make one's own decisions. The comprehensive understanding revealed that as older people become more dependent on caregivers' help, their opportunity to self-determine is challenged and this is stressful for them. The older persons assess their opportunity to self-determine differently, depending on who they are as a person. The caregivers need an awareness of this, and further research is needed to gain knowledge and understanding of how caregivers can improve the way they support and enhance older people's opportunity to decide for themselves. The findings revealed older persons need to exercise more self-determination and caregivers' need for knowledge to enable this. Further, it indicates a move towards a person-centred approach to focus on persons as individuals and see them as interdependent. The findings contribute to improvements in similar contexts worldwide.

Walking on the edge: meanings of living in an ageing body and using a walker in everyday life – a phenomenological hermeneutic study

In order to maintain one's state of health whilst growing older, the ability to walk is essential. The aim of this study was to illuminate the meanings of the lived experience of living in an ageing body and using a walker in daily life. Narrative interviews were performed with seven older persons aged 79-95 years. The transcribed text was analysed using a phenomenological hermeneutic method. The key finding of the study was that the lived experience of living in an ageing body and using a walker in daily life was interpreted as 'walking on the edge' based on the themes 'Being vulnerable and dependent' and 'Being confident and independent'. The results highlight the importance of reflecting on this phenomenon as a health care professional while meeting the care needs of older persons who use walkers. Nurses need to consider the walker as a personal and valued possession of the individual and handle the walker in agreement with the older person, placing the walker close at hand with the brakes locked to give secure support.

Daily life for chronically ill oldest old persons

In the past, the study of old age often focused on the losses and problems associated with ageing. In recent times, the focus has been on the positive aspects, such as quality of life, inner strength, and enjoying life. The aims of this study were to highlight the ways in which chronically ill older persons experience the meaning of daily life and to understand what it means to live at home with chronic disease. In-depth interviews were used to illustrate individual experiences. The sample consisted of 13 chronically ill persons, aged 80 to 94 years, living at home and receiving assistance in the form of home nursing care. Data were analyzed using the phenomenological hermeneutical method. After a naïve reading and a structural analysis of the text, we identified three themes: <em>being insufficient</em>, <em>becoming dependent</em>, and <em>enjoying life</em>. The comprehensive understanding suggested that daily life involved <em>bad days</em>, described as illness with dysfunctions, limited energy, and dependency on others. Daily life also had its positive aspects, described as <em>enjoying life</em>. Dignity was threatened by feelings of being a burden to others and was affirmed by experiencing a will to live. It was concluded that <em>bad days</em> with experiences of suffering and <em>good days</em> that provided the older with experiences of enjoying life could help them meet adversity through qualities of resilience that gave meaning to daily life and helped them to think positively in times of greater difficulty.

Nurses lived experiences of conscience reaction: a qualitative phenomenological study

Background and objectives: Conscience is a cornerstone of ethics, affecting both our private and professional lives. Everyday health care practice raises questions about conscience and how to understand its role. Conscience has also been described as inducing self-growth and protecting personal integrity. Nurses views on their reactions to behaviors consistent or contrary to conscience could therefore help us to understand the meaning of the reactions of conscience. This study aimed to illuminate meanings of nurses lived experience of conscience reaction in their daily practices.Material and methods: Interviews with nine nurses were interpreted using a phenomenological hermeneutic (Colaizzi, 1978) method. Data was collected in 2010 among nurses working in various hospitals in Kermanshah. The nurses were selected for participation purposively.Results: The nurses lived experience of conscience reaction was formulated in three themes and ten sub-themes. The first theme is ‘being peace, which includes three sub-themes: Being calm, being pleased, and being satisfying. The second theme is ‘trouble conscience’ which includes four subthemes: guilt, thinking engagement, discomfort, and fretfulness. The third theme is responding which includes three sub-themes: expressing, compensation, and lack of repeat.Conclusions: The nurses lived experience of conscience reaction showed that nurses considered conscience reaction to be an important factor in the exercise of their profession, as revealed by the descriptive categories: being peace when they act consistent with conscience; trouble conscience when they act contrary on conscience; and responding after doing an anti conscience practice. They perceived that conscience played a role in nursing actions involving patients and next of kin, and guided them in their efforts to provide high quality care. DOI: http://dx.doi.org/10.3329/bioethics.v2i3.10257Bangladesh Journal of Bioethics 2011;2(3):3-9

Learning to live with diabetes – integrating an illness or objectifying a disease

This paper is a report of a study of illuminating the meaning of 'learning to live with diabetes' 3 years after being diagnosed. A changed situation, for example, in relation to living with diabetes, raises a need to understand. How time for experience contributes to this learning process for people living with diabetes is not yet well understood. It would therefore seem valuable to ask people, who have had diabetes over a similar length of time, to narrate their experience in relation to daily life situations in order to understand better how learning is established. The study has a qualitative design. A life world approach was used, with interviews being conducted with 13 people who had been diagnosed with diabetes 3 years earlier. Data were collected in 2007, and analyses were conducted using a phenomenological-hermeneutic method. How a person experiences the physical body was found to be crucial in the learning process. If the body with its signals is understood it can be a tool for experiencing and understanding the world and oneself. Feeling insecure about one's own needs, and not trusting or understanding bodily signs, made participants dependent on others to make decisions for them. This study showed that duration of illness was 'not' of importance for the understanding of living with diabetes. Living with diabetes 3 years after being diagnosed meant to experience both an overall balance in one's existence and a daily struggle.

Stressing Reproduction: Reading Into Parents of Disabled Children

What does is mean to be the parent of a disabled child? This article explores assumptions which permeate the author's encounter with of a prominent Canadian newspaper text on "stress". Through a hermeneutic phenomenological method, the author opens up broader cultural meanings that contribute to and rely upon the category of "parents of disabled children". In particular, the author explores the prescriptions presented on disability, race, class, gender, nationality, and sexuality which emerge in the reading process. Additionally, the author considers how medico-scientific authority is asserted in this textual encounter, and examines the historical grounding of such interpretive moves. Keywordsstress, parents, mothers, fathers, history, disability, gender, nation, race, class, sexuality, reproduction, children

Primary Care Providers' experiences with Pharmaceutical Care-based Medication Therapy Management Services

This study explored primary care providers' (PCPs) experiences with the practice of pharmaceutical care-based medication therapy management (MTM). Qualitative, semi-structured interviews were conducted with six PCPs who have experiences working with MTM pharmacists for at least three years. The first author conducted the interviews that were audio-taped, transcribed, and coded independently. The codes were then harmonized via discussion and consensus with the other authors. Data were analyzed for themes using the hermeneutic-phenomenological method as proposed by Max van Manen. Three men and three women were interviewed. On average, the interviewees have worked with MTM pharmacists for seven years. The six (6) themes uncovered from the interviews included: (1) "MTM is just part of our team approach to the practice of medicine": MTM as an integral part of PCPs' practices; (2) "Frankly it's education for the patient but it's also education for me": MTM services as a source of education; (3) "It's not exactly just the pharmacist that passes out the medicines at the pharmacy": The MTM practitioner is different from the dispensing pharmacist; (4) "So, less reactive, cleaning up the mess, and more proactive and catching things before they become so involved": MTM services as preventative health care efforts; (5)"I think that time is the big thing": MTM pharmacists spend more time with patients; (6) "There's an access piece, there's an availability piece, there's a finance piece": MTM services are underutilized at the clinics. In conclusion, PCPs value having MTM pharmacists as part of their team in ambulatory clinics. MTM pharmacists are considered an important source of education to patients as well as to providers as they are seen as having a unique body of knowledge äóñmedication expertise. All PCPs highly treasure the time and education provided by the MTM pharmacists, their ability to manage and adjust patients' medications, and their capability to address patients' medication experiences. MTM pharmacists are seen as being different from dispensing pharmacists, and PCPs usually highlight that difference to patients as they refer them to MTM services. Lastly, it is apparent that MTM pharmacists struggle to explain what their role is within the healthcare team and they need to find a more effective way to explain the unique value they add to the care of patients.
 
 Type: Original Research

Experience of being a low priority patient during waiting time at an emergency department

BackgroundWork in the emergency department is characterized by fast and efficient medical efforts to save lives, but can also involve a long waiting time for patients. Patients are given a priority rating upon their arrival in the clinic based on the seriousness of their problem, and nursing care for lower priority patients is given a lower prioritization. Regardless of their medical prioritization, all patients have a right to expect good nursing care while they are waiting. The purpose of this study was to illustrate the experience of the low prioritized patient during their waiting time in the emergency department.MethodsA phenomenological hermeneutic research method was used to analyze an interview transcript. Data collection consisted of narrative interviews. The interviewees were 14 patients who had waited more than three hours for surgical, orthopedic, or other medical care.ResultsThe findings resulted in four different themes, ie, being dependent on care, being exposed, being vulnerable, and being secure. Lower priority patients are not paid as much attention by nursing staff. Patients reported feeling powerless, insulted, and humiliated when their care was delayed without their understanding what was happening to them. Not understanding results in exposure that violates self-esteem.ConclusionThe goal of the health care provider must be to minimize and prevent suffering, prevent feelings of vulnerability, and to create conditions for optimal patient well being.

Struggling for existence—Life situation experiences of older persons with mental disorders

Older persons with mental disorders represent a vulnerable group of people with extensive and complex needs. The older population is rapidly increasing worldwide and, as a result of deinstitutionalization in mental health care, older persons are remaining at home to a greater extent. Although they constitute a large proportion of the population, older persons with mental disorders have been neglected in research as well as in care organizations. As there is little previous knowledge concerning older persons’ experiences of their own situations, this study aimed to illuminate the meaning of the life situation as experienced by older persons with mental disorders (excluding dementia disorders). Interviews were conducted with seven older persons and the text was analyzed using a phenomenological hermeneutical research method, inspired by the philosophy of Paul Ricoeur. “Struggling for existence” emerged as a main theme in the older persons’ narratives, understood as a loss of dignity of identity and involving being troubled and powerless as well as yearning for respect. The older persons fought to master their existence and to be seen for who they are. The study highlights the importance for caregivers, both formal and informal, to avoid focusing on the diagnoses and rather acknowledge the older persons and their lifeworld, be present in the relation and help them rebuild their dignity of identity. This study brings a new understanding about older persons with mental disorders that may help reduce stigma and contribute to planning future mental health care.

Life situation and identity among single older home-living people: A phenomenological–hermeneutic study

Being able to continue living in their own home as long as possible is the general preference for many older people, and this is also in line with the public policy in the Nordic countries. The aim of this study was to elucidate the meaning of self-care and health for perception of life situation and identity among single-living older individuals in rural areas in southern Norway. Eleven older persons with a mean age of 78 years were interviewed and encouraged to narrate their self-care and health experiences. The interviews were audio taped, transcribed verbatim and analysed using a phenomenological–hermeneutic method inspired by the philosophy of Ricoeur. The findings are presented as a naïve reading, an inductive structural analysis characterized by two main themes; i.e., “being able to do” and “being able to be”, and a comprehensive interpretation. The life situation of the interviewed single-living older individuals in rural areas in southern Norway was interpreted as inevitable, appropriate and meaningful. Their identity was constituted by their freedom and self-chosen actions in their personal contexts. The overall impression was that independence and the ability to control and govern their own life in accordance with needs and preferences were ultimate goals for the study participants.

The lived experiences of adult intensive care patients who were conscious during mechanical ventilation: A phenomenological-hermeneutic study

The aim of this study was to illuminate the lived experience of patients who were conscious during mechanical ventilation in an intensive care unit (ICU). Interviews with 12 patients assessed as being conscious during mechanical ventilation were conducted approximately one week after discharge from an ICU. The text was analysed using a phenomenological-hermeneutic method inspired by Ricoeur. Apart from breathlessness, voicelessness was considered the worst experience. The discomfort and pain caused by the tracheal tube was considerable. A feeling of being helpless, deserted and powerless because of their serious physical condition and inability to talk prompted the patients to strive for independence and recovery and made them willing to 'flow with' the treatment and care. Comments from the patients suggest that their suffering can be alleviated by communication, participation in care activities and companionship. A patient's endurance whilst conscious during mechanical ventilation seems to be facilitated by the presence of nurses, who mediate hope and belief in recovery, strengthening the patient's will to fight for recovery and survival.

A qualitative study on the role of patient–nurse communication in acute cardiac care

Background: This study aimed to illuminate the meaning of the patient–nurse communication during a hospital stay as narrated by patients after a myocardial infarction (MI). Methods: Narrative interviews from 10 patients were analyzed, using a phenomenological-hermeneutic method. Results: The nursing dialogue meant a safe mooring point on the trajectory from initial chaos after a MI to a reoriented life. Nurses’ presence and availability for non-verbal and verbal communication created a trustful relationship where new knowledge was acquired and motivational strength for life-style changes was mobilized. A person-centered perspective was preferred, where relatives were invited into the conversation. Conclusions: These results highlight that patient–nurse communication based on the patient’s view is possible in acute care after MI, and is an issue of attitude rather than time. Trust lays the foundation for a person-centered communication and is developed through the nurse’s presence and availability not only in the emergency phase, but throughout hospitalization. Discussions focused on personal action plans with emphasis on the patient’s health assets may facilitate a successful rehabilitation.

Paramedic clinical decision-making in mental health care: a new theoretical approach

This article aims to present a new theoretical approach for examining paramedic clinical decision-making in relation to mental health care. Recent theorizing has begun exploring key clinical decision-making approaches that are particularly relevant to paramedic practice. These approaches have also revealed some important factors that influence clinical decision-making behaviours among paramedics such as prior experience and clinical and tacit knowledge. The literature, however, provides very little insight into the clinical decision-making strategies paramedics draw on and use when dealing with mental health patients, in particular, those patients who are dealt with under involuntary provisions of mental health legislation. In addition, the literature provides limited coverage to account for how paramedics deal with and mitigate risk factors relating to patients experiencing a mental health emergency. Following these shortcomings, this article will propose the use of hermeneutic phenomenological methods as a suitable and innovative interpretive research approach for examining paramedic clinical decision-making in relation to prehospital mental health care. It is argued that this approach is well suited for exploring how paramedics make sense of their experience providing emergency mental health care, how they perceive their role within the clinician-patient relationship, and the particular circumstances in which paramedics exercise their legislative responsibilities under mental health legislation.

Migraine – more than a headache: women’s experiences of living with migraine

Purpose: In this qualitative study the aim was to explore the meaning of living with migraine. Methods: In-depth interviews were conducted with ten women about their experience of living with migraine. Halfway through the interview, the women drew a picture of what living with migraine is like, and the interview continued with the conversation being guided by the picture. The interviews were analyzed using a hermeneutic phenomenological method inspired by van Manen. Results: The analysis revealed an essence “Being obliged to endure a life accompanied by an unpredictable and invisible disorder” and three themes “Being besieged by an attack”, “Struggling in a life characterized by uncertainty” and “Living with an invisible disorder.” Conclusions: Migraine is a debilitating disorder which accompanies life in the sense that it or the threat of its return is always present, and yet invisible to others. The struggle of enduring life with migraine is worsened by the feeling of having an invisible disorder and of being doubted. There is a need to increase the knowledge among healthcare professionals about what it means to live with migraine, something this qualitative study offers.Implications for RehabilitationThe meaning of living with migraine is experienced as having a debilitating disorder which accompanies life in the sense that it or the threat of its return is always present, and yet invisible to others.There is a need for healthcare professionals to increase their awareness of the meaning of living with migraine, to enable them to meet the needs of each person with migraine.

Paramedic clinical decision-making in mental health care: a new theoretical approach

This article aims to present a new theoretical approach for examining paramedic clinical decision-making in relation to mental health care. Recent theorizing has begun exploring key clinical decision-making approaches that are particularly relevant to paramedic practice. These approaches have also revealed some important factors that influence clinical decision-making behaviours among paramedics such as prior experience and clinical and tacit knowledge. The literature, however, provides very little insight into the clinical decision-making strategies paramedics draw on and use when dealing with mental health patients, in particular, those patients who are dealt with under involuntary provisions of mental health legislation. In addition, the literature provides limited coverage to account for how paramedics deal with and mitigate risk factors relating to patients experiencing a mental health emergency. Following these shortcomings, this article will propose the use of hermeneutic phenomenological methods as a suitable and innovative interpretive research approach for examining paramedic clinical decisionmaking in relation to prehospital mental health care. It is argued that this approach is well suited for exploring how paramedics make sense of their experience providing emergency mental health care, how they perceive their role within the clinician-patient relationship, and the particular circumstances in which paramedics exercise their legislative responsibilities under mental health legislation.