Interprofessional practice: the path toward openness.

This article seeks to shed light on the meanings healthcare practitioners attach to practicing interprofessionally and how interprofessional relationships play out in "everyday" practice. It draws on findings from a hermeneutic phenomenological study of health professionals' lived experience of practice, interpreted in relation to Martin Heidegger's concept of a path through the dense forest which leads to an open space where there is no predefined path to follow. Analysis of data from in-depth, semi-structured interviews with 12 health professionals from medicine, midwifery, nursing, occupational therapy, physiotherapy, speech and language therapy, and social work suggests that health practitioners come upon the clearing having walked their own track toward practicing interprofessionally. Our argument is that when: getting to know others; genuine dialogue; trust; and respect are in play, a spirit of interprofessional practice flourishes. The ontological view presented, sheds light on the nature of the relationships and the personal qualities that foster a spirit of interprofessional practice in these human-to-human interactions. It highlights how health practitioners need to be free to enact their humanity; to move beyond the "professional" pathway, which encourages them to leave "who they are" at home.

The History of Allied Health: An International Perspective.

The term allied health is not an uncommon one within the healthcare lexicon. However, the derivation and meaning of the term sit within the murkiness of history, making relevance in the current context perplexing. This article sets out to explore the origins of the term, and in turn how the term and its associated meaning have developed internationally. To give perspective, case studies of the term within the United States, Australia, Scotland, and New Zealand are used. Each is traced within discoverable literature, and a conclusion is drawn as to how the term within these case studies developed, the impact of the term, and whether the term is seen as symbolic or associative.

The unsustainability of occupational based model diagrams.

Background: Occupation-based models are generic explanations of occupational engagement. Their associated diagrams are conceptual tools that represent the key concepts and their interrelationships, which have withstood substantial shifts in the profession's knowledge base and scope over the last 30-40 years.Aims: We aim to bring into question the sustainability of the diagrams used to represent models.Methods: Intellectual history and semiotic analysis are combined as tools for examining the history of selected occupation-based models and the convention of representing them diagrammatically. Our critique employs a hermeneutically inspired semiotic technique to scrutinise the diagrams as stand-alone symbolic objects.Results: We argue that the rigid categorisation and oversimplified structure of diagrams keeps the profession pinned to dated perspectives based in positivism and dualism, bypassing the real, lived experiences of people. Our critique highlights the ontological absences from diagrammatic representations of occupation-based models.Conclusions: The continued practice of depicting models with diagrams needs to change, to create space to integrate other theory and perspectives, such as a more fundamentally human, ontological perspective.Significance: An ontological perspective is important for practice to advance past the dualistic or pluralistic stance the profession has held for decade, to understand how people experience their world rather than how the profession sees a person's world.

The making of occupation-based models and diagrams: History and semiotic analysis.

BACKGROUND.: Models provide a structure for organizing knowledge and facilitating learning and are upheld by occupational therapy as epitomizing the cornerstones of its practice. PURPOSE.: This article briefly examines the scientific history of occupation-based model development in the 1950s before addressing the process of conceptual model making in occupational therapy. Using the theory of semiosis, it explains and takes a critical perspective on conceptual model building in occupational therapy. KEY ISSUES.: Since the surge of development in the mid-1970s, models have grown and undergone some revision. However, while the profession has often contested the definitions of its core terms, it has not challenged the accepted models and diagrams that present the constituents of practice. IMPLICATIONS.: Examining the processes of conceptual model development from a critical, semiotic point of view foregrounds models in the historico-theoretical literature and brings into scrutiny a model's relevancy in current practice.

Interprofessional practice: beyond competence.

Interprofessional practice is commonly discussed in the literature in terms of competencies. In this study we move away from the theoretical notions of criteria, concepts and guidelines to adopt an ontological approach which seeks to stay as close to the lived experience as possible. Our research asked 12 participants from a variety of health disciplines to tell their stories of working interprofessionally. We sought to glean meaning from the lived experience. Our phenomenological hermeneutic approach and interpretation were informed by Heidegger and Gadamer. Rather than offering a thematic overview, in this article we share three stories from the research that were congruent with other stories. The first, told by a doctor, is of a resuscitation in an emergency department. It shows how the effective working together of the interprofessional team was more than each member following a resuscitation protocol. There was 'something' about how they worked together that made this story stand out, even though the patient died. The second story showcases how 'who' the person is makes a difference. This nurse makes an effort to get to know other staff as people, to find common interests. In such a way interprofessional practice comes to flourish. The third story shows how a physiotherapist and a psychologist joined in conversation to seek innovative possibilities for a challenging situation. In such a way each built on the others expertise and were excited at the success they achieved for the patient. From these ontological accounts we have come to see that interprofessional practice flourishes when practitioners are their authentic, caring selves. Who the person is matters.

Working in a spirit of interprofessional practice: a hermeneutic phenomenological study.

Interprofessional practice is recognized as essential to providing patient-centered, collaborative and high quality care, contributing to optimal health outcomes. Understandings of how best to cultivate practitioners able to 'be' and 'become' interprofessional remain problematic. To advance that understanding, this hermeneutic phenomenological study addressed the question: 'What are health professionals' experiences of working with people from other disciplines?' In-depth, semi structured interviews with 12 health professionals from nursing, occupational therapy, physiotherapy, speech and language therapy, medicine, social work, and midwifery were undertaken using a conversation style. Three unifying themes revealed things which appear to be at the 'heart' of interprofessional practice; the call to interprofessional practice, working in a spirit of interprofessional practice and safeguarding and preserving interprofessional practice. This paper focuses on the first two themes. The findings contribute to a deeper understanding of interprofessional practice as a way of being that extends beyond known and measureable skills and knowledge, to dispositions and qualities. Dispositional qualities come from within a person and what they care about, and from experiences that shape their understandings. This study points toward interprofessional practice as being about a spirit. Who people are, what they bring and how they act is what matters.

Action research and millennials: Improving pedagogical approaches to encourage critical thinking.

BACKGROUND: This article examines the effects of intergenerational diversity on pedagogical practice in nursing education. While generational cohorts are not entirely homogenous, certain generational features do emerge. These features may require alternative approaches in educational design in order to maximize learning for millennial students. METHOD: Action research is employed with undergraduate millennial nursing students (n=161) who are co-researchers in that they are asked for changes in current simulation environments which will improve their learning in the areas of knowledge acquisition, skill development, critical thinking, and communication. These changes are put into place and a re-evaluation of the effectiveness of simulation progresses through three action cycles. RESULTS: Millennials, due to a tendency for risk aversion, may gravitate towards more supportive learning environments which allow for free access to educators. This tendency is mitigated by the educator modeling expected behaviors, followed by student opportunity to repeat the behavior. Millennials tend to prefer to work in teams, see tangible improvement, and employ strategies to improve inter-professional communication. CONCLUSION: This research highlights the need for nurse educators working in simulation to engage in critical discourse regarding the adequacy and effectiveness of current pedagogy informing simulation design. Pedagogical approaches which maximize repetition, modeling, immersive feedback, and effective communication tend to be favored by millennial students.

Unsettling moods in rural midwifery practice.

BACKGROUND: Rural midwifery and maternity care is vulnerable due to geographical isolation, staffing recruitment and retention. Highlighting the concerns within rural midwifery is important for safe sustainable service delivery. METHOD: Hermeneutic phenomenological study undertaken in New Zealand (NZ). 13 participants were recruited in rural regions through snowball technique and interviewed. Transcribed interview data was interpretively analysed. Findings are discussed through the use of philosophical notions and related published literature. FINDINGS: Unsettling mood of anxiety was revealed in two themes (a) 'Moments of rural practice' as panicky moments; an emergency moment; the unexpected moment and (b) 'Feelings of being judged' as fearing criticism; fear of the unexpected happening to 'me' fear of losing my reputation; fear of feeling blamed; fear of being identified. CONCLUSIONS: Although the reality of rural maternity can be more challenging due to geographic location than urban areas this need not be a reason to further isolate these communities through negative judgement and decontextualized policy. Fear of what was happening now and something possibly happening in the future were part of the midwives' reality. The joy and delight of working rurally can become overshadowed by a tide of unsettling and disempowering fears. IMPLICATIONS: Positive images of rural midwifery need dissemination. It is essential that rural midwives and their communities are heard at all levels if their vulnerability is to be lessened and sustainable safe rural communities strengthened.

Crafting Stories in Hermeneutic Phenomenology Research: A Methodological Device.

Hermeneutic phenomenology, as a methodology, is not fixed. Inherent in its enactment are contested areas of practice such as how interview data are used and reported. Using philosophical notions drawn from hermeneutic phenomenological literature, we argue that working with crafted stories is congruent with the philosophical underpinnings of this methodology. We consider how the practical ontic undertaking of story crafting from verbatim transcripts is integral with the interpretive process. We show how verbatim transcripts can be crafted into stories through examples taken from interview data. Our aim is to open dialogue with other hermeneutic phenomenological researchers and offer alternate possibilities to conventional ways of work with qualitative data. We argue that crafted stories can provide glimpses of phenomena that other forms of data analysis and presentation may leave hidden. We contend that crafted stories are an acceptable and trustworthy methodological device.

Real life narratives enhance learning about the 'art and science' of midwifery practice.

Health professional educators have long grappled with how to teach the more elusive art of practice alongside the science (a term that encompasses the sort of professional knowledge that can be directly passed on). A competent practitioner is one who knows when, how and for whom to apply knowledge and skills, thereby making the links between theory and practice. They combine art and science in such a way that integrates knowledge with insight. This participatory hermeneutic study explored the experience of teachers and students of implementing a narrative-centred curriculum in undergraduate midwifery education. It revealed that when real life narratives were central to the learning environment, students' learning about the art of midwifery practice was enhanced as they learned about midwifery decisions, reflected on their own values and beliefs and felt an emotional connection with the narrator. Further, art and science became melded together in the context specific wisdom of practice (phronesis).

Mood and birth experience.

BACKGROUND: Those at the birth of a baby sometimes speak of the experience as significant and meaningful; an experience in which there is an atmosphere or mood that surrounds the occasion. This paper explores this mood, its recognition, disclosure and how we attune or not to it. The paper is philosophically underpinned by hermeneutic phenomenology. The Heideggerian notion of "attunement to mood" is used to interpret this phenomenon. This paper describes how such a mood becomes visible. METHODS: Using a hermeneutic phenomenological approach, 14 tape-recorded transcribed interviews, each about an hour long, were conducted over 8 months from mothers, birth partners, midwives and obstetricians. The stories crafted from these transcripts have been interpreted alongside my own preunderstandings and related literature. Appropriate ethical approval was gained. FINDINGS: Analysis suggests that there is a positively construed mood of joy at birth that can be concealed when disrupted. Disturbing this mood has the effect of exposing the world of birth and its inherent activities and feelings revealing possible meanings inherent in the lived birth experiences. Disturbances at birth provide distinctions and tensions in which a concealed constitutive mood at birth can be seen. This paper provides insight towards a deeper appreciation into how the sacred joy of birth may be protected. IMPLICATIONS FOR PRACTICE: The way in which we attune to birth may have consequences to birth outcomes and to the experience of childbirth. The consequences of these findings for those in the world of birth are discussed.

The sounds of silence-a hermeneutic interpretation of childbirth post excision.

Four women who had been excised were interviewed about their experiences of giving birth. Using hermeneutic phenomenology we analyzed their narratives to more fully understand their experiences of childbirth in the context of excision. Childbirth is characterized by silence related to excision. To ensure safe care, increased communication is needed. The onus for opening channels of communication rests with health professionals whose aim is to provide safe, appropriate care to women and their families. In this article we give voice to women's call for sensitive communication that acknowledges their excision and supports them through the challenges it presents for birth.

A phenomenological study of occupational engagement in recovery from mental illness.

BACKGROUND: Recovery from mental illness has been described as a process involving personal growth and a search for meaning. Occupation is a primary medium for human development as well as the creation of life meaning, suggesting the exploration of recovery from an occupational perspective is warranted. PURPOSE: To explore the experience and meaning of occupation for 713 people who self-identified as being in recovery from mental illness. METHODS: Recovery narratives were collected from participants in conversational interviews that were recorded and transcribed. The transcripts were analysed using hermeneutic phenomenology. FINDINGS: A range of experiences were evident in the recovery narratives, from complete disengagement to full engagement in occupations. Insights into the experience and meaning of different states of occupation were revealed. IMPLICATIONS: All forms of occupational engagement, including disengagement, can be meaningful in the recovery process. Increased understanding of different modes of occupational engagement will assist therapists to support recovery more effectively.

Ankle sprains: patient perceptions of function and performance of physical tasks. A mixed methods approach.

PURPOSE: To investigate patient's perceptions of function and performance of physical tasks after discharge from treatment for an ankle sprain. METHODS: Using a mixed methods approach, 40 participants who presented with an acute sprained ankle and their treating clinicians completed two questionnaires related to function at the start and end of a rehabilitation programme. Additionally, participants completed the questionnaires at 6 weeks following discharge at which time they also performed physical tasks that were still perceived as difficult. Ten participants also completed a semi-structured interview. RESULTS: There were no significant differences (p > 0.05) in the participant's and clinician's initial assessment of function. However, at discharge participants scored their function significantly (p < 0.05) lower than clinicians. This difference was not apparent 6 weeks later (p > 0.05). However, there was a significant difference (p  < 0.05) following actual performance of tasks with an effect size of 1.58. Participant interviews confirmed that patients had a fear of re-injury until they actually performed tasks that were perceived as difficult. CONCLUSIONS: Clinicians and participants do not have a similar perception of the recovery of an ankle sprain at discharge. Performing tasks which were perceived as difficult were valuable in assisting participants gain an improved appreciation of their function.

Exploring the meaning of occupation: the case for phenomenology.

BACKGROUND: Some authors are beginning to challenge current categorisations of occupation as self-care, productivity, and leisure in favour of categories that address meaning. However, the meaning of occupation receives relatively little attention in the literature. PURPOSE: To provide a synthesis of the contemporary literature that considers the meaning of occupation and to argue that phenomenological insights into the meaning of occupation might usefully inform occupational therapy research, theory, and practice. KEY ISSUES: Meaning is a key aspect of occupation. Three phenomenological meanings of occupation uncovered by a study conducted in New Zealand-the call, Being-with and possibilities-provide a starting point for practice, research, and theory informed by understandings of the lived experience of occupation. IMPLICATIONS: Occupational therapy's theories would benefit from an evidence base that includes meaning, which in turn would lead to authentic occupational therapy practice.

Re-collecting and 'thinking' the story of New Zealand's postgraduate nursing scholarship development.

Nursing in New Zealand has undergone a rapid rise of postgraduate scholarly development over the past four decades. Early nurse scholars had no choice but to study university papers outside the discipline of nursing. Their reflections show how much their thinking was sparked by such experiences. On the other hand, the excitement of nursing finding its own body of knowledge and moving into research is also recalled. Hermeneutic analysis of these two aspects encourages 'thinking' of how postgraduate education gets shaped. The discussion draws on Heidegger's notion that it is the void of the jug that holds the fluid - what goes into the jug itself (postgraduate learning) is often discretionary.

From experience to definition: addressing the question 'what is qualitative research?'.

Most health professionals today have heard of 'qualitative research' but many remain confused as to what it is and how to go about doing it. In this paper, two experienced qualitative researchers become engaged in conversation exploring the question 'what is qualitative research?' Lynne Giddings and Liz Smythe are Associate Professors in the Faculty of Health & Environmental Sciences at the Auckland University of Technology. They engage a reader in exploring issues such as: What might draw you to qualitative research? How does qualitative research make a difference to practice? How can reading a qualitative research article inform practice? From a qualitative perspective, what is 'truth'? How many participants? What happens to the data? What about the bias of the researcher? Can qualitative findings be trusted? Stories and exemplars are used to highlight the processes and issues involved in undertaking a qualitative research study.

Courage as integral to advancing nursing practice.

Courage is an elusive but fundamental component of nursing. Yet it is seldom mentioned in professional texts and other literature nor is it often recognised and supported in practice. This paper focuses on the illumination of courage in nursing. Data from a hermeneutic analysis of nurses' practice stories is integrated with literature to assist deeper understanding of the meaning of courage in contemporary nursing practice. The purpose is to make visible a phenomenon that needs to be actively fostered or 'en-courage-d' if nursing is to effectively contribute to an improved health service.