Living with schizophrenia and type 2 diabetes and the implication for diabetes self-care: A qualitative study.

AIM: To achieve an in-depth understanding of the challenges associated with diabetes management when having both schizophrenia and type 2 diabetes, while also identifying the needs for improved diabetes self-care. DESIGN: The study employed a qualitative explorative design utilizing a phenomenological-hermeneutic inspired approach, involving field observations and individual semistructured interviews. METHODS: Data were collected during 2020-2021 through 17 field observations of outpatient consultations and 13 individual semistructured interviews. Data, including field notes and verbatim transcribed interviews, underwent analysis following Ricoeur's interpretive philosophy, encompassing three levels: naïve reading, structural analysis and critical interpretation and discussion. This study adheres to the COREQ guidelines for qualitative research. RESULTS: Three key themes emerged: 'Diabetes when life is noisy', 'Sacrifices and compromises in life' and 'The double silence'. Everyday life is significantly affected when having both schizophrenia and T2D. The mental health state dominates in relation to diabetes self-care and individuals experience challenges balancing between the two conditions. However, there exists a general acknowledgement for diabetes and its long-term complications as a serious medical condition demanding careful attention and treatment. CONCLUSION: Self-managing two such complex conditions can be overwhelming and make it difficult for the individual to differentiate symptoms and prioritize diabetes care. Moreover, the existing fragmentation within healthcare systems poses communication challenges, resulting in disjointed patient pathways. IMPLICATIONS FOR PATIENT CARE: The study emphasizes the need for a holistic re that addresses the physical, emotional and social challenges. There is also a need for increased awareness and education among informal caregivers and healthcare professionals to foster better understanding and support.

Steering the energy with music: hermeneutic phenomenological study of user perspectives of music and music therapy for co-occurring ADHD and substance use problems.

BACKGROUND: User perspectives and involvement are crucial for improving substance use treatment service provision. First-hand accounts provide rich perspectives on how users experience change within therapeutic approaches like music therapy. People with substance use problems have a higher incidence of experiencing challenges with impulsivity, hyperactivity and inattention. Such challenges can negatively affect social functioning and outcomes of substance use treatment. Music therapy can offer people a means to regulate emotions and facilitate social relationships. There is a lack of research on user perspectives of music therapy in substance use treatment, and we could identify no studies that explore user perspectives of music therapy for adults with substance use problems and co-occurring impulsivity, hyperactivity and inattention. METHODS: The aim of this phenomenological study was to center the voices of people living with co-occurring attention deficit hyperactivity disorder (ADHD) and substance use disorder (SUD) to understand how they experience music and music therapy in their process of recovery. We used a hermeneutic phenomenological approach to qualitative analysis of transcripts from in-depth interviews with 8 adult service users from a Norwegian substance use treatment facility. RESULTS: Our main finding was that music and music therapy enabled experiences of motivation and mastery that ultimately afforded social belonging. The participants demonstrated detailed and nuanced understanding of how they use music to steer the energy and restlessness that are characteristic of ADHD, to change mood, and to shift negative thought patterns. These forms of music-centered regulation served as pre-requisites for more active and gratifying participation in social communities. For several participants, musicking offered a means of establishing drug-free identity and fellowship. The motivation and mastery experienced during musicking lowered the threshold for social engagement, and served as an incentive for continuing substance use treatment for some participants. CONCLUSIONS: The nuanced descriptions from our participants illustrate the importance of motivation, and how music therapy can contribute to motivation in substance use treatment. In particular, the context surrounding musicking, adaptations from the music therapist, and social affordances of such musicking contributed to pleasure, mastery, participation, development of identity and social belonging, which in interaction generated motivation.

Phenomenography: An emerging qualitative research design for nursing.

BACKGROUND: Phenomenography emerged from pedagogy to examine the qualitatively different ways that individuals experience and perceive the same phenomenon. Despite its uniqueness, the uptake of phenomenography in nursing research is still limited. Potentially, this may be related to confusion regarding what the design is about, its philosophical underpinnings and how distinct it is from other qualitative designs. OBJECTIVES: To offer a better understanding of phenomenography by comparing it with other established qualitative research designs, examining its theoretical foundations, highlighting some studies that have employed the approach in nursing and offering methodological guidance to improve its uptake in nursing. DESIGN: Discussion paper. FINDINGS: Compared to the traditional qualitative designs employed in nursing, phenomenography has been utilized in fewer studies. The ontological, epistemological and methodological basis of phenomenography highlights it as a distinct design. The strength of phenomenography lies in its emphasis on understanding the collective variations between participants and presenting these holistically as an 'outcome space'. DISCUSSION: Phenomenography is a distinct qualitative research approach that presents a unique opportunity for nursing to further its use. Issues regarding bracketing, the inclusion of phenomenography studies in qualitative meta-synthesis and employing a hermeneutic approach to phenomenography are avenues for further work in nursing. PATIENT AND PUBLIC CONTRIBUTION: No patient or public contribution.

Sustained practice of Qigong results in a somatic hermeneutic process, contributing to appreciation of life. An interpretative phenomenological analysis.

Over the past few decades evidence has accumulated into the health benefits of practising Qigong, particularly in the amelioration of physical conditions. Previous studies have been conducted using positivist biomedical model methodologies, which may be limited in understanding the nuanced meaning-making and embodied experience of practitioners. This study uses Interpretative Phenomenological Analysis (IPA) to inquire into how the sustained practice of Qigong contributes beyond the relief of physical conditions to improved self-awareness and appreciation of life. Semi-structured interviews were conducted with five Qigong practitioners who each had over 10-years' experience and analysed using the interpretive methodology of IPA. Findings reveal a crucial antecedent theme of 'Openness to experience' and four, interrelated, super-ordinate themes common to each of the participants: 'Finding a Teacher', 'Bodymind' (proprioception and interoception), 'Primary Process of Developmental Change', and 'Awareness of emergent Authenticity'. Insights revealed how each practitioner makes sense of the sustained 'autotelic' practice of Qigong, and how this contributes to a transformative understanding of themselves and of life. Qigong presents a possible promising intervention to improve both physical and psychological well-being.

A Hermeneutic Phenomenological Study of Aesthetics in Nursing Practice Among Hospitalized Cancer Patients in Nepal.

Background: Aesthetics is the art of nursing that is expressive, subjective, and visible in the act of caring in nursing practice. Aesthetics in nursing practice satisfies holistic needs and achieves the quality of whole-person care. Purpose: The aim of this study is to describe the meanings of the lived experiences of cancer patients in terms of receiving care from the perspective of aesthetics in nursing practice. Methods: The hermeneutic phenomenological approach grounded on Gadamerian philosophy guided this study. Eleven Nepalese cancer patients who met the inclusion criteria shared their experiences through graphic illustrations (drawings) and interviews. Data were analyzed and interpreted following van Manen's phenomenological approach reflective of the four life worlds. The trustworthiness of findings was established following the criteria by Lincoln and Guba. Results: Thematic categories of the lived experience of cancer patients were revealed, reflecting the four life worlds: lived relation expressed as being nurtured as a family; lived space as appreciating the healing space; lived time as being hopeful; and lived body as receiving a new life. This experience was described as experiencing self and other while appreciating the healing space, being hopeful and nurtured as family and having a new life Implications for Practice: Aesthetics in nursing practice values on politely nurturing cancer patients as nurses' family members in a pleasant healing environment. Further, cancer patients experience having a new life.

Midwives' experiences of encountering immigrant women during labour and birth who do not master the host country's language. A lifeworld hermeneutic study.

BACKGROUND: Immigrant women are in a vulnerable position during labour and birth due to language barriers. Communication with women who do not master the host country's language is difficult for midwives, but there are few studies about midwives' experiences. AIM: To explore Norwegian midwives' experiences of encountering immigrant women during labour and birth who do not master the native language. METHOD: A hermeneutic lifeworld approach. Interviews with eight midwives working at specialist clinics and hospital maternity wards in Norway. RESULTS: The findings were interpreted based on four concepts in the theory "Birth territory: A theory for midwifery practice" by Fahy and Parrat presented in five themes: language barriers can cause disharmony and prevent participation, language barriers can lead to midwifery domination and poorer care, midwives strive for harmony and to be a guardian, medicalisd birth due to language barriers, and disharmony can lead to crossing boundaries. The main interpretation shows that it is midwifery domination and disintegrative power that are prominent. However, the midwives strived to use their integrative power and be guardians, but in doing so they encountered challenges. CONCLUSION: Midwives need strategies for better communication with immigrant women involving the women and for avoiding a medicalised birth. To be able to meet immigrant women's needs and to establish a good relationship with them, challenges in maternity care need to be addressed. There are needs of care that focus on cultural aspects, leadership teams that support midwives, and both theoretical and organisational care models that support immigrant women.

Registered nurses' experience of care for adult patients with a temporary tracheostomy at general hospital wards. A phenomenological-hermeneutic explorative study.

BACKGROUND: Caring for adult patients with a temporary tracheostomy in general wards can be challenging and complex. Little research has explored registered nurses' experiences with caring for these groups of patients. OBJECTIVES: This study sought to interpret and describe registered nurses' lived experiences of caring for adult patients with a tracheostomy in general wards. RESEARCH DESIGN/METHODOLOGY: Six registered nurses were interviewed in this study. The interviews were analysed to gain comprehensive knowledge about caring for adult patients with a temporary tracheostomy. The interviews were transcribed, analysed, and interpreted by using Gadamers philosophical hermeneutics and Kvale and Brinkmann's three steps of understanding. SETTING: Three different wards medical, surgical, and neurological of a teaching hospital in Norway. FINDINGS: Three themes emerged from data analysis. These included experiencing clinically challenging patients, a lack of clinical support from the intensive care nurses, and a lack of professional confidence. CONCLUSION: This study highlighted the challenges surrounding the care of an adult patient with a tracheostomy in the general wards. Identifying these challenges would lead to further improvement in registered nurses' experiences and, in turn, in the quality of competent care for adult patients with a tracheostomy in the general ward. IMPLICATIONS FOR CLINICAL PRACTICE: Understanding the registered nurses' experiences will assist the head nurses in planning and providing relevant information and education to provide safe and holistic patient care. Adequate support from intensive care unit nurses and professional development are required to ensure high-quality care. This study recommends that healthcare managers focus on establishing step-down units to improve patient outcomes, especially for high-risk patients and to increase the competencies of registered nurses in caring for adult patients with a tracheostomy as a whole person.

Future-proofing the Profession: Physiotherapists' perceptions of their current and emerging role.

OBJECTIVES: As healthcare systems continue to modernise, physiotherapists are required to transform their practice to remain contemporary and meet future population needs. The study aims to gain an insight into physiotherapists' perceptions of their current and emerging future role. The intention is to develop an understanding of the physiotherapist's role and how it can continue to evolve to support populations' needs in more sustainable and innovative ways. DESIGN: A qualitative design using semi-structured interviews was undertaken informed by Gadamerian hermeneutic philosophy. PARTICIPANTS: Participants were gained from a postgraduate physiotherapy programme in Northwest England that recruits physiotherapists from across the UK; via the research teams' professional networks and using snowball sampling. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was undertaken. Ethical approval and informed consent was obtained. RESULTS: 23 participants (15 female). 4 themes were identified: 'An underpinning philosophy of practice' that promotes holistic care and supports patient wellbeing. An 'evolving role broadening the scope of practice' with many 'agents of change shaping the profession'. When 'preparing the future workforce and their transition into practice', graduates were seen as more adaptable and resilient. However, more affiliation between the university and placement providers to enhance learning environments is needed. CONCLUSIONS: Physiotherapists need to re-evaluate their role so a clear vision for the future can be co-created to ensure they remain contemporary and continue to optimise their potential. An emerging role that re-envisages a holistic approach that incorporates health promotion as fundamental to this role could support physiotherapists' transformation in practice. CONTRIBUTION OF THE PAPER.

Supporting the spirituality of older people living with dementia in nursing care: A hermeneutic phenomenological inquiry into older people's and their family members' experiences.

BACKGROUND: Supporting spirituality is an essential aspect of the holistic nursing care of older people living with dementia. Spirituality is defined as a search for answers to questions about the meaning and purpose of life and the individual's relationship with the sacred or transcendent. This relationship may or may not involve an affiliation with a specific religion. OBJECTIVE: To understand how older people living with dementia and their family members experience spirituality and its support in nursing care. DESIGN: A qualitative study informed by the principles of Ricoeurian hermeneutic phenomenology. SETTINGS: We conducted the study in home care and long-term care settings in Southern Finland. PARTICIPANTS: We collected data between 2017-2020 from a purposive sample of 10 older people living with dementia and their 9 family members (n = 19). METHODS: We used interviews to collect data and adapted and used Ricoeur's theory of interpretation as a method for analysis. RESULTS: The findings of this study show that older people living with dementia need spiritual support in nursing care based on their personal understanding of spirituality. The four elements of this spirituality that emerged were: religion, meaningful relationships, nature, and art. The participants addressed some challenges to spiritual support in the nursing care of older people living with dementia including: the competence and abilities of nursing, time available, presence and experience. CONCLUSIONS: Older people living with dementia and their family members consider spiritual support an important aspect of nursing care. To support the spirituality of these older people, the elements of spirituality need to be understood as these are central to each person's spiritual position. Additionally, spiritual support requires understanding knowledge, experience, time and presence, to manage all four elements with individuals.

A caring and living environment that supports the spirituality of older people with dementia: A hermeneutic phenomenological study.

INTRODUCTION: Meeting spiritual needs is an important part of the quality of nursing for older people living with dementia. The spirituality-supportive caring and living environment has rarely been studied, even though the environment plays an important role in supporting the well-being of older people with dementia. AIM: To further understanding about the spirituality-supportive elements of a caring and living environment from the perspective of older people with dementia and their family members. DESIGN, SETTING AND PARTICIPANTS: We adapted hermeneutic phenomenology as a philosophical background and methodological approach in this study. After receiving the approval of the researcher's University Ethics Committee, a purposive sample of ten older people with dementia and their nine family members, in home care and long-term care settings in Southern Finland were recruited for interviews. METHODS: An interview-based study was conducted using photography to collect the data. The in-depth interviews were conducted in dyads between September 2017 and March 2020 and transcribed verbatim. Thematic analysis was used to interpret the data. RESULTS: Spirituality was seen as a continuum within human life, manifested through the environment even if older people with dementia were unable to express themselves. The spirituality experiences of the participants within the caring and living environment were summarized into three themes: "Where do I belong?", "What remains of me in the world?" and "Where am I going?" The older people, their family members and other people involved in their care provided a caring and living environment that supported spirituality with opportunities to seek answers to these questions through to the meaning of their life. DISCUSSION AND CONCLUSIONS: This hermeneutic phenomenological study provides a new insight into the environment that supports the spirituality of older people with dementia. The elements of caring and living environment can remind older people with dementia of what supports their own way of thinking about spirituality and brings meaning to their life. Therefore, spirituality is worth of considering when planning a caring and living environment that supports what is important to the personhood of older people with dementia. TWEETABLE ABSTRACT: Spirituality is worth of considering when planning a caring and living environment that supports what is important to the personhood of older people with dementia.

The lived experiences of racial bias for Black, Asian and Minority Ethnic students in practice: A hermeneutic phenomenological study.

AIM: This study explored the lived experiences of racial bias for Black, Asian and Minority Ethnic students undertaking an undergraduate or post-graduate degree in nursing, midwifery and allied health courses in the United Kingdom. BACKGROUND: Previous research indicates that students from Black, Asian and Minority Ethnic groups have fewer opportunities to succeed at university and this has brought about a race awarding gap in their degree attainment. The reasons for this awarding gap are complex and multi-factorial and it is crucial that the lived experiences of racial bias are explored from the student perspective. DESIGN: A hermeneutic phenomenological approach was adopted to elicit individual and collective experiences in the practice environment, a mandatory component of the student's degree. METHODS: A focus group and individual semi-structured interviews were conducted to collect data from sixteen participants and analysed using thematic analysis RESULTS: Three encompassing themes were identified which included a sense of not belonging, trauma impact on mental health and understanding covert and overt racism. Participants reported incidences of racism and appeared to be traumatised by their experiences within practice and the university. They also reported poor mental health and well-being as shared experiences and a lack of confidence in the university and practice to mitigate racial issues. CONCLUSIONS: Meaningful action must be taken by universities and practice partners to advance racial inequality initiatives by having robust anti-racism action plans and processes. These should be co-created with students and staff to reduce the race awarding gap.

Non-Participatory Observation Of Integrated Management Of Childhood Illness Practices At Selected Basic Health Units Of District Abbottabad, Kp, Pakistan: A Qualitative Hermeneutic Study.

BACKGROUND: It was in 1995 when a strategy was devised to reduce under-five mortality in countries with a prevalence of child mortality above 40/1000 live births. This strategy is called "Integrated Management of Childhood Illness" (IMCI). Improvement in the skills of healthcare workers (HCWs) depends on the IMCI training received by them. To make IMCI training more effective and scale up, a global technical consultation committee in Geneva recommended implementing an innovative training approach in 2014: the distance learning IMCI (dIMCI). This study was conducted to observe qualitatively the practices of IMCI-trained HCWs at their respective workplaces. METHODS: This qualitative hermeneutic study was conducted through non-probability criterion sampling in the district Abbottabad of Pakistan on all 26 basic health units trained in IMCI (either standard or distance learning) from December 9, 2019, to March 9, 2020. Data collection was done by qualitatively observing consultations and interactions of caretakers of under-five children at basic health units. Inductive thematic analysis was used. This qualitative exploration was underpinned by Hans Georg Gadamer's philosophy of hermeneutics. RESULTS: Four themes emerged from the observation notes. These themes are gratification after consultation, altercation for medication, non-observance of protocol, and methodical consultation. CONCLUSIONS: Improvement in the skills of HCWs in the form of IMCI training, either through distance learning or the common eleven-day standard method, can improve caretakers' satisfaction. However, awareness at the community level is needed for better compliance.

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.

The un-silencing of Japanese women's voices in maternity care: A hermeneutic phenomenological study of the woman-midwife relationship.

OBJECTIVE: The purpose of this article is to understand the meaning of the woman-midwife relationship, with the overall aim to improve maternity care and women's birth experiences in Japan. To better understand the meaning of the woman-midwife relationship, this article presents women's and midwives' experiences of having or not having a voice in maternity care. RESEARCH DESIGN: Hermeneutic phenomenology, as described by Max van Manen, helped to uncover the meaning of the phenomenon-the woman-midwife relationship-through participants' lived experience. Individual interviews were conducted with 14 women and 10 midwives living in Japan. The interview data were interpreted and thematically analysed to reveal the meaning of the woman-midwife relationship. FINDINGS: 'Having a voice' emerged as a central theme underpinning the meaning of the woman-midwife relationship; aspects of which included, 1) being unheard, 2) losing a voice, 3) having a voice, and 4) midwives speaking for women. Although having a voice should be a legitimate right for women in maternity care, some women's voices were unheard or lost in the experience with midwives. Conversely, some women gained a voice, especially when they positively and continuously developed their relationship with their midwife. How the woman and the midwife related to each other clearly affected their experience of having a voice in maternity care. KEY CONCLUSION: Having a voice, which portrays dimensions of choice, control, and autonomy, in their own maternity care is vital for women's positive birth experience. The woman-midwife relationship is critical in enabling women to have a voice and midwives to speak for women. Women and midwives need to develop their relationship. Moreover, the maternity care system needs to allow sufficient time and space, for instance, by ensuring midwife continuity of care to develop a positive woman-midwife relationship.

O lúdico no processo de hospitalização das crianças com câncer / Plays in the hospitalization process of children with cancer

Trata-se de uma pesquisa que tem como objetivo analisar as contribuições do lúdico para o processo de hospitalização das crianças com câncer. Durante a sua hospitalização, a criança é afetada em seu estado físico, psicológico ou emocional, porém isso pode ser amenizado através de atividades lúdicas. Metodologicamente, esta pesquisa foi desenvolvida na abordagem qualitativa com método da hermenêutica dialética, que envolveu crianças em tratamento no hospital de referência na cidade de Recife/PE. Nesse caso, a comunicação foi tratada através dos dados recolhidos em fontes bibliográficas, observações dos jogos através do diário de campo e das entrevistas semiestruturadas com as crianças com câncer e seus acompanhantes. Com isso, foi constatado que a ludicidade é um recurso terapêutico enriquecedor, que contribuiu para ao desenvolvimento das crianças com câncer.

This research aims to analyze playfulness's contributions to the hospitalization process of children with cancer. During hospitalization, a child is affected physically, psychologically, or emotionally; however, this can be alleviated through playful activities. Methodologically, this research was developed in a qualitative approach based on dialectic-hermeneutics, which involved children undergoing treatment at a reference hospital in the city of Recife/PE. In this case, communication was treated through data collected from bibliographic sources, observations of the games through field diaries, and semi-structured interviews of children with cancer and their caretakers. Thus, it has been found that playfulness is an enriching.

Multi-professional ethical competence in healthcare - an ethical practice model.

INTRODUCTION: The starting point is that ethical competence is the basis for ethical healthcare practices and quality of care. Simultaneously, there is a need for research and development from a holistic multi-professional perspective. AIM: The aim is to create a proposed model for multi-professional ethical competence grounded in clarified meanings and dimensions of ethical competence studied from a multi-professional healthcare perspective. The research questions are, what is ethical competence from a multi-professional healthcare perspective and what strengthens a multi-professional ethical healthcare practice? RESEARCH DESIGN: The research has a qualitative approach and hermeneutic application research design. Two groups with six participants from clinical practice and two scientific researchers in each group met four times for dialogue. Thematic analysis was used as an analysis method. ETHICAL CONSIDERATIONS: The research is approved by the Declaration of Helsinki, the General Data Protection Regulations, and ethical permission was asked from the Norwegian Centre for Research Data (NSD). RESULTS: The proposed model for multi-professional ethical competence encompasses a three-dimensional ethical value base that is underpinned by: Ethical attitude - a personal desire to do good; Ethical basis - the best for the patient as a common goal and Ethical culture - common goals and values in the organization. Multi-professional ethical competence is strengthened by: Reflection - to see with new wondering eyes; Time for talk - interdisciplinary teamwork and Leadership - an ethical role model and support. DISCUSSION: Ethical competence has a strong link to the core of caring ethics and a deeper personal value base and attitude. Ethical competence involves the whole culture and is seen as a shared value base and a responsibility to do the best for the patient as a multi-professional team and organization. Ethical competence becomes active in healthcare practice by opening up for meaningful multi-professional talks and reflections.

Midwifery students' experiences of support for ethical competence.

BACKGROUND: Midwifery students are confronted with several ethical dilemmas and challenging situations during clinical midwifery care practice. Since ethical competence of midwifery students is under development, it is important to support the students' learning progress of ethical issues from diverse viewpoints. OBJECTIVE: From the perspective of didactics of caring science and the context of midwifery students, to explore how midwifery students' experience supports for ethical competence in midwifery education and investigate how ethically challenging situations have been carried out during clinical midwifery care practice. DESIGN: Qualitative, explorative and descriptive design with inductive nature. METHODS: Focus group interviews with nine Swedish midwifery students. Hans-Georg Gadamer's philosophical hermeneutics was applied to guide the interpretation. ETHICAL CONSIDERATIONS: Ethical principles and scientific guidelines were followed. Informed consent was obtained from the participants. Confidentiality was respected and quotations anonymised. RESULTS: Receiving support when ethically challenging situations occur in clinical midwifery practice is important and necessary. One main theme, such as support is a human and caring factor in the midwifery students' Bildung process on ethical competence, and four subthemes, such as supporting through trust and responsibility; supporting through dignity and respect; supporting through truthfulness and justice; and supporting through dialogue and reflection, were created from the hermeneutical interpretation. DISCUSSION: Teaching ethics should be carefully planned, consistent and continue throughout the midwifery education. There is dispersion in the pedagogy of ethical situations, the methods and perceptions associated with it, and in obtaining possible support for students. Developing well-experienced methods could benefit the support of midwifery students' ethical competence when they experience ethically challenging situations in midwifery care practice.

Aesthetics in Nursing Practice for Cancer Patients as Experienced by Nurses in Nepal: A Hermeneutic Phenomenological Study.

BACKGROUND: Aesthetics in nursing practice address creating beautiful, meaningful, desirable, and satisfying experiences for both the nurse and the patient. However, little is known about aesthetics in nursing practice. OBJECTIVE: The aim of this study was to describe the lived experiences of nurses who provide aesthetically pleasant care in nursing practice for cancer patients. METHODS: The hermeneutic phenomenological approach grounded on Gadamer's philosophy was used in this study. Sixteen Nepalese nurses who met the inclusion criteria were the participants. The data collection consisted of 2 methods of drawing graphic illustrations to reflect aesthetic nursing practices and in-depth interviews to explain them. The researchers analyzed and interpreted art-based graphic illustrations and interview transcriptions of 16 Nepalese nurses using van Manen's approach. RESULTS: The 5 thematic categories covering these meanings comprised (1) knowing persons as whole, (2) creating a pleasant healing environment, (3) creative use of palliative care resources, (4) nurturing hope, and (5) rewarding the self. CONCLUSION: This study provides the understanding of the nurses' thoughts and actions of aesthetics in their nursing practice. The inductive knowledge from the experiences of the nurses informs the nursing discipline and profession to promote aesthetics in nursing. IMPLICATIONS FOR PRACTICE: These findings can be used to promote aesthetics in nursing practice to improve patients' well-being holistically and increase nurses' satisfaction from caring.

The rationale for including osteopathic manipulative treatment in the management of infections: a hermeneutic review.

INTRODUCTION: As the prevalence of drug-resistant infections continues to outpace the development of new antibiotics, we must explore all reasonable options for enhancing the effectiveness of existing anti-infectives. The emergence of novel pathogens without initial drug treatments or vaccines, typified by the severe acute respiratory syndrome coronavirus-2 pandemic, further underscores the need for non-pharmacologic adjunctive measures for infection management. Osteopathic manipulative treatment (OMT) may represent such an adjunct. AREAS COVERED: PubMed, CINAHL, Google Scholar, Cochrane databases and relevant chapters of major osteopathic texts were searched for animal experiments, case reports, observational studies, non-randomized, and randomized trials pertaining to infection, OMT, and the complications or safety of OMT. OMT was associated with one or more of the following: decreased bacterial colony counts in lung tissue; changes in immunologic profiles manifested by significant differences dendritic cells and levels of IL-8, MCP-1, MIP-1a, and G-CSF; shorter durations of IV antibiotics; decreased length of hospitalization; decreased rates of respiratory failure and death; decreased post-surgical lengths of stay; and enhanced patient satisfaction. EXPERT OPINION: Preliminary, lower-grade evidence suggests that OMT can improve some infection-related outcomes, and is safe. The role of OMT in infection management should undergo further controlled trials without delay.

Opening Possibilities for a Meaningful Life Narrative Identity in Service of Existential Health and Spiritual Care.

Paul Ricoeur's understanding of philosophical hermeneutics offers a valuable tool to think about the meaning of life. By approaching philosophy as a way of living through the need for meaning, Ricoeur places his hermeneutics between two common directions in twentieth-century philosophy as a way of living, Sartrean humanism and Foucauldian antihumanism. As such, Ricoeur's narrative conception of the self can contribute to rethinking a conception of existential health and spiritual care.