Heideggerian phenomenological hermeneutics: Working with the data.

It is one thing to read about the methodology and methods of Heideggerian hermeneutic phenomenological research, the ontic description. It is quite another thing to be faced with an interview transcript. This article draws on a study that asked doctoral students about their experience of doing such research. How did they become "phenomenological/hermeneutic" in their thinking and writing? What helped them to find their way? We offer this article as a means of letting others learn from our own experiences. We support our insights with the writings of Heidegger and Gadamer to show the methodological congruence that is essential to Heideggerian phenomenological hermeneutic research.

Reading Heidegger.

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

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.

Patient advocacy by nurses - past, present and future.

BACKGROUND: Patient advocacy is central to the nursing profession yet a sense of certainty about the concept, its meaning and its implications for nursing practice remains elusive. AIM: This scholarly paper examines the concept of patient advocacy and its relevance to the nursing profession in Aotearoa/New Zealand. DESIGN: A broad historical overview of the evolution of the role of advocacy in nursing practice is provided including factors that encourage or discourage nurses to practice patient advocacy. CONCLUSIONS: This paper highlights the gap between the ideal of patient advocacy and the realities of everyday nursing practice. The responsibility for enacting advocacy sits with both individual practitioners and the organizations nurses work within.

Humanitarian Nursing in Developing Countries: A Phenomenological Analysis.

BACKGROUND: Surgical nursing within humanitarian contexts is complex, sporadically described in literature and little understood. AIM: To achieve a deeper understanding of the lived experience of New Zealand nurses providing humanitarian aid within surgical settings and war zones in developing countries. METHOD: In-depth conversational interviews were undertaken with four New Zealand nurses whose humanitarian experience lay in general surgical, military, and intensive care settings. A qualitative descriptive method as described by Sandelowski, informed by van Manen's phenomenology in terms of analysis, was used. RESULTS: Specialized knowledge and nursing expertise are recognized to be essential but not sufficient for humanitarian work. Understanding local cultures contributes to positive feelings about work effectiveness. Themes included feeling anxious and misunderstood, practicing differently, and adjusting to life back home. DISCUSSION: This study highlights the need to better prepare nurses who volunteer for humanitarian work, with implications for recruiting organizations, educators, and clinicians.

Kairos time at the moment of birth.

BACKGROUND: there is something extraordinary in the lived experience of being there at the time of birth. Yet the meaning and significance of this special time, named Kairos time in this paper, have received little attention. AIM: to describe the lived-experience of Kairos time at birth and surface its meaning. METHODOLOGY: this is an interpretive hermeneutic phenomenology study informed by the writings of Heidegger and Gadamer. 14 in-depth interviews with mothers, birth partners, midwives and obstetricians were transcribed and stories from the data were hermeneutically analysed. FINDINGS: there is a time, like no other, at the moment of birth that is widely known and valued. This paper reveals and names this phenomenon Kairos time. This is a felt-time that is lineal, process and cyclic time and more. Kairos time describes an existential temporal experience that is rich in significant sacred meaning; a time of emergent insight rarely spoken about in practice yet touches everyone present. The notion of Kairos time in relation to the moment of birth is introduced as a reminder of something significant that matters. KEY CONCLUSIONS: Kairos time is revealed as a moment in and beyond time. It has a temporal enigmatic mystery involving spiritual connectedness. Kairos time is a time of knowing and remembrance of our shared natality. In this time life is disclosed as extraordinary and beyond everyday personal and professional concerns. It is all this and more. IMPLICATIONS: Kairos time at birth is precious and powerful yet vulnerable. It needs to be safeguarded to ensure its presence continues to emerge. This means maternity care providers and others at birth need to shelter and protect Kairos time from the sometimes harsh realities of birth and the potentially insensitive ways of being there at the moments of birth. Those who find themselves at birth need to pause and allow the profundity of its meaning to surface and inspire their actions.

The joy at birth: an interpretive hermeneutic literature review.

OBJECTIVES: this literature review examines the experience of joy at birth and what that joy means. The premise is that the whole of the birthing experience has not been fully explicated in the literature and that something of significance remains unexplored and unspoken. It is argued that a hermeneutic phenomenological approach to reviewing literature provides unique insights and leads to deeper understandings about birth and the experience of joy that attunes at that moment. METHODOLOGY: the philosophical underpinnings informed by Heidegger and Gadamer are central to this review and therefore the process of reviewing literature hermeneutically is described. Heideggerian phenomenology is used as the method to ask the questions of the literature in order that concealed and hidden experiences of joy at birth are made visible where they are gleaned from the literature. A hermeneutic lens is used to uncover relationships within the phenomenon of joy at birth and meaning. FINDINGS: although a vast birth literature was reviewed joy at birth was often ignored, hidden or covered over. Reviewing the literature on relationships, professional presence, place of birth, birth satisfaction studies and birth as peak and spiritual experience provides glimpses of the phenomenon 'joy at birth'. CONCLUSION: it is argued that joy at birth remains largely neglected as a phenomenon worthy of consideration. Plausible interpretations are presented that suggest that joy at birth points to something significant and meaningful. Spiritual and sacred meaning is alluded to in the papers reviewed yet the majority of papers that investigate birth leave this meaning unspoken. The review highlights a need for further thinking and questioning about birth that would direct on-going investigation.

Dementia: The need for attitudinal change.

OBJECTIVE: To undertake a systematic inquiry into the experience of living with dementia in the community. DESIGN: Action research, underpinned by critical hermeneutics, brought together action and reflection, theory and practice to generate knowledge. Data were gathered by interviews and observations in participants' homes, and focus group discussions in community settings. PARTICIPANTS: Eleven people with mild to moderate dementia and their primary caregiver aged 59-84, living in Auckland, New Zealand. RESULTS: The findings reveal a conflict between living positively with dementia, and enduring the negative attitudes that typify the dominant social discourse. The central argument arising from the findings is the significance of personal attitudes. CONCLUSIONS: Implications for policy makers, health care providers, and caregivers highlight the need to change the ways in which dementia is perceived. The pursuit of positive attitudes will do much to change social perceptions and enable people with dementia to live with a sense of well-being.

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.

Oral hygiene care in the pediatric intensive care unit: practice recommendations.

Oral hygiene significantly affects children's well being. It is an integral part of intensive and critical care nursing because intubated and ventilated children in the Pediatric Intensive Care Unit (PICU) are dependent on the health care team to tend to their everyday basic needs. Fourteen articles were identified as being relevant to pediatric oral care in the PICU. These articles were subsequently appraised, and an oral hygiene in the PICU guideline was developed. Research highlighted the relationship between poor oral hygiene in the intensive care unit (ICU) and an increase in dental plaque accumulation, bacterial colonization of the oropharynx, and higher nosocomial infection rates, particularly ventilator-associated pneumonia. Research and a local, informal audit found the provision of oral hygiene care to PICU children varied widely and was often inadequate. Children in the PICU need their mouths regularly assessed and cleaned. Maintaining consistent, regular, and standardized oral hygiene practices in the PICU will also set an example for children and their families, encouraging and teaching them about the life-long importance of oral hygiene.

A qualitative study of youth living with Crohn disease.

Little is known about what it is like to live in adolescence with a chronic inflammatory bowel disease. This article reports the findings of a small qualitative study that explored the experience of four New Zealand youth aged between 16 and 21 years, who had been recently diagnosed with Crohn disease. Semistructured interviews focused on discovering the youth' thoughts, feelings, and perceptions of living with this condition. Analysis of the transcribed data is presented thematically. The findings reveal stress as integral to living with Crohn disease. They illuminate the paradoxical relationship between fear and hope and provide insight into what helps and what hinders young people's ability to cope with the disease and its treatments. Collectively, these three themes describe the ways in which the lives of young adults are drastically and almost irreparably changed by Crohn disease. The findings contribute to the "promoting wellness" literature and will inform those who support the increasing number of young people living and coping with a chronic inflammatory bowel disease.

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.

Implementing a prescribing practicum within a Master's degree in advanced nursing practice.

The recent introduction of Nurse Practitioner registration in New Zealand has resulted in the development of a number of Master's degree programmes in which students focus clinically and can complete a Nursing Council of New Zealand approved programme for prescribing. This article reports the implementation of a collaborative project undertaken to monitor and improve the effectiveness of the prescribing practicum papers delivered within two Master's degree programmes in advanced nursing practice. A developmental action research approach was used. Data were collected through interviews with practicum students, their medical supervisors and academic staff. Formative findings were progressively used to refine delivery of the practicum papers and a thematic analysis of summative findings identified areas for further improvement. The findings suggest that the processes being implemented are developing well. Further education is required to clearly differentiate medical and advanced nursing roles. Greater attention needs to be paid to the preparation of medical supervisors and, most significantly, revision of funding is required to more equitably support the ongoing development of nurses for advanced practice roles.

Within the web: the family-practitioner relationship in the context of chronic childhood illness.

This hermeneutic phenomenological study explores the relationship between health professionals and families who have a child with a chronic illness. Study participants included 10 family groups who had a child with a chronic illness and 12 practitioners from the disciplines of nursing, medicine, dietetics, physiotherapy and speech therapy. Data were collected by narrative audiotaped interviewing. The results of this study revealed that chronic childhood illness 'throws' families and practitioners together into a web of relationships, which must work for the sake of the child. However, children are usually excluded from the relationship. To understand and manage the child's illness, practitioners and families 'go around' and act 'in-between' relationships. While the quality of the relationship from the family perspective is not essential, relationships are more successful when practitioners recognize the uniqueness of each family web. The nature of the relationship is often simple, yet it coexists with complexity.

Hermeneutic notions augment cultural safety education.

Nurses are beginning to demand educational approaches that confront racism, rather than teach cultural diversity. One example of the latter approach is the introduction of kawa whakaruruhau, or cultural safety, in nursing and midwifery education in New Zealand. In the nursing and midwifery context of kawa whakaruruhau, nurses and midwives recognize, respect, and nurture the unique cultural identity of New Zealand's indigenous people, the tangata whenua, and safely meets their needs, expectations, and rights. In this article, I integrate literature pertaining to the implementation of cultural safety with the findings of a hermeneutic project that described the experience of nursing people from cultures other than one's own, and argue that the Gadamerian notions of "horizon," "prejudice," and "play" can be used to facilitate understanding of the tensions and contradictions inherent in cross-cultural practice. In addition, I recommend strategies that enable students to explore the prejudices, paradoxes, and possibilities experienced personally and professionally. As Gadamer noted, the art is in seeing what is questionable. There is also art in knowing how to question in a manner that makes new understanding possible.

Nursing people from cultures other than one's own: a perspective from New Zealand.

Nursing a person from another culture is a dynamic, complex and tension-filled phenomenon. It is also always culturally and historically situated. This paper provides an overview of the evolving meaning of 'culture' in New Zealand nursing. Then, drawing upon the findings of research that used hermeneutic phenomenology to explore the experience of nursing people from cultures other than one's own, a description of the constituent parts is of this phenomenon is briefly outlined and followed by an exemplar that describes the coalescent and contradictory nature of the phenomenon as a whole. As New Zealand nurses negotiate the conflicts essential for ongoing development of their practice, interplay of the notions of prejudice, paradox and possibility is evident at intrapersonal and interpersonal levels as well as in relation to professional and other discourses.

Win-win-win: collaboration advances critical care practice.

Against a background of increasing interest in education post registration, New Zealand nurses are working to advance their professional practice. Because the acquisition of highly developed clinical capabilities requires a combination of nursing experience and education, collaboration between clinicians and nurse educators is essential. However, the accessibility of relevant educational opportunities has been an ongoing issue for nurses outside the country's main centres. Within the framework of a Master of Health Science, the postgraduate certificate (critical care nursing) developed between Auckland University of Technology and two regional health providers is one such example. Students enrol in science and knowledge papers concurrently then, in the second half of the course, are supported within their practice environment to acquire advanced clinical skills and to analyse, critique and develop practice within their specialty. This paper provides an overview of the structure and pr month, distance education course focused on developing the context of critical care nursing.