In: Nursing
Has phenomenology influenced the way your think about nursing care and the way you care for patients?
Phenomenology about nursing care
1. Phenomenology is regarded as influential to generate in-depth evidence about suffering that is grounded in chronically ill patients’ perspectives.
2. Due to nursing’s involvement in examining phenomena within a contextual health care framework, phenomenology is not only conducive to the discovery of information but also the development of nursing knowledge essential to the profession.
3. The philosophical constructs of suffering suggested fundamental dimensions such as stress, distress, hopelessness, and depression along with pain.
4. Phenomenology is also quite useful to qualitative nurse researchers because it can be an effective vehicle for illuminating and clarifying fundamental issues in the health care sector.
5. Hermeneutic phenomenology was adopted as an effective strategy to elucidate human experience leading to the discovery of the embedded meanings of life experience.
6. Phenomenology plays a pivotal role in the nursing profession because it values not only the individual’s experience but also the principles and modalities of their holistic healing into daily life and clinical practice.
Types of phenomenology
Descriptive or Husserlian phenomenology was developed by Husserl (1859–1938), and is aimed at ‘uncovering and describing the essence of the phenomena of interest’ (Priest 2004). Interpretive or Heideggerian phenomenology was developed by Heidegger (1889–1976), and is aimed at ‘the interpretation of phenomena to uncover hidden meanings.
Descriptive phenomenology
Husserl is considered the ‘father’ of the phenomenological movement. Central to his ideas was the ‘fundamental recognition of experience as the ultimate ground and meaning of knowledge’ (Koch 1995). Husserl’s method focused on description and explanation (Ray 1985), with the prime aim of uncovering the ultimate structures of the consciousness (essences) (Koch 1995). According to Kleinman (2004), essence refers to ‘the most essential meaning for a particular context’. It is the essence that forms the consciousness and perception of the world. Following are assumptions:-
A phenomenon is believed to be a reality, a truth that exists as an essence (of the phenomenon), and which can be disclosed – a ‘realist’ belief.
▪ This essence of the phenomenon exists independently from the researcher – an ‘objectivist’ opinion.
▪ The phenomenologist can, and should, seek to disclose the essence of the phenomenon in its purity, untainted by the phenomenologist’s preconceptions of the phenomenon – objectivity is essential.
Interpretive phenomenology
Although it is recognised that interpretive phenomenology has been informed by various philosophers, such as Gadamer 1989, Habermas 1990, Heidegger 1962 and Ricoeur 1981, this discussion will focus on the approach developed by Heidegger. Parse (1995) suggested that Heideggerian phenomenology could be viewed as an extension of Husserl’s original ideas, adding meaning and interpretation to descriptions without the notion of bracketing. Heidegger did not believe that getting to know and describe the experience of individuals was enough. Instead, he stressed the importance of knowing how respondents come to experience phenomena in the way they do (Parahoo 2006). Heidegger considered that the primary focus of philosophy was on the nature of existence (ontology), while Husserl focused on the nature of knowledge (epistemology). According to Koch (1995), Heidegger focused on the ‘experience of understanding’, while Husserl focused on the ‘experience itself’. As Moules (2002) suggested, Heidegger brought the ‘something’ (self/being, tradition, history, and experience) back into the ‘experience of something’.
The dominant themes in interpretive phenomenology are the hermeneutic circle and the historicality of understanding (Koch 1995 and Heidegger 1962 described understanding in terms of a three-fold structure consisting of:
▪ fore-having – something we have in advance;
▪ fore-sight – something we see in advance;
▪ fore-conception – something we grasp in advance.
Patients care by Nurses
The use of phenomenology within nursing research has been a direct consequence of the ability of this approach to answer questions of particular relevance to nursing practice (Lawler 1998 and Taylor 1993). It has been advocated that phenomenology is congruent with nursing, where humanistic knowledge is valued (Rose et al 1995). As noted by Beck (1994), ‘phenomenology affords nursing new ways to interpret the nature of consciousness in the world’. Many nurse researchers regard phenomenology as a research method that could provide understanding of the person’s reality and experience, one that values individuals and the nurse–patient relationship, and one which embraces a holistic approach to the person (Benner 1994 and Holmes 1990). In commenting on the use of phenomenology as a research method for nurses, Lawler (1998) suggested that:
Unless nurses know what meanings people attach to events that disrupt their lives, nurses – as practitioners and people – have a restricted capacity to help their patients or find ways to deal with their own experiences as practitioners’
Some examples of phenomena that have been explored using phenomenology have included:
▪ Women’s experience of acute myocardial infarction (Svedlund et al 1994);
▪ Registered nurses’ perspective of caring for adolescent females with anorexia nervosa (King & Turner 2000);
▪ Patients’ and nurses’ experience of caring in nursing (McCance 2003);
▪ Providing information to patients receiving radiation therapy (Long 2001);
▪ Patient’s experience of an intensive care unit following a liver transplant (Del Barrio et al 2004);
▪ Nurses’ experience of day hospital chemotherapy (McIlfatrick et al 2006).
Conclusion:
The phenomenological approach provides nursing research with the pathway to explore patients’ suffering experiences in the chronically ill.