This thesis is a hermeneutic phenomenological study of the concept of disclosure in maternity care contexts using the example of sexual orientation. There is a significant body of literature within psychology and sociology relating to the health and social purposes and consequences of disclosure. There is a further body of outcomes-focused evidence relating to disclosure of sexual orientation in health care. There is, however, little research undertaken into the disclosure of sexual orientation in pregnancy as an action with motive and purpose. This study aimed to address this issue. The study employed unstructured interviews with eight lesbian mothers, seven of whom were birth mothers and one was a social mother. The hermeneutic method used an iterative process of analysis integrating researcher pre-understandings, thematic analysis of individual interview transcripts and broader analysis of the individual interview data within the total interview data, exploring the parts within the whole. The aim was to identify the shared meaning of disclosure for the participants Data analysis resulted in five main themes: being invisible/visible; being upfront; being me; being entitled; being safe. An additional finding was the process of managing negativity through strategies such as rationalisation. Three encompassing concepts were identified: protection; power; and identity. Two motivations for disclosure were also identified: pro-action and altruism The thesis concludes that disclosure is a motivated and purposeful act which has real meaning and consequences. It makes extensive recommendations for midwifery practice including acknowledging the disclosure, understanding the legal complexity, and recognising the lesbian family. Recommendations for policy suggest having explicit and detailed policies that include information about how to be inclusive rather than only abstract concepts of inclusion. Recommendations for research include qualitative and quantitative research with midwives about attitudes and knowledge as well as research exploring the role of the social mother in promoting family health outcomes.

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Chronic disease is the largest cause of death in the world. Yet little is known about how globalization forces affect the body and the experience of someone who is chronically ill. The need for specialized knowledge of subjective data is significant as it will assist us to improve our understanding and develop stronger nursing practices for people who are chronically ill. The purpose of this research is to understand the effect that globalization forces have on the personal experience of people living with chronic illnesses. People living with chronic illness from Canada and Colombia are participants in the study. The following research questions guided the study “What is it like to live with a chronic illness in the context of contemporary globalization forces? How do these political, economical and social forces affect the body of the chronically ill? Are experienced difficulties similar or different in a middle-income country as compared to a high-income country? The methodology for the study follows an interpretive inquiry approach using a critical hermeneutic phenomenological method. Hermeneutic phenomenology explores the various dimensions of human experience in human situations such as embodiment, spatiality, relationality and temporality. Critical pedagogy as a theoretical perspective invoking the work of Paulo Freire and Enrique Dussel is used to examine emerging findings in the context of globalization and resulting global inequities. This dissertation presents the experience of people who are chronically ill including access to health care, respect, compassion, social, political and legal exclusion, and calls for understanding and action on the part of health care professionals, policy makers and society. The findings urge us to move from merely acknowledging the difficulties people living with chronic illness endure in an age of globalization to action to bring about health care, social, and political reform through a process of conscientization and mutual transformation.

The topic of disability permeates medical literature. Yet, while disability as a medical condition is a focus of research and discussion, this research and discussion occurs often in neglectful ignorance of the total life experience of the individual person. This research is grounded in interpretive phenomenology. The philosophical grounding for the study draws on the works of Heidegger and Merleau-Ponty. The methodological structure of the research used van Manen’s (1990) hermeneutic phenomenology to guide a deeper understanding of the human experiences surrounding physical disability. Nine men and women living in different rural communities participated in a series of audiotaped, in-depth, unstructured interviews. The study suggests that living with disability encompasses a complex multidimensional phenomenon to be found within the context of a person’s life. Defined by physical and social barriers, living with disability denotes an interaction between impairment, activity limitation, and restricted participation. Four themes emerged that explicate the experience: (1) The Everyday Life of the Body; (2) Valuing a Rural Life; (3) Relationships in Life; and (4) Relating Time to Life. Disability was understood as a life-changing experience that entails complex time-consuming and energy-depleting processes and is defined by personal, family and social development. For the participants in this study, the lived experience of disability can be characterised by the expression: “life is not the same”. The understanding of the essential nature of this lived experience that emerged from this study has implications for health practice. The practice of disability intervention, based solely on impairment, may be inadequate to facilitate optimal health outcomes for rural people. Instead, physiotherapists can assist these people in discernment of priorities, maintaining existing relationships, advocation of rights, and finding the balance to encounter physical and societal adversity. Thus, the study suggests that health professionals need a broad conceptualisation of what constitutes legitimate knowledge for practice and a recognition that disability is an ongoing journey rather than a final destination.

There are an estimated 5 million family caregivers supporting persons suffering from advanced heart failure (AHF) which constitutes the final stage of cardiovascular disease and is the primary cause of death for 1 in 8 Americans. AHF caregivers are instrumental in monitoring symptoms, promoting adherence, communicating with healthcare providers and making treatment choices for their care recipients (CRs) at the end of life. What little is known about the AHF caregiver experience comes from surveys, instruments and structured interviews and tends to exclude caregivers of CRs with advanced disease. The purpose of this interpretive phenomenology was to elicit the meaning of caring for a spouse with AHF and is the first of its kind in the US. Seven older spouses caring for persons with NYHA class III-IV HF recruited by the Advance Practice RN of a large regional hospital participated in 3 reflective interviews over the course of 2 months. Grounded in the Philosophy of Ethics by Paul Ricoeur and using a method based on his Theory of Interpretation, their reflections revealed the essence of the caregiver experience as "being fearfully vigilant, at the mercy of the disease while worrying about that which remains unspoken". Separate inquiries invited participants to explore the meaning of symptom interpretation which was likened to "a walk in the fog on the rocky shore by a treacherous river"; and communication which illuminated caregivers' ethical intention in caring for themselves and their loved ones. The fourth and final research question explored caregivers' meaning making in the experience, symptom interpretation and communication over time which uncovered several missed opportunities for advance care planning. Findings support and add to recent models in palliative care, shared care and advance care planning in AHF. This study gives healthcare providers insight into the challenges to respect, self esteem and autonomy encountered by aging couples in the context of AHF. Participants identified personal learning needs related to being a caregiver, symptom interpretation, and managing clinical and emotional manifestations of AHF. Naming specific barriers in communication with their CRs as well as with healthcare providers they called for relationship counseling for the CG-CR dyad, and to be respected as part of the team by healthcare providers. Participants gave moving examples of how current models of care failed to meet their needs, with urgent implications for coordinated care by an interdisciplinary team of healthcare providers. This study identified the need for more phenomenological inquiry to understand (1) implications of CR's cognitive fluctuations on decision making for preferences of care, (2) CRs' personality changes attributed to an awareness of death being near, (3) the need to retain a purpose in living both as individuals and as a couple, and (4) how CRs reconcile daily choices in illness management and adherence with preferences for care at the end of life.

Experiencing the death of a loved one is often life changing, and learning ways to cope is an important part of the healing process. Such a change can be particularly difficult for late adolescents (individuals between 18 and 25 years of age) who are already going through significant life changes. Spirituality and mental health has received increasing scholarly attention in recent years, and the Association for Spirituality, Ethics, and Religious Values in Counseling has developed competencies for counselors to use when working with clients who wish to incorporate spirituality in their treatment. Despite increased interest in the field, there is little scholarly literature on the use of spirituality in counseling late adolescents who are experiencing grief and loss. The purpose of this hermeneutic phenomenological study was to explore the meaning and role of spirituality and spiritual practices in the grieving processes of late adolescents. Existential theory provided the framework for the study. Participants were recruited from a local grief center, college, and university as well as CESnet and ASERVIC listservs. Seven late adolescents took part in semistructured interviews regarding their grieving process. Lindseth and Norberg's phenomenological hermeneutical method was used to analyze the data consisting of naïve reading, structural analysis, and comprehensive understanding. Themes included experiences with death, surviving the loss, and changes. Findings indicated that spiritual practices were beneficial in helping grieving late adolescents cope with the death of a loved one. Results may provide counselors with additional ways to work with this population during their grieving process.

Indiana University-Purdue University Indianapolis (IUPUI) / While much has been written about the work of school counselors in urban schools, there remains a void of information about the unique experiences of Black female school counselors, particularly in relation to their work with Black adolescent girls in the urban middle school space. This qualitative study seeks to illuminate these experiences via the contributions of four Black female school counselors who have worked in this capacity serving Black girls. Three points of inquiry or Research Questions served as guideposts for this study: (1) What are the personal and professional experiences of Black female school counselors in their work with Black adolescent girls in urban middle schools?, (2) What are Black female school counselors’ perspectives on the ways in which they are supported or not supported in working with Black adolescent girls? and, (3) In what ways (if any) does the concept of “mothering” show up in the relationships and counseling practices involving Black female school counselors and Black adolescent girls in urban middle schools? Thus far, it appears that Black women’s voices and perspectives have been devalued and ignored in research relating to school counseling. To adequately represent the perspectives and experiences of Black women as a marginalized group, I employed a critical hermeneutic phenomenological methodology, along with a Black feminist framework. I engaged the participants in two semi-structured interviews, along with asking them to construct a reflective vision board, serving as a mosaic of their lifeworlds as school counselors working with Black adolescent girls. These actions, along with a review of literature on the schooling experiences of Black adolescent girls in urban schools enabled me to acquire data leading to seven overarching themes relating to the following: relationships and connections based on culture and conversation, the need for support from decision-makers on programming, the physical and emotional investment in the work, mentoring, and the marginalization of Black women in school spaces. Lastly, I present conclusions and implications for school systems, school administrators, and professional school counselor organizations to aid in establishing effective practices in serving Black female students and enhancing the overall school counseling profession.

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Although existing literature is rich with descriptions of the process of coming out for lesbian women, the present study is distinctive in its systematic examination of coming out from the perspective of lesbian women who were sexually abused as children. Through the hermeneutic-phenomenological analysis of interviews with selected participants who identified as lesbian women, the objective of this study was to identify and describe participants' perspectives of childhood sexual abuse, coming out experiences, and their perception of how these experiences might interrelate. Within the complex layers that were common to all the participants, the researcher attempted to interpret and make sense of phenomena across all cases, while respecting and recognizing the meanings that each participant brought to the interview. The results of this study were consonant with findings from previous studies that suggested maintaining a lesbian identity is an ongoing task, continually informed by events and relationships that typically occur during the lifespan of an individual. However, in the course of this investigation, the findings pointed to a new understanding—the coming out process becomes more complicated when histories of childhood sexual abuse need to be considered. While family and social factors had powerful influences on coming out for all the participants, the emotional and behavioral strategies that each woman adapted in order to cope with long-term sequelae of CSA, also appeared to have considerable impact on the coming out process as well. / Ph. D.

This dissertation investigated the meanings students from beginner jazz ensembles ascribe to learning jazz improvisation through Dalcroze-inspired activities. Over the course of ten weeks, students from three respective beginner jazz ensembles were exposed to Dalcroze-inspired activities as the medium for learning to improvise. The sessions were held on a weekly basis, facilitated by the researcher. Hermeneutic phenomenology guided the research procedures. In-depth interviews, personal reflections, participant reflection essays as well as video recordings were the methods of data collection. Through the use of Atlas.ti 7, the data were organized and analysed by means of coding and categorisation, which led to the identification of five themes. The five themes that emerged from the data analysis were: feeling the music in my body, supporting development as a jazz musician, building character, building relationships, and stimulating and motivating learning. This study provides an understanding of the connection between jazz improvisation and Dalcroze Eurhythmics as well as how students experience learning jazz improvisation through Dalcrozeinspired activities. Through this understanding this study proposes a more holistic approach to jazz improvisation teaching that can inform further research and application of Dalcroze Eurhythmics in jazz pedagogy. / MMus (Musicology), North-West University, Potchefstroom Campus, 2015