Doctorate of Health Sciences / Abstract The aim of this study was to understand the meaning of caring as experienced by Arab Muslim nurses within the context of Arab culture. A qualitative approach using ethnographic methodology based on the approaches of Geertz (1973), Fitzgerald (1997) and Davies (1999) was used to develop a description that embeds the phenomena of the nurses’ meaning of caring within the cultural context. Good and Good’s (1981) meaning–centred approach was used to interpret the nurse’s explanatory models of health, illness and healing that inform the caring experience. This study conveys the cultural worlds of Arab Muslim nurses from Saudi Arabia, Lebanon, Jordan and Egypt while caring for Arab Muslim patients in Saudi Arabia. Data were collected over a four year period (2004-2007). Arab Muslim nurses have a religiously informed explanatory model where health is spiritual, physical and psycho-social well-being. Spirituality is central to the belief system where spiritual needs take priority over physical needs as a distinctive care pattern. The professional health belief system blends into the nurses’ cultural and religious belief system, forming a culturally distinct explanatory health beliefs system. This finding suggests that in non-Western health contexts, professional models are not dominant but incorporated into nurses’ indigenous worldviews in a way that makes sense within the culture. Caring is based on shared meanings between nurse and patient. Caring is an act of spiritualty and an action by the nurse to facilitate his or her own spirituality and that of the patient. In turn, the nurse receives reward from Allah for caring actions. A distinct ethical framework based on principles of Islamic bio-ethics guides the nurses in their caring. This research provides the missing link between Western professional nursing systems and Arab Muslim nurses’ caring models and contributes to the development of a caring model that is relevant to, and reflective of, Arab cultural and Islamic religious values. This caring model can provide direction for nurse education and the provision of care to Muslim patients, whether in Arab cultures, Islamic societies or with immigrant Muslim populations. In addition, it provides the basis for an Islamic nursing identity and a beginning point for improving the moral status and image of nursing in the Middle East.

Doctorate of Health Sciences / Abstract The aim of this study was to understand the meaning of caring as experienced by Arab Muslim nurses within the context of Arab culture. A qualitative approach using ethnographic methodology based on the approaches of Geertz (1973), Fitzgerald (1997) and Davies (1999) was used to develop a description that embeds the phenomena of the nurses’ meaning of caring within the cultural context. Good and Good’s (1981) meaning–centred approach was used to interpret the nurse’s explanatory models of health, illness and healing that inform the caring experience. This study conveys the cultural worlds of Arab Muslim nurses from Saudi Arabia, Lebanon, Jordan and Egypt while caring for Arab Muslim patients in Saudi Arabia. Data were collected over a four year period (2004-2007). Arab Muslim nurses have a religiously informed explanatory model where health is spiritual, physical and psycho-social well-being. Spirituality is central to the belief system where spiritual needs take priority over physical needs as a distinctive care pattern. The professional health belief system blends into the nurses’ cultural and religious belief system, forming a culturally distinct explanatory health beliefs system. This finding suggests that in non-Western health contexts, professional models are not dominant but incorporated into nurses’ indigenous worldviews in a way that makes sense within the culture. Caring is based on shared meanings between nurse and patient. Caring is an act of spiritualty and an action by the nurse to facilitate his or her own spirituality and that of the patient. In turn, the nurse receives reward from Allah for caring actions. A distinct ethical framework based on principles of Islamic bio-ethics guides the nurses in their caring. This research provides the missing link between Western professional nursing systems and Arab Muslim nurses’ caring models and contributes to the development of a caring model that is relevant to, and reflective of, Arab cultural and Islamic religious values. This caring model can provide direction for nurse education and the provision of care to Muslim patients, whether in Arab cultures, Islamic societies or with immigrant Muslim populations. In addition, it provides the basis for an Islamic nursing identity and a beginning point for improving the moral status and image of nursing in the Middle East.

Aim: The overall aim of the thesis was to describe the experiences of awake patients during surgery under regional anesthesia. In addition, the aim was to develop a model for intraoperative care that can support and enhance patients’ well-being during the intraoperative period.   Methods: Study I was a patient interview study guided by a reflective lifeworld approach. In study II a philosophical reflection of the findings from study I was carried out. In study III a hermeneutic approach inspired by Ricoeur and Gadamer was used in order to interpret video recorded material. In study IV a hermeneutic approach inspired by Gadamer was used to synthesize the findings in studies I-III transformed into an intraoperative caring model.  Overall main findings: The analysis shows that being awake during surgery can be compared with walking a tightrope because of ambiguous feelings. The proximity and presence of the nurse anesthetist (NA) anchors the patient in the present and strengthens the patient’s feeling of trust. The temporary disruption in the relationship between the body and the world due to regional anesthesia means that the patient’s being in the world is exposed to revolutionary experiences. Gaps between the patient’s experiences and the situation can be bridged over when the NA acts as the patient’s bodily extension and links the patient as a subject to the world in the intraoperative situation. From the patient’s perspective this calls for the NA’s proximity and genuine presence in the ‘intraoperative caring space’. When the NA’s performance of his/her professional duties clashes with the patient’s existential being in the intraoperative situation the need of present presence from the NA is crucial. Conclusions: The findings contribute to knowledge development about intraoperative care and raise awareness that care for the awake patient cannot be performed on formal routines that might disregard the uniqueness of each patient’s situation. The model can be used as a tool to encounter awake patients’ existential needs in the intraoperative situation and to further enlighten NAs about the possible impact of their proximity, interaction and communication behavior in the delivery of intraoperative nursing care.

Plusieurs écrits scientifiques ont mentionné que les pratiques humanistes-caring en formation infirmière sont avantageuses pour les personnes étudiantes. En effet, les pratiques humanistes-caring professorales créent les conditions qui favorisent les apprentissages. Des études ont rapporté la perspective de la clientèle étudiante témoignant des bienfaits des pratiques humanistes-caring de professeurs. Elles constituent une piste de solution pouvant réduire la déshumanisation dans les milieux académiques d’enseignement et d’apprentissages des soins infirmiers. Mais à la connaissance de l’étudiant-chercheur, aucune étude issue de la discipline infirmière ne s’est intéressée à la compréhension de la signification des pratiques humanistes-caring de professeurs, de même qu’aux contributions de celles-ci à l’égard de la personne étudiante. Inspirée par l’humanisme et le caring comme philosophie, le Modèle humaniste des soins infirmiers-Université de Montréal (Cara et al., 2016) a été retenu comme perspective disciplinaire de la présente étude. Cette dernière avait pour but d’explorer et comprendre, auprès de professeurs, la signification de leurs pratiques humanistes-caring, de même que leurs perceptions quant aux contributions de celles-ci au développement des apprentissages de la personne étudiante en formation infirmière. Pour ce faire, huit entrevues ont été réalisées auprès de professeurs dans une université québécoise. Les données recueillies ont été analysées à l’aide de la méthode phénoménologique de Giorgi (1997). Le processus d’analyse a permis l’émergence de sept thèmes. Parmi ces thèmes, quatre se rapportent à la signification des pratiques humanistes-caring de professeurs (première question de recherche), à savoir : 1) valeurs humanistes-caring comme fondement du rôle professoral, 2) attitudes humanistes-caring de professeurs envers la personne étudiante, 3) comportements humanistes-caring de professeurs envers la personne étudiante et, 4) conditions contextuelles des pratiques humanistes-caring des professeurs. Finalement, les trois derniers thèmes documentent la contribution des pratiques humanistes-caring à l’égard de la personne étudiante (deuxième question de recherche), à savoir : 1) épanouissement de la personne étudiante, 2) succès académique de la personne étudiante, 3) sentiment d’accomplissement professoral. L’ensemble des sept thèmes a favorisé l’émergence de la structure essentielle du phénomène investigué qui s’intitule « influencées par des conditions contextuelles, les pratiques professorales empreintes de valeurs, d’attitudes et de comportements humanistes-caring favorisent l’épanouissement et le succès académique de la personne étudiante, de même que l’accomplissement professoral ». La présente étude s’est révélée innovante puisque les résultats constituent de précieuses données pour les connaissances en sciences infirmières. Ces résultats peuvent être utilisés pour créer ou maintenir un environnement favorable aux enseignements et aux apprentissages dans les milieux de formation infirmière. De même, les milieux cliniques de soins peuvent les utiliser en vue d’améliorer la qualité du suivi auprès des personnes étudiantes en stage. Enfin, ces résultats peuvent susciter l’intérêt de réaliser d’autres recherches subséquentes et ce, dans d’autres milieux académiques en formation infirmière. Mots-clés : Pratiques humanistes-caring, Modèle Humaniste-Caring, formation infirmière, professeur, étudiant infirmier, méthode phénoménologique, valeurs humanistes-caring, attitudes humanistes-caring, comportements humanistes-caring. / A number of scientific studies have shown that humanistic-caring practices in nursing education are beneficial for students. In fact, humanistic-caring professorial practices create conditions that promote learning. Studies have reported on the benefits of professors’ humanistic-caring practices from the perspective of students. They constitute a possible solution that can reduce dehumanization in academic nursing teaching and learning environments. However, to the best of the student-researcher's knowledge, no study within the nursing discipline has focused on understanding the professors’ meaning of their humanistic-caring practices, as well as their contributions for students. Inspired by humanistic and caring philosophies, the Humanistic Model of Nursing Care-Université de Montréal (Cara et al., 2016) was chosen as the disciplinary perspective for this study. The purpose of this research was to explore and understand professors’ meaning of their humanistic-caring practices, as well as their perceptions of the contributions of these practices to the development of nursing students’ learning. To this end, eight interviews were conducted with professors working in a Quebec university. The data collected were analyzed using Giorgi’s (1997) phenomenological method. The analysis process revealed seven themes. Four of these themes relate to the meaning of professors’ humanistic-caring practices (first research question), namely: 1) humanistic-caring values as the foundation of the professorial role, 2) professors’ humanistic-caring attitudes towards the student, 3) professors’ humanistic-caring behaviours towards the student and, 4) contextual conditions of professors’ humanistic-caring practices. The other three themes correspond to the contribution of humanistic-caring practices towards the student (second research question), explicitly: 1) student self-fulfillment, 2) student academic success and, finally, 3) sense of professorial accomplishment. Together, the seven themes led to the emergence of the essential structure of the investigated phenomenon: "Influenced by contextual conditions, professorial practices imbued with humanistic-caring values, attitudes and behaviours foster students’ self-fulfillment and academic success, as well as professorial accomplishment". The present study proved to be innovative since its results constitute valuable data for nursing knowledge. These results can be used to create or maintain an environment conducive to teaching and learning in nursing training environments. Clinical care settings can use them to improve the quality of the follow-up offered to students during their internship. Finally, these results may spark the interest in carrying out subsequent research, elsewhere in other academic settings in nursing education. Keywords: Humanistic-caring practices, Humanist-Caring Model, nursing education, professor, nursing student, phenomenological method, humanistic-caring values, humanistic-caring attitudes, humanistic-caring behaviors.