This study explores the phenomenon of dilemma in paediatric practice. Using a hermeneutic phenomenological method informed by the writings of Heidegger [1889-1976] and Gadamer [1900 -2002] this study provides an understanding of the meaning of ‘being in dilemma’ from the perspective of predominantly paediatric health care professionals but also families in New Zealand. Study participants include four families who had a child requiring health care and fifteen health care practitioners from the disciplines of medicine, nursing, physiotherapy, play specialist and occupational therapy who work with families and children requiring health care. Participants’ narratives of their experiences of ‘being in dilemma’ were captured via audio taped interviewing. These stories uncover the everyday realities facing health professionals and families and provide an ontological understanding for the notion of dilemma. The findings of this study suggest that experience of dilemma for health professionals reveals a world that is uncertain and questionable where they are thrown into having to make uncomfortable choices and must live with the painful consequences of their actions. The consequences of being in such dilemma have to find ways of living with the angst, or risk becoming too sensitive or desensitizing. For families the experience of dilemma reveals a similar phenomenon most evident in circumstances where they feel totalized by the impact of heath care encounters. This study has uncovered that the perspectives that health professionals and families bring to the experience of dilemma reveal different concerns and commitments and may be hidden from each other. This thesis proposes that health professionals and families need support in living with their own personal encounters of enduring experiences of dilemma.

“A child has been born unto us”, is the most beautiful expression of humankind’s ability to cherish hope and trust for the world, writes Hanna Arendt. She describes how every child’s birth is the beginning of something new, something that the title is intended to emphasise. “Us” in the title also indicates that the child with a functional impairment becomes a public child in a special way. The purpose of this study is to describe the experience of becoming a parent when the child has a functional impairment. The study is based on a relational perspective. The theoreticians whose ideas have been used are, aside from Arendt, also Buber, Stern and Winnicott. In the analysis of the parental narratives, inspiration was taken from Ricoeur in a hermeneutic phenomenological approach. Encounters are the themes in this thesis, and have been formulated as encounters with the child, the environment and the professionals. 30 parents (19 mothers and 11 fathers) were interviewed about their experiences of parenthood. The diagnosis of the child’s functional impairment was a chaotic and upsetting situation for the parents. Many strong, different feelings came into play. The parents could feel that they had been “thrown out into space”, and that their future was suddenly taken away from them. The future was what worried them most, and the question that was singled out was “How can we live this life?” Many professionals became involved in the child’s life, which could be both advantageous and disadvantageous for the family. The professionals’ attitudes and advices had a profound influence on the parents. Even though the child became in a sense a public child, the parents also had a feeling of having to carry on a struggle for their child in society, a” struggle of love” demanding the consideration of the child’s potential. Another “struggle of love” initially involved the parents’ own attempts to establish a relationship to the child. Thus there were two “struggles of love”. In their new, hesitant parenthood they had to “find their place in the world” and a way to exist. In their interaction with the child they had two competing figures of mind during the first period, “to be” and “to act”. The grief the parents had felt for the diagnosis could after a while be separated from the child, and it was the child who helped the parents to handle the grief. In the thesis the parents’ experiences are discussed, based on questions confronting them. How playing and training are interrelated is also discussed, as well as the significance of narration and the responsibility of the professionals. These results can be expected to have consequences for special educational work in this field.

The purpose of this study was to explore how physiotherapists working in stroke care understand their role(s) in the context of clinical practice and how this is mediated by their post-licensure educational experiences. Specifically the study focused on their experiences with the Bobath Concept, a well-developed post-licensure neurology physiotherapy program. This study was oriented within sociocultural theory as a way to understand how the experiences and interactions of physiotherapists mediate their professional practice and their sense of professional identity in a way not previously studied in physiotherapy literature. In order to honour the voices of the participants, this study drew on hermeneutic phenomenology and used a principled data analysis tool to present an understanding of the interrelationships involved in stroke care from their perspectives. Four physiotherapists participated in this study by responding in writing and orally to a clinical case and participating in an in-depth interview regarding their professional roles and experiences. The findings suggest that these physiotherapists understand the Bobath Concept as a professional stance which informs their practice and contributes to an ethos of caring, which is reflected in the ways they understand their roles in clinical practice.

The purpose of this study was to explore the meaning of physical activity experiences to older women. A qualitative hermeneutic phenomenological design was used. A purposeful sample of 9 women, age 67 to 83 years old, enrolled in a group physical activity program participated in the study. Data was collected through in-depth semi-structured interviews, artifact documentation, and descriptive and reflective fieldnotes. The transcripts and significance of the artifacts were analyzed using thematic line-by-line analysis. Three themes emerged from the thematic analysis, trading roles, a happier me, and pride and delight. <p>Trading roles refers to the womens perceptions of a new era of their lives given the transition experienced in their life roles. Many of the things they considered stable in their lives changed. Friends dropped away, family moved, they no longer fulfilled the role of wife, and their active grandmothering period was ending. <p>The theme, a happier me, speaks of the impact their involvement in a physical activity program had on their social lives. Living as widowed or single women, they recognized that they could become isolated within their own homes. Engaging in a physical activity program provided a context where they could expand their social network. The interaction with others in a physical activity program brought a sense of happiness and well-being to their days.<p>The theme, pride and delight, captures the deep understanding of their own sense of well-being and took pride in planning and developing the physical activity program. The assumption that more knowledgeable others must plan, implement, and evaluate programs to meet the needs of older adults was challenged by these participants. <p>The meanings of the experiences were interpreted with the support of Weiss (1973) theoretical framework on loneliness. The results of the study highlighted the importance of the contacts made in the physical activity program to the social network of the women, including provisions of attachment, nurturance, and social integration. Physical activity programs for older adults have the potential to expand the social network of older adults and with further research may prove to be an effective intervention for social isolation and ultimately loneliness.

The purpose of this study was to explore how physiotherapists working in stroke care understand their role(s) in the context of clinical practice and how this is mediated by their post-licensure educational experiences. Specifically the study focused on their experiences with the Bobath Concept, a well-developed post-licensure neurology physiotherapy program. This study was oriented within sociocultural theory as a way to understand how the experiences and interactions of physiotherapists mediate their professional practice and their sense of professional identity in a way not previously studied in physiotherapy literature. In order to honour the voices of the participants, this study drew on hermeneutic phenomenology and used a principled data analysis tool to present an understanding of the interrelationships involved in stroke care from their perspectives. Four physiotherapists participated in this study by responding in writing and orally to a clinical case and participating in an in-depth interview regarding their professional roles and experiences. The findings suggest that these physiotherapists understand the Bobath Concept as a professional stance which informs their practice and contributes to an ethos of caring, which is reflected in the ways they understand their roles in clinical practice.

The purpose of this study was to explore the meaning of physical activity experiences to older women. A qualitative hermeneutic phenomenological design was used. A purposeful sample of 9 women, age 67 to 83 years old, enrolled in a group physical activity program participated in the study. Data was collected through in-depth semi-structured interviews, artifact documentation, and descriptive and reflective fieldnotes. The transcripts and significance of the artifacts were analyzed using thematic line-by-line analysis. Three themes emerged from the thematic analysis, trading roles, a happier me, and pride and delight. <p>Trading roles refers to the womens perceptions of a new era of their lives given the transition experienced in their life roles. Many of the things they considered stable in their lives changed. Friends dropped away, family moved, they no longer fulfilled the role of wife, and their active grandmothering period was ending. <p>The theme, a happier me, speaks of the impact their involvement in a physical activity program had on their social lives. Living as widowed or single women, they recognized that they could become isolated within their own homes. Engaging in a physical activity program provided a context where they could expand their social network. The interaction with others in a physical activity program brought a sense of happiness and well-being to their days.<p>The theme, pride and delight, captures the deep understanding of their own sense of well-being and took pride in planning and developing the physical activity program. The assumption that more knowledgeable others must plan, implement, and evaluate programs to meet the needs of older adults was challenged by these participants. <p>The meanings of the experiences were interpreted with the support of Weiss (1973) theoretical framework on loneliness. The results of the study highlighted the importance of the contacts made in the physical activity program to the social network of the women, including provisions of attachment, nurturance, and social integration. Physical activity programs for older adults have the potential to expand the social network of older adults and with further research may prove to be an effective intervention for social isolation and ultimately loneliness.

Acute myocardial infarction is a serious diagnosis. Both the patient and the loved ones experience an immediate uncertainty. To be able to emotionally support the patient´s spouse, the nurse in the coronary care unit must be prepared to also encounter the world of the spouse. The aim of this study was from a nursing perspective to illuminate how life was experienced during the first two months by the spouse of someone, who was stricken by a first time acute myocardial infarction. Interviews with six spouses were conducted. The methodological approach was phenomenological-hermeneutic, based on the French philosopher Paul Riceour. The result of the qualitative text analysis showed four themes: To lose one´s foothold, To be exposed to the medical and nursing staff, To get a changed relationship to one´s partner, To wish to make the most of one´s life. The first theme highlighted the spouse’s strong feelings of uncertainty concerning the outcome of the patient. The second theme showed the spouse’s confidence in the medical care. It also showed the spouse’s sense of being insulted by the nurses, who did not acknowledge the spouses´ need of obtaining information and emotional support. The third theme demonstrated how the partner cared for and felt responsible for observing the former patient´s health condition. The fourth theme showed that the spouse realized that life has to come to an end and therefore wanted to realize his/her plans for the future before it was too late. The findings from this study emphasize the importance of the medical and nursing staff to show interest in the spouses´ experiences. Thereby the spouses can experience a support in congruence with their needs, and their life situation might thereby be improved. It would be of great interest to study how nurses regard the spouses´ life situation during the patients´ stay in hospital. Further research could also highlight which factors could minimize the sufferings of partners to seriously sick patients, regardless of the patients´ diagnosis.

<p>Acute myocardial infarction is a serious diagnosis. Both the patient and the loved ones experience an immediate uncertainty. To be able to emotionally support the patient´s spouse, the nurse in the coronary care unit must be prepared to also encounter the world of the spouse. The aim of this study was from a nursing perspective to illuminate how life was experienced during the first two months by the spouse of someone, who was stricken by a first time acute myocardial infarction. Interviews with six spouses were conducted. The methodological approach was phenomenological-hermeneutic, based on the French philosopher Paul Riceour. The result of the qualitative text analysis showed four themes: To lose one´s foothold, To be exposed to the medical and nursing staff, To get a changed relationship to one´s partner, To wish to make the most of one´s life. The first theme highlighted the spouse’s strong feelings of uncertainty concerning the outcome of the patient. The second theme showed the spouse’s confidence in the medical care. It also showed the spouse’s sense of being insulted by the nurses, who did not acknowledge the spouses´ need of obtaining information and emotional support. The third theme demonstrated how the partner cared for and felt responsible for observing the former patient´s health condition. The fourth theme showed that the spouse realized that life has to come to an end and therefore wanted to realize his/her plans for the future before it was too late. The findings from this study emphasize the importance of the medical and nursing staff to show interest in the spouses´ experiences. Thereby the spouses can experience a support in congruence with their needs, and their life situation might thereby be improved. It would be of great interest to study how nurses regard the spouses´ life situation during the patients´ stay in hospital. Further research could also highlight which factors could minimize the sufferings of partners to seriously sick patients, regardless of the patients´ diagnosis.</p>

ABSTRACT Spirituality has been recognized as a positive factor in the lives of older adults, especially as it influences their emotional, mental, and physical well-being. This convenience sample study included 17 older adults residing at a faith based continuing care retirement community in Florida. The sample was represented by Caucasian older adults with an average age of 84 years, highly educated, majority Protestant and mostly female. Spiritual life reviews were conducted using spiritual life maps (Hodge, 2005) and semi-structured interview questions. Erikson's epigenetic stage of ego-integrity was used along with Butler's life review process and Tornstam's gerotranscendence as a conceptual framework for understanding late life development and spirituality in older adults. This mostly qualitative study used a hermeneutic phenomenological approach to analyze the responses to the open-ended interview questions about spirituality across the life-time. Ego-integrity was measured at the beginning and end of the spiritual life review study. Paired t-tests found that participation in the spiritual life review did not influence the ego integrity scores of participants. Specifically, there were no statistically significant difference between the pre ego integrity score (M=82.94, SD= 8.235) and the post ego integrity score (M=84.47, SD= 7.551); t (16) = -.769 p= .453. However, in comparison, the qualitative analysis revealed that the spiritual life review does influence ego-integrity in some participants. Additionally, the spiritual life review confirms gerotranscendence and contributes to information about spiritual development in the lives of older adults. The conclusion offers a discussion about the study's limitations, strengths, implications for future research, and suggestions for clinical practice.

This study explored adult women’s lived experiences with body dissatisfaction. Using a multi-methods qualitative approach incorporating in-depth semi-structured interviews and arts-based projects, women between the ages of 20-39 engaged in a critical exploration of their body experiences in order to deepen understanding of the psychological construct of body dissatisfaction and its ongoing influence in their lives. Ten women from diverse social and ethnocultural backgrounds took part in the study, completing 1-2 interviews, an in-session drawing exercise, and a creative project. Interview transcripts, drawings, and creative projects were analyzed for themes using an hermeneutic phenomenological approach. Four core categories emerged from the data. The first category contained the women’s understanding of the experience and meaning of body dissatisfaction. The second category captured the external reinforcement of body dissatisfaction and related body beliefs. The third emergent category delineated the impact of body dissatisfaction on daily life, including body-self relationships and interpersonal relationships. The final category captured the difficulties the women encountered as they attempted to overcome their feelings of body dissatisfaction and their negative body beliefs. This research highlighted the complex and multidimensional meaning of body dissatisfaction in adult women’s lives.