Syftet med studien var att undersöka hur sjuksköterskor skildrar och kommunicerar med psykospatienter och vilket lärande de upplever i dessa möten inom slutenvården. Metoden var halvstrukturerade intervjuer som transkriberats och sedan analyserats med hjälp av van Manens fenomenologiska och hermeneutiska metod och hans livsvärldsexistentialer; relationen, rummet, tiden och kroppen. Sjuksköterskorna beskrev patienter med skilda egenskaper som från att vara starkt fysiskt påverkade och ha kramper till att vara vältränade och se bra ut men också från att vara skrämmande till att vara trevliga. Patienter kunde ha press från anhöriga, ha mycket resurser och de kunde förbättras snabbt men också snart återkomma för inläggning. Strategier vid kommunikation beskrevs som: Ett fokus på här, nu och framåt; ett balanserat, känsligt och kärleksfullt bemötande som förmedlar ett budskap av hopp, delaktighet och realistisk framtidstro. Fysisk omvårdnad kan motverka känslor av rädsla, misstänksamhet och skygghet. Sjuksköterskan kan behöva både sätta egna känslor åt sidan och tänka sig in i patientens situation. För en lyckad kommunikation krävs: Intresse, tålamod, lust och förmåga att se problem som en utmaning vilket skapar möjligheter till lärande för både vårdtagare och personal; utrymme för reflektion som kan förbättra arbetssätt; tid och tillgänglighet för ömsesidigt lärande mellan patient, anhöriga och sjuksköterskor. Humor kan förmedla hopp och avdramatisera kitsliga stämningar. Attityder till patienter som ”jobbig, tråkig eller obegriplig” skadar möjligheten för patienten att känna hoppfullhet. Tvångslagens utformning kan påverka attityder. Jag har funnit att sjuksköterskan bör ställa krav på sig att försöka förstå; inte ge upp; ha tålamod; känsligt möta patientens uppfattning; ingjuta hopp och inspirera till uthållighet; vara uppmärksam på patientens fysiska välbefinnande. Kärlek sågs som vägledande för ett etiskt lärande möte och erfarenheter från dessa användes i framtida möten med patienter. Kommunikationen måste anpassas till olika patienters behov och förutsättningar. / The aim of this study was to investigate how nurses depict meetings with psychosis patients, how they communicate with psychosis in-patients and what kind of learning they experience in these meetings. Semi structure interviews were transcripted and then analyzed with the phenomenological and hermeneutic perspective from van Manen and his life-world existentials; lived relation, lived space, lived time and lived body. The nurses described patients with varied characteristics, ranging from strong physical influence with spasms, to fit and good-looking but also as frightening or being pleasant. Patients could be exposed to pressure from relatives, have a lot of resources and quickly improve and despite these circumstances fall back into needing treatment. Strategies among the nurses when communicating with patients were described as: To focus on here, now and onwards; to give a balanced, sensitive and loving treatment that leaves an actual message of hope, participation and a realistic faith in the future. Physical care could work against feelings of fear, suspicion and shyness. Nurses need to both put their own feelings aside and to imagine themselves in the situation of the patient. To succeed in communicating the nurses need to have: Interest, patience, a will to help and the ability to see a problem as a challenge. These factors create possibilities for learning for both the patients and the staff, and also create time for reflection that can improve working methods, and give time and accessibility for mutual learning between patients, relatives and nurses. Humor could support the patient´s hope and calm an irritable atmosphere. Attitudes to patients as “trying, boring or incomprehensible” indicate a lack of competence and damage the possibility for a patient to perceive hope. The compulsory law design can have an influence on attitudes.  I have found that nurses should demand of themselves to try to understand; not give up; have patience; sensitively meet the patient’s concept; encourage hope and inspire to hold on and be aware of patient’s physical well-being. Love was seen as guide for an ethical learning in meetings with patients and the experiences from these meetings were used when meeting patients later on. Communication has to be adjusted to the patient´s individual needs and conditions.

Thesis advisor: Rosanna F. DeMarco / The purpose of this study was to understand the lived experience and meanings of percutaneous injury (PI) and its aftermath among US registered nurses. An interpretive phenomenological approach was utilized to carry out the study which included nine percutaneous injury experiences. Van Manen's existential framework was used as a reflective guide. Findings from this study emerged as three essential themes which were common to all participants: being shocked: the potential of a serious or life-threatening infection; needing to know it's going to be okay; and sensing vulnerability. The first theme, <italic>being shocked</italic>, was identified as the primary mode of living with the sudden occurrence of PI. In the moment of injury, participants' language reflected shock and an immediate consciousness of the potential threat of a serious or life-threatening infection. Nurses' responses were visceral and emotional. All acted on their need to reduce foreign blood contamination and the urgency they felt for immediate care. <italic>Needing to know it's going to be okay</italic> represented the initial meaning of living in the aftermath of PI as nurses assessed their risk and sought post exposure intervention and caring responses from others. <italic>Sensing vulnerability</italic> was identified as the secondary mode of living in the aftermath of PI as participants reflected on the fragile nature of health into the future, distinguished between supportive vs. non-supportive relationships in their overall PI experience, and identified the need to be vigilant in the future with respect to their health, life and PI prevention. Together, these three essential themes and their dimensions represent the essence and meanings of percutaneous injury and its aftermath for at least one group of US registered nurses. Findings in this study support the conclusion that the lived experience of PIs and its aftermath imposed a significant psychological burden on nurses. These findings offer a better understanding of the essence and meanings of PI and its aftermath and contribute knowledge to inform nursing education, nursing practice, health policy and future research. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Knowledge of genetic predisposition to future illness and disability creates uncertainties that shape and influence life decisions about reproduction, career, health behavior, and the need for care. Current research has not yet identified the meaning of the experience of feeling uncertain among intimate partners of persons who have received genetic information pertaining to future health status. The purpose of this phenomenological study was to understand the meaning of uncertainty as a lived experienced among intimate partners of persons who have tested positive for a mutation in the gene causing Huntington disease (HD) but have not yet been clinically diagnosed with HD. The specific aims were to create a rich, vivid description of uncertainty as experienced by this population and to present these findings within an existential phenomenological perspective. Using van Manen's hermeneutic-phenomenological methodology, experiential descriptions from 10 intimate partners of persons in the prodromal phase of HD were obtained. Thematic aspects of the lived experience of uncertainty were uncovered and isolated; essential themes were determined; and linguistic transformations were composed. The analysis revealed four essential themes, indicating that the meaning of the lived experience of uncertainty was 1) an intangible reality characterized by 2) anticipating with ebbing and flowing disquietude while feeling 3) a weighty pull to dwell upon, towards inner turmoil and 4) a subdued presence with freeing possibilities. The implications of these findings are that nurses need to ensure adequate opportunity is created in which the meaning of the lived experience of uncertainty can be ascertained and explored among persons who are on the cusp of the inevitable but not yet graspable. Continued research is needed to further address the implications of being situated in this potentially fracturing phase of the disease trajectory and to determine appropriate interventions.

Cerebral vascular accidents (CVAs) rank as the third leading cause of death in Canada with more than 50,000 of these events occurring annually. The evidence base from which to provide end-of- life care to patients dying from a CVA is currently limited, and there is a dearth of research examining the experiences of nurses charged with the responsibility of caring for these patients. In order to begin to address this gap in the literature, a qualitative study, using van Manen’s interpretive phenomenology was conducted to examine and describe the lived experiences of nurses working on an acute neurosciences unit in a tertiary hospital. Nine nurses were interviewed initially, and two nurses participated in follow-up interviews to confirm the interpretation of the data. This manuscript will discuss the essence of nurses’ lived experience in caring for these patients, as well as implications for education, practice, and future research.

Cerebral vascular accidents (CVAs) rank as the third leading cause of death in Canada with more than 50,000 of these events occurring annually. The evidence base from which to provide end-of- life care to patients dying from a CVA is currently limited, and there is a dearth of research examining the experiences of nurses charged with the responsibility of caring for these patients. In order to begin to address this gap in the literature, a qualitative study, using van Manen’s interpretive phenomenology was conducted to examine and describe the lived experiences of nurses working on an acute neurosciences unit in a tertiary hospital. Nine nurses were interviewed initially, and two nurses participated in follow-up interviews to confirm the interpretation of the data. This manuscript will discuss the essence of nurses’ lived experience in caring for these patients, as well as implications for education, practice, and future research.

Background: Breastfeeding is globally recognised as a gold standard of nutrition, recommended for the first six months of an infant’s life. Despite its benefits, most women in Ghana do not breastfeed, as recommended by World Health Organization (WHO) and United Nations International Children Emergency Fund (UNICEF). Aim: To gain in-depth understanding of first-time Ghanaian mother lived experience of breastfeeding. Design/Method: A longitudinal qualitative design was adopted, underpinned by the hermeneutic phenomenological approach, as described by van Manen (1990). The study explored the lived experiences of thirty first-time women recruited from antenatal clinic. A series of three semi-structured, in-depth interviews were conducted; the first in late pregnancy, the second in the first week following childbirth and the final one between four and six months postpartum. Findings: Inductive thematic analysis informed by van Manen (1990) and principles of hermeneutic interpretation allowed the emergence of four main themes: the ‘Breastfeeding Assumption,' Breastfeeding as Women’s Business,’ the Postnatal Experience of Breastfeeding and ‘Family as Enabler or Disabler’. Within the context of this study, breastfeeding is expressed as an activity within the family and social environment. The overall phenomenon that emerged was ‘Social Conformity’. This demonstrates an understanding of the breastfeeding experience suffused with emotions as women project an image of themselves as successful breast feeders in order to conform to family and social expectations. Conclusion: Findings from the study demonstrated the multifactorial dimensions of breastfeeding. Most importantly, it was identified that first-time breastfeeding women use emotion work to cope with their experience of breastfeeding, within the social context. It was suggested that midwives play a pivotal role in helping women develop realistic expectations prior to breastfeeding. Furthermore encouraging family centered education that promotes holistic support for women. The findings therefore suggested the need for better antenatal education based on evidence-based practice. Breastfeeding women require individualised support that assesses their emotional needs and offers encouragement. Developing policies that ensure training of midwives and breastfeeding advocates was recommended. Future research could explore the impact of these interventions on breastfeeding practices, helping first time women to breastfeed effectively.

Nurses make up the largest human resource component of healthcare. With this in mind, understanding what quality care means to the nurses providing it becomes relevant. There have been numerous efforts made to understand, define, measure, and influence the phenomenon of quality nursing care. These efforts have reflected the perspectives of patients, nurses, and nursing leadership. Bedside critical care nurses provide care in a dynamic, high-paced environment where patients have life-threatening conditions, may not be conscious of their care or condition, and outcomes including mortality are multifactorial, not always care-dependent. In such a scenario, outcome-based assessments of quality nursing care may result in inaccurate findings, making it difficult to create and institute improvement efforts. This qualitative phenomenological study was designed to uncover the meaning of quality nursing care through the lived experiences of bedside critical care nurses. Twenty-two bedside critical care nurses were interviewed, and their responses analyzed using van Manen’s method of phenomenology to uncover five essential themes that represent the meaning of quality nursing care: (a) It is not just taking care of the illness; (b) Being there for another, it’s the little things; (c) It is knowing your stuff—bed bath, and beyond; (d) It is roles, not just responsibilities; and (e) It means having resources.The results and discussion aim to clarify, through example, the meaning of quality nursing care differentiated from its definition. Findings of this study contribute to a large body of literature regarding quality nursing care. Furthermore, the results are relevant to nurses, educators, managers, and leadership to aid in assessment of quality nursing care and support its provision.

The purpose of this study was to examine and document second language teachers' perceptions of their implementation of a meaning-making approach, known as the Acquisition Model, to second language instruction. Of particular focus were the concerns and strategies the second language teachers experienced when changing their pedagogical practice from mechanical to meaning making. The main research question, which guided this study, was: "What is the 'lived experience' of L2 teachers as they implement an innovative pedagogy to teach a second language?" The researcher addressed this research question through Max van Manen's (1990) six step phenomenological method, "Researching Lived Experience" and image-based research techniques (i.e., photo elicitation and reflexive photography). In addition, the researcher also created and applied an innovative data collection technique, which she called Collaborative Imagery. Findings from this study generated various implications in the areas of second language education, curricular change, teacher reflection, image-based research, and educational research.

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Dans la perspective de faire disparaître la dichotomie existant entre la santé et la maladie, le concept « santé-dans-la-maladie » (health-within-illness) est apparu dans les écrits infirmiers pour étudier la santé chez les personnes vivant avec une maladie chronique. Or, la recherche sur ce phénomène s’est surtout centrée sur l’expérience de santé (wellness) occultant celle de la maladie (illness). À l’heure actuelle, peu d’études ont été réalisées pour comprendre la coexistence de l’expérience de santé (wellness) et celle de maladie (illness) impliquée dans la réalité quotidienne des personnes vivant avec une maladie chronique. De plus, aucune d’entre elles ne s’est adressée à une clientèle vivant avec la sclérodermie systémique. Ainsi, cette étude avait pour but de décrire et de comprendre l’expérience de la sclérodermie systémique et celle de santé-dans-la-maladie dans le contexte d’adultes vivant avec cette maladie chronique. La perspective disciplinaire de la chercheure, en l’occurrence la philosophie du caring humain de Watson (1979, 1988, 1999, 2006, 2008), a soutenu le processus de recherche. En cohérence avec cette auteure, la méthode qualitative de type phénoménologique existentielle herméneutique élaborée par van Manen (1984, 1997, 2002) a été choisie pour encadrer ce processus. La collecte des données repose principalement sur l’expérience d’adultes québécois vivant avec la sclérodermie systémique, recueillie au moyen de 34 entretiens en profondeur réalisés auprès de 17 participants (14 femmes et trois hommes). Les résultats ont permis d’identifier quatre thèmes pour décrire d’une part, l’essence de l’expérience de la sclérodermie systémique, soit : (a) la souffrance interminable d’un corps malade; (b) la dysharmonie intérieure et relationnelle du soi; (c) le processus d’accommodation et (d) l’heuristique d’accommodation. D’autre part, les deux thèmes suivants ont émergé pour exposer l’essence de l’expérience de santé-dans-la-maladie: (a) la prise de pouvoir d’un nouveau soi et (b) l’harmonie avec l’existence. Un travail de mise en relation de ces deux essences a été effectué afin de développer une conceptualisation de l’expérience de santé-dans-la-maladie dans le contexte d’adultes québécois vivant avec la sclérodermie systémique. Ainsi, elle se conçoit comme « une dialectique dans laquelle le nouveau soi mobilise son pouvoir pour vivre en harmonie avec l’existence et pour s’accommoder à la souffrance interminable, où une dysharmonie intérieure et relationnelle est vécue dans le corps malade ». Les résultats de cette étude permettent de mieux comprendre la souffrance vécue par les personnes ayant la sclérodermie systémique de même que le processus et les stratégies d’accommodation à cette souffrance. Ils mettent également en évidence les moyens utilisés pour exercer un nouveau pouvoir sur leur vie et pour vivre en harmonie dans tous les aspects de leur existence. Enfin, la dialectique de santé-dans-la-maladie proposée dans cette étude souligne le caractère dynamique, continu et subjectif du processus d’intégration impliquant les expériences indissociables de la santé (wellness) et de la maladie (illness). Cette nouvelle conceptualisation de l’expérience de santé-dans-la-maladie, pouvant contribuer au renouvellement des pratiques de soins, suggère également une manière inédite d’exister lorsque la maladie chronique survient, soit celle d’ « être ni en santé, ni malade ». / With a view towards eliminating the existing dichotomy between illness and health, the concept of health-within-illness appeared in nursing research on health in persons living with chronic disease. Presently, research on this phenomenon is mainly centred on the experience of wellness not revealing that of illness. At the same time, few studies have been aimed at understanding the coexistence of the experience of wellness and illness involved in the daily lives of persons with chronic disease. Furthermore, none have addressed a population living with systemic sclerosis. Consequently, the purpose of this study is to describe and understand the experience of systemic sclerosis as well as that of heath-within-illness in adults living with this chronic disease. The disciplinary perspective of the researcher, in this case, Watson’s human caring philosophy (1979, 1988, 2006, 2008), supported the research process. In accordance with this author, van Manen’s (1984, 1987, 2002) hermeneutic existential phenomenological method was chosen as the basis of the research process. Data was mainly collected from the experience of adult Quebeckers living with systemic sclerosis, through 34 in-depth interviews with 17 participants (14 women and three men). The results allowed the identification of four themes that describe, on the one hand, the essence of the experience of systemic sclerosis, that is: (a) endless suffering of a diseased body; (b) the inner and relational disharmony of the self; (c) the process of adjustment and (d) adjustment heuristics. On the other hand, the following two themes emerged showing the essence of the experience of health-within-illness: (a) empowerment of a new self and (b) harmony with life. The two essences were interrelated in order to develop a conceptualisation of the experience of health-within-illness in adult Quebeckers living with systemic sclerosis. Thus, it is conceived as a “dialectic in which the new self shifts his or her power to live in harmony with life and to adjust to endless suffering while being in a diseased body that experiences inner and relational disharmony.” The results of this study allow a better understanding of the suffering experienced by persons with systemic sclerosis as well as of the process and strategies conceived to adjust to this suffering. They also highlight the means used to exert a new power on their lives and live in harmony with every aspect of their existence. Finally, the dialectic of health-within-illness that emerged from this study underlines the dynamic, continuous, and subjective character of the integrative process involving the inseparable experiences of wellness and illness. This new conceptualisation of the experience of health-within-illness, that can contribute to a renewal of health care practice, also suggests a novel way of living with chronic disease, that of “being neither in health nor in illness”.