Modern technology has enabled the use of new forms of information in the care of critically ill patients. In intensive care units (ICUs), technology can simultaneously reduce the lived experience of illness and magnify the objective dimensions of patient care. The aim of this study, based upon two empirical studies, is to find from a philosophical point of view a more comprehensive understanding for the dominance of technology within intensive care. Along with caring for critically ill patients, technology is part of the ICU staff's everyday life. Both technology and caring relationships are of indispensable value. Tools are useful, but technology can never replace the closeness and empathy of the human touch. It is a question of harmonizing the demands of subjectivity with objective signs. The challenge for caregivers in ICU is to know when to heighten the importance of the objective and measurable dimensions provided by technology and when to magnify the patients’ lived experiences, and to live and deal with the ambiguity of the technical dimension of care and the human side of nursing.
A symbiotic relationship exists between technology and caring, however, technologically advanced environments challenge caregivers. The aim of this study is to uncover the meaning of being a caregiver in the technologically intense environment. Ten open-ended interviews with intensive care personnel comprise the data. A phenomenological analysis shows that ambiguity abounds in the setting. The act of responsibly reading and regulating instruments easily melds the patient and the machinery into one clinical picture. The fusion skews the balance between objective distance and interpersonal closeness. The exciting captivating lure of technological gadgets seduces the caregivers and lulls them into a fictive sense of security and safety. It is mind-boggling and heart-rending to juggle ‘moments’ of slavish mastery and security menaced by insecurity in the act of monitoring a machine while caring for a patient. Whenever the beleaguered caregiver splits technique from human touch, ambiguity decays into ambivalence. Caring and technology become polarized. Everyone loses. Caregiver competence wanes; patients suffer. The intensive care unit should be technologically sophisticated, but also build-in a disclosive space where solace, trust, and reassurance naturally happen. Caring professionals need to balance state-of-the-art technology with integrated and comprehensive care and harmonize the demands of subjectivity with objective signs.
Equipment and procedures developed during the past several decades have made the modern intensive care unit (ICU) the hospital’s most technologically advanced environment. In terms of patient care, are these advances unmitigated gains? This study aimed to develop a knowledge base of what it means to be critically ill or injured and cared for in technologically intense environments. A lifeworld perspective guided the investigation. Nine unstructured interviews with intensive care patients comprise its data. The qualitative picture uncovered by a phenomenological analysis shows that contradiction and ambivalence characterized the entire care episode. The threat of death overshadows everything and perforates the patient’s existence. Four inter-related constituents further elucidated the patients’ experiences: the confrontation with death, the encounter with forced dependency, an incomprehensible environment and the ambiguity of being an object of clinical vigilance but invisible at the personal level. Neglect of these issues lead to alienating ‘moments’ that compromised care. Fixed at the end of a one-eyed clinical gaze, patients described feeling marginalized, subjected to rituals of power, a stranger cared for by a stranger. The roar of technology silences the shifting needs of ill people, muffles the whispers of death and compromises the competence of the caregivers. This study challenges today’s caregiving system to develop double vision that would balance clinical competence with a holistic, integrated and comprehensive approach to care. Under such vision, subjectivity and objectivity would be equally honoured, and the broken bonds re-forged between techne, ‘the act of nursing’, and poesis, ‘the art of nursing’.
Patients are vital for student learning. However, research has primarily focused on student nurse learning from a student or supervisor perspective; few studies have investigated patient perspectives. This study examines student care practice for patients in acute psychiatric day care. The aim was to describe patientsâ experiences of care by student nurses in a psychiatric education unit, a collaboration between the clinic and academia. Data were collected through 17 lifeworld interviews with patients, of which 10 also included observations. Data have been analysed for meanings using reflective, lifeworld research (RLR). The findings reveal that the encounters involve an interactive process of giving and receiving, providing students with both health opportunities and risks. The findings can further be described by the following constituents: exposed and vulnerable; responsibility to support; the importance of accessibility; reciprocity; and engagement that evokes the desire to live a life with dignity. In a patientâstudent community, there are prerequisites for proper caring. Patient health seems to be positively affected when patients are involved in both their own care and student learning.
Aim To describe the importance of supervisors working together in supporting the learning process of nurse students through reflective caring science supervision. Background A supervision model has been developed in order to meet the need for interweaving theory and practice. The model is characterized by learning reflection in caring science. A unique aspect of the present project was that the student groups were led by a teacher and a nurse. Method Data were collected through interviews with the supervisors. The analysis was performed with a phenomenological approach. Results The results showed that theory and practice can be made more tangible and interwoven by using two supervisors in a dual supervision. The essential structure is built on the constituents ‘Reflection as Learning Support’, ‘Interweaving Caring Science with the Patient’s Narrative’, ‘The Student as a Learning Subject’ and ‘The Learning Environment of Supervision’. Conclusion The study concludes that supervision in pairs provides unique possibilities for interweaving and developing theory and practice. Implications for nursing management The supervision model offers unique opportunities for cooperation, for the development of theory and practice and for the development of the professional roll of nurses and teachers.
Purpose: Anabolic androgenic steroids (AAS) are used by men for their aesthetic and performance-enhancing effects and are associated with risk for side effects. Our research aims to deepen knowledge and understanding of men´s experiences of using AAS. Method: This phenomenological study is based on the reflective lifeworld research approach. Lifeworld interviews were conducted with twelve men about their experiences of using AAS. Results: By using AAS, men strive towards a muscular, strong and athletic ideal. Self-imposed demands, self-discipline and performance accelerate male physical development. The perfect male body ideal thus attained is fragile from both an existential and a biological perspective. The perfect self-image can easily be shattered by adversity. A man’s very existence may be jeopardized if the use of AAS is revealed to others or if the body is let down by illness. Conclusions: Men´s use of AAS is a complex phenomenon. It partly concerns a traditional view of masculinity that is reflected in the community. It requires both broad and deep knowledge and understanding to be able to meet men using AAS in their problems and vulnerability; a meeting that is hampered by their low trust in healthcare, and by the fact that AAS are illegal. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
Purpose: Anabolic androgenic steroids (AAS) are used for their aesthetic and performance-enhancing effects and are associated with physical and psychological side effects. Behavioural changes/side effects as mood swings, aggressiveness, depression, potency problems, anxiety, and emotional coldness have been reported by next of kin to people using AAS.
Methods: This phenomenological study is based on the reflective lifeworld research approach. Interviews were conducted with twelve next of kin about their experiences of living close to persons using AAS.
Results: Next of kin to persons using AAS are particularly vulnerable because they experience little opportunity to influence their situation. Their given and safe context is lost, and their lives are circumscribed by feelings of insecurity, fear, powerlessness, and grief. Feelings of loneliness develop when their problems are not noticed by others and support is lacking from family and society.
Conclusions: Our research adds important knowledge on how the use of AAS affects next of kin. Understanding is required to approach the lifeworld of next of kin with flexibility and empathy in their difficulties and vulnerability. Healthcare professionals and other concerned professions need to be aware of next of kin existential needs to be able to meet and support them in their life situation.
Anabolic androgenic steroids are used by women to increase their muscle mass and because of their performance-enhancing effects. Despite permanent/high risk of side effects, knowledge is inadequate. Our aim has been to deepen understanding about women's use of anabolic androgenic steroids. This phenomenological study is based on the reflective lifeworld research (RLR) approach. Lifeworld interviews were conducted with 12 women, aged 21-56 years, about their experiences of using anabolic steroids. The results show that women experience a sense of pride when they successfully achieve their goals. This is the driving force, triggering tension between suffering and success. Our research adds important knowledge from a reflective lifeworld perspective and shows that women's use of anabolic androgenic steroids is a complex phenomenon. Understanding and knowledge are important in order to be able to meet and support women in their fears and difficulties.
This article focuses on patients' violence against caregivers. Several studies show that violence and threats within the health care setting are an increasing problem. Encounters that become violent have been the issue of many debates but the phenomenon is still not fully understood. It is important to understand the course of events in violent encounters, both for the sake of the patients and the caregivers' well-being. The aim of this study was to describe the essence of violent encounters, as experienced by nine patients within psychiatric care. Guided by a phenomenological method, data were analyzed within a reflective lifeworld approach. The findings explicate violent encounters characterized by a tension between “authentic personal” and “detached impersonal” caring. “Authentic personal” patients are encountered in an undisguised, straightforward, and open way, and they sense unrestricted respect that caregivers would show another human being. In these encounters violence does not develop well. However, in caring that is “detached impersonal,” the encounters are experienced by the patients as uncontrolled and insecure. These encounters are full of risks and potential violence.
The study reported in this paper focused on nursing students' learning and, in particular, their integration of caring science in theory and practice. An educational model incorporating educational drama was developed for implementation in three different teaching contexts within the nursing and midwifery study programmes at a Swedish college. A central aim was to understand the dynamics of educational drama in the healthcare context and its impact on learning and teaching. Using a phenomenological approach, seventeen students and six teachers were interviewed and their experience of drama as an educational method explored. The research findings illustrate the meaning of learning and teaching that is sensitive to students' lifeworld experiences. In order to be a successful method for closing the gap between caring science theory and practice, not only the educational drama, but teaching in general, must be anchored in the lived world of the students - that is, their experiences of health and care. While embodied reflection, as a key factor in integrating theory and practice, was shown to be well supported by educational drama, it was also found that "the method" tends too readily to take over and govern teaching and learning. The findings of this study further indicate how learning in practice and embodied reflection can be supported by the inclusion of well-chosen caring science theory to cast light on caring practice dilemmas.
This paper presents a research project where the aim was to develop a new model for learning support in nursing education that makes it possible for the student to encounter both the theoretical caring science structure and the patient’s lived experiences in his/her learning process. A reflective group supervision model was developed and tested. The supervision was lead by a teacher and a nurse and started in patient narratives that the students brought to the supervision sessions. The narratives were analyzed by using caring science concepts with the purpose of creating a unity of theory and lived experiences. Data has been collected and analyzed phenomenologically in order to develop knowledge of the students’ reflection and learning when using the supervision model. The result shows that the students have had good use of the theoretical concepts in creating a deeper understanding for the patient. They have learned to reflect more systematically and the learning situation has become more realistic to them as it is now carried out in a patient near context. In order to reach these results, however, demands the necessity of recognizing the students’ lifeworld in the supervision process.
The starting point for this article is the concept that there is a risk in slavishly adhering to one particular method in nursing education. With this approach in mind, the aim was to examine the use of an educational model with drama in relation to Gadamer's idea of method, as well as to discuss the conditions for lifeworld dialogues in learning encounters.
Den livsvärldsdidaktiska forskningen har fokus på hur lärandet kan optimeras med betoning på hur teoretisk praxisrelaterad kunskap kan sammanflätas med den lärandes livsvärld. Reflexionens betydelse i denna lärandeprocess är central i forskningen. Forskningen syftar till att utveckla lärandestöd, såsom handledning, som kan öka vårdstudenters och vårdares möjligheter att möta och förstå patientens värld. Detta är en grundförutsättning för god vård. Avsikten med denna bok, som bygger på resultat av just denna forskning, är att klargöra vad lärande innebär, dess villkor och förutsättningar men också hur lärande om och i vårdsammanhang kan stödjas ur ett livsvärldsdidaktiskt perspektiv. Nyckelfenomenen är reflexion och handledning.
This chapter gives a Swedish perspective of the Dedicated Education Unit as a learning environment where caring and learning are united in ‘reflective tutoring’ at the University of Borås. The author discusses the overall purpose and structure of the Borås Dedicated Education Units, their scientific and philosophical bases and their focus on patient-centred student learning, reflection and research. She explains the key tutoring roles within the Borås Dedicated Educational Units, the lifeworld perspective of caring science that forms a frame of reference for learning and tutoring there and strategies that affirm and clarify the fundamental principle that caring and learning are parallel and common phenomena. She also describes the challenge for Borås Dedicated Education Units to focus on active patient care development through research, reflects on what is needed for successful tutoring, explains how Dedicated Education Units contain rich possibilities for concretising caring theory into practice and outlines six themes that characterise a Dedicated Education Unit from the students’ and tutors’ perspectives. The chapter concludes with the results of research evaluating the effectiveness of the DEUs as student clinical learning environments and suggests strategies for future development of the Borås Dedicated Education Units.
The learning process for nursing students is characterised by the encounter between the student’s own lifeworld and scientific knowledge in theory and in practice. The aim is for the students to be able to gain sufficient knowledge so that they can understand the patient and the care context where the world of the patient is in focus. Didactics is needed in order to provide support for this meeting and create the conditions for a reflective process that strengthens the integration between the lifeworld and theoretical and practical knowledge. The purpose of the present project was to develop a supervision model which is able to meet these demands. Furthermore, we intended to develop a form of examination for the clinical training that makes it possible to assess the development of the student’s understanding of the patient’s own situation and needs. This project has been financially supported by the Council for the Renewal of Higher Education in Sweden.
This article illustrates the significance of reflection in nursing and nursing education. In this context reflection is often used as a method that has its roots in Schön's theory of developing knowledge in action through reflection. This approach to reflection is investigated by using the lifeworld theory. Three aspects are used to comprehend the meaning of reflection; the natural attitude, the reflective attitude and the open-minded attitude. These lead us to an understanding that reflection may never be objectified or reduced to a separate process. The article thus strongly refutes the idea that reflection has a technological function in relation to the learning of nursing and caring science knowledge. Describing reflection merely as an educational method or tool is, on this understanding, considered insufficient. A lifeworld perspective allows a new and deeper understanding of the role of reflection in nursing students' learning processes and also in students' abilities to integrate caring science theory with caring practice. This new understanding may have considerable implications for changes in nursing education.
Parallellt med uppbyggnaden av den vårdvetenskapliga forskarutbildningen vid Växjö universitet har utveckling och forskning av didaktiken inom vårdvetenskapen pågått. Med vårdvetenskaplig didaktik, avses lärandestöd i vårdkontexter i såväl utbildningar som kliniska verksamheter. Mer preciserat handlar det om hur lärandet kan stödjas för att optimera möjligheterna att stödja patienters hälsoprocesser i vårdandet. Av detta följer att vårdvetenskapens didaktik som kunskapsområde inbegriper lärandestöd för vårdstuderande av alla slag samt vårdpersonal, men också för patienter och deras närstående. I föreliggande sammanställning används främst begreppet student för den lärande, beroende på att den didaktik som här beskrivs härleds företrädesvis från vårdvetenskapliga utbildningssammanhang, så som sjuksköterskeutbildning.
This paper highlights how caring and learning interact and become an intertwined phenomenon. The analysis of the research findings from two studies, in which the interaction between caring and learning in two educational units was investigated, has been guided by a Reflective Lifeworld Research approach grounded in a lifeworld-oriented phenomenology. The analysis procedure was concluded in a synthesis of the interaction between caring and learning in a Dedicated Educational Unit (DEU) and a didactic method inspired by a lifeworld educational perspective has been developed.
The results show that through trust and genuine meetings between patients and students caring and learning can converge and be intertwined. Both students and patients take an active role in the health process as well as the learning process. In order to achieve an intertwining process qualified supervision, care managers who take responsibility for a caring and learning environment and a consensus between the nursing school and the healthcare organization is required.
The didactic method that can support the intertwining of caring and learning consists of three themes; genuine meetings, sensitivity for the patient's story and reflection in interaction. These themes are tools for the supervision.
Background Caring and learning in clinical educational contexts is characterized by an encounter between lived experiences of the patient and the student’s knowledge and understanding. In other words, it is an encounter between two lifeworlds, which has the potential to create a fruitful tension to develop deep knowledge about the patient’s world that can give direction for practice. We will argue that a particular kind of Caring science knowledge becomes an important tool to support this caring and learning process where the goal is to intertwine lived experiences of health and illness with professional knowing and scientific knowledge. From this perspective is even caring and learning an intertwined phenomenon, and it is this intertwining that enables lifeworld led care. Aim This paper presents a study that illustrate how caring and learning is intertwined from the students’ view in an educational clinical context. Method/design The study was carried out using Reflective Lifeworld Research (RLR) with a phenomenological approach. Lifeworld interviews were conducted with students after their clinical placement on a Dedicated Education Unit (DEU). Result The result shows that the essential meaning of the intertwined phenomenon is a movement where caring and learning fall into place which appears in an atmosphere filled with appealing challenges, but has to be sensitive to the students’ readiness. The atmosphere depends on their sense of security and how they experience confirming and affirming responses. Encountering the patient means that the students can gain a sense of the whole and the theory falls into place. The results also highlight how the student, in this atmosphere, has a desire to find a new role in a personal style. Conclusions On the basis of this study a challenge to the curriculum is presented, that is, to develop didactics and supervision models that use a holistic approach and adopt a reflective attitude upon caring and learning as intertwined and not separated.
Scientific knowledge is characterized by abstract descriptions and structures, which are not identical to the lived reality. Scientific knowledge cannot directly be applied on the lived existence, without being transformed and adjusted to the individual’s very complex lifeworld. Learning in caring contexts is an encounter between the scientific knowledge of caring and the learner’s lifeworld. This encounter needs a support that has the potential to bring caring science to life and to start an intertwining process with the lifeworld that creates embodied knowledge. Lifeworld didactics are built on an approach about learning as an individual process and that learning takes its point of departure in the learner’s previous experiences, which accompanies the learning process. The challenges within lifeworld didactics are to be open and sensitive to the learner’s lifeworld and with tact support the development of a reflective attitude in the learning process. Lifeworld didactics strategies are of crucial importance in different caring contexts. This symposium presents three lifeworld led phenomenological research projects that have focused on acquiring caring science knowledge in caring contexts, more precisely it is the encounter between caring science and the lifeworld. The research is within the framework of lifeworld didactics, but the three projects each have a special focus.
Scientific knowledge is characterized by abstract descriptions and structures which are not identical to the lived reality. Scientific knowledge cannot directly be applied on the lived existence, without being transformed and adjusted to the individual’s very complex lifeworld. Learning in caring contexts is an encounter between the scientific knowledge of caring and the learner’s lifeworld. This encounter needs a support that has the potential to bring caring science to life and to start an intertwining process with the lifeworld that creates embodied knowledge. Lifeworld didactics are built on an approach about learning as an individual process and that learning takes its point of departure in the learner’s previous experiences, which accompanies the learning process. The challenges within lifeworld didactics is to be open and sensitive to the learner’s lifeworld and with tact support the development of a reflective attitude in the learning process. Lifeworld didactics strategies are of crucial importance in different caring contexts. This paper presents three lifeworld led phenomenological research projects that have focused on acquiring caring science knowledge in caring contexts, more precisely it is the encounter between caring science and the lifeworld. The research is within the framework of lifeworld didactics, but the three projects each have a special focus. The first illustrates how the learning and caring processes merge and become an intertwined phenomenon in nursing students’ learning. The research is carried out in Dedicated Educational Units (DEU), within psychiatric and orthopedic care. Three perspectives are illustrated in the project; that of the students, the supervisors and the patients. The overall aim is to develop a supervision model that has the potential to support the students’ learning processes as well as the patients’ caring processes. The second illustrates how the concepts ‘patient perspective’ and ‘patient participation’ can be implemented in a clinical setting for elderly patients in order to improve the quality of care. This project is inspired by Participatory Action Research and is built on collaboration between the university and the health care services. The aim is to develop reflective educational material in terms of filmed drama episodes, based on the result of two studies about elderly patients’ participation in team meetings. The third illustrates the perspective of lifeworld didactics in two phenomenological studies that focus on Students` learning in an encounter with patients and Students` learning on the way to becoming professional - supported by supervision in pairs of students. The findings show patterns of essential meanings that have specific significance in the art of supporting students` learning in clinical education. These are; the significance of responsibility, its extent and shape in relation to the supervisor’s ability to adopt a reflective supervising attitude and to be supportive enough but at the same time to not assume the responsibility. The learning process shows to be a challenge for students, where safety in pairs of students has a great significance when coping with the challenge to learn and develop.
Anaesthesia nursing care during regional anaesthesia is characterized by the encounter between the ‘awake’ patient’s own lifeworld and the nurse anaesthetist’s knowledge in theory and in practice. This study aims to present an intraoperative caring model from the patient’s perspective that will facilitate nurse anaesthetists’ (NA) practice to enhance and support the ‘awake’ patient’s intraoperative well-being during surgery under regional anaesthesia. The model is underpinned by a synthesis based on interviews with patients, a philosophical reflection using Merleau-Ponty’s philosophy, and video recordings from orthopaedic surgeries under regional anaesthesia. 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 behaviour in the delivery of intraoperative nursing care. The model can help NAs to access, understand and learn through lived experiences, thereby deepening their professional caring skills. The model is a way to get research knowledge ready for use by NAs to reflect on what gaps need to be filled between what nurses know (research) and do (practice).
Purpose The purpose of this study was to interpret and describe the patient-nurse anesthetist (NA) interaction during regional anesthesia. Design Video recordings conducted during orthopedic surgery at a surgical clinic in Sweden formed the basis for the study, in which three patients and three NAs participated. Methods A hermeneutic analysis was conducted on the data. Finding The findings of the analysis demonstrated that the NA was in either “present” presence or “absent” presence in the awake patient's visual field during surgery. The NA's professional actions at times dominated the patient's existential being in the intraoperative situation. The findings conveyed insights about the patient-NA interaction that open up possibilities for nurses to understand and reflect upon their own practice in an expanded way. Conclusions Using video recordings for reflections enables development of professional skills that positively influence the care quality for patients during regional anesthesia.
It is obvious that the gap between theory and praxis in nursing education affects the students’ ability to develop understanding and professional knowledge that stems both from theory and practice. Appropriate didactic methods are thus needed in nursing education. In a project we developed and practised a didactic model with the intention of encouraging a reflective attitude within the student, considering caring science in theory as well as in praxis. The didactic model, based on educational drama, was implemented during three terms of the nursing education programme. In this paper we present the educational model and its theoretical foundation. We also present the preliminary outcomes of the project.