En vårdvetenskaplig teori om interkulturellt vårdande : att föda barn i en annan kultur

The aim of this dissertation is to develop a theory on intercultural caring to deepen the understanding of caring between nurses and patients who have different cultural backgrounds. The research questions are: 1) What is intercultural caring? 2) How is intercultural caring described and understood? 3) How is intercultural caring described and understood in a maternity care context from the patients’ perspective? 4) What is the substance in a theory on intercultural caring? 5) What is the substance in a theory on intercultural caring in maternity care from the patients’ perspective? The theoretical perspective is based on caritative theory and the caring science-tradition (Eriksson, 2001, 2002) and has a hermeneutic approach. In the first study, 19 texts of Campinha-Bacote, Kim-Godwin, Leininger and Ray are analysed through content analysis. A model for intercultural caring is then created abductively. The second study is a metasynthesis of 40 studies on intercultural caring in maternity care research. The third study is a focused ethnography, in which 17 immigrant mothers are interviewed and observed. The theory on intercultural caring is created through a hermeneutic synthesis of the three studies. A synthesis of the studies with a maternity context results in five patterns of interpretation: the experience of caring is related to power; the family is always present; childbearing and change of culture can give women multiple vulnerabilities; both the mother and the nurse change when they meet; conflicts can cause change. The theory and patterns of interpretation consolidate into a contextual theory on intercultural caring for clinical maternity praxis. In this theory, caring consists of four dimensions: universal, cultural, contextual, and unique caring, which permeate each other. Universal caring is nondependent of time and space. Cultural caring considers the cultural background, the acculturation and the equality of each mother. In the maternity care culture, cultural competence, cultural safety, and acculturation of the nurse are emphasised. Contextual caring considers the specific cultural features of the childbearing mother. In this respect, the nurse is expected to be an expert and to clarify cultural assumptions in maternity care. In unique caring, the mother expects good communication, respect for the family, goodwill and somebody who cares for her and meets her needs, in order for trust to be built. In this respect, the nurse listens to the woman’s narrative, is flexible, open, courageous, and non-judgemental. The nurse shows an understanding for the life situation of the woman, and strives for continuity to preserve the care relationship. It was found that external circumstances affect intercultural caring. Moreover, intercultural caring is expected to decrease misunderstandings and conflicts, alleviate suffering and promote health and life. The theory adds knowledge to the phenomenon of intercultural caring for the nursing and caring sciences, and for the nursing care of patients with other cultural backgrounds than the nurses. The theory can be used in nursing, education, research and administration.

Christlich-religiöse Textwelt als translatorisch-hermeneutischer Gegenstand Gegenstandsbeschreibung und Herangehensweisen

Tämä teorialähtöinen, hermeneuttinen tutkimus sijoittuu käännöstieteen sekä uskonnon- ja kielifilosofian rajapintaan. Tutkimuksessa kuvataan kristinuskon tekstimaailmaa relevantin tulkintakehyksen kautta sekä esitetään tekstimaailman tulkintaan soveltuva lähestymistapa ammattikääntäjän eli välittävän vastaanottajan näkökulmasta. Tutkimus pureutuu käännösprosessin hermeneutiikkaan eli lähdetekstin ja sen maailman tulkintaan, ymmärtämiseen ja selittämiseen liittyviin aspekteihin. Tutkimuksessa ei esitetä käännösratkaisuja. Tutkimus nostaa esiin filosofisen ja teologisen hermeneutiikan peruskysymyksiä. Niitä ovat Raamatun tekstien vaikutushistoria, erilaiset todellisuus- ja kielikäsitykset, kirkon oppi, teologian pääsuuntaukset, uskonnolliset yhteisöt ja niiden perinteet, inhimillinen kulttuuri ja aika. Ne ovat ulottuvuuksia, jotka vaikuttavat kääntäjän tekstin- ja maailmantulkintaan ja vaativat laajojen kontekstien huomioonottamista sekä lähestymistä monista eri näkökulmista. Ludwig Wittgensteinin myöhäisfilosofiaan liittyvän kielipelin idea tarjoaa ajatusmallin, jonka avulla uskonnon käsite-, merkki- ja tekstimaailmalle voidaan luoda moninäkökulmainen tulkintakehys. Kielipelin käsitettä käytetään tässä tutkimuksessa tekstien samankaltaisuutta ja erilaisuutta kokoavana järjestelmänä, joka toimii intratekstuaalisesti eli sillä on omat pelisääntönsä, tulkinnan lähteensä sekä tunnistettava identiteetti. Järjestelmän keskiössä ovat uskonnon konstituioivat käsitteet ja kertomukset, jotka ovat muiden tulkintojen eli metatekstien lähde. Kääntäjän varsinaisina tulkintakohteina ovat metatekstit, eivät raamatunkääntämiseen liittyvät kysymykset suoranaisesti. Tutkimuksessa luodaan kuitenkin tulkintamalli, jonka mukaan metatekstejä ja raamatun tekstejä luetaan rinnakkain. Ymmärtäminen ja ongelmanratkaisu rakentuvat tekstuaalisen kommunikaation pohjalta. Tekstejä luetaan sekä sääntöteorian että narratiivisen teorian valossa. Kertomus puhuttelee vastaanottajaa eri tavalla kuin sääntö. Tulkintamallissa yhdistyvät sekä analyyttinen että luovan mielikuvituksen sallima lukutapa. Molemmat toimivat yhdessä kääntäjän tekstin- merkin- ja maailmantulkinnan apuna. Tutkimuksessa pohditaan myös tekstiteorettisia kysymyksiä, tekstin ja merkin käsitteitä sekä niiden toimintadynamiikkaa. Tulkinnan mekanismi esitetään semioosin käsitteen avulla. Teksti määritellään heuristiseksi ja eksemplaariseksi kuvaukseksi maailmasta, ja se edustaa vain osaa tulkintakokonaisuudesta. Kääntäjän hermeneuttinen kenttä ulotetaan tekstinulkoiseen maailmaan, käytäntöön ja elämänmuotoon.

Luonnonhaltijat ‒ haltijoita luonnonympäristössä? : Nature spirits : continuity and change : Conference of Belief Narrative Network of ISFNR, Zugdidi, Georgia 1.‒4.10.2014

Konferenssiraportti

Tekstuaalisessa liikkeessä : Textual trails : transmissions of oral and written texts : the 11th Conference of the European Society for Textual Scholarship 30th of October − 1st of November 2014

Konferenssiraportti

The long-term outcome after acute kidney injury: a narrative review

This review will focus on long-term outcomes after acute kidney injury (AKI). Surviving AKI patients have a higher late mortality compared with those admitted without AKI. Recent studies have claimed that long-term mortality in patients after AKI varied from 15% to 74% and older age, presence of previous co-morbidities, and the incomplete recovery of renal function have been identified as risk factors for reduced survival. AKI is also associated with progression to chronic kidney (CKD) disease and the decline of renal function at hospital discharge and the number and severity of AKI episodes have been associated with progression to CKD. IN the most studies, recovery of renal function is defined as non-dependence on renal replacement therapy which is probably too simplistic and it is expected in 60-70% of survivors by 90 days. Further studies are needed to explore the long-term prognosis of AKI patients.

A qualitative narrative inquiry of the experience of accessing community supports among women who have experienced trauma

Abuse related trauma can have serious consequences on individuals' health and their state of well-being and may result in decreased access to different determinants of health. The purpose of this qualitative narrative inquiry using secondary data was to explore the experience of accessing community supports among eight women who had experienced abuse-related trauma. A conceptual framework drawn from the literature on social inclusion and social exclusion and a narrative inquiry method were used to explore epiphanies, customs, routines, images, and everyday experiences (Clandinin & Connelly, 2000) among the women. A Three-Dimensional Space Narrative Structure was used to explore the participants' personal or internal conditions, feelings, hopes and reaction as well as their social experiences in interaction with others in community. The participants described experiencing the impact of trauma in their past and present circumstances, a lack of accommodation of difference, challenges in maintaining a sense of self in a world of assumption and labels, impact of trauma on the determinants of health, and uncertainty about the future. The findings from the study demonstrate experiences of social exclusion among the participants in the past, further isolation and social exclusion in the present when personal life issues were ignored by community support services, and uncertainty about what the future will bring for them. The findings indicate close relationships between the women's personal lives and their social connections which need to be considered to mitigate social exclusion and enhance social inclusion.

Learning English as an adult: a narrative of women's improvised and empowered lives /

This thesis is a narrative inquiry of learning English as an adult. It stories the journey of 7 women, including me, and unravels lived experiences that serve as learning models. Learning English as an adult presents challenges and results in lifelong implications both in personal and professional life. Every learner's experience is imique and, when reflected upon, each experience is a valuable source of knowledge for constructing meanings and forging new identities. The stories are testimony to the participants' lives: interrupted yet improvised, silenced yet roused, dependent yet independent, intimidated yet courageous, vulnerable yet empowered. The personal experiences elucidate the passion, the inner voices, the dreams, and the rewards that compel persistence in learning a new language and releaming new social roles. The stories provide encouragement and hope to other women who are learning or will learn English in their adult years, and the lived experiences will offer insights for English language teachers. This thesis employs the phenomenology methodology of research with heuristic (discovery) and hermeneutical (interpretative) approaches using the reflective-responsivereflexive writing and interviewing methods for data gathering and unravelling. The narrative inquiry approach reaffirms that storytelling is an important tool in conducting research and constructing new knowledge. This thesis narrates a new story about sharing experiences, interconnecting, and continuing to learn.

Thinking skills in the language arts : an application of cognitive schema theory to the narrative writing process /

A cognitively based instructional program for narrative writing was developed. The effects of using cognitively based schematic planning organizers at the pre-writing stage were evaluated using subjects from the Primary, Junior and Intermediate divisions. Results indicate that the use of organizers based on problem solving significantly improved the organization and the overall quality of narrative writing for students in grades 3, 6 and 7. The magnitude of the improvement of the treatment group over the control group performance in Organization ranged from 10.7% to 22.9%. Statistical and observational data indicate many implications for further research into the cognitive basis for writing and reading; for the improvement and evaluation of school writing programs; for the design of school curricula; and for the inservice education for teachers of writing.

Paradigms and prisons: a narrative of translation and transformation : my hero's journey from "at-risk" youth to teacher/learner in a jail setting /

All life is suffering. Life is the pursuit ofhappiness. These are two foundational Buddhist dictums that, in their simplicity, I have entirely misunderstood regarding their depth, misreading them as contradictory. Indeed, my superficial interpretations led me to Thoreau's life ofquiet desperation and deep depression. We come to know and bring understanding to our lives by storying them. My own Hero's Journey, the path from my egoic selftoward the universal Self, can be understood as the resultant translations and transformations. Inevitably each of us is involved in such a story, though most are unaware of the stages along our own Hero's journey. ' Narrative honours writing as a means of knowing. The contemplative reflection allows insight into our imprisoning paradigms, beliefs, behaviours, and blind spots. My research revisits and explores nodal experiences along my Hero's Journey through 4 categories: self, society, soil, and Self. While the value of this process of narrative inquiry lay in its ability to come to know and understand one's self, perhaps its greater value is of a more universal nature. My inquiry, while adding to the body of academic educational narrative literature, may also illuminate a path to educators, students, and all interested, encouraging a response to the call of their own Hero's journey. I am a teacher/learner in a jail setting, working with youth between the ages of 12 and 18 who have committed crimes such as armed robbery, assault, rape, and murder. As this thesis follows my continual development from egoic self/teacher/learner to universal Self/Teacher/Learner, it also enables me to both consciously and unconsciously open the ways in which I expand my care, compassion, and love to work with at-risk youth.

A journey into narrative inquiry : one teacher's lived experience with eating disorders /

In "A Journey Into Narrative Inquiry: One Teacher's Lived Experience With Eating Disorders," an elementary teacher searches for answers regarding how education can help prevent eating disorders by journeying into her own experience of having had such a disorder. This qualitative study is a personal narrative based on an individual's experience, a method appropriate to the sharing of personal voices and stories told in education research. It is an attempt to address the gap found in the research on this topic by offering a subjective and unique perspective of what it is like to live within the nightmare of an eating disorder and by sharing the wisdom gained from having survived such an experience. This narrative inquiry explains how a teacher found herself at a stage where she was willing and ready to share her experience for the sake of research. The story of having had an eating disorder, consisting of both anorexia and bulimia, for over a decade is shared in a genuine, reflective manner. The researcher then shares the analysis of her own story, unpacking the themes of journeying toward voice, self-esteem, self-acceptance, and self and the completion of an M.Ed. degree. Bridges are made which connect these themes to the personal and professional life of the researcher, to the schools in terms of both curriculum and climate, to research directions, and to the larger culture. Suggestions are made for possible changes in educational settings that may help teachers in providing students with some tools and strategies to prevent turning to eating disorders as coping mechanisms. A literature review of eating disorders is included as well, as a guide for others to use when undertaking such qualitative studies.

Pausing at the river's edge : a narrative inquiry into the practice of a reading teacher /

In this narrative self-study I retell and connect the stories ofmy personal journey with literacy from childhood to the present. I use narrative as both methodology and method as I story my life experiences and my personal encounters with literacy. The heart ofmy reflections comes from the pages of personal journals written and storied over many years of trying to make meaning of powerful literacy experiences in my life. Now, in going back through the stories and reconstructing meaning, I make connections between the memories along the journey and the place from which I now tell my story. The interpretations I construct give voice to beliefs 1 have lived by and illuminations to moments in time that I have come to see with new eyes as I have engaged in this inquiry. The journey and self-reflection within the pages of this inquiry provide understanding of the driving force behind my personal passion for literacy. I am better able to understand my motivations and share the stories that validate my personal and professional path through time.

A sequential analysis of therapist scaffolding and child concept formation in narrative therapy

Narrative therapy is a postmodern therapy that takes the position that people create self-narratives to make sense of their experiences. To date, narrative therapy has compiled virtually no quantitative and very little qualitative research, leaving gaps in almost all areas of process and outcome. White (2006a), one of the therapy's founders, has recently utilized Vygotsky's (1934/1987) theories of the zone of proximal development (ZPD) and concept formation to describe the process of change in narrative therapy with children. In collaboration with the child client, the narrative therapist formalizes therapeutic concepts and submits them to increasing levels of generalization to create a ZPD. This study sought to determine whether the child's development proceeds through the stages of concept formation over the course of a session, and whether therapists' utterances scaffold this movement. A sequential analysis was used due to its unique ability to measure dynamic processes in social interactions. Stages of concept formation and scaffolding were coded over time. A hierarchical log-linear analysis was performed on the sequential data to develop a model of therapist scaffolding and child concept development. This was intended to determine what patterns occur and whether the stated intent of narrative therapy matches its actual process. In accordance with narrative therapy theory, the log-linear analysis produced a final model with interactions between therapist and child utterances, and between both therapist and child utterances and time. Specifically, the child and youth participants in therapy tended to respond to therapist scaffolding at the corresponding level of concept formation. Both children and youth and therapists also tended to move away from earlier and toward later stages of White's scaffolding conversations map as the therapy session advanced. These findings provide support for White's contention that narrative therapists promote child development by scaffolding child concept formation in therapy.

ESL students' off-line and on-line texts : differences and similarities /

This study was undertaken to investigate any textual differences and similarities within essays written with a word processing program and an e-mail editor by non-native writers. It arose from many contradictions and a paucity of empirical research within the field of second language learning and electronic technology. To further explore these contradictory observations, 3 classes of intermediate level ESL (English as a Second Language) students v^ote 6 essays, alternating between a word processing program and an e-mail editor. Prior to the data collection, students read brief texts and responded to questions that focused upon three formal topics: immigration, economics, and multiculturalism. Data were examined for (a) the differences in the frequency counts of 12 cohesive devices, (b) sentence complexity, which focused upon the occurrences of simple and complex sentences, (c) the number of words within the writings, (d) the method of contextualization preferred by writers, and (e) any variations in the final grades of the students' texts that resulted from holistic rating. Results of analysis indicated that there were no statistically significant differences in the frequency counts of the linguistic features. Sentence complexity did not vary within the off-line and on-line essays. The average number of words found within the off-line essays was approximately 20% greater than within on-line essays. Contextualization methods were not different within word-processed or e-mailed essays. Finally, there was no difference in the quality of the texts when holistically rated.