Tid och det tidlösa i tiden : en frambrytande vårdvetenskaplig teorigestaltning

Denna vårdvetenskapliga grundforskning syftar till att ur ett vårdvetenskapligt perspektiv och genom en hermeneutisk ansats fördjupa förståelsen för tiden och hur den gestaltas i vårdandets värld ur patientens synvinkel. Ett abduktivt syfte är att söka evidens för hur tiden kunde gestaltas ur ett vårdvetenskapligt perspektiv. Forskningsuppgiften är att teoretiskt och empiriskt utveckla kunskap om tidens substans och ontologi i vårdandets värld i ljuset av hälsa och lidande. Forskningsdesignen består av att genom induktion, deduktion och abduktion skapa hermeneutiska förståelsehorisonter. Sökandet efter det sanningslika och friläggandet av mening sker genom begreppsbestämning, tolkning av filosofers texter och tolkning av patienters texter. Vid avtäckandet av teorifragment har ett hermeneutiskt kunskapsarkeologiskt närmelsesätt utprövats. Horisontsammansmältningen framträder genom en vårdvetenskaplig mångdimensionell klangbotten och därigenom skapas den sammanvävda bilden. Bilden framvisar en frambrytande vårdvetenskaplig teorigestaltning där tid och det tidlösa i tiden bildar en dialogisk rörelse. Den mångdimensionella tiden tillför gestaltningar av dimensioner, skikt och nivåer. Den ontologiska nivån presenteras som ’flödande tid’, ’tillvarons tid’, ’kroppsligt innesluten tid’ och ’den andres föregående tid’. Tidens väsensdimensioner artikuleras som ’besittningstiden’, ’nuflödet’ och ’tidens genuina skepnad’. Tidens ’rymd’ eller det som kunde ses som en transcendent nivå har indelats i ’den förlösande tiden’, ’den tidlösa tiden’ och ’evighetshägring’. Den existentiella nivån framträder i en dialogisk rörelse mellan hälsa och lidande och synliggör tidens dubbelhet genom den yttre tidens gestaltade rörelse och den inre tidens beslöjade rörelse. Patienters vittnesbörder om tidsupplevelser, vilka framstiger inom vårdandets värld har genom en tolkningsrörelse förts in i dialog mellan ’hälsa’ och ’lidande’. Därigenom bildas ett mönster som visar på den genom lidandet förändrade tidens gestalt. Denna är en grund för den vårdande tidens tankemönster. Tankemönstret presenteras som ’tidspektras valv’, ’nuvarons tillgänglighet’ och ’varda i tid att lida ut’.

Hjärtats vanor, tankens välvilja och handens gärning : dygd som vårdetiskt grundbegrepp

The main aim of the study is to elucidate the meaning and dimensions of the concept of „virtue‟, and to find the place of virtue in a caritative caring ethics, i.e. a caring ethics based on human love and mercy. The intention is to create a theory model which utilizes the possibilities of virtue in developing the caritative caring ethics as a whole. The caritative caring ethics has a universal potential – it is primarily not a professional ethics, but it may form a frame of reference and basis for formulating ethical codes, and for ethical discussions within different caring contexts. The hermeneutic approach of the study is inspired by Gadamer‟s philosophical hermeneutics combined with the view of hermeneutics as a hypothetical-deductive process. The study is guided by Eriksson‟s model of definition of concepts. The concept of „virtue‟ is studied focusing on its ethical dimensions. These ethical dimensions of virtue are seen as anchored to an inner ethos, whereas ethos stands for the ontological goodness, a basic notion of the Good that permeates the entity of the human being, and forms the base of the culture where he lives and acts. The overarching research questions are: 1. What is virtue? 2. What is „virtue‟ as a basic concept in caring science? 3. What place does virtue have in caritative caring ethics? The answer of the first question is mainly searched for by an ontological determination comprising partly an etymologic and semantic analysis of „virtue‟, and partly a determination of the essence of virtue. The answer to the second and third questions are mainly searched for using a contextual determination, where the purposive context and pragmatic features of virtue are studied in relation to caring ethics. The ontological and contextual determinations are brought together through hermeneutical interpretation, forming a new whole, which constitutes the results of the study. The results of the study are depicted in a theory model, in which the movement of virtue from ethos to deed is moulded as caritative caring ethics. The material of the study consists of dictionaries, texts written by Aristotle and St. Thomas Aquinas, articles, dissertations, and books, as well as parts of a pilot survey answered by 33 nurses. The results of the study show that the essence of virtue is primarily functional, not ethical. The ethical emerges when virtue is contextualized in a human communion. Virtue makes something fulfil its function well; makes the human being good, and gives him morals and morality. The human being needs prudence, love, and humility to acquire and develop the moral virtues. Virtue is a power, related to a value, which considering a caritative caring ethics consists of the caritas motif. Human love is shown through deeds, making the human being do what he is expected to do. Virtue, as an active power of becoming, affirms and clarifies the human being‟s ability to develop in the direction of the Good. Virtue becomes essential and unifying when morality appears in the human mind as auctoritas, an inner, prompting power based on divinity or a transcendental ethos. Together ethos and virtue create opportunities for an inner ethics based on voluntariness and joy in being and doing the true, the good, and the beautiful.

Hälsans grund kan bara hjärtat förstå : ett sökande efter kunskap om hälsa i ljuset av Blaise Pascals tänkande

The aim of this thesis is to gain new understanding of health based on the work Penseés (Thoughts) by Blaise Pascal. The research interest originates from the motive of the heart for the greatness of man in conjunction with his baseness. The study is hermeneutic and the purpose is to describe health formulated as new abductive theses based on the assumption that caring science and caring theology can be conjoined in the same ontology. The work Penseés is, in Gadamer’s sense, alive since the text is constantly being made use of and is in this occurence interpreted through the requirements made by caring science. Pascal’s arguments continue through the historically effected consciousness while the interpretation is confronted with the ontological model of health. In the initial horizon we find the understanding of the motion of health and the extension towards text materials which is undertaken by Pascal’s Penseés. to open up the perspective and be able to project the horizon of the text. In the encounter with the text, the core content will first be discussed in an interpretative part after which the understanding gained will be summarized into new abductive assumptions. On the basis of Gadamer’s emphasis on the applications of the interpretations, the merging of the horizons will identify health as something desired by man, what he is and what he wants to accomplish. The creation of health is the reason of the heart, and on the basis of what man wants to confide in, the rise of health will be established. The totality of greatness and baseness of man is achieved by the accomplishment of health. That man owns spiritual devotedness means health whereas unhealthy means that he is insecure of his character and leads a life with ill-considered amusements. When according to Pascal, man’s desires and thoughts are joined in the heart, a connecting relation will arise. Hence the spiritual edification that man will fail to secure if he puts too much of his confidence in transient reason is included, something that is insufficient when it comes to understand the meaning of health.

Vårdande och icke-vårdande tröst

The aim of the thesis is, from a caring science perspective including a caring theology perspective, to illustrate the meaning of the phenomenon consolation and howconsolation relates to suffering and care. Two studies were completed where staff and elderly care receivers were interviewed and a third study focused on an analysis of consolation as it is presented in the Book of Job in the Old Testament. These studies deal with carers' experiences of consolation and consoling, elderly care receivers' experiences of consolation, and Job's experience of consolation. Phenomenology and hermeneutics form the basis for the methodological approach. A phenomenological- hermeneutic method, inspired by Paul Ricoeur, has been used for the text analyses. The thesis also covers significant aspects of poetical and religious texts. The metaphors that occur in the interview studies with the carers and the elderly are analysed in order to take care of the excess of meaning that, according to Ricoeur, can be expressed in metaphors. The result showfive overall meanings: The contradictory consolation, The bonding consolation, The mute and rigid consolation, The uncontrolled consolation and The restful consolation. A caring consolation is contradictory in the sense that it entails that the sufferer on the one hand passes on his or her suffering to someone else and on the other hand that the suffering can be returned to be suffered. Consolation can thus entail suffering. The bonding consolation is present, i.e. is with the sufferer and is based on that person's suffering. This consolation is characterised by a close fellowship, a feeling of being understood at a deeper level. The results also reveal a consolation that is mute and rigid. This consolation does not respond to the sufferer's experience of his or her suffering, is shapeless and therefore unable to follow the suffering. An example of a mute, rigid and non-caring consolation is the consolation of the friends in the Book of Job. This consolation is not capable of consoling because it does not correspond to where Job is, i.e. in his experience of his suffering. A caring consolation is also uncontrolled because it is on the one hand spontaneous and on the other hand helps the sufferer to lose control over the suffering. To lose control entails, amongst other things, the sufferer giving up trying to understand suffering and instead lets that which is incomprehensible be incomprehensible. A consoling and health-bringing rest in or from the struggle with suffering presents itself by giving up what in various ways is tied to the suffering. The result as a whole is interpreted from a caring science perspective with the following important concepts: caring relationship, faith, health and sacrifice. Consolation as health is considered on the basis of a theoretical model inspired by Katie Eriksson's ontological health model. The research is also illustrated from a philosophical-ethical perspective, mainly based on the work of Emmanuel Levinas. The findings are discussed in relation to previous research and also to caring science, society and care.

Kampen for livet i vemodets slør : å leve i spenningsfeltet mellom livets mulighet og dødens nødvendighet

The overallpurpose of this research is to develop knowledge about health and suffering in connection with serious cancer disease through the development of a contextual model describing how patients live their lives between the possibility of life and the necessity of death. The research takes its point of departure from a caring science perspective, and Gadamer's hermeneutical philosophy is chosen as the overall methodology. In addition to the caring science perspective, the existential philosophy of Kierkegaard constructs a framework of interpretation. The research consists of three empirical studies. In two of the studies 21 patients participated, whilst 8 nurses took part in the remaining study. The patients were seriously ill and the nurses had long experience of caring for seriously ill patients. Scientific conversations were used for data collection. The findings from the patient studies show that the relationship with one-self, others, God or the supernatural and nature, constitute the unit of meaning, in which the struggle between health and suffering takes place. This struggle takes the form of a dialectic movement between being delivered and being accommodated and confirmed. The patients strive, in their delivery, for health and integration, for being a self by being reconciled with one self. The patients are lonely in this struggle, as conversations related to existence and death seldom occurs with either the natural or the professional caregivers. Themes related to patients' death remain mainly unarticulated. The patients' life struggle appears on the existential level as a threefold struggle against time and annihilation, towards being accommodatedand confirmed and for restoration and reconciliation. Through the hermeneutic process the struggle at the ontological level appears as a struggle of the will between anxiety and love. The patients in this research experience their life's tragedy. A holistic interpretation of living under the pressure created between the possibility of life and the necessity of death appears to be a struggle for life in the veil of pensiveness. The nurses want to be involved in the patients' struggle, and they show a deep desire to support the dignity of the patients. The depth in the nurses' view of their responsibility for the patient as an entityof body, soul and spirit seems to be related to the nurses' understanding of life.

Generic and professional caring in a Chinese setting: an ethnopraphic study

The objective of the present study is to describe the cultural care practices, meanings, values and beliefs which form the basis of caring in a Chinese context. The research has its starting point in a caring science perspective and a qualitative research approach with interpretative ethnography as methodological guideline. The theoretical perspective is formed by elements of the theory of caritative caring, developed by Eriksson, and the theory of Culture Care Diversity and Universality, developed by Leininger. Previous research of suffering, culture and caring is described and also a presentation of actual transcultural nursing research as well as a presentation of the social structure dimensions of Chinese culture is included in the theoretical background. The empirical part includes patients and relatives, nurses and Hu Gongs as informants. The data collected are analysed based on Geertz’s idea of forming “thick descriptions” through examining the “what, how and why” of people’s actions. The findings show that the family has a prominent position in Chinese caring practices. The patient plays an unobtrusive role and a mutual dependence between the patient and the family members is evident. The professional nursing care is an extended act which includes the family in the caring relationship. The care practices of the Chinese nurse are characterized by great professional nursing skills. Suffering is described by the informants as being caused by disease, pain and social circumstances. “Social suffering” is described as worse than physical or mental suffering. Culturally competent and congruent care is a prerequisite for avoiding cultural pain, imposition and blindness when caring for the suffering human being. The findings of the present study necessitate a broadening in caring theory to include the family in the caring relationship. A further conclusion is that a broadening in our perception and understanding of culture would promote the delivery of culturally competent and congruent care. Suffering need to be seen as enclosed in cultural patterns of how it is expressed, interpreted, understood and relieved. Care and caring need to be seen as embedded in culture and the care practices values and beliefs have to be congruent with the cultural patterns where the care is provided.

Det gyldne snitt : den estetiske dimensjon, en kilde til helse oget etisk anliggende

Within caring science, investigations and explorations have been carried out on the ontology of caring, and many aspects of the field have been the subject of scientific research. The main subject for this study is grounded on the human need for aesthetics. The purpose is to find how the aesthetic dimension is taken into consideration and how the aesthetic surroundings are evaluated and attended to, in the general hospitals in Norway. The theoretical perspective is founded basicly on the study of litterature from caring science and philosophy. The aim is to develop a disposition for a framework on the aesthetic surroundings in the hospitals, and to develop phenomenological and ontological knowledge and understanding of the aesthetic dimension. The study aspires to attain a deeper understanding of the aesthetic acknowledgment and of the aesthetic needs. The focus is how the aesthetic dimension can promote health and wellbeing, both for patients and for the caring staff, in the general hospitals and why the aesthetic dimension should be obligatory in `evident care¿. The study concentrates on 11 selected categories in the hospital environment, where aesthetics is of importance. The research is implemented on 5 part studies: 1. part is a study of caring science and philosophical theories about aesthetics, as a framework for the investigation. 2. part is a survey of the physical environment, in Norwegian somatic hospitals, with focus on aesthetics. This by analyzing the strategy plans for the hospitals. 3. and 4. part is questionnaires to patients and nurses to get their opinion and evaluation of the aesthetic environment in the hospitals they are connected to, and their opinion on how this influences the health and wellness for both patients and caring staff. 5. part is qualitative interviews with 16 experts, to get their opinion and evaluation of the aesthetic environment in hospitals they are or have been connected to. How would the experts like the aesthetic surroundings to be, and also their opinion on what influence they think aesthetics has on health and wellness. The main literature of caring science is rooted in K. Erikssons caring theory as well as philosophic literature; mainly I. Kant, Platon and Y. Hirn's theories on aesthetics. Various scientificresearchers of aesthetics have also been referred to. The methodological approach is a triangulation with a hermeneutic exploration, where H.G. Gadamer and Ricoeur provides the inspirational foundation. The findings and conclusions result in the development of new hypothesis for the caring science foundation and suggestions, a disposition for a framework related to future planning of the aesthetic environments in general hospitals. It might be said that a common thread arises/appears in the invariance's (invariables) that are discerned from the analysis and interpretation of the interviews and also important angles shows in the variances that crystallized. Based on the conclusions the study confirms that there is a clearconnection between health, wellness and aesthetics in the environment and that it is an ethical obligationfor those in the caring professions to be aware of and attend to the aesthetic dimension.

Den etiske akten : den caritative etikken når pasientens fordringer er av eksistensiell art

The purpose of this thesis is to develop a theory model about some core concepts and phenomena within caritative ethics when patients' demands are existential. There are two research questions, (A) Which realities represent concepts such courage, responsibility, and sacrifice within the caritative ethics. (B) Which phenomena of ethical significance are made current and applicable when patients¿ demands are existential. This study takes as its point of departurecertain chosen theoretical perspectives that discuss some perspectives of the concepts of courage, responsibility, and sacrifice in terms of their significanceto the research questions A. This represents the study¿s theoretical data. The empirical data provide answers to the research question B. In the end, the thesis discusses synthesis of these two accesses of knowledge in order to formulate theses and create a theory model. Løgstrup's contribution and description of the ethical claim helps in understanding and interpreting the links between the substance of the caritative ethic and the concrete reality in the encounter with existential issues. This thesis is a study within the field of Caring Science. The nursing profession provides empirical data and reflects the study topic, by addressing issues of relevance to the application of the knowledge of Caring Sciencein light of the nursing profession's various daily challenges. This study proceeds from the basic assumption: "Caring relationships form the meaningful contextfor caring and derive from the ethos of love, responsibility, and sacrifice, i.e. a caritative ethics" (Eriksson 2001). This study attempts to explore and prove this statement in the light of theoretical and empirical data, in the light ofthe caring scientific perspective which is here linked particularly to the viewof man as a unity of body, mind, and soul, and to the ontological health model. Hermeneutics is the overall perspective for the interpretations proposed in this thesis. Through conversation and hermeneutic observations, I try to understandthe challenges of nursing performance in the encounter with existential issues. This constitutes the empirical data that was gathered on a ward treating cancerpatients. The discussion proceeds sequence by sequence, first by discussing theconditions of the caritative ethics when meeting the existential claims in the light of the concepts of courage, sacrifice, and responsibility. Then a thesis is formulated concerning the caritative ethics in the light of Caring Science. This is the foundation of the creation of the theory model. The resulting theses concern the chosen concepts and phenomena which promote caritative ethics when patients' claims are existential: Freedom is the hallmark of caritative ethics. Freedom is the basic category of caring. When attending to the patient's existential claims, it is of vital importance to secure human relationships as caring interpersonal communions, created by responsible persons who have shown courage and sacrifice. Courage and sacrifice constitute the ethos of caring communities (communions). Courage and sacrifice are then a part of the collective ethos of caring communities, because the patient is confirmed as the unity of body, mind, and soul.

Hemmet som ethos : en idéhistorisk studie av hur hemmet som ethos blev evident i hälsosysterns vårdande under 1900-talets första hälft

The home as ethos, an ethical dimension of human beings, is this study’s focus of interest. Can the home as ethos comprise motive and driving force for a human being? This dissertation has a mainly hermeneutic approach with a Caring Science interpretive horizon. Firstly, the purpose of this study is to develop the concept “home” through etymological and semantic analysis. The concept’s Caring Science content is also investigated. Secondly, the purpose of this study is to investigate, through the use of a history of ideas method, how the home as ethos is made visible and evident in public health nurses’ caring during the first half of the 20th century. Which motives compromise the driving force behind public health nurses’ caring? Which idea patterns are stressed? Material for the study’s concept determination consists of tymological dictionaries as well as Swedish language dictionaries published from 1850 – 2001. The results of the concept determination provide a preliminary idea-model, where dimensions such as ethos as a human being’s innermost room, human beings’ manner of being, and the metaphor “my home is my castle” are stressed. These results comprise the background of the history of ideas portion of the study. The study’s history of ideas investigation occurs through the evaluation and interpretation of historical sources focusing on the caring provided by public health nurses. Public health nurses comprise both the context and prevalent traditions during the time-period studied. The historical sources consist of three different types of sources, namely textbooks, archived material, and the professional nursing journals Epione and Sairaanhoitajatarlehti. The purpose is to rediscover fundamental idea-patterns through the thematic structuring of the patterns appearing in the historical sources. Three main idea-patterns and underlying themes are rediscovered: love- a fire which burns inside human beings; reverence for human beings and home; and the honor of responsibility. The emerging patterns are tightly interwoven and form a pattern. A new interpretation occurs, widening the study’s horizon and leading to the emergence of the theory-model’s contours. The study’s theory-model is formed from three different levels. Ethos as a human being’s innermost room- the spirit, encompasses a human being’s value base and the spirit that he/she is permeated with. Fundamental values are converted into an internal ethic, becoming visible in human beings’ manner of being- the manner of conduct. The metaphor “my home is my castle”- the tone, symbolizes the room where a human being’s abstract or concrete being lives. The spirit, the ethos, is expressed in a home’s culture and atmosphere, that is to say the tone of a home or how one lives in a room. Communion is a significant component in the creation of a culture and atmosphere. This study’s theory-model gives rise to a new perspective that can generate new patterns of action. The study’s theory-model results in a new historically-based view that create new patterns of action in care and Caring Science today.