The decision of an obese woman to have bariatric surgery: the social phenomenology

Objective To understand the process by which an obese woman decides to have bariatric surgery. Method A qualitative survey with a social phenomenology approach, carried out in 2012, with 12 women, using the phenomenological interview. Results A woman bases the decision to have the surgery on: the inappropriateness of her eating habits; a physical appearance that is incompatible with an appearance that is standardized by society; the social prejudice that she has to live with; the limitations imposed by obesity; and her lack of success with previous attempts to lose weight. Outcomes that she hopes for from the decision to have the surgery include: restoring her health; achieving social inclusion; and entering the labor market. Conclusion This study allows one to reflect that prescriptive actions do not give a satisfactory response to a complexity of the subjective questions involved in the decision to have surgery for obesity. For this, what is called for is a program of work based on an interdisciplinary approach, and training that gives value to the bio-psycho-social aspects involved in a decision in favor of surgical treatment.

Supplemental nursing staff´s experiences at a Spanish hospital: Qualitative phenomenology research

The objective of this study was to describe the Supplemental Nursing Staff´s experiences at different hospital units. A qualitative phenomenological approach was conducted; a purposeful and theoretical sampling was implemented with supplemental nursing staff at Santa Barbara Hospital of Soria (Spain), to gain a more in-depth understanding of the Supplemental Nursing Staff ´s experience. Data were collected by in-depth interviews and through a field notebook. Data were analyzed using the Giorgi proposal. Twenty-one nurses with a mean age of 46 years were included. Three main topics emerged from the data analysis: building the first contact, carving out a niche and establishing interprofessional/interpersonal relationships. We conclude that the experience of hosting the supplemental nursing staff in changing clinical environments is conditioned by various factors. It is necessary for nurses and hospital managers to establish clear objectives with regard to the supplemental nursing staff´s role in the units.

Understanding unsuccessful attempts to quit smoking: a social phenomenology approach

Abstract OBJECTIVE The aim of this paper is to understand the experience of smokers in view of unsuccessful attempts to quit smoking. METHOD This study is based on social phenomenology. Between November and December of 2014, nine interviews were conducted with people that had attempted to quit smoking. The content of these interviews was analyzed and discussed based on the related literature. RESULTS Unsuccessful attempts to quit smoking are related to tobacco addiction; cigarettes are seen as a support to cope with everyday stressful situations. Attempts to quit the smoking habits were based on the need of health improvement and insistence of family and friends. Smokers reported the use of habit cessation strategies learned in support groups, but they also express expectation of specialized psychological support. CONCLUSION The study points out the need to expand the strategies of approaching smokers, and reinforcing psychological support in order to achieve success in the attempt to quit smoking.

Existential values transformation in all organ transplantation : a qualitative prospective study

The aim of this qualitative study was to analyze psychological concerns in wait-listed patients T1 and six months after transplantation T2. Semi-structured interviews were conducted and qualitative analysis performed. T1 Kidney patients maintained apparent normality, building emotional protection, and a fatalist attitude. Liver patients set physical limits, reevaluation of life values was reported. Lung patients developed physical and psychological self-protection. Modified life values, fatalism and spirituality were mentioned. Heart patients husbanded ressources and self-protection. Modified life values, fatalist attitude were reported. T2 Kidney patients described new life perspectives and increase of empathy. Liver patients underlined positive identity and life values modifications. Lack of respect of life values generated anger. Heart and lung patients set their existential priorities and underlined increase in spirituality, greater openness and more closeness to significant ones. Lack of respect of human values induced negative feelings. TX comes with physical benefits, but also with positive existential values transformations and a humanistic, altruistic attitude.

Mastectomy, Body De-Construction and Impact on Identity: A qualitative study

Objectives: This qualitative study aims at understanding the consequences of body deconstruction through mastectomy on corporality and identity in women with breast cancer. Design: Nineteen women were contacted through the hospital. All had to undergo mastectomy. Some were offered immediate breast reconstruction, others, because of cancer treatments, had no planned reconstruction. A qualitative reflexive methodological background was chosen. Method: Women were invited to participate in three semi-structured interviews, one shortly before or after mastectomy, and the other interviews later in their illness courses, after surgery. All interviews were transcribed verbatim. Thematic analysis was performed. The analysis of the first interview of each woman is presented in this article. Results: Mastectomy provokes a painful experience of body deconstruction. Even when immediate reconstruction is proposed, contrasted feelings and dissonance are expressed when comparing the former healthy body to the present challenged body entity. Body transformations are accompanied with experiences of mutilation, strangeness, and modify the physical, emotional social, symbolic and relational dimensions of the woman's gendered identity. Although the opportunity of breast reconstruction is seen as a possible recovery of a lost physical symmetry and body integrity, grieving the past body and integrating a new corporality leads to a painful identity crisis. Conclusion: With mastectomy, the roots of the woman's identity are challenged, leading to a re-evaluation of her existential values. The consequences of mastectomy transform the woman's corporality and embodiment, and question her identity. Psychological support is discussed in the perspective of our results.

Determinants of the effect of existential behavioral therapy for bereaved partners: a qualitative study.

BACKGROUND: Informal caregivers of palliative patients took part in existential behavioral therapy (EBT), a group intervention comprising mindfulness exercises to reduce psychological distress and improve quality of life. OBJECTIVES: This study examined what the participants perceived as helpful to cope with their loss during the first year of bereavement, particularly with regard to the EBT intervention. DESIGN: Sixteen problem-centered, semi-structured interviews were evaluated with content analysis. RESULTS: Two main categories were found: social support and self-regulation. Social support includes sense of belonging as well as emotional, cognitive, and practical help experienced from others. Mindfulness and acceptance, a clear focus on the positive, and orientation toward the future were helpful strategies of self-regulation; these were also part of the EBT intervention. Mindfulness was understood as permitting emotions and acceptance of one's inner processes, even if they were not pleasant, and was found to be helpful to stop ruminative thinking. CONCLUSIONS: The categories considered as being helpful parallel core elements of EBT and recent grief theories. The intervention was found to be supportive and met the needs of the participants. The interviewees appreciated the continuity of EBT support from palliative care into bereavement.

Specificities of psychodynamic psychotherapy in the medically ill

Psychodynamic psychotherapy with patients suffering from somatic diseases is based on general principles of psychodynamic understanding, such as the influence of development and biographical elements on patient.s adaptation to illness or the role of defense mechanisms when facing existential threat. However, differences exist, such as the adaptation of the therapeutic setting, which thus loses some of its diagnostic and therapeutic power, or the early emergence of powerful transference, which cannot always be interpreted by the therapist. In addition, psychodynamic psychotherapy in the medically ill has some specificities, which differentiate it from classical psychoanalytic theory. The specificities concern, for example, transference of the medically ill, which is more adequately conceived by concepts of the existential analysis (Daseinsanalyse), or the patient.s loss of a sense of continuity, which needs an understanding beyond psychological theory taking into account philosophical (e.g. phenomenology), anthropological and ethical concepts.

Den talande bokens poetik : en studie med fokus på olika unga vuxnas reception av tre fiktiva texter inlästa på band

The purpose of the research project The poetics of the talking book is to contribute to the knowledge about patterns of understanding in young adults’ reception of fiction, which they listened to through audio books. The problem explored was: How do different groups of listeners receive fictive text presented as a talking book with variations regarding use of voice, engagement and sound effects? The problem formulation rendered four specific research questions: 1. What patterns can be identified in the listeners’ answers regarding story structure and cognitive content in a comparative perspective comprising different reading styles in the taped versions of the text? 2. What patterns of understanding in interpretative reading can be identified in different listeners? 3. Which thoughts do the listeners have about what the talking book should sound like? 4. What affordances for young adults with the functional disability of mild mental retardation can be made visible through guided literature conversations? The theoretical frame of reference was formed by text–reader-oriented literary theory, psychological schema theory, and research regarding voice quality and communication. The project was carried out in two steps. The first phase was to produce the audio books with two variations of reading practice of three short stories with an existential theme in each text. The second step comprised interviewing of 32 young adults (a special group with a reading handicap in form of mild mental retardation, and a reference group with no handicap). The interviews formed as literary conversation were carried out three times during one year. The phenomenological-hermeneutic approach focused on the life worlds of the participants as meaning seeking beings. The analysis was carried out using method triangulation, mainly using phenomenological meaning concentration. The double hermeneutics in use when interpreting the interpretations of the participants revealed a capacity for aesthetic reading of fiction in the special group as well as in the reference group. The aesthetic qualities were found sufficient in all variations of reading by the professional readers of the audio book they listened to. The young adults also could describe how they wanted the audio book to sound: just as if you were reading yourself. A model describing the analytical steps and concepts in use was a result that can serve as an outline of a poetics for the talking book. Unexpected research results were how important the guided literary conversation turned out to be in order to realise the affordances given by the texts regarding exploration of existential themes in the young adults’ life worlds. Thus the result of the research project can be positioned as a piece of emancipatory research stressing the importance of including this group of young adults in the society’s conversation about culture and meaning.

Rummet i vårdandets värld

This study is made in the context of basic research within the field ofcaring science. The aim is to make a theoretical and ontological investigation of what the space is in the world of caring. The basic proposition is that the space, as a fundamental dimension, has an impact on how the appreciation of one's mental health and suffering is shaped, and vice versa. The overall purpose is to develop a theoretical model of space from the caring science point of view andalso to offer an ideal concept of space to caring science. Guided by a theoretical horizon (Eriksson 1993, Eriksson 1995, Eriksson 2001) and methodological approach grounded in Gadamer's philosophic and existential hermeneutics a three-stage analysis and interpretation is conducted. The hermeneutic spiral of this investigation starts through a procedure in accordance with Eriksson's model (1997) of concept definition. The goal is to clarify the etymology of the concept as well as semantic differences between synonymous concepts, i.e. to identify the different extents of the concept of `space` (`rum`) in order to bring these closer for an exploration. The second phase is to analyse and interpret a sample of narratives in order to explicate the ontological nature and meaning of the space. The material used here is literary texts. The goal is to clarify the characteristics of the very inside of the space when it is shaped in relation to the human being in encountering suffering. In the third phase an interview study is taken place. The focus of the study is directed towards the phenomenon of space as it is known by a patient in a landscape of psychiatric care, i.e. what the space is in a contextual meaning. Then, a gradual hermeneutic understanding of the space is attempted by using theories from the field of caring science as well as additional theories from other disciplines. Metaphors are used as they are vivid and expressive tools for generating meaning. Different metaphoric space formations depict here a variety of purports that, although not quite the same, share extensive elements. Six metaphorically summarized entities of meaning emerged. The comprehensive form of space is pointed out as the Mobile-Immobile Room. Furthermore, the Standby, the Asylum, the Wall and the Place. In the further dialogue with the texts the understanding has deepened ontologically. The theoretical model ofthe space sums up the vertical, horizontal and the inward extent of deepness inthe movement of mental health. Three entities of ontological meaning have emerged as three significant rooms: the Common Land emerges as the ideal concept of mutual creation in the freedom of doing, being and becoming health. On the interpersonal level it means freedom, which includes sovereignty, choice and dignity of the human being. The Ice World signifies, ultimately, the space as a kind of frozenness of despair which "wallpapers" the person's entire being in the world in the drama of suffering. The Spiritual Home is shaped when the human being has acquired the very core of his/her inner and outer placeness as a kind of "at-homeness" and rootedness. Time is a central element and the inward extent of deepness of this trialectic space. Each of the metaphors is then the human being's unique, although even paradoxical, way of conceiving reality, and mastering spiritual suffering. They condense characteristic structures and patterns of dynamic scenery, which take place within the movement of health. The space encloses a contradictory spatiality constituted through the dynamic field of meaningfulness and meaninglessness. Anyway, it is not through a purging of these contradictions but through bringing them together in a drama of suffering that the space is shaped as ontologically good and meaningful in the world of caring.

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.

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.

Karneval i klassrum – kunskap på hjul : en studie av elevers möten med clown analyserade med narrativ metod och poetisk etnografi

The aim of this study is to contribute to the knowledge about learning in and through art related to pupils’ study processes developing clown characters in secondary school. The pre understanding of this qualitative piece of micro ethnographic research is that the elaboration of clown has openness to play, creative activity and imagination. The art form clown inspires and motivates. The clown character creates a kind and friendly atmosphere, calls upon smile, which promotes learning. It is an art form promoting deep and personal reflection and evoking questions regarding identity formation. The pre understanding finally is that existential themes are brought to articulation in the art form clown. The problem formulation for the hermeneutic phenomenological study is an exploration of the meaning potential of an arts educational work with clown from the pupils’ as well as the teacher’s perspective. The study elaborates the following research questions: 1.) How are the pupils staging themselves in the work with clown? a) How are they constructing the clown character? b) How do they reflect upon their construction? c) What are the characteristics of the working process in the elaboration of clown? 2.) What is characteristic of the teacher’s contribution to the arts educational work? 3.) What is characteristic of the meaning making in the elaboration of clown? One group of 21 pupils and their drama teacher in a Swedish secondary school in six workshops (each one 90 minutes) elaborating the clown theme is the group under study through video observation, interviews, students’ logs and drawings, teacher log and researcher’s field notes. The theoretical framework comprises three perspectives on clown: a perspective on the culture of carnival, a drama education perspective and a performance perspective. Through a content analysis of texts about clown a set of characteristics for the clown is used as analytical concepts in the subsequent analysis of the pupils’ working process when they create three clown characters: August, the white clown and the bag lady. The results are presented as fictive narratives built on the video observations and the interviews. The presentation is brought to even more condensation through poetic ethnographic writing of haiku poems by the researcher. This ethnographic writing is idiomatic to the art form under study, and can be seen as a metaphorical meta commentary to the narratives. As a main result the researcher has developed a model describing the different aspects of the clown characters and the meaning potential of the clown as learning regarding exploration of identity and elaboration of existential questions regarding life, loneliness, love, religion and death.