Phenomenology as a method to investigate the experience lived: a perspective from Husserl and Merleau Ponty's thought

Aim. By taking nursing as a human relationships activity, in spite of its strong technical-scientific features, this article reflects on the phenomenological method as one of the ways to develop ail investigation and acquire knowledge of the topic.Rationale. Based on Husserl's phenomenology, which is opposed to the way of doing science based on the laws that regulate the physics and mathematics, the article introduces Merleau Ponty's existential phenomenology as the theoretical foundation for the method it proposes. My existential conceptions-people as historic beings inserted in a world over which they act but which, in its turn, determines them; the human perception as reference for our way of being in the world; the space-time structure of perception-these are the key concepts that have led to the elaboration of ail approach to phenomenological research.Proposal of a methodology. Steps are proposed for such ail approach, namely phenomenological description, reduction and analysis. These lead to the building up of ideographic and nomothetic analyses, thus unveiling and describing general truths about the phenomenon studied. Finally, the possibilities for applying the methodology to nursing research are discussed, illustrated by my research into student nurses' perspectives on working oil an isolation ward.

Toward an understanding of how individuals overcome challenges to development: A phenomenological study of an inner -city student's attitude toward academic orientation and life

The purpose of this qualitative case study was to gain an understanding of the phenomenon of academic orientation by seeking the insights into an inner-city Haitian-American middle school student's attitudes and world view toward education and life. A phenomenological approach was used in order to explore the way in which Cindy, a minority student, gives meaning to her lived-experiences in terms of her desire to meet academic expectations and her ability to overcome social adversity and/or other risk factors.^ The study attempted to answer the following two research questions: (1) What provides the focus for Cindy's (the subject's) approach to her school work and/or life? (2) What are the processes that give meaning and direction to academic orientation and life for Cindy? In-depth interviewing was the primary method of data collection. In addition, journal and sketchbook entries and school district records were used and classroom observations made.^ The nature of the study to understand lived-experience facilitated the use of the case study method and a phenomenological method of description. Data analysis was conducted by means of an adapted form of the constant comparative approach. Patterns in the data which emerged were coded and categorized according to underlying generative themes. Phenomenological reflection and analysis were used to grasp the experiential structures of Cindy's experience. The following textural themes were identified and confirmed to be essential themes to Cindy's experience: personal challenge to do her best, personal challenge to want to learn, having a sense of determination, being able to think for self, having a disposition to like self, achieving self-respect through performance, seeing a need to help others, being intrinsically motivated, being an independent learner, attending more to academic pressure and less to peer pressure, having motivational catalysts in her life, learning and support opportunities, and having a self-culture. Using Mahrer's humanistic theory of experiencing, Cindy's development was interpreted in terms of her progression through a sequence of developmental plateaus: externalized self, internalized self, and integrating and actualizing self.^ The findings of this study were that Cindy's desire to meet academic expectations is guided by a meaning construction internal frame of reference. High expectations of self in conjunction with other protective factors found in Cindy's home and school environments were also found to be linked to her educational resilience and success. Cindy's lived-experiences were also found to be related to Mahrer's theory of human development. In addition, it was concluded that "minority" students do not all fit into social categories and labels. ^

A phenomenological perspective of the lived experiences of Jewish holocaust survivors seeking health care in the United States today

Seven Jewish Holocaust survivors were interviewed using a phenomenological method to determine the essence of the Jewish Holocaust survivor's experience with health care in the United States today. The transcriptions were analyzed using Colaizzi's approach to phenomenological research. This approach includes extraction of significant statements, from the transcriptions, that described the participant's health care behaviors and needs. Formulated meanings of the significant statements were then organized into six themes: Hiding and Avoidance, Self care, Fear/Trust Dichotomy, Security, Luck, and Need for Understanding. These six themes were forms of protection for the participants, which ultimately led to continued survival, the essence of their experience. Knowledge of their experience may direct the nurse in implementing creative and appropriate nursing interventions to provide comfort and assist the survivor with their needs in today's health care arena.

The visibility of the world and the invisibility of the soul. Phenomenological structure of the human perception

The essay intends to demonstrate the need to postulate an (invisible) spiritual reality in the human being as a condition of possibility of the world’s visibility. For that purpose, it employs the phenomenological method. It describes the structure of human sensitive perception. This description firstly presents the world’s structure (first distance). Secondly, it manifests the importance of the body as a border element between the soul and the world and as an organ by means of which the soul structures the world. It is the second distance the distance between the body and the world. But, thirdly, the description states that, no matter how intimately the soul interpenetrates the body and requires it to know the world, the soul is not the body. It is the third distance or the primordial distance between the soul and everything else (including the body itself).

Ateliê de desenho e Rorschach: estudo fenômeno-estrutural

A produção de desenhos em grupo e o método de Rorschach foram utilizados ao longo do tratamento de um paciente com esquizofrenia, acompanhado em Centro de Atenção Psicossocial. O referencial proposto para a compreensão do caso é o método fenômeno-estrutural que busca acessar o modo de ser e de vivenciar a doença que afeta o paciente, a partir do que ele revela nas imagens e na linguagem. Aos desenhos de cores acromáticas e conteúdos humanos deformados, o paciente insere cores, representantes da expressão afetiva, e figuras humanas integradas, denotando disponibilidade nas relações. O Rorschach indica contato mais adequado com a realidade, dado a diminuição da distorção da percepção da forma e de figuras fantasiosas. Após diminuição da sintomatologia persecutória e isolamento social, o paciente recebeu alta. O uso desses instrumentos tem contribuído na difícil tarefa diagnóstica e no acompanhamento da evolução de pacientes, nos cuidados interdisciplinares em saúde mental.

Career barriers influencing career success: A focus on academics’ perceptions and experiences

Purpose – Few research has addressed the factors that undermine people’s subjective perceptions of career success. Hence, the purpose of this paper is to further illuminate the issue of career barriers in perceptions of career success for a specific group of professionals: academics. Design/methodology/approach – This study adopts an interpretative-social constructionist methodology. Complementarily, it was employed a phenomenological method in data gathering and analysis – with the use of in-depth interviews and a theme analysis. The research was undertaken with a group of 87 Portuguese academics of both sexes and in different stages of their academic careers. Findings – The findings pinpoint the existence of multi-level barriers encountered by the academics when trying to succeed in their careers. The interviewees mentioned particularly the organizational-professional career barriers pertaining to three general themes: poor collegiality and workplace relationships; the lack of organizational support and employment precariousness; and the career progression standards and expectations. At the individual life cycle level the interviewees referred to the theme of finding balance; at the same time, the gender structure was also a theme mentioned as an important career barrier in career success, particularly by the women interviewed. Research limitations/implications – One of the limitations of this research is related to the impossibility of generalizability of its findings for the general population. Nevertheless, the researcher provides enough detail that grants the reader with the ability to judge of its similarity to other research contexts. Practical implications – This research highlights the role played by distinct career barriers for a specific professional group: academics. This has implications for higher education policy-makers and for human resources managers in higher education institutions. Originality/value – The current study extends the literature on career success by offering detailed anecdotal evidence on how negative work experiences might hinder career success. This research shows that to understand career barriers to success it is useful to consider multi-level factors: organizational-level factors (e.g. poor collegiality and workplace relationships); individual-level factors (e.g. life-cycle factors such as age/career stage); and structural-level factors (e.g. gender).

Kroppen som bärare av hälsa och lidande

The overall aim of this study is to seek new knowledge and deeper understanding of the body as a phenomenon from a caring science point of view. By means of a hermeneutic definition, the body is studied on a contextual as well as an ontological level in order to create a deeper understanding for human beings in relation to health and suffering. The study focuses of the body as a perspective of human beings. It is important for the knowledge growth in caring science to create a deeper understanding for the body, thus making it possible to understand patients in nursing care. The overall methodology is a hermeneutic definition which covers a contextual and an ontological concept definition. In the three empirical studies, Giorgi’s phenomenological method was used. The first empirical study comprises twelve students’ statements about experiences of their body in different situatons in life. The second study is composed of interviews with fifteen patients who had been afflicted by illness and been subjected to surgical treatment. In the third empirical study, ten patients who had been cared for in perioperative nursing care were interviewed. In the data analysis, the essential meaning of the body as a phenomenon is described, along with its variations and nuances. In the ontological determination of the body, an etymologic and semantic analysis is carried out, as well as a qualitative analysis of ideas, where the material is comprised of chosen texts on the body from different perspectives. In the concluding analysis the results were synthesized. The result of the first empirical study shows that a body is expressive and manifests movement in its striving for dignity. The body harbours language and inherent powers to cope with the unexpected, as well as feelings of anxiety, fear and powerlessness. The second study shows that the body is experienced as mysterious when it is afflicted by illness, but it is also found mysterious as an opponent to man and life. A battle is fought between the illness that breaks down the body, and human beings fighting to keep their unity whole. The body appears as a prison and a host for a threatening illness. The body bears a feeling of powerlessness when it is changed by illness and suffering. In a care and treatment context, the body is objectified by the patient and the caregiver. It is the illness that forces the patient to sacrifice parts of the body in order to once again become whole in the unity. The third study shows that the patient in a perioperative nursing context delivers him-/herself over to the hands of the caregiver, who defends and protects body and life. The patient experiences a sense of well-being when the caretaker receives him/her and protects the body from dangers. Suffering is alleviated when the patients are allowed to talk about what has happened in their body. The result of the semantic analysis shows that the body as a concept is described as bending around the human soul and spirit. Linguistically, dimensions like corporeal, shape, totality, unity and mortal clay, are described. Different ideas about the body described it as: a material animate part of man, active and demanding, something that perceives its surrounding world and as a subjective body of senses, thoughts and language. Ideas about the body also describe it as a biological and physiological, living organism, submitted to the laws of nature, a passive apparatus and a socially constructed gender. The results of the different studies were synthesized and reflected against a caring science perspective. The research has created a deeper understanding for the body as a material abode and as an entity of body, soul and spirit.

The nature experiences of wilderness recreation leaders : throwing a stone

Through this descriptive exploratory study, the ways that wilderness recreation leaders experience nature are illuminated, deconstructing the assumed environmental benefits of and practices used in outdoor recreation (Haluza-Delay, 2001). This study also offers a foundation for advancing an environmental ethic among wilderness recreation leaders, participants, and organizations. With the continued degradation of and threats to natural environments, and the rising popularity of outdoor recreation participation, the outdoor recreation professional can be a leader in promoting human reconnections to the Earth (Henderson, 1999). Leaders of outdoor recreation experiences play an important role in encouraging these revived relationships to natural settings and can contribute to the necessary environmental consciousness shift needed within Western society (Hanna, 1995; Jordan, 1996). The purpose of this research was to describe the lived-experience in nature of wilderness recreation leaders. Specifically, a phenomenological method of inquiry was used to describe the meaning of nature, the connections and relationships to nature, and the behaviours and emotions experienced in nature by a group of wilderness canoe trip leaders employed by a residential summer camp. In addition to the implications of this research, achieving this outcome provides a rich descriptive understanding of wilderness leaders' experiences—a basis from which to extend future research endeavours and programmatic practices that promote effective environmental outcomes of outdoor recreation participation. Each of the five study participants was employed in the summer of 2003 by an Ontario residential summer camp organization that sponsors extended wilderness river canoe trips for youth. Two in-depth and semi-structured interviews were performed with each participant, asking them to reflect on the canoe trip that they led for the summer camp organization during 2003. Phenomenological data was analyzed according to Colaizzi's (1978) thematic analysis process. Consistent with van Manen's (1997) emphasis on phenomenological writing, the final result presents the essence of the nature experiences of wilderness recreation leaders in the format of a narrative description. This narrative piece is the culmination of this research effort. Throughout the journey, however, various foundations within the outdoor recreation field, such as minimum impact principles, environmentally responsible behaviours, anthropocentric and ecocentric worldviews, and effective leadership are deconstructed and discussed.

Husserl's approach to transcendental intersubjectivity

It is our intention in the course of the development of this thesis to give an account of how intersubjectivity is "eidetically" constituted by means of the application of the phenomenological reduction to our experience in the context of the thought of Edmund Husserl; contrasted with various representative thinkers in what H. Spiegelberg refers to as "the wider scene" of phenomenology. That is to say, we intend to show those structures of both consciousness and the relation which man has to the world which present themselves as the generic conditions for the possibility of overcoming our "radical sol itude" in order that we may gain access to the mental 1 ife of an Other as other human subject. It is clear that in order for us to give expression to these accounts in a coherent manner, along with their relative merits, it will be necessary to develop the common features of any phenomenological theory of consdousness whatever. Therefore, our preliminary inquiry, subordinate to the larger theme, shall be into some of the epistemological results of the application of the phenomenological method used to develop a transcendental theory of consciousness. Inherent in this will be the deliniation of the exigency for making this an lIintentional ll theory. We will then be able to see how itis possible to overcome transcendentally the Other as an object merely given among other merely given objects, and further, how this other is constituted specifically as other ego. The problem of transcendental intersubjectivity and its constitution in experience can be viewed as one of the most compelling, if not the most polemical of issues in phenomenology. To be sure, right from the beginning we are forced to ask a number of questions regarding Husserl's responses to the problem within the context of the methodological genesis of the Cartesian Meditations, and The Crisis of European Sciences and Transcendental Phenomenology. This we do in order to set the stage for amplification. First, we ask, has Husserl lived up to his goal, in this connexion, of an apodictic result? We recall that in his Logos article of 1911 he adminished that previous philosophy does not have at its disposal a merely incomplete and, in particular instances, imperfect doctrinal system; it simply has none whatever. Each and every question is herein controverted, each position is a matter of individual conviction, of the interpretation given byaschool, of a "point of view". 1. Moreover in the same article he writes that his goal is a philosophical system of doctrine that, after the gigantic preparatory work. of generations, really be- . gins from the ground up with a foundation free from doubt and rises up like any skilful construction, wherein stone is set upon store, each as solid as the other, in accord with directive insights. 2. Reflecting upon the fact that he foresaw "preparatory work of generations", we perhaps should not expect that he would claim that his was the last word on the matter of intersubjectivity. Indeed, with 2. 'Edmund Husserl, lIPhilosophy as a Rigorous Science" in Phenomenology and theCrisis6fPhilosophy, trans". with an introduction by Quentin Lauer (New York.: Harper & Row, 1965) pp. 74 .. 5. 2Ibid . pp. 75 .. 6. 3. the relatively small amount of published material by Husserl on the subject we can assume that he himself was not entirely satisfied with his solution. The second question we have is that if the transcendental reduction is to yield the generic and apodictic structures of the relationship of consciousness to its various possible objects, how far can we extend this particular constitutive synthetic function to intersubjectivity where the objects must of necessity always remain delitescent? To be sure, the type of 'object' here to be considered is unlike any other which might appear in the perceptual field. What kind of indubitable evidence will convince us that the characteristic which we label "alter-ego" and which we attribute to an object which appears to resemble another body which we have never, and can never see the whole of (namely, our own bodies), is nothing more than a cleverly contrived automaton? What;s the nature of this peculiar intentional function which enables us to say "you think just as I do"? If phenomenology is to take such great pains to reduce the takenfor- granted, lived, everyday world to an immanent world of pure presentation, we must ask the mode of presentation for transcendent sub .. jectivities. And in the end, we must ask if Husserl's argument is not reducible to a case (however special) of reasoning by analogy, and if so, tf this type of reasoning is not so removed from that from whtch the analogy is made that it would render all transcendental intersubjective understandtng impos'sible? 2. HistoticalandEidetic Priority: The Necessity of Abstraction 4. The problem is not a simple one. What is being sought are the conditions for the poss ibili:ty of experi encing other subjects. More precisely, the question of the possibility of intersubjectivity is the question of the essence of intersubjectivity. What we are seeking is the absolute route from one solitude to another. Inherent in this programme is the ultimate discovery of the meaning of community. That this route needs be lIabstract" requires some explanation. It requires little explanation that we agree with Husserl in the aim of fixing the goal of philosophy on apodictic, unquestionable results. This means that we seek a philosophical approach which is, though, not necessarily free from assumptions, one which examines and makes explicit all assumptions in a thorough manner. It would be helpful at this point to distinguish between lIeidetic ll priority, and JlhistoricallJpriority in order to shed some light on the value, in this context, of an abstraction.3 It is true that intersubjectivity is mundanely an accomplished fact, there havi.ng been so many mi.llions of years for humans to beIt eve in the exi s tence of one another I s abili ty to think as they do. But what we seek is not to study how this proceeded historically, but 3Cf• Maurice Natanson;·TheJburne in 'Self, a Stud in Philoso h and Social Role (Santa Cruz, U. of California Press, 1970 . rather the logical, nay, "psychological" conditions under which this is possible at all. It is therefore irrelevant to the exigesis of this monograph whether or not anyone should shrug his shoulders and mumble IIwhy worry about it, it is always already engaged". By way of an explanation of the value of logical priority, we can find an analogy in the case of language. Certainly the language 5. in a spoken or written form predates the formulation of the appropriate grammar. However, this grammar has a logical priority insofar as it lays out the conditions from which that language exhibits coherence. The act of formulating the grammar is a case of abstraction. The abstraction towards the discovery of the conditions for the poss; bi 1 ity of any experiencing whatever, for which intersubjective experience is a definite case, manifests itself as a sort of "grammar". This "grammar" is like the basic grammar of a language in the sense that these "rulesil are the ~ priori conditions for the possibility of that experience. There is, we shall say, an "eidetic priority", or a generic condition which is the logical antecedent to the taken-forgranted object of experience. In the case of intersubjectivity we readily grant that one may mundanely be aware of fellow-men as fellowmen, but in order to discover how that awareness is possible it is necessary to abstract from the mundane, believed-in experience. This process of abstraction is the paramount issue; the first step, in the search for an apodictic basis for social relations. How then is this abstraction to be accomplished? What is the nature of an abstraction which would permit us an Archimedean point, absolutely grounded, from which we may proceed? The answer can be discovered in an examination of Descartes in the light of Husserl's criticism. 3. The Impulse for Scientific Philosophy. The Method to which it Gives Rise. 6. Foremost in our inquiry is the discovery of a method appropriate to the discovery of our grounding point. For the purposes of our investigations, i.e., that of attempting to give a phenomenological view of the problem of intersubjectivity, it would appear to be of cardinal importance to trace the attempt of philosophy predating Husserl, particularly in the philosophy of Descartes, at founding a truly IIscientific ll philosophy. Paramount in this connexion would be the impulse in the Modern period, as the result of more or less recent discoveries in the natural sciences, to found philosophy upon scientific and mathematical principles. This impulse was intended to culminate in an all-encompassing knowledge which might extend to every realm of possible thought, viz., the universal science ot IIMathexis Universalis ll •4 This was a central issue for Descartes, whose conception of a universal science would include all the possible sciences of man. This inclination towards a science upon which all other sciences might be based waS not to be belittled by Husserl, who would appropriate 4This term, according to Jacab Klein, was first used by Barocius, the translator of Proclus into Latin, to designate the highest mathematical discipline. . 7. it himself in hopes of establishing, for the very first time, philosophy as a "rigorous science". It bears emphasizing that this in fact was the drive for the hardening of the foundations of philosophy, the link between the philosophical projects of Husserl and those of the philosophers of the modern period. Indeed, Husserl owes Descartes quite a debt for indicating the starting place from which to attempt a radical, presupositionless, and therefore scientific philosophy, in order not to begin philosophy anew, but rather for the first time.5 The aim of philosophy for Husserl is the search for apodictic, radical certitude. However while he attempted to locate in experience the type of necessity which is found in mathematics, he wished this necessity to be a function of our life in the world, as opposed to the definition and postulation of an axiomatic method as might be found in the unexpurgated attempts to found philosophy in Descartes. Beyond the necessity which is involved in experiencing the world, Husserl was searching for the certainty of roots, of the conditi'ons which underl ie experience and render it pOssible. Descartes believed that hi~ MeditatiOns had uncovered an absolute ground for knowledge, one founded upon the ineluctable givenness of thinking which is present even when one doubts thinking. Husserl, in acknowledging this procedure is certainly Cartesian, but moves, despite this debt to Descartes, far beyond Cartesian philosophy i.n his phenomenology (and in many respects, closer to home). 5Cf. Husserl, Philosophy as a Rigorous Science, pp. 74ff. 8 But wherein lies this Cartesian jumping off point by which we may vivify our theme? Descartes, through inner reflection, saw that all of his convictions and beliefs about the world were coloured in one way or another by prejudice: ... at the end I feel constrained to reply that there is nothing in a all that I formerly believed to be true, of which I cannot in some measure doubt, and that not merely through want of thought or through levity, but for reasons which are very powerful and maturely considered; so that henceforth I ought not the less carefully to refrain from giving credence to these opinions than to that which is manifestly false, if I desire to arrive at any certainty (in the sciences). 6 Doubts arise regardless of the nature of belief - one can never completely believe what one believes. Therefore, in order to establish absolutely grounded knowledge, which may serve as the basis fora "universal Science", one must use a method by which one may purge oneself of all doubts and thereby gain some radically indubitable insight into knowledge. Such a method, gescartes found, was that, as indicated above by hi,s own words, of II radical doubt" which "forbids in advance any judgemental use of (previous convictions and) which forbids taking any position with regard to their val idi'ty. ,,7 This is the method of the "sceptical epoche ll , the method of doubting all which had heretofor 6Descartes,Meditations on First Philosophy, first Med., (Libera 1 Arts Press, New York, 1954) trans. by L. LaFl eur. pp. 10. 7Husserl ,CrisiS of Eliroeari SCiences and Trariscendental Phenomenology, (Northwestern U. Press, Evanston, 1 7 ,p. 76. 9. been considered as belonging to the world, including the world itself. What then is left over? Via the process of a thorough and all-inclusive doubting, Descartes discovers that the ego which performs the epoche, or "reduction", is excluded from these things which can be doubted, and, in principle provides something which is beyond doubt. Consequently this ego provides an absolute and apodictic starting point for founding scientific philosophy. By way of this abstention. of bel ief, Desca'rtes managed to reduce the worl d of everyday 1 ife as bel ieved in, to mere 'phenomena', components of the rescogitans:. Thus:, having discovered his Archimedean point, the existence of the ego without question, he proceeds to deduce the 'rest' of the world with the aid of innate ideas and the veracity of God. In both Husserl and Descartes the compelling problem is that of establ ishing a scientific, apodictic phi'losophy based upon presuppos itionless groundwork .. Husserl, in thi.s regard, levels the charge at Descartes that the engagement of his method was not complete, such that hi.S: starting place was not indeed presupositionless, and that the validity of both causality and deductive methods were not called into question i.'n the performance of theepoche. In this way it is easy for an absolute evidence to make sure of the ego as: a first, "absolute, indubitablyexisting tag~end of the worldll , and it is then only a matter of inferring the absolute subs.tance and the other substances which belon.g to the world, along with my own mental substance, using a logically val i d deductive procedure. 8 8Husserl, E.;' Cartesian 'Meditation;, trans. Dorion Cairns (Martinus Nijhoff, The Hague, 1970), p. 24 ff.

La signification de l’expérience d’« être avec » la personne soignée et sa contribution à la réadaptation : la perception d’infirmières

De multiples auteurs de la discipline infirmière réclament la valeur inestimable de la relation de caring et de ses bienfaits pour la clientèle nécessitant des soins et services de réadaptation. En dépit de cette importance, la recherche concernant les bienfaits thérapeutiques de la relation de caring pour la clientèle de réadaptation demeure encore un domaine peu exploité. Actuellement, aucune étude scientifique québécoise, canadienne ou internationale, issue de la discipline infirmière, ne porte sur la compréhension de l’expérience d’« être avec » la personne soignée dans un contexte de réadaptation, aspect qui s’avère central à la relation de caring selon Watson. Au cœur même de la philosophie du Human Caring de Watson, la présente étude vise à explorer, par des entrevues qualitatives auprès de 17 infirmières oeuvrant en contexte de réadaptation, la signification de l’expérience d « être avec » la personne soignée, de même que leur perception de la contribution de cette expérience à la réadaptation de la personne soignée. Cinquante et une entrevues, c’est-à-dire trois entrevues réalisées pour chaque participant de recherche, ont été analysées à l’aide de la méthode phénoménologique intitulée « Relational Caring Inquiry » développée par Cara (1997). Le processus de recrutement des participants a impliqué la direction des soins infirmiers des deux centres de réadaptation ciblés par l’étude. Une attention particulière a été mise afin de favoriser une diversité de participants (par exemple : genre, niveau éducationnel, quart de travail, unité de soins). Le processus d’analyse des données a permis la découverte de cinq eidos-thèmes. Parmi ces eidos-thèmes, quatre se rapportent à la signification de l’expérience d’«être avec» la personne soignée (première question de recherche), à savoir : (a) l’importance des valeurs humanistes au centre du soin, (b) l’investissement de l’infirmière et de la personne soignée, (c) les dimensions réciproque et relationnelle du soin et, finalement, (d) l’expérience de soin irremplaçable d’une complexité contextuelle. De façon plus détaillée, le premier eidos-thème dévoile les fondements humanistes à la base de l’expérience d’« être avec » la personne soignée. Le deuxième manifeste l’implication substantielle de l’infirmière et de la personne soignée. Le troisième eidos-thème met en lumière la réciprocité et la dimension relationnelle comme étant des éléments centraux à l’expérience d’« être avec » la personne soignée. Le quatrième eidos-thème documente les natures fondamentale et complexe de cette expérience de soin unique, de même que les conditions contextuelles qui la facilitent et la contraignent. Le cinquième et dernier eidos-thème ayant émergé de la présente étude, « rehaussement de l’harmonie corps-âme-esprit chez la personne soignée et l’infirmière », illustre la perception des participantes quant à la contribution thérapeutique de l’expérience d’« être avec » la personne soignée à la réadaptation de cette dernière (deuxième question de recherche). Cette contribution se situe en termes de répondre aux besoins du patient, d’optimiser les progrès de réadaptation de la personne soignée, de promouvoir le niveau de bien-être de la personne soignée et de l’infirmière et, finalement, de hausser la croissance intérieure des personnes engagées dans cette expérience de soin extraordinaire. La reconnaissance des cinq eidos-thèmes a favorisé l’émergence de l’essence universelle du phénomène à l’étude qui s’intitule « la rencontre humaine profonde, thérapeutique et transformatrice ». La présente étude contribue de façon novatrice au développement des connaissances, notamment en permettant une meilleure compréhension de ce que signifie l’expérience d’« être avec » la personne soignée, pour des infirmières en réadaptation et en proposant une multitude de résultats probants pouvant servir de guide à la promulgation de soins infirmiers en contexte de réadaptation. En déterminant la signification ontologique de cette expérience de soin, la présente étude permet de préciser la place du phénomène d’« être avec » la personne soignée au centre de la théorie du caring. Ces résultats qui découlent de la deuxième question de recherche participent au développement initial d’un corpus de connaissances. Ces résultats probants serviront de guide au renouvellement de la pratique infirmière en contexte de réadaptation. De plus, en identifiant les bienfaits de cette expérience de soin, la présente étude reconnaît l’élément au cœur de la relation transpersonnelle de caring, qui contribue à rehausser l’harmonie corps-âme-esprit chez la personne soignée et l’infirmière. En plus de la clinique, des recommandations au niveau de la formation et de la recherche en sciences infirmières découlent de la présente étude.

Signification de l’expérience de la phase palliative du cancer, pour des personnes atteintes et leurs familles des Baléares, alors que le pronostic leur est connu

Le cancer est considéré comme l’une des principales causes de morbidité et de mortalité et, en Espagne, représente à lui seul 25% du taux de mortalité globale. Lorsqu’une personne et sa famille font l’expérience de traverser la phase avancée du cancer, celles-ci vivent un grand choc émotionnel où les souffrances physique, psychique et spirituelle peuvent être présentes. L’information donnée par les professionnels de la santé aux membres de la famille, incluant la personne atteinte, en ce qui concerne le diagnostic et le pronostic du cancer est maintenant plus fréquente dans le contexte méditerranéen. Il n'est pas clair, toutefois, comment cette nouvelle approche est vécue par les familles. C’est pourquoi, le but de cette recherche qualitative de type phénoménologique est d’explorer la signification de l’expérience de familles dont l’un des membres est atteint d’un cancer terminal, alors que tous connaissent le pronostic de la maladie. Les résultats obtenus reposent sur l’analyse en profondeur d’entrevues réalisées auprès de quatre couples. L’analyse des données, à l’aide de la méthode phénoménologique de Giorgi (1997), fait émerger deux thèmes centraux caractérisant la signification de cette expérience de la phase palliative de cancer, alors que l’information sur le mauvais pronostic est connue tant par la personne atteinte que sa famille. Le premier thème central est celui de vivre intensément la perte de la vie rêvée et comporte le vécu suite au choc du pronostic fatal, le fait de vivre constamment des sentiments et des émotions liés à différentes pertes telles que la tristesse, la frustration, l’inquiétude et l’incertitude, et l’espoir de ne pas souffrir. Le deuxième thème central qui ressort est le développement de stratégies par les couples participants afin de rendre leur vie plus supportable. Ces stratégies sont les suivantes : accueillir l’information et le soutien professionnel, retrouver une certaine normalité dans la vie quotidienne, profiter de la vie, recevoir l’aide de la famille et des amis, maintenir une communication cognitive et instrumentale ouverte, se protéger au niveau émotionnel et envisager l’avenir sans la personne aimée. Tous ces éléments, dans le contexte individuel de vie de chaque famille transforment chacun de ces vécus en une expérience unique qui doit être comprise et respectée comme telle par tous les professionnels de la santé impliqués. Les connaissances développées par cette recherche permettront aux infirmières de mieux comprendre l’expérience de la phase palliative du cancer pour des couples dont le diagnostic et le pronostic fatal sont connus par tous, ceci afin d’améliorer leur qualité des soins. Afin de poursuivre le développement du savoir infirmier, il est recommandé de poursuivre des études afin d’explorer plus en profondeur la communication au sein des couples.

L’expérience de dispenser des soins palliatifs à domicile pour des infirmières travaillant dans un contexte non spécialisé

Depuis plusieurs années, la définition des soins palliatifs a été élargie pour inclure toutes les maladies ayant un pronostic réservé. Le Québec s’est doté d’une politique de soins palliatifs dont l’un des principes directeurs est de maintenir les patients dans leur milieu de vie naturel. Alors que présentement environ 10 % de la population nécessitant des soins palliatifs en reçoit, on peut s’attendre à une augmentation des demandes de soins palliatifs à domicile dans les CSSS du Québec. La présente étude a pour but de décrire et comprendre l’expérience de dispenser des soins palliatifs à domicile pour des infirmières travaillant dans un contexte non spécialisé. Une étude qualitative ayant comme perspective disciplinaire la théorie de l’humain-en-devenir de Parse a été réalisée. Des entrevues ont été effectuées auprès de huit infirmières travaillant au maintien à domicile d’un CSSS de la région de Montréal qui font des soins palliatifs dans un contexte non spécialisé. L’analyse des données a été effectuée selon la méthode d’analyse phénoménologique de Giorgi (1997). Les résultats s’articulent autour de trois thèmes qui décrivent l’expérience de dispenser des soins palliatifs à domicile pour des infirmières qui travaillent dans un contexte non spécialisé. Elles accompagnent les patients et leur famille, en s’engageant à donner des soins humains, et développant une relation d’accompagnement avec le patient et ses proches. Elles doivent composer avec les réactions du patient et de sa famille et doivent parfois informer le patient de la progression de son état de santé. De plus, elles se préoccupent de donner des soins de qualité en composant avec la complexité des soins palliatifs à domicile tout en s’assurant de soulager les symptômes des patients et de tenter de développer leur expertise. Finalement, le fait d’être confrontée à la mort permet de cheminer. Ainsi, les infirmières vivent des émotions, reçoivent du soutien, sont touchées personnellement par la mort, éprouvent de la satisfaction envers les soins qu’elles donnent et apprennent personnellement de leur expérience. L’essence du phénomène à l’étude est que lorsque les infirmières font un véritable accompagnement du patient et de sa famille en s’efforçant de donner des soins de qualité, cela crée des conditions permettant qu’un cheminement personnel et professionnel sur la vie et la mort soit effectué par les infirmières.

L'expérience du dévoilement telle que perçue par des femmes vivant avec le VIH nées au Québec

Le dévoilement de sa séropositivité représente une préoccupation quotidienne des femmes vivant avec le VIH, complexifié par la stigmatisation. L'état des connaissances demeure très fragmenté : les études révèlent des patterns (à qui les femmes dévoilent et à quelle fréquence), les raisons pour dévoiler ou non, les conséquences positives et négatives ainsi que les facteurs liés au dévoilement, limitant une compréhension globale du phénomène. Inspirée de la toile de fond de Parse (1998, 2003), cette présente étude visait à décrire et à mieux comprendre l'expérience du dévoilement, telle que perçue par des femmes vivant avec le VIH nées au Québec. La méthode phénoménologique a été privilégiée afin de recueillir des données auprès de sept participantes, par la tenue d’une entrevue semi structurée. L’analyse des données a reposé sur deux activités de recherche proposées par van Manen (1997), soit la réflexion et l’écriture, permettant d’identifier les sept thèmes suivants : 1) Se respecter tout en considérant les confidents ; 2) Ressentir l’appréhension; 3) Exercer un contrôle pour assurer une protection; 4) S’engager délibérément dans une démarche de révélation-dissimulation; 5) S’exposer au contexte social stigmatisant empreint d’exclusion; 6) Souffrir intérieurement; 7) Bénéficier des retombées positives de sa décision. Ces thèmes ont contribué à la formulation de l’essence du phénomène étudié soit : vivre l’ambivalence d’une démarche paradoxale de révélation-dissimulation, au cœur d’une souffrance profonde intensifiée par la stigmatisation, tout en s’enrichissant des bienfaits recueillis. Il est permis de croire que ces résultats puissent avoir des retombées positives pour guider la pratique infirmière autour du soutien aux femmes dans leur expérience de dévoilement.

L'expérience de sclérodermie systémique et de santé-dans-la-maladie pour des adultes : une étude phénoménologique existentielle herméneutique

Dans la perspective de faire disparaître la dichotomie existant entre la santé et la maladie, le concept « santé-dans-la-maladie » (health-within-illness) est apparu dans les écrits infirmiers pour étudier la santé chez les personnes vivant avec une maladie chronique. Or, la recherche sur ce phénomène s’est surtout centrée sur l’expérience de santé (wellness) occultant celle de la maladie (illness). À l’heure actuelle, peu d’études ont été réalisées pour comprendre la coexistence de l’expérience de santé (wellness) et celle de maladie (illness) impliquée dans la réalité quotidienne des personnes vivant avec une maladie chronique. De plus, aucune d’entre elles ne s’est adressée à une clientèle vivant avec la sclérodermie systémique. Ainsi, cette étude avait pour but de décrire et de comprendre l’expérience de la sclérodermie systémique et celle de santé-dans-la-maladie dans le contexte d’adultes vivant avec cette maladie chronique. La perspective disciplinaire de la chercheure, en l’occurrence la philosophie du caring humain de Watson (1979, 1988, 1999, 2006, 2008), a soutenu le processus de recherche. En cohérence avec cette auteure, la méthode qualitative de type phénoménologique existentielle herméneutique élaborée par van Manen (1984, 1997, 2002) a été choisie pour encadrer ce processus. La collecte des données repose principalement sur l’expérience d’adultes québécois vivant avec la sclérodermie systémique, recueillie au moyen de 34 entretiens en profondeur réalisés auprès de 17 participants (14 femmes et trois hommes). Les résultats ont permis d’identifier quatre thèmes pour décrire d’une part, l’essence de l’expérience de la sclérodermie systémique, soit : (a) la souffrance interminable d’un corps malade; (b) la dysharmonie intérieure et relationnelle du soi; (c) le processus d’accommodation et (d) l’heuristique d’accommodation. D’autre part, les deux thèmes suivants ont émergé pour exposer l’essence de l’expérience de santé-dans-la-maladie: (a) la prise de pouvoir d’un nouveau soi et (b) l’harmonie avec l’existence. Un travail de mise en relation de ces deux essences a été effectué afin de développer une conceptualisation de l’expérience de santé-dans-la-maladie dans le contexte d’adultes québécois vivant avec la sclérodermie systémique. Ainsi, elle se conçoit comme « une dialectique dans laquelle le nouveau soi mobilise son pouvoir pour vivre en harmonie avec l’existence et pour s’accommoder à la souffrance interminable, où une dysharmonie intérieure et relationnelle est vécue dans le corps malade ». Les résultats de cette étude permettent de mieux comprendre la souffrance vécue par les personnes ayant la sclérodermie systémique de même que le processus et les stratégies d’accommodation à cette souffrance. Ils mettent également en évidence les moyens utilisés pour exercer un nouveau pouvoir sur leur vie et pour vivre en harmonie dans tous les aspects de leur existence. Enfin, la dialectique de santé-dans-la-maladie proposée dans cette étude souligne le caractère dynamique, continu et subjectif du processus d’intégration impliquant les expériences indissociables de la santé (wellness) et de la maladie (illness). Cette nouvelle conceptualisation de l’expérience de santé-dans-la-maladie, pouvant contribuer au renouvellement des pratiques de soins, suggère également une manière inédite d’exister lorsque la maladie chronique survient, soit celle d’ « être ni en santé, ni malade ».

L'expérience de femmes atteintes de sclérodermie et vivant avec une limitation fonctionnelle : une étude phénoménologique.

La sclérodermie est une maladie méconnue par la population en général et également par les professionnels de la santé. La méconnaissance est reliée en partie à l’aspect que la sclérodermie est une maladie rare et reçoit peu d’intérêt de la part des chercheurs, des organismes subventionnaires et des compagnies pharmaceutiques. Ainsi, à l’heure actuelle, peu d’études ont été réalisées pour comprendre la signification de l’expérience de femmes atteintes de sclérodermie et vivant avec une limitation fonctionnelle. La présente étude avait pour but de décrire et comprendre la signification de l’expérience de femmes atteintes de sclérodermie avec une limitation fonctionnelle. L’étudiante-chercheuse a utilisé la perspective infirmière de Watson, la philosophie du caring humain (1988, 1999, 2005, 2006a, 2008). La méthode qualitative de type phénoménologique de Giorgi (1997) a été choisie pour analyser les entrevues. Six femmes ont accepté de participer en partageant leur expérience lors d’un entretien individuel. L’analyse des données a fait émerger trois thèmes, soit : Urgence de vouloir vivre, Déclin de l’autonomie comme source de souffrance et Réappropriation continue du soi. Les résultats permettent de mieux comprendre l’expérience de femmes atteintes de sclérodermie et vivant avec une limitation fonctionnelle. L’incertitude de l’évolution de la sclérodermie dans la vie de ces femmes contribue grandement à l’urgence de vouloir vivre normalement avant qu’il ne soit trop tard. Les résultats évoquent les stratégies adaptatives qu’elles choisissent pour y parvenir, tout en vivant des moments de détresse accompagnés d’espoir. Cette détresse psychologique et émotionnelle est teintée par les conséquences limitantes liées aux symptômes et à l’atteinte à l’image corporelle. Au quotidien, ces femmes se réapproprient un soi qui se renouvèle avec l’évolution de la maladie, la sclérodermie.