Caritas--caring as an ethical conduct.

The aim of this theoretical study is to describe and analyze caritas by seeking the primary source for this phenomenon, which is used as a central motive in Eriksson's Caritative Theory. The search for the origin and the essence of caritas by critical analysis will create an opportunity to assimilate new meaning into the practice of caring science. This new meaning, based on interpretation, will also act as a solid base for the creation of future theories within caring science. Although this study does not intend to create a new theory for this domain, an attempt is made to shed light on new understandings to establish a deeper foundation for further discussion. Therefore, the methodological basis used is the hermeneutics phenomenology described by Nygren. The starting points refer to three basic assumptions, the former two of which present the core of caring science as an academic discipline; the latter borrows from philosophical creation theology. Therefore, the path for analyzing caritas and the significance of developing a deeper and meaningful understanding are based on the writing of Eriksson as well as through historical and philosophical sources from Judaism, such as the Bible and the Talmud. The results of this study have introduced a new meaning and created a 'space' for caritas. These results are related to the notion of attitudes, being driven by curiosity and questioning, that link faith and scientific investigation. Above all, these attitudes form a central motive profoundly linked to love. Hence, caritas as an attitude turns the concept of care into a more ethical act. However, these new understandings have given rise to ethical questions that obligate consideration towards further study.

Drama as a new rehabilitation possibility for women afflicted with breast cancer.

The aim of this qualitative longitudinal study was to evaluate drama as a method within the rehabilitation of women afflicted with breast cancer. By purposeful sampling, 11 of a total of 20 women participated in the study and were interviewed 3 times over 9 months. The interviews were transcribed. The data analysis was an inductive latent content analysis. The results show that the women felt that their lives were out of balance before the drama exercises; the female and physical dimension was emphasized. During the drama exercises, it became apparent that breast cancer was a unifying factor; the women were able to share difficult experiences with each other. After the drama group, it appeared that the women's joy of living had returned, as well as better self-confidence, inner peace, and feelings of good health. During group meetings, the women experienced drama, support, and solidarity within a closed group. Important events in their lives were revealed, and the women were given an opportunity to confront their hidden thoughts and feelings and to express them. All the women felt support and solidarity within the group as well as a personal development. Drama can be seen as a suitable rehabilitation method for women with breast cancer.

Virtue and health--finding meaning and joy in working life.

The perspective of this investigation is the humanistic caring tradition of caring science where caritas motive, i.e. charity and love, constitutes the basic motive and suffering the basic category of caring, i.e. Eriksson's theory of caritative caring. The concept of virtue is used in accordance with Aristotle's theory of virtue and fragments of theory are added to the study from Arendt. The aim of the study was to investigate the meaning of virtues for worker's health and to develop a theoretical model of the inner health domains. The investigation comprises an empirical study using focus-group interviews for the collection of data. The participants were 16 employees, in four focus groups, in the wood-processing industry. The study was conducted from September 1999 to January 2000. Hermeneutical interpretation has been used in the search for a deeper understanding of the connection between virtue and health in working life. Abduction is the conclusion method, which is used in this study. The result is presented at four levels of interpretation and the final findings constitutes four theses which comprise the virtues of pride, generosity, love and honesty as important in working life and a theoretical model comprising three dimensions: the innermost dimension, the middle dimension and the outer dimension. These dimensions reflect health as becoming. By means of virtues it is possible to find the way to the inner domains of health. Pride as a virtue and how it is heeded at work, is decisive in determining whether health becomes discernable in working life and the value, i.e. found in pride is decisive when it comes to the employee's conception of the meaning of work. The study shows that the connection between health and virtue is important to recognize. This approach points out underlying values that effects worker's health.

The role of significant others in the care of women with breast cancer.

This study seeks to gain knowledge of how significant others experience the nursing care of women with breast cancer and what their own caring needs might be. The overall research design is a clinical application research within the hermeneutic tradition. Thirty-seven significant others have contributed their own narratives about the care on the basis of open, structured questions. The narratives have been submitted to an analysis of contents. The result shows that significant others have no given place in nursing care. Their place in nursing care is to look on, be present or be ignored. No matter what their place is, the significant others feel a need for caring conversations and information in an ethical manner. The faith and trust of significant others, the sharing, sense of communion and the information about woman's illness strengthen the significant others' own vitality. Their inmost desire concerns the sensitiveness of caregivers with regard to the woman's as well as the significant others' personal needs. If space is allowed and this desire meets with response, significant others can constitute a source of strength in the care of the woman suffering from breast cancer.

Clinical application research: a hermeneutical approach to the appropriation of caring science.

Clinical caring science researchers contribute, by means of various participatory research efforts, to bring clinical practice closer to the ideals of caring. These research efforts have in the main been developed from classical action research rooted in critical theory. In this article, the authors launch an alternative research approach called clinical application research, the basis of which can be traced to the interpretative paradigm, or hermeneutics. The basic cornerstones of this research approach are ontology, context, and appropriation as well as understanding, interpretation, and application. Using an example from ongoing clinical research, the authors demonstrate the utility of this approach. Their aim in this article is to contribute to the development of methods within clinical research.

Suffering related to health care: a study of breast cancer patients' experiences.

A previous study indicated that patient narratives include experiences of suffering caused or increased by health-care encounters. The aim of this study was to interpret and understand the meaning of patients' experiences of suffering related to health care from an ethical, existential and ontological standpoint. Sixteen women with breast cancer in Sweden and Finland took part in qualitative interviews analysed with a hermeneutic, interpretive approach. The outcome showed that suffering related to health care is a complex phenomenon and constitutes an ethical challenge to health-care personnel. The women's experiences of suffering related to health care tended to be of similar seriousness as their experiences of suffering in relation to having cancer. In an ethical, existential and ontological sense, suffering related to health care is basically a matter of neglect and uncaring where the patient's existential suffering is not seen and she is not viewed as a whole human being.

Significant others' experience of suffering when living with women with breast cancer.

This is an inquiry into how significant others experience being close to a woman suffering from breast cancer. In order to find this out, theme interviews were arranged with 17 women and 16 significant others from four different caring cultures in Sweden and Finland. A phenomenological case study methodology was adopted and in the analysis of the data a scientific teamwork model was employed, based on ideas developed at the Vancouver School of Doing Phenomenology. The findings show that the significant others experience deep often unrelieved suffering. They consider themselves prisoners of a situation of uncertainty and powerlessness when standing by the woman. They are torn between their own suffering and their desire to alleviate the woman's suffering. A vicious circle of mutual protection intensifies the suffering of the significant other, while actively sharing the suffering brings relief. The gravity of the situation creates an ethical urge in the significant other to assume responsibility for life in common with the woman.

Grasping the essence of the spiritual dimension reflected through the horizon of suffering: an interpretative research synthesis.

The purpose of this research synthesis was to describe the essence of the spiritual dimension reflected through the horizon of suffering. The material reviewed consisted of 18 articles published between 1989 and 2000 in caring and nursing journals. A depth in the interpretation of the texts was discovered where four different themes emerged: undemanding communion, confirmation of dignity, the dialectic of suffering, and the creation of coherence of meaning.

Hermeneutics and narration: a way to deal with qualitative data.

Hermeneutics and narration: a way to deal with qualitative data This article focuses a hermeneutic approach on the interpretation of narratives. It is based on the French philosopher Paul Ricoeur's theory of interpretation but modified and used within a caring science paradigm. The article begins with a presentation of the theoretical underpinnings of hermeneutic philosophy and narration, as well as Ricoeur's theory of interpretation, before going on to describe the interpretation process as modified by the authors. The interpretation process, which consists of several stages, is exemplified and discussed using a single case from a larger study on suffering. The results of that study indicate that the struggle of suffering is perceived as a struggle formed between shame and dignity, and that nurses must engage in the process of preserving and restoring the dignity of their suffering patients. The authors suggest that Ricoeur's theory of interpretation is useful when trying to understand narrative data if the researcher realises that the process of distanciation, although central in Ricoeur's thinking, is not the goal of the process but rather a means to deal with the researcher's pre-understandings. According to Ricoeur, distanciation is accomplished by putting the context aside and dealing with the text 'as text' and thereby explaining its meaning. Explanation thus becomes the dialectic counterpart to understanding in the interpretation process. The researchers further argue that distanciation must be followed by reflection, where the interpretations are linked back to the empirical context.

The face of suffering among women with breast cancer-being in a field of forces.

Through qualitative interviews, the suffering experiences of women with breast cancer and their significant others were disclosed. Seventeen women with different stages of breast cancer and 16 significant others from 4 different care cultures in Sweden and Finland participated. Five of the women had advanced metastatic breast cancer, and 12 had a localized disease. Mean age was 48 years. As a methodology, a team approach, inspired by the Vancouver School of Doing Phenomenology, was used. The findings elucidate how the suffering experience touched the women's inner existence and values. This can metaphorically be described as a "field of force" and affected everything in the women's lives, including their views of themselves and their relationships. Existential questions were raised about life and death and the meaning of life. In their suffering, the women's dependency upon significant others, as well as healthcare personnel, was prominent. Suffering related to healthcare was a strong theme. Different faces of suffering related to breast cancer may still be unknown by healthcare professionals working in cancer care.