An analysis of time conceptualisations and good care in an acute hospital setting.

This study articulates the relationship between conceptualisations of time and the accounts of good care in an acute setting. Neoliberal healthcare services, with their focus on efficiencies, predominantly calculate quality care based on time-on-the-clock workforce management planning systems. However, the ways staff conceptualise and then relate to diverse meanings of time have implications for good care and for staff morale. This phenomenological study was undertaken in acute medical-surgical wards, investigating the contextual, temporal nature of care embedded in human relations. The study interviews involved 17 participants: 11 staff, 3 previous patients and 3 family members. Data were analysed iteratively to surface the phenomenality of temporality and good care. The following constituents of the data set are explored that together illustrate the relationship between the conceptualisations of time and the accounts of good care in an acute setting: patient time as a relational journey; patient time, sovereign time and time ethics and time, teamwork and flow. The findings are clinically significant because they offer a contrasting narrative about the relationship between time and care quality. The experiences of giving and receiving good care are indivisible from how temporality is experienced and the social relations within which care is embedded. Healthcare staff experience temporality differently from patients and families, a point that healthcare participants in this study appeared to comprehend and accommodate. For all parties involved in providing care or being the recipient of care, however, the capacity to be present was valued as a humanising ethic of care. Our study reinforces the importance of not creating presumptive binaries about which temporal structures are more or less humanising-there is a place for a fast-paced tempo, which can be experienced as being in the flow of human relations with one's team and on behalf of patients.

A Heideggerian analysis of good care in an acute hospital setting: Insights from healthcare workers, patients and families.

This study articulates the relational constituents of good care beyond techno-rational competence. Neoliberal healthcare means that notions of care are readily commodified and reduced to quantifiable assessments and checklists. This novel research investigated accounts of good care provided by nursing, medical, allied and auxiliary staff. The Heideggerian phenomenological study was undertaken in acute medical-surgical wards, investigating the contextual, communicative nature of care. The study involved interviews with 17 participants: 3 previous patients, 3 family members and 11 staff. Data were analysed iteratively, dwelling with stories and writing and rewriting to surface the phenomenality of good care. The data set highlighted the following essential constituents: authentic care: caring encompassing solicitude (fürsorge); impromptu care: caring beyond role category; sustained care: caring beyond specialist parameters; attuned care: caring encompassing family and culture; and insightful care: caring beyond assessment and diagnosis. The findings are clinically significant because they indicate the importance of nurse leaders and educators harnessing the potential capacity of all healthcare workers to participate in good care. Healthcare workers reported that participating in or witnessing good care was uplifting and added meaning to their work, contributing to a sense of shared humanity.

Challenges to the provision of clinical education in nursing.

Objective: To outline and discuss the challenges inherent in providing clinical education for undergraduate nursing students.Design: Discussion paper.Discussion: The primary goal of undergraduate nursing education is the preparation of graduates able to function as newly registered nurses in acute hospital, primary care, continuing care and mental health settings. Clinical practice is a critical yet complex and challenging component of students' professional development.Conclusions: It is argued that different models for clinical learning are appropriate for different contexts and stages of student development. Nursing needs, however, to be fully cognisant of the importance of collaborative development underpinned by adequate funding and to be aware of the often invisible impacts of neoliberal policies and priorities on health and education.

Confidence: Fundamental to midwives providing labour care in freestanding midwifery-led units.

The aim of this study was to reveal what enables, safeguards and sustains midwives to provide labour care in freestanding midwifery-led units. DESIGN: A hermeneutic phenomenological study was undertaken in the Auckland region of New Zealand. In-depth interviews were conducted with 14 participants: 11 midwives who provide care in freestanding midwifery-led units and three obstetricians who provide antenatal consultations on site in midwifery-led units. MAIN FINDINGS: Confidence is necessary to provide intrapartum care in freestanding midwifery units. This confidence is cultivated by working in the community or freestanding unit and believing this unit is an appropriate space for healthy women to labour and birth. Normal labour and birth are commonplace in this space which in turn reinforces midwives' confidence. Maintaining confidence for midwives to work in these units requires trusting relationships in the midwifery team. Further, there needs to be mutually respectful relationships with obstetric colleagues. Midwives who have lesser experience, or experience in obstetric unit only, may need support to step into the role of providing labour care in freestanding midwifery units. When the midwife feels supported, when s/he witnesses women and families experiencing their normal birth, one's resolve to practising in this manner is strengthened. The midwife holds confidence. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Confidence required to provide labour care in a midwifery-led unit is cultivated through immersion in these units.

Working in the dark: a hermeneutic inquiry into health professionals' stories of ketamine sedation with children.

BACKGROUND: Physiological risks of ketamine have been well researched, yet for health professionals (HPs) undertaking paediatric ketamine sedation, questions of benefit and harm remain. RESEARCH QUESTION: What are health care professionals' experiences of undertaking ketamine sedation with children? METHODOLOGY: Hermeneutic narrative. METHODS: The study comprised hermeneutic narrative analysis of stories from seven HPs in nursing, medicine, paramedicine, and play therapy. FINDINGS: The theme, "seeking to control and protect" reveals the chaotic nature of paediatric emergency work and how ketamine can deliver control. The second theme "working in the dark" acknowledges that HPs try to balance perceived benefit and harm, adopting "dream-seeding" in an attempt to mitigate potentially negative psychotropic events. CONCLUSION: The study recommends further research into children's experiences of ketamine sedation and the use of dream-seeding to mitigate negative emergence phenomena. It also recommends education for clinicians to increase awareness of the potential for non-physiological risk and harm.

Supervising for Robust Hermeneutic Phenomenology: Reflexive Engagement Within Horizons of Understanding.

Undertaking philosophically hermeneutic research requires embodying the fundamental hermeneutic notions espoused by Heidegger, Gadamer, and other related philosophers. For both supervisors and students, there is "a way" of working that infuses a hermeneutic project with a particular kind of contemplative openness. In this article, I will draw from my own experience of coming to appreciate the nature of this approach. Reading Gadamer challenged me to see that, before interpreting the meanings inherent in research data, I first needed to grapple with the fact that I brought ready-made prejudices to the interpretation. Further, and perhaps more importantly, was the recognition that while prejudices may have a negative influence, they could also bring a positive view. Just as I needed to understand key Gadamerian notions to shed light on the interpretive nature of philosophical hermeneutics, I will unpack these to underpin the ongoing discussion of hermeneutic research strategies. In articulating "how" to be hermeneutic, I explain how I guide students embarking on hermeneutic research. Discussion centres on surfacing and engaging with preunderstandings through 'presuppositions interviewing', journalling and the careful selection of words that refine and crystallise meanings in ways that reflectively and reflexively engage and expand horizons of understanding. In this article, I use examples from my own experience as a doctoral student and supervisor of doctoral students to assist other supervisors and students understand both the importance of "being hermeneutic" and ways of achieving robust and philosophically congruent hermeneutic research.

Preparing registered nurses depends on "us and us and all of us".

The primary goal of undergraduate nursing education is the preparation of graduates able to function as competent beginning clinicians. Avariety of academic-service partnerships are being used to support the clinical preparation of undergraduate nurses but, in today's demanding and fiscally challenged health and education environments, debate continues about how bestto provide students with quality learning in the clinical setting. This article reports the qualitative findings of a collaborative study undertaken to monitor implementation of a new model of clinical education for undergraduate nursing students. Three partners: a District Health Board (DHB) and two universities have developed, and are refining, a clinical education model based on the inclusion of student nurses in team nursing. In response to the question "How well is the student integration model working?" the qualitative findings, from a DHB and university staff perspective, suggest that students are better integrated within the nursing team. Registered nurses from academic and clinical backgrounds are sharing reponsibility for students' learning but there is a clear need to further develop relationships, skills and processes in order to maximise the student development. The survey results, which include the student perspective, have and are being reported separately.

Rebuilding the foundations: major renovations to the mental health component of an undergraduate nursing curriculum.

Concerns relating to the adequacy of nurses' preparation for the care of people with mental illness prompted significant revision of the mental health component in a Bachelor of Health Science nursing programme in New Zealand that prepares approximately 200 students per year. Working collaboratively with clinical providers, university staff developed and introduced three courses (equivalent to 450 hours of learning) specifically focused on mental health science, inpatient practice, and primary community mental health practice. This paper provides an overview of the new courses and reports the findings of an appreciative inquiry evaluation of this curriculum innovation.

Feeling like a nurse: re-calling the spirit of nursing.

PURPOSE: To explore the essential meaning of being a nurse. DESIGN: Nine registered nurses were each asked to write a story of a time when they felt like a nurse. Analysis was informed by Heideggerian hermeneutic philosophy, seeking to reveal the phenomenon of "feeling like a nurse." METHODS: As part of a workshop on phenomenological methodology, participants were invited to reflect on a personal experience of feeling like a nurse. These documents were analyzed according to the method of van Manen. Participants were kept informed throughout each phase. FINDINGS: Feelings announce primordial meaning of feeling like a nurse. Nurses experience the call as mood attuned by an anxiety that creates possibilities for authentic caring. It is a way of being that encompasses watching and acting, doing to and caring for, and taking over and giving back. Moreover, it is after the encounter that the essential meaning is more clearly revealed. We argue that there is value in continuing to question the meaning of "being a nurse." Amid a complex and increasingly technological world, this calls the profession to remember the human encounter at the heart of all nursing.

Doing Heideggerian hermeneutic research: a discussion paper.

BACKGROUND: Much has been published related to the epistemology of Heideggerian hermeneutic research. We seek to reveal insights from our experience of enacting such research. OBJECTIVE: To articulate the lived experience of 'doing' Heideggerian hermeneutic research. DESIGN: The authors of this paper shared their experiences with the primary author towards articulating the process of 'doing' such research. PARTICIPANTS: The authors all have long experience with Heideggerian hermeneutic research and meet regularly at the Institute for Interpretive Phenomenology. They supervise student's research and are mindful of the process of coming to understand how to work in a phenomenological/hermeneutic manner. METHODS: First the section on philosophical underpinnings was written by the primary author and then shared with all authors. There was published data related to the experience of three of the participants already available. This provided a spring board to further conversations when the primary author visited America, able to engage in daily conversations with three of the co-authors. In the spirit of phenomenology this paper represents a process of reading, talking, writing, talking, reading, re-writing, re-talking and so forth. RESULTS: The process of doing hermeneutic phenomenology is represented as a journey of 'thinking' in which researchers are caught up in a cycle of reading-writing-dialogue- which spirals onwards. Through such disciplined and committed engagement insights 'come'. The researcher is always open to questions, and to following a felt-sense of what needs to happen next. However, it is not a process of 'do whatever you like' but rather a very attentive attunement to 'thinking' and listening to how the texts speak. CONCLUSION: This paper argues that alongside a disciplined understanding of the methodology, both researcher and reader need to share a commitment to 'thinking' which is willing to question, and open to trusting the resonance of understanding that 'comes' without expecting answers that are declared 'truth' for all time.

Registered nurse participation in performance appraisal interviews.

Performance appraisal interviews have, over the past two decades, become a common phenomenon in nursing. Yet evidence--both anecdotal and those reported in the literature--suggest that these interviews provide minimal satisfaction and are thus not always effective. This article presents the findings of an interpretive study that explored and documented the meaning and impact of participating in performance appraisal interviews. Data gleaned from nine New Zealand registered nurses employed by a single district health board provide evidence that nurses are often disappointed by the process of performance appraisal. Although they believe in the potential value of performance appraisal interviews, they seldom experience the feedback, direction, and encouragement necessary for an effective appraisal process. Changes to the current professional development program and its accompanying performance appraisal will require skilled commitment on the part of nurses, managers, and the employing organization to improve and develop the assessment and promotion of nursing practice.