Adolescents' challenging and grief-filled transitions when living with a parent with ALS: A qualitative interpretive study.

OBJECTIVE: The study aimed to explore the meaning for adolescents of living with a parent with amyotrophic lateral sclerosis (ALS). METHODS: The design is qualitative. Interviews were conducted between December 2020 and April 2022 with 11 adolescents (8-25 y), living in households with a parent with ALS in Sweden. The analysis was phenomenologically hermeneutical. RESULTS: The adolescents were in a difficult and exposed situation, especially if the parent had a severe disability and assistant care providers were in the home. Witnessing the gradual loss of the parent in an indefinite battle against time, while still needing them, elicited grief-filled and hard-to-manage emotions. Everyday life was turned upside down, resulting in greater responsibility for the adolescents, not only in helping with household chores and assisting the ill parent, but also in emotionally protecting both parents. It forced the adolescents to mature faster and put their own life on hold, triggering experiences of being limited. This, together with changing family roles yet being more attached to home, reinforced the imbalance in the adolescents' lives. The interpreted whole of the adolescents' narratives revealed that living with a parent with ALS meant a challenging and grieving transition during an already transition-filled adolescence, which left the adolescents struggling to keep a foothold on a life torn apart. CONCLUSION: The unbalanced life situation may hinder the adolescents' identity formation and emancipation, which are developmentally important for managing a healthy and independent adulthood. The results emphasize the importance of early targeted support to reach this vulnerable group in order to secure their health.

Reflexões sobre práxis investigativa cogestora em contexto de emergência sanitária / Reflections on co-managing investigative praxis in the context of a health emergency

Resumo O artigo trata do interesse do campo científico em sistematizar a práxis investigativa cogestora em cenário de emergência sanitária a partir da análise de uma pesquisa de abordagem qualitativa multicêntrica, valendo-se do referencial da pesquisa-apoio e da análise da hermenêutica critica. Como resultados, identificou-se que a elaboração de um guia-mapa contribuiu como documento norteador, com o objetivo de organizar diferentes técnicas para a preparação e formação dos pesquisadores de campo, também como instrumento de análise dos dados. A formação de pesquisadores para o referencial teórico da pesquisa-apoio, assim como a cogestão e a implicação deles nas diferentes etapas da pesquisa, mostrou-se como diferencial para produção de sujeitos e coletivos com a práxis investigativa, permitindo a troca dialógica dentre coordenadores e pesquisadores e o compartilhamento regular dos resultados. Conclui-se que a forma como a metodologia foi proposta possibilitou a ampliação da capacidade reflexiva e de compreensão sobre a realidade, contribuindo para a formação de pesquisadores como sujeitos ativos e críticos no processo de coleta, análise e discussão dos dados, incentivando a atuação sensível e atenta ao mesmo tempo em que buscou identificar as particularidades de cada contexto.

Abstract This article deals with the interest of the scientific field in systematizing the co-management investigative praxis, in a health emergency scenario, based on the analysis of a research with a multicentric qualitative approach, using the framework of the Support Research and the analysis of critical hermeneutics. As a result, it was identified that the creation of a map guide contributed as a guiding document, aiming at organizing different techniques for the organization and formation of field researchers, as well as an instrument of data analysis. The training of researchers for the theoretical framework of Support Research, as well as their co-management and involvement in the different stages of research, proved to be a differential for the production of subjects and collectives with investigative praxis, allowing a dialogic exchange between coordinators and researchers and regular sharing of the results. It is concluded that the way in which the methodology was proposed, allowed the expansion of the reflective capacity and understanding of reality, contributing to the formation of researchers as active and critical subjects in the process of data collection, analysis and discussion, encouraging sensitive and attentive actions while seeking to identify the particularities of each context.

Leading care close to the patient in community home care for older persons: A lifeworld hermeneutic study from nurses' perspectives.

AIM: To explain and understand leading care close to older persons in community home care from the perspective of registered nurses (RNs). BACKGROUND: Leading care close to older persons in home care is an overlooked and not well-described phenomenon. In home care, specific demands are placed on the registered nurse, as responsible for leading care guided by the older person's expectations and desires. DESIGN: A reflective lifeworld hermeneutic approach grounded in the philosophy of phenomenology and hermeneutics. The study followed the COREQ checklist. METHODS: Individual interviews were conducted with nine RNs working in community home care in a community in western Sweden. The data were analysed with a lifeworld hermeneutic approach. RESULTS: The findings present four partially interpreted themes: leading with respect in a shared space, leadership that involves existential questions of life, balancing responsibility enables preservation of autonomy and challenges in maintaining a patient perspective. The partially interpreted themes conclude in a main interpretation: The patient perspective as an anchor when balancing responsibility for another person in an existential vulnerability of life. CONCLUSION: Leading care means being both close to the patient and at a distance when caring is performed through the hands of others. Ethical demands are placed on RNs as they encounter the vulnerability of the older person. RELEVANCE TO CLINICAL PRACTICE: The findings can contribute to a greater understanding of the meaning of RNs as leaders and may have an impact for decision makers and policies to create conditions for leadership that contributes to dignified care for older persons in community home care. PATIENT OF PUBLIC CONTRIBUTION: Registered nurses working in community home care participated in data collection.

Exploring the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business: a hermeneutic phenomenological study.

AIM: To explore the experiences of UK-based private physiotherapists when running and progressing a physiotherapy business. DESIGN: A hermeneutic phenomenological approach. PARTICIPANTS: Six UK-based private physiotherapy practice owners were recruited via purposive and snowball sampling. METHODS: In-depth, semi-structured video interviews (2 per participant), audio-recorded and transcribed. Field notes, respondent validation and a reflexive diary were used. Data underwent line-by-line analysis, identifying codes and themes. Constant comparison of data, codes and themes occurred throughout. Peer review was utilised, small sections of data and all emerging codes were independently reviewed. RESULTS: Three interconnecting themes. Working for myself: participants highlighted the freedom, flexibility and independence of business ownership, whilst acknowledging the additional pressures/challenges associated with this. Evolution of a practice: business growth was slow, requiring income supplementation initially. Successful growth often utilised luck and unexpected opportunities. Working with others: participants faced decisions regarding solo or joint ownership, when/what additional staff were required, whether staff should be employed or self-employed, and how to appropriately manage/support staff. CONCLUSIONS: Private practice ownership brings an array of benefits and challenges. Areas for future research include exploring the stresses of private roles and business ownership, the evolution of private physiotherapy practices, small-scale business partnerships, and employment vs self-employment. CONTRIBUTION OF THE PAPER.

Hospitalized children experience: Play heroes to build bridges between hospital days and everyday life.

Play has positive effects on children's well-being and development. Play heroes, in Danish, called "Legeheltene", have worked, for the last 7 years, to improve play and movement for hospitalized children in Danish hospitals. However, the significance of this novel Danish intervention is insufficiently researched. This phenomenological-hermeneutic study explored how children experience interacting with a play hero when hospitalized at a Danish paediatric unit. Combined observations and interviews were performed with children from two paediatric departments. Data were analyzed with inspiration from the French philosopher Paul Ricoeur. Three themes were identified: "A sense of familiarity," "From loneliness to connectedness," and "Becoming more powerful." Children experience that interaction with play heroes is existentially meaningful. Through playful activities, children experience that they are connected to their daily lives outside the hospital and their true selves. Bridges to children's everyday lives are built, leading to an improved sense of freedom, security, and the ability to manage difficult aspects of their hospital stay. Engagement with play heroes provides children with an experience of well-being and can be a positive direction in care provided to hospitalized children.

Narrative Capacity.

What develops in adulthood? More specifically, what develops in adult analysis, not just in terms of thwarted childhood capacities, not just through accrued experience, but even more fundamentally in terms of abilities or structures not possible until the present moment? In this paper, I posit narrative capacity-the capacity to organize conflictual aspects of self and other in a temporary causal-motivational sequence-as a core feature of what develops in the clinical encounter between the analyst and adult patient. It develops, as I demonstrate, through play with narrative fragments, contrasts, and integrations in the analytic field. I present a clinical process note to show how these elements texture and problematize one another. A successful analysis leads not to any one life story but to the more basic ability to weave and unweave our stories.

Heretical microcosmogony in Paracelsus's Astronomia Magna (1537/8) and the anonymous Astrologia Theologizata (1617): Paracelsian anthropology in the light of Lutheran biblical hermeneutics.

The study evaluates Paracelsus's and Paracelsian-Weigelian microcosmogonies, i.e. theories concerning the nature and creation of human beings, especially their biblical underpinnings, and particularly in the light of Luther's and Lutheran anthropological and biblical-exegetical stances. The Lutheran approach to the origin and components of human beings-as seen in Luther's early Magnificat Commentary and the Genesis Commentary of his late career-relied on such magisterial principles as adherence to sola scriptura, literal biblical exegesis, and the hermeneutical standard to 'let scripture interpret scripture,' whereas the Paracelsians, Weigelians, and Pseudo-Weigelians-in such works as Paracelus's Astronomia Magna (1537/38) and the anonymous Astrologia Theologizata (1617)-employed such extra-biblical concepts as 'sidereal bodies,' the 'light of nature,' and a microcosm-macrocosm theory based on an alchemical interpretation of the limus terrae of Genesis 2:7. Seventeenth-century Orthodox Lutherans, including Nikolaus Hunnius and Ehregott Daniel Colberg, castigated the 'heretical' in Paracelsus and the Astrologia Theologizata. The study also addresses the authorship of several texts entitled Astrologia Theologizata and speculates on reasons for the tracts' deviations from Paracelsus's views. The case study of Paracelsian-Weigelian microcosmogonies underscores the centuries-long staying power of some of Paracelsus's core theological concepts, which were both seconded by votaries and vituperatively criticized by opponents.

Being a Newly Qualified Nurse: A Nordic Focus Group Study.

Introduction: The transition to working life as a newly qualified nurse (NQN) can be challenging, leading to heightened stress levels. While NQNs are generally enthusiastic about starting their careers, they often express concerns about various responsibilities and a perceived lack of experience in independently dealing with clinical care in complex environments. Objective: To acquire an in-depth understanding, from a caring science perspective, of what it means to be an NQN during the transition period of the first 18 months in the profession. Methods: This study relied on an exploratory qualitative design. The methodological approach followed Gadamer's hermeneutic philosophy. Six focus group interviews were conducted in northern Norway (n = 3) and northern Sweden (n = 3) from January through May 2021. The interpretation of the data was inspired by Fleming et al. Nineteen female and seven male NQNs working in different contexts, including hospitals and municipalities, participated in the study. The consolidated criteria for qualitative research were used to report the results. Results: Perspectives on NQNs are presented as three themes: a) the responsibility was perceived as a significant challenge, b) being a nurse is complex and demanding, and c) a desire for personal and professional development. Learning to be a nurse shouldering responsibility necessitates support and guidance from caring and compassionate colleagues and leaders. Conclusions: This study sheds light on the importance of creating a workplace culture where NQNs' learning is promoted and supported by designated mentors during their transition to working life. The responsibilities should be aligned with their level of knowledge. It is important that leaders hold developmental dialogues and ensure a career plan for NQNs to continuously develop their knowledge and skills. Intervention studies designed to evaluate the meaning of the support from appointed mentors within structured mentorship programs are needed.

Experiences of caring after religious disaffiliation: A qualitative study based on the DEW model.

BACKGROUND AND AIM: Leaving a religious community may occasionally lead to suffering in a human being's life and difficult existential life issues, such as loss of social relationships, identity and well-being. Only a few studies have been conducted on what kind of care and support human beings who are suffering need in this context. The aim of this study was to increase the understanding of what a human being perceives as caring after religious disaffiliation. METHODS: In-depth interviews were conducted with 18 participants who had left different religious communities in Finland. The material was analysed through a deductive thematic analysis according to Braun and Clarke, based on the Dressing an existential wound model by Rehnsfeldt and Arman. RESULTS AND CONCLUSION: The results show that what human beings experience as caring after religious disaffiliation is encountering a care professional who understands the needs of someone in this life situation. Based on these needs, caring is described through seven themes. Care professionals need to understand the impact religious disaffiliation may have on clients' lives and respond to their needs. Understanding the suffering of a human being calls for a care professional's holistic view and caring for the whole human being, including spiritual dimensions. This new knowledge can be used by care professionals to develop caring for clients after religious disaffiliation.

Listening to the Voices of Mothers Who Participated in a Video Feedback Intervention for Postpartum Depression.

Postpartum depression (PPD) symptoms can negatively influence mother-infant interactions. Video-Feedback Interaction Guidance for Improving Interactions Between Depressed Mothers and their Infants (VID-KIDS) is a parenting intervention that allows mothers experiencing PPD symptoms to observe and improve their interactions with their infants. VID-KIDS has also positively influenced infants' stress (cortisol) patterns. There is limited research on maternal perspectives of interventions like VID-KIDS. In this hermeneutic study, four mothers were interviewed to increase understanding of the VID-KIDS experience. Key findings included: 1) VID-KIDS provided an opportunity for mothers with PPD symptoms to positively transform their identity; 2) VID-KIDS provided a chance to witness the mother-infant relationship forming and improve maternal mental health t, and; 3) VID-KIDS provided a space for mothers to dialogue about their experience with PPD symptoms authentically. VID-KIDS promoted healing from PPD as mothers experienced a transformation in how they perceived themselves and their relationships with their infants.

The Role of Metaphor in Hermeneutic Research.

The identification and interpretation of metaphor is useful to hermeneutic research. Metaphor is a way of conceiving one concept in terms of another and serves as a function of understanding. The author explores the rise of hermeneutics research and its relevance to nurse artsciencing. Metaphors are a creative strategy hermeneutic researchers can use to analyze and interpret data, and serve as a powerful strategy to represent complex realities, illuminate unnoticed aspects of a phenomenon, and provide depth of meaning to the understanding of human experiences.

Leading-Following Interpretations: Living Quality and Working, the Musical.

It is important to explore the ways that the working lives of persons provides meaning in personal, professional, and organizational ways. In this paper, the author utilized the processes of Parse's (2021a) humanbecoming hermeneutic sciencing (discoursing with penetrating engaging, interpreting with quiescent beholding, and understanding with inspiring envisaging) and the leading-following model to further understanding of the meaning of "working" through Stephen Schwarz's Broadway show, Working, the Musical (Browning & Schwartz, 1982/2002). Although not a formal sciencing project, this interpretive reflection provided a way to "see" how work is "lived out" uniquely.

Paradoxes in Humanbecoming Hermeneutic Sciencing.

The author explores humanbecoming hermeneutic sciencing and provides exemplars of paradoxes that are used by scholars in this mode of inquiry.

Hermeneutics: An Ethical Journey.

Hermeneutics is an important philosophical mode of inquiry where discipline-specific theories and methodologies provide important windows of understanding human experiences. The author discusses the embedded truths of ethics found in the formal inquiry where human living quality phenomena are highlighted. The valuable insights and the importance to the future of the discipline of nursing focus on ideas for suggested further study.

Perspectives of healthcare workers on integrated management of childhood illness in Pakistan: A phenomenological approach.

In 2019, an estimated 5.2 million deaths were reported among children less than 5 years of age. At primary healthcare level, healthcare workers (HCWs) mostly rely on history and clinical findings and less on inadequate diagnostic facilities. To enhance case management skills of HCWs, World Health Organization devised an integrated management of childhood illnesses (IMCI) strategy in 1995, modified to distance learning IMCI in 2014. A qualitative phenomenological study was conducted to explore perceptions of HCWs about standard and distance IMCI. Four focus group discussions were conducted with purposively selected 26 HCWs (IMCI trained) from 26 basic health units of Abbottabad district in Pakistan. Gadamer's philosophical hermeneutics were adopted during the inductive thematic analysis. Five themes that emerged are inexorable health seeking behaviors, IMCI being a comprehensive algorithm for consultation, a tedious protocol, scaling up protocol to specialists and private practitioners, and administrative insufficiency by the department of health. Improvement in case management skills of HCWs was reported as a result of IMCI trainings. It needs administrative support, regulations to control poly-pharmacy and provision of drugs without prescription, and a curb on political and bureaucratic interference.

Promoting dignity in nursing education - How educators manoeuvre to promote dignity.

BACKGROUND: Dignity is a core value in nursing. One of the objectives in nursing education is to promote dignity and contribute to the students' discovery of this value. Research shows that dignity in nursing education is threatened, due to lack of attention and an increasing problem with incivility. PURPOSE: The study aims to explore how nursing educators experience their contribution in promoting dignity in nursing education. METHOD: Five focus group conversations were conducted with nursing educators, and Gadamer's philosophical hermeneutics was chosen as the study's scientific theoretical approach. FINDINGS: The educators experienced that they promoted dignity by safeguarding the dignity in the nursing profession in general, by promoting the dignity of the nursing students in particular, and through promoting dignity in challenging situations. CONCLUSION: The study emphasizes the importance of promoting dignity in nursing education. It found that the nursing educators promoted dignity by safeguarding the dignity of both the nursing profession and the nursing students, and by manoeuvring judiciously between these two when there was disharmony between them. By manoeuvring challenging situations using discretion, the ethical demand will be given room. Dignity can then be fulfilled between people in harmony with professional, social and cultural norms, and in that way promote dignity in nursing education.

Live music in the intensive care unit - a beautiful experience.

BACKGROUND: The growing number of lightly or non-sedated patients who are critically ill means that more patients experience the noisy and stressful environment. Live music may create positive and meaningful moments. PURPOSE: To explore non-sedated patients' experiences of patient-tailored live music interventions in the intensive care unit. DESIGN: A qualitative study using a phenomenological-hermeneutic approach. Data were collected at two intensive care units from September 2019 to February 2020 exploring 18 live music interventions performed by music students from The Royal Academy of Music, Aarhus, Denmark. METHODS: Observations of live music interventions followed by patient interviews. All data together were analysed using Ricoeur's theory of interpretation. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used. RESULTS: Five themes emerged: 1) A break from everyday life, 2) A room with beautiful sounds and emotions, 3) Too tired to participate, 4) Knowing the music makes it meaningful and 5) A calm and beautiful moment. CONCLUSION: Patient-tailored live music to awake patients is both feasible and acceptable and perceived as a break from every-day life in the ICU. IMPLICATIONS FOR PRACTICE: Supporting health and well-being by bringing a humanizing resource into the intensive care setting for patients and nurses to enjoy.

Providing end of life care in the emergency department: A hermeneutic phenomenological study.

BACKGROUND: Registered nurses report the experience of delivering end of life care in emergency departments as challenging. The study aim was to understand what it is like to be a registered nurse providing end of life care to an older person in the emergency department. METHODS: A hermeneutic phenomenological study was conducted in 2021, using semi-structured interviews with seven registered nurses across two hospital emergency departments in Queensland, Australia. Thematic analysis of participants' narratives was undertaken. FINDINGS: Seven registered nurses were interviewed; six of whom were women. Participant's experience working in the emergency department setting ranged from 2.5-20 years. Two themes were developed through analysis: (i) Presenting the patient as a dying person; and (ii) Mentalising death in the context of the emergency department. CONCLUSIONS: Nurses providing end of life care in the emergency department draw upon their personal and aesthetic knowing to present the dying patient as a person. The way death is mentalised suggests the need to develop empirical knowing about ageing and supportive medical care and ethical knowing to assist with the transition from resuscitation to end of life care. Shared clinical reflection on death in the emergency department, facilitated by experts in ageing and end of life care is recommended.

Striking fear into students' hearts: Unforeseen consequences of prescribing education.

PURPOSE: Undergraduate medical education (UGME) has to prepare students to do safety-critical work (notably, to prescribe) immediately after qualifying. Despite hospitals depending on them, medical graduates consistently report feeling unprepared to prescribe and they sometimes harm patients. Research clarifying how to prepare students better could improve healthcare safety. Our aim was to explore how students experienced preparing for one of their commonest prescribing tasks: intravenous fluid therapy (IVFT). METHODS: Complexity assumptions guided the research, which used a qualitative methodology oriented towards hermeneutic phenomenology. The study design was an uncontrolled and unplanned complex intervention: judicial review of the iatrogenic death of five children due to hyponatraemia in our region had resulted in the recommendation that students' education in 'the implementation of important clinical guidelines' relevant to fluid and electrolyte balance should be intensified. An opportunity sample of 40 final-year medical students drew and gave audio-recorded commentaries on rich pictures. We completed two template analyses: one of participants' transcribed commentaries on the pictures and one using a novel heuristic to analyse the pictures themselves. We then reconciled the two analyses into a single template. RESULTS: There were four themes: affects, teaching and learning, contradictions, and the curriculum as a journey. To explore interconnections between themes, we chose the picture best exemplifying each of the four themes and interpreted the curriculum journey depicted in each of them. These interpretations were grounded in each participant's picture, verbal account of the picture, and the aggregate findings of the template analysis. Participants' experiences were influenced by the situated complexity of IVFT. Layered on top of that, contradictions, overlaps, and gaps within the curriculum introduced extraneous complexity. Confusion and apprehension resulted. CONCLUSIONS: After spending five years preparing to prescribe IVFT, participants felt unprepared to do so. We conclude that intensive teaching had not achieved its avowed goal of improving students' preparedness for safe practice. Merton's seminal work on the 'unanticipated consequences of purposive social action' suggests that intensive teaching may even have contributed to their unpreparedness.

For the good of the children-Life and ethical values when undergoing paternal alienation and involuntary loss of paternity.

BACKGROUND AND AIM: Today there is an aspiration and desire for fathers to be caring masculinities that build long-term father-child relationships and emotional presence with their children. Previous research shows that life changes where fathers are deprived of the opportunity for equal parenting and close contact with their children affect the fathers' lives and mental health. The aim of this caring science study is thereby to gain a deeper understanding of life and ethical values when undergoing paternal alienation and experiencing involuntary loss of paternity. DESIGN, RESEARCH METHODS, AND PARTICIPANTS: The study has a qualitative design. The data collection was carried out in 2021 through individual in-depth interviews according to Kvale and Brinkmann. The five fathers who participated in the interviews had experiences of undergoing paternal alienation and involuntary loss of paternity. The interviews were analysed with a reflexive thematic analysis according to Braun and Clarke. RESULTS: Three main themes emerged. Putting yourself aside includes forgetting one's own needs and prioritising the children's and being the best version of oneself for them. In playing with the cards you have been dealt lies an acceptance of life as it has become and also a responsibility not to let the grief take over, by creating new patterns for everyday life and holding up hope. Keeping your dignity as a human being includes being heard, affirmed and consoled, and a form of re-awakening one's dignity as a human being. CONCLUSION: It is fundamental to understand the grief, longing and sacrifice that paternal alienation and involuntary loss of paternity cause human life and how every day can be a struggle to hold on to hope, find comfort and reconcile with the situation. The fundamental foundation that makes life worth living is love and responsibility for the good of the children.