Understanding Older Persons' Experiences of Care Encounters in the Home Environment: A Hermeneutic Study.

AIM: To explore and gain a deeper understanding of older persons' experiences of care encounters when their home becomes a workplace. BACKGROUND: Worldwide healthcare services are increasingly being provided in older persons' homes by registered nurses. This presents new challenges as the home environment of older persons now doubles as a workplace for healthcare professionals. However, there is limited research available on how older persons experience care encounters when their homes serve as workplaces and how this influences their overall well-being and quality of life. DESIGN: A qualitative hermeneutic study. METHODS: In-depth face-to-face interviews were conducted in Sweden from October 2023 to January 2024 with 10 purposefully selected older persons (aged 65+). Each participant received regular visits from a home care nurse in their home to address specific care needs, such as wound care, medication administration, blood sampling and general supervision. The interviews were audiotaped, transcribed verbatim and analysed using a hermeneutic interpretation. FINDINGS: The hermeneutic analysis emerged with one main theme: 'Experiencing care encounters at home as a lottery', with two underlying themes: 'Adapting to loss of control in the private sphere' and 'Striving for independence while navigating daily living'. CONCLUSIONS: Older persons try to control their lives despite the challenges associated with ageing and receiving care at home. They strive to maintain their independence and autonomy, which reflects their desire for self-determination. Supporting these efforts in an interdependent relationship can enhance their well-being and quality of life. REPORTING METHOD: Findings were reported following the Consolidated Criteria for Reporting Qualitative Research guidelines. PATIENT OR PUBLIC CONTRIBUTION: Data were collected by patient interviews. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: This study emphasises the importance of supporting older persons in maintaining control over their lives while being cared for in their homes. In the care encounters with home care nurses, their well-being and quality of life can be improved by respecting their autonomy, involving them in decision-making and offering tailored support.

Ação Direta de Inconstitucionalidade nº 5.779: a preponderância da efetividade do direito à saúde sobre a hierarquia das normas jurídicas / Direct Action of Unconstitutionality No. 5.779: the preponderance of the effectiveness of the right to health over the hierarchy of legal norms / Acción Directa de Inconstitucionalidad nº 5.779: la preponderancia de la efectividad del derecho a la salud sobre la jerarquía de las normas jurídicas

Objetivo: refletir se a hierarquia das normas jurídicas deve ser usada como método de solução infalível mesmo quando um conflito aparente entre normas jurídicas que envolva o direito à saúde e, sobretudo, a sua efetividade, puder ser melhor resolvido mediante decisão técnica do órgão regulador competente. Metodologia: estudo descritivo de abordagem qualitativa e análise documental. Foram analisadas as Resolução de Diretoria Colegiada nº 52/2011, Lei nº 13.454/2017 e Ação Direta de Inconstitucionalidade nº 5.779-DF. Buscou-se doutrina jurídica especializada sobre os temas central e periféricos. Para análise dos dados utilizou-se a técnica da revisão crítico-narrativa. Resultados: no Brasil, a adoção das agências reguladoras como agente normativo e regulador de atividades econômicas viabilizou a tomada de decisões pautadas menos em critérios políticos que em critérios técnicos. O legislador, ancorado em critérios políticos, segundo o entendimento do Judiciário, não pode ultrapassar os critérios técnicos. Conclusão: do julgamento da Ação Direta de Inconstitucionalidade nº 5.779 se extrai que o conceito hodierno e a natureza jurídica do direito à saúde impõem novos paradigmas jurídicos que validam o papel das agências reguladoras (tomada de decisões técnicas em prol da máxima efetividade do direito à saúde), ainda que em detrimento de decisões do legislador, legitimadas politicamente. O paradigma formal não pode obstar a materialização do direito.

Objective: To reflect on whether the hierarchy of legal norms should be used as an infallible method of solution even when an apparent conflict between legal norms involving health law can be better resolved through a technical decision by the competent regulatory agency. Methodology: data was collected. In particular, Resolução de Diretoria Colegiada nº 52/2011, Law nº 13.454/2017 and Ação Direta de Inconstitucionalidade nº 5.779-DF. Specialized legal doctrine was sought on the central and peripheral themes. The data collected was analyzed using the critical-narrative review technique. Results: In Brazil, the adoption of regulatory agencies as normative agents and regulators of economic activities has made it possible to make decisions based less on political criteria than on technical criteria. The legislator, anchored in political criteria, according to the judiciary, cannot go beyond technical criteria. Conclusion: the judgment in Ação Direta de Inconstitucionalidade nº 5.779 shows that today's concept and the legal nature of the right to health impose new legal paradigms that validate the role of regulatory agencies (making technical decisions in favor of maximum effectiveness of the right to health), even to the detriment of politically legitimized decisions by the legislature. The formal paradigm cannot prevent the materialization of the right.

Objetivo: reflexionar si la jerarquía de las normas jurídicas debe utilizarse como método infalible de solución, incluso cuando un conflicto aparente entre normas jurídicas que impliquen al Derecho sanitario pueda resolverse mejor mediante una decisión técnica del órgano regulador competente. Metodología: se recopilaron datos. En particular, RDC nº 52/2011, Ley nº 13.454/2017 y ADI nº 5.779-DF. Se buscó doctrina jurídica especializada sobre los temas centrales y periféricos. Los datos recogidos se analizaron mediante la técnica de revisión crítico-narrativa. Resultados: En Brasil, la adopción de las agencias reguladoras como agentes normativos y reguladores de las actividades económicas ha permitido tomar decisiones basadas menos en criterios políticos que en criterios técnicos. El legislador, anclado en criterios políticos, según el poder judicial, no puede ir más allá de los criterios técnicos. Conclusión: la sentencia en el asunto ADI 5.779 demuestra que el concepto actual y la naturaleza jurídica del derecho a la salud imponen nuevos paradigmas jurídicos que validan el papel de las agencias reguladoras (que adoptan decisiones técnicas en favor de la máxima efectividad del derecho a la salud), incluso en detrimento de las decisiones políticamente legitimadas del poder legislativo. El paradigma formal no puede impedir la materialización del derecho.

Being Open to a Process of Learning: The Meaning of Joint Activities With Patients as Narrated by Nursing Staff in Psychiatric Inpatient Care.

Forming therapeutic relationships is considered important within psychiatric and mental health nursing. One way of achieving this is through social interaction when engaging in joint activities. However, introducing and using nursing interventions based on joint activities in psychiatric inpatient care has proven challenging. Since staff motivation is important, researching the meaning of engaging in joint activities from the nursing professional's point of view can provide information that is relevant in this area. This study aims to illuminate the meaning of participating in joint activities with patients as narrated by nursing professionals in psychiatric inpatient care. Narrative interviews with 14 nursing professionals with experience from psychiatric inpatient care were conducted. Data were analysed using phenomenological hermeneutics and reported following the consolidated criteria for reporting qualitative research (COREQ) guidelines. Results illuminate that engaging in joint activities means being open to a process of learning. Four themes contributed to this understanding: Struggling with uncertainty, discovering aspects of the other, unfolding paths to self-fulfilment and sharing personhood. Being open to a process of learning means being willing to face uncertainty when engaging in activities as well as being open to learning about oneself as well as the other. Through openness to this process of learning, a sharing of personhood can be achieved, where the nursing professional and the patient approach becoming two persons. Illuminating the meaning of joint activities from the nursing professionals' perspective may provide valuable insights related to introducing and using interventions focusing on joint activities.

A qualitative study of hermeneutic analysis in individuals with schizophrenia, psychiatrists and psychiatric nurses writings on selected narratives.

WHAT IS KNOWN ON THE SUBJECT?: In daily psychiatric practice, understanding individuals often involves formulating the clinical case, which may lead to viewing them solely as symptoms to be solved. Consequently, it can be challenging to see the individual beyond their symptoms. However, trying to understand the individual by his/her writings about narratives can offer broader perspectives and extend beyond being a medium for patients to express their experiences. On understanding writing, hermeneutics will be a resourceful method. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study aims to propose a reevaluation of the nature of therapeutic communication among individuals with schizophrenia, psychiatrists, and psychiatric nurses by interpreting their writings on the same written narratives through a hermeneutic analysis. Our study has unique features compared to previous studies on communication between mental health professionals and patients. We directly investigated the act of understanding through the writings of the three groups of participants. The participants were also engaged in reading and writing about the narratives instead of relying on clinical interviews or self-report questionnaires. To the best of our knowledge, our study is the first hermeneutic study to examine the nature of reflection while all three groups encounter the same narratives as readers. IMPLICATIONS FOR PRACTICE?: The results point to the need for psychiatrists/psychiatric nurses to develop new perspectives and skills in understanding/interacting with individuals with schizophrenia. Our study could be a pioneer sample in applying hermeneutics as a prevailing method to mental health nursing practice. ABSTRACT: INTRODUCTION: Understanding individuals with schizophrenia is an essential but challenging phenomenon in psychiatry. AIM/QUESTION: This study proposes a reevaluation of the nature of therapeutic communication among individuals with schizophrenia, psychiatrists and psychiatric nurses by interpreting their writings on the same written narratives through a hermeneutic analysis. METHOD: In this study, employing a qualitative descriptive methodology utilising hermeneutic analysis, participants read the five narratives, wrote down their opinions on each narratives and answered nine questions to express their own personal writing experiences. RESULTS: Participants from each group acted as both 'readers' and 'authors' while rewriting the selected five short narratives based on their own sense of readings. The expression, rewriting refers to the act of reading and written interpretations of participants and researchers in this study. While individuals with schizophrenia primarily focused on the text (narrative) in their readings and writings, psychiatrists and psychiatric nurses tended to focus on reader (themselves) in their interpretations. DISCUSSION: Although reading should be approached as a process of discovery rather than merely seeking predetermined knowledge, psychiatrists and psychiatric nurses read the narratives as if the author were a patient or as the signs of an illness. IMPLICATIONS FOR PRACTICE: The results point to the need for psychiatrists/psychiatric nurses to develop new perspectives and skills in understanding and interacting with individuals with schizophrenia.

Idealism, materialism, and Vygotsky's cultural historical theory.

Vygotsky straddled the period of the Russian Revolution and found himself facing the Marxist materialist ideology of the Soviet Union with the need for a new method of psychology. Ironically, the Soviet Union's need for a Marxist based method of psychology coincided with Vygotsky's prior research on methods of interpretation which were inspired by Hegel and primarily based on the role of consciousness and culture. As a result of Vygotsky's pre-revolutionary work and inspiration from Hegel clashing with the post-revolutionary need for a new methodology for psychology, Vygotsky developed his Cultural Historical Theory. In presenting his new theory, Vygotsky attempted to resolve a fundamental ideological conflict between idealism and materialism. Furthermore, Vygotsky worked to create an effective new research method by drawing inspiration from Gestalt psychology, Hegel, Marx, and Engels. The result of Vygotsky's efforts was a theory based on psychology of consciousness and mind rather than a biology-based psychology focused entirely on analysis of stimuli and responses. In analyzing Vygotsky's theory, it is useful to draw inspiration from Vygotsky's criticism of pure empiricism, and to be inspired by Vygotsky's demonstration on how deeply rooted differences between societies may be bridged by finding unexpected commonalities within opposing ideologies.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.