Musculoskeletal physiotherapists' experiences of using remote consultations during the COVID-19 pandemic: A qualitative study.

BACKGROUND: The coronavirus (COVID-19) pandemic resulted in the rapid implementation of remote consultations to maintain musculoskeletal physiotherapy services. However, little is known about UK musculoskeletal physiotherapists' experiences of providing services during the COVID-19 pandemic. OBJECTIVES: To explore musculoskeletal physiotherapists' experiences of using remote consultations in one area of England during the COVID-19 pandemic. DESIGN: Qualitative study using hermeneutic phenomenology based on the approach of Gadamer. METHODS: Semi-structured interviews with twelve musculoskeletal physiotherapists were conducted online using Microsoft Teams. Data were analysed using frameworks based on the philosophical concepts of Gadamer's hermeneutics. FINDINGS: Musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic was framed by three concepts: therapeutic relationship, transformational change, and uncertainty. These concepts are underpinned by four main themes capturing their experiences: (1) Disconnection: Difficulties building a rapport and reduced non-verbal communication affected building an effective therapeutic relationship, (2) Necessity: Transformation of services to remote consultations was positive, although technology and connectivity issues had a negative impact, (3) Loss of control: Diagnostic uncertainty, being unprepared, and experience affected physiotherapists' clinical practice, (4) Protection: Peer support and the use of technology facilitated a feeling of protection for physiotherapists. CONCLUSION: The findings of this study contribute to a better understanding of musculoskeletal physiotherapists' experience of using remote consultations during the COVID-19 pandemic. Implications for practice include the need to provide training for all musculoskeletal physiotherapists and undergraduates to enable the effective delivery of remote physiotherapy. Furthermore, digital infrastructure should be optimised to support future delivery of remote musculoskeletal physiotherapy services.

Contribution of peer group supervision to nursing practice: An interpretive phenomenological study.

AIM: To provide insight into peer group supervision practices through understanding the lived experience of community health nurses. BACKGROUND: The recent Covid-19 health crisis highlights the importance of supportive mechanisms to sustain and retain nurses in the workforce. While the support of quality clinical supervision for registered nurses is recognised, the benefits and challenges of peer group supervision are less clearly articulated. DESIGN: Nurses' experiences of peer group supervision in an Australian tertiary health service were explored using a Gadamerian philosophical hermeneutic approach. METHOD: Semi-structured in-depth interviews were conducted in 2021 and provided nurses with the opportunity to share their experiences of using the New Zealand Coaching and Mentoring Model of peer group supervision. The study included a total of 31 nurse participants across multiple community health contexts. Interview data were analysed using a hermeneutic approach from which themes arose. FINDINGS: The findings demonstrated that strong peer group supervision foundations that include personal and professional preparation and active participation are essential. Dual pillars of "the unique individual" and "the unique group" with responsibilities identified in each pillar that enable interactions and worthiness in peer group supervision practice. The foundations and pillars support peer group supervision in nursing practice to provide a mechanism for reflection, support and professional guidance. CONCLUSIONS: Peer group supervision is a worthy, contributory process in community health nursing when implementation processes are supported and teams are educated and prepared. Perceptions of peer group supervision are unique and varied across individuals. The individual experience has an impact on the group experience and vice versa. Knowledge of the process and group by participants is required to enable professional reflection through nursing peer group supervision.

A Gadamerian approach to nursing: Merging philosophy with practice.

Philosophy is commonly criticized for being too abstract and detached from practical spheres. Upon chronicling how philosophy has gained this reputation, the authors explore the philosophical fields of phenomenology and hermeneutics that have explicitly attempted to merge philosophy with everyday life contexts. In recent decades, phenomenology and hermeneutics have been applied to healthcare. In the realm of nursing, Patricia Benner's nursing theory is especially informed by phenomenology, which is briefly explored through her relationship with one of her mentors, the philosopher Hubert Dreyfus. The authors then turn their attention to Hans-Georg Gadamer's philosophy in an attempt to mine concepts relevant to the practice of nursing. Gadamer juxtaposed the human sciences from the natural sciences and thought that both needed different approaches: whereas natural sciences are guided by episteme, that is, universal knowledge, human sciences are guided by phronesis, that is, practical wisdom. Gadamer's philosophy is especially helpful in understanding how to cultivate phronesis in nursing wherein a nurse relies upon one's clinical experience to masterfully navigate each unique patient relationship. Nurses must serve as authorities in the realm of healthcare but also be open to the authority of their patients, who ultimately choose their course of treatment in our contemporary era of patient autonomy. Gadamer's philosophy can help us understand why phronesis requires not only practice but also reflection on that practice to be appropriately cultivated. The authors apply this to the realm of nursing in showing how both practice-clinically and via simulation-and reflection-through journaling or dialogue-are necessary for phronesis to emerge.

The philosophy of Hans-Georg Gadamer: An exemplar of the complicated relationship between philosophy and nursing practice.

Philosophy has a complicated relationship with nursing practice. Selected concepts from Hans-Georg Gadamer's Truth and Method specifically prejudice, conversation, and language are articulated. An exemplar involving nursing practice at an outpatient clinic for women seeking pre- and postbreast cancer care is offered to explicate these concepts. We considered the fit of Gadamer's philosophy, particularly the concept of conversation, within a public health nursing practice context in home and community settings of the client/family and offered tentative conclusions. To extend the discussion of the relationship between philosophy and nursing practice, we posed questions developed to provide deeper insight into this complicated relationship.

Do enhanced recovery after lung cancer surgery programs risk putting primacy of caring at stake? A qualitative focus group study on nurses' perspectives.

AIMS AND OBJECTIVES: To gain insight into nursing in an enhanced recovery after surgery program for lung cancer, we explored its meaning for nurses in a thoracic surgery unit. BACKGROUND: Since nurses play a key role in overcoming implementation barriers in enhanced recovery after surgery programs, successful implementation depends on their care approach during the surgery pathway. DESIGN: Qualitative focus group study. METHODS: A hermeneutic approach inspired by Gadamer guided the research. Sixteen thoracic surgery nurses participated in focus group interviews. Benner and Wrubel's primacy of caring theory enhanced understanding of the findings. COREQ guidelines were followed. RESULTS: The thoracic surgery nurses compared the streamlined trajectory in the program to working in a factory. Shifting focus away from a dialogue-based, situated care practice compromised their professional nursing identity. The program made combining scientific evidence with patients' lifeworld perspectives challenging. Although the nurses recognised that the physiological processes and positive outcomes promoted recovery, they felt each patient's life situation was not sufficiently considered. To meet the program's professional nursing responsibilities and provide comprehensive care, specialised thoracic nursing should continue after discharge to allow professional care while meaningfully engaging with the patient's situatedness and lifeworld. CONCLUSIONS: Primacy of caring risks being compromised if accelerated treatment is implemented uncritically. If care is based on the dominant rational justifications underpinning surgical nursing, living conditions and patient values might be overlooked, affecting how disease, illness and health are managed. RELEVANCE TO CLINICAL PRACTICE: Our findings focus on obvious unintended consequences of enhanced recovery after surgery programs. To avoid dehumanising patients, surgical lung cancer programs must adopt a humanistic attitude in a caring practice guided by the moral art and ethics of care and responsibility. PUBLIC CONTRIBUTION: To reminding us of what matters and helping us think differently, we discussed the results of the study with organisational stakeholders.

Hermeneutic Constructivism: One ontology for authentic understanding.

Nursing and nurses rely upon qualitative research to understand the intricacies of the human condition. Acknowledging the subjective nature of reality and commonly founded in a constructivist epistemology, qualitative approaches offer opportunities for uncovering insights from the perspective of the individual participants, the insider's view, and the construction of representations that maintain an intimacy with the subject's realities. Debate continues, however, about what is needed for a qualitative construction to be considered an authentic understanding of a subject's realities. Authenticity in the context of qualitative research has been described as entailing consideration of a number of well-trodden dimensions: fairness, ontological, educative, catalytic and tactical. Taking these dimensional requirements as key, this paper argues that authenticity may not always be as well-developed through some of the standard practices in qualitative research as perhaps expected. In particular, qualitative understandings of authenticity stress that participants should not be merely reported on but instead should be dynamically involved in and changed by the constructions and interpretations of data developed throughout the research process. As this paper illustrates, such engagements appear problematic for qualitative research approaches that are beholden to designative commitments in the context of language and meaning-making and which tend to prioritise commonality and generality at the expense of individual authenticity. An alternative qualitative approach, Hermeneutic Constructivism, is proposed as better able to achieve the requirements of the dimensions of authenticity. As outlined, this approach is well-placed to present an understanding of human experience through a genuinely expressivist approach and transcends the stress upon the common or the general that can be pervasive and problematic.

The optics of weight: expert perspectives from the panopticon and synopticon.

Objective: That we all weigh something is a fact of life, yet the material reality of weight is refracted through multiple layers of surveillance revealing contradictions in experience and understanding, depending on one's vantage point. We explored the complexities of weight with the specific aim of furthering understanding of this multifaceted surveillance.Methods and Measures: We used hermeneutics, the philosophy and practice of interpretation, as the method of inquiry. Ten experts by experience and seven professional experts participated in interviews, which were audio- recorded, transcribed, and analyzed. Interpretations were developed through group discussions among the eight authors and reiterative writing.Results: Using the metaphor of optics, we demonstrate how the interplay of the panopticon (the few watching the many) and synopticon (the many watching the few) help us gain a deeper understanding of weight through "fitting in," being "captured by numbers," "dieting: the tyrannic tower," and "the male gaze."Conclusion: Monitoring and judging body weight have become so normative in Western society that "weight watching" practices are synonymous with good citizenship and moral character. This study offers insight about how weight is conceptualized in personal and professional contexts, with implications for body image, dieting, eating disorders, public health, and weight bias.

Unveiling beauty: Insight into being tattooed postmastectomy.

BACKGROUND: It could be argued that mastectomy tattoos are being considered by some women in contemporary society as an alternative to breast reconstruction. AIM: To gain insight into the experience of "being" tattooed where breast(s) once occupied space, six women with mastectomy tattoos were interviewed. METHODOLOGY: The teachings of Gadamer's philosophical hermeneutics were engaged to better understand what it means "to be" tattooed postmastectomy. RESULTS AND DISCUSSION: Discoveries include feeling sad and damaged postmastectomy, embodying the tattoo as a novel representation of self for women living without breast(s), and reclaiming power, control, and confidence in a way that is symbolically meaningful. CONCLUSION: Health care providers working with women diagnosed with breast cancer are invited to learn from women with mastectomy tattoos and to consider expanding discourse about care to include options beyond breast reconstruction.

The lived experiences of young people living with type 1 diabetes: A hermeneutic study.

AIMS: The aim of this hermeneutic study was to explore and elucidate the lived experiences of young people living with type 1 diabetes in terms of their everyday life and school in Sweden. DESIGN: A qualitative interview study with a hermeneutic approach inspired by Gadamer's thinking. METHODS: Interviews were conducted with a purposive sample of seven girls and three boys with type 1 diabetes between January and September 2017 and analysed with a hermeneutic method. RESULTS: Young peoples' everyday lives were transformed and re-organized by their illness and they parodically live a double-edged everyday life. To support young people's healthcare personnel, headmasters and teachers must understand this double-edged situation.

Um percurso gadameriano na produção de conhecimento em Abordagem Centrada na Pessoa / A gadamerian route in the production of knowledge in a Person-Centered Approach / Una ruta gadameriana en la producción de conocimientos en un Enfoque Centrado en la Persona

O presente artigo objetiva apresentar o percurso teórico-metodológico, construído pelo primeiro autor em sua Dissertação de Mestrado sob a orientação do segundo, baseado na filosofia hermenêutica de Hans-Georg Gadamer. Justifica-se sua relevância por ser uma alternativa estruturada para a realização de pesquisas bibliográficas dentro do escopo da Abordagem Centrada na Pessoa (ACP). Para isso, procura-se inicialmente justificar a escolha da hermenêutica gadameriana em sua relação com o objetivo da pesquisa. Em seguida, apresenta-se a rede conceitual formada pela articulação das concepções preconceito, linguagem, tradição, atualização e fusão de horizontes que sustentam essa perspectiva, de forma que permita, posteriormente, sistematizar as fases investigação das informações, análise compreensiva e síntese hermenêutica para o desenvolvimento da pesquisa sobre o problema proposto. Finaliza-se o artigo com a constatação da potencialidade e proficuidade referente à aproximação, e consequente articulação, entre a ACP e a perspectiva filosófica gadameriana, com reflexões sobre as implicações quanto ao uso de um método hermenêuticofilosófico na produção de conhecimento na abordagem.

This article aims to present the theoretical-methodological route, built by the first author in his Master's Dissertation under the guidance of the second, based on Hans-Georg Gadamer hermeneutic-philosophical philosophy. Its relevance is justified because it is a structured alternative for conducting bibliographic research within the scope of the Person Centered Approach (PCA). For this, we initially want to justify an epistemological choice of gadamerian hermeneutics in its relation to the research objective. Then, we present the conceptual network formed by the articulation of prejudice, language, tradition, update and fusion of horizons that supports this perspective, in a ways that allows, later, to systematize the phases of information investigation, comprehensive analysis and hermeneutic synthesis to the development of research on the proposed problem. The article ends with the observation of the potentiality and proficiency related to the approximation, and consequent articulation, between PCA and the Gadamerian philosophical perspective, with reflections on the implications regarding the use of a hermeneutic-philosophical method in the production of knowledge in the approach.

El presente artículo tiene como objetivo presentar el camino teórico-metodológico, construido por el primer autor en su disertación de maestría bajo la guía del segundo, basado en la filosofía hermenéutica de Hans-Georg Gadamer. Su relevancia se justifica porque es una alternativa estructurada para realizar investigaciones bibliográficas dentro del alcance del Enfoque Centrado en la Persona (ECP). Para eso, se busca inicialmente justificar la elección de la hermenéutica gadameriana en su relación con el objetivo de la investigación. En seguida, presenta-se la red conceptual formada por la articulación de las concepciones prejuicio, lenguaje, tradición, atualización, y fusión de horizontes que sostiene esa perspectiva de forma que permita, posteriormente, sistematizar las fases investigación de las informaciones, analisis comprensiva y síntesis hermenéutica para el desarrollo de la investigación sobre el problema propuesto.El artículo finaliza con la verificación de la potencialidad y rentabilidad relacionadas con la aproximación, y la articulación consiguiente, entre ECP y la perspectiva filosófica gadameriana, con reflexiones sobre las implicaciones con respecto al uso de un método hermenéutico-filosófico en la producción de conocimiento en el enfoque.