Epistemological aspects of participatory design studies conducted in the field of health science.

AIM(S): To discuss the methodological aspects of participatory design, arguing for a three-phase approach and the suitability of situating participatory design within a phenomenological-hermeneutical tradition in health science. DESIGN AND METHODS: Methodological discussion based on participatory design theory, epistemology and research studies. RESULTS: The epistemological and methodological discussions show how the core values and key elements of participatory design align with the phenomenological-hermeneutical approach. In addition, examples of participatory design studies are provided to illustrate how it can be conducted in health science. CONCLUSION: Participatory design is a flexible framework based on genuine participation, defined by three core values: having a say, mutual learning and democratization. The iterative processes allow for adjustments in alignment with the core values and the scientific stance that defines the choice of methods, tools and techniques. A phenomenological-hermeneutic approach in participatory design studies is relevant and aligned with the core values of participatory design. Thus, this paper argues for a close integration between the participatory design methodology and the phenomenological-hermeneutic scientific approach within health science. IMPLICATIONS FOR THE PROFESSION: Participatory design is a powerful methodology with core values that can co-design sustainable health technologies with potential to impact patient care and the clinical practice of nurses. When combined with qualitative research methods, patients' lived experiences serve as the foundation for improving clinical nursing practice. Discussing the epistemological aspects of participatory design provides nurse researchers with a coherent methodological understanding, essential for the continual development of nursing research. IMPACT: This paper discusses the research methodology of participatory design within health sciences. It aims to address the lack of understanding of the methodology, particularly within a specific scientific stance. The main finding is the elaboration on participatory design and the relevance of a phenomenological-hermeneutical approach. The paper has the potential to impact researchers, master's and PhD students, as well as others engaged in participatory design or other methodologies related to user involvement within health science. REPORTING METHOD: No available EQUATOR guidelines were applicable to this methodological paper, as no new data were created or analysed. PATIENT OR PUBLIC CONTRIBUTION: There was no direct patient or public contribution, as this is a methodological paper.

Exploring the lived and coping experiences of patients with kidney failure undergoing haemodialysis in Malaysian private hospitals.

Background: Chronic kidney disease is associated with structural and functional abnormalities in the kidney caused by a range of different aetiologies. Purpose: The study's purpose was to explore the lived and coping experiences of patients with kidney failure undergoing haemodialysis in three private hospitals in Malaysia. Methods: Applying an interpretative phenomenological analysis using a hermeneutic phenomenological design to derive common meaning from participants lived and coping experiences. In the study, data were collected using a semi-structured interview guide from 15 purposefully sampled patients with kidney failure. Data were analysed using the interpretative phenomenological analysis principles. Results: Patients with kidney failure reported emotional distress, life limitations, financial burdens, knowledge deficits and varying perceptions of the haemodialysis treatment. Body image changes, financial assistance, social support and hope were coping strategies used by patients with kidney failure. It was identified that patients with kidney failure used unique coping strategies such as applying perfume and using clothes to conceal the impact of haemodialysis on their bodies, which is not comprehensively discussed in published literature. Conclusion: Nurses who deliver care to patients with kidney failure should focus on mitigating emotional distress, increasing knowledge related to kidney failure and improving perception of the haemodialysis treatment. Delivering and providing social support are indispensable nursing roles to help patients cope with haemodialysis treatment.

Care Integration for Hepatitis C Virus Treatment Through Facilitated Telemedicine Within Opioid Treatment Programs: Qualitative Study.

BACKGROUND: Telemedicine has the potential to remove geographic and temporal obstacles to health care access. Whether and how telemedicine can increase health care access for underserved populations remains an open question. To address this issue, we integrated facilitated telemedicine encounters for the management of hepatitis C virus (HCV), a highly prevalent condition among people with opioid use disorder (OUD), into opioid treatment programs (OTPs). In New York State, OTPs are methadone-dispensing centers that provide patient-centered, evidence-based treatment for OUD. We investigated the integration and impact of facilitated telemedicine into OTP workflows in these settings. OBJECTIVE: This study aims to understand OTP staff experiences with integrating facilitated telemedicine for HCV treatment into OTPs, including best practices and lessons learned. METHODS: We conducted semistructured interviews with 45 OTP staff members (13 clinical, 12 administrative, 6 physicians, and 14 support staff members) at least one year after the implementation of facilitated telemedicine for HCV management. We used hermeneutic phenomenological analysis to understand OTP staff experiences. RESULTS: We identified 4 overarching themes illustrating the successful integration of facilitated telemedicine for HCV care into OTPs. First, integration requires an understanding of the challenges, goals, and values of the OTP. As OTP staff learned about new, highly effective HCV therapies, they valued an HCV cure as a "win" for their patients and were excited about the potential to eliminate a highly prevalent infectious disease. Second, the integration of facilitated telemedicine into OTPs fosters social support and reinforces relationships between patients and OTP staff. OTP staff appreciated the ability to have "eyes on" patients during telemedicine encounters to assess body language, a necessary component of OUD management. Third, participants described high levels of interprofessional collaboration as a care team that included the blurring of lines between disciplines working toward a common goal of improving patient care. Study case managers were integrated into OTP workflows and established communication channels to improve patient outcomes. Fourth, administrators endorsed the sustained and future expansion of facilitated telemedicine to address comorbidities. CONCLUSIONS: OTP staff were highly enthusiastic about facilitated telemedicine for an underserved population. They described high levels of collaboration and integration comparable to relevant integrative frameworks. When situated within OTPs, facilitated telemedicine is a high-value application of telemedicine that provides support for underserved populations necessary for high-quality health care. These experiences support sustaining and scaling facilitated telemedicine in comparable settings and evaluating its ability to address other comorbidities. TRIAL REGISTRATION: ClinicalTrials.gov NCT02933970; https://clinicaltrials.gov/study/NCT02933970.

'Food doesn't control me anymore!' psychosocial experiences during dietary management in adults with inflammatory bowel disease: A qualitative study.

AIMS: To explore the psychosocial experiences during dietary management among Chinese adults with inflammatory bowel disease. DESIGN: Qualitative phenomenological design. METHODS: Eighteen adults diagnosed with inflammatory bowel disease for more than 6 months were recruited using purposive sampling from June to December 2023. Two trained researchers used van Manen's approach to analyse the data. RESULTS: The three themes with multiple subthemes emerged: facing the unknown: at a loss and aggrieved, trying to cope: uncertain and distressed, and growing in adaptation: relieved and transcendent. The first theme included unknown relapses, overlooking diet management and the absence of dietary rules. The second theme showed different coping situations, like complex dietary information and ever-closing worlds. The third theme explores how participants adapted to disease and their eating patterns. CONCLUSION: The psychosocial experiences during dietary management are complex. The accumulation of diet-related experience, acceptance of illness and social support facilitate patients in overcoming negative emotions and adhering to dietary management. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Nurses should provide tailored dietary guidance and appropriate psychological interventions to promote healthy eating in patients. IMPACT: This study may enhance healthcare professionals' understanding, particularly those in China, of the diet-related experiences among patients. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research checklist. PATIENT OR PUBLIC CONTRIBUTION: Participants contributed by sharing their first hand experiences.

Breastfeeding mother's experiences with breastfeeding counselling: a qualitative study.

BACKGROUND: Mothers are recommended to breastfeed their children but can find it challenging and experience breastfeeding problems. Qualified breastfeeding counselling from healthcare professionals can help mothers master breastfeeding, but there is a need to explore mothers' lived experiences with receiving breastfeeding counselling. We aimed to reveal breastfeeding mothers' experiences with receiving breastfeeding counselling from midwives and public health nurses (PHNs) to provide a deeper insight into the phenomenon of breastfeeding counselling, which may improve breastfeeding counselling in practice. METHODS: A qualitative design with a hermeneutic phenomenological approach was used. Individual interviews of 11 breastfeeding mothers from Norway were conducted from September 2021 to 2022. Van Manen's guided existential inquiry guided the reflective process to provide deeper insights into the phenomenon of breastfeeding counselling. RESULTS: The study captured the meaning of breastfeeding mothers' lived experiences with breastfeeding counselling. Three themes and eight sub-themes were found. Breastfeeding was at stake for the mothers because breastfeeding could be reduced or stopped, and qualified breastfeeding counselling from midwives and PHNs was essential for them to establish and continue breastfeeding. They needed to be perceived as both breastfeeding mothers and as women with their own needs to master everyday life during the breastfeeding period. CONCLUSIONS: This study offers insights to midwives, PHNs and others offering breastfeeding counselling by facilitating an understanding of being a breastfeeding mother receiving breastfeeding counselling. Qualified breastfeeding counselling and a trusting relationship with midwives and PHNs are essential for mothers to establish and continue breastfeeding, while deficient counselling may cause breastfeeding difficulties. Mothers need to be treated as whole and competent persons to avoid objectification and fathers/partners need to be included in breastfeeding counselling. The 'Baby-Friendly Hospital Initiative' should be continued, and guidelines should align with the mothers' need to incorporate breastfeeding into their daily lives during the breastfeeding period.

Lived Experience of Human T-cell Leukemia Virus type-1 -Associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP): A Phenomenology Study.

Background: Human T-cell Leukemia Virus type-1 (HTLV-1) -associated myelopathy causes sufferers to experience changes in several aspects of their lives. Gaining a deeper understanding of these changes can help healthcare professionals improve care, enhance strategic decision-making, meet expectations, and manage patients effectively. However, there is no information about the experience and problems of patients with HTLV-1-associated myelopathy/tropical spastic paraparesis in Iran. Therefore, this study aimed to explain the lived experience of patients with HTLV-1-associated myelopathy/tropical spastic paraparesis. Methods: This qualitative study used hermeneutic phenomenology in 2022 in Mashhad, Iran. Participants were selected using purposeful sampling. Data were collected through 21 semi-structured in-depth interviews with 20 eligible patients with HTLV-1-associated myelopathy/tropical spastic paraparesis. The data were analyzed in MAXQDA/2020 using the six stages proposed by Van Manen. Results: The main concept of "Reduced self-sufficiency and social dignity" emerged from the narratives of the patients, which included three main categories "Disruption of desirable personal and social life", "reduced perception of role competencies", and "obligatory unpleasant lifestyle changes". Conclusion: HTLV-1-associated myelopathy/tropical spastic paraparesis slowly makes patients feel insufficient and causes a sense of degradation in dignity. The disease can fundamentally change personal and social life. Thus, due to its incurability and progressiveness, palliative care should be provided to them to live with dignity.

Virtuous Collective Attention.

How can a collective pay attention virtuously? Imagine a group of scientists. It matters what topics they pay attention to, that is, which topics they draw to the foreground and take to be relevant, and which they leave in the background. It also matters which aspects of an investigated phenomenon they foreground, and which aspects they leave unnoticed in the background. If we want to understand not only how individuals pay attention of this kind virtuously, but also collectives, we first need a framework to understand virtuous collective agency. A result of this article will be that virtuous collective action depends on the collective being institutionalized. At the same time, we have to think of the constituents of the collective in terms of practical identities (as opposed to individuals). This is what enables us to understand how a collective can acquire the stability required for virtue, and how we don't end up with a summative account of group virtue, respectively. It will be argued that collectives only have the required stability in their actions when their commitments are habitualized in the form of institutionalized procedures. An Aristotelian understanding of virtue distinguishes between commitment, inclination, and action. Only when a subject's inclination is fully lined up with her commitment, do we arrive at the required stability (of character) for virtuous action. In the case of individuals, to build up an appropriate inclination consists in an inscribing of the commitment into the feelings and body of the subject. If a commitment is fully 'embodied' in this sense, it has formed the individual's inclination accordingly. How can one make sense of this in the case of collective subjects? This article tries to show that for collectives, the embodiment of commitment (the forming of the fitting inclinations) consists in creating policies, procedures, and rules that stabilize the acting according to the commitment, irrespective of the motivation of each individual involved in the collective. Hence, embodiment of commitment, in the case of collectives, is institutionalization. The article then explores what this requirement of institutionalization means for collective attention. The illustration will draw on a distinction between focused and open-minded attention. It will be shown that for either case - focused and open-minded - in order for a collective to pay attention virtuously, it needs to have its commitments institutionalized.

Traditional health practitioners' understanding of spirit possession in Gauteng province, South Africa.

Background: Traditional health practitioners (THPs) understand spirit possession as a cultural or religious spirit occupying a person, while the mental healthcare providers understand it as a mental illness. The different understanding is based on manifestations that mimic that of mental illness, such as seeing and hearing things that others cannot see or hear. Spirit possession holds different meanings in different cultures and religions that could be either beneficial or detrimental. Furthermore, spirit possession is understood as a channel of communication between the living and the dead or God or a supernatural phenomenon in which a spirit owns a person. Aim: This study explored and interpreted THPs' understanding of spirit possession in Gauteng province, South Africa. Method: Hermeneutic phenomenology study explored and interpreted the THPs' understanding of spirit possession in Gauteng province. In-depth individual interviews were conducted with 12 THPs who were selected through snowball sampling techniques. Data analysis followed Heidegger's and Gadamer's philosophies and Van Manen's six steps of the analytic approach. Results: The findings revealed that THPs understood spirit possession as spiritual illness, ancestral calling and demonic spirit or witchcraft. Conclusion: Traditional health practitioners' understanding of spirit possession could promote mental health and prevent mental illness by providing support to a spirit-possessed person and referral to mental healthcare services. Contribution: This study contributed that not all manifestations presented by persons with spirit possession are actual and clear-cut mental illness, but could be unwritten cultural and/ or religious illnesses that needs cultural and religious services also.

Cronicidad: significado construido por los cuidadores y las personas cuidadas / Cronicidade: Significado construído por cuidadores e pessoas cuidadas / Chronicity: Meaning constructed by caregivers and people cared

Introducción: Las enfermedades crónicas no transmisiblesvan en aumento, ocasionando discapacidad y dependenciaen quien la padece, así como la necesidad de un cuidador.La cronicidad es un concepto que se ha analizado desde lamirada de la persona que la padece, dejando un vacío en lacomprensión del significado para el cuidador.Objetivo: Comprender el significado de la cronicidad paralas personas con Enfermedades crónicas no transmisiblesy sus cuidadores informales.Materiales y métodos: Investigación cualitativa fenomenológica-hermenéutica según la propuesta de Van Manen, muestreocasual orientado por criterio, participaron 10 personasenfermas y 9 cuidadores. Los criterios de rigor de credibilidad yconfirmabilidad, confiabilidad y la transferibilidad, garantizaronla calidad del estudio.Resultados: emergieron los siguientes temas: brindar y recibircuidado como un acto de amor; unión de la familia; enfrentarsea la dureza; recibir, brindar y buscar apoyo; estar pendiente;cambio de vida; proceso de aprendizaje; una compañía paratoda la vida; imponer restricciones, limitaciones y pérdidas.Conclusiones: el significado de la cronicidad para loscuidadores y las personas enfermas es complejo, dinámicoy multidimensional; por lo tanto, es necesario realizarintervenciones que ayuden a mitigar el impacto que estaproduce en la vida de este binomio.(AU)

Introduction: Noncommunicable chronic diseasesare rising, causing disability and dependence in theones who suffer from them, as well as the necessityof a caregiver. Chronicity is a concept which has beenanalyzed from the perspective of the ill, leaving a voidin the comprehension of the meaning for the caregiver.Aim: To understand the meaning of chronicity forpeople with non transmissible chronic diseases andtheir informal caregivers.Materials and methods: Qualitative phenomenological-hermeneutic investigation according to the Van Manenproposal, casual sampling orientated by criteria withthe participation of 10 sick people and 9 caregivers.The rigor criteria of credibility and confirmability,reliability, and transferability guaranteed the qualityof the study.Results: The next topics emerged: to offer and receivecare as a love act, family union, facing the hardness,receiving, giving, and looking support, being aware,change of life, learning process, a company for wholelife, imposing restrictions, limitations, and loss.Conclusions: The meaning of chronicity for caregivers andsick people is complex, dynamic, and multidimensionalwhich is why it is important to realize interventionsthat help mitigate the impact in the life of the binomial.(AU)

Introdução: As doenças crônicas não transmissíveisestão aumentando, causando incapacidade e dependênciaem quem as sofre, bem como a necessidade de umcuidador. A cronicidade é um conceito que vem sendoanalisado na perspetiva da pessoa que a sofre, deixandouma lacuna na compreensão de seu significado parao cuidador.Objetivo: compreender o significado da cronicidadepara pessoas com doenças crônicas não transmissíveise seus cuidadores informais.Materiais e métodos: Pesquisa qualitativa fenomenológico-hermenêutica segundo a proposta de Van Manen,amostragem casual orientada por critérios, participaram10 doentes e 9 cuidadores. Os rigorosos critérios decredibilidade e confirmabilidade, confiabilidade etransferibilidade garantiram a qualidade do estudo.Resultados: emergiram os seguintes temas: dar ereceber cuidado como ato de amor; união familiar;enfrentar aspereza; receber, fornecer e buscar apoio;estar pendente; mudança de vida; processo deaprendizagem; uma empresa para a vida; imponharestrições, limitações e perdas.Conclusões: o significado da cronicidade paracuidadores e pessoas doentes é complexo, dinâmicoe multidimensional; portanto, é necessário realizarintervenções que ajudem a mitigar o impacto queisso produz na vida desse binômio.(AU)

Nursing Students' Perception of Missed Perioperative Nursing Care: Hermeneutic Phenomenology.

PURPOSE: Missed nursing care is a condition that is likely to be encountered frequently in the surgical care process and is generally related to the educational and emotional needs of the patients. Perception of and witnessing missed care can affect nursing images, expectations, and experiences by causing nursing students to experience professional disappointment. The purpose of the study was to explore nursing students' perception of perioperative missed nursing care (PMNC) according to "role theory" and Benner's "novice to expert" theories. DESIGN: The study used a qualitative design based on Heidegger's hermeneutical phenomenological approach. METHODS: Study data were collected using a semistructured interview form prepared by the researchers through face-to-face interviews lasting approximately 50 minutes. The analysis of the data was conducted using van Manen's thematic analysis. The Standards for Reporting Qualitative Research checklist was used in reporting the study. FINDINGS: This study, which was conducted to explore awareness of PMNC, consisted of 12 students, including five males and seven females. It was understood that nursing students noticed PMNC in clinical practice, experienced internal conflict about the issue, were concerned about the image of nursing, and experienced role and professional identity confusion. The themes of the study were formed in light of these experiences of nursing students. Three themes and 11 subthemes emerged in the study. The themes of the study were (1) perceived PMNC application-behavior patterns, (2) internal reflections of PMNC-its impact on professional identity development, and (3) perceptions of professionalism in perioperative nursing. CONCLUSIONS: This study provided important data about the awareness of PMNC in the surgical clinical practice of nursing students in Turkey and the effects of this awareness on the professional roles and professional identity process. Students were aware of the behavioral patterns of PMNC and that they experienced internal conflict, anxiety about the nursing image, role confusion, and professional identity confusion due to this awareness. Some students justified the PMNC behaviors of the nurses and others saw themselves as the power to change the PMNC behaviors.

In pursuit of credibility: Evaluating the divergence between member-checking and hermeneutic phenomenology.

Credibility refers to the trustworthiness, genuineness, and plausibility of the research findings and has always been a contentious issue in qualitative research, particularly for those conducting studies on the hermeneutic phenomenology paradigm. The relationship between credibility and high qualitative research is noted by many qualitative scholars. Member checking, also known as participant or respondent validation, is a technique for exploring the credibility of results where data or results are returned to participants to check for accuracy and resonance with their experiences. Although member-checking has long been accepted as the gold standard in quantitative research, research shows that it is not the pinnacle for expressing rigor in Heideggerian hermeneutic phenomenology because it contradicts many of the underpinning philosophies. Within this article the author explores how member checking has been used in published research and presents a brief overview of the various discourses on member checking in qualitative research. The author discusses the importance of evaluating whether the method fits with the theoretical position of a study and the importance to consider how member checking was undertaken and for what purpose. It is essential that researchers are transparent about what they hope to achieve with the method and how their claims about credibility and validity fit with their epistemological stance.

On the Spot Scaffolding as the Hermeneutic Phenomenology Action Field: Critical Thinking Case for Medical Students in Iran.

Background: A major contribution to the humanities literature has been the development and application of Vygotsky's sociocultural theory in relevant fields. Constructivism as a paradigm is owed to Vygotsky and his efforts. On-the-spot scaffolding in this regard is one of the innovations that can be triangulated with hermeneutic phenomenology to pave the way for a paradigm shift in the educational system in a broad view and for critical thinking for medical students in a narrow view. This study aimed to illuminate the other side of the behavioristic lesson plan, which is on-the-spot scaffolding in implementing one of the modules of essential skills for doctors of medicine (Adab-e Pezeshki), which is critical thinking. Methods: This study was qualitative and longitudinal. It is longitudinal due to the 3 years of involvement and qualitative due to the study design approach and the use of discourse analysis and hermeneutic phenomenology as tools. Results: Three main findings emerged from the study's qualitative nature: first, students who attended the sessions or who merely completed the assignments created an on-the-spot critical thinking scaffolding design, which is an alternative to a behavioristic lesson plan; and second, the students wrote numerous movie reviews in both Persian and English. One of the components of reflective autobiography is these film critics and a student-written, instructor-edited paper submitted to ICHPE 2023. Conclusion: There is an urgent need for a paradigm shift and comparative-historical investigations in the medical education system in Iran.

Ghanaian women's experiences of unsuccessful in-vitro fertilisation treatment, unravelling their meanings: a Heideggerian hermeneutic phenomenological study.

BACKGROUND: Women having experienced infertility over a period usually decide on an option for an invitro fertilisation treatment (IVF). However, in the quest to seek help and to be part of motherhood, they sometimes become unsuccessful in their fertility journey. The researchers aimed to explore the meanings and emotions attached to infertility and unsuccessful invitro fertilisation (IVF) treatment among Ghanaian women, as this area of inquiry is less explored in Africa and specifically in the Ghanaian context. METHODS: The study followed a qualitative approach and drew inspiration from the Heideggerian phenomenological philosophy and design. Six (6) women, aged between 29 and 40 years, who had experienced at least one unsuccessful IVF cycle, were purposefully selected from a private specialist fertility hospital in Kumasi, Ghana. One-on-one interviews were conducted with the participants, and the interviews were transcribed verbatim. The collected data was analyzed using Van Manen six-step framework, which helped to uncover the existential meanings and interpretations these women ascribed to their experiences. RESULTS: The results of the study revealed four main themes that were deemed essential aspects of meaning for the participants. These themes were: (1) Experiencing an Existential Faith and Hope. The participants described their journey through infertility and invitro fertilisation (IVF) treatment as a profound test of their existential faith and hope finding strength in maintaining a positive outlook despite the challenges and setbacks they faced., (2) Facing up to the Angst: This theme highlights the participants' courage in confronting the emotional dimensions of their struggles. The women acknowledged and confronted their anxieties, fears, and emotional distress associated with their infertility and unsuccessful IVF treatment., (3). Non-disclosedness: This theme refers to the participants' experiences of keeping their struggles with IVF treatment private, often due to societal and cultural factors. (4). Endured feelings of inadequacy of being-in-the-world-of-motherless: Participants expressed feelings of inadequacy, self-doubt, and a sense of being incomplete due to their inability to conceive and fulfill the societal role of motherhood. Their narratives revealed the profound impact of societal expectations on their self-perception and identity. CONCLUSION: The study's findings reveal insights into the experiences and interpretations of infertility and unsuccessful IVF treatment among Ghanaian women. Employing Heideggerian hermeneutics, the research elucidates the diverse existential, emotional, and societal aspects inherent in the struggles of infertility. The multifaceted nature of these women's journeys underscores the significance of a comprehensive approach to infertility care that recognizes the cultural, social, emotional, and existential dimensions of the IVF process. Additionally, the study emphasizes the necessity for culturally sensitive support systems and interventions to address the unique challenges faced by this population.

Role cognition of assigned nurses supporting Hubei Province in the fight against COVID-19 in China: a hermeneutic phenomenological study.

Aims: During the COVID-19 epidemic, nurses played a crucial role in clinical treatment. As a special group, front-line nurses, especially those assigned to support Hubei Province in the fight against COVID-19 between February and April 2020, brought diverse experiences from different provinces in China in taking care of COVID-19 patients and role cognition. Therefore, our purpose is to explore the real coping experience and role cognition of front-line nurses during the novel coronavirus outbreak to provide relevant experience references for society and managers in the face of such major public health emergencies in the future. Design: This qualitative study was performed using the phenomenological hermeneutics method. Method: This is a qualitative phenomenological study. Semi-structured in-depth interviews were used to collect data. The interviewees were 53 front-line nurses who assisted and supported the fight against COVID-19 in Hubei Province during the COVID-19 epidemic. Data were collected through individual online and telephone interviews using a semi-structured interview during March 2020. The COREQ guidance was used to report this study. Results: The findings revealed that front-line nurses assisting in the fight against COVID-19 developed a context-specific role cognition of their work and contribution to society. The qualitative analysis of the data revealed 15 sub-categories and 5 main categories. These five themes represented the different roles identified by nurses. The roles included expectations, conflicts, adaptation, emotions, and flow of blessing. Belief in getting better, a sense of honor, and training could help them to reduce feelings of conflict in this role and adapt more quickly. Discussion: This article discusses the real coping experience and role cognition of front-line nurses during the novel coronavirus epidemic. It provides relevant experience references for society and managers to face similar major public health emergencies in the future. This study makes a significant contribution to the literature because it demonstrates how non-local nurses sent to Hubei to work perceived their roles as part of a larger narrative of patriotism, duty, solidarity, and hope.

Discovering clinical phronesis.

Phronesis is often described as a 'practical wisdom' adapted to the matters of everyday human life. Phronesis enables one to judge what is at stake in a situation and what means are required to bring about a good outcome. In medicine, phronesis tends to be called upon to deal with ethical issues and to offer a critique of clinical practice as a straightforward instrumental application of scientific knowledge. There is, however, a paucity of empirical studies of phronesis, including in medicine. Using a hermeneutic and phenomenological approach, this inquiry explores how phronesis is manifest in the stories of clinical practice of eleven exemplary physicians. The findings highlight five overarching themes: ethos (or character) of the physician, clinical habitus revealed in physician know-how, encountering the patient with attentiveness, modes of reasoning amidst complexity, and embodied perceptions (such as intuitions or gut feeling). The findings open a discussion about the contingent nature of clinical situations, a hermeneutic mode of clinical thinking, tacit dimensions of being and doing in clinical practice, the centrality of caring relations with patients, and the elusive quality of some aspects of practice. This study deepens understandings of the nature of phronesis within clinical settings and proposes 'Clinical phronesis' as a descriptor for its appearance and role in the daily practice of (exemplary) physicians.

The experience of being in acute emergency care following an overdose with suicidal intent: A hermeneutic phenomenological study.

INTRODUCTION: Nurses working within Emergency Departments are frequently required to care for individuals impacted by suicidal behaviour. LITERATURE REVIEW: Published research into the experience of such individuals in emergency care, is limited. Studies identified do not distinguish between self-harming and suicidal behaviour and do not reveal the lived experience in depth. AIM AND METHODOLOGY: This research reveals the lived experience of being in emergency care following an overdose with suicidal intent, through the collection of data while patients are still in hospital. Sixteen semi-structured interviews were conducted with patients on a medical admission ward. The research uses an interpretive hermeneutic phenomenological approach. ANALYSIS: A thematic analysis indicated six key themes: The fear of death and dying, The hospital - a place of safety, Loved ones a reason to live, Feelings of hopelessness, Eclipsed as a suicidal patient, and the Impact of human relationships. DISCUSSION: The findings are discussed and contextualized within wider literature: The fear of death, hopelessness, the role of stigma and shame, including anticipatory stigma, and the impact of kindness and relationships. Implications for practice are outlined, informing how care can be enhanced by nursing staff.

Attuning to the World of Peace of Mind and Trust: Women's Lived Experience of the Woman-Midwife Relationship in Japan.

In Japan, many pregnant women and mothers suffer from anxiety, depression, and other postnatal issues that can be exacerbated by their birth experiences. While benefiting from advanced medical care, these women's mental and psychological health may be disregarded in their maternity care. Midwives have the potential to play a significant role in improving women's birth experiences. Hence, this study aimed to explore the meaning of the woman-midwife relationship, with a specific focus on sensing peace of mind and trust to improve women's birth experiences. Using a hermeneutic phenomenological approach, 14 Japanese women were interviewed. Sensing peace of mind and trust was one of the significant meanings of the woman-midwife relationship and is articulated across five themes: (1) attuning to the world, (2) different kinds of safety and trust, (3) relying on and entrusting midwives, (4) making a mother, and (5) an emotional bridge. The positive relationship with midwives enhanced the women's mental well-being through allowing the women to attune to the peaceful mind which directed their future perspectives and sustained them in motherhood. They became confident mothers by trusting their midwives. The maternity care system in Japan needs to shift to more relationship-based care to ensure continuity of midwifery care that will improve women's birth experiences and their long-term well-being.

Interventions and contextual factors to improve retention in care for patients with hypertension in primary care: Hermeneutic systematic review.

BACKGROUND: Regular engagement over time in hypertension care, or retention, is a crucial but understudied step in optimizing patient outcomes. This systematic review leverages a hermeneutic methodology to identify, evaluate, and quantify the effects of interventions and contextual factors for improving retention for patients with hypertension. METHODS: We searched for articles that were published between 2000 and 2022 from multiple electronic databases, including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, clinicaltrials.gov, and WHO International Trials Registry. We followed the latest version of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guideline to report the findings for this review. We also synthesized the findings using a hermeneutic methodology for systematic reviews, which used an iterative process to review, integrate, analyze, and interpret evidence. RESULTS: From 4686 screened titles and abstracts, 18 unique studies from 9 countries were identified, including 10 (56%) randomized controlled trials (RCTs), 3 (17%) cluster RCTs, and 5 (28%) non-RCT studies. The number of participants ranged from 76 to 1562. The overall mean age range was 41-67 years, and the proportion of female participants ranged from 0% to 100%. Most (n = 17, 94%) studies used non-physician personnel to implement the proposed interventions. Fourteen studies (78%) implemented multilevel combinations of interventions. Education and training, team-based care, consultation, and Short Message Service reminders were the most common interventions tested. CONCLUSIONS: This review presents the most comprehensive findings on retention in hypertension care to date and fills the gaps in the literature, including the effectiveness of interventions, their components, and contextual factors. Adaptation of and implementing HIV care models, such differentiated service delivery, may be more effective and merit further study. REGISTRATION: CRD42021291368. PROTOCOL REGISTRATION: PROSPERO 2021 CRD42021291368. Available at: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291368.

Facing a new life-The healthy transition to motherhood: What individual and environmental factors are needed? A phenomenological-hermeneutic study.

OBJECTIVE: The aim of the study was to highlight first-time mothers' experiences of the transition to motherhood uncovering personal and environmental conditions facilitating or preventing the process of a healthy transition in a Swedish context. DESIGN: A qualitative study with interview data analyzed using a phenomenological hermeneutic method. SETTING AND PARTICIPANTS: Ten recent first-time mothers were selected from three primary healthcare centers in western Sweden. FINDINGS: Four themes emerged, and the transition could be divided into several phases, interpreted as facing a new life, while feeling unprepared for identity and existential issues. The experience of becoming a mother was described as oscillation between a loss of former identity from previous life, and on the other hand, the joy and expectations of forming a new family. The mothers had high demands of themselves, often influenced by social media and needed to value the flow of information and `let go of control` to be able to make adequate decisions. The close family of origin was invaluable in this process being able to provide confirmation in the new role, facilitating the development of their own security and self-confidence. KEY CONCLUSIONS: The vulnerability expressed by new mothers shows that support from the family of origin, partners and professionals are indispensable. The desired result after the transition to motherhood is a prosperous, maturity and confident mother. The main promoting factor in this process seems to be having a safe base that can provide required support. IMPLICATIONS FOR PRACTICE: The level of wellbeing after the transition is crucial and the possibility of a warm, responsive and secure parenting needs to be strengthened. The challenge to preventive health care will be to identify a lack of support and ensure that these mothers gain sufficient support to meet today´s demands and still feel that they are good enough mothers for their children.

Moving between doing and being-Meanings of person-centredness as narrated by nursing home managers. A phenomenological hermeneutical study.

AIM: This study aimed to illuminate meanings of person-centredness as narrated by nursing home managers in nursing homes rated as highly person-centred. DESIGN: A phenomenological hermeneutical approach was used. METHODS: Twelve nursing home managers in 11 highly person-centred nursing homes in 7 municipalities in Sweden were included in this interview study. The findings were interpreted, reflected and discussed through the lens of Ricoeur. RESULTS: Meanings of person-centredness could be understand as moving between doing and being through knowing, sensing, sharing and giving for person-centredness. These aspects contributed via knowledge, understanding, interaction and action that involved doing for and being with older persons through these caring dimensions. By moving between doing for, being with and being part of the overall nursing home narrative, knowing, sensing, sharing and giving could support the persons' identity in different ways. This may also contribute to sense-making, preserving dignity and promoting self-esteem when aiming to provide a good life for older persons in nursing homes, within an ever-present ethical frame. NO PATIENT OR PUBLIC CONTRIBUTION: This study illuminated meanings of person-centredness as narrated by nursing home managers. No patient of public contribution was investigated.