Listening to Patients A Phenomenological Approach to Nursing Research and Practice Sandra P Thomas, PhD, RN, FAAN, is Professor and Director of the PhD Program in Nursing at the University of Tennessee in Knoxville Her initial nursing preparation was at St Mary's Hospital School of Nursing She holds bachelor's, master's, and doctoral degrees in education, majoring in educational psychology She also earned a master's degree in nursing, with clinical specialization in mental health nursing; her nursing practice and research have primarily focused on women's anger, stress, and depression Her program of research received the Chancellor's Award for Research at the University of Tennessee She is the editor of Issues in Mental Health Nursing and the author of over 80 journal articles, books, and book chapters She is a member of the American Nurses Association, the American Psychological Association, and Sigma Theta Tau International She is a board member of the International Council on Women's Health Issues and a charter member of the Southern Nursing Research Society In 1996, she was named a Fellow of the American Academy of Nursing In 1999, she became a Fellow of the Society of Behavioral Medicine, Howard R PeUio, PhD, is Alumni Professor of Psychology at the University of Tennessee in Knoxville He received his bachelor's and master's degrees in psychology from Brooklyn College and his PhD in experimental psychology from the University of Michigan His areas of specialization include learning and thinking, college teaching, figurative language, humor, and existential-phenomenological approaches to psychology He has published over 120 journal articles, book chapters, and books He was the founding editor of the journal Metaphor and Symbol, He has been president of the Southeastern Psychological Association and a Phi Beta Kappa national lecturer He is a Fellow of two divisions of the American Psychological Association and has received a number of teaching and research awards Listening to Patients A Phenomenological Approach to Nursing Research and Practice Sandra P Thomas, PhD, RN,FAAN Howard R, Pollio, PhD Springer Publishing Company Copyright C 2002 by Springer Publishing Company, Inc All rights reserved No part of this publication may be reproduce4 stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, Inc Springer Publishing Company, Inc 536 Broadway New York, NY 10012-3955 Acquisition Editor: Helvi Gold Production Editor: Jeanne Libby Cover design by Susan Hauley 01 02 03 04 OS/ Library of Congress Cataloging-in-Publkation Data Thomas, Sandra P, Listening to patients : a phenomenological approach to nursing / Sandra P Thomas, Howard R Pollio p cm Includes bibliographical references and index ISBN 0-8261-1466-0 Nurse and patient Existentialism Interpersonal communication Patients—Counseling of Nursing—Philosophy I, Pollio, Howard R II Title [DNLM: Nurse-Patient Relations Attitude to Health Existentialism 4, Patients—psychology Philosophy, Nursing WY87T4615L2001] RT42.T48 2001 610.73'06'99—dc2! 2001034183 Printed in the United States of America by Sheridan Books, Inc This book is dedicated to the patients who shared their experiences with us We are hopeful that nurses everywhere will hear their voices This page intentionally left blank Contents Preface Acknowledgments IX xiii I Phenomenology and Nursing The Patient, the Nurse, and the Philosopher; Seeing Rose Through the Eyes of Merleau-Ponty If a Lion Could Talk: Phenomenological Interviewing and Interpretation 20 II Nursing and the Human Experience of the Human Body The Human Experience of the Human Body 51 "It's Like Getting Kicked by a Mule": Living With an Implanted Defibrillator 62 "Now It's Me and This Pain": Living With Chronic Pain 73 III Nursing and the Human Experience of Other People The Human Experience of the World of Others 97 "We AH Became Diabetics": The Experience of Living With a Diabetic Sibling 109 "Walking in the Dark": The Experience of Living With a Daughter Who Has an Eating Disorder 124 "She Became an Alien": The Father's Experience of Living With Postpartum Depression 140 vii viii Contents IV, Nursing and the Human Experience of Time 10 The Human Experience of Time 153 11 "One Day You're Working and the Next Day You're an Invalid": Recovering After a Stroke 163 12 " The Point of No Return": Formerly Abused Women's Eiperience of Staying Out of the Abusive Relationship 177 13 "It Was the Dark Night of the Soul": Wresting Meaning From a Time of Spiritual Distress 190 V Nursing and the Human Experience of the World 14 The Human Experience of the Non-Human World 205 15 "Eventually It'll Be Over": The Dialectic Between Confinement and Freedom in the World of the Hospitalized Patient 214 16 "Like a Bunch of Cattle": The Patient's Experience of the Outpatient Health Care Environment 237 Epilogue 253 References 259 Index 285 Preface This book began with a casual remark, a jaunty little exchange between an experimental psyehologist-turned-phenomenologist (Howard) and a psychiatric nurse-turnedresearcher (Sandra) who had studied phenomenology with Howard in 1981 and later developed a fuller appreciation of its relevance for the discipline of nursing For nearly a decade, the two of us have collaborated in leading an interdisciplinary phenomenology research group on Tuesday afternoons Sparked by discussion among the group, this book was conceived on one of those Tuesdays, Our brief exchange that afternoon went something like this: "Why don't we write a book for nurses?" "Great idea! I'll draft a prospectus." After Ursula Springer concluded that the prospectus had merit and invited us to proceed with the book, a great deal of new learning and hard thinking was required before we could complete it The process of writing this book has deepened not only our knowledge and appreciation of existential phenomenology but also our mutual respect for each other as scholars and as people At times we knew what we wanted to say to nurses but struggled to find ways to say it Writing is always a humbling experience The philosopher Maurice MerleauPonty, on whom we rely heavily for inspiration, understood how writers must grope for the right words to communicate with their readers How true we found his observation that "writers experience the excess of what is to be said beyond their ordinary capacities" (The Prose of the World, 1973, p, 57) At other times, we really did not know what we thought about a topic until we wrote about it Putting words on paper, and then repeatedly revising them, eventually clarified our thoughts Again, MerleauPonty was prescient: "Many writers begin a book without knowing exactly what they are going to put in it" (The Phenomenology of Perception, 1962, p 177) Eventually, all the words were on paper It is our hope that readers will sense our passion for existential phenomenology and understand our conviction that it provides a basis for a new dimension of nursing science and practice Who are the potential readers of this book? As we wrote, we thought of graduate students and faculty, certainly, but we also meant to speak directly to clinicians, in all specialty areas of nursing, who might be interested in hearing about a humanistic philosophy and research methodology that has the potential to illuminate the deeper meanings of health crises and universal human experiences such as pain and spiritual distress or 280 References Stranahan, S, (2001) Spiritual perception, attitudes about spiritual care, and spiritual practices among nurse practitioners Western Journal of Nursing Research, 23, 90-104, Straus, E (1947), Disorders of personal time in depressive states Southern Medical Journal, 40, 254-259 Straus, E (1964) Chronognosy and chronopathy In E Strais (Ed,), Phenomenology: Pure and applied The First Lexington Conference Pittsburgh: Duquesne University Press Straus, M (1976) Sexual inequality, cultural norms, and wife beating Victimology: An International Journal, 1, 54-76 Sunderland, S (1978) Nerves and nerve injuries, 2nd ed Edinburgh: ChurchillLivingston Swanson, K, M, (1991) Empirical development of a middle range theory of caring Nursing Research, 40, 161-166, Swanson, K M (1993), Nursing as informed caring for the well-being of others Image: Journal of Nursing Scholarship, 25(4), 352-357, Tait, R C., & Chibnall, J T, (1997) Physician judgments of chronic pain patients Social Science and Medicine, 45, 1199-1205 Tanner, C., Benner, P., Chesla, C., & Gordon, D (1993) The phenomenology of knowing the patient Image: Journal of Nursing Scholarship, 25, 273-280 Taylor, A G., Skelton, J A,, & Butcher, J (1984) Duration of pain condition and physical pathology as determinants of nurses' assessments of patients in pain Nursing Research, 33, 4-8 Taylor, E., Highfield, M., & Amenta, M (1994) Attitudes and beliefs regarding spiritual care Cancer Nursing, 17(6), 479—487, Taylor, S., & Epstein, R (1999) Living well with a hidden disability Oakland, CA: New Harbinger Publications Taylor, S C (1980) The effect of chronic childhood illnesses upon well siblings Maternal-Child Nursing, 9(2), 109-116 Teplitz, L., Egenes, K I, & Brask, L (1990) Life after sudden death: The development of a support group for automatic implantable cardioverter deflbrillator patients Journal of Cardiovascular Nursing, 4(2), 20-32 Thomas, S, P (1998) Transforming nurses' anger and pain: Steps toward healing New York: Springer Publishing Thomas, S P (2000) Response by Thomas Western Journal of Nursing Research, 22(6), 702-705 Thomas, S P., & Donnellan, M M (1993) Stress, role responsibilities, social support, and anger In S, P Thomas (Ed,), Women and anger (pp 112-128) New York: Springer Thomas, S P., & Droppleman, P G Channeling nurses* anger into positive interventions Nursing Forum, 32(2), 13-21, Thomas, S P., McCoy, J D., & Martin, R (2000, August) Men's anger: A phenome- References 281 nalogical exploration of its meaning Poster presented at the annual meeting of the American Psychological Association, Washington, DC, Thomas, S, P., Shattell, M., & Martin, T (2001, February) The phenomenal world of the hospitalized psychiatric patient Paper presented at the Second International Interdisciplinary Conference "Advances in Qualitative Methods," Edmonton, Alberta, Canada, Thomas, S P., Smucker, C., & Droppleman, P (1998) It hurts most around the heart: A phenomenological exploration of women's anger Journal of Advanced Nursing, 28(2), 311-322 Thompson, C,, Locander, W., & Pollio, H R (1989) Putting consumer experience back into consumer research: The philosophy and method of existential-phenomenology Journal of Consumer Research, 16, 133-146 Thompson, J K., Heinberg, L 1, Altabe, M., & Tartleff-Dunn (1999) Exacting beauty, Washington, DC: American Psychological Association Press Thome, S,, & Paterson, B, (1998) Shifting images of chronic illness Image: Journal of Nursing Scholarship, 50(2), 173-178, Thweatt, M (2000) The experience of being lost Unpublished doctoral dissertation, the University of Tennessee, Knoxville Travelbee, J (1971) Interpersonal aspects of nursing (2nd ed.) 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Advances in Nursing Science, 22(2), 25-38 Wolf, B, (1977) Living with pain New York: Seabury, Wolf, Z (1988), Nurses work: The sacred and the profane Philadelphia: University of Pennsylvania Press, Wood, A., Meighan, M., Thomas, S P., & Droppleman, P G (1997) The downward spiral of postpartum depression MCN, The American Journal of Maternal Child Nursing, 22, 308-317, Woodside, A,, Nielsen, R., Walters, E, Muller, G (1988) Preference segmentation of health care services: The old-fashioneds, value conscious, affluents, and professional want-it-alls Journal of Health Care Marketing, 8(2), 14-24 Wuest, I, & Merritt-Gray, M (1999) Not going back: Sustaining the separation in the process of leaving abusive relationships Violence Against Women, 5(2), 110-133 Yalom, I (1980) Existential psychotherapy New York: Basic Books, Zalon, M L (1997) Pain in frail, elderly women after surgery Image: Journal of Nursing Scholarship, 29(1), 21-26 Zipfel, S., Lowe, B., Reas, D L., Deter, H., & Herzog, W (2000) Long-term prognosis in anorexia nervosa: Lessons from a 21-year follow-up study The Lancet, 355(9205), 721-722, This page intentionally left blank Index Aging population, 163 Abusive relationships: bracketing interview, 180-181 developmental stages, 183 duration of abuse, 181-182 figural themes, 183-187 frequency of abuse, 181 learned helplessness, 179 leaving, 179-180,182 legal protection, 178 nursing practice, implications of, 188-189 partner abuse, reasons for, 178-179 point of no return, 182, 189 post-study reflections, 189 time of recovery, 183 Acceptance, chronic pain patients, 85-86 Accreditation, 91 Acknowledgment, of eating disorders, 129 Activity, human body experience, 59 Adaptation, to chronic illness, 123 AIDS, 60, 90 Alienation, in meaning of nature, 210 Allegory, 23 Alzheimer's disease, 212 Ambulatory surgery centers, see Outpatient health care environment American Diabetic Society, 112 American phenomenology, 11 Analgesia, 77, 80 Anger: maternal, 134-135 paternal, 144 Anorexia nervosa (AN), 57-58,125-126 See also Eating disorders Anosognosia, 55 Anti-constractionists, Anti-reductionism, Anxiety, AICD recipients, 69-70 Aphasia, 169, 175 Appearance: body image as, 56-58 human body experience, 59 Arendt, Hannah, 90 Assimilation, AICD recipients, 65, 71 Authenticity, 103 Automatic implantable cardioverter-defibrillator (AICD), living with: bracketing interviews, 64 cardiac events leading to implantation, 64-66 conflicting emotions, 70 development of, 62 nursing practice, implications of, 71 post-study reflections from Stephen Krau, 71-72 research literature, 63 shock sensation of participants, 65-66 thematic meaning, 66-70 Autonomy, 126 Bachelard, Gaston, 207 Beauty, in meaning of nature, 210-211 Beauty and awe theme, non-human world, 207 Beddoe, Suzanne, 48 Bedside manner, 16 Being-in-the-world, 14, 18, 57,206 Beings-in-relation, 256 Being- with-others, 14 255 286 Belief system, spiritual distress and, 198-199 Benchmarks, significance of, 153-154 Benefit themes, 107,137-138 Berg, I H, Van den, 106 Binge eating, 118 Body-as-self, 52 Body dissatisfaction, 58 Body image: as appearance, 56-58 perceptions of, 53-54 phantom limbs, 54—56 Body object, 52-53 Body subject, 52-53 Bracketing interview: abusive relationships, 180-181 AICD, living with, 64 characteristics of, 32-34 chronic pain, 77, 80 confinement and freedom of hospitalized patients, 218-220 diabetic sibling, 112-113 eating disorders, 127 outpatient health care environment, 240-241 postpartum depression (PPD), 142 spiritual distress, 193 time, human experience of, 166 Breaking the Web, spiritual distress: case illustration, 195 characteristics of, generally, 199 defined, 194 falling apart, 196,200 instability, 196 pain, 196 "something beyond," 197 wondering, 196-197 Briscoe, Dianne, 93 Buber, Martin, 7,48, 104,106 Bulimia, 57-58,125 See also Eating disorders Calendars, 155-156,159 Camus, Cannon, Walter B., 52 Care providers, characteristics of, Index Cared for theme, outpatient health care environment, 247-249 Caring, defined, Carr, David, 15 Catharsis, 25 Change and Continuity theme, in time experience, 161 Change and Permanence theme, in meaning of nature, 210 Chinn, Peggy, Choice/No choice theme, AICD recipients, 66-67 Chronic pain: bracketing interviews, 77, 80 coping skills, 80-81, 85-89 defined, 77 descriptions of, 80-81 figural themes, 81-89 impact of, generally, 73-74 limitations of, 81-82, 90 nursing practice, implications of, 91-93 physiologic mechanisms, 75-76 post-study reflections, 93 present research, overview, 76-77 qualitative studies, 74-75 quantitative studies, 75-76 separation from other people theme, 84 Chronic Pain Self-Management Program (CPSMP), 92 Chronological age, significance of, 154-155 Cold and Not Inviting theme, outpatient health care environment, 243-244 Comfort, 6,60, 69 Communicable diseases, 60 Communication: chronic pain patients and, 91 family systems and, 122 importance of, 8, 254-255 in outpatient health care environment, 250 Comparison themes, 107, 137-138 Confidentiality, 31, 180 Confinement and freedom, hospitalized patients: bracketing interview, 218-220 nursing practice, implications of, 234-235 post-study reflections, 235-236 Index thematic structures, 220-234 Conflict resolution, AICD recipients, 69 Confusion, maternal, 136 Connectedness, 170,173 Connecting-separating, 70-71 Connection theme: chronic pain patients, 88 in meaning of nature, 210 non-human world, 207 in relationships, 103-104,107 stroke recovery patients, 166,168-170 Consent form, 32 Continuity theme, stroke recovery patients, 171-172 Control, loss of, 145 Control theme, in time experience, 168 See also Powerlessness Conversational interviews, 24 Coping skills: chronic pain patients, 80-81, 85-89 eating disorders and, 131-132 Corporeality, human body experience, 59 Cosmetic surgery, 57 Credibility, in nursing diagnosis, 191-192 Cues, in phenomenological interviews, 28 Cumulative Index to Nursing and Allied Health Literature (CINAHL), 192 Danger and Safety theme, in meaning of nature, 210 Dasein, 16-18, 103 Davis, Mitzi, 139 Death: meaning of, 193-194 time concepts and, 162 Debriefing, 30 Deciding theme, chronic pain patients, 89 Decision-making process, 72 Deconstruetkm, 106 Dehumanizing care, 239,245-246,254 Denial, chronic pain patients, 85-86 Dependence-disability theme, stroke recovery patients, 166, 170-171 Depression: in AICD recipients, 69-70 chronic pain and, 75 287 severe, 158 stroke recovery patients, 164-165 Derrida, 12 Descartes, 52 Descriptive phenomenology, 10-12 Detachment, 101 Diabetic sibling: bracketing interview, 112-113 burden of, 119 empathy, 118 etiology of, 114 family patterns, changes in, 113—114 fear, 115-116 guilt and, 115, 118-119 impact of, generally, 109-110 isolation, 115-116 jealousy toward, 115 post-study reflection, 123 preferential treatment of, 114 relationship changes, 116-117 responsibility without power, 117-118 sadness, 118 sibling relationship, changes in, 114 stressorsof, 110,121 worry, 117 Dialogue, existential philosophers on, 103-104, 257 Difficult patients, 102 Dilaudid, 809 Disconnectedness, 169-170 Disconnection/connection theme, in hospitalized patients: generally, 234-235 medical patients, 224-226 psychiatric patients, 230-231 Disconnection from others theme, stroke recovery patients, 166, 168-170 Discontinuity theme, stroke recovery patients, 171-173 Disorientation, 157-159 Doctor-patient relationship, 174 Domestic abuse, see Abusive relationships Duquesne school, 11 Early life relationships, significance of, 98 Eating disorders: 288 Index acknowledgment from others, 129 anger, maternal, 134-135 bracketing interview, 12? confusion, maternal, 136 consumption by, 130-131 coping skills, 131-132 etiology of, 124-125 family dynamics and, 125-126 fear, maternal, 135-136 figural themes, 128 guilt, maternal, 135 heartbreak caused by, 133-134,137 helplessness and, 136 incidence of, 125 ineptoess, maternal, 136 long-term effects, 57,133 nursing practice, implications of, 138-139 post-study reflections, 139 responsibility for, 130,132-133 sample selection, 127-128 suspicion of, 128-130 thematic aspects of, 133-136 Eidetic phenomenology, 10-12 Embodiment, Merleau-Ponty philosophy, 12 Emergency room, outpatient health care, 242-243 Empathy, diabetic sibling and, 118 Empowered theme, in abusive relationship, 181, 185-187 Empowerment, 25, 185-187 Enabling-Iimiting theme, AICD recipients, 70 Endurance theme, chronic pain patients, 86-87 Engagement, in human body experience, 58-59 Ethics, 32 European phenomenology, 11 Evaluating theme, chronic pain patients, 89 Eventually it'll be over theme, in hospitalized patients, 221-222 Existential phenomenology: applications of, characteristics of, 4,6-9 historical perspective, 9-10 Existential-phenomenological study, 44-46 Existenz, 16,18 Expression of self, human body experience, 59 Eye contact, 250 Falling apart, in spiritual distress, 196, 200 Family decision-making, 72 Family patterns, changes in, 113-114, 130 Fast and Slow theme, in time experience, 161 Fear: in abusive relationship, 182 diabetic sibling and, 115-116 outpatient health care environment theme, 247-249 Feedback, phenomenological interview, 38 Ferlic, Anne, 10 Field notes, phenomenological interview, 29 Figure drawings, body image and, 56-57 Figure/ground phenomena, 17-19 First-person perspective, 15,19,25,43, 46-47, 59 Flowers, meaning of, 212 Follow-up, to phenomenological interview, 29 Form, in role performance, 102 Frank!, 17 Freedom, 16-17 Functioning intentionality, 15-16 Gadamer, 7, 160 Generalizability, phenomenological, 41-43 Generalized other, 99 Gestalt, 16 Goffman, Erving, 100 Good/bad theme, in abusive relationship, 183-184 Guilt, diabetic sibling and, 110,115,118-119 Healing, 25 Heidegger, 82,90,103,106,160, 162,205, 257 Heideggerian hermeneutics, 7, 10,12,16 Helplessness, 83 Helpless theme, in abusive relationships, 181, 185-187 Hermeneutics: defined, 20 Heideggerian, 7, 10, 12, 16 human understanding and, 21-23 Index Hermes, 21 Hiding theme, chronic pain patients, 85,90 HI^60 Holism, 12, 191 Holistic care, 255 Home, meaning of, 233 Hospitalized patients: confinement and freedom of, see Confinement and freedom medical, thematic structures of, 220-226, 233 overview, 214-215 perceptions of environment, 232-233 psychiatric, thematic structures of, 226-231 research studies, 216-218 window rooms, 212-213, 235 Hospitals, historical perspective, 215-216 Human becoming theory, 70 Human body: automatic implantable cardioverterdefibrillator (AICD), 62-72 body image, 53-58 body object, 52-53 body subject, 52-53 chronic pain, 73-93 human existence and, 51-52 nursing practice, implications for, 60-61 themes, 58-60 Human existence, existential grounds of, Human experience of other people: diabetic sibling, 109-123 eating disorders, 124-139 postpartum depression (PPD), 140-149 world of others, 97-108 Human experience of time: abusive relationships, 177—189 spiritual distress, 190-202 stroke recovery patients, 163-176 time, 155-162 Human experience of the world: hospitalized patients, confinement and freedom, 214-236 non-human world, 205-213 outpatient health care environment, 237-251 Husserl, Edmund, 7,9,14-15 289 Hyperawareness, 102 Hypoglycemia, 115-116 Identity, hospitalized patients and, 233-234 Identity theme, non-human world, 207 I-It relationship, 104 Immediate theme, outpatient health care environment, 241-243 Independence-ability theme, stroke recovery patients, 166, 170-171 Individualism, 103 Infants: development stages, 155-156 social behaviors, 98-99 Informed consent, 27, 32 Ingram, Harry, 99 Insights, Institutional Review Board, 32 Instrument, human body experience, 59 Insulin-dependent diabetes mellitus (IDDM), 111-1112 IntentionaHty, Merleau-Ponty philsophy, 15-16,55 Interpersonal meaning, human body experience, 59 Interpretation, implications of, 21-23 Interpretive phenomenology, 10-12 Interpretive research group, role of, 34-35 tatersubjeetivity, 13 Interviewer, role of, 27-28, 43 Interviews, see Bracketing interviews advice about, 27-30 conversational, 24 phenomenological, see Phenotnenological interview Intimacy, loss of, 145-146 Intuition, 46 Invisibility to others theme, chronic pain patients, 83 Isolation, diabetic sibling and, 115-116 I-Thou relationship, 104 James, William, 155 Janet, Pierre, 155 Jaspers, Jealousy, in sibling relationship, 115 290 Johari window, 99-100 Jourard, Sidney, 101 Journaling, 30,47 Kierkegaard, Soren, Krau, Stephen, 71-72 Learned helplessness, 179 Limits and Choices theme, 161 Listening skills, 91-92 Loneliness: hospitalized patients and, 234 outpatient health care environment, 248 Loss/effort theme, stroke recovery patients, 166-167 Low back pain, 75-76 Luft, Joseph, 99-100 Manen, Max van, 60 Marital relationship: changes in, 146, 148 violent, see Abusive relationships Maslow's hierarchy of needs, 138 Me/not me theme, in hospitalized patients: medical patients, 233 psychiatric patients, 230 Meaning: of body, 58-59 defined, first-person, 19, 59 of life, 194 in Merleau-Ponty philosophy, 12-13, 208 in nature, 210-213 in phenomenological interview, 35 Medical patients, thematic structures of: disconnection/connection, 224-226 eventually it'll be over, 221-222 insecurity/security, 223-224 no possibility/possibilities, 222-223 not me/me, 223 Meighan, Molly, 148-149 Merleau-Ponty, Maurice, 7,9,12-16 Merleau-Ponty philosophy: aim of, 13-14 functioning intentionality, 15-16 human body, 51-52, 54 overview, 12-13 Index perception, primacy of, 14-15 on place, 208 reciprocity, 104 on relating/relationships, 98, 103-104 on time, 160 Metaphors: A1CD recipients, 66 chronic pain, 89-90 leaving abusive relationships, 182 phenomenological interview, 36 protective shield, 113-114 social interactions, 101 time, 160 Methodolatry, 47 Misunderstanding, 22-23 Monitoring theme, chronic pain patients, 89 Mother-daughter relationship, eating disorders and, 126-139 Multivariate analysis, Natural attitude, Nature, meaning of, 210-213 Neonatal intensive care, 240 Nightingale, Florence, 7, 77, 174 Noncompliant patients, 102 Non-human world, human experience in: being lost, 209-210 nature, meaning of, 210-213 objects and things, 208-209 place, meaning of, 206-208 space, meaning of, 206-208 Nonverbal communication, 28,250 No possibility/possibilities theme, in hospitalized patients: medical patients, 222-223 psychiatric patients, 228-229 North American Nursing Diagnosis Association (NANDA), 76-77, 191-192 Not me/me theme, in hospitalized patients: medical patients, 223 psychiatric patients, 230 Now or Never theme, 161 Nurse management, 254 Nurse-patient relationship, generally hierarchical nature of, 24 importance of, Nursing diagnosis movement, 191 Index Nursing education, 106, 255 Nursing faculty, challenges for, 106 Nursing history, Nursing practice, implications of: abusive relationships, 188—189 automatic implantable cardioverterdefibrillator (AICD) recipients, 71 chronic pain, 91-93 confinement and freedom of hospitalized patients, 234-235 eating disorders, 138-139 human body experience, 60-61 postpartum depression (PPD), 147-148 spiritual distress, 200-202,205 stroke recovery patients, 174-175 Obesity, 57 Object/person theme, outpatient health care environment, 244-246 Objects and things, in non-human world, 208-209 Oiler, Carolyn, 10 Ornery, Anna, 10 Open-ended questions, 28 Out-of-control theme: chronic pain patients, 82-83 stroke recovery patients, 166-168 Outpatient health care environment: bracketing interview, 240-241 clinic, defined, 238 facility design, significance of, 238-239, 244, 249 physical aspects of, 238,245,247 post-study reflections, 251 thematic structures, 241-250 trends in, 238-239 Pain center therapies, 91 Parse, Rosemarie, 10, 69-71 Paterson, Josephine, 10 Pathophysiology, 74 Peplau, Perception, in Merleau-Ponty philosophy, 13-15 Perceptual distortion, 58 Perceptual-cognitive events, 99-100 Personal change, 155-157 291 Personal meaning, 13 Person-centered communication, 250 Phantom limbs, 54-56 Phenomenological interview: bracketing interview, 32-34 characteristics of, 25-27 feedback from participants, 38 interpretive process, 35 interpretive research group, 34-35 metaphors, mining the data, 36 opening question, 32 reading the transcript in interpretive group, 36 sample selection, 30-32 thematic structure, 37-38 Phenomenology, generally: in clinical practice, defined, descriptive, 10-12 eidetic, 10-12 existential, 4, 6-10 interpretive, 10-12 Merleau-Ponty philosophy, 13 origins of, Physical care, 60 Plaas, Kristina, 240,251 Place, meaning of, 206-208 Plants, meaning of, 212 Position-centered communication, 250 Possessions, place and, 209 Possibilities, theme, non-human world, 207 Postpartum depression (PPD), father's experience; attempts "to fix," 143-144, 147 bracketing interview, 142 health care response, 146-147 impact on father, generally, 141,143-145 loss of control, 145 loss of intimacy, 145-146 marital relationship, altered, 146 nursing practice, implications of, 147-148 onset of depression, 143 post-study reflections, 148-149 sacrifices, 144 screening techniques, 148 Power and Scale theme, in meaning of nature, 210 292 Index Powerless/powerful theme, outpatient health care environment, 246-247 Powerlessness: diabetic siblings an4 119 in nurses, generally, 253-254 Prayer: abused women and, 186-188 spiritual distress and, 201 Predictive validity, Projected thrownness, 17 Protection shield metaphor, 113-114 Psychiatric patients, thematic structures of: connection/disconnection, 230-231 me/not me, 230 possibilities/no possibilities, 228-229 refuge from self-destructiveness, 226-228 security/insecurity, 229 Psychosocial distress, 192 Psychosomatic illness, 53 Public report, 47 Qualitative Outcome Analysis, 43 Qualitative studies, 74—75, 254 Quality of life (QOL): importance of, influential factors, 163-164, 173 nature, impact on, 213 Quantitative research, Questionnaires, as research method, Questions: conversational interviews, 24 open-ended, 28 phenomenological interview, 32 types of, 24 "what," 43 Rationalism, 211 Rebuilding the Web, spiritual distress: change and growth, 198-199 characteristics of, generally, 199-200 defined, 194, 197 something beyond, 199 stability, 198 wondering, 198-199 Reachable moment, 48 Reciprocity, 104 Redundancy, 41—42 Reesman, Karen, 189 Referrals, 29 Reflections, importance of, 53 Refuge from self-destructiveness theme, in hospitalized patients, 226-228 Rehabilitation, stroke recovery, 165,174 Reinforcement, 15, 101 Relating, social aspects of, 98-99 Relationship-centered care, Relationships: concentric circles, 97-98 dialogue and, 103-104 early life, 98 mother-daughter, 126 reciprocity in, 104 siblings, 109-111 See also Diabetic sibling themes, generally, 107,137 Relaxation techniques, 87 Reliability, research, 39-40 Responsibility, eating disorders and, 130, 132-133 Return to work, stroke recovery patients, 171-172 Revealing-concealing theme, A1CD recipients, 70 Revealing theme, chronic pain patients, 85,90 Ricoeur, 12 Rituals, 101 Role behaviors, 101-102 Role reversal, 116-117 Romanticism, 211 Rounds, social interactions of, 101 Rubin, Edgar, 17 Sadness, diabetic sibling and, 118 Sartre, 12,94 Schizophrenic sibling, impact of, 110-111, 122 Scientific thinking, 13 Secrest, Janet, 4,175-176 Security/insecurity theme, in hospitalized patients: medical patients, 223-224, 233 psychiatric patients, 229 Security theme, non-human world, 207 Index Self-awareness, 35 Self-expectations, 102 Self-management skills, 92 Self-other relationship, as perceptualcognitive event, 99-100 Self-perception, body image and, 58 Self-pity, chronic pain and, 75 Self-realization, 126 Setting, for phenomenological interview, 27 Shattell, Mona, 235-236 Shock sensation, AICD recipients, 65-66 Sibling illness, see Diabetic sibling; Schizophrenic sibling Situational context of human life, 16 Skinner, B E, 15 Smith, Marilyn, 123 Smucker, Carol, 202 Social interaction, as drama, 100-101 Social norms, development of, 98-99 Social order, 105-106 Social role enactments, 101-103 Space, meaning of, 206-208 Special actions, AICD recipients, 66, 69 Speech impairment, stroke recovery and, 175 Spiritual distress: bracketing interview, 193 Breaking the Web stage, 194-197, 199 characteristics of, 191 defined, 199-200 illness as source of, 190 nursing diagnosis, 191-193 nursing practice, implications for, 200-202, 255 post-study reflections, 202 Rebuilding the Web stage, 194, 197-200 recognition of, 191 Stable/unstable theme, in abusive relationship, 184-185 Standard of care, Stress, Stroke recovery patients; bracketing interview, 166 case illustration, 4, 16-17, 19 comorbidities, 163-164 depression and, 164-165 nursing care and, 173-174 293 nursing practice, implications of, 174-175 perceptions of, 164 post-study reflections, 175—176 quality of life (QOL), 163-164, 173 rehabilitation, 165,174 Structure of Behavior (Merleau-Ponty), 15 Spousal abuse, see Abusive relationships Suicide/suicidal thoughts, 119, 165, 173 Support, importance of, 66, 68 Support groups: abused women, 188 AICD recipients, 63, 66, 68 chronic pain patients, 84, 92 eating disorders and, 131-132 Syzygy of feelings, AICD recipients, 66, 68-69 Technological advances, impact of, 255 See also Automatic implantabte cardioverter- defibrillator (AICD) Themes: abusive relationships, 183-187 chronic pain patients, 81-89 eating disorders, 128 human experience of human body, 58-60 in phenomenological interview, 37-38 relationships, 107, 137 stroke recovery patients, 171-172 time experience, 161-162 world of others experience, 106-108 Thomas, Sandra, 93 Thrownness, 16-17 Thweatt, Michael, 209 Time, human experience of: disorientation, 157-159 overview, 153-155,256 personal change, 155-157 as system in adult life, 159-160 themes in, 161-162 Transcription, of phenomenological interview, 29 Transference relationships, 98 Transforming, AICD patients, 71 Translation problems, 21-22 Travelbee, Trust/absence of trust, AICD recipients, 66,68 294 Index Tuan, Yi-Fu, 206,209, 233, 235 Type I diabetes, 111 Unconscious, 43-44 Understanding: AICD recipients, 66-68 hermeneutics and, 21-23 Unfreedom, 17 Unitary human beings, 12 Vaillot, Sister Madeleine Cleraence, 10 Validity, research, 40-41 Vicarious stress, Violent relationships, see Abusive relationships Vitality: defined, 89 human body experience, 59 Waiting theme, outpatient health care environment, 241-243, 250, 255 Walking in the dark, 128, 131,134 Warm and inviting theme, outpatient health care environment, 243-244 Weather, perceptions of, 211 Well-being, importance of, 26,202, 250-251 Withdrawal, chronic pain patients, 88 Wittgenstein, Ludwig, 22 World of others, human experience of: dialogue, insights of existential philosophers, 103-104 early life relationships, 98 generally, 97-98 relating, social aspects of, 98—99 self-other relationship, as perceptual-cognitive event, 99-100 social interaction as drama, 100-101 social order, 105-106 social role enactments, 101-103 themes of, 106-108 Worry, diabetic sibling and, 117 Zderad, Loretta, 10 Zuhand, 208 .. .Listening to Patients A Phenomenological Approach to Nursing Research and Practice Sandra P Thomas, PhD, RN, FAAN, is Professor and Director of the PhD Program in Nursing at the University... Library of Congress Cataloging-in-Publkation Data Thomas, Sandra P, Listening to patients : a phenomenological approach to nursing / Sandra P Thomas, Howard R Pollio p cm Includes bibliographical... administrators to even approach "their" patients to explain a study Despite provision of written and verbal explanations about phenomenological interviewing and assurances that (a) participation