Dianne M. Tapp

Human understanding in dialogue: Gadamer's recovery of the genuine

In this paper, the notion of the genuine as it relates to conversation is explored based on the work of H. G. Gadamer in his major work, Truth and Method (1989). The application of the genuine to human interaction and understanding in the context of qualitative research is examined. In addition, possible outcomes of the researchers philosophical hermeneutic position, as exemplified through the use of the genuine conversation in her work, are discussed. Both the problem as well as the productivity of self-application and prejudice are addressed through the lens of the genuine conversation. We then illustrate the character of interviewing and interpretation of text as research practices that can be informed by Gadamers philosophical hermeneutics while resisting methodology as a necessary feature of research inquiry.

Clinical nurses' understanding of autonomy: accomplishing patient goals through interdependent practice.

Objective: The purpose of the study was to enable nurse managers to identify strategies to support and enhance autonomous practice based on clinical nurses’ understanding of autonomy. Background: Findings from an organizational work-life satisfaction survey led a nursing management team to question how clinical nurses understand autonomy. The nursing literature offers inconsistent definitions of autonomy and interchangeable use of related concepts. Methods: Twelve focus groups involving 43 nurses working in cardiovascular service units discussed instances of satisfaction and dissatisfaction with autonomy in their clinical practice and work life. Verbatim transcripts of group discussions were interpreted by a research team to identify salient examples and descriptions of autonomy. Results: Nurses described autonomy as their ability to accomplish patient care goals in a timely manner by using their knowledge and skills to understand and contribute to the overall plan of care; assess patient needs and conditions; effectively communicate concerns and priorities regarding patient care; and access and coordinate the resources of the multidisciplinary team. Conclusions: These findings challenge assumptions about autonomy as independent decision making and practice. They highlight nurses’ contributions to patient care goals through knowledge of how to get things done within hospital systems and through interdisciplinary coordination and collaboration.

The Ethics of Relational Stance in Family Nursing: Resisting the View of “Nurse as Expert”

Nurses make choices about how to situate themselves in relation to the people they encounter in clinical practice. In this article, the notion of resisting the view of the “nurse as expert” is offered as a caution against some of the ways that professional values and practices of experts can influence relational skills in clinical nursing practice with families. These ideas are based on a hermeneutic research project that explored the advanced clinical practice of nurses engaged in therapeutic conversations with families experiencing ischemic heart disease. Exemplars from the research project illustrate relational practices that can counterbalance expert professional views by explicitly acknowledging the expertise and knowledge of those persons and families encountered in practice. These practices include offering commendations, coevolving a description using the family’s language, exploring the illness story and the medical story, asking questions that invite reflection, and initiating conversations about family members’ preferences.

Family Skills Labs: Facilitating the Development of Family Nursing Skills in the Undergraduate Curriculum

This article describes the implementation offamily nursing skills labs with undergraduate nursing students at the University of Calgary. The intent of the family nursing skills labs is to facilitate the development of family interviewing skills of students and to apply these skills to a variety ofclinical settings. The incorporation of demonstration interviews, role playing, and practice interviews provides students with simulated situations to implementfamily interviewing skills. Students who participate in thefamily skills labs are invited to consider therapeutic conversations as interventions and are offered a preferred relational stance for working with families. Specific strategies for implementing the family skills labs are proposed.

Grandparents’ Experiences of Childhood Cancer, Part 1: Doubled and Silenced

In this study, the authors examined the experiences of grandparents who have had, or have, a grandchild with childhood cancer. Sixteen grandparents were interviewed using unstructured interviews, and the data were analyzed according to hermeneutic–phenomenological tradition, as guided by the philosophical hermeneutics of Hans-Georg Gadamer. Interpretive findings indicate that grandparents suffer and worry in many complex ways that include a doubled worry for their own children as well as their grandchildren. According to the grandparents in this study, this worry was, at times, silenced in efforts to protect the parents of the grandchild from the burden of concern for the grandparent. Other interpretations include the nature of having one’s universe shaken, of having lives put on hold, and a sense of helplessness. The grandparents in this study offer advice to other grandparents as well as to the health care system regarding what kinds of things might have been more helpful to them as one level of the family system, who, like other subsystems of the family, are also profoundly affected by the event of childhood cancer.

Grandparents’ Experiences of Childhood Cancer, Part 2 The Need for Support

In this study, the authors examined the experiences of grandparents who have had, or have, a grandchild with childhood cancer. Sixteen grandparents were interviewed using unstructured interviews, and the data were analyzed according to a hermeneutic–phenomenological tradition, as guided by the philosophical hermeneutics of Hans-Georg Gadamer. In Part 1 of this report, interpretive findings around worry, burden, silence, the nature of having one’s universe shaken, of having lives put on hold, and a sense of helplessness were addressed. In Part 2, the authors discuss interpretations related to the notions of support, burden, protection, energy, standing by, buffering, financial shouldering, and relationship. The study concludes with implications that the grandparents in the study bring to pediatric nurses in their practices with families in pediatric oncology.

Family nursing labs: shifts, changes, and innovations

This article describes recent innovations and shifts in the family skills labs that have been offered since 1995 in the undergraduate family nursing curriculum at the University of Calgary. The authors describe a shift from a strict adherence to role play as a way to teach and hone skills in working with families to more experiential and interactive exercises aimed at creating personal, meaningful, and realistic possibilities in learning. The lab activities are based on the belief that family nursing is a relational practice that is best learned through experiential and inquiry-based activities. Student feedback suggests these changes in the delivery of the family nursing labs are notably reshaping students’ thinking and practices in the nursing of families.

Impact of Ischemic Heart Disease: Family Nursing Research, 1984-1993

Based on 35 nursing research articles, this article reports a methodological and substantive review of nursing research done between 1984 and 1993 regarding the impact of illness on families with a member experiencing ischemic heart disease. Limitations identified include lack of explicit conceptualization of family; implicit definitions of family restricted to the marital dyad; sampling procedures limited by convenience selection, gender, and elite bias; and data generated by individuals not interacting with other family members. Suggestions for future nursing research include integration of the growing body of family research methods, study of family strengths and coping over the process of disease progression, inclusion of the perspectives of children, and the impact on the family developmental life cycle.

Renewing caregiver health and wellbeing through exercise (RECHARGE): A randomized controlled trial

BACKGROUND Family caregivers (FCs) to cancer patients are at increased risk for physical and emotional health problems as a result of being in the caregiver role. Current research on interventions for FCs has focused on psychological support or educational interventions, with very little investigation of exercise in maintaining or improving health. Based on our preliminary survey, participation in regular exercise to improve health was noted as a priority for FCs. The purpose of the study described in this protocol is to examine the impact of a 12-week structured exercise program on physical functioning (primary outcome), physical activity levels and psychological well-being (secondary outcomes), in FCs caring for adult cancer patients. In addition, the trial described here will examine the outcomes from a 12-week maintenance program, immediately following the initial program. METHODS/DESIGN A mixed methods design using a randomized control trial (RCT) with a 50/50 allocation ratio for the quantitative portion, followed by face to face interviews and qualitative data analysis. Approximately 86 participants will be enrolled over a 10 month period. The intervention will consist of a structured exercise program of aerobic and resistance training. An intention to treat principle using mixed effects modeling will guide data analysis. DISCUSSION FCs will continue to play a pivotal role in the care of cancer patients as the incidence and chronicity of cancer increases. The research described in this protocol will provide information about the impact of an exercise program in supporting FC health. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02580461.

Examining the Effects of Childhood Cancer on the Parental Subsystem: Implications for Parents and Health Care Professionals—Part 3

This article is the third part of a hermeneutic research study examining the impact of childhood cancer experiences on the parental relationship. In Part 1, we offered an exploration of the phenomenon with background literature; a description of the research question, method, and design; and finally a discussion of relationships that survived, thrived, or demised, with an emphasis on the notions of difference and trading. In Part 2, we furthered the interpretations to look at the complexities of issues such as teams, roles, focus, protection, intimacy, grieving, putting relationships on hold, and reclaiming them. In this article, we discuss the advice that the participants offered us and how that advice might have implications for other parents in similar situations and health care professionals working with families experiencing childhood cancer.