Febe Friberg

Issues about Thinking Phenomenologically while Doing Phenomenology

This methodological article explores issues related to having the ontological ground for phenomenological empirical research present throughout the research process. We discuss how ontology needs to be taken into consideration regarding the phenomena to be studied and how ontological aspects of phenomena need to be highlighted during various data collection and analysis procedures. Here, we discuss how philosophical works can be used in the context of specific research projects. In illustrating our statements, we present four empirical examples connected to the themes of life changes and learning processes with the purpose of exemplifying and discussing how general lifeworld ontology can be integrated as an active resource in empirical phenomenological research.

The Relationship Between Facilitators' Questions and the Level of Reflection in Postsimulation Debriefing

Introduction Simulation-based education is a learner-active method that may enhance teamwork skills such as leadership and communication. The importance of postsimulation debriefing to promote reflection is well accepted, but many questions concerning whether and how faculty promote reflection remain largely unanswered in the research literature. The aim of this study was therefore to explore the depth of reflection expressed in questions by facilitators and responses from nursing students during postsimulation debriefings. Methods Eighty-one nursing students and 4 facilitators participated. The data were collected in February and March 2008, the analysis being conducted on 24 video-recorded debriefings from simulated resuscitation teamwork involving nursing students only. Using Gibbs’ reflective cycle, we graded the facilitators’ questions and nursing students’ responses into stages of reflection and then correlated these. Results Facilitators asked most evaluative and fewest emotional questions, whereas nursing students answered most evaluative and analytic responses and fewest emotional responses. The greatest difference between facilitators and nursing students was in the analytic stage. Only 23 (20%) of 117 questions asked by the facilitators were analytic, whereas 45 (35%) of 130 students’ responses were rated as analytic. Nevertheless, the facilitators’ descriptive questions also elicited student responses in other stages such as evaluative and analytic responses. Conclusion We found that postsimulation debriefings provide students with the opportunity to reflect on their simulation experience. Still, if the debriefing is going to pave the way for student reflection, it is necessary to work further on structuring the debriefing to facilitate deeper reflection. Furthermore, it is important that facilitators consider what kind of questions they ask to promote reflection. We think future research on debriefing should focus on developing an analytical framework for grading reflective questions. Such research will inform and support facilitators in devising strategies for the promotion of learning through reflection in postsimulation debriefings.

Exploration of communicative patterns of consultations in palliative cancer care

Building on the research conducted on institutional communication, and the analysis of actual communication taking place in clinical settings, this study describes and highlights features of palliative care consultations and focuses on the distribution of discursive space (i.e., share of words, lengths of turns), occurring topics and conversational frames. Six consultations between physicians, patients and significant others were videotaped and all participants took part in audio-taped interviews. The recordings were transcribed and analysed in regard to expectations of, the discursive space of, and topics addressed in the consultations. The distribution of the discursive space was unequal; the physicians had the greatest share of words and length of turns in all six consultations, and they mostly initiated discussion of medical issues connected to examinations and treatment, while only patients initiated the topic of the patients future. During the consultations, institutional framing tended to dominate over client framing. There was found to be room for further study of the structure and content of palliative care consultations with emphasis on how the voice of the patient can manifest itself within the framework of the medical agenda of the consultation and its significance for palliative cancer team work.

Searching for knowledge and understanding while living with impending death*a phenomenological case study

In this article, expression of the quest for knowledge and understanding while living with the threat of fatal cancer is explored. By means of a case study, recurrent narrative interviews and participant observations were performed with one 71-year-old man and the oncology nurse taking care of him. The data were analysed phenomenologically and the results disclose three paths during the illness trajectory at the end-of-life; the stable path, the turning point and the waiting. Existential uncertainty is managed in the stable path, while confronting existential uncertainty is characterized by the turning point, and there is a shift towards living existential certainty during the waiting. The significance of openness towards the intertwinement of the experiential and existential dimensions of living in end-of-life care is emphasized. Research into patients’ multidimensional learning at the end of life is needed in order to expand knowledge of how the patient makes sense of their situation particularly in relation to the information they receive from palliative care professionals.

Meanings of existential uncertainty and certainty for people diagnosed with cancer and receiving palliative treatment: a life-world phenomenological study

BackgroundMany people around the world are getting cancer and living longer with the disease. Thanks to improved treatment options in healthcare, patients diagnosed with advanced gastrointestinal cancer can increasingly live for longer. Living with cancer creates existential uncertainty, but what does this situation mean for the individual? The purpose of the study is to interpret meanings of existential uncertainty and certainty for people diagnosed with advanced gastrointestinal cancer and receiving palliative treatment.MethodsThis study is part of a larger project in which 7 men and 7 women aged between 49 and 79 participated in a study of information and communication for people with advanced gastrointestinal cancer. A total of 66 interviews were conducted with participants who were followed up over time. The narrative interviews were transcribed verbatim and the texts were analysed in three steps: naive reading, structural analysis and interpreted whole by utilizing a phenomenological life-world approach.ResultsThis study has identified different spheres in which people diagnosed with advanced gastrointestinal cancer vacillate between existential uncertainty and certainty: bodily changes, everyday situations, companionship with others, healthcare situations and the natural environment. Existing in the move between existential uncertainty and certainty appears to change people’s lives in a decisive manner. The interview transcripts reveal aspects that both create existential certainty and counteract uncertainty. They also reveal that participants appear to start reflecting on how the new and uncertain aspects of their lives will manifest themselves –a new experience that lays the foundation for development of knowledge, personal learning and growth.ConclusionsPeople diagnosed with advanced gastrointestinal cancer and receiving palliative care expressed thoughts about personal learning initiated by the struggle of living with an uncertain future despite their efforts to live in the present. Their personal learning was experienced through a changed life for themselves and having to confront their own pending death and develop self-insight regarding finality of life. Healthcare professionals can try to support people receiving palliative treatment for cancer by diversifying avenues for their personal growth, thus helping them manage their existential uncertainty and gravitate towards greater existential certainty.

Ways of talking about illness and prognosis in palliative cancer care consultations—two interactional frames

Goals of workThe purpose of the study was to describe how interaction about changes in illness and prognosis was shaped by participants in outpatient palliative cancer care consultations.Patients and methodsThe data collection involved six video-recorded consultations at an outpatient oncology unit at a university hospital in Sweden. The interactions were studied by means of discourse analysis. Inclusion criteria for the patients were gastro-intestinal cancer and receiving palliative care. The sample included three men and three women, aged 54–70, with various metastasised gastro-intestinal tumours. Significant others (SOs) were included where patients brought one to the consultation. Three male consultants aged 55–59 participated.Main resultsIn palliative care consultations, the person-to-person and the patient–professional conversation frames were found to be in use as patients, SOs and physicians talked about the patients’ illness and prognosis. Within the patient–professional frame, three interactional patterns were found: the patient emphasising emotional experiences of illness or well-being and the physicians responding by toning down strategies, patients asking direct questions and getting straight answers and finally interaction marked by cautiousness and avoidances. Within the person–person frame, the interactions were described as: playful talk, collegial talk and existential talk.ConclusionsWhen patients shared their personal interpretations of illness and prognosis, their narrative was more enhanced by the person-to-person frame than the patient–professional frame. Finding out if and how patients and SOs want to express their worries and finding a balance between the interactional patterns that occur are ethical challenges which health professionals must face. Since patients and SOs may restrain their emotional experiences, investigating grounded ways of overcoming these difficulties is imperative.

Communication patterns in antenatal diabetes care: an explorative and descriptive study of midwife-led consultations.

AIM To explore and describe the verbal communication patterns in antenatal consultations between pregnant women with diabetes and their midwives. BACKGROUND Few studies have focused on the efficacy of communication during consultations between midwives and their clients, especially in a high-risk context. DESIGN An explorative and descriptive study of antenatal consultations between midwives and their clients at four antenatal diabetes clinics in Norway. METHODS Thematic analysis was used to study verbal communication in ten woman-midwife consultations that were audio recorded and transcribed. The analysis was based on the following questions: (1) who talks and to what degree? (2) What are the topics discussed and who is the initiator? and (3) What characterises the dialogue in the consultations? RESULTS The results suggest that there was a predominantly medical focus in the consultations, with the communication style characterised by a combination of informal and formal talk. The consultations were structured into three phases, each with its own conversation style. CONCLUSIONS The communication patterns adopted appeared to limit the opportunities of mothers-to-be to express freely any concerns. It is suggested that a larger degree of openness to the emotional and psychological aspects of pregnancy should be incorporated into the consultations. To take advantage of the different competencies in this multidisciplinary diabetes team, the contribution of the midwife to this specialised antenatal care should be both recognised and defined. RELEVANCE TO CLINICAL PRACTICE Awareness of each midwifes own communication style, as well as their attentiveness to a womans implicit concerns, is required for the satisfactory support and understanding of the individual pregnant woman. It is necessary to support midwives in the continuous development of their communication skills, a task that should be included as part of midwifery education and undertaken by practitioners in the clinical environment.

Educating for teamwork--nursing students' coordination in simulated cardiac arrest situations.

AIM The overarching aim was to explore and describe the communicative modes students employ to coordinate the team in a simulation-based environment designed for resuscitation team training. BACKGROUND Verbal communication is often considered essential for effective coordination in resuscitation teams and enhancing patient safety. Although simulation is a promising method for improving coordination skills, previous studies have overlooked the necessity of addressing the multifaceted interplay between verbal and non-verbal forms of communication. METHOD Eighty-one nursing students participated in the study. The data were collected in February and March, 2008. Video recordings from 28 simulated cardiac arrest situations in a nursing programme were analysed. Firstly, all communicative actions were coded and quantified according to content analysis. Secondly, interaction analysis was performed to capture the significance of verbal and non-verbal communication, respectively, in the moment-to-moment coordination of the team. FINDINGS Three phases of coordination in the resuscitation team were identified: Stating unconsciousness, Preparing for resuscitation, Initiating resuscitation. Coordination of joint assessments and actions in these phases involved a broad range of verbal and non-verbal communication modes that were necessary for achieving mutual understandings of how to continue to the next step in the algorithm. This was accomplished through a complex interplay of taking position, pointing and through verbal statements and directives. CONCLUSION Simulation-based environments offer a promising solution in nursing education for training the coordination necessary in resuscitation teams as they give the opportunity to practice the complex interplay of verbal and non-verbal communication modes that would otherwise not be possible.

Reflective Exploration of Beekman’s Participant Experience

In this study we explored the researcher as an instrument in phenomenological research.To contribute to the discussion on phenomenological research methods for use in fieldwork, we explored Ton Beekman’s participant experience (1986) as a way of enhancing the rigor and quality of data construction in phenomenological fieldwork. Beekman’s approach is characterized by dialogue, bodily presence, being there, time and space dimensions, social and personal meaning, and interpretations that are close to life. An example from fieldwork in palliative cancer care is presented, in which we used reflective analysis to discern the cocreating aspect of participant experience. We recommend further investigation of cocreating participant experience as part of phenomenological fieldwork.

The experience of being a female carrier of haemophilia and the mother of a haemophilic child

Limited research has been conducted on how the female carrier experiences her life with a haemophilic child, and earlier studies are mostly questionnaire‐based. No previous qualitative study on the female carriers situation has been conducted in Sweden. The aim of the study was to describe the lived experience of being a carrier of severe or moderate haemophilia and of being the mother of a haemophilic child. The study was conducted via qualitative interviews and analysed by means of a phenomenological hermeneutic method; a total of 13 haemophilia carriers were interviewed in 2010. Being a carrier of haemophilia and having a haemophilic child was life changing. The women moved from a state of sad, guilty chaos to reconciling themselves with the new situation. Our analysis revealed three acts in which phenomena appeared: the time after diagnosis, the turning point and reconciliation with a changing life. Emerging as crucial to the process of reconciliation with a changing life was a sense of being fully informed and supported. The Haemophilia Treatment Centre (HTC) should create an environment that encourages learning, and the team should invite and encourage the womans partner to be actively involved in the childs care. Moreover, the results indicate that it would be beneficial to invite female carriers to receive patient education at the HTC before they plan to start a family. During this visit, the woman may gain a greater understanding of her carriership to prepare her for future decisions concerning prenatal diagnosis, for example.