Les Todres

The Status of Method: Flexibility, Consistency and Coherence

Many elements of qualitative research are shared between the variety of approaches, and often the overlap of epistemology, ethics and procedures encourages a generic and flexible view of this type of inquiry. This article argues that there is an essential tension between flexibility on the one hand, and consistency and coherence on the other. Such tension may encourage qualitative researchers to consider the intentions and philosophical underpinnings of the different approaches in greater depth in order to arrive at an epistemological position that can coherently underpin its empirical claims. This article is intended to encourage a more thoughtful engagement with different qualitative approaches by highlighting distinctive elements of three of the most common approaches. We suggest that the researcher be contextsensitive and flexible as well as considerate of the inner consistency and coherence that is needed when engaged in qualitative research.

Lifeworld-led healthcare is more than patient-led care: an existential view of well-being

In this paper we offer an appreciation and critique of patient-led care as expressed in current policy and practice. We argue that current patient-led approaches hinder a focus on a deeper understanding of what patient-led care could be. Our critique focuses on how the consumerist/citizenship emphasis in current patient-led care obscures attention from a more fundamental challenge to conceptualise an alternative philosophically informed framework from where care can be led. We thus present an alternative interpretation of patient-led care that we call ‘lifeworld-led care’, and argue that such lifeworld-led care is more than the general understanding of patient-led care. Although the philosophical roots of our alternative conceptualisation are not new, we believe that it is timely to re-consider some of the implications of these perspectives within current discourses of patient-centred policies and practice. The conceptualisation of lifeworld-led care that we develop includes an articulation of three dimensions: a philosophy of the person, a view of well-being and not just illness, and a philosophy of care that is consistent with this. We conclude that the existential view of well-being that we offer is pivotal to lifeworld-led care in that it provides a direction for care and practice that is intrinsically and positively health focused in its broadest and most substantial sense.

The humanization of healthcare: A value framework for qualitative research

Qualitative research, through its illumination of peoples perspectives and experiences, has contributed a particular kind of useful evidence for caring practices. Until now however, it has found its location in healthcare without making the powerful impact on humanizing practice that is its key strength. Our paper develops a conceptual framework for humanizing care, and through examples illustrates an emerging agenda that moves qualitative research into its next and overdue phase: to enter policy-making; curricula in professional education; and to be meaningfully translated into practice in ways that place people as human beings at the centre of care. This paper provides eight philosophically informed dimensions of humanization, which together, form a framework that constitutes a comprehensive value base for considering both the potentially humanizing and dehumanizing elements in caring systems and interactions. In each case, we show, with reference to published studies, how qualitative research findings are already consistent with the humanizing focus articulated in our conceptual framework. We finally describe a reciprocal relationship in which the humanizing value framework guides a dedicated focus for qualitative research, and in which qualitative research in its turn, supports the humanising emphasis because of its intrinsic features.

Being With That: The Relevance of Embodied Understanding for Practice

In this keynote presentation, I consider one way of articulating a more intimate relationship between the findings of qualitative research and the practice of care in health-related contexts. Drawing on the writings of Gadamer and Gendlin, I consider the kind of understanding that might be particularly relevant to everyday practice. I call this “embodied relational understanding.” I further pursue the question of how the findings of qualitative research can become a rich resource for sensitizing practitioners to engage with the complexities of practice. I argue that providing such a resource requires us to pay more attention to the evocative power of our findings and their potentially transformational power for personal and professional development.

“Dwelling-mobility”: An existential theory of well-being

In this article we offer an existential theory of well-being that is guided by Heideggers later writings on “homecoming”. We approach the question of what it is about the essence of well-being that makes all kinds of well-being possible. Consistent with a phenomenological approach, well-being is both a way of being-in-the-world, as well as a felt sense of what this is like as an experience. Drawing on Heideggers notion of Gegnet (abiding expanse), we characterise the deepest possibility of existential well-being as “dwelling-mobility”. This term indicates both the “adventure” of being called into expansive existential possibilities, as well as “being-at-home-with” what has been given. This deepest possibility of well-being carries with it a feeling of rootedness and flow, peace and possibility. However, we also consider how the separate notions of existential mobility and existential dwelling as discrete emphases can be developed to describe multiple variations of well-being possibilities.

Kinds of well-being: a conceptual framework that provides direction for caring

This article offers a conceptual framework by which different kinds and levels of well-being can be named, and as such, provides a foundation for a resource-oriented approach in situations of illness and vulnerability (rather than a deficit-oriented approach). Building on a previous paper that articulated the philosophical foundations of an existential theory of well-being (“Dwelling-mobility”), we show here how the theory can be further developed towards practice-relevant concerns. We introduce 18 kinds of well-being that are intertwined and inter-related, and consider how each emphasis can lead to the formulation of resources that have the potential to give rise to well-being as a felt experience. By focusing on a much wider range of well-being possibilities, practitioners may find new directions for care that are not just literal but also at an existential level.

Embodying Nursing Openheartedness: An Existential Perspective

In this article, the authors attempt to articulate one view of the nature of nursing openheartedness and its central role for guiding caring in complex nursing situations. To do this, vignettes of everyday nursing life situations are used to illustrate the following three essential dimensions that constitute nursing openheartedness: (a) the infinity of otherness: keeping open the others difference, (b) embodiment: our shared vulnerable heritage, and (c) practical responsiveness: embracing the value of the objectified gaze and technology. Each of these dimensions is philosophically informed by distinctive insights from the work of Heidegger, Levinas, and Merleau Ponty. Furthermore, guided by Gendlins contributions regarding the nature of embodied understanding, a writing style that attempts to present the nature of nursing openheartedness as a possible experience rather than as an abstract theory is employed.

“Caring for insiderness”: Phenomenologically informed insights that can guide practice

Understanding the “insider” perspective has been a pivotal strength of qualitative research. Further than this, within the more applied fields in which the human activity of “caring” takes place, such understanding of “what it is like” for people from within their lifeworlds has also been acknowledged as the foundational starting point in order for “care” to be caring. But we believe that more attention needs to be paid to this foundational generic phenomenon: what it means to understand the “insiderness” of another, but more importantly, how to act on this in caring ways. We call this human phenomenon “caring for insiderness.” Drawing on existing phenomenological studies of marginal caring situations at the limits of caring capability, and through a process of phenomenologically oriented reflection, we interrogated some existential themes implicit in these publications that could lead to deeper insights for both theoretical and applied purposes. The paper provides direction for practices of caring by highlighting some dangers as well as some remedies along this path.

Continuous subcutaneous insulin infusion in Type 1 diabetes: patient experiences of ‘living with a machine’

Diabet. Med. 27, 1201–1204 (2010)

Pursuing Both Breadth and Depth in Qualitative Research: Illustrated by a Study of the Experience of Intimate Caring for a Loved One with Alzheimer's Disease

In this article, the authors explore the methodological and epistemological tensions between breadth and depth with reference to a study into the experience of caring for a loved one with Alzheimers disease. They consider the benefits and limitations of each of two phases of the study: a generic qualitative study of narrative breadth and a descriptive phenomenological study of lifeworld depth into selected phenomena. The article concludes with a reflection on the kinds of distinctive knowledge generated by each of these two phases and the benefits of their complementary relationship with one another.