Nancy J. Moules

Hermeneutic Inquiry: Paying Heed to History and Hermes An Ancestral, Substantive, and Methodological Tale

Hermeneutic or interpretive inquiry is a living tradition of interpretation with a rich legacy of theory, philosophy, and practice. This paper is not intended to be a treatise on the right way to view and practice this tradition, but an exploration of the legacies that inform the philosophy of practice as the author has taken it up. In this explication, the author examines the ancestral, philosophical, and methodological histories that inform a current practice of hermeneutic inquiry.

Thematic Analysis: Striving to Meet the Trustworthiness Criteria

As qualitative research becomes increasingly recognized and valued, it is imperative that it is conducted in a rigorous and methodical manner to yield meaningful and useful results. To be accepted as trustworthy, qualitative researchers must demonstrate that data analysis has been conducted in a precise, consistent, and exhaustive manner through recording, systematizing, and disclosing the methods of analysis with enough detail to enable the reader to determine whether the process is credible. Although there are numerous examples of how to conduct qualitative research, few sophisticated tools are available to researchers for conducting a rigorous and relevant thematic analysis. The purpose of this article is to guide researchers using thematic analysis as a research method. We offer personal insights and practical examples, while exploring issues of rigor and trustworthiness. The process of conducting a thematic analysis is illustrated through the presentation of an auditable decision trail, guiding interpreting and representing textual data. We detail our step-by-step approach to exploring the effectiveness of strategic clinical networks in Alberta, Canada, in our mixed methods case study. This article contributes a purposeful approach to thematic analysis in order to systematize and increase the traceability and verification of the analysis.

Legitimizing Grief: Challenging Beliefs That Constrain

The author explores the commonly held belief that grief, in response to a significant loss, is a finite, time-limited, and predictable process. Examination of this idea suggests the possibility that this belief creates personal and societal expectations that contribute to increased suffering in the lives of grieving people and renders them subject to diagnostic labels fostering incompetence, failure, and pathology. Alternately, the author offers her assumptions and beliefs about the opportunity of developing a relationship with grief that is potentially lifelong, but livable, and as much filled with comfort and creativity as it is with sorrow. A clinical advanced nursing practice model, as developed and presented by Wright, Watson, and Bell (1996), is explored in relation to working with grieving families and to targeting beliefs about grief that constrain families, nurses, and our cultural ideas and expectations of this life experience. Clinical examples and a clinical exemplar are offered.

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.

Therapeutic Letters in Nursing: Examining the Character and Influence of the Written Word in Clinical Work With Families Experiencing Illness

This article summarizes the first research to be completed on the Family Systems Nursing intervention of therapeutic letters. In the Family Nursing Unit (FNU) at the University of Calgary, therapeutic letters have been used for more than 22 years in work with families experiencing illness and suffering. Using Gadamerian philosophical hermeneutic inquiry, the research explores 11 therapeutic letters sent and received in the work with three families (four participants) seen in the FNU. Textual interpretation of the 11 letters was complemented by research interviews with the families and nurses who wrote the letters as well as in-session, presession, and postsession transcriptions. Interpretations suggest that letters have an influence related to the tone of the individuals and the relationship created; the balancing of questions, commendations, and artful writing; memory and remembrance; measures and markers of change; and the obligation of meeting people experiencing illness at the point of their suffering.

Waiting to Return to Normal An Exploration of Family Systems Intervention in Childhood Cancer

The illness suffering of families in childhood cancer is characterized in part by a loss of family normalcy. Hermeneutic phenomenology and family process research methods were used to analyze videotaped family intervention sessions and post-intervention family/clinician interviews. Within this article, some of the findings from the larger doctoral study that focused on the illness suffering of family members and relational, family systems intervention based on the Illness Beliefs Model are described. Although the larger study included findings of family interventions that addressed several aspects of the illness suffering experienced, this article details specific findings related to the theme of the loss of family normalcy and a longing to return home. Family systems intervention practices which facilitated a lessening of illness suffering included the following: offering new interpretations of suffering within a reflecting team, articulating family strength, sensitively acknowledging the illness suffering, and eliciting the experiences of family members in a shared therapeutic conversation.

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.

“And Then You'll See Her in the Grocery Store”: The Working Relationships of Public Health Nurses and High-Priority Families in Northern Canadian Communities

The aim of the study is to examine and articulate the nature of working relationships of public health nurses and high-priority families in small communities in northern Canada. Public health nurses working in northern, rural, and remote communities face unique and varied challenges. Reportedly, the hardest part of their job is working with families who have been deemed high priority or high risk. Working with these families in these contexts relies on relationships of reciprocity, trust, and communication. This qualitative research was guided by an interpretive hermeneutic inquiry; 32 families, 25 public health nurses, and three lay home visitors were interviewed from July 2005 through July 2006. Analysis was completed individually and through teamwork of the researchers. Findings suggest that the working relationship of public health nurses and high-priority families in northern communities is complex and multifaceted. Nurses carefully negotiate the process of engaging and entering relationships, maintaining the relationships, and negotiating boundaries. The analysis offers insight into the everyday practices and problems that public health nurses and families encounter in providing care to a vulnerable, isolated, and often marginalized population while navigating the complexity of living and working in the same small communities.