How do we close the hermeneutic circle?A Gadamerian approach to justification in interpretation in qualitative studies

In this article, an attempt is made to analyse important implications of the hermeneutic approach in qualitative studies. The article discusses the hermeneutic circle with regard to reasoning contexts, on which the researcher's interpretation is based. Problems in connection with achievement of 'proper' understanding in an interpretative process are discussed in light of Gadamer's hermeneutic philosophy. Some features of qualitative studies are addressed. This is concerned with arguments in the presentation of findings in qualitative studies using the hermeneutic approach. The essence of the article is there are grounds for reasonable understanding, even though it cannot be absolute in the hermeneutic.     

A Nursing-Specific Model of EPR Documentation: Organizational and Professional Requirements

PURPOSE: To present the Norwegian documentation KPO model (quality assurance, problem solving, and caring). To present the requirements and multiple electronic patient record (EPR) functions the model is designed to address. METHODS: The model's professional substance, a conceptual framework for nursing practice is developed by examining, reorganizing, and completing existing frameworks. The model's methodology, an information management system, is developed using an expert group. Both model elements were clinically tested over a period of 1 year. RESULTS: The model is designed for nursing documentation in step with statutory, organizational, and professional requirements. Complete documentation is arranged for by incorporating the Nursing Minimum Data Set. A systematic and comprehensive documentation is arranged for by establishing categories as provided in the model's framework domains. Consistent documentation is arranged for by incorporating NANDA-I Nursing Diagnoses, Nursing Intervention Classification, and Nursing Outcome Classification. CONCLUSIONS: The model can be used as a tool in cooperation with vendors to ensure the interests of the nursing profession is met when developing EPR solutions in healthcare. Clinical RELEVANCE: The model can provide clinicians with a framework for documentation in step with legal and organizational requirements and at the same time retain the ability to record all aspects of clinical nursing.     

Patients’ experiences of waiting for a liver transplantation

Organ transplantation has increased worldwide while the number of organ donors have not increased similarly. Consequently, the waiting period for transplant candidates is prolonged. Patient narratives have uncovered physical and psychosocial suffering in the transplantation process. However, relatively few studies have explored patients’ experiences in the actual waiting period. This qualitative study was conducted in Norway and aimed to describe patients’ experiences of being accepted as recipients of a new liver and their waiting following this decision. A sample of 21 patients with end‐stage liver disease, placed on the ordinary waiting list for a liver transplant, were interviewed in the hospital before they went home to wait for a compatible liver. Uncertainty related to life and death was a major issue, both in the waiting period and as a response to being put on the waiting list. Another central issue was their overwhelming lack of energy. Patients inferred a linear relationship between lack of energy, physical limitations and mental distress. Despite major advances in medical treatment, little follow‐up was given during the waiting period and most of the patients seemed resigned to the inevitability of their suffering. This raises issues of health personnel responsibility and a need to heighten awareness about patient suffering during the waiting period.     

Stool DNA analysis detects premorphological colorectal neoplasia: a case report

We found, in an asymptomatic patient with familial occurrence of malignancy, that mutations in the oncogene Kras could be detected in stool 18 months before a premalignant polyp was detected and removed endoscopically. Colorectal cancers usually develop from benign adenomas in a lengthy period of 5-10 years. During this period, several major biochemical pathways are involved, each characterized by one or several genetic alterations. Our patient did not present any signs or symptoms of colorectal disease during his two visits to the endoscopist. This case report shows that the use of genetic markers in stool testing has the potential to detect colon cancer in its very early stages when treatment is simple and often successful.     

Resilience as a predictor of depressive symptoms: a correlational study with young adolescents

This correlational study explored the Resilience Scale for Adolescents (READ) as a predictor for developing depressive symptoms controlling for known risk factors. A young adolescent sample (N = 387) completed the READ, the Short Mood and Feeling Questionnaire (SMFQ), Social Phobia Anxiety Index for Children (SPAI-C), and the occurrence of Stressful Life Events (SLE). In addition, a subsample of their parents (N = 240) completed a parental version of READ (READ-P). The results indicated that the READ assesses important protective factors that are associated with fewer depressive symptoms among young adolescents even when controlling for known risk factors. All five READ-factors were predictors of depressive symptoms, while the READ-P showed no predictive value. There were no significant interaction effects between READ and SLE. There were, however, significant main-effects supporting a compensatory model of protective factors. The findings suggest that the READ is a significant predictor of mental health and a useful tool for further research examining differences in stress tolerance among young adolescents.     

Postoperative pain and self-management: women's experiences after cardiac surgery

Title.  Postoperative pain and self-management: women's experiences after cardiac surgery.
Aim.  This paper is a report of a study to describe women's experiences and their self-management of postoperative pain after elective cardiac surgery.
Background.  Cardiac surgery involves several pain-sensitive areas, and untreated postoperative pain may lead to chronic pain. Early discharge requires increased patient participation in pain management. Women report more postoperative pain than men after cardiac surgery.
Methods.  Semi-structured interviews were conducted in 2004–2005 with 10 women 1–2 weeks after discharge from their first elective cardiac surgery. Qualitative content analysis was used to identify recurring themes. Pain diaries were used to record postoperative pain experiences 1–2 weeks before the interviews, providing more nuances to the experiences of pain and pain management.
Findings.  Postoperative pain experiences varied from no pain to pain all the time. Worst pain intensity was recorded as moderate or more. Pain experiences depended on what women's expectations of pain after cardiac surgery. None wanted to complain about their painful experiences. The women had needed for more individualized information about self-management of pain, and had difficulties remembering the information they had received. Most did not want to use pain medication, or waited to do so until pain was unbearable.
Conclusion.  Patients need more individualized and gender-specific information before early discharge from cardiac surgery to improve self-management. More specific predischarge education on self-management using analgesics regularly might prevent pain ratings rising to a severe level after discharge home.     

The Effect of Stomatognathic Treatment: A Clinical Follow-up Study

Temporomandibular disorders (TMD) are common but complex problems in dentistry. Most patients can be treated using relatively simple methods, such as counselling, splint therapy, and occlusal adjustment. Patients who do not respond to conservative treatment may benefit from surgical treatment. Ninety-two patients (68 women, 24 men, mean age 36 years, range 14–74 years) were treated between 1988 and 1990 in the Department of Prosthetic Dentistry and Stomatognathic Physiology. Sixty-two patients, of which 15 were surgically treated, attended for clinical follow-up in 1994. Success of treatment was evaluated using the anamnestic and clinical dysfunction indices of Helkimo. All patients reported that they had benefitted from their treatment. Symptoms of TMD were also noted to be clinically less than before. The results of the study reported show that the effects of stomatognathic treatment are beneficial in long-term, i.e. the patients were subjectively satisfied, and symptoms recorded clinically on follow-up were statistically significantly less than before.     

Hermeneutic observational studies: describing a method

There is a need to develop and use research observations in the clinical field, primarily to gain insight into and assess evidence of what comprises caring in a real‐life situation and confirm what is actually taking place. In addition, assessments lead to a new and different understanding of what caring constitutes, thereby enabling the identification of what kind of care is being provided and is required. Such observations also enable the observer to perceive and verbalise caring. There are ongoing discussions, specifically in Nordic countries, on how to use caring science‐based observations as a means of collecting and interpreting qualitative data through the application of a hermeneutic approach, which constitutes describing what has been seen and reporting on it by way of ethical obligation. This article contributes to the debate through the provision of additional content and by reflecting on the development and usability of hermeneutical research observations from a method and methodological perspective, thereby refining previous ideas and extending previous assumptions. The primary study objective was to report on the experience of utilising observations as a single data collection method for hermeneutic research with the aim of evaluating the interplay between intensive care unit (ICU) patients and their next of kin. A secondary objective was to highlight the impact of preknowledge and preunderstanding on the interpretation process. An intensive care context was assessed as the most appropriate, as the majority of patients are unable to engage in verbal narratives during ongoing treatment and care. The benefits of employing hermeneutic observation as well as interpretation and preunderstanding from a caring science perspective are considered.     

Survival of intimate partner violence as experienced by women

Aims and objectives. The study set out to describe women's experiences of intimate partner violence, the consequences of such violence, the help they received and women's experiences of their survival. Background. Social and health professionals do not have sufficient ability to identify and help families who suffer from intimate partner violence. Methods for identifying and treating partner violence not have been developed adequately. Method. The study was conducted in Finland by loosely formulated open‐ended interviews with seven battered women. The data were analysed by inductive qualitative content analysis. Findings. Women had past experience of maltreatment and a distressing climate at their parental home. Women experienced both themselves and their spouse as having weak identities; their ideals, patterns of marriage and sexuality were different. Violence occurred in situations of disagreement. Women tried to strike a balance between independence and dependence in the relationship. The different forms of couple violence were interlinked. The women sought help when their health and social relationships got worse. An awareness of the problem, taking action, counselling and social relationships helped them survive. Religiousness was a factor that involved commitment to the couple relationship, made religious demands on women and promoted the recovery of integrity. Conclusions. Intimate partner violence was associated with the family model, childhood experience of maltreatment, the partners’ weak identity and conflicts between individualism and familism. Social and healthcare professionals need competence in early intervention and skills to discuss moral principles, sexuality, and violence in a way that is free of prejudice and condemning attitudes. Spiritual approaches in the context of interventions should be taken into consideration. Relevance to clinical practice. In a clinical context, nurses should be aware of the symptoms of violence, and they should have skills in dealing with intimate moral and spiritual issues.