Meaning and normativity in nurse–patient interaction

Abstract It is a fundamental assumption in nursing theory that it is important for nurses to understand how patients think about themselves and the contexts they are in. According to modern theories of hermeneutics, a nurse and a patient must share the same concepts in order to communicate beliefs with the same content. But nurses and patients seldom understand medical concepts in exactly the same way, so how can this communicative aim be achieved in interaction involving medical concepts? The article uses a theory of concepts from recent cognitive science and philosophy of mind to argue that nurses and patients can share medical concepts despite the diversity of understanding. According to this theory, two persons who understand medical language in different ways will nevertheless possess the same medical concepts if they agree about the normative standards for the applications of the concepts. This entails that nurses and patients normally share medical concepts even though patients’ conceptions of disease and illness are formed in idiosyncratic ways by their social and cultural contexts. Several practical implications of this argument are discussed and linked to case studies. One especially important point is that nurses should seek to make patients feel comfortable with deferring to a medical understanding. In many cases, an adequate understanding of patients presupposes that nurses manage to do this. Another implication is that deference‐willingness to normative meaning is not equivalent to the actual application of concepts. Deference‐willingness should rather be thought of as a pre‐communicative attitude that it is possible for patients who are not fully able to communicate to possess. What is important is that nurses and patients have the intention of conforming to the same meaning.     

Towards an ethics of immediacy A defense of a noncontractual foundation of the care giver—patient relationship

In this article, I argue that the relationship between patients and their health care providers need not be construed as a contract between moral strangers. Contrary to the (American) legal presumption that health care providers are not obligated to assist others in need unless the latter are already contracted patients of record, I submit that the presence of a suffering human being constitutes an immediate moral commandment to try to relieve such suffering. This thesis is developed in reference to the French philosopher Levinas and the Dutch theologian Schillebeeckx. An expanded version of the biblical parable of the Good Samaritan serves as test case.This revised version was published online in October 2005 with corrections to the Cover Date.     

45岁以上一线护士职业心理体验及人力资源配置的质性研究

目的了解45岁以上一线护士的职业心理体验和需求,为管理者制定人性化护理管理制度提供依据。方法采用现象学研究法,深入访谈14名45岁以上一线护士。结果通过对资料阅读、分析和整理提出5个主题：一线大龄护士职业心理变化、日益加重的生理性疲劳、家庭压力增大、追求非临床一线工作的心理和日益积累的工作经验。结论45岁以上一线护士存在不同程度工作疲惫感,但有着丰富的护理经验。提示护理管理者应注重一线大龄护士的身心健康,合理调整工作岗位,使其充分发挥作用。     

Meanings of at‐homeness at end‐of‐life among older people

Maintaining the well‐being of older people who are approaching the end‐of‐life has been recognised as a significant aspect of well‐being in general. However, there are few studies that have explicitly focused on at‐homeness among older people. This study aims to illuminate meanings of at‐homeness among older people with advancing illnesses. Twenty men and women, aged 85 or older, with advancing illnesses and who lived in their own homes, in nursing homes or in short‐term nursing homes in three urban areas of Sweden were strategically sampled in the study. Data were generated in narrative interviews, and the analysis was based on a phenomenological hermeneutical method. After obtaining a naïve understanding and conducting structural analyses, two aspects of the phenomenon were revealed: at‐homeness as being oneself and at‐homeness as being connected. At‐homeness as being oneself meant being able to manage ordinary everyday life as well as being beneficial to one's life. At‐homeness as being connected meant being close to significant others, being in affirming friendships and being in safe dependency. Here, at‐homeness is seen as a twofold phenomenon, where being oneself and being connected are interrelated aspects. Being oneself and being connected are further interpreted by means of the concepts of agency and communion, which have been theorised as two main forces of the human being.     

An Exploration of the Support Person's Perceptions and Experiences of Complex Regional Pain Syndrome and the Rehabilitation Process

We explored the perceptions and experiences of those who support a relative or friend with complex regional pain syndrome (CRPS), a chronic pain condition of unknown aetiology usually affecting a single limb. Semi‐structured interviews were analysed using interpretative phenomenological analysis, and four superordinate themes are presented here. These themes describe the efforts of carers to make sense of CRPS and the rehabilitation process, to be sensitive to the discomfort of the person with CRPS and to respond in an attuned and helpful way. CRPS had become integrated into the carers' lives as they sought to monitor, protect and motivate the person they supported. The themes are discussed in relation to each other and to extant literature, including work on social support and adjustment to chronic illness, and the clinical implications are explored. Copyright © 2011 John Wiley & Sons, Ltd.     

Waiting: the experience of persons in a critical care waiting room.

The purposes of this study were to discover the essences of the experience of waiting, to provide new knowledge about what it is like to wait, and to contribute to nursing knowledge. Participants were 12 persons who were family members or friends of persons in an adult critical care unit. The Parse research method was used to answer the research question: What is the structure of the lived experience of waiting? The central finding of this study was this structure: The lived experience of waiting is a vigilant attentiveness surfacing amid an ambiguous turbulent lull as contentment emerges with uplifting engagements. The structure is discussed in relation to nursing knowledge and in relation to how it can inform future research and practice. © 2002 John Wiley & Sons, Res Nurs Health 25:58–67, 2002.