journal of advanced nursing volume 37 issue 3 2002 [doi 10.1046%2fj.1365-2648.2002.02071.x] maria...

8/12/2019 Journal of Advanced Nursing Volume 37 issue 3 2002 [doi 10.1046%2Fj.1365-2648.2002.02071.x] Maria Lcia Ara

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METHODOLOGICAL ISSUES IN NURSING RESEARCH

Phenomenology as a method to investigate the experience lived:a perspective from Husserl and Merleau Pontys thought

Maria Lu cia Arau jo SadalaPhD RGN

Professor, Department of Nursing, School of Medicine, Botucatu, Universidade Estadual Paulista (UNESP), Sao Paulo, Brazil

and Rubens de Camargo Ferreira Adorno PhD

Professor, School of Public Health, Universidade de Sao Paulo (USP), Sao Paulo, Brazil

Submitted for publication 13 June 2001

Accepted for publication 25 October 2001

Introduction

Recently nurses have seen phenomenology as an important

methodology for understanding nursing experience. Under-

stood as a more appropriate approach to understanding the

lived world as opposed to the Cartesian method, which

privileges focusing on the object under study from a pseudo-

neutral and strictly objective stance this approach

seems better able to handle human issues by adding new

perspectives and broadening our knowledge. Critelli (1996)describes this in terms of two opposing paradigms. The

phenomenological approach introduces the issue of perspec-

tive, which points to the mutable and relative character of

truth. On the other hand, in metaphysical thought it is

assumed that the truth is unique, stable and absolute, and so

is the path to reaching it. In our opinion, phenomenologists

have neither defined nor clearly described a research method:

instead, ways to carry out phenomenological research can be

282 2002 Blackwell Science Ltd

Correspondence:

Maria Lucia Araujo Sadala,

Avenida Mario Arita 163,

CEP 14802-404,

Araraquara,

S~aao Paulo,

Brazil.

E-mail: [email protected]

S A D AL A M L A & A D OR N O R D E C F ( 2 00 2 )S A D A L A M .L .A . & A D O R N O R . D E C .F . ( 2 0 0 2 ) Journal of Advanced Nursing

37(3), 282293

Phenomenology as a method to investigate the experience lived: a perspective

from Husserl and Merleau Pontys thought

Aim. By taking nursing as a human relationships activity, in spite of its strongtechnical scientific features, this article reflects on the phenomenological method

as one of the ways to develop an investigation and acquire knowledge of the topic.

Rationale. Based on Husserls phenomenology, which is opposed to the way of

doing science based on the laws that regulate the physics and mathematics, the

article introduces Merleau Pontys existential phenomenology as the theoretical

foundation for the method it proposes. My existential conceptions people as

historic beings inserted in a world over which they act but which, in its turn,

determines them; the human perception as reference for our way of being in the

world; the space-time structure of perception these are the key concepts that have

led to the elaboration of an approach to phenomenological research.

Proposal of a methodology. Steps are proposed for such an approach, namely

phenomenological description, reduction and analysis. These lead to the building up

of ideographic and nomothetic analyses, thus unveiling and describing general

truths about the phenomenon studied. Finally, the possibilities for applying the

methodology to nursing research are discussed, illustrated by my research into

student nurses perspectives on working on an isolation ward.

Keywords:phenomenology, nursing, research, Merleau Ponty, Husserl, qualitative

research, existential phenomenology, phenomena, methodology, phenomenological

method


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found scattered among several authors work (for example,

Merleau Ponty 1945, Heidegger 1993, Gadamer 1997,

Husserl 2000, others).

Philosophically, phenomenology shares with other orien-

tations the building up of knowledge in a process of

development. The influence of this philosophical assumption

can be found in other qualitative methodologies, for example

interactionism.

Our aim here is to present how we understand phenom-

enological thought by discussing Husserls and Merleau

Pontys ideas as the basis for conducting an empirical study

in this case of nursing students perspectives on a placement

in an isolation ward.

Husserl

Phenomenology as discussed by Husserl (2000) is a return to

the lived world, the world of experience, which as he sees it is

the starting point of all science. Phenomenology proposesthat a phenomenon be described instead of being explained

or having its causal relations searched for, and it focuses on

the very things as they manifest themselves.

Focusing on the very things means turning to the world of

experience by taking into account that before any objective

reality there is a subject who experiences; before any

objectivity there is a pregiven world and before any know-

ledge there is a life on which it is based. This means that any

knowledge has its origin in experience, which is prereflexive

(Dartigues 1973).

Phenomenology emerged at the end of the 19th century to

solve simultaneously a crisis in philosophy, a crisis in the

human sciences and a pure and simple crisis in the sciences,

when positivism was unable to answer the questions being

asked of human sciences (Merleau Ponty 1945). What

Husserl criticized in the positivist sciences, mainly

psychology, was their borrowing of the methods of natural

sciences and applying them without realizing that their

objective was different. Dilthey had already shown concern

about this by saying that the sense of life had to be returned

to, and this was more fundamental than the data of the

science, according to Dartigues (1973).

Husserls conception, as an alternative proposal to positi-vism, tries to reintegrate the world of science and the life-

world. The idea of the life-world refers to the prereflexive or

preobjective world, that is, to the experience lived by a

researcher that enables them to question the world and

phenomena (Martins 1992). It links a phenomenon and being

in an inseparable way: there is a phenomenon only when

there is a subject who experiences the phenomenon. As stated

by Martins & Bicudo (1989) phenomenology describes a

humans experience as it is rather than according to the preset

propositions of the natural sciences. It is a particular way of

doing science: doing qualitative research by substituting

individual descriptions for statistical correlations and inter-

pretations resulting from the experiences lived for causal

connections.

The phenomenological method, according to Giorgi

(1985), starts by describing a situation experienced in daily

life. It comes from a position prior to reflexive thought called

prereflexive thought, which consists of a return to the very

things. A researcher obtains descriptions of whatever there is

in front of a persons eyes and not of that things existence. At

that moment it is important that the researcher holds a

phenomenological stance that will enable them to keep

themselves open enough to live that experience as a Gestalt,

that is, in its wholeness, by trying to prevent any judgement

from interfering with their openness to the description. The

researcher tries to set aside any prior thought, conception,

judgement they may have about the phenomenon. In doingthis, the researcher will be placing that phenomenon in

epoche;by working with the description of the phenomenon

the researcher focuses on searching for its essence, the most

invariable parts of that experience as it is located within a

context. The essence, therefore, is the very nature of what is

being questioned.

The core of phenomenology is the intentionality

of consciousness, understood as the direction of conscious-

ness towards understanding the world. This intention is

turned towards the world that it neither includes

nor possesses, but towards which it is always turned (Martins

1992). Therefore, there is no consciousness without the

world, nor is there a world without consciousness. Through

the intentionality of consciousness all actions, gestures, habits

and human actions have a meaning. Consciousness, through

such intentionality, is understood as the agent that attributes

meanings to objects. Without these meanings it would be

impossible to talk either about an object or objects essence.

Thus, the researchers task is to analyse the intentional

experiences of consciousness in order to perceive how the

meaning a phenomenon is given meaning and to arrive at its

essence. Phenomenological reduction is the fundamental

resource that ensures a reliable description of a phenomenon.This reduction highlights the intentional character of

consciousness turned towards the world once it brackets

the reality conceived by common sense and cleanses the

phenomenon of everything that is unessential and accidental

in order to make what is essential visible. Husserl has created

a technique that enables us to be sure of keeping only the

essence of the phenomenon under study. This process is

calledeidetic variationof the object being studied in order to

Methodological issues in nursing research Phenomenology as a method to investigate the experience lived

2002 Blackwell Science Ltd, Journal of Advanced Nursing, 37(3), 282293 283


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identify the objects unvarying components the invariable

aspects that define the objects essence (Dartigues 1973).

This movement of the researcher searching for the essence

of a phenomenon being studied has an interesting illustration

in Pablo Picassos work: Metamorphosis of a bull(copyright

by Muse e Picasso, Paris). Here the painter displays images of

a bull in a sequence where he clearly looks for the bulls

essence and, little by little, he eliminates its unessential

characteristics and reaches the essential bull, as can be seen

in Figure 1a, b.

Thus, a researcher, when investigating a phenomenon

starting from the experiences lived by the research

Figure 1 Metamorphosis of a bull (Taureu, Picasso). Reunion des Musees Nationaux, Paris.

M.L.A. Sadala and R. de C.F. Adorno

284 2002 Blackwell Science Ltd, Journal of Advanced Nursing, 37(3), 282293


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participants, obtains their descriptions of their experience

and then has significant discourses that are able to be

understood and to have their essence unveiled. It is possible

to see the phenomenons essence by means of a funda-

mental notion, the principle of the intentionality: conscious-

ness understood as consciousness of something. That is,

consciousness is only consciousness when it is turned

towards an object. Studying the objectsubject relationship

consists of a descriptive analysis of the field of conscious-

ness, which has led Husserl (2000, p. 45) to define

phenomenology as the descriptive science of the essences

and actions of consciousness (Husserl 2000).

Figure 1 (Continued).




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Merleau pontys existentialist phenomenology

Merleau Ponty develops Husserls thinking. He suggests that

phenomenology is the rigorous science of the search for

essences, but also that it is a philosophy that sees people in a

world that already exists before any reflection. He sees this

individual as the body itself, at a place and time, acting in the

world in which it lives. The body itself is the perceiving

subject: the point of view of the world, the time-space

structure of the perceiving experience (Martins 1992).

Merleau Pontys phenomenology is existentialist in the

sense that it deals with the existence of people in a pregiven

world. It is a philosophy that is not interested in the abstract,

but in a historical person in as much as they engage with and

live in the world (Martins 1992). Based on Husserls

phenomenology but moving ahead, Merleau Ponty proposes

the task of returning to the very thing in a search for the

essences of objects, their qualities, but seeing these as part of

the lived and experienced world, which is a world of thingsthat have not been reflected upon, and on which sciences are

constructed (Merleau Ponty 1945).

For Merleau Ponty, the truth does not inhabit the inner

man (sic), that is, there is no inner man. Rather there are

people in the world and it is in the world that they learn

about themselves. This supersedes the notion of a self-

contained consciousness. It is not a matter of denying the

inner world, as empiricists do, nor or denying the existence of

the world outside, as idealists do (Merleau Ponty 1942). The

prereflexive, lived experience of a human being in the world

(etre-au-mond) in the sense of being thrown into the world,

with its intentionality, in an already-existing world, ready but

not thoroughly ready these are the founding conceptions of

Merleau Pontys phenomenology, which seeks to understand

people as beings in a situation, never fully free but in a world

never fully finished either: being born is simultaneously being

born from and in the world. The world has already been

formed, albeit never completely. However, this analysis is

still abstract because we exist in both relationships

simultaneously. There is never either determinism or full

choice; I am never a thing nor pure consciousness (Merleau

Ponty 1945-p.v.).

In Structure of Behaviour (Merleau Ponty,La structure ducomportement, 1942) and in %Phenomenology of Perception

(Merleau Ponty et al., La phenomenologie de la perception,

1945) Merleau Ponty deals with the body, the body itself, the

body lived, by which I can be in the world and relate to other

people and things. For him, the body is our anchor in the

world, or our general means of holding on to a world

(Merleau Ponty, 1945, p. 239). Going beyond the materialist

concept of a body which deems it an object, and the spiritual

approach which does not take the body into account as

something opposite to the soul, Merleau Ponty takes the body

as the self I do not have a body, but I am my body.

As we see it, Merleau Ponty deals with human behaviour

not only as a reaction to stimuli, or a projection of actions

caused by a separate mind. It is neither exclusively objective

nor exclusively subjective, and nor is it the sum of the two.

There is a dialectic relationship between a person as a body

and the world where it is located. The conditions of the world

limit but do not determine a body; instead, people are in

charge of determining themselves through their own choices.

The idea of a dialectic interrelationship between the being

as a lived body and the world is better explained by Coelho

(1991) when he talks about the body simultaneously

perceiving and being perceived and, based on this perception,

it throws itself into the world and knows the world through

an ambiguous movement where it continuously slides from a

universal polarity to a private polarity and vice versa.

Referring to this ambiguous movement, Coelho Jr.describes the meaning of ambiguity in Merleau Pontys

thought. The dialectics Merleau Ponty proposes is called

dialectics without synthesis and this clarifies the concept of

ambiguity in the sense that it is never thoroughly overcome.

There is no absolute truth, neither in knowledge, nor in

ambiguity. There are no certainties. The question and the

investigation remain open, always in transformation. As in

the research, reported in this paper, whenever a new horizon

of knowledge was reached, when our questions could be

answered, we could see ahead new horizons of new questions

and we set out a new search for more answers. People, from

this standpoint, are eternally coming-into-being, always in

the move, and, therefore, in a dialectic without synthesis.

That is why Merleau Ponty is called the philosopher of

ambiguity, this expression being understood as a continuous

search and transformation in which people are always

moving forward, in a coming-into-being of possibilities.

In this sense, Merleau Ponty is against the positivist science

view that sees people as static beings composed of auton-

omous parts and which explains facts based on causality. His

whole work is a criticism of this positivist model, mainly in

Structure of Behaviour (1942) and in Phenomenology of

Perception (1945). He sees people as a set of possibilities thatkeep being realized through dialectical relationships with the

world. He proposes a return to actual experience as basic

data for building science, which we could define, according to

Coelho (1991), as a model of a noncausal reality where the

circularity of the dialectical movement without synthesis

seems much more radical than the linear models of positi-

vism. This maintains the opposition and continuous tension

between the polarities the person and the world always in




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transformation, in a movement of endless search with each

new phenomenon.

People as lived bodies in the worlds they inhabit get in

touch with beings and things that are part of those worlds.

How do they perceive within their dialectical relationships

with these worlds? How do they make choices when facing

these limitations?

Martins (1992, p. 55) describes the body itself within this

movement very clearly: I am my body, I am space, I am time,

I am place, I am language, I am gesture. In short, I am my

body a body itself lived, which experiences within a

concrete reality. In this reality, in this world out there where I

live, my universality meets the others universality that limits

mine. Then, in this world of relationships with the other,

when I talk about the self I talk about alter ego, the self and

the self who is the other. The world in my consciousness,

therefore, as much as the world in the others consciousness,

is not a private world. My world results from how I perceive

the world and from how the other perceives me in the world,and from how I perceive the other, which results in an

objective subjectivity that we could call intersubjectivity.

Constituting the world, therefore, is an intersubjective

phenomenon.

For Merleau Ponty, in this condition of being in a situation

in an already given world of relationships, the others

universality leads me to a selective operation in order to

adapt to the situation. Each body, with its own structure,

selects ways to adapt, which are never repeated either with

others or with itself at other moments and places.

From this perspective, even considering the world as

already given, the human condition of existing in a pregiven

world and being limited by this condition and the restrictions

I am subject to, I am the subject of my experiences and I

make my choices. Despite being located and involved in a

pregiven world, which is already there, I give me to myself,

and this means that this situation is never hidden from me, it

is never around me as an alienated given, and I am never shut

inside a world like an object inside a box. My freedom, the

fundamental power I hold because I am the subject of all my

experiences, does not diverge from my insertion in the world

(Martins 1992).

By relating with the worlds objects, beings and things, aperson is a being who perceives the world from different

standpoints depending on the situation in time and space,

who perceives particular perspectives that vary accordingly to

the perceptual field which is a horizon, that is, the place of

perceptual experiences. We can perceive objects from

different places, at different moments. These ideas are key

concepts for the study reported here, that is, perspective, field

and horizon, which can be better explained with the example

of perceiving a house that Merleau Ponty (1945, pp. 8183)

uses in Phenomenology of Perception (my translation):

We perceive a neighbouring house we pass by it. When we come

closer, firstly we see one side, then, as we walk by, we see the front of

the house and next, the other side. If we went around the house, we

would see its back and, if we could get in, we would see the inside

from several angles according to where we were. As we have adifferent view from each angle and as we know that it is a house, we

conclude that the house exists by itself, independently from any

perspective. At the same time any view we might have from any angle

whatsoever would allow us to know that it is a house. Seeing the

house is therefore seeing it from somewhere, at a certain moment,

i.e. seeing it in a multiperspective way, at a certain place, at a certain

moment referred to as a horizon. Thus, seeing a house implies

being able to see it from several perspectives, which are various

possibilities.

These concepts related to the space-time structure refer to the

phenomenological methodology based on Merleau Ponty:when we ask several subjects for descriptions of a certain

phenomenon being investigated, we understand that each will

give this accordingly to their standpoint from where they

perceive the phenomenon and that different peoples percep-

tions, at different times and places, are given to us as several

views from different perspectives of that phenomenon, which

cross each other in inter-subjectivity and present to us

common meanings that enable us to understand that

phenomenons structure. Next, when we make a phenome-

nological interpretation of these data, the phenomenons

structure is understood within our perspective as a researcher,

which is another perspective, another field, another horizon,

that of scientific knowledge. These interpreted data allow us

to reach a specific field of generalities, which we can say

belongs to the general structure of the phenomenon.

The phenomenon, thus, depends on a peoples perceiving

perspectives. As something that alternatively shows and hides

itself, it shows itself to whoever perceives it according to

human perception, which means ones perception from

different standpoints in time and space. One could say that

a phenomenon is never seen in its totality, because this would

be an abstraction; the convergence of several perspectives,

however, leads us to perceive a phenomenons structure.Using this approach the whole scientific universe has been

built up from perception of the lived world and, thinking

with scientific rigour, it is first necessary to review experi-

ences in the lived world from which science is the second

expression.

In this perspective, when thinking about the issues that

concern us in our practice, that is, how students live their

experience of nursing inpatients on an isolationward,we try to




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understand what our students experience in a situation where

they relate to an already given world, which is out there, into

which they are launched and which they will have necessarily

to face. In their descriptions we focus on their perceptions of

theisolation world: of peopleand objects in theisolation ward;

on meanings attributed by their consciousness in this experi-

ence and especially on the meanings of the relationships with

patients whom they have nursed.

As we understand it, Merleau Pontys existential phenom-

enology which deals basically with human beings in the

world within their condition of existing in a pregiven world

and being limited by this condition, and their freedom to

choose can offer significant contributions to the study of

professional experience when it tries to place a researcher in

the perspective of the research participants in order to

understand their experience and feelings, thus unveiling what

it means, from their point of view, to be in the situation

within the experience of nursing the sick. This approach

investigates the truth starting from the origin of all know-ledge experience of the world trying, from there, to

describe the phenomenon, to analyse and interpret it, thus

succeeding in understanding what is essential and invariable,

namely the phenomenons structure. In this sense, when one

chooses a theme to research, for example, nursing students

views on nursing on an isolation ward, phenomenology

emerges as the most appropriate method for conducting the

study because it allows us to approach and understand the

different perspectives of participants who experience nursing

in a world of the isolation ward.

Next, a possible way to develop a phenomenological

investigation is described, the approach of a research project

seeking to understand nursing students views on nursing on

an isolation ward (Sadala 1995). The project is based on

Merleau Pontys existential phenomenology: phenomenolog-

ical description, reduction and interpretation in a search for

general truths about a phenomenon the structure of the

phenomenon of nursing on an isolation ward from the

perspective of nursing students.

The study

The question

What does nursing on an isolation ward mean? This question

expresses our own concerns about the lived experience on an

isolation ward during our professional life. By researching we

try to understand this phenomenon.

We chose to approach this understanding from the nursing

students standpoint, those who live the experience of being

with inpatients on an isolation ward. The group chosen for

the research was students who were starting their activities on

isolation wards because we wanted to study how the

experience of getting in touch with an isolation ward takes

place from their standpoint because it is there where our

concerns lie: how we can help them start to work on an

isolation ward. We chose students who were experiencing

being on an isolation ward while the research was conducted

because we believed that while they were actually experien-

cing the isolation ward their thoughts and feelings related to

the experience would show up in their perceptions before

undergoing a reflexive process. In their descriptions we

looked for their prereflexive experience, which is the origin of

the whole reflexive process and knowledge of the world.

Once the subjects and location of the research were chosen,

we turned to the question to be asked of the students. It is not

easy to formulate such a question. We had to devise a very

clear question that enabled us to receive more than a simple

answer, because we wanted a description that would answer

the uneasiness that triggered our research. We did not wantjust a limited description of what it means to be on an

isolation ward; we wanted a description involving feelings

and thoughts about the reality experienced and the percep-

tion of that reality within a context leading to a reflection on

its meanings and its impact on peoples lives. Initially we

decided to ask interviewees the following question: What

does it mean for you to nurse inpatients on the isolation

ward?. However, the consensus reached in a phenomenology

group of which we were once members led us to other

elaborations. What is could lead to limited responses or

definitions. What does it mean still sounded limiting.

How does it seem came up as a way of asking that would

come closer to what had to be asked. Thus, we formulated

the question to be asked of interviewees as follows: How

does the activity of nursing patients on the isolation ward

seem to you?

To summarize, the questions objective in the format

elaborated was to understand what nursing on the isolation

ward was from the nursing students standpoint and, by

subjecting their responses to an interpretative analysis, to

reach the essential characteristics of the phenomenon under

study, which would enable understanding its essential mean-

ings its structure.

The description

We asked this guiding question to students in the third year of

the Nursing Faculty where we are teachers on a course in

NurseClient Relationships. The 11 female students were

giving nursing care to inpatients on the isolation ward. After

recording their descriptions and listening to them several




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times we thought the study still required more data because

we wanted to have a broader perspective on the phenomenon

by understanding it within another context in addition to that

our own school. According to Martins (1992), the more

subjects there are, the better is the possibility of unveiling

what is the essence of the phenomenon studied. Therefore,

seven students from another faculty who were also on

placement on an isolation ward at that time were interviewed.

During these interviews we tried to maintain a phenom-

enological stance: we introduced ourselves, described our

work, requested their collaboration and their consent to tape-

recording. Then we explained the project that had been

approved by the institution and obtained their formal

consent. We tried to listen to them in an understanding and

nonjudgemental way, with no time limit, and to be empa-

thetically involved with them and show how interested we

were, without either interrupting or asking any other ques-

tions. With this approach the interviewees spontaneously

expressed their views on the meanings of their experience.The statements were later transcribed exactly as they had

been produced (Box 1).

Methodological approach

The phenomenological methods objective is to describe the

full structure of an experience lived, or what that experience

meant to those who lived it. Differently from positivism,

which intends to find causes and formulate laws, phenome-

nology uses attentive observation to describe data as they

emerge. Phenomenology is concerned with understanding a

phenomenon rather than explaining it (Martins 1992).

As qualitative research is involved here, generalizations are

not intended. Attention focuses on how a phenomenon is

unveiled and the surrounding world is questioned. Rigour

rather than numerical precision is maintained, but this

methodological rigour involves trying to understand

phenomena that cannot be studied quantitatively because

they have personal dimensions which can be more properly

researched by means of a qualitative approach (Martins

& Bicudo 1989).

An analysis of the structure of a phenomenon within a

context is one of the outcomes of phenomenological research.

This is guided by phenomenologys fundamental ideas and

follows the steps we will introduce next, following Martins

(1992).

The first step in this phenomenological method is the

description. All sciences, including exact sciences, use

description as a basic element. However, in the phenomeno-

logical research a description has special characteristics and

that is why it is called phenomenological description: it isintended to mirror and express a participants conscious

experience.

The second step is the phenomenological reduction, which

is a critical reflection on a descriptions contents. This can be

carried out at three different moments:

at the first moment, by keeping the description in its

original format, a researcher puts it between brackets

(called epoche), aiming to analyse the experience as lived

without allowing personal or theoretical concepts to get in

the way of the rigour with which the description is being

listened to;

at the second moment a radical gestalt perspective is

created where observer and subject are the focus of the

description. This process consists of arranging the data into

themes, where the researcher identifies significant topics in

that subjects transcript, i.e. what is called units of

significance;

at the third moment the researcher tries to focus on the

prereflexive sources (what interviewees say about their

daily lives) and states the meanings of the experience

(psychological insights) included therein, that is, inter-

viewees recognition of their own understanding of what

happens to them when living that situation. The researcher,at that moment, transforms participants everyday expres-

sions into expressions appropriate to the scientific

discourse supporting the research.

The third step of the method is the phenomenological

interpretation, when the four stages of the hermeneutic

procedures are identified:

locating the elements that can be found and those that are

not visible but that can be unveiled in the description.

At the beginning I thought it would be very hard to relate with the

patient, even to administer any nursing care1. But, daily contact

with the patient rendered things easier, I felt like helping2, because

I noticed they had an enormous need of having somebody close to

them, of feeling that they were important, that somebody was

carrying for their health3. Then, from that moment I started to

perform my duty better, you know, but it was, it were the patients

those who helped4 (pause). I also think that they started to teach

me, like showing me, I learnt with them to see the sense of life in

death, you know, when one sees death very close you know that itcan happen to you, that you can die too, then you start learning

that you must live each day as it would be really the last one, turn

it into the best one, even if it wont be perfect5. I think it worked.

It was a very good experience. I think it was valid for me to learn,

lead me to reflect on how was I conducting myself at the nursing

station, on what was the meaning of the patients to me6, if I was

giving them the importance that they deserved. It made me

reassess all of this. I think it was very important. I am sure that

from now on I will be a better nursing student7.

Box 1 Statement no. 2




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Figure 2 Complete chart of the converging points.




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Learning about the phenomenon as totality means

capturing aspects of what is being revealed, aspects that

may vary: sometimes they are visible, but sometimes they

are hidden, according to the perspective adopted by the

researcher. What sometimes is invisible to the viewer may

become visible when viewed from a different perspective. I

sought to understand fully the phenomenon, rather than

only its outline. Therefore, I tried to change perspective in

order to reveal what could be seen and what was hidden;

the radical cogito the researchers effort to reach the

phenomenons totality which produces the reflexive

phenomena present in the consciousness;

the manifestation of preconscious phenomena;

the final result, which is the hermeneutic judgement or

specification of the existential meaning, that is, the meaning

of the phenomenon that the participant experiences.

According to Martins (1992), existential phenomenology

uses interpersonal communication to understand the mean-

ings of the experience lived by a person. It focuses on thispersons conscious experience, which allows epistemological

limits to be defined that is, determining the way subjects

know about their own experience at a descriptive level. By

using logical inferences, reduction of the conscious experi-

ence enables the researcher to locate those elements of

meaning that are empirically present in the situation and are

perceived and expressed through the participants discourse.

Construction of the findings

Following the steps Martins proposes, the students descrip-

tions of their experiences were analysed and interpreted. The

units of meaningwere individually identified in each state-

ment, that is, the parts of the discourse that answered the

researchers question. At this point in the individual analysis

of the discourse, an ideographic analysis is conducted. The

researcher interprets and analyses each discourse individually

and eventually articulates their own understanding of the

description. Figures 1 and 2, Box 2 and Table 1 are examples

of the steps of the ideographic analysis, showing the proce-

dures carried with one of the statements.

After conducting the ideographic analysis for each one of

the transcripts, when all the units of significance in each havebeen obtained, the researcher looks for the convergence of

those data. This is the nomothetic analysis (Table 1) which

shows the confluence of all the research subjects views under

different perspectives and, by showing convergence, it unveils

the invariable aspects of the phenomenon studied, its essence.

In this move from the ideographical analysis to the nomo-

thetic analysisthe convergences, which will be interpreted by

the researcher, are arranged into themes and categories, and

this will cast light on the data gotten, on the knowledge and

on the data to be studied related to the theme, looking for

broadening the discussion and the understanding of the

significance of the scientific knowledges universe.

In the phenomenological approach, as in the other modal-

ities of qualitative research, the researcher takes a positioninitially when they define their concerns and explains their

life-world (the experience they have been living related to the

study topic). While data are collected (descriptions), analysed

and interpreted, the researcher tries to keep a phenomeno-

logical stance: theepoche, that is, to keep suspended every-

thing they know and think about the phenomenon in

question. However, when findings have been constructed,

the researcher positions themselves as a participant in the

study by analysing what process has meant to them, the

unveiling of this new horizon of which they are also a part

after conducting the research. It is as if the researcher closed a

hermeneutic circle: the development of their own knowledge

in intersubjectivity with the research subjects, the authors

brought into the discussion, and the researchers own

experience before and during the investigation show the

continuous movement of the human experience.

As nurses and researchers, we think that the great contri-

bution made by Phenomenology to Nursing lies in the

possibility it opens to a professional by unveiling the nature

of human experience through an open, multiperspective

approach, where one can consider the relativity and tempo-

rality of knowledge, in the light of how temporary the human

conditions is and the infinite ways a human being can be. Ithandles cognitive issues within an existential approach.

As we see it, nursing can be defined as a human helping

relationship; therefore, it is an existential situation for both

patient and nurse. Thus, it is possible to understand the high

degree of acceptance and of phenomenology as a research

approach by nurses. This approach and understanding of the

reality experienced when nursing allowed by the phenom-

enological method seems to reflect a search by nurses among

At the beginning the student felt her relation to the patient so

difficult that any contact with him seemed to be a barrier.

However, through her daily contact with him she noticed his

loneliness and his need for help, thus understanding the meaning

of her work there. She learnt with terminal patients to grasp the

meaning of life in death, and the meaning of living each day as the

last one. From then on, she begins to reflect on herself, her relationwith patients and with her profession. Regarding to this relation-

ship, she adopted the do it as best you can manner of working,

because each moment of life is irretrievable and, as such, one must

make the most of it.

Box 2 Ideographic analysis articulation of ideas




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Table 1 Ideographical analysis (statement no. 2)

Units of meaning

subjects language First elucidations Researchers language

Units of meaning changed

through the questioned

phenomena

1. At the beginning I thought it

would be very hard to relate

with the patient, even to

administer any nursing care.

To relate with: to involve oneself

therapeutically with the patient

in order to help him to overcome

his problems with the disease

and of being hospitalized

Administer: to offer, to provide,

to apply. (Ferreira 1986).

Nursing care: nursing assistance.

At the beginning the student

felt it would be difficult to the

patient on the isolation ward,

even to give any nursing care.

2.1. Initially the student

experienced an extremely

high feeling of anxiety

that it seemed very hard

to her start a relationship

with the patient.

2. Daily contact with the

patient made things easier,

I felt like helping.

Patient: in context, student refers

to the HIV-positive patient.

Daily contact: familiarity, daily

contact. (Ferreira 1986).

Helping: assist, help. To be available

to offer support to the person who

needs outside help (Ferreira 1986).

The daily contact with the

patient rendered things easier,

the student felt like helping.

2.2. Starting a relationship

with the patient, keeping

a daily contact with him

arouse the willing

to help.

3. I noticed they had an

enormous need of having

somebody close to them,

of feeling that they were

important, that somebody

was carrying for their health.

Somebody: some person, another

person. (Ferreira 1986).

Close to: near. (Ferreira 1986)

In context: on the isolation ward,

patients, particularly those these with

HIV-positive, stay completely alone.

Important: essential, indispensable.

(Ferreira 1986).

The student had noticed that

patients had an enormous need

of somebody around, who care

for them and for whom they

were important.

4. Then I started to perform

my duty better, you know,

but it was, it were the patients

those who helped me.

Duty: using physical or intellectual

activities. (Ferreira 1986).

In context: systematization of

nursing assistance.

From comprehension of the

patients needs, the student

was able to perform her job.

It were the patients whohelped her.

2.3. The patients helped her

to do her job, grasping

their needs was a

stimulus to her to under-stand the meaning of

nursing cares there.

5. They started to teach me,

like showing me, I learnt with

them to see the sense of life

in deathyou must live each

day as if it would be really the

last one, turn it into the best

one, if it wont be perfect.

Sense: meaning. (Ferreira 1986).

Teaching: to make known, to point

(Ferreira 1986).

Learning: to become aware of.

(Ferreira 1986).

Perfect: complete, without imperfections.

(Ferreira 1986).

She learnt with patients the

sense of life in death, to live

each day as it were the last

one, to render that day the

best one, even if not perfect.

2.4. She learnt with the

patients to reflect on the

meaning of life and

death, and on her

relationship with her

patients.

6. I think it workedlead

me to reflect on how was

I conducting myself at the

nursing station, on what was

the meaning of the patients

to me.

To conduct oneself: to act, to

behave. (Ferreira 1986).

The student reflected on her

behaviour at the nursing

station, on the meaning

of patients to her.

2.5. These experience

represented to her a more

thoughtful stand about

her profession.

7. I am sure that from now on

I will be better nursing student.

The student is sure that from

now on she will be a better

nursing student.




12/12

current trends toward more humane health care for a way of

privileging the affective and reflexive aspects of practice. It is

as if they are trying to compensate for the human distance that

the amazing technicalscientific advances in health care have

created in the inhuman relationships between professionals

and patients. In short, it is a search endeavouring to under-

stand the meaning of human experience both for patients and

professionals within a nursing relationship.

Acknowledgements

I would like to thank the Musee Picasso, Paris, for copyright

permission, FUNDUNESP (Universidade Estadual Paulista

Julio de Mesquita Filho), Sao Paulo, Brazil, for funding the

work, and Maria Helena Bononi for help with translation.

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journal of advanced nursing volume 37 issue 3 2002 [doi 10.1046%2fj.1365-2648.2002.02071.x] maria...

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