Transcript Caring Inquiry

CARING INQUIRY
Marilyn A. Ray, RN, PhD, CTN-A
Professor Emeritus
The Christine E. Lynn College of Nursing
Florida Atlantic University
Boca Raton, FL 33431
©Marilyn A. Ray, All Rights Reserved
Philosophy of Caring Inquiry
• Grounded in care/caring philosophy (Ray,
1981a, b, 1991, 1989,1990, 1994, 2011, 2012)
• Grounded in phenomenological-hermeneutics
(descriptive-interpretive reflection and analysis)
• Influenced by van Manen, Husserl, Heidegger,
Gadamer, Ricoeur, Buber, the philosophy of
care/caring, and aesthetics
• Focuses on the caring relationship in nursing
and human experience
Caring Inquiry
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Research method that:
Seeks to describe the meaning of experience of people
Seeks to understand a person’s reality and experiences
Honors the human-environment integral relationship
Values individual human beings
Values the nurse/researcher-patient relationship
Embraces a holistic approach (body, mind, spirit)
Approaches the research experience and the
participants from a compassionate, loving, and spiritualethical view
Caring Inquiry
• The Philosophy of Caring Inquiry
Caring and love are synonymous. Inquiring
about caring touches the heart and translates
through the soul, the ‘speaking together’
between the one caring and the one cared for….
the shifting of consciousness from a focus on
‘they’ or ‘I’ to a compassionate ‘we.’
(Ray,1991/2012)
Caring Inquiry
• Compassion is defined as the following:
a wounding of the heart where the other enters into us
and makes us other. It is an immersion into the human
encounter that also reveals the human, environmental
and spiritual [and ethical] contexts that are nursing. In
the compassionate way of being, the forms of ‘other’ in
consciousness communicate a depth of felt realness or
authenticity which is intuitive and depends on the
granting to the other to whom one communicates, a
share in one’s being.
(Ray, 1991/2012)
Caring Inquiry
• Caring inquiry as an aesthetic/artistic process:
in research (creativity, sensitivity, quality of presencing) attends to
both the immanence—communion with and transcendence—
reflective intuition and spiritual creativity.
• Caring inquiry engagement:
the compassionate ‘we’ is enacted for caring inquiry-descriptive
phenomenology, and interpretation (phenomenologicalhermeneutics), and the aesthetic knowing of the experience of
caring are the means by which questions about the meaning of
caring are illuminated. (Ray, 1991/2012)
Caring Inquiry: Husserl’s
Phenomenology
• Husserlian Phenomenology: Theory of knowledge, an
epistemology
• Being of the world
• Science of the mind
– How do human beings know?
– Capture human beings in life world (Lebenswelt)
– Captures meaning
– Modes of reflection at heart of philosophic and human
science thought
Caring Inquiry: Intentionality
• Inseparable connectedness of the human being
to the world
• Consciousing the world: Fundamental structure
of consciousness is intentional
• All thinking (imagining, perceiving, remembering,
anticipating), thinking about something—
Intentionality—Integral evidence: The knower and known are integral
through reflection
• Retentions (past)
• Portentions (anticipation of the future),in the NOW, the present
Caring Inquiry: Essences
• Essences
– The ideal or true meaning of something
– Ultimate structures (essences) of consciousness
– Systematic view of mental content, brought into internal
consciousness by cognitive processes
– Object of experience—the body as a container for the
mind (Cartesian—mind-body split)
– Returning to the things themselves—whatness of a thing
– Those concepts that give essential meaning to the
phenomenon under investigation
– Emerge in isolation or in relation to each other
Caring Inquiry: Intuition
• A technical term relating to the mode of
awareness in which the object is not only
“meant” but originally given
• One sees what is meant
• Make lived experience evident to clear
intuition (insight)
Caring Inquiry: Phenomenological
Reduction
• Transcendental Reduction: Eidectic reduction
(Ideal form)-Structured Reflection
• Bracketing presuppositions (suspension)--Outer
world not denied but bracketed
• Universal essences—Reduction from particular
facts to general essences
• To intuit meanings as they are [direction
apperception of the whole] in the description of
experience
Caring Inquiry: Heidegger’s
Phenomenology
Ontology—a study of the modes of ‘being
in the world
Phenomenology is hermeneutical or
interpretive
Presuppositions constitute the possibility
of intelligibility or meaning
Being is being present in the world
(German, Dasein—being there)
Caring Inquiry: Heidegger’s
Phenomenology
• Dasein—human being but also, openness
in which entities are revealed in light of
being
• World is revelatory
• World and person co-constitute each other
• Things show up as significant and
significance is background for Reflective
Understanding
Caring Inquiry: Heidegger’s
Phenomenological Hermeneutics
• Understanding a persons in context—what a person
values and finds significant
• Hermeneutics—interpretation
• Goes beyond description to discover meaning, uncover
hidden phenomena and their meanings
• Interpretations based on horizons of meaning we already
have
• The ontological path—we can effectively attend to
epistemological concerns after we first understand
ourselves and what it means to be human
Caring Inquiry: Hermeneutics:
Gadamer
• Articulated an interpreted within the context of
temporality and historicity of human existence
• Ontological
• Tradition is preunderstanding—the total
background of prejudices, practices, vocabulary,
concepts, hypotheses
• Human understanding does not occur through a
silent act of self reflection but a dialogical
process of linguistic experiences
Caring Inquiry: Ricouer’s
Hermeneutic-Phenomenology
• Ricoeur
– All phenomenological description is text interpretation or
hermeneutics
– Widened the notion of textuality to any human action or situation
– To interpret a social situation is to treat the situation as text and
then to look for the metaphor that may be seen to govern the text
– Returns hermeneutics from ontology (understanding as a mode
of being) to the question of epistemology (understanding as
human science method)—Explanation and understanding in
terms of distanciation (keeping a distance emotionally or
intellectually and participation)
– Human science is descriptive and interpretive—no such thing as
uninterpreted phenomena
Human Science
• Name that reflects a number of
approaches to research e. g.,
phenomenology, hermeneutics, semiotics,
critical social theory
• The study of meaning
• Descriptive-interpretive studies of patterns,
themes, structures, levels of experiential
or textual meanings
Hermeneutic-Phenomenology:
van Manen
• A general concern for examining human values that
would restore a sense of meaningfulness, personal
relationship—an at “homeness” in the world
Integrates phenomenology description, hermeneutics
(interpretation) and semiotics (signs)
Writing the story—textual reflection is where insight
occurs
“We can only understand something or someone for
whom we care.”
Caring Inquiry Evolution
• Caring as the essence of nursing as the basis for the
research methodology
• Integrates philosophies from Husserlian and
Heideggerian, Gadamerian, Ricoeurian, van Manen
Phenomenological traditions
• Method seeks integrity—” the thought, word and
love/caring” are a synthesis
• Human choice to share in the life of another
• Call to a deeper life, integrated wholeness, coming to
understand meaning of life world experiences and
relationships more fully (the I-Thou relationship (Buber))
Phases of the Process of Caring
Inquiry
A. The Intentionality of the Inner Being of the
Researcher
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Researcher focuses on the meaning of caring in nursing--past,
future within the present
Focuses on her/his inner being to reflect on the self and the life of a
caring researcher to come to appreciate the “vision” within
Recognizes the research relationship as co-presencing with the
other, and
Focuses on identifying one’s presuppositions of care and caring in
nursing
Practicing bracketing to hold in abeyance one’s
preshistory and presuppositions about caring in
nursing
Phases of the Process of Caring
Inquiry
B. The Process of Dialogic Experiencing
• Selecting participants for the study grounded within the imaged
vision
• Engaging with the participants to discuss the roles of interviewer and
interviewee, and securing informed consent signatures
• Co-presencing/sensing the other by recognizing the immediate
impact of each other’s being on each other—the compassionate
“we”
• Conversing with participants in tape/digitally recorded, intensive
interviews lasting about one hour, about the meaning of caring by
asking the phenomenological question, “What is the meaning of
care/caring to you in your experience? What is it like to experience
caring?
Phases of the Process of Caring
Inquiry
B. The Process of Dialogic (Communicative)
Experiencing (continued)
• Engaging in a cue-taking, talk-turning, researcher-bracketed,
dialogical-dialectical interactive process based on participants’
experience to penetrate the meaning of and experience how caring
is constructed for or understood by the other
• Researcher at this time of dialogic interviewing holds in abeyance or
temporarily sets aside, his/her knowledge of caring that is a part of
his/her embodied consciousness
• Flow of interviewing from the lead question of the meaning of the
caring experience follows a cue-taking, talk-turning interaction
whereby the researcher learns more deeply about the phenomenon
of concern or interest from the participant as meaning is probed
Phases of the Process of Caring
Inquiry
C. The Process of Phenomenological-Hermeneutical
Reflecting and Transforming: The Flow of Analysis
occurs through:
• Reflecting and feeling the presencing of the participants’
beings in one’s consciousness
• Transcribing the phenomenological data of the meaning
of the art of nursing/caring as texts through an analytic
system of computer-assisted program
• First Encounter with Data Analysis:
– Bracketed reflection (bracketing one’s interpretive tendencies:
Pure descriptive phenomenology or receptive knowing in
consciousness of the researcher
Phases of the Process of Caring
Inquiry
• Attending to the speaking of language in the texts. If a
transcriber, other than the researcher transcribing the
data, the researcher should listen to the digital
recordings or tapes at the time of encountering the texts
for the first time
• Descriptive phenomenology: Highlighting the descriptive
experiences (the art of caring in nursing) by using a
highlighter pen or device or computer-assisted program
to illuminate the participants’ language of experience
Phases of the Process of Caring
Inquiry
• Interpretive reflecting (hermeneutical thinking or
“unbracketed” reflection to reveal the immanent
themes (linguistic dimensions) emerging in the
text--“Unbracketed reflecting” is the foundation for
phenomenological-hermeneutical interpretation—the
horizon of meaning of the researcher is brought into
being in the dialectic of consciousing the text
• Moving back and forth in understanding the meaning of
the textual data (copresencing and dialoguing with data)
Phases of the Process of Caring
Inquiry
• Writing and transforming the themes in the transcribed
text to cocreate metathemes—linguistic abstractions of
the descriptive themes
– Pattern can be identified and is that which persists throughout
the dialogic process and is retrievable
Phases of the Process of Caring
Inquiry
• Phenomenological Reducing and Intuiting
– Turning to the nature of the transcendental meaning of the
phenomenon by grasping the unity of meaning as a direct,
unmediated apprehension of the whole of the experience—a
universal-a transcendent experience of knowing wherein the
researcher as knower makes a connecting leap of insight and
the separateness of the phenomenon melds into a whole. The
universal is reached by a “coming together” of the variations.
Thus, variations or similarities of the experience are intuitively
and authentically grasped and constituted in consciousness, the
primordial material of sensation out of which arises the knowing
of the meaning of experience (insight or new awareness). A new
way of thinking and theorizing is opened up for the researcher—
this experience may occur at any time; a metaphor may be
grasped as the unity of meaning as well.
Phases of the Process of Caring
Inquiry
• Composing linguistic transformation of the data
to themes, metathemes, patterns or metaphor
(metatheme and metaphor may be the
transcendent experience)
Phases of the Process of Caring
Inquiry
D. The Movement of PhenomenologicalHermeneutical Theorizing to a Theory of
Meaning
• Putting together a theory of meaning, which, when
constituted by the descriptions, themes, metathemes,
and/or metaphor/s, and transcendent unity of meaning
becomes the form or structure of the phenomenological
meaning of caring
• The theory as form may be represented as a visual
model showing all the dimensions of the experience
Phases of the Process of Caring
Inquiry
• A theory in phenomenological philosophy and method may seem
contradictory given the fundamental notion of the continuous
experiencing process of the living world. However, the idea of theory
in this sense is a way of giving form to the intentional acts of the
research itself—where the knower and the known are one, are
integral (Reeder, 1984), and where the researcher communicates to
the world the integrality of understanding of the esthetic act itself
(the transformation by the “artist” to bring to speech (in writing or
speaking) reflective understanding of a phenomenon—a caring act).
• Theorizing (and subsequently theory) in this sense aims at making
explicit the universal meaning of the whole of the experience—a full
description of human actions, behaviors, intentions, and experiences
in the lifeworld (van Manen, 2003, p. 20).
Phases of the Process of Caring
Inquiry
E. Dialoguing with Written Texts: Examining
Similarities and Differences
• Relating the theory of meaning to literary writings in nursing, art, and
other literature to enhance the epistemic development of nursing
theory—information is expressed by illustrating and illuminating
similarities and differences, and differences from phenomenological
analytic data and theory or theories previously advanced. The form
or structure of the meanings, i.e., the phenomenological theory gives
rise to its value in relation to the existing theories or literary works.
• Recommendations are made for nursing education, administration,
leadership, research and practice
Phases of the Process of Caring
Inquiry
F. Credibility and Significance of the Process of the
Phenomenology of the Esthetic Act of Caring in
Nursing
– Recognizing
– Believing
– Acknowledging
Meaning convince, and the meanings of the experience enlarge
human awareness directly or expand the range of human
perception with new ways of experiencing. Deepening and
expanding the possibilities of being—the quality of making
humans more human, humane, moral and spiritual.
Phases of the Process of Caring
Inquiry
• Affirming and Confirming
– The dynamics of the significance of the research are expressed and
understood not as agreement, conformity or generalization, but moving
toward the universal which is paradoxical. The universal is deep. It is a
sympathetic relationship through which the researcher is transposed
into the interior lives of others. It is undifferentiated wholeness or caring
wisdom, a reflective symmetry, which brings together into a unity the
reflective interiority of the researcher with the possibilities or traditional
contradictions of historical-cultural horizons of meaning. The
transformations or possibilities in experiencing (the epistemological) are
open or available to all readers in the reflective symmetry or the
synthesis encapsulated in the theory of meaning (the phenomenological
nod –recognizing it as an experience we have had or could have
(Buytendijk, 2003, p. 27).
References
• Buber, M. (1958). I-Thou (Trans. R/ Smith)(2nd ed.). New York:
Collier Books, Macmillan Publishing Company.
• Leininger, M. (2012). Caring-an essential human need: Proceedings
of three national caring conferences. In M. Smith, M. Turkel, &
Z. Wolf (Eds.), Caring in nursing classics: An essential
resource. (pp. 127-141). New York: Springer Publishing
Company.
• Ray, M. (1985). A philosophical method to study nursing
phenomena. In M. Leininger (Ed.), Qualitative research
methods in nursing (pp. 81-92). Orlando: Grune & Stratton,
Inc.
• Ray, M. (1990). Phenomenological method for nursing research. In
N. Chaska (Ed.), The nursing profession: Turning points (pp.
173-179). St. Louis: Mosby.
References
• Ray, M. (1991). Caring inquiry: The esthetic process in the way of
compassion. In D. Gaut & M. Leininger (Eds.), Caring: The
compassionate healer (pp. 181-189). New York: National
League for Nursing Press.
• Ray, M. (1994). The richness of phenomenology: Philosophic,
theoretic, and methodological concerns (pp. 116-133). In J.
Morse (Ed.), Critical issues in qualitative research.
Thousand Oaks, CA: Sage Publications.
• Ray, M. (2011). Complex caring dynamics: A unifying model of
nursing inquiry. In A. Davidson, M. Ray & M. Turkel (Eds.),
Nursing, caring, and complexity science: For humanenvironment well-being. New York: Springer Publishing
Company.
References
• Ray, M. (2012). Caring inquiry: The esthetic process in the way of
compassion . In M. Smith, Z. Wolf & M. Turkel (Eds.), Caring
classics in nursing. New York: Springer Publishing Company.
• Reeder, F. (1984). Philosophical issues in the Rogerian science of
unitary human beings. Advances in Nursing Science, 8(1), 1423.
• Reeder, F. (1988). Hermeneutics. In B. Sarter (Ed.), Paths to
knowledge: Innovative research methods for nursing (pp. 193238). New York: National League for Nursing Press.
• Smith, M., Turkel, M. & Wolf, Z. (Eds.)(2012). Caring in nursing
classics: An essential resource. New York: Springer Publishing
Company.
References
• Smith, M. (2012). Theoretical perspectives on caring. In M. Smith,
M. Turkel & Z. Wolf (Eds.), Caring in nursing classics: An
essential resource (pp. 117-126). New York: Springer
Publishing Company.
• van Manen, M. (2003). Researching lived experience. London, ON:
Althouse Press.
© Marilyn A. Ray, All Rights Reserved