Abstract

This paper will demonstrate the distinctive use and applicability of hermeneutic phenomenology to doctoral study addressing nurses’ experience of nursing the outlier patients. The problem of the “outlier patient” as currently being experienced within acute care clinical environments occurs where “patients end up in the wrong bed…in a ward inappropriate for their condition… (and they) are less likely to receive the specialist medical and nursing attention that their conditions needs” (Garling, 2008:990).

The approach taken to exploring this problem, that is my focus on the nurses’ experience of nursing outlier patients, has been questioned in seminars and discussions by clinical and research colleagues. I argue however, that the bed shortage within acute care hospitals is an existing problem within the health care system and that the visible consequence of, this is the occurrence of outlier patients. My argument as to the visibility of this problem is further supported by the recent NSW Health initiative that established a “mixed-gender bed” hotline in response to Garling’s identification of the problem. The presence of outlier patients within the wards is also having a direct but unacknowledged effect on the experience of nursing within acute care. To many nurses an outlier patient is not so much a consequence of a policy decision, but a patient they are required to nurse in a ward that is not suited or equipped to address the specific needs of the outlier patients. Reflecting on my challenging experience as a nurse, nursing for outlier patients has highlighted for me the need for a humanistic way of understanding the phenomenon of nursing outlier patients.

Hermeneutic phenomenology is therefore the philosophical underpinning of this study.   

In order for nurses to experience their caring for the outlier patients, an understanding of Husserl’s (1917:2) view of consciousness is crucial as “consciousness is the only access human beings have to the world” (Van Manen, 1990:9). Nevertheless, the epistemological focus of this study is not an investigation of the structure of consciousness or establishing what Crotty (1997:18) called the “essence” of what makes a thing what it is. Rather is Heidegger’s interpretative phenomenology (Heidegger, 1962), the exploration of being, the nurses’ existence and the meaning they attach to their experience of nursing outlier patients that serve our research goal.

In order to capture the complexities of the individual nurses’ experience and to achieve and communicate a shared understanding in interpreting the nurses’ experience of nursing outlier patients, this study takes account of Van Manen’s (1990:101-105) lifeworld existential, including corporeality (lived body), temporality (lived time), relationality (lived others) and spatiality (lived space). It is through the lived body, the lived space, the lived other and lived time that the nurses experience the phenomenon of nursing outlier patients. Through identifying the differences between 1) body and lived body, 2) time and lived time, 3) others and lived others and 4) place, space and the lived space in relation to the phenomenon of this study, we can appreciate the use of hermeneutic phenomenology in informing our understanding of this phenomenon.   

Reference

Crotty, M. (1996). Phenomenology and Nursing Research. South Melbourne: Churchill Livingstone.

Garling, P. (2008). First Report of the Special Commission of Inquiry: Acute Care Services in NSW Public Hospitals Retrieved 23 Febuary 2009, from http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/vwFiles/E_Volume3.pdf/$file/E_Volume3.pdf.

Heidegger, M. (1962). Being and Time. New York: Harper & Row.

Husserl, E. (1917). Pure Phenomenology. Inaugural Lecture of Freiburg in Breisgau  Retrieved 20 March, 2010, from http://www.stanford.edu/dept/relstud/Sheehan/pdf/5_husserls_texts_online/5-%201917%20HUSSERLINAUGURAL%20ADDRESS.pdf

Van-Manen, M. (1990). Research lived experience: Human science for an action sensitive pedagogy. USA: State University of New York Press.