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Emotional knowing in nursing practice: in the encounter between life and death
Örebro University, School of Health and Medical Sciences. (Omsorg i livets slut)
Örebro University, School of Health and Medical Sciences. Department of Palliative Care Research, Ersta Sko¨ndal University College, Stockholm, Sweden. (Omsorg i livets slut)
Örebro University, School of Humanities, Education and Social Sciences. South African Chair for Education and Development, University of South Africa, Pretoria, South Africa; Centre for Adult and Continuing Education, University of the Western Cape, Cape Town, South Africa.
Department of Palliative Care Research, Ersta Sköndal University College, Stockholm, Sweden; Stockholms Sjukhem Foundation, Stockholm, Sweden; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden. (Omsorg i livets slut)
2010 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 5, no 2, 5367Article in journal (Refereed) Published
Abstract [en]

Patients, next of kin and nurses in surgical wards often raise existential questions in the encounter between life and death. Nurses' emotional knowing at this encounter is crucial. Consequently, this study's purpose was to analyse and describe nurses' emotional knowing to reveal (a) how this knowing is expressed in daily work and (b) what emotions, thoughts and actions this knowing includes. This study used combined ethnographic and hermeneutic methodologies. Data were collected using participant observations, informal conversations and interviews. We found that nurses' emotional knowing could be interpreted in relation to various rooms of emotions, thoughts and actions. Nurses' judgements formed these rooms. They strived to do things correctly in the normative room; created a safe, secure milieu for patients and next of kin in the safety–security room; and questioned their actions in the critical room. They created affinity for co-operation that benefitted encounters with patients in their affinity room. And they demonstrated sensitivity and compassion to patients and next of kin; sensitivity and compassion were particularly evident in the closeness room. In our main interpretation, we found that nurses' judgements in various rooms (emotional knowing) constitute an expression of practical wisdom (phronesis) in nursing practice.

Place, publisher, year, edition, pages
Järfälla, Sweden: Co-Action Publishing , 2010. Vol. 5, no 2, 5367
Keyword [en]
Emotional knowing, ethnography, critical hermeneutics, nurses, assistant nurses, nursing practice, phronesis
National Category
Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-9541DOI: 10.3402/qhw.v5i2.5367ISI: 000281886700013PubMedID: 20640014Scopus ID: 2-s2.0-84873993867OAI: oai:DiVA.org:oru-9541DiVA: diva2:291523
Available from: 2010-02-02 Created: 2010-02-02 Last updated: 2017-02-20Bibliographically approved
In thesis
1. Bakom rutinerna: kunskap och omvårdnadspraxis i mänskliga gränssituationer
Open this publication in new window or tab >>Bakom rutinerna: kunskap och omvårdnadspraxis i mänskliga gränssituationer
2010 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to study how family members, next of kin, and healthcare professionals construct and use knowledge in nursing praxis in human boundarysituations.The study was carried out on a surgical ward at a university hospital in Sweden.Methodology: Study I: A case study; data concerning a family with six familymembers were collected over 10 months using interviews, conversations, and diary notations.Study II: A hermeneutic approach; interviews with 27 family carers were conductedsix to eight months after a family member’s death. Studies III, IV: a combinedethnographic and hermeneutic approach; participant observations (285 hours), informalconversations (190), and interviews (25) were conducted with 25 nurses and 18 assistant nurses.

The main findings were: (I) The family members used beliefs to explain and understandcancer, dying and death. The beliefs were aggregated into eight main beliefs and fourthemes: cancer is a deadly threat/death is a liberator; death can be held at bay/death canbe lived near; dying is done alone/dying should not be done alone; and life has anend/life is endless. These beliefs appear to oscillate between seemingly contrastingpoles. (II) The family carers made their own assessment of their loved one’s conditionand situation. Their actions were characterized by struggling to get treatment, being leftbehind, being partners, keeping the illness at a distance, hovering beside their loved one,waiting for death, and being experts and protectors. The family carers used practicalwisdom, phronesis, regarding what care was the best, or least harmful, for their lovedone in the encounter with professional care. (III) The nurses constructed knowledgethrough greeting the patient, and reading the patient. By being sensitive, using humor,and emotional involvement, understanding was deepened. By being suspicious and selfcritical,interaction was sought with nurse colleagues, the patient, relatives, and the doctor,and additional knowledge was obtained. They strived to be one step ahead in theirefforts to attain an understanding of the patient´s situation. The knowledge nurses makeuse of can be related to the intertwined and embodied forms of theoretical knowledge,i.e., episteme, practical professional knowledge, i.e., techne, and practical wisdom i.e.,phronesis. (IV) The nurses created and used emotional knowing that could be interpretedin relation to various rooms of emotions, thoughts and actions. They strived to dothings correctly in the normative room; created a safe, secure milieu for patients andnext of kin in the safety-security room; and questioned their actions in the critical room.They created an affinity for co-operation that was of benefit in encounters with patientsin the nurses’ affinity room. And they demonstrated compassion for patients and next ofkin; this compassion was particularly evident in the closeness room.Conclusion: In praxis, construction and use of knowledge occurs that often takes placebehind the routines. This knowledge constitutes an important content in nursing. Thehermeneutic spiral can serve a pedagogic purpose in elucidating nursing and its differentforms of knowledge.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2010. 104 p.
Series
Örebro Studies in Care Sciences, ISSN 1652-1153 ; 27
National Category
Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-9542 (URN)978-91-7668-711-6 (ISBN)
Public defence
2010-01-22, Hörsal P2, Örebro universitet, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-02-02 Created: 2010-02-02 Last updated: 2014-12-17Bibliographically approved

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