21 May REFLECTION QUESTION
Years ago, an elderly woman bedridden with a stroke looked at me with her stark, piercing blue eyes. Though I usually didn’t like loud music, I turned up the radio to drown the sorrows of the sick room I was in—to drown out the sounds and, in some strange way, the sight of the suffering one before me. Unspeaking, I looked at her. She spoke with her heart. Uncomfortable in her presence, but responding to the life of compassion deep within my heart and soul, I turned off the radio. The journey of sharing the pain—that is, nursing—began. I wrote this chapter to share ideas and an approach to the method that may capture the complexity of researching—caring. I have spent much time researching and reflecting on the nature of caring and feel intensely that it is the way of compassion, a journey of love. Caring and love are synonymous (Ray, 1981). Inquiring about caring touches the heart and translates through the soul: The “speaking together” between the one caring and the one cared for. It is an immersion into the human encounter that also reveals the human, environmental, and spiritual contexts that are nursing. The metaphorical heart and soul are the symbols and synonyms for life, living, sensitivity, reason, and integrity. These symbols represent a creative process: The gradual or, more often, abrupt shifting of consciousness from a focus on the “they” or “I” to a compassionate “we” (Kidd, 1990), which is also spiritual (that which deepens and moves one forward and upward) (Kandinsky, 1977). Compassion is a wounding of the heart by the other, where the “other” enters into us and makes us other. In the minutes of presence and dialogue with the other, we have the transformative powers of the esthetic—the understanding of forms of meaning within the sheer presence of the other and of dialogue or language that exercises the most penetrative authority over consciousness (Steiner, 1989). In the compassionate way of being, the forms of “other” in consciousness communicate a depth of felt-realness or authenticity, which is intuitive (Steiner, 1989) and depends on the granting to the other to whom one communicates a share in one’s being (Buber, 1965). The esthetic act in a compassionate way of being thus communicates in the understanding of forms of meaning a simultaneous immanence and transcendence—human choice to share in the life of the other, and an intuitive knowing, which, as we become “other,” can be translated into a call to a deeper life, a more integrated wholeness, and a coming to understand more fully what we have understood. What does this mean for nursing and nursing inquiry? For nursing, real presence and dialogue as choice and intuition in compassionate forms of meaning in understanding is an act of creation. This esthetic act, this conceiving and bringing into being, is a birthing and growth of the divine or spiritual life within. Steiner has (1989) intimated that in an esthetic act, there can be no experience which does not wager on a presence of sense that is, finally, theological. He states, “So far as it [the esthetic act] wagers on meaning, an account of the act of reading in the fullest sense, of the act of the reception and internalization of significant forms within us, is a metaphysical and, in the last analysis, a theological one”; “[t]he meaning of meaning is a transcendent postulate” (1989, pp. 215–216). Transcendence in the felt-realness of the compassionate encounter is the unwritten theology. The meaning of meaning or transcendence as unwritten theology is an apprehension of the “radically inexplicable presence, facticity and perceptible substantiality of the created, it is; we are” (p. 201) because there is creation. For nursing inquiry as the way of compassion, the esthetic (creative) act of knowing about the meaning of the meaning of nursing as caring, presumes creation—the conceiving of and bringing into being a knowledge of the substantiality of the created. There is transcendence that is also theological. There is a presence that, as the researcher dwells with the data to read “being anew” or to apprehend the nature of caring, “is the source of powers, of significations in the text, in the work [that is] neither consciously willed nor consciously understood … the unmastered ‘thereness’ of a secret-sharer, of a prior creation with and against which the art [esthetic] act has been effected” (Steiner, 1989, pp. 211–212). In essence, the felt-realness of compassion (caring) in nursing and nursing research, because of the focus on the compassionate “we,” is a theological enterprise. As Emily Dickinson notes in one of her poems (Stone, 1990), “The soul selects her own society—Then, shuts the door—” (p. 9). CARING INQUIRY: THE PHENOMENOLOGY OF ESTHETIC RESEARCH Caring inquiry as an esthetic process in research is a unique method of presence and dialogue. It attends to both immanence—communion with and transcendence—and reflective intuition. When a researcher engages in caring inquiry, the compassionate “we” is enacted. Encountering the “other” to learn anew the world of caring, not the world as previously encoded by scientific analysis, is where the word and compassion (love) interact (Steiner, 1989). Both description (phenomenology) and interpretation (phenomenological hermeneutics) and esthetic knowing of the experience of caring are the means by which questions about the meaning of caring are illuminated. Phenomenology and phenomenological hermeneutics (Van Manen, 1990) are human sciences that study persons who are experiencing the life world. Esthetic knowing in caring research attends to creativity, sensitivity, and the quality of presences. It is an approach of describing and understanding the meaning of being and becoming through caring. In bringing to reflective awareness the nature of caring in the events experienced in the world of nursing, the researcher (as well as possibly the research participant) is transformed, contributing to the fullness of being and the call to a deeper life—a life of integrated wholeness and openness to creative forces within and without. Thus, what makes phenomenological hermeneutics an esthetic enterprise is an investment of one’s own being in the process of the events of the research. The response to the descriptions and interpretations of the events of caring in esthetic inquiry is one of pure receptivity and responding responsibly, or being answerable to the text in the specific sense, which is at once moral, spiritual, and psychological (Steiner, 1989). The translation of data communicated as text from “shared remembrances” of participants of the meaning of caring into the general perspective of human recognition is teaching the way of the compassionate heart and soul. It illuminates a valuation of the theological or spiritual. The phenomenology of esthetic research of caring presupposes and validates an enmeshment in the metaphysical and theological. What the method is seeking is integrity—a coming to understand more fully what we have understood—where the word and love are a synthesis. The following is a methodological process I developed based on the ideas of Husserl (Natanson, 1973), Van Manen (1990), Reeder (1984, 1988), and other philosophers of human science, art, and theology. The process is outlined as follows (Ray, work in progress): 1. The Intentionality of Inner Being of the Researcher 2. The Process of Dialogic Experiencing 3. The Process of Phenomenological–Hermeneutical Reflecting and Transforming 4. The Movement of Phenomenological–Hermeneutical Theorizing to a Theory of Meaning 5. Dialoguing with Written Texts: Examining Similarities and Differences 6. Credibility and Significance of the Process of the Phenomenology of the Esthetic Act The general research question relates to the meaning of the experience of caring or compassion in nursing research. A specific question could be: “What is the meaning of caring in your experience?” This methodology also could be used for any other phenomenological–hermeneutical question in nursing. THE ESTHETIC PROCESS IN CARING INQUIRY A dynamic, disciplined, dialectical, reflective, and creative approach among the following activities forms the process of the esthetic phenomenological–hermeneutical inquiry and is outlined as follows (Ray, work in progress): A. The Intentionality of Inner Being of the Researcher 1. Imagining the vision of the caring in nursing—past and future within the present 2. Listening to the “voices” within embodied consciousness, as a feeling and a form of discourse about the meaning of caring in nursing 3. Focusing on and identifying one’s presuppositions of caring in nursing 4. Practicing bracketing to hold in abeyance one’s prehistory and presuppositions about the caring in nursing B. The Process of Dialogic Experiencing 1. Selecting the participants for the study grounded within the imagined vision 2. Engaging with the participants to discuss the roles of interviewer and interviewee, and securing informed consent signatures 3. Copresencing/sensing the other by recognizing the immediate impact of each other’s being on each other—the compassionate “we” 4. Conversing with participants in tape-recorded, intensive dialogical interviews lasting approximately 1 hour, about the meaning of caring in nursing by asking the phenomenological question, “What is the meaning of caring in your experience?” 5. Engaging in a cue-taking, talk-turning, researcher-bracketed, dialogical–dialectical interactive process based on the participants’ experience to penetrate the meaning of and experience how caring nursing is constructed for or understood by the other. The researcher at this time of dialogic interviewing holds in abeyance, or temporarily sets aside, his or her knowledge of caring that is a part of his or her embodied consciousness. There is continued controversy over the issue of bracketing in phenomenological philosophy (Stapleton, 1983). For the purpose of this research approach, bracketing of presuppositions about caring is used during the interviews by moving from the lead question of the meaning of experience of caring followed by the cue-taking, talk-turning interaction of the actual dialogue itself. C. The Process of Phenomenological–Hermeneutical Reflecting and Transforming
The Flow of Analysis occurs through 1. Reflecting and feeling the presencing of the participants’ beings in one’s consciousness. 2. Transcribing the phenomenological data of the meaning of the art of nursing as texts through a computer-assisted data text and analytic system (Seidel, 1988). 3. Bracketed reflecting for a pure descriptive phenomenology or receptive knowing in consciousness while engaging in the first encounter with the transcribed data (bracketing one’s interpretive tendency in relation to one’s history and presuppositions about the phenomenon). 4. Attending to the speaking of language in the texts. If a transcriber, other than the researcher, transcribes the data, the researcher should listen to the tapes at the time of encountering the texts for the first time. 5. Highlighting the descriptive experiences of the art of nursing in the texts by using a highlighter pen, or device to illuminate the participants’ language of experience. 6. Interpretive reflecting (hermeneutical thinking or unbracketed reflecting) to reveal the immanent themes (linguistic dimensions) emerging in the data. Unbracketed reflecting is the foundation for phenomenological–hermeneutical interpretation. Rather than bracketing one’s preassumptions of caring, the history or horizon of meaning of the researcher is brought into being in the dialectic of consciousness and the text. 7. Moving back and forth in understanding the meaning of the textual data to and in consciousness (co-presencing and dialoguing with the data in consciousness). 8. Writing and transforming the themes in the transcribed text to cocreate the metathemes that are linguistic abstractions of the themes. 9. Phenomenological Reducing or Intuiting—turning to the nature of the transcendental meaning of the phenomenon by intuiting or grasping the unity of meaning as a direct, unmediated apprehension of the whole of the experience. This is an intersubjective 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 (the possibility of the phenomenological genesis or beginning, that is, what has been experienced as apart comes together as insight/new awareness, but is not put together from the different dimensions). References to the data, or themes, of experiences-as-meant of the meaning of caring in nursing from participants’ experiences undergoes transformation into the researcher’s intentional life, and stands out as a component of the researcher’s concrete essence. A new way of experiencing, thinking, and theorizing thus is opened up for the researcher. (This experience may occur at any time in the process of reflection.) A metaphor(s) may be grasped as the unity of meaning at this time. 10. Composing linguistic transformation of data to themes, metathemes, or metaphor (metatheme and metaphor may be the transcendent experience). D. The Movement of Phenomenological–Hermeneutical Theorizing to a Theory of Meaning. 1. “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. 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 the esthetic act itself. Theory in this sense aims at making explicit the universal meaning of the whole of the experience. Note the etymology of theory—theo and eros—God and love. E. Dialoguing with Written Texts: Examining Similarities and Differences 1. Relating the theory of meaning to literary writings in art or nursing to enhance the epistemic development of nursing theory is expressed by illustrating and illuminating similarities, and differences from the phenomenological analytic data and theory or theories previously advanced. The form or structure of the meanings, that is, the phenomenological theory, gives rise to its value in relation to the existing theories or literary works and subsequently to the implications or recommendations for nursing education, practice, administration, and research. F. Credibility and Significance of the Process of the Phenomenology of the Esthetic Act 1. Recognizing, believing, and acknowledging are the dynamics of credibility of the research. The phenomenological evidence of the reality-as-meant of caring is what has been lived and communicated by the participants. Reality, as expressed in experience, is not inauthentic. Meanings convince, and the meanings of the experience alter the sensibilities of those dwelling in the phenomenological written text—the researcher and other readers. Phenomenology enlarges human awareness directly or expands the range of human perception with new ways of experiencing, rather than with new, objective, mechanistic interpretations as in traditional science. Deepening and expanding the possibilities of being—the quality of making humans more human, humane, and spiritual (the ontologic), rather than more mechanistic—is the valid experience of phenomenological esthetic inquiry. 2. Affirming and confirming the meaning of the lived experience are the dynamics of significance of the research and are expressed and understood not as agreement, conformity, or generalization, but moving toward the universal that is paradoxical. The capacity to grasp and communicate the meaning of the whole of the experience is articulated and “tested” through the reflective intuition and individuality of the researcher. The universal is deep. It is a sympathetic relationship through which the researcher is transposed into the interior lives of others. The universal is undifferentiated wholeness or caring wisdom that is ultimately both within and without—a reflective symmetry, which brings together into a unity the reflective interiority of the researcher with the possibilities and contradictions of historical–cultural horizons. The quest for meaning is a social signifier and therefore exists in the relationship between the personal–mutual, the individual–community, and the specificity–commonality of culture. The movement of phenomenological theorizing to a theory of meaning captures, through the solitude of the researcher’s reflection on the meaning, the researcher’s capacity to bridge participants’ meaning of experience of caring and the universality of human action as esthetic. Thus, the transformations or possibilities in experiencing (the epistemologic) are open or available to all readers in the reflective symmetry or synthesis encapsulated in the theory. CONCLUSION This chapter focused on the sharing ideas and an approach to the method that reflects the complexity and creative power of caring inquiry as a way of compassion and an esthetic act. What I have affirmed by expressing the interiority of compassion as presence and dialogue through metaphysical and epistemological means is that caring and caring inquiry in the final analysis are spiritual and theological. The density of theological presence in nursing research has been effectively communicated by its absence in the last few decades, possibly because of the logical positivist teachings of science, or the newer dimensions of deconstructionist philosophy. It may well be that forgetting the question of the theological, in a sense forgetting to address the mystery of the hidden, yet revealed an interiority of the heart and soul that will continue to drain from nursing its creative, authentic caring potential, and the entire sphere of the esthetic—the meaning of meaning. The crisis in nursing science and practice today demonstrates an emptiness that echoes of the loss of the theological. I have communicated the loss. It could be, however, more from silence than emptiness. This chapter has given voice to this silence. REFERENCES Buber, M. (1965). The knowledge of man. New York, NY: Harper and Row. Kandinsky, W. (1977). Concerning the spiritual in art. (M. T. Sadler, Trans.). New York, NY: Dover. Kidd, S. (1990). Birthing compassion. Weavings: A Journal of the Christian Spiritual Life, 5(6), 18–30. Natanson, M. (1973). Edmund Husserl: Philosopher of infinite tasks. Evanston, IL: North-Western University Press. Ray, M. (1981). A philosophical analysis of caring within nursing. In M. Leininger (Ed.), Caring: An essential human need (pp. 25–36). Thorofare, NJ: Slack. Ray, M. (work in progress). Caring inquiry: The dialectic of science and art. New York, NY: National League for Nursing. Reeder, F. (1984). Philosophical issues in the Rogerian science of unitary human beings. Advances in Nursing Science, 8(1), 14–23. Reeder, F. (1988). Hermeneutics. In B. Sarter (Ed.), Paths to knowledge (pp. 193–238). New York, NY: National League for Nursing. Seidel, J. (1988). The ethnograph. Littleton, CO: Qualis Research Associates. Stapleton, I. J. (1983). Husserl and Heidegger: The question of the phenomenological beginning. Albany, NY: State University of New York Press. Steiner, G. (1989). Real presence. London, UK: Faber and Faber. Stone, J. (1990). In the country of hearts. New York, NY: Delacorte Press. Van Manen, M. (1990). Researching lived experience. London, Ontario: The Althouse Press.
QUESTIONS FOR REFLECTION:
Master’s 1. How is the text or material of phenomenological studies obtained by investigators? 2. What did you learn about how Ray (1991) created the methodological process to study the experience of caring or compassion in nursing research and the meaning of caring in the researcher’s experience? What are the sources used in this new method? 3. What affects you about the way Ray (1991) looked at caring inquiry?
Smith RN PhD AHN-BC FAAN, Marlaine C.. Caring in Nursing Classics: An Essential Resource (Kindle Locations 9664-9856). Springer Publishing Company. Kindle Edition.
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