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Background: The literature review highlights that a motivated leader plays a key role in motivating employees and fostering a health‐promoting work environment. Despite its importance, there is limited knowledge about the motivational forces, from a caring science perspective, that drive nurse leaders to develop a health‐promoting work environment. Aim: This study aims to gain a deeper understanding of the motivational forces driving nurse leaders toward developing a health‐promoting work environment. Method: A qualitative design with a hermeneutic approach inspired by Gadamer was chosen. Data were collected through semistructured interviews with 13 nurse leaders in northern Norway between December 2023 and February 2024. The Standards for Reporting Qualitative Research (SRQR) were followed in reporting the results. Findings: The nurse leader's motivational forces in developing a health‐promoting work environment imbued with an ethos of (1) sense of inner responsibility for promoting the wellbeing of others, (2) sense of trusting relationships in the workplace, (3) sense of mastery through learning and development, and (4) sense of recognition from superiors through being seen, supported, and involved. Conclusion: This study highlights the importance of raising awareness and articulating nurse leaders' underlying motives and values. Doing so transforms abstract concepts into tangible factors that stakeholders can grasp. In particular, this insight provides valuable guidance to politicians and decision‐makers on how to facilitate improved working conditions for nurse leaders, thereby maintaining and enhancing their motivation. Implications for Nursing Leadership: The findings of this study recommend that superior leaders and policymakers should prioritize involving nurse leaders in decision‐making and promoting their autonomy and room for action. In addition, it suggests facilitating further education and training programs for leaders, as well as maintaining leadership networks where nurse leaders can reflect, exchange experiences, and address challenges. [ABSTRACT FROM AUTHOR]

Aim: To explore and interpret relationships that influence caring in nursing leadership, in the context of Nordic municipal health care, from first‐line nurse managers' perspectives. Design and method: We chose a visual hermeneutic design. A three‐stage interpretation process outlined by Drew and Guillemin, based on Rose, was used to analyse drawings and the following reflective dialogue from three focus groups, with a purposive sample of 11 first‐line nurse managers. The study was conducted from February to May 2018. Results: The findings demonstrated that first‐line nurse managers struggled to balance their vision with administrative demands. Caring for patients implied caring for staff; however, they often felt as if they were drowning in contradictory demands. First‐line nurse management could be a lonely position, where the first‐line nurse managers longed for belonging based on increased self‐awareness of their position within an organisation. Superiors' support enabled first‐line nurse managers' in their primary aim of caring for patients. Conclusion: First‐line nurse managers showed deep roots to their identities as nurses. Caring for patients included caring for staff and was their main concern, despite demanding reforms and demographic changes affecting leadership. Superiors' support was important for FLNMs' self‐confidence and independence in leadership, so the first‐line nurse managers can enact their vision of the best possible patient care. This study adds knowledge of the significance of caring in nursing leadership and the caritative leadership theory. Impact: In order to recognise FLNMs as vulnerable human beings and provide individual confirmation and support, a caring organisational culture is needed. FLNMs need knowledge based on caring and nursing sciences, administration and participation in formal leadership networks. These findings can serve as a foundation for developing educational programmes for nurse leaders at several organisational levels. [ABSTRACT FROM AUTHOR]

Aims: The aim of this hermeneutic study was to explore and elucidate the lived experiences of young people living with type 1 diabetes in terms of their everyday life and school in Sweden. Design: A qualitative interview study with a hermeneutic approach inspired by Gadamer's thinking. Methods: Interviews were conducted with a purposive sample of seven girls and three boys with type 1 diabetes between January and September 2017 and analysed with a hermeneutic method. Results: Young peoples' everyday lives were transformed and re‐organized by their illness and they parodically live a double‐edged everyday life. To support young people's healthcare personnel, headmasters and teachers must understand this double‐edged situation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to provide information on the ethical problems faced by family caregivers of patients with schizophrenia. Method: This study was conducted using a hermeneutical approach to phenomenology. Data were obtained by means of an individual interview process using a semi‐structured interview guide. Results: The results of this study revealed the following themes and sub‐themes: higgledy‐piggledy, walking on a thorny path, decision‐making, subtheme, back of the mirror, victim, and dark well. Practice Implications: Expressed concerns have shown that caregivers not only face difficult challenges in the management of complicated and complicated illnesses, but also face ethical issues inherent in the role of caregivers and must take ethical decisions. [ABSTRACT FROM AUTHOR]

Dennis Cooper's latest project, a series of HTML novels composed entirely of GIFs, Zac's Haunted House published by Kiddiepunk, showcases the changing literary times and styles. As literature and the Internet become further integrated, our hermeneutical theory and praxis of style must change as well. The influence of the Internet upon the written word is irreversible and has ushered in paradigmatic change. The central question of classical hermeneutics, the relations between writing and the word, and the word to the event has become obfuscated in our digital age. Cooper's HTML novels explicitly play with questions of digital hermeneutics pushing the horizons and perhaps calling for a queer rhizomatic hermeneutics of style. Through his emphasis on structure over narrative, Cooper develops a phenomenology of the digital. Cooper's HTML novel forces the reader to engage in a rhizomatic hermeneutics of the imaginary, that is to say, one must allow the text to develop into multiplicities of worlds, then enter and explore those multiplicities with all the paradoxes and syntheses inherent in them. Cooper's new texts not only question the limits of reading, but also question our hermeneutical methodology and analyses, thus prompting reinterpretation of our understanding of style and its hermeneutical and rhizomatic conceptualizations. [ABSTRACT FROM AUTHOR]

Objective: The evidence base for the treatment of morbid jealousy with integrative therapies is thin. This study explored the efficacy of cognitive analytic therapy (CAT). Design: An adjudicated hermeneutic single‐case efficacy design evaluated the cognitive analytic treatment of a patient meeting diagnostic criteria for obsessive morbid jealousy. Method: A rich case record was developed using a matrix of nomothetic and ideographic quantitative and qualitative outcomes. This record was then debated by sceptic and affirmative research teams. Experienced psychotherapy researchers acted as judges, assessed the original case record, and heard the affirmative‐versus‐sceptic debate. Judges pronounced an opinion regarding the efficacy of the therapy. Results: The efficacy of CAT was supported by all three judges. Each ruled that change had occurred due to the action of the therapy, beyond any level of reasonable doubt. Conclusions: This research demonstrates the potential usefulness of CAT in treating morbid jealousy and suggests that CAT is conceptually well suited. Suggestions for future clinical and research directions are provided. Practitioner points: The relational approach of CAT makes it a suitable therapy for morbid jealousy. The narrative reformulation component of CAT appears to facilitate early change in chronic jealousy patterns. It is helpful for therapists during sessions to use CAT theory to diagrammatically spell out the patterns maintaining jealousy. [ABSTRACT FROM AUTHOR]

Background: Many patients suffering from a neurological disease experience eating difficulties during mealtimes in the hospital. Consequently, they often refrain from eating in public places to avoid potentially awkward situations. Eating is an essential part of life, providing patients with comfort during their hospitalisation. Therefore, attention should be paid to these patients, who encounter eating difficulties to foster a positive mealtime experience. Aim: To study what patients afflicted with a neurological disease experience and assign meaning when participating in mealtimes during hospitalisation. Method: Ten semi‐structured interviews with patients were conducted and recorded. After transcription the text was analysed, and interpreted compromising three methodological steps inspired by the French philosopher, Paul Ricouer. Findings: Three themes were identified through data analysis and interpretation: i) The missing feeling of homeliness, ii) The battle between socialisation vs. isolation, and iii) The sense of time, rhythm, and presence. Conclusions: To patients suffering from a neurological disease, mealtimes are not only a manageable task, but also a part of existential care that leads to positive experience. Aesthetic elements were shown to have the potential of making the patients feel comfortable and homely when hospitalised. This was important, as our study also identified that patients were longing for homeliness when participating in mealtimes during hospitalisation. Relevance to clinical practice: Our findings emphasised the need of proceeding to interventions that includes mealtime assistance and protects the mealtime activity. Hence, it informs hospital organisations of the importance of restructuring mealtime environment, so that existential care can take place. [ABSTRACT FROM AUTHOR]

Providing health and social care to older persons is challenging, since older persons often have multiple diseases and a complex health situation. Hence many professions and organisations are involved. Lack of interprofessional and interorganisational collaboration leads to fragmented care. Care planning meetings before hospital discharge have long been used to overcome this fragmentation, but meetings conducted at the hospital have limitations in identifying long‐term needs at home. A new model for health and social care planning in collaboration (HSCPC) in older persons’ homes was introduced in two Swedish municipalities. The aim of this study was to gain a deeper understanding of the HSCPC‐meeting from the perspectives of older persons, family members, and professionals. Ten care planning meetings from two municipalities were consecutively included. Interviews in retrospect with ten older persons, eight family members, and ten groups of professionals who had attended the HSCPC‐meeting at home were analysed with a hermeneutic approach. Four themes emerged: unspoken agendas and unpreparedness, security and enhanced understanding, asymmetric relationships, and ambiguity about the mission and need for follow‐up. The comprehensive interpretation is that the professionals handled the HSCPC‐meeting mainly as a routine task, while the older persons and family members viewed it as part of their life course. Older persons are in an inferior institutional, cognitive and existential position. However, meeting together in the home partly reduced their inferior position. Findings from this study provide some general suggestions for how HSCPC‐meetings should be designed and developed: attention of power relations, the importance of meeting skills and follow‐up. [ABSTRACT FROM AUTHOR]

Aim To deepen understanding of the meaning of caring in prenatal care from Swedish women's perspectives. Method Ten women, who had given birth between 1 and 2 months previously, were interviewed. The women have taken part in the routine programme that constitutes maternity care Sweden. A hermeneutic approach inspired by Gadamer was used to analyse the data and gain a deeper understanding of the women's experiences. Findings Three themes were identified in the hermeneutical analysis. The themes highlight an existential and ontological aspect for caring as experienced of the women in the study: invitation and caring promise, witnessing and confirmation, and caring emerges in vulnerability. Conclusion The life-changing gravidity and vulnerability motivates caritative care during pregnancy. Reception of caring is not just a superficial feeling, but gives a new understanding of life on an ontological level. In a genuine caring relationship, the pregnant woman not only receives something but also a power and an opportunity to go further and find her own inner strength. [ABSTRACT FROM AUTHOR]

Background Older persons with multimorbidity being cared for at home often have complex needs which cannot be met by one single caregiver. Interprofessional collaboration is therefore considered necessary if care is to be organised according to the needs of the older person. To achieve coherent health care, municipalities and county councils need to develop their collaboration. Aim The aim of this study was to illustrate how various professionals belonging to homemaker services, home care services in municipality and hospital-based home care services experience collaboration in caring for older persons with multimorbidity. Method A hermeneutic approach was used. Eleven informants participated in the study and were individually interviewed. Findings The findings show that collaboration between players comprises various types of experiences which influence not only the staff who are involved in collaboration but also the outcome of the collaboration itself. The informants' experience of collaboration was defined by distrust and trust and by insecurity and security. To focus on patients' needs and to develop the collaboration further, it was important for informants to take the relations into account and have a reflective and questioning approach. This attitude resulted in a feeling of trust and security, and a flexible and critical approach without boundary drawings between basic and specialised care. Conclusion and relevance of practice Complex situations cannot be solved with simple models. Instead, a flexible approach appears necessary with focus shifting from structures to interpersonal relations and interactions. Therefore, the different professionals have to work as a transprofessional team where close interactions, flexibility and improvisation are keys to success. The transprofessional team approach is suggested to have the potential to take the competence of all staff into account when high-quality home health care to older persons with multimorbidity is to be provided by multiple caregivers. [ABSTRACT FROM AUTHOR]

Aim To make visible the existential character of pregnancy by searching for its health dimensions as it is described in the ontological health model. Method Eight women were interviewed two or three times during their pregnancy and one time shortly after birth. The women have taken part in the routine programme that constitutes maternity care in Sweden. A hermeneutic approach inspired by Gadamer was used to analyse the data. An ontological health model was used to interpret the findings. Findings Nine themes on a rational and a contextual level were clustered to three themes on an existential level: A new life stage, The new life takes shape and Health is jeopardised. Contents of these themes were interpreted together with an ontological health model. Expecting a child means to do, be and become in expectation of the new life. Suffering and health are two different dimensions in a woman's life during pregnancy; they are integrated with one another and ever-present. It is in the meeting with the inevitable, life-changing gravidity and vulnerability that the integrative movement creates the new. Longing is the desire that provides motivation to continue. [ABSTRACT FROM AUTHOR]

Background When living with a chronic disease, the whole human being is affected and his/her experience of health challenged. Aim This study had a dual aim: to obtain a new understanding of experiences of the body among persons suffering from the chronic neurological disease multiple sclerosis ( MS) and how they come to terms with such experiences. Method A total of ten interviews were re-analysed using a hermeneutic approach. Results The experiences of the body were revealed as 'Learning to fly with broken wings', comprising two themes: 'Getting to know the foreign body' and 'Building a new living space', both requiring reappraisal of time and space. Conclusion Living with a chronic disease such as MS means learning to fly with broken wings, which involves subordination to the body leading to a higher level of integration in the process of becoming towards health and well-being. [ABSTRACT FROM AUTHOR]

Introduction This study attempts to contribute to the knowledge of caring science and mental health care by means of a profound understanding of the patients' existential world when being a mother in receipt of psychiatric care, with focus on inner processes such as health and suffering. Mothers struggle to cope with the demands of the illness and the responsibility for their children. They see themselves through their children and regard the child as an important part of themselves. Mothers experience guilt and shame related to motherhood, and when they have to relinquish their responsibility as a mother, they consider themselves a failure. Despite a range of practical and emotional difficulties, motherhood involved extremely positive experiences, which provide a purpose as well as fulfilment and meaning in life. Methodology This study is rooted in philosophical hermeneutics inspired by Gadamer with an inductive-deductive-abductive approach. Interpretation of the data was made on different levels of abstraction described as rational, contextual, existential and ontological. The point of departure was the caring science theory about health and suffering and the hermeneutic philosophy of understanding. Result of the interpretation The interpretation revealed the mothers' experiences of health and suffering as a struggle between the darkness of suffering and their inner source of strength. In the light of the theory of caring, the conscience became visible as the bearer of the human being's inner ethos of love and compassion. Experiences of health and suffering were interpreted as a struggle between guilt and responsibility, where conscience emerged as the road from ontological guilt to responsibility that leads the human being to what is true, beautiful and good in life. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2013; 27; 354-362 Aspects of care culture in municipal care for elderly people: a hermeneutic documentary analysis of reports of abuse Introduction: Care culture is an important contextual factor in care practice. Care culture refers to a process of creating meaning out of tradition, horizon and bildung. The care culture is often taken into consideration in situations that go beyond the everyday routine, such as cases of abuse. In Sweden, health care professionals are obliged to document and report any suspected bad conditions. Although the reports have the potential to communicate underlying values and assumptions about the care culture, such studies have not been performed. Aim: The aim of this study was to understand how elderly care abuse in institutions could be understood from a care culture perspective. Design and methods: A hermeneutic documentary analysis was conducted on 269 incident reports concerning suspected mistreatment of the elderly in three municipalities in Sweden. The hermeneutic analysis followed a four-stage process: selecting and reading the text, setting out the context, closing the hermeneutic circle, and finally creating a conceptual bridge towards a critical understanding from a phenomenological lifeworld perspective. Findings: The care of the elderly in the municipality was based on a social culture that placed residents' needs at the centre. Following routines were considered important in preventing mistreatment and were intended to ensure that all patients were treated fairly and equally. Care was described as task oriented and often lacking in interpersonal relations. From a phenomenological lifeworld perspective, it was interpreted that in the municipalities' care of the elderly, there was a focus on elderly people's freedom at the expense of the vulnerability aspects of well-being. Conclusion: Raising awareness of the care culture underlying abuse could help to improve understanding of care practice. Change may be only possible when reflected on the existing perspectives underpinning the care culture, and integrate them into a broader framework for caring. [ABSTRACT FROM AUTHOR]

While several authors are referring to Gadamer's philosophy, the operationalization of his thinking into practical use in nursing science is less common. The goal of this paper is to systematize some of the basic key concepts in Gadamer's hermeneutics into a methodological approach to the interpretation of texts. This is a somewhat different approach to his work from those described in earlier commentaries and should be useful for nursing science. In this paper, Gadamer's hermeneutics is explored with a particular focus on some of the basic concepts of his philosophy. A four-step approach is proposed that may be used to develop a research plan in the Gadamerian hermeneutic tradition. Gadamer himself did not develop a method of interpretation, but elaborated upon the old hermeneutic tradition, of an inner fusion of subtilitas intelligendi (understanding), subtilitas explicandi (interpretation) and subtilitas applicandi (application). Hence, the analyses are not open and accessible, but inherent in the interpretation (auslegung). To use Gadamer's philosophy as a methodological approach, the interpreter must acquire a comprehensive understanding of the basic ideas and key concepts of his philosophy. These concepts may be used as a framework upon which to develop a research plan. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2012; 26; 553-560 Variations in older persons' descriptions of the burden of loneliness Research indicates that approximately one-third of older people over the age of 65 years report loneliness, with even higher rates among those aged over 85. Loneliness is associated with a variety of health issues, such as depression, anxiety, physical impairment and social isolation. The purpose of this paper is to describe the characteristics of the burden of loneliness, and investigate the variability in how it is described by older. In-depth interviews were conducted with 12 older people in autumn 2006 and spring 2007 in Norway. Participants aged from 70 to 97 years were recruited from a variety of backgrounds, and varied in health status and social status. The findings reported in this paper are based on hermeneutic analyses of the interviews. Our findings indicate that some of the participants experienced loneliness that they felt able to manage. They experienced a fluctuating loneliness that was linked to feeling valuable and having power and energy. However, another group described experiences of agonising loneliness. They felt a present and extensive loneliness, together with feeling less valuable and lacking in power and initiative. They seemed trapped in their loneliness, and unable to overcome their situation themselves. Our findings indicate that the burden of loneliness is experienced differently. For some older persons, the experience of loneliness is so severe that they urgently need help to manage their situation. [ABSTRACT FROM AUTHOR]

rørtveit k. & severinsson e. (2012) Journal of Nursing Management 20, 631-639 Leadership qualities when providing therapy for women who suffer from eating difficulties Aim The aim of this study was to reflect on aspects of mental health nursing leadership qualities with special focus on the therapeutic process for women who suffer from eating difficulties (ED). Background Therapy for patients with ED involves motivating them to make meaningful changes. Leadership qualities in MHN should focus on the relationship with the patient and positive empowerment processes. Methods In-depth interviews were conducted with six women suffering from ED who had participated in art therapy. The interviews were analysed by means of an interpretative hermeneutic approach. Results A main theme 'The mental health nurse as a formative and mindful leader in a group therapeutic relationship' and two themes 'Leading sensitively towards awakening the patients' awareness of their pre-understanding' and 'Leading dialectically towards solving patients' existential dilemmas' were developed and comprised two aspects of leadership. Conclusion The nurse-patient relationship is influenced by the patients' pre-understanding and existential dilemmas. Leadership qualities associated with being formative and mindful represent important aspects of this relationship and should be investigated and thematically described in greater detail in future research. Implications for nursing management The nurse-patient relationship should focus on clinical supervision, in order to strengthen the nurses' leadership qualities in terms of being aware and dialectical. [ABSTRACT FROM AUTHOR]

The aim of this study was to illuminate and interpret guilt and shame expressed by mothers with eating difficulties (ED). The research question was: What is the meaning of guilt and shame experienced by mothers with ED? Experiences of guilt and shame in mothers with ED may be strong, yet concealed, and should be addressed when promoting women's mental health. The study design was explorative, and in-depth interviews were conducted with eight mothers suffering from ED. The data were analysed by means of qualitative content analysis and interpreted according to a hermeneutic approach. The main theme ‘Struggling in silence with guilt and shame as a mother living with ED and trying to keep it secret’ was interpreted on two levels: emotional, ‘Feeling worried about failure and wanting to be successful’, and cognitive, ‘Having condemning thoughts about one's own sense of responsibility’. In addition, each theme contained two subthemes. Feelings and awareness of guilt and shame are strong; they vary between individuals and are intensified in mothers who suffer from ED. It is important for mental health nurses to help mothers with ED articulate such feelings in order to promote health. [ABSTRACT FROM AUTHOR]

lyberg a. & severinsson e. (2010) Journal of Nursing Management 18, 383–390 Fear of childbirth: mothers' experiences of team-midwifery care – a follow-up study Aim The aim of this study was to illuminate mothers’ fear of childbirth and their experiences of the team-midwifery care model during pregnancy, childbirth and the postnatal period. Background Maternal anxiety and fear of childbirth lead to emotional suffering and affected women’s well-being. A previous negative experience of childbirth may result in postnatal depression or avoidance of future pregnancies. Methods This hermeneutic study comprised interviews with 13 women, which were audio-taped and transcribed verbatim, after which interpretative content analysis was performed. Ethical approval was granted. Results The findings revealed one main theme: The woman’s right to ownership of the pregnancy, childbirth and postnatal care as a means of maintaining dignity and three themes; Being aware of barriers and reasons for fear; Being prepared for childbirth and Being confirmed and treated with dignity by the midwife. Each theme contained several sub-themes. Conclusion The findings contribute insights into how midwives can be educated to reduce fear of childbirth and promote positive birth experiences, despite the existence of negative memories of previous births. Implication for nursing management In order to achieve continuity and a trusting relationship it is necessary to organise leadership and to adopt models that are flexible and support women’s health. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2004; 18; 264–272The progression of suffering implies alleviated sufferingThere is a lack of research focusing directly on both patients’ suffering and alleviated suffering in relation to care. The aim of this paper was to investigate the progression of suffering in relation to the encounter between the suffering person and the caregiver from the perspective of an understanding of life. The progression of suffering is assumed to be an existential‘sign’ of the development of understanding of life as an ontological or spiritual entity, which demands a meaning-creating encounter between the patient and caregiver. The concept‘existential caring encounter’ was used to describe how the encounter between patient and caregiver can create meaning in communion and thereby alleviate suffering by making it bearable. The study was carried out using an interpretive, hermeneutic approach. The study as a whole comprises three parts, and these include letter-writing and interviews. The findings are described by the following main theses: (a) a darkness in life understanding is existentially experienced as unbearable suffering and requires an encounter involving attentive care and confrontation; (b) the turning point means that the struggle of suffering begins; and (c) the encounter involves being meaning-creating in a communion in the struggle of suffering. An understanding of the patterns of unbearable and bearable suffering can be of help to the caregiver in caring for the patient by serving as a basis for meaning-creation in communion. This may thereby be a way of alleviating the patient's suffering by making it bearable during the progression of suffering. [ABSTRACT FROM AUTHOR]

The purpose is to construct a hermeneutic understanding of the significance of the journey to budget travellers. Narrative interviews were gathered from budget travellers. This research confirms the complexity, holistic reflections and personal travel history associated with the journey. The participants' narratives indicated the primacy of personal authenticity instead of cultural authenticity. The sight became a landmark to distinguish the destination, participants' geographical placement and some of their travails on their journeys. The nomothetic significance of the journey involved the meaning themes of personal development and liminal encounters and meaning factors of styles, visual cues and problem solving. Copyright © 2004 John Wiley &Sons, Ltd. [ABSTRACT FROM AUTHOR]

It is over 20 years since Michael Crotty's groundbreaking critique of phenomenological research in nursing. However, rather than entering into the acrimonious discussions that followed, we developed a research method that we believed translated Gadamer's philosophy into the world of empirical research. Fundamental to that work was our differentiation of hermeneutics from phenomenology. The aim of the present paper was to provide a critical analysis of the citations from publication in 2003 until the end of 2017. We identified 402 citations of which 362 were included. One hundred and sixty‐three articles mentioned the article in passing, usually in a list of authors who had discussed hermeneutics. Sixteen citations misrepresented the method mainly claiming that we discussed a method for hermeneutic phenomenology (or phenomenological hermeneutics). Of the 117 citations that partially used the method, the main focus was the four steps of data analysis. Sixty studies used our method in totality although they derive from varying philosophical standpoints. Disappointingly, there has been little critique of our Gadamerian research method. For health disciplines to truly make progress in the academic stage, it is vital that we engage in with critique, some of which will come through open and honest reflexive engagement with our topics. [ABSTRACT FROM AUTHOR]