caring inquiry marilyn a. ray, rn, phd, ctn-a professor emeritus the christine e. lynn college of...

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

• 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 spiritual-ethical 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 (phenomenological-hermeneutics), 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• 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


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?


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


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


• 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


• 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)


• 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


• 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.


• Composing linguistic transformation of the data to themes, metathemes, patterns or metaphor (metatheme and metaphor may be the transcendent experience)


D. The Movement of Phenomenological-Hermeneutical 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


• 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).


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


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.


• 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 human-environment 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),

14- 23. • Reeder, F. (1988). Hermeneutics. In B. Sarter (Ed.), Paths to

knowledge: Innovative research methods for nursing (pp. 193-238). 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

caring inquiry marilyn a. ray, rn, phd, ctn-a professor emeritus the christine e. lynn college of...

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